Sıçanlarda Deneysel ERCP Modelinde; Kontrast Madde Uygulama Hızının ve Kanal İçi Basınç Artışının Etkileri

Year 2020, Volume: 30 Issue: 1, 58 - 65, 01.03.2020

Enes Şahin Serdar Yormaz

Abstract

Amaç: Bu çalışmanın amacı ERCP işlemi sonrası akut pankreatit gelişiminde biliopankreatik kanaldaki basınç artışının ve opak madde verilme hızının etkilerini belirlemektir.Gereç ve Yöntem: Çalışmamızda 24 adet rat 4 gruba ayrıldı. Grup 1 de sadece biliopankreatik kanal kanülasyonu yapıldı. Diğer gruplara biliopankreatik kanal içerisine farklı hızlarda opak madde infüzyonu uygulandı ve kanal içinde oluşan basınç ölçüldü. Bulgular: Deney sonrası sıçanlar takibe alındı. 24 saat sonra akut pankreatit gelişimi ve şiddetinin değerlendirilmesi amacıyla sıçanlar sakrifiye edilerek kan ve doku örnekleri alındı. Alınan kan örneğinden lökosit sayısı, amilaz, lipaz, üre, kreatinin, glukoz, AST, ALT, ALP, LDH, kalsiyum, CRP, albümin, total protein, MDA, TAS, TOS değerleri çalışıldı. Pankreas dokuları akut pankreatit gelişimi açısından histopatolojik olarak değerlendirildi.Sonuç: Kanal içi hidrostatik basınç artışın akut pankreatit gelişmesine neden olmaktadır ve biliopankreatikkanal içerisindeki hidrostatik basınç arttıkça, pankreatitin şiddetinin de arttığı gözlenmiştir

Keywords

ERCP, akut pankreatit, ERCP sonrası akut pankreatit, kanal içi hidrostatik basınç artışı

The effects of contrast agent administration rate and intraductal pressure increase in an experimental ercp model in rats

Abstract

Objective: In this experimental study, we investigated the possible correlation between the increase in the hydrostatic pressure within the pancreatic duct caused by opaque substance given during ERCP procedure and the development of acute pancreatitis.Material and Methods: In our study, 24 rats were divided into 4 groups. The first of these groups was designated as the control group and only biliopancreatic duct cannulation was performed. In other groups, the opaque substance was infused into the biliopancreatic duct at various rates and the resulting intra-ductal pressure was measured.Results: After the experiment, the rats were followed up. 24 hours later, the rats were sacrificed, and blood and tissue samples were taken to evaluate the development and severity of acute pancreatitis. Leukocyte WBC count, amylase, lipase, urea, creatinine, glucose, AST, ALT, ALP, LDH, calcium, CRP, albumin, total protein, MDA, TAS and TOS were studied from the blood samples taken. The pancreatic tissues were histopathologically evaluated for the development of acute pancreatitis.Conclusion: it has been concluded that an increase in the intra-ductal hydrostatic pressure led to acute pancreatitis. As the hydrostatic pressure in the biliopancreatic duct increased, the severity of acute pancreatitis was observed to have increased

Keywords

ERCP, acute pancreatitis, post-ERCP acute pancreatitis, intraductal hydrostatic pressure increase

References

• Yalnız M. Etiyopatogenez, Epidemiyoloji ve Klinik, in Pankreas Hastalıkları, O.A. Necati Örmeci, Editor. 2016, Dünya Tıp Kitabevi. p. 25-32.
• Glazer G. Acute pancreatitis. Experimental and clinical aspects of pathogenesis andmanagement, in Contentious issues in acute pancreatitis, R. Glazer G and JHC, Editors. 1988, Bailliere Tindall: London. p. 1-36.
• Schmidt J, Rattner DW, Lewandrowski K, et al. A better model of acute pancreatitis for evaluating therapy. Annals of surgery 1992;215: 44.
• Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. New England Jour- nal of Medicine 1996; 335: 909-19.
• Brust R, Brust R, Thomson AB, Wensel RH, Sherbaniuk RW, Costopoulos L. Pancreatic injury following ERCP: Fa- ilure of prophylactic benefit of Trasylol®. Gastrointestinal endoscopy 1977;24: 77-9.
• Osnes M, Skjennald A, Larsen S. A comparison of a new non-ionic (metrizamide) and a dissociable (metrizoate) contrast medium in endoscopic retrograde pancreatograp- hy (ERP). Scandinavian journal of gastroenterology 1977; 12: 821-5.
• Sherman S, Lehman GA, ERCP-and endoscopic sphincte- rotomy-induced pancreatitis. Pancreas 1991; 6: 350-67.
• Borislow D. The etiology of post-ERCP pancreatitis. in gastrointestinal endoscopy. 1989. mosby-year book inc 11830 westline industrial dr, st louis, mo 63146-318.
• Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointestinal endoscopy 2001; 54: 425-34.
• Wehrmann T, Schmitt TH, Arndt A, Lembcke B, Caspary WF, Seifert H. Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction. Alimentary pharmacology & therapeutics 2000; 14: 1469-77.
• Sand J, Nordback I, Arvola P, Pörsti I, Kalloo A, Pasricha P. Effects of botulinum toxin A on the sphincter of Oddi: an in vivo and in vitro study. Gut 1998; 42: 507-10.
• Kaffes AJ, Bourke MJ, Ding S, Alrubaie A, Kwan V, Willi- ams SJ. A prospective, randomized, placebo-controlled trial of transdermal glyceryl trinitrate in ERCP: effects on tech- nical success and post-ERCP pancreatitis. Gastrointestinal endoscopy 2006; 64:351-7.
• Goebel C, Hardt P, Doppl W, Temme H, Hackstein N, Klör HU. Frequency of pancreatitis after endoscopic retrograde cholangiopancreatography with iopromid or iotrolan: a randomized trial. European radiology 2000; 10: 677-80.
• Pfau PR, Mosley RG, Said A, et al. Comparison of the effect of non-ionic and ionic contrast agents on pancreatic histo- logy in a canine model. JOP 2006; 7:27-33.
• Ogawa M, Kawaguchi Y, Kawashima Y, et al. Comparison of ionic, monomer, high osmolar contrast media with non-i- onic, dimer, iso-osmolar contrast media in ERCP. Tokai J Exp Clin Med 2013; 38: 109-13.
• Sofuni A, Maguchi H, Itoi T, et al. Prophylaxis of post–en- doscopic retrograde cholangiopancreatography pancreati- tis by an endoscopic pancreatic spontaneous dislodgement stent. Clinical Gastroenterology and Hepatology 2007; 5: 1339-46.
• Bailey AA, Bourke MJ, Kaffes AJ, Byth K, Lee EY, Williams SJ. Needle-knife sphincterotomy: factors predicting its use and the relationship with post-ERCP pancreatitis (with vi- deo). Gastrointestinal endoscopy 2010; 71: 266-71.
• Cheung J,Tsoi KK, Quan WL, Lau JY, Sung JJ. Guidewire versus conventional contrast cannulation of the common bile duct for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Gastrointestinal en- doscopy 2009; 70:1211-9.
• Gong B, Hao L, Bie L, Sun B, Wang M. Does precut tech- nique improve selective bile duct cannulation or increase post-ERCP pancreatitis rate? A meta-analysis of randomi- zed controlled trials. Surgical endoscopy 2010; 24: 2670-80.
• Saari A, Kivisaari L, Standertskjöld-Nordenstam CG, Brac- kett K, Schröder T. Experimental pancreatography: a com- parison of three contrast media. Scandinavian journal of gastroenterology 1988; 23: 53-8.
• Polack EP, Fainsinger MH, Bonnano SV. A death following complications of roentgenologic nonoperative manipulati- on of common bile duct calculi. Radiology 1977; 123: 585-6.
• Deschamps J, Allemand H, Janin Magnificat R, Camelot G, Gillet M, Carayon P. Acute pancreatitis following gastroin- testinal endoscopy without ampullary cannulation. Endos- copy 1982; 14: 105-6.
• Corfield AP, Cooper MJ, Williamson RC. Acute pancrea- titis: a lethal disease of increasing incidence. Gut 1985; 26: 724-9.
• Aziz AMA, Lehman GA. Pancreatits after endoscopic ret- rograde cholangio-pancreatography. World Journal of Gastroenterology 2007; 13:2655.
• Ranson J, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974; 139: 69-81.
• Longnecker DS. Pathology and pathogenesis of diseases of the pancreas. The American journal of pathology 1982; 107: 103.