The Clinical Study On Acute Pancreatitis Using Endoscopic Retrograde Colangio-pancreatography Method

Objective:Acute severe biliary pancreatitis (ASBP) is a severe and fatal disease, and the expenditure is huge and therapeutic effects are still not satisfactory. This study aimed to improve the therapeutic effects and reduce the expenditure of ASBP treatment. Methods:105 patients diagnosed with ASBP were recruited in our department from January 2004 to July 2009. Patients were divided into two groups; the E group:50 patients who underwent endoscopic retrograde choledochopancreatography (ERCP)+endoscopic sphincterotomy (EST)+ endoscopic lithotripsy basket (ESR)+endoscopic retrograde biliary drainage (ERBD) and enteral nutrition (EN), and the R group:55 patients who underwent conventional treatment without ERCP. Subsequently, subjective symptoms, signs, biochemical analysis, serum endotoxin, TNF-α, grades by computed tomography (CT), cost of hospitalization and length of stay were compared between the two groups. Results: All enrolled patients complied well with all therapeutic regimens. Endoscopic therapy that combined EN could significantly improve symptoms, clinical signs, laboratory values, tumor necrosis factor a and endotoxin while significantly reducing hospital expenditure and length of hospital stay. The experimental findings revealed that there were obvious advantages in the E group compared with the R group. Conclusions: Endoscopic therapy combined with EN is an effective, safe and economic therapeutic regimen of acute severe biliary pancreatitis. Objective:Post-ERCP pancreatitis (PEP) is one of the most common and serious complications after ERCP. This study aims to test this hypothesis that the incidence of post-ERCP declined over time due to improved patient selection and/or endoscope equipments and endoscopic techniques. Methods:A total 7,168 cases of ERCP procedures were retrospectively analyzed. According to different development stages of ERCP equipments and techniques, cases were divided into four groups. Incidence rate and major risk factors for acute PEP were compared between groups. Results:Of the 7,168 cases, the overall incidence of PEP was 3.70%(265/7,168). The incidence of PEP was 4.09%(77/1,884) in the StageⅠ,5.79%(86/1,489) in the StageⅡ,3.95% (62/1,568) in the StageⅢ, and 1.80%(40/2,227) in the StageⅣ. The identifiable risk factors for PEP from multivariate analysis include repeated cannulation (OR 3.462), pancreatic duct injection (OR 3.218), balloon dilation of biliary sphincter (OR 2.847), papillae pre-cut (OR 2.493), non-selective high-pressure injection (OR 1.428), excessive electrocoagulation incision (OR 1.263), history of pancreatitis (OR 3.843), and suspected sphincter of Oddi dysfunction (OR 1.782). Conclusions:Improved technical procedures were associated with a significant reduction in the incidence of PEP. Risks for developing PEP may be minimized by constant improvement in the ERCP techniques, such as a routine use of guidewire, highly selective cannulation, pancreatic stent placement, and cautious incision. Objective:Post-ERCP pancreatitis (PEP) is one of the most common and serious complications after ERCP. This study aims to assess prophylactic value of pancreatic and biliary stent placement for PEP. Methods:A total 409 high risk cases were divided into three groups according to different therapeutic strategy. Incidence rate and degree of PEP were compared between groups. Results:The incidence of PEP was 23.2%(13/56) in non drainage group,11.9%(32/270) in the group of ENBD/ERBD,3.6%(3/83) in the group of ERBD+ERPD, there were significant difference of incidence of PEP among each group (P<0.05). The incidence of mild PEP was not significantly different among each group (P>0.05). The incidence of moderate PEP in group of ERBD+ERPD was lower than it in group of ENBD/ERBD (1.2% vs.7.4%; P=0.035) and group of non drainage (1.2% vs.0.10.7%; P=0.017). The incidence of severe PEP in group of ENBD/ERBD was lower than it in non drainage group (1.1% vs.7.1%; P=0.018). Conclusions:Pancreatic and biliary stent placement could reduce the incidence and degree of PEP for high risk patients, which is safe and effective approach for prophylaxis of PEP, deserving further clinical application and extension in future.