The Application Research Of Small Dose Of Octreotide Preoperation In The Prevention Of Post-ECRP Pancreatitis And Hyperamylasemia

Objective:To observe the effect on small dose of octreotide which is applied before endoscopic retrograde cholangiopancreatography(ERCP) for prevention of Post-ERCP Pancreatitis(PEP) and hyperamylasemia, try to evaluate the clinical application value of small doses of octreotide(0.1 mg) before ERCP and provide the useful information for preventive medicine for clinical ERCP.Methods:The study selected 553 cases treated with ERCP from Auguest 2011 to December 2014 in the department of general surgery of Cangzhou Central Hospital. Male 308 cases, female 245 cases, aged 31 to 88 years old,average(67.5±11.5) years old, including 280 cases with choledocholithiasis, 126 cases with cholangiocarcinoma, 89 cases with carcinoma of head of pancreas, 31 cases with ampullary carcinoma, 23 cases with duodenal papilla carcinoma and 4 cases with duodenal inflammatory stenosis. Patients were tested blood amylase one day before operation, six hours, and twenty-four hours, after operation, whether having abdominal pain, nausea and vomiting, fever, abdominal tenderness or not, the patients who were diagnosed PEP by CT examination. The patients were divided into octreotide group and control group according to whether or not applicated of small doses of octreotide(0.1 mg) half an hour before ERCP, the study to observe the changes of serum amylase and clinical manifestations before and after ERCP in the two groups, to compare the incidence of PEP and hyperamylasemia and the recovery times in the patients who were diagnosed PEP and hyperamylasemia in the two groups. The incidence of PEP and hyperamylasemia were compared respectively in choledocholithiasis 、cholangiocarcinoma、carcinoma of head of pancreas、chronic pancreatitis and the patients whose duodenal papilla were cutted by needle knife in operation between octreotide group and control group. All the data were analyzed by SPSS13.0 software package, the difference was statistically significant when P < 0.05, and there was significant difference when P < 0.01.Results:In 553 patients, octreotide group 263 cases、 control group 290 cases, the patients’ baseline was consistent and comparable on age, sex, disease category constituent ratio, comorbid medical conditions, past history and operation situation in the two groups. The value of blood amylase at 6 h 、 24 h after operation of octreotide group(119.49±117.58 U/L,118.79±145.73 U/L) were lower than the control group(214.51±238.52 U/L,258.32±372.45 U/L), and the difference was significant(P<0.01).The occurs in PEP and hyperamylasemia, 13 patients occurred PEP in octreotide group(including 1 cases of severe PEP, the choledocholithiasis patient with history of chronic pancreatitis), the incidence rate was 4.94%(0.38%), 25 cases had hyperamylasemia(22 cases of chronic pancreatitis or metal stent implantation or needle knife incision), the incidence rate was 9.51% in octreotide group; In the control group, 22 cases had PEP, including 9 cases of severe(5 cases of choledocholithiasis patients whose duodenal papilla were cutted by needle knife or with history of chronic pancreatitis, 4 cases of carcinoma of head of pancreas for metal stent implantation), 70 cases had hyperamylasemia(52 cases of chronic pancreatitis or metal stent implantation or needle knife incision), the incidence of PEP(severe PEP)and hyperamylasemia were 7.59%(3.10%)and 24.14%, the octreotide group compared with the control group, the incidence of severe PEP and hyperamylasemia in the former was obviously lower than that in the latter, especially on the hyperamylasemia(P < 0.01), and severe PEP and hyperamylasemia occurred mainly in choledocholithiasis patient with history of chronic pancreatitis or were cutted by needle knife or carcinoma of head of pancreas for metal stent implantation. In the choledocholithiasis and cholangiocarcinoma, the incidence of PEP(7.58%、3.23%) in the patients who were applied with octreotide had no difference with who without the application of octreotide(8.78% 、 1.56%), in carcinoma of head of pancreas, chronic pancreatitis, and the patients whose duodenal papilla were cutted by needle knife in operation, the incidence of PEP(2.22%,7.89%,8.77%) in the patients who were applied with octreotide was lower than that without the application of octreotide(18.18%,26.32%,21.86%), and had significant difference(P < 0.05), the carcinoma of head of pancreas patients who complicated with PEP were all metal stent implantation. 130 patients were diagnosed as PEP and hyperamylasemia, the serum amylase of them return to normal in 2 d to 11 d through active treatment, except 2 cases of death due to severe PEP in the control group, the recovery times of octreotide group(3.94土2.01 d) was shorter than the control group(4.92土2.36 d), P<0.05.Conclusion:1 The patients who with the history of chronic pancreatitis and the carcinoma of head of pancreas patients who will be placed metal stent need to be given small dose of octreotide before ERCP;2 Non of the above cases, small doses of octreotide need’t be given before ERCP;3 Because we can’t predict that the patients will be cutted by needle knife whether or not, so the patients who without the application of octreotide before ERCP considered to be given small dose of octreotide promptly when needle knife incision required.