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When should we perform ERCP in acute pancreatitis with biliary origin?

Year 2009, Volume: 17 Issue: 2, 94 - 98, 01.08.2009

Murat Korkmaz Hakan Ünal Haldun Selçuk Uğur Yılmaz

Abstract

Although more than 100 years have passed since acute pancreatitis was clinically recognized, the defined management strategies have not changed substantially. The precise timing and indications of endoscopic retrograde cholangio-pancreatography procedure in acute biliary pancreatitis have been questioned after the era of routine utilization of endoscopic retrograde cholangio- pancreatography for biliopancreatic diseases. However, a limited number of prospective, randomized clinical studies have been performed to date, and they reported that endoscopic retrograde cholangio-pancreatography is useful only if the patient suffers from severe pancreatitis or has cholangitis. Mild or transient pancreatitis cases did not show additional benefits. More recent studies pointed out the importance of the time period of biliopancreatic obstruction, the course and severity of disease, and availability and use of other diagnostic tools such as endoscopic ultrasound and magnetic resonance cholangiopancreatography. They advised physicians to make a final decision after evaluating all these parameters. We should also keep in mind that performing a useless endoscopic retrograde cholangio-pancreatography procedure could be harmful to the patient.

Keywords

Biliary pancreatitis early ERCP urgent ERCP

References

  • Hui CK, Lai KC, Yuen MF. Acute cholangitis-predictive factors for emer- gency ERCP. Aliment Pharmacol Ther 2001;15:1633-7.
  • Salek J, Livote E, Sideridis K, et al. Analysis of risk factors predictive of early mortality and urgent ERCP in acute cholangitis. Clin Gastroenterol 2009;43:1715.
  • Neoptolemos JP, Carr-Locke DL, London NJ, et al. Controlled trial of ur- gent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 1988;2:979-83. 4.Fan ST, La- i EC, Mok FP, et al. Early treatment of acute biliary pancreatitis by en- doscopic papillotomy. N Engl J Med 1993;328:228-32.
  • Nowak A, Nowakowska-Dulawa E, Marek TA, et al. Final results of the prospective, randomized, controlled study on endoscopic sphinctero- tomy versus conventional management in acute biliary pancreatitis (abs- tract). Gastroenterology 1995;108:A380,
  • Rünzi M, Saluja A, Lerch MM, et al. Early ductal decompression prevents the progression of biliary pancreatitis: an experimental study in the opossum. Gastroenterology 1993;105:157-64.
  • Acosta JM, Rubio Galli OM, Rossi R, et al. Effect of duration of ampul- lary gallstone obstruction on severity of lesions of acute pancreatitis. J Am Coll Surg 1997;184:499-505.
  • Acosta JM, Katkhouda N, Debian KA, et al TV. Early ductal decompres- sion versus conservative management for gallstone pancreatitis with am- pullary obstruction: a prospective randomized clinical trial. Ann Surg 2006;243:33-40.
  • Folsch UR, Nitsche R, Ludtke R, et al. Early ERCP and papillotomy com- pared with conservative treatment for acute biliary pancreatitis. The Ger- man Study Group on Acute Biliary Pancreatitis. N Engl J Med 1997;336:237-42.
  • Sharma VK, Howden CW. Metaanalysis of randomized controlled trials of endoscopic retrograde cholangiography and endoscopic sphinctero- tomy for the treatment of acute biliary pancreatitis. Am J Gastroenterol 1999;94:3211-4.
  • Ayub K, Imada R, Slavin J. Endoscopic retrograde cholangiopancreatog- raphy in gallstone-associated acute pancreatitis.Cochrane Database Syst Rev 2004;18:4:CD003630.
  • Moretti A, Papi C, Aratari A, et al. Is early endoscopic retrograde cholan- giopancreatography useful in the management of acute biliary pancreati- tis? A metaanalysis of randomized controlled trials. Dig Liver Dis 2008;40:379-85.
  • Petrov MS, Uchugina AF, Kukosh MV. Does endoscopic retrograde cho- langiopancreatography reduce the risk of local pancreatic complications in acute pancreatitis? A systematic review and metaanalysis. Surg Endosc 2008;22:2338-43.
  • Petrov MS, van Santvoort HC, Besselink MG, et al. Early endoscopic ret- rograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of rando- mized trials. Ann Surg 2008;247:250-7.
  • Oría A, Cimmino D, Ocampo C, et al. Early endoscopic intervention ver- sus early conservative management in patients with acute gallstone pan- creatitis and biliopancreatic obstruction: a randomized clinical trial. Ann Surg 2007;245:10-7.
  • Behrns KE, Ashley SW , Hunter JG, et al. Early ERCP for gallstone pan- creatitis: For whom and when? J Gastrointest Surg 2008;12:629-33.
  • Forsmark CE, Baillie J. AGA Institute Clinical Practice and Economics Committee. AGA Institute technical review on acute pancreatitis. Gastro- enterology 2007;132:2022-44.
  • Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101:2379 -400.
  • Van Santvoort HC, Besselink MG, De Vries AC, and the members of the Dutch Acute Pancreatitis Study Group. Early endoscopic retrograde cho- langiopancreatography in predicted severe acute biliary pancreatitis. A prospective multicenter study. Ann Surg 2009;250:68-75.
  • Kimura Y, Takada T, Kawarada Y, et al. JPN guidelines for the manage- ment of acute pancreatitis: treatment of gallstone-induced acute pancre- atitis. J Hepatobiliary Pancreat Surg 2006;13:56-60.
  • Acosta JM, Rubio Galli OM, Rossi R, et al. Effect of duration of ampul- lary gallstone obstruction on severity of lesions of acute pancreatitis. J Am Coll Surg 1997;184:499-505.
  • Acosta JM, Pellegrini CA, Skinner DB. Etiology and pathogenesis of acu- te biliary pancreatitis. Surgery 1980;88:118-25.
  • Mazen Jamal M, Yoon EJ, Saadi A, et al. Trends in the utilization of en- doscopic retrograde cholangiopancreatography (ERCP) in the United States. Am J Gastroenterol 2007;102:966-75.
  • Liu CL, Fan ST, Lo CM, et al. Comparison of early endoscopic ultraso- nography and endoscopic retrograde cholangiopancreatography in the management of acute biliary pancreatitis: a prospective randomized study. Clin Gastroenterol Hepatol 2005;3:1238-44.
  • Polkowski M, Regula J, Tilszer A, et al. Endoscopic ultrasound versus en- doscopic retrograde cholangiography for patients with intermediate pro- bability of bile duct stones: a randomized trial comparing two manage- ment strategies. Endoscopy 2007;39:296-303.
  • Lee YT, Chan FK, Leung WK, et al. Comparison of EUS and ERCP in the investigation with suspected biliary obstruction caused by choledocho- lithiasis: a randomized study. Gastrointest Endosc 2008;67:660-8.
  • Wada K, Takada T, Kawarada Y, et al. Diagnostic criteria and severity as- sessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancre- at Surg 2007;14:52-8.
  • Maxim S Petrov. Early use of ERCP in acute biliary pancreatitis with (out) jaundice. An unjaundiced view. JOP. J Pancreas (Online) 2009;10:1-7.

Biliyer etyolojili akut pankreatitte ERCP ne zaman yapılmalı?

Year 2009, Volume: 17 Issue: 2, 94 - 98, 01.08.2009

Murat Korkmaz Hakan Ünal Haldun Selçuk Uğur Yılmaz

Abstract

Akut pankreatit 100 yılı aşkın bir süredir tanınmasına rağmen temelde tedavi yaklaşımı pek değişmemiştir. Endoskopik retrograt kolanjiopankreatografi'nin klinik kullanıma girmesinden sonra biliyer pankreatitte endoskopik retrograt kolanjiopankreatografi'nin yeri ve zamanı sorgulanmaya başlanmıştır. Son 20 yılda bu konu ile ilgili az sayıda prospektif randomize klinik çalışma yapılmış ve erken dönemde ciddi pankreatit varlığında, kolanjit tablosu olaya eşlik ediyorsa faydalı olduğu belirtilmiştir. Hafif ve geçici olgularda ek bir fayda sağlamadığı görülmüştür. Daha yeni verilerin ışığında ise biliyopankreatik tıkanıklığın süresi, hastalığın şiddeti ve seyri, elimizde var olan manyetik rezonans kolanjiopankreatografi/endoskopik ultrasonografi gibi diğer tanısal yöntemlerin kullanılabilirliği gibi birçok farklı parametreyi birlikte değerlendirip bir analiz yapmanın daha akılcı olduğu ifade edilmeye başlanmıştır. İnvaziv bir işlem olan endoskopik retrograt kolanjiopankreatografi'nin mevcut tabloyu daha da kötüleştirebileceği de akılda tutulmalıdır.

Keywords

Biliyer pankreatit erken ERCP acil ERCP

References

  • Hui CK, Lai KC, Yuen MF. Acute cholangitis-predictive factors for emer- gency ERCP. Aliment Pharmacol Ther 2001;15:1633-7.
  • Salek J, Livote E, Sideridis K, et al. Analysis of risk factors predictive of early mortality and urgent ERCP in acute cholangitis. Clin Gastroenterol 2009;43:1715.
  • Neoptolemos JP, Carr-Locke DL, London NJ, et al. Controlled trial of ur- gent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 1988;2:979-83. 4.Fan ST, La- i EC, Mok FP, et al. Early treatment of acute biliary pancreatitis by en- doscopic papillotomy. N Engl J Med 1993;328:228-32.
  • Nowak A, Nowakowska-Dulawa E, Marek TA, et al. Final results of the prospective, randomized, controlled study on endoscopic sphinctero- tomy versus conventional management in acute biliary pancreatitis (abs- tract). Gastroenterology 1995;108:A380,
  • Rünzi M, Saluja A, Lerch MM, et al. Early ductal decompression prevents the progression of biliary pancreatitis: an experimental study in the opossum. Gastroenterology 1993;105:157-64.
  • Acosta JM, Rubio Galli OM, Rossi R, et al. Effect of duration of ampul- lary gallstone obstruction on severity of lesions of acute pancreatitis. J Am Coll Surg 1997;184:499-505.
  • Acosta JM, Katkhouda N, Debian KA, et al TV. Early ductal decompres- sion versus conservative management for gallstone pancreatitis with am- pullary obstruction: a prospective randomized clinical trial. Ann Surg 2006;243:33-40.
  • Folsch UR, Nitsche R, Ludtke R, et al. Early ERCP and papillotomy com- pared with conservative treatment for acute biliary pancreatitis. The Ger- man Study Group on Acute Biliary Pancreatitis. N Engl J Med 1997;336:237-42.
  • Sharma VK, Howden CW. Metaanalysis of randomized controlled trials of endoscopic retrograde cholangiography and endoscopic sphinctero- tomy for the treatment of acute biliary pancreatitis. Am J Gastroenterol 1999;94:3211-4.
  • Ayub K, Imada R, Slavin J. Endoscopic retrograde cholangiopancreatog- raphy in gallstone-associated acute pancreatitis.Cochrane Database Syst Rev 2004;18:4:CD003630.
  • Moretti A, Papi C, Aratari A, et al. Is early endoscopic retrograde cholan- giopancreatography useful in the management of acute biliary pancreati- tis? A metaanalysis of randomized controlled trials. Dig Liver Dis 2008;40:379-85.
  • Petrov MS, Uchugina AF, Kukosh MV. Does endoscopic retrograde cho- langiopancreatography reduce the risk of local pancreatic complications in acute pancreatitis? A systematic review and metaanalysis. Surg Endosc 2008;22:2338-43.
  • Petrov MS, van Santvoort HC, Besselink MG, et al. Early endoscopic ret- rograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of rando- mized trials. Ann Surg 2008;247:250-7.
  • Oría A, Cimmino D, Ocampo C, et al. Early endoscopic intervention ver- sus early conservative management in patients with acute gallstone pan- creatitis and biliopancreatic obstruction: a randomized clinical trial. Ann Surg 2007;245:10-7.
  • Behrns KE, Ashley SW , Hunter JG, et al. Early ERCP for gallstone pan- creatitis: For whom and when? J Gastrointest Surg 2008;12:629-33.
  • Forsmark CE, Baillie J. AGA Institute Clinical Practice and Economics Committee. AGA Institute technical review on acute pancreatitis. Gastro- enterology 2007;132:2022-44.
  • Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101:2379 -400.
  • Van Santvoort HC, Besselink MG, De Vries AC, and the members of the Dutch Acute Pancreatitis Study Group. Early endoscopic retrograde cho- langiopancreatography in predicted severe acute biliary pancreatitis. A prospective multicenter study. Ann Surg 2009;250:68-75.
  • Kimura Y, Takada T, Kawarada Y, et al. JPN guidelines for the manage- ment of acute pancreatitis: treatment of gallstone-induced acute pancre- atitis. J Hepatobiliary Pancreat Surg 2006;13:56-60.
  • Acosta JM, Rubio Galli OM, Rossi R, et al. Effect of duration of ampul- lary gallstone obstruction on severity of lesions of acute pancreatitis. J Am Coll Surg 1997;184:499-505.
  • Acosta JM, Pellegrini CA, Skinner DB. Etiology and pathogenesis of acu- te biliary pancreatitis. Surgery 1980;88:118-25.
  • Mazen Jamal M, Yoon EJ, Saadi A, et al. Trends in the utilization of en- doscopic retrograde cholangiopancreatography (ERCP) in the United States. Am J Gastroenterol 2007;102:966-75.
  • Liu CL, Fan ST, Lo CM, et al. Comparison of early endoscopic ultraso- nography and endoscopic retrograde cholangiopancreatography in the management of acute biliary pancreatitis: a prospective randomized study. Clin Gastroenterol Hepatol 2005;3:1238-44.
  • Polkowski M, Regula J, Tilszer A, et al. Endoscopic ultrasound versus en- doscopic retrograde cholangiography for patients with intermediate pro- bability of bile duct stones: a randomized trial comparing two manage- ment strategies. Endoscopy 2007;39:296-303.
  • Lee YT, Chan FK, Leung WK, et al. Comparison of EUS and ERCP in the investigation with suspected biliary obstruction caused by choledocho- lithiasis: a randomized study. Gastrointest Endosc 2008;67:660-8.
  • Wada K, Takada T, Kawarada Y, et al. Diagnostic criteria and severity as- sessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancre- at Surg 2007;14:52-8.
  • Maxim S Petrov. Early use of ERCP in acute biliary pancreatitis with (out) jaundice. An unjaundiced view. JOP. J Pancreas (Online) 2009;10:1-7.
There are 27 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Murat Korkmaz This is me

Hakan Ünal This is me

Haldun Selçuk This is me

Uğur Yılmaz This is me

Publication Date August 1, 2009
Published in Issue Year 2009 Volume: 17 Issue: 2

Cite

APA Korkmaz, M., Ünal, H., Selçuk, H., Yılmaz, U. (2009). Biliyer etyolojili akut pankreatitte ERCP ne zaman yapılmalı?. Endoskopi Gastrointestinal, 17(2), 94-98.
AMA Korkmaz M, Ünal H, Selçuk H, Yılmaz U. Biliyer etyolojili akut pankreatitte ERCP ne zaman yapılmalı?. Endoskopi Gastrointestinal. August 2009;17(2):94-98.
Chicago Korkmaz, Murat, Hakan Ünal, Haldun Selçuk, and Uğur Yılmaz. “Biliyer Etyolojili Akut Pankreatitte ERCP Ne Zaman yapılmalı?”. Endoskopi Gastrointestinal 17, no. 2 (August 2009): 94-98.
EndNote Korkmaz M, Ünal H, Selçuk H, Yılmaz U (August 1, 2009) Biliyer etyolojili akut pankreatitte ERCP ne zaman yapılmalı?. Endoskopi Gastrointestinal 17 2 94–98.
IEEE M. Korkmaz, H. Ünal, H. Selçuk, and U. Yılmaz, “Biliyer etyolojili akut pankreatitte ERCP ne zaman yapılmalı?”, Endoskopi Gastrointestinal, vol. 17, no. 2, pp. 94–98, 2009.
ISNAD Korkmaz, Murat et al. “Biliyer Etyolojili Akut Pankreatitte ERCP Ne Zaman yapılmalı?”. Endoskopi Gastrointestinal 17/2 (August 2009), 94-98.
JAMA Korkmaz M, Ünal H, Selçuk H, Yılmaz U. Biliyer etyolojili akut pankreatitte ERCP ne zaman yapılmalı?. Endoskopi Gastrointestinal. 2009;17:94–98.
MLA Korkmaz, Murat et al. “Biliyer Etyolojili Akut Pankreatitte ERCP Ne Zaman yapılmalı?”. Endoskopi Gastrointestinal, vol. 17, no. 2, 2009, pp. 94-98.
Vancouver Korkmaz M, Ünal H, Selçuk H, Yılmaz U. Biliyer etyolojili akut pankreatitte ERCP ne zaman yapılmalı?. Endoskopi Gastrointestinal. 2009;17(2):94-8.