Matsubara H, Urano F, Kinoshita Y, Okamura S, Kawashima H, Goto H, Hirooka Y. Analysis of the risk factors for severity in post endoscopic retrograde cholangiopancreatography pancreatitis: The indication of prophylactic treatments. World J Gastrointest Endosc 2017; 9(4): 189-195 [PMID: 28465786 DOI: 10.4253/wjge.v9.i4.189]
Corresponding Author of This Article
Yoshiki Hirooka, MD, Associated Professor, Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-Cho, Showa-ku, Nagoya City, Aich Prefecture 466-8550, Japan. hirooka@med.nagoya-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Apr 16, 2017; 9(4): 189-195 Published online Apr 16, 2017. doi: 10.4253/wjge.v9.i4.189
Analysis of the risk factors for severity in post endoscopic retrograde cholangiopancreatography pancreatitis: The indication of prophylactic treatments
Hiroshi Matsubara, Fumihiro Urano, Yuki Kinoshita, Shozo Okamura, Department of Gastroenterology, Toyohashi Municipal Hospital, Toyohashi City, Aich Prefecture 441-8570, Japan
Hiroki Kawashima, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya City, Aich Prefecture 466-8550, Japan
Yoshiki Hirooka, Department of Endoscopy, Nagoya University Hospital, Nagoya City, Aich Prefecture 466-8550, Japan
Author contributions: Matsubara H designed and performed the research and wrote the paper; Hirooka Y designed the research and supervised the report; Urano F, Kinoshita Y, and Okamura S provided clinical advice; Kawashima H and Goto H supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Toyohashi Municipal Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yoshiki Hirooka, MD, Associated Professor, Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-Cho, Showa-ku, Nagoya City, Aich Prefecture 466-8550, Japan. hirooka@med.nagoya-u.ac.jp
Telephone: +81-52-7442602 Fax: +81-52-7442602
Received: October 6, 2016 Peer-review started: October 7, 2016 First decision: December 13, 2016 Revised: December 25, 2016 Accepted: February 8, 2017 Article in press: February 13, 2017 Published online: April 16, 2017 Processing time: 190 Days and 3.9 Hours
Abstract
AIM
To determine the risk factors of severe post endoscopic retrograde cholangiopancreatography pancreatitis (sPEP) and clarify the indication of prophylactic treatments.
METHODS
At our hospital, endoscopic retrograde cholangiopancreatography (ERCP) was performed on 1507 patients from May 2012 to December 2015. Of these patients, we enrolled all 121 patients that were diagnosed with post endoscopic retrograde PEP. Fourteen of 121 patients diagnosed as sPEP were analyzed.
RESULTS
Forty-one patients had contrast media remaining in the pancreatic duct after completion of ERCP. Seventy-one patients had abdominal pain within three hours after ERCP. These were significant differences for sPEP (P < 0.05). The median of Body mass index, the median time for ERCP, the median serum amylase level of the next day, past histories including drinking and smoking, past history of pancreatitis, sphincter of Oddi dysfunction, whether emergency or not, expertise of ERCP procedure, diverticulum nearby Vater papilla, whether there was sphincterotomy or papillary balloon dilation, pancreatic duct cannulation, use of intra-ductal ultrasonography enforcement, and transpapillary biopsies had no significant differences with sPEP.
CONCLUSION
Contrast media remaining in the pancreatic duct and the appearance of abdominal pain within three hours after ERCP were risk factors of sPEP.
Core tip: Post endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a typical endoscopy-related accident in the biliopancreatic field. Since PEP is a predictable pathology, and if discovered and appropriately treated early many patients rapidly recover. However, some cases aggravate to a severe state and become fatal. Therefore, it is important to identify factors leading PEP to a severe state. In our study, significant differences were noted in residual enhancement of the pancreatic duct and development of abdominal pain showing that these were independent risk factors of severe PEP. The presence of these findings is an indication of therapeutic intervention for severe PEP.
