Endoskopik Retrograd Kolanjiopankreatografi Komplikasyonlarının Gelişiminde Sfinkterotomi Tekniklerinin Önemi

Abstract

Amaç: Endoskopik retrograd kolanjiopankreatografi ERCP öncelikli olarak terapötik girişimler için kullanılmaktadır. Precut sfinkterotomi, klasik safra kanülasyon yöntemleri başarısız olduktan sonra kullanılan bir tekniktir. Çalışmada, precut tekniklerin komplikasyonların sıklığını artırıp artırmadığını araştırmak amaçlanmıştır.Gereç ve Yöntemler: ERCP yapılan 215 hasta prospektif olarak değerlendirildi. Çalışmaya dahil edilen 185 hasta kanülasyon tekniklerini temel alarak üç gruba ayrıldı: Grup 1: Derin bilier kanülasyon veya kılavuz tel ile kanülasyon; Grup 2: Precut tekniği; Grup 3: Bu iki teknikle 10 dakika içinde kanülasyon yapılamayıp, needle-knife sfinkterotomisi uygulanan hastalar. Hastaların prosedürden önce ve sonra tam kan sayımı, kan serum amilaz ve lipaz düzeyleri değerlendirildi, hastalar herhangi bir komplikasyon gelişimi açısından 30 gün boyunca takip edildiBulgular: Onsekiz hastada pankreatit % 9,7 , altı hastada kolanjit % 3,2 ve iki hastada % 1,1 hemoraji olmak üzere 185 hastanın 26'sında % 14 komplikasyon izlendi. Komplikasyonların sıklığı grup 1'de %9,2, grup 2'de %9,3 ve grup 3'te %35,3 idi p

Keywords

• Endoskopik retrograd kolanjiopankreatografi, Komplikasyon, Pankreatit, Precut sfinkterotomi

The Significance of Sphincterotomy Techniques in the Complications of Endoscopic Retrograde Cholangiopancreatography

Abstract

Objective: Endoscopic retrograde cholangiopancreatography ERCP has been used primarily for therapeutic interventions. Precut sphincterotomy is a technique that is used after conventional methods of biliary cannulation have failed. We aimed to evaluate whether the precut technique increases the frequency of complications.Material and Methods: Two hundred fifteen patients in whom ERCP was performed were prospectively evaluated. One hundred eighty-five patients included in the study were divided into three groups based on the cannulation technique: Group 1: Deep biliary cannulation or cannulation by guide wire; Group 2: Precut technique; Group 3: If cannulation was not possible with these two techniques within 10 minutes, a precut with needle-knife sphincterotomy was carried out in these patients. Complete blood count, and blood serum amylase and lipase levels were checked before and after the procedure. The patients were monitored for 30 days for the development of any complications.Results: Complications were observed in 26 14% of 185 patients, including pancreatitis in 1 8 9.7% patients, cholangitis in six 3.2% patients, and hemorrhage in two 1.1% patients. The frequency of complications was 9.2% in group 1, 9.3% in group 2, and 35.3% in group 3 p

Keywords

• Endoscopic retrograde cholangiopancreatography, Complication, Pancreatitis, Precut sphincterotomy

References

1. 1. Young HS, Keeffe, EB. Complications of gastrointestinal endoscopy. In: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 6th ed. Philadelphia: WB Saunders, 1998, 301.
2. 2. Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, Leighton JA, Raddawi HM, Varg JJ 2nd, Waring JP, Fanelli RD, Wheeler-Harbough J, Eisen GM, Faigel DO; Standards of Practice Committee. Complications of ERCP. Gastrointest Endosc 2003;57: 633-7.
3. 3. Cotton PB. Precut papillotomy-a risky technique for experts only. Gastrointest Endosc 1989;35:578-9.
4. 4. Conio M, Saccomanno S, Aste H, Pugliese V. Precut papillotomy: Primum non nocere. Gastrointest Endosc 1990;36(5):544.
5. 5. Rabenstein T, Ruppert T, Schneider HT. Benefits and risks of needle-knife papillotomy. Gastrointest Endosc 1997;46:207-11.
6. 6. Leung JW, Banez VP, Chung SC. Precut (needle knife) papillotomy for impacted common bile duct stone at the ampulla. Am J Gastroenterol 1990;85:991-3.
7. 7. Foutch PG. A prospective assessment of results for needle-knife papillotomy and standard endoscopic sphincterotomy. Gastrointest Endosc 1995;41:25-32.
8. 8. Goff JS. Common bile duct pre-cut sphincterotomy: Transpancreatic sphincter approach. Gastrointest Endosc 1995;41:502-5.

9. 9. Bruins Slot W, Schoeman MN, Disario JA, Wolters F, Tytgat GN, Huibregtse K. Needle-knife sphincterotomy as a precut procedure: A retrospective evaluation of efficacy and complications. Endoscopy 1996;28:334-9.
10. 10. Gholson CF, Favrot D. Needle knife papillotomy in a university referral practice. Safety and efficacy of a modified technique. J Clin Gastroenterol 1996; 23: 177-80.
11. 11. Rabenstein T, Schneider HT, Hahn EG, Ell C. 25 years of endoscopic sphincterotomy in Erlangen: assessment of the experience in 3498 patients. Endoscopy 1998; 30: 194-201.
12. 12. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest Endosc 1991;37:383-93.
13. 13. Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Risk factors for post-ERCP pancreatitis: A prospective, multicenter study. Gastrointest Endosc 2001;54:425-34.
14. 14. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335:909-18.
15. 15. Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F, De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A. Major early complications from diagnostic and therapeutic ERCP: A prospective multicenter study. Gastrointest Endosc 1998;48:1-10.
16. 16. Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: A prospective multicenter study. Am J Gastroenterol 2001;96:417-23.
17. 17. Kiviniemi H, Juvonen T, Makela J. Acute phase response in patients with uncomplicated and complicated endoscopic retrogradic cholangiopancreaticography. HPB Surgery 1994;8:129-31.
18. 18. Dickinson R, Davies S. Post ERCP pancreatitis and hyperamylasemia: The role of operative and patient factors. Eur J Gastroenterol Hepatol 1998;10:423-8.
19. 19. Wozniak B, Wisniewska-Jarosinska M, Drzewoski J. Evaluation of selected parameters of the inflammatory response to endoscopic retrograde cholangiopancreatography. Pancreas 2001;23:349-55.
20. 20. Kaw M, Singh S. Serum lipase, C-reactive protein, and interleukin-6 levels in ERCP-induced pancreatitis. Gastrointest Endosc 2001;54:435-40.
21. 21. Sherman S, Lehman GA. ERCP and endoscopic sphincterotomy induced pancreatitis. Pancreas 1991;6: 350-67.
22. 22. Kaffes AJ, Sriram PV, Rao GV, Santosh D, Reddy DN. Early institution of precutting for difficult biliary cannulation: A prospective study comparing conventional vs. a modified technique. Gastrointest Endosc 2005; 62(5):669-74.
23. 23. Cennamo V, Fuccio L, Zagari RM, Eusebi LH, Ceroni L, Laterza L, Fabbri C, Bazzoli F. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography related complication risk? Meta-analysis of ramdomized controlled trials. Endoscopy 2010;42:381-8.
24. 24. Lee TH, Park do H, Park JY, Kim EO, Lee YS, Park JH, Lee SH, Chung IK, Kim HS, Park SH, Kim SJ. Can wireguided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial. Gastrointest Endosc 2009; 69:444-9.
25. 25. Vandervoort J, Soetikno RM, Tham TC, Wong RC, Ferrari AP Jr, Montes H, Roston AD, Slivka A, Lichtenstein DR, Ruymann FW, Van Dam J, Hughes M, Carr-Locke DL. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002;56: 652-6