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Endoskopik retrograd kolanjiyopankreatografi sonrası pankreatitin önlenmesinde majör papillaya doğrudan epinefrin püskürtme yönteminin değerlendirilmesi

Yıl 2022, Cilt: 21 Sayı: 3, 126 - 135, 29.12.2022
https://doi.org/10.17941/agd.1136078

Öz

Giriş ve Amaç: Akut pankreatit, endoskopik retrograd kolanjiyopankreatografinin en yaygın komplikasyonudur. Dikkate değer morbidite ve mortalite oranlarına sahiptir. Bu çalışmanın amacı, tek başına lokal epinefrin uygulamasının endoskopik retrograd kolanjiyopankreatografi sonrası pankreatit sıklığını ve şiddetini azaltmadaki etkisini araştırmaktır. Gereç ve Yöntem: Endoskopik retrograd kolanjiyopankreatografi yapılan 979 hastanın verileri retrospektif olarak değerlendirildi. Yaş, cinsiyet, endoskopik retrograd kolanjiyopankreatografi endikasyonları, tekniği, endoskopik retrograd kolanjiyopankreatografi sonrası pankreatit riskini artıran durumlar, endoskopik retrograd kolanjiyopankreatografi sonrası pankreatit varlığı ve şiddeti, serum amilaz, lökosit ve C-reaktif protein seviyeleri (öncesi ve sonrası) kaydedildi. Veriler sadece lokal epinefrin profilaksisi alan 473 hasta ve almayan 506 hasta olmak üzere iki grup arasında karşılaştırıldı. Bulgular: Tüm hastalar arasında endoskopik retrograd kolanjiyopankreatografi sonrası pankreatit oranı %6.8, yüksek riskli hasta grubunda ise %13.6 olarak saptandı. Lokal epinefrin profilaksisi alan grupta, almayan gruba göre endoskopik retrograd kolanjiyopankreatografi sonrası pankreatit daha az görüldü (%9.1’e karşı %4.4; p = 0.004). Epinefrin grubunda endoskopik retrograd kolanjiyopankreatografi sonrası amilaz, lökosit ve C-reaktif protein düzeyleri epinefrin almayan gruba göre anlamlı olarak düşük saptandı (p = 0.001, p = 0.004, p = 0.001). Epinefrin grubunda daha az sıklıkla şiddetli ve orta derecede şiddetli pankreatit görüldü (p = 0.003). Yüksek riskli hasta grubunda lokal epinefrin irrigasyonunun endoskopik retrograd kolanjiyopankreatografi sonrası pankreatit oranını düşürdüğü gözlendi (%18.9’a karşı %7.9; p = 0.002). Sonuç: Majör papillaya direkt püskürtme yöntemi ile epinefrin irrigasyonu endoskopik retrograd kolanjiyopankreatografi sonrası pankreatitin önlenmesinde uygulaması kolay, güvenli ve ümit verici bir yöntemdir. Etkinliğini araştırmak için geniş popülasyonlarla daha fazla çalışmaya ihtiyaç vardır.

Kaynakça

  • 1. Dumonceau JM, Andriulli A, Elmunzer BJ, et al; European Society of Gastrointestinal Endoscopy. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014. Endoscopy 2014;46:799-815.
  • 2. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007;102:1781-8.
  • 3. Andriulli A, Forlano R, Napolitano G, et al. Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks. Digestion 2007;75:156-63.
  • 4. Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification. Adv Clin Exp Med 2018;27:149-54.
  • 5. Pekgöz M. Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment. World J Gastroenterol 2019;25:4019-42.
  • 6. Akshintala VS, Hutfless SM, Colantuoni E, et al. Systematic review with network meta-analysis: pharmacological prophylaxis against post-ERCP pancreatitis. Aliment Pharmacol Ther 2013;38:1325-37.
  • 7. Mine T, Morizane T, Kawaguchi Y, et al Clinical practice guideline for post-ERCP pancreatitis. J Gastroenterol 2017;52:1013-22.
  • 8. Sotoudehmanesh R, Khatibian M, Kolahdoozan S, et al. Indomethacin may reduce the incidence and severity of acute pancreatitis after ERCP. Am J Gastroenterol 2007;102:978-83.
  • 9. Khoshbaten M, Khorram H, Madad L, et al. Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis. J Gastroenterol Hepatol 2008;23:e11-6.
  • 10. Balmadrid B, Kozarek R. Prevention and management of adverse events of endoscopic retrograde cholangiopancreatography. Gastrointest Endosc Clin N Am 2013;23:385-403.
  • 11. Matsushita M, Takakuwa H, Shimeno N, et al. Epinephrine sprayed on the papilla for prevention of post-ERCP pancreatitis. J Gastroenterol 2009;44:71-5.
  • 12. Prat F, Amaris J, Ducot B, et al. Nifedipine for prevention of post-ERCP pancreatitis: a prospective, double-blind randomized study. Gastrointest Endosc 2002;56:202-8.
  • 13. Schwartz JJ, Lew RJ, Ahmad NA, et al. The effect of lidocaine sprayed on the major duodenal papilla on the frequency of post-ERCP pancreatitis. Gastrointest Endosc 2004;59:179-84.
  • 14. Xu LH, Qian JB, Gu LG, et al. Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by epinephrine sprayed on the papilla. J Gastroenterol Hepatol 2011;26:1139-44.
  • 15. Shao LM, Chen QY, Chen MY, Cai JT. Nitroglycerin in the prevention of post-ERCP pancreatitis: a metaanalysis. Dig Dis Sci 2010;55:1-7.
  • 16. Hatami B, Kashfi SMH, Abbasinazari M, et al. Epinephrine in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A preliminary study. Case Rep Gastroenterol 2018;12:125-36.
  • 17. ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA, Muthusamy VR, et al. Adverse events associated with ERCP. Gastrointest Endosc 2017;85:32-47.
  • 18. Bai Y, Li F, Wang SL, et al; Chinese Digestive Endoscopist Committee, Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP). J Dig Dis 2019;20:103-13.
  • 19. Nakaji K, Suzumura S, Nakae Y, et al. Effects in the control of edema of the papilla of Vater by epinephrine saline irrigation after endoscopic retrograde cholangiopancreatography in an endoscopy center in Japan, 2003 to 2007: exploratory retrospective analysis to evaluate the characteristics of eligible patients with a focus on serum amylase levels. Inter Med 2009;48:945-52.
  • 20. Kamal A, Akshintala VS, Talukdar R, et al. A randomized trial of topical epinephrine and rectal indomethacin for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients. Am J Gastroenterol 2019;114:339-47.
  • 21. Gromski MA, Fogel EL. End of the road for epinephrine spraying of the papilla to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis? Clin Gastroenterol Hepatol 2019;17:1446-7.
  • 22. Aziz M, Ghanim M, Sheikh T, et al. Rectal indomethacin with topical epinephrine versus indomethacin alone for preventing Post-ERCP pancreatitis; A systematic review and meta-analysis. Pancreatology 2020;20:356-61.
  • 23. Kubiliun NM, Adams MA, Akshintala VS, et al; United States Cooperative for Outcomes Research in Endoscopy (USCORE). Evaluation of pharmacologic prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: A systematic review. Clin Gastroenterol Hepatol 2015;13:1231-9.
  • 24. Iqbal U, Siddique O, Khara HS, et al. Post-endoscopic retrograde cholangio-pancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis. Endosc Int Open 2020;8:E1061-7. Epub 2020 Jul 21.
  • 25. Toussaint E, Dumonceau JM. Should we incorporate topical epinephrine in the ESGE guideline on prevention of post-ERCP pancreatitis? Endosc Int Open 2020;8:E1068-E1069. Epub 2020 Jul 21.
  • 26. Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001;54:425-34.
  • 27. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998;48:1-10.
  • 28. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001;96:417-23.
  • 29. Williams E J, Taylor S, Fairclough P, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007;39:793-801.

Evaluation of direct epinephrine injection into the major papilla in the prevention of post ERCP pancreatitis

Yıl 2022, Cilt: 21 Sayı: 3, 126 - 135, 29.12.2022
https://doi.org/10.17941/agd.1136078

Öz

Background and Aims: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography, and has remarkable rates of morbidity and mortality. The aim of this study is to investigate the effect of local epinephrine administration alone in reducing the frequency and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Materials and Methods: The data of 979 patients who underwent endoscopic retrograde cholangiopancreatography were evaluated retrospectively. Age, gender, indications for endoscopic retrograde cholangiopancreatography procedure, technique, conditions that increase the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis, presence of post-endoscopic retrograde cholangiopancreatography pancreatitis and it’s severity, serum amylase, leukocyte and C-reactive protein levels (before and after endoscopic retrograde cholangiopancreatography) were recorded. The data were compared between two groups as 473 patients who received only local epinephrine prophylaxis and 506 patients that did not. Results: Post-endoscopic retrograde cholangiopancreatography pancreatitis rate was 6.8% in all patients and 13.6% in patients with high risk. Post-endoscopic retrograde cholangiopancreatography pancreatitis was observed less frequently in the group that received local epinephrine prophylaxis when compared to the group that did not (9.1% vs 4.4%; p = 0.004). Post-endoscopic retrograde cholangiopancreatography amylase, leukocyte and C-reactive protein levels were significantly lower in the epinephrine group when compared to the null group (p = 0.001, p = 0.004, p = 0.001). Less severe and moderate pancreatitis was observed in the epinephrine group (p = 0.003). Local epinephrine irrigation was observed to reduce the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with high risk (18.9% vs 7.9%; p = 0.002). Conclusion: Epinephrine irrigation with direct spraying method to major papillae is an easy-to-apply, safe and promising method in prevention of post- endoscopic retrograde cholangiopancreatography pancreatitis. Further studies with large populations are needed to investigate its effectiveness.

Kaynakça

  • 1. Dumonceau JM, Andriulli A, Elmunzer BJ, et al; European Society of Gastrointestinal Endoscopy. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014. Endoscopy 2014;46:799-815.
  • 2. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007;102:1781-8.
  • 3. Andriulli A, Forlano R, Napolitano G, et al. Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks. Digestion 2007;75:156-63.
  • 4. Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification. Adv Clin Exp Med 2018;27:149-54.
  • 5. Pekgöz M. Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment. World J Gastroenterol 2019;25:4019-42.
  • 6. Akshintala VS, Hutfless SM, Colantuoni E, et al. Systematic review with network meta-analysis: pharmacological prophylaxis against post-ERCP pancreatitis. Aliment Pharmacol Ther 2013;38:1325-37.
  • 7. Mine T, Morizane T, Kawaguchi Y, et al Clinical practice guideline for post-ERCP pancreatitis. J Gastroenterol 2017;52:1013-22.
  • 8. Sotoudehmanesh R, Khatibian M, Kolahdoozan S, et al. Indomethacin may reduce the incidence and severity of acute pancreatitis after ERCP. Am J Gastroenterol 2007;102:978-83.
  • 9. Khoshbaten M, Khorram H, Madad L, et al. Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis. J Gastroenterol Hepatol 2008;23:e11-6.
  • 10. Balmadrid B, Kozarek R. Prevention and management of adverse events of endoscopic retrograde cholangiopancreatography. Gastrointest Endosc Clin N Am 2013;23:385-403.
  • 11. Matsushita M, Takakuwa H, Shimeno N, et al. Epinephrine sprayed on the papilla for prevention of post-ERCP pancreatitis. J Gastroenterol 2009;44:71-5.
  • 12. Prat F, Amaris J, Ducot B, et al. Nifedipine for prevention of post-ERCP pancreatitis: a prospective, double-blind randomized study. Gastrointest Endosc 2002;56:202-8.
  • 13. Schwartz JJ, Lew RJ, Ahmad NA, et al. The effect of lidocaine sprayed on the major duodenal papilla on the frequency of post-ERCP pancreatitis. Gastrointest Endosc 2004;59:179-84.
  • 14. Xu LH, Qian JB, Gu LG, et al. Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by epinephrine sprayed on the papilla. J Gastroenterol Hepatol 2011;26:1139-44.
  • 15. Shao LM, Chen QY, Chen MY, Cai JT. Nitroglycerin in the prevention of post-ERCP pancreatitis: a metaanalysis. Dig Dis Sci 2010;55:1-7.
  • 16. Hatami B, Kashfi SMH, Abbasinazari M, et al. Epinephrine in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A preliminary study. Case Rep Gastroenterol 2018;12:125-36.
  • 17. ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA, Muthusamy VR, et al. Adverse events associated with ERCP. Gastrointest Endosc 2017;85:32-47.
  • 18. Bai Y, Li F, Wang SL, et al; Chinese Digestive Endoscopist Committee, Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP). J Dig Dis 2019;20:103-13.
  • 19. Nakaji K, Suzumura S, Nakae Y, et al. Effects in the control of edema of the papilla of Vater by epinephrine saline irrigation after endoscopic retrograde cholangiopancreatography in an endoscopy center in Japan, 2003 to 2007: exploratory retrospective analysis to evaluate the characteristics of eligible patients with a focus on serum amylase levels. Inter Med 2009;48:945-52.
  • 20. Kamal A, Akshintala VS, Talukdar R, et al. A randomized trial of topical epinephrine and rectal indomethacin for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients. Am J Gastroenterol 2019;114:339-47.
  • 21. Gromski MA, Fogel EL. End of the road for epinephrine spraying of the papilla to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis? Clin Gastroenterol Hepatol 2019;17:1446-7.
  • 22. Aziz M, Ghanim M, Sheikh T, et al. Rectal indomethacin with topical epinephrine versus indomethacin alone for preventing Post-ERCP pancreatitis; A systematic review and meta-analysis. Pancreatology 2020;20:356-61.
  • 23. Kubiliun NM, Adams MA, Akshintala VS, et al; United States Cooperative for Outcomes Research in Endoscopy (USCORE). Evaluation of pharmacologic prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: A systematic review. Clin Gastroenterol Hepatol 2015;13:1231-9.
  • 24. Iqbal U, Siddique O, Khara HS, et al. Post-endoscopic retrograde cholangio-pancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis. Endosc Int Open 2020;8:E1061-7. Epub 2020 Jul 21.
  • 25. Toussaint E, Dumonceau JM. Should we incorporate topical epinephrine in the ESGE guideline on prevention of post-ERCP pancreatitis? Endosc Int Open 2020;8:E1068-E1069. Epub 2020 Jul 21.
  • 26. Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001;54:425-34.
  • 27. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998;48:1-10.
  • 28. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001;96:417-23.
  • 29. Williams E J, Taylor S, Fairclough P, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007;39:793-801.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Emre Gerçeker Bu kişi benim 0000-0001-7494-2912

Serkan Cerrah Bu kişi benim 0000-0002-9139-8039

Ahmet Ramiz Baykan Bu kişi benim 0000-0001-6798-0240

Hakan Yüceyar Bu kişi benim 0000-0003-1545-362X

Yayımlanma Tarihi 29 Aralık 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 21 Sayı: 3

Kaynak Göster

APA Gerçeker, E., Cerrah, S., Baykan, A. R., Yüceyar, H. (2022). Endoskopik retrograd kolanjiyopankreatografi sonrası pankreatitin önlenmesinde majör papillaya doğrudan epinefrin püskürtme yönteminin değerlendirilmesi. Akademik Gastroenteroloji Dergisi, 21(3), 126-135. https://doi.org/10.17941/agd.1136078

test-5