Analysis Of The Risk Factors And Prevention Of Post-ERCP Pancreatitis

Objective: In order to improve the level of diagnostic and therapeutic ERCP and reduce the incidence of PEP,in this paper,we investigated the risk factors of post-ERCP pancreatitis,and combined with related literature and clinical experience.Based on above results,we explored the preventive measures.Methods: A retrospective analysis of the clinical data of 222 patients with diagnosis and treatment by ERCP from January 2011 to December 2015 in Dalian Medical University Affiliated Second Hospital was conducted.According to the inclusion and exclusion criteria,we judged the occurrence of pancreatitis by collecting the basic information of patients(including gender,age,basic diseases,past surgical history),the results of preoperative laboratory tests(including liver biochemistry,the blood amylase,etc.)and preoperative auxiliary examination(including CT,MRCP,etc.),and by recording ERCP operation and intraoperative diagnosis and the serum amylase level with the patients after ERCP,as well as combination with abdominal signs.At first,the effect of 20 factors,such as gender,age,diameter of the common bile duct,and the development of pancreatic duct,were analyzed by single factor analysis.Then the univariate Logistic regression analysis was conducted to analyze the independent risk factors of pancreatitis after ERCP.All data were processed by SPSS17.0 statistical software.Result: 222 cases of ERCP were examined by retrospective analysis and the ERCP success rate was 97.30% with 216 success cases and 6 failure cases.There are 8 ERCP diagnosis and 214 ERCP treatment.The distribution of ERCP is classified by diseases:120 cases of bile duct stones,43 cases of benign stricture,24 cases of malignant tumor,simple dilatation of the bile duct in 17 cases,5 cases of sclerosing cholangitis,4 cases of suppurative cholangitis,3 cases of SOD,ampullary lesions except for 2 cases,dilatation of the main pancreatic duct in 2 cases,2 normal cases.The distribution of ERCP is classified by gender: male 123 cases,female 99 cases,which mean age is63.59±16.25 years old.In 222 cases of clinical cases,18 cases were in accordance with the criteria of diagnosis of pancreatitis after ERCP.The incidence rate of post-ERCP pancreatitis was 8.11%.The results of the univariate analysis showed that patients younger than 60 years old with post-ERCP pancreatitis incidence rate was higher than the group of less than 60 years old(13.92%vs4.90%,P=0.018).The incidence rate of post-ERCP pancreatitis in patients with difficult intubation was higher than that in patients with non difficult intubation(19.51%vs5.52%,P=0.003).Long operation time more than 60 minites group with post-ERCP pancreatitis incidence is higher than that operation time is less than 60 minites group(17.65%vs6.38%,P=0.027).The incidence of post-ERCP pancreatitis was higher in the patients with pancreatic duct than that in the non pancreatic duct development group(50%vs6.54%,P<0.001).The incidence of post-ERCP pancreatitis was higher in the patients without placing the nasal biliary drainage group than that in the patients with the placement of the nasal biliary drainage group(17.5%vs2.82%,P<0.001).These five factors were associated with post ERCP pancreatitis(P <0.05),while other factors had no obvious correlation.The above five factors were included in the Logistic regression equation,and it was found that the development of pancreatic duct and the age less than 60 years were the independent risk factors of pancreatitis after ERCP.Placement of nasal biliary drainage tube is the protective factor of post-ERCP pancreatitis.Conclusion: 1.The incidence of post-ERCP pancreatitis was related to age less than 60 years old,the pancreatic duct development,difficult intubation,and the long duration of operation.Pancreatic duct development and age less than 60 years old are independent risk factor respectively.2.Placement of nasobiliary postoperativ,avoidance of pancreaticduct development,improving the success rate of intubation and reducing the ERCP operation time can effectively reduce the incidence of post-ERCP pancreatitis.