| Objective: Post-ERCP pancreatitis is the most common and serious complication after ERCP,and its prevention is the focus of clinical research.Intraoperative guide wire into the pancreatic duct is one of the high risk factors of post-ERCP pancreatitis.The conventional preventive measure is to insert pancreatic duct stent.This study aims to investigate the efficacy and safety of intraoperative pancreatic duct decompression in preventing post ERCP pancreatitis in patients with guide wire entering the pancreatic duct,so as to provide a new method and basis for the prevention of post-ERCP pancreatitis.Methods: This is a prospective randomized controlled study.The patients who received ERCP from November 2019 to February 2021 in the the First Affiliated Hospital of Dalian Medical University were randomly divided into two groups.The experimental group was treated with intraoperative pancreatic juice suction and decompression to prevent PEP,while the control group was treated with pancreatic stent implantation to prevent PEP.Through the inclusion and exclusion criteria,a total of 48 patients were included in this study,including 25 cases in the experimental group and 23 cases in the control group.The general information(gender,age,body mass index,hypertension,diabetes,cardiovascular disease,cerebrovascular disease,chronic lung disease,liver cirrhosis,postoperative changes of gastrointestinal tract,abnormal bile pancreatic junction,suspected Oddi sphincter dysfunction,past ERCP history)of the two groups were recorded,and the intraoperative indexes(operation indication,operation time,intubation mode of bile duct,intubation times of pancreatic duct,and the time of guide wire insertion into pancreatic duct,etc.),preoperative and postoperative test results(alanine aminotransferase,aspartate aminotransferase,gamma glutamyl transpeptidase,alkaline phosphatase,total bilirubin).Blood routine: white blood cell count,percentage of neutrophils,blood amylase,blood lipase),incidence of other postoperative complications(PEP,hyperamylasemia,bleeding,perforation)and hospital related indicators(ERCP operation cost,total hospital cost,postoperative hospital stay and the number of days needed to resume eating after operation),and the data were analyzed statistically.Results: In this prospective,single center randomized controlled study,there were no serious complications in the pancreatic duct suction and decompression group and the pancreatic duct stent implantation group.Except for the preoperative ALP test results(P< 0.05),the general information,ERCP operation indications,risk factors related to patients and the proportion of risk factors related to the operation process of the two groups were similar(P > 0.05),as shown in the table The baseline data between the two groups were balanced and comparable.The incidence of pep in the experimental group was similar to that in the control group,1 case in the experimental group and 1 case in the control group had mild PEP,and there was no significant difference in the incidence of PEP between the two groups(P > 0.05).The indwelling time of the guide wire in the pancreatic duct of the control group was significantly longer than that of the experimental group(P < 0.05).Although the incidence of PEH in the experimental group was significantly higher than that in the control group,and the values of serum amylase and lipase in the experimental group were also higher than those in the control group(P < 0.05),after conservative treatment,there was no disease progression and postoperative pancreatitis in the two groups.The ERCP operation cost of the experimental group was significantly lower than that of the control group(P < 0.05).Conclusion: 1.The incidence of PEP in the pancreatic aspiration group is similar to that in the pancreatic stent implantation group,indicating that the preventive effect of pancreatic aspiration on PEP is not weaker than that of pancreatic stent implantation,at the same time,it can avoid the risk of pancreatic stent implantation.2.The cost of ERCP in the pancreatic juice aspiration group was significantly lower than that in the pancreatic duct stent implantation group,indicating that pancreatic juice aspiration can reduce the cost of surgical treatment and relieve the economic pressure of patients.3.The incidence of PEH,serum amylase and lipase in pancreatic juice aspiration group were significantly higher than those in pancreatic duct stent implantation group,but the patients did not progress to PEP after conservative treatment,and its safety and effectiveness need to be further studied and verified. |
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