Endoskopik Retrograd Kolanjiopankreatografi Sonrası Pankreatit ile Preoperatif Dönemde Bakılan Laboratuar Parametrelerinin İlişkisi

Year 2024, Volume: 8 Issue: 1, 43 - 47, 29.04.2024

Soner Önem Süleyman Dolu Mehmet Camcı Arif Yüksel

https://doi.org/10.46332/aemj.1192501

Abstract

Amaç: Endoskopik retrograd kolanjiopankreatografi (ERCP) öncesinde bakılan laboratuar tetkikleri ile post-ERCP pankreatit ilişkisinin araştırılması.

Araçlar ve Yöntem Mart 2015- Haziran 2016 tarihleri arasında yapılan ERCP işlemler retrospektif olarak incelendi. ERCP yapılan hastaların yaşı, cinsiyeti, ERCP endikasyonları, ERCP sırasında yapılan işlemler, işlem sonrası oluşan komplikasyonlar belirlendi. İşlem öncesinde hastaların beyaz küre, nötrofil, lenfosit, hemoglobin, trombosit, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), alkalen fosfataz (ALP), gama glutamil transferaz (GGT), total bilirubin, albumin, laktat dehidrogenaz (LDH) değerleriyle post-ERCP pankreatit ilişkisi araştırıldı.

Bulgular: Hastaların işlem öncesi bakılan laboratuar parametrelerinden GGT ve AST seviyesi pankreatit geçiren hastalarda, geçirmeyenlere oranla düşüktü. (GGT p=0.001, AST p=0.006). Diğer parametrelerde ise anlamlı fark saptanılmadı.

Sonuç: Post-ERCP pankreatit ERCP’nin en sık görülen komplikasyonudur. Pankreatit gelişimi açısından risk faktörleri bulunan hastaların tespiti erken tanı ve tedavi açısından önem taşımaktadır. AST düzeyinin normal üst sınırından 1.5 kat ve GGT düzeyinin 4 kattan düşük olması pre-operatif pankreatit risk değerlendirmesinde kullanılabilir.

Keywords

pankreatit, post-ERCP, risk faktörü

Relationships Between Post-Endoscopıc Retrograde Cholangiopancreatography Pancreatitis and Preoperative Laboratory Parameters

Abstract

Purpose: Investigation of the relationship between post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and laboratory tests performed before ERCP.

Materials and Methods: ERCP procedures performed between March 2015 and June 2016 were analyzed retrospectively. Patient’s age, gender, ERCP indications, procedures performed during ERCP, complications after ERCP were determined. The relationship between post-ERCP pancreatitis and white blood cell, neutrophil, lymphocyte, hemoglobin, thrombocyte, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gama-glutamly transferase (GGT), total bilirubin, albumin, lactate dehydrogenase (LDH) values of the patients before the procedure was investigated.

Results: GGT and AST levels in the preoperative period were lower in patients with pancreatitis compared to those who did not (GGT p=0.001, AST p=0.006). No significant difference was found in other parameters.

Conclusion: Post-ERCP pancreatitis is the most common complication of ERCP. Detection of patients with risk factors for the development of pancreatitis is important for early diagnosis and treatment. AST level lesser than 1.5 times normal value and GGT level lesser than 4 times can be used in pre-operative pancreatitis risk assessment.

Keywords

pancreatitis, post-ERCP, risc factors

References

• 1. McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg. 1968;167(5):752-756.
• 2. Freeman ML. Complications of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin N Am. 2012;22(3): 567-586.
• 3. Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52(2):127-149.
• 4. ASGE Standards of Practice Committee, Anderson MA, Fisher L, et al. Complications of ERCP. Gastrointest Endosc. 2012;75(3):467-473.
• 5. Bhatt H. Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: An Updated Review of Current Preventive Strategies. Clin Exp Gastroenterol. 2021;14:27-32.
• 6. ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA, et al. Adverse events associated with ERCP. Gastrointest Endosc. 2017;85(1):32-47.
• 7. IBM SPSS Statistics | IBM. Available from: https://www.ibm.com/products/spss-statistics Erişim tarihi 01 August, 2016.
• 8. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007;102(8):1781-1788.
• 9. Elmunzer BJ, Scheiman JM, Lehman GA, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med. 2012;366(15): 1414-1422.
• 10. Thaker AM, Mosko JD, Berzin TM. Post-endoscopic retrograde cholangiopancreatography pancreatitis. Gastroenterol Rep (Oxf). 2015;3(1):32-40.
• 11. Freeman ML. Pancreatic stents for prevention of post-ERCP pancreatitis: for everyday practice or for experts only?. Gastrointest Endosc. 2010;71(6):940-944.
• 12. Martinez NS, Inamdar S, Firoozan SN, et al. Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions. Endosc Int Open. 2021;9(6):E888-E894.
• 13. Dumonceau JM, Andriulli A, Deviere J, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010;42(6):503-515.
• 14. Jokelainen J, Ismail S, Kylänpää L, et al. Effect And Predictive Value Of Routine Preoperative Laboratory Testing For Endoscopic Retrograde Cholangiopancreatography. Scand J Surg. 2020;109(2):115-120.
• 15. Jamry A. The prognostic value of serum and urine amylase levels and blood count parameters in assessing the risk of post-endoscopic pancreatitis development. Prz Gastroenterol. 2021;16(2):132-135.
• 16. Mohammad Alizadeh AH, Afzali ES, Behzad C, et al. Is ESR Important for Predicting Post-ERCP Pancreatitis?. Clin Med Insights Gastroenterol. 2015;8:23-27.
• 17. Li H, Bao J, Mei Q. Markers of immune responsiveness and post-ERCP pancreatitis?. Gastrointest Endosc. 2020;92(3):796.
• 18. Kusumoto K, Nakai Y, Itokawa Y, et al. Prediction of pancereatits following endoscopic retrograde cholangiopancreatography. Nihon Shokakibyo Gakkai Zasshi. 2020;117(9):788-795.