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

Abstract


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.


Keywords


endobiliary transpapillary operations; acute post-ERCP pancreatitis

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DOI: https://doi.org/10.22141/1997-2938.3.22.2013.87376

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