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4 yıllık endoskopik retrograd kolanjiyopankreatografi vakalarımızın retrospektif değerlendirilmesi

Yıl 2016, Cilt: 26 Sayı: 2, 53 - 57, 01.06.2016

Cem Onur Mehmet Asıl Cem Onur Kıraç Ali Demir

Öz

Amaç: Endoskopik retrograd kolanjiyopankreatografi ERCP , pankreatikobiliyer hastalıkların tanı ve tedavisinde altın standart yöntemdir. Biz bu çalışmada son 4 yıllık ERCP deneyimimizi gözden geçirmeyi amaçladık.Gereç ve yöntem: Necmettin Erbakan Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniğinde son 4 yılda ERCP yapılan hastalar çalışma kapsamına alındı. Veriler hastane arşiv sisteminden retrospektif olarak elde edildi.Bulgular: 1155 hastaya toplam 1471 ERCP işlemi yapılmıştı. Hastaların 664’ü kadın ve 491’i erkek ve ortalama yaş 60,2 yaş idi 10-97 years . En sık ERCP endikasyonu hiperbilirubinemi ve serum ALP ve GGT düzeylerinde artış idi 703 patients, %47,8 . 1250 hastada %85 standart sfinkterotomla kanülasyon başarılı olurken 217 %14,8 hastaya iğne uçlu sfinkterotomla önkesi yapılmış ve bu hastaların 104’ü %7 önkesi sonrası kanüle edilebilmişlerdi. Total kanülasyon başarısı %92,0 idi. 152 hastada ERCP ile ilişkili komplikasyonlar saptandı. En sık komplikasyon 113 hastada %7,7 saptanan post-ERCP pankreatit idi. İğne uçlu sfinkterotomla önkesi yapılan hastalarda post-ERCP pankreatit gelişme sıklığı belirgin olarak yüksekti %17,1 . 1 hasta şiddetli post-ERCP pankreatit ve buna bağlı multiorgan yetmezliği nedeniyle öldü. ERCP ile ilişkili kanama 5 %0,3 ve perforasyon 3 %0,2 hastada saptandı.Sonuç: ERCP çeşitli pankreatikobiliyer hastalıkların tedavisinde hala altın standart yerini korumaktadır. İnvaziv olması nedeniyle ERCP’nin tanı için kullanılmaması ve terapötik amaçla kullanılmasının uygun olacağı kanaatindeyiz

Anahtar Kelimeler

kolanjiyopankreatografi endoskopik retrograt pankreatit kateterizasyon

Kaynakça

  • McCune WS, Shorb PE, Moscovitz H. Endoscopic cannula- tion of the ampulla of vater: a preliminary report. Ann Surg 1968;167:752.
  • Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. Endos- copic sphincterotomy of the ampulla of Vater. 1974; 20:148- 51.
  • 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.
  • Cotton PB. Are low-volume ERCPists a problem in the United States? A pleato examine and improve ERCP pra- ctice-NOW. Gastrointest Endosc. Gastrointest Endosc 2011;74:161-6.
  • Atamanalp SS, Yıldırgan Mİ, Kantarcı A. Endoscopic ret- rograde cholangiopancreatography (ERCP): outcomes of 3136 casesover 10 years. Turk J Med Sci 2011; 41: 615-621.
  • Neoptolemos JP1, Carr-Locke DL, London NJ, et al. Cont- rolled trial of urgent endoscopic retrograde cholangiopanc- reatography and endoscopic sphincterotomy versus con- servative treatment for acute pancreatitis due to gallstones. Lancet 1988; 29:979-83.
  • Fan ST1, Lai EC, Mok FP, Lo CM, Zheng SS, Wong J.Early treatment of acute biliary pancreatitis by endoscopic papil- lotomy. N Engl J Med 1993; 328:228-32.
  • Freeman ML. Adverse outcomes of ERCP. Gastrointest En- dosc 2002; 56: 273-82.
  • Masci E, Toti G, Mariani A, et al. Complications of diagnos- tic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001; 96: 417-23.
  • Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001;54:425-34.
  • Cheng CL, Sherman S, Watkins JL, et al. Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol 2006;101:139-47.
  • Wang P, Li ZS, Liu F, et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gast- roenterol 2009; 104:31-40.
  • Basat O, Köklü S, Çiçek B, Parlak E, Şahin B. Endoskopik retrograd kolanjio-pankreatografi komplikasyonları: Tek merkezli retrospektif çalışma. Akademik gastroenteroloji Dergisi 2006; 5: 169-72.
  • Kodali S, Mönkemüller K, Kim H, Ramesh J, Trevino J, Varadarajulu S, Wilcox CM. ERCP-relatedperforations in thenewmillennium: A large tertiary referral center 10-year experience. United European Gastroenterol J 2015; 3:25-30.

Yıl 2016, Cilt: 26 Sayı: 2, 53 - 57, 01.06.2016

Cem Onur Mehmet Asıl Cem Onur Kıraç Ali Demir

Öz

Introduction: Endoscopic retrograde cholangiopancreatography ERCP is the gold standart technique for the diagnosis and treatment of pancreaticobiliary diseases. In this study we aimed to evaluate our ERCP experience of the last four years.Material and Methods: Patients to whom ERCP is performed in the Gastroenterology Clinic of Necmettin Erbakan University Faculty of Medicine in the last 4 years were included in the study. Data were collected retrospectively from the medical records of the hospital archive system.Results: 1471 ERCP procedures were performed to 1155 patients. 664 patients were female %57,5 and 491 were male with a mean age of 60,2 years 10-97 years . The most common indication for ERCP was hyperbilirubinemia and elevation of serum ALP and GGT levels 703 patients, 47,8% . Selective cannulation with standard sphincterotome was achieved in 1250 patients 85,0% . Precut sphincterotomy with needle knife sphincterotome was performed in 217 patients 14,8% and in 104 patients 7,0% cannulation was successfull. Total cannulation success was 92%. In 152 patients 10,3% ERCP related complications were detected.The most frequent complication was post-ERCP pancreatitis 113 patients, 7,7% . Post ERCP pancreatitis rate was significantly higher among patients to whom precut needle knife sphincterotomy was performed 17,1% . 1 patient died due to multiorgan failure associated with postERCP pancreatitis. ERCP related bleeding and perforation were detected in 5 0,3% and 3 0,2% patients respectively.Conclusions: ERCP is still the gold standard method for the treatment of various pancreaticobiliary diseases. Due to its invasive nature it shouldn’t be performed for diagnostic purposes and reserved for therapeutic interventions

Anahtar Kelimeler

Cholangiopancreatography Endoscopic Retrograde pancreatitis catheterization

Kaynakça

  • McCune WS, Shorb PE, Moscovitz H. Endoscopic cannula- tion of the ampulla of vater: a preliminary report. Ann Surg 1968;167:752.
  • Kawai K, Akasaka Y, Murakami K, Tada M, Koli Y. Endos- copic sphincterotomy of the ampulla of Vater. 1974; 20:148- 51.
  • 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.
  • Cotton PB. Are low-volume ERCPists a problem in the United States? A pleato examine and improve ERCP pra- ctice-NOW. Gastrointest Endosc. Gastrointest Endosc 2011;74:161-6.
  • Atamanalp SS, Yıldırgan Mİ, Kantarcı A. Endoscopic ret- rograde cholangiopancreatography (ERCP): outcomes of 3136 casesover 10 years. Turk J Med Sci 2011; 41: 615-621.
  • Neoptolemos JP1, Carr-Locke DL, London NJ, et al. Cont- rolled trial of urgent endoscopic retrograde cholangiopanc- reatography and endoscopic sphincterotomy versus con- servative treatment for acute pancreatitis due to gallstones. Lancet 1988; 29:979-83.
  • Fan ST1, Lai EC, Mok FP, Lo CM, Zheng SS, Wong J.Early treatment of acute biliary pancreatitis by endoscopic papil- lotomy. N Engl J Med 1993; 328:228-32.
  • Freeman ML. Adverse outcomes of ERCP. Gastrointest En- dosc 2002; 56: 273-82.
  • Masci E, Toti G, Mariani A, et al. Complications of diagnos- tic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001; 96: 417-23.
  • Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001;54:425-34.
  • Cheng CL, Sherman S, Watkins JL, et al. Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol 2006;101:139-47.
  • Wang P, Li ZS, Liu F, et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gast- roenterol 2009; 104:31-40.
  • Basat O, Köklü S, Çiçek B, Parlak E, Şahin B. Endoskopik retrograd kolanjio-pankreatografi komplikasyonları: Tek merkezli retrospektif çalışma. Akademik gastroenteroloji Dergisi 2006; 5: 169-72.
  • Kodali S, Mönkemüller K, Kim H, Ramesh J, Trevino J, Varadarajulu S, Wilcox CM. ERCP-relatedperforations in thenewmillennium: A large tertiary referral center 10-year experience. United European Gastroenterol J 2015; 3:25-30.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Original Article
Yazarlar

Cem Onur Mehmet Asıl Bu kişi benim

Cem Onur Kıraç Bu kişi benim

Ali Demir Bu kişi benim

Yayımlanma Tarihi 1 Haziran 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 26 Sayı: 2

Kaynak Göster

Vancouver Asıl COM, Kıraç CO, Demir A. 4 yıllık endoskopik retrograd kolanjiyopankreatografi vakalarımızın retrospektif değerlendirilmesi. Genel Tıp Derg. 2016;26(2):53-7.

Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.