The Effect of ERCP on Mortality and Morbidity in Acute Pancreatitis

Öz

Background: Gallstones and biliary sludge are the most important causes of acute pancreatitis (AP) in our country. For many years, endoscopic retrograde cholangiopancreatography (ERCP) has been used to diagnose and treat acute biliary pancreatitis (ABP). The patient's treatment with acute biliary pancreatitis should be assessed in light of current international guidelines. This study aimed to analyze the patients who were admitted to our clinic with the diagnosis of acute biliary pancreatitis and underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) for treatment, in the light of the literature.
Materials and Methods: The records of patients who underwent ERCP with a diagnosis of acute biliary pancreatitis in our general surgery endoscopy department between April 2020 and March 2021 were retrospectively reviewed.
Results: ERCP was performed in 131 patients with acute biliary pancreatitis. 60 (45.8%) of the patients were male, whereas 71 (54.2%) were female. ERCP was performed on 121 (92.36%) patients for common choledochal stones, 9 (6.87%) for periampullary/distal end of the choledochal tumor, and 1 (0.76%) for acute pancreatitis due to biliary tract rupture after hepatic cyst surgery. While 30 patients underwent ERCP, endoscopic sphincterotomy (ES), and the placement of a plastic stent in the common bile duct, 99 patients underwent ERCP, ES, and stone extraction from the common bile duct. There was no operative mortality.
Conclusions: Acute pancreatitis is a very heterogeneous disease, ranging from mild edematous pancreatitis to severe necrotizing pancreatitis with a mortality of 20%. There are still many controversial issues in the diagnosis and treat-ment of this disease. However, endoscopic retrograde cholangiopancreatography, a minimally invasive biliary pan-creatitis procedure, should be at the forefront of diagnosis and treatment.

Keywords: Acute biliary pancreatitis, Endoscopic retrograde cholangiopancreatography, choledocholithiasis

Anahtar Kelimeler

• Acute biliary pancreatitis
• Endoscopic retrograde cholangiopancreatography
• choledocholithiasis
• Acute biliary pancreatitis, Endoscopic retrograde cholangiopancreatography, choledocholithiasis

Akut Pankreatitte ERCP’nin Mortalite ve Morbiditeye Etkisi

Öz

Amaç: Ülkemizde akut pankreatitin (AP) en önemli nedeni safra taşı ve safra çamurudur. Endoskopik retrograd kolan-jiyopankreatografi (ERCP) uzun yıllardır akut biliyer pankreatitin (ABP) tanı ve tedavisinde kullanılmaktadır. Akut biliyer pankreatitli hastanın tedavisi; güncel uluslararası kılavuzlar eşliğinde değerlendirilmelidir. Bu çalışmada akut biliyer pankreatit tanısı ile kliniğimize yatırılan ve tedavi amacıyla Endoskopik Retrograde Kolanjio pankreotografi (ERCP) yapılan hastaları literatür eşliğinde analiz etmeyi amaçladık.
Materyal ve metod: Nisan 2020-Mart 2021 tarihleri arasında akut biliyer pankreatit tanısıyla Genel Cerrahi Endos-kopi Ünitemizde ERCP yapılan hastaların kayıtları retrospektif olarak incelendi.
Bulgular: kut biliyer pankreatit tanısı alan 131 hastaya ERCP yapıldı. Hastaların 60’ı (%45,8) erkek, 71’i(%54,2) kadındı. Hastaların 121’i (%92,36) koledok taşı, 9’u(%6,87) periampuller/koledok distal uç tümörü, 1’i(%0,76) kist hadatik ameliyatı sonrası safra yollarına kist rüptürüne bağlı Akut Pankreatit nedeniyle ERCP’ ye alınmışlardı. 30 hastaya ERCP, endoskopik sfinkterotomi (ES) ve koledoğa plastik stent yerleştirilmesi işlemi yapılırken 99 hastaya ERCP, ES ve kole-doktan taş ekstraksiyonu işlemi yapıldı. Operatif mortalite olmadı.
Sonuç: Akut pankreatit; hafif ödematöz pankreatitten, %20 mortaliteye sahip şiddetli nekrotizan pankreatite kadar uzanan, oldukça heterojen dağılıma sahip bir hastalıktır; tanı ve tedavisinde halen birçok tartışmalı konu mevcuttur. Ancak biliyer pankreatitte minimal invaziv bir işlem olan Endoskopik retrogratkolanjiopankreatografi tanı-teşhis ve tedavi sağlaması bakımından ilk planda tutulmalıdır.

Anahtar Kelimeler

• Acute biliary pancreatitis
• Endoscopic retrograde cholangiopancreatography
• choledocholithiasis

Kaynakça

1. 1. Acosta JM, Ledesma CL. Gallstone migration as a cause of acute pancreatitis. N Engl J Med 1974;290:484–487
2. 2. Digestive Diseases and Sciences https://doi.org/10.1007/s10620-021-06905-7 EDITORIAL Overcoming Ductal Block: Emergency ERCP and Sphincterotomy Plus Common Bile Duct Stenting Improves Therapeutic Outcomes in Severe Gallstone Pancreatitis David Q. H. Wang1 · Piero Portincasa2 · Min Liu3 · Patrick Tso3
3. 3. Gülten M. Endoscopic Retrograde Cholangiopancreatography in Acute Pancreatitis Turkiye Klinikleri J Gastroenterohepatol-Special Topics. 2014;7(3):104-8
4. 4. Dönmez E, Sekizli M, Açıkgöz S.B, Sekizli H. Relationship between serum endocan levels and clinical follow-up in patients with acute pancreatitis: Can serum endocan be a biomarker for acute pancreatitis? The Turkish Journal of Academic Gastroenterology 2019;18:27-32.
5. 5. Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;14:27
6. 6. Van Geenen EJ, van der Peet DL, Bhagirath P, Mul¬der CJ, Bruno MJ. Etiology and diagnosis of acute biliary pancreatitis. Nat Rev Gastroenterol Hepatol 2010; 7: 495-502.
7. 7. Van Erpecum KJ. Complications of bile duct stones: acute cholangitis and pancreatitis. Best Practice&Research Clinical Gastroenterology 2006; 20: 1139-52
8. 8. Cotton, P.B. ERCP: risks, prevention, and management. In: Advanced Digestive Endoscopy Series: ERCP Section. Cotton, P.B.; Ed Charleston, S.C., USA: The Digestive Disease Center at the Medical University of South Carolina (MUSC). Edited by: Peter, B. Cotton and Joseph, W.C. Leung. Blackwell Pub, 2005; 13: 339 –404

9. 9. Schmalz, M.J. ve Geenen, J.E. Therapeutic pancreatic endoscopy. Endoscopy 1999; 31(1): 88 – 94
10. 10. Tandoğa G, Coşkun BN, Eroğlu A. et al. Retrospective analysis of the treatment approach in patients with acute pancreatitis, Şişli Etfal Hospital Medical Bulletin 2012;46(1);9-15
11. 11. Hookey LC, Debroux S, Delhaye M, et al. Endoscopic drainage of pancreatic fluid collections in 116 patients: a comparison of etiologies, drainage techniques and outcomes. Gastrointest Endosc 2006; 63: 635-43.
12. 12. İNCE A.T. Current Approach in the Treatment of Acute Pancreatitis Turkey Clinics J Gastroenterohepatol-Special Topics. 2013;6(2):1-6
13. 13. Korkmaz M, Ünal H, Selçuk H, Yılmaz U. When should ERCP be performed in acute pancreatitis with biliary etiology? Journal of Endoscopy August 2009.17(2);95-98 14. 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.
14. 15. Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Data- base Syst Rev. 2012;(5)
15. 16. BİNİCİER Ö.B.PATIR D.Ç. Acute Pancreatitis Treatment. Turkey Clinics J Intern Med. 2021;6(1):22-38
16. 17. Sagi SV, Schmidt S, Fogel E, Lehman GA, McHenry L, Sherman S, et al. Association of greater intravenous volume infusion with shorter hospitalization for patients with post-ERCP pancreatitis. J Gastroenterol Hepatol. 2014;29(6): 1316-20
17. 18. Acosta JM, Rubio Galli OM, Rossi R, et al. Effect of duration of ampullary gall Stone obstruction on severity of lesions of acute pancreatitis. J AmCollSurg 1997;184:499-505. 19. Petrov MS. Early use of ERCP in acute biliary pancreatitis with (out) jaundice. An unjaundiced view. JOP. J Pancreas (Online) 2009;10:1-7.
18. 20. Pfau PR, Banerjee S, Barth BA, Desilets DJ, Kaul V, Kethu SR, et al. Sphincter of Oddi manometry. Gastrointest Endosc 2011; 74: 1175-80.
19. 21. Uğurlu ET.Tercan M. Our Experiences in Monocentric Endoscopic Retrograde Cholangiopancreatography. Vol 18, Issue 2, 233 - 239, 27.08.2021)
20. 22. Wada K, Takada T, Kawarada Y, et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007;14:52-8.
21. 23. Sherman S, Gottlieb K, Lehman GA. Therapeutic biliary endoscopy. Endoscopy. 1994;26:93-112.
22. 24. Oría A, Cimmino D, Ocampo C, et al. Early endoscopic intervention versus early conservative management in patients with acute gallstone pancreatitis and biliopancreatic obstruction: a randomized clinical trial. Ann Surg 2007; 245: 10-7.
23. 25. Forsmark CE, Baillie J; AGA Institute Clinical Practice and Economics Committee; AGA Institute Governing Board. AGA Institute technical review on acute pancreatitis. Gastroenterology 2007; 132: 2022-44
24. 26. Nowak A, Nowakowska-Dulawa E, Marek T et al. Final results of the prospective randomized controlled study on endoscopic sphincterotomy versus conventional management