Complex Prevention of Acute Pancreatitis after X-ray Endoscopic Transpapillary Operations

B.O. Matviychuk, A.I. Kushniruk, I.Ya. Kletsko, V.M. Salo, I.Ya. Tumak


Aim of the study. Acute reactive pancreatitis (ARP) is the most common complication after diagnostic or therapeutic endoscopic retrograde cholangiopancreatography (ERCP). It is diagnosed in 3–13 % of patients after ERCP. The aim of this study was to analyze the efficiency of the complex approach of ARP prevention after ERCP in patients with biliary obstruction syndrome (BOS).
Material and Methods. Retrospective analysis of the complication rate after ERCP in patients with BOS was performed. The ARP frequency was analyzed after diagnostic and/or therapeutic ERCP in two groups of patients. In the first group (333 patients) ERCP was performed according to standard procedure protocol, and in the second (1565 patients) — with improved protocol by using a defined set of ARP prevention.
Results. The implementation of technical and pharmacological peculiarities of ERCP protocol promoted a significant reduction in the total number of ARP from 2.5 % in the 1st control group to 0.66 % in the 2nd (p = 0.002), as well as the frequency of severe pancreatitis and mortality due to ARP.
Conclusion. Polypositional fluoroscopy control of especially primer biliary guide-wire canulization for the prevention of unnecessary pancreatic duct contrast injection is one of the main prerequisites for prevention of ARP.


endobiliary transpapillary operations; acute post-ERCP pancreatitis


Инструментальная диагностика и малоинвазивное эндоскопическое лечение патологических изменений фатеральной зоны, прогноз и профилактика осложнений: автореферат диссертации на соискание ученой степени доктора медицинских наук: спец. 14.00.27 «Хирургия», 14.00.19 «Лучевая диагностика» / М.П. Манцеров. — Москва, 2008. — 45 с.

Манцеров М.П. Реактивный панкреатит после эндоскопических манипуляций на большом дуоденальном сосочке / М.П. Манцеров, Е.В. Мороз // Российский журнал гастроэнтерологии, гепатологии, колопроктологии. — 2007. — № 3. — С. 14-23.

Complications of endoscopic biliary sphincterotomy / M. Freeman, D. Nelson, S. Sherman [et al.] // N. Engl. J. Med. — 1996. — Vol. 335(13). — P. 909–918.

Complications of ERCP: a prospective study / M. Christensen, P. Matzen, S. Schulze [et al.] // Gastrointest Endosc. — 2004. — Vol. 60 (5). — P. 721-731.

Donnellan F. Prevention of Post-ERCP Pancreatitis / F. Donnellan, M. F. Byrne // Gastroenterology Research and Practice. — Vol. 2012. — Р. 1-12.

Endoscopic sphincterotomy complications and their management: an attempt at consensus / P.B. Cotton, G. Lehman , J. Vennes [et al.] // Gastrointest. Endosc. — 1991. — Vol. May — Jun 37(3). — P. 383-93.

Frequency and severity of post — ERCP pancreatitis correlated with extent of pancreatic ductal opacification / Y.K. Cheon , K.B. Cho, J.L. Watkins [et al.] // Gastrointest Endosc. — 2007. — Vol. 65(3). — P. 385-93.

Guideline: Prophylaxis of post-ERCP pancreatitis / J.-M. Dumonceau, A. Andriulli, J. Deviere [et al.] // Endoscopy. — 2010. — Vol. 42. — P. 503-515.

Mechanisms Involved in the Onset of Post-ERCP Pancreatitis / R. Pezzilli, E. Romboli, D. Campana [et al.] // JOP. J Pancreas. — 2002. — Vol. 3(6). — P. 162-168.

Post-ERCP pancreatitis: Randomized, prospective study comparing a low- and high-osmolality contrast agent / S. Sherman, R.H. Hawes, S.W. Rathgaber [et al.] // Gastrointestinal Endoscopy. — 1994. — Vol. 40, Is.4. — P. 422-427.

Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis / E. Masci, A. Mariani, S. Curioni [et al.] // Endoscopy. — 2003. — Vol. 35(10). — P. 830-834.

Risk factors for post-ERCP pancreatitis: a prospective, multicenter study / M.L. Freeman, J.A. DiSario, D.B. Nelson [et al.] // Gastrointestinal Endoscopy. — 2001. — Vol. 57. — P.425-434.

Role of osmolality of contrast media in the development of post-ERCP pancreatitis: a metanalysis / S. George, A.A. Kulkarni, G. Stevens [et al.] // Dig Dis Sci. — 2004. — Vol. 49. — P. 503-508.

Woods K.E. Endoscopic retrograde cholangiopancreato-graphy associated pancreatitis: A 15-year review / K.E. Woods, F.F. Willingham // World J. Gastrointest Endosc. — 2010. — Vol. 2(5). — Р. 165-178.


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