Risk factors of pancreatitis after endoscopic sphincterotomy. Review of literature and practical remarks based on approximately 10,000 ERCPs
Journal Title: Polish Journal of Surgery - Year 2017, Vol 89, Issue 5
Abstract
Post-endoscopic pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Depending on the presence of risk factors, PEP can occur in 4,1% to about 43% of patients. According to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines, only three to patient-associated risk factors have been identified: suspected sphincter of Oddi dysfunction (SOD) (OR 4.09), female gender (OR 2.23), and previous pancreatitis (OR 2.46). Another three procedure-associated factors include cannulation attempt duration > 10 minutes (OR 1.76), more than one pancreatic guidewire passage (OR 2.77, CI: 1.79 – 4.30), and pancreatic injection (OR 2.2, CI: 1.60 – 3.01). Importantly, analyses of cumulative risk due to coexistence of several factors emphasize the importance of female sex, difficult cannulation, CBD diameter <5 mm, young age, and many other factors. Unfortunately, studies performed to date have included only small numbers of patients with several co-existing risk factors. Therefore, further analysis of other risk factors and the cumulative risk related to their co-occurrence is necessary. Based on current evidence, special care must be given to patients with several risk factors. Also, care should be given to proper qualification of patients, use of guidewires, early pre-cut incision, protective Wirsung’s duct stenting, and rectal NSAID administration.<br/><br/>
Authors and Affiliations
Andrzej Jamry
Keywords
Related Articles
- EP ID EP230056
- DOI 10.5604/01.3001.0010.5409
- Views 86
- Downloads 0
Results of Laparoscopic Appendectomies Performed with the Use of Titanium Clips for Closure of the Appendicular Stump
Nowadays laparoscopy is used frequently not only in elective surgery but also in abdominal emergencies, including acute appendicitis. There are several techniques used to close the appendicular stump during laparoscopic...
Severe vascular complications of acute pancreatiti
Acute pancreatitis (AP) develops as a result of the imbalance of the mechanisms inhibiting the activity of enzymes in the pancreatic cells, which causes their autoactivation in the pancreas. The incidence of AP ranges fr...
The influence of rifaximin on diverticulitis rate and quality of life in patients with diverticulosis
Diverticulosis, its associated symptoms and complications are one of the most common pathologies of the gastrointestinal tract in more economically developed countries. Presence of diverticuli and their clinical conseque...
Zespół Boerhaavego – ponad 290 lat doświadczeń chirurgów Czy możliwy jest nawrót tego schorzenia?
Samoistna perforacja przełyku (zespół Boerhaavego) jest schorzeniem rzadkim, stanowiącym poważne wyzwanie chirurgiczne. Analiza piśmiennictwa wykazała przypadki nawrotu samoistnej perforacji przełyku, a incydentalny char...
Melanoma of Unknown Primary as a Cause of Intestinal Obstruction - a Case Description