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

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

Biliyer etyolojili akut pankreatitte ERCP ne zaman yapılmalı?

Öz

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.

Anahtar Kelimeler

• Biliyer pankreatit, erken ERCP, acil ERCP

Kaynakça

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