Published online Apr 16, 2017. doi: 10.4253/wjge.v9.i4.189
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
To determine the risk factors of severe post endoscopic retrograde cholangiopancreatography pancreatitis (sPEP) and clarify the indication of prophylactic treatments.
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.
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.
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.