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Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail

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World Journal of Gastroenterology 2018年第22期24卷 2392-2399页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Yuichi Waragai Mika Takasumi Takuto Hikichi Hiromasa Ohira Department of Gastroenterology School of Medicine Fukushima Medical University Department of Endoscopy Fukushima Medical University Hospital

AIM To investigate the location to which a pancreatic stent should be inserted to prevent post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP).METHODS Over a ten-year period at our hospital, 296 patients underwent their first ERCP procedure and had a pancreatic stent inserted; this study included 147 patients who had ERCP performed primarily for biliary investigation and had a pancreatic stent inserted to prevent PEP. We dividedthese patients into two groups: 131 patients with a stent inserted into the pancreatic head(head group) and 16 patients with a stent inserted up to the pancreatic body or tail(body/tail group). Patient characteristics and ERCP factors were compared between the *** Pancreatic amylase isoenzyme(p-AMY) levels in the head group were significantly higher than those in the body/tail group [138.5(7.0-2086) vs 78.5(5.0-1266.5), P = 0.03] [median(range)]. No cases of PEP were detected in the body/tail group [head group, 12(9.2%)]. Of the risk factors for post-ERCP hyperamylasemia(≥ p-AMY median, 131 IU/L), procedure time ≥ 60 min [odds ratio(OR) 2.65, 95%CI: 1.17-6.02, P = 0.02) and stent insertion into the pancreatic head(OR 3.80, 95%CI: 1.12-12.9, P = 0.03) were identified as independent risk factors by multivariate *** Stent insertion up to the pancreatic body or tail reduces the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.

关键词： Pancreatic stent endoscopic retrograde cholangiopancreatography post-endoscopic retrograde cholangiopancreatography pancreatitis post-endoscopic retrograde cholangiopancreatography hyperamylasemia Pancreatic body or tail

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Prophecy about post-endoscopic retrograde cholangiopancreatography pancreatitis:From divination to science

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World Journal of Gastroenterology 2013年第5期19卷 631-637页

作者： Sung-Hoon Moon Myung-Hwan Kim Department of Internal Medicine Hallym University Sacred Heart HospitalHallym University College of MedicineAnyang 431-070South Korea Department of Internal Medicine University of Ulsan College of MedicineAsan Medical CenterSeoul 138-736South Korea

One unresolved issue of endoscopic retrograde cholangiopancreatography(ERCP)is post-ERCP pancreatitis (PEP),which occurs in up to 40%of *** of risk factors for PEP is especially important in the field of ERCP practice because it may assist physicians in taking protective measures in situations with high risk.A decade ago,Freeman et al meticulously evaluated a large number of potentially relevant risk factors for PEP,which can be divided into patient-relat-ed and procedure-related *** this commentary, we summarize this classic article and reevaluate the risk factors for PEP from the current point of *** is followed by assessment of strategies for prevention of PEP that can be divided into mechanical and pharmacologic methods.

关键词： endoscopic retrograde cholangiopancrea-tography post-endoscopic retrograde cholangiopancreatography pancreatitis Risk factor Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis Pancreatic stents Nonsteroidal antiinflammatory drugs

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Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by pancreatic duct stenting using a loop-tipped guidewire

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World Journal of Clinical Cases 2016年第8期4卷 213-218页

作者： Yuji Sakai Toshio Tsuyuguchi Harutoshi Sugiyama Masahiro Hayashi Jun-ichi Senoo Reina Sasaki Yuko Kusakabe Masato Nakamura Shin Yasui Rintaro Mikata Masaru Miyazaki Osamu Yokosuka Department of Gastroenterology and Nephrology Graduate School of Medicine Chiba University Department of General Surgery Graduate School of Medicine Chiba University

AIM: To examine whether it is possible to prevent the occurrence of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis in patients experiencing difficulties with selective biliary duct cannulation by pancreatic duct stenting using a looptipped ***: Procedure success rate, frequency of unintended insertion of the guidewire into side branches of the pancreatic duct, and incidence of procedural accidents were examined using a loop-tipped guidewire(Group A, 20 patients), and a conventional straighttype guidewire(Group B, 20 patients).RESULTS: The success rate of the procedure was 100% in both groups. Unintended insertion of the guidewire into a side branch of the pancreatic duct occurred 0.056 ± 0.23(0-1) times in Group A and 2.3 ±1.84(0-5) times in Group B; thus, unintended insertion of the guidewire into a side branch of the pancreatic duct was seen significantly less frequently in Group A. There were no procedural accidents in Group A, whereas pancreatitis occurred in one Group B patient; however, the difference between the two groups was not statistically significant. The serum amylase level after ERCP was 257.15 ± 136.4(88-628) IU/L in Group A, and 552.05 ± 534.57(101-2389) IU/L in Group B, showing a significantly lower value in Group A. Hyperamylasemia was found in two patients(10%) in Group A, and nine(45%) in Group B, showing a significantly lower value in Group ***: The results suggest that in patients who experience difficulties with biliary cannulation, the use of a loop-tipped guidewire for pancreatic duct stenting may assist with the prevention of post-ERCP pancreatitis, and thereby to a reduction of the risk of post-ERCP pancreatitis or hyperamylasemia.

关键词： Hyperamylasemia post-endoscopic retrograde cholangiopancreatography pancreatitis Guidewire

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Antioxidant therapy in acute,chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis:An updated systematic review and meta-analysis

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World Journal of Gastroenterology 2015年第30期21卷 9189-9208页

作者： Maziar Gooshe Amir Hossein Abdolghaffari Shekoufeh Nikfar Parvin Mahdaviani Mohammad Abdollahi Department of Toxicology and Pharmacology Faculty of Pharmacyand Pharmaceutical Sciences Research Centerand Endocrinology and Metabolism Research CenterEndocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical Sciences Pharmacology and Applied Medicine Department of Medicinal Plants Research CenterInstitute of Medicinal PlantsACECRKaraj 31375369Iran International Campus ICTUMSTehran University of Medical Sciences Department of Pharmacoeconomics and Pharmaceutical Administration Faculty of PharmacyTehran University of Medical Sciences Department of Pharmaceutics Faculty of PharmacyTehran University of Medical Sciences

AIM:To investigate the efficacy and adverse effects of antioxidant therapy in acute pancreatitis(AP),chronic pancreatitis(CP) and post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP).METHODS:Pub Med,Scopus,Google Scholar,Cochrane library database,and Evidence-based medicine/clinical trials published before August 2014 were searched. Clinical and laboratory outcomes of randomized trials of antioxidant therapy in patients with AP,CP and PEP were included. The methodological quality of the trials was assessed by the Jadad score based on the description of randomization,blinding,and dropouts(withdrawals). The results of the studies were pooled and meta-analyzed to provide estimates of the efficacy of antioxidant ***:Thirty four trials out of 1069 potentially relevant studies with data for 4898 patients wereeligible for inclusion. Antioxidant therapy significantly reduced the length of hospital stay in AP patients {mean difference-2.59 d(95%CI:-4.25-(-0.93)],P = 0.002}. Although,antioxidant therapy had no significant effect on serum C reactive protein(CRP) after 5-7 d in AP patients [mean difference-9.57(95%CI:-40.61-21.48,P = 0.55],it significantly reduced serum CRP after 10 d {mean difference-45.16 [95%CI:-89.99-(-0.33)],P = 0.048}. In addition,antioxidant therapy had no significant effect on CP-induced pain [mean difference-2.13(95%CI:-5.87-1.6),P = 0.26]. Antioxidant therapy had no significant effects on the incidence of all types of PEP [mean difference 1.05(95%CI:0.74-1.5),P = 0.78],severe PEP [mean difference 0.92(95%CI:0.43-1.97),P = 0.83],moderate PEP [mean difference 0.82(95%CI:0.54-1.23),P = 0.33],and mild PEP [mean difference 1.33(95%CI:0.99-1.78),P = 0.06]. Furthermore,while antioxidant therapy had no significant effect on serum amylase after less than 8 h sampling [mean difference-20.61(95%CI:-143.61-102.39),P = 0.74],it significantly reduced serum amylase close to 24-h sampling {mean difference-16.13 [95%CI:-22.98-(-9.28)],P <

关键词： Acute pancreatitis Chronic pancreatitis post-endoscopic retrograde cholangiopancreatographypancreatitis Antioxidants Meta-analysis

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Updated meta-analysis of pancreatic stent placement in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

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World Journal of Gastroenterology 2015年第24期21卷 7577-7583页

作者： Jin-He Fan Jun-Bo Qian Ya-Min Wang Rui-Hua Shi Cheng-Jin Zhao Department of Gastroenterology Nantong First People’s Hospital Department of Gastroenterology People’s Hospital of Jiangsu Province

AIM: To investigate the efficacy and safety profile ofpancreatic duct(PD) stent placement for prevention of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP). METHODS: We performed a search of MEDLINE, EMBASE, and Cochrane Library to identify randomized controlled clinical trials of prophylactic PD stent placement after ERCP. Rev Man 5 software provided by Cochrane was used for the heterogeneity and efficacy analyses, and a meta-analysis was performed for the data that showed homogeneity. Categorical data are presented as relative risks and 95% confidence intervals(CIs), and measurement data are presented as weighted mean differences and 95%CIs. RESULTS: The incidence rates of severe pancreatitis, operation failure, complications and patient pain severity were analyzed. Data on pancreatitis incidence were reported in 14 of 15 trials. There was no significant heterogeneity between the trials(I2 = 0%, P = 0.93). In the stent group, 49 of the 1233 patients suffered from PEP, compared to 133 of the 1277 patients in the no-stent group. The results of this meta-analysis indicate that it may be possible to prevent PEP by placing a PD stent. CONCLUSION: PD stent placement can reduce postoperative hyperamylasemia and might be an effective and safe option to prevent PEP if the operation indications are well controlled.

关键词： Pancreatic stent placement Pancreatitis endoscopic retrograde cholangiopancreatography post-endoscopic retrograde cholangiopancreatographypancreatitis

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Risk factors for the development of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones

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World Journal of Gastrointestinal Endoscopy 2019年第10期11卷 515-522页

作者： Hirokazu Saito Tatsuyuki Kakuma Ikuo Matsushita Department of Gastroenterology Kumamoto Chuo Hospital1-5-1TainoshimaMinami-kuKumamoto CityKumamoto 862-0965Japan Department of Biostatics Center Medical SchoolKurume University67AsahimachiKurume CityFukuoka 830-0011Japan

BACKGROUND Previous studies have revealed that patients with asymptomatic common bile duct(CBD)stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).However,no studies to date have addressed the risk factors for PEP in patients with asymptomatic CBD *** To examine the risk factors for PEP in patients with asymptomatic CBD *** Using medical records of three institutions in Japan for 6 years,we identified a total of 1135 patients with choledocholithiasis including 967 symptomatic patients and 168 asymptomatic patients with native papilla who underwent therapeutic *** performed univariate and multivariate analyses to examine the risk factors for PEP in the 168 patients with asymptomatic CBD *** The overall incidence rate of PEP in all the patients with during study period was 4.7%(53/1135).Of the 168 patients with asymptomatic CBD stones,24(14.3%)developed *** univariate analysis,precut sphincterotomy(P=0.009)and biliary balloon sphincter dilation(P=0.043)were significant risk factors for *** multivariate analysis,precut sphincterotomy(P=0.002,95%CI:2.2-27.8,odds ratio=7.7),biliary balloon sphincter dilation(P=0.015,95%CI:1.4-17.3,odds ratio=4.9),and trainee endoscopists(P=0.048,95%CI:1.01-8.1,odds ratio=2.9)were significant risk factors for *** ERCP for asymptomatic CBD stones should be performed by experienced *** performing precut sphincterotomy or biliary balloon sphincter dilation in patients with asymptomatic CBD stones,the placement of a prophylactic pancreatic stent is strongly recommended to prevent PEP.

关键词： endoscopic retrograde cholangiopancreatography post-endoscopic retrograde cholangiopancreatography pancreatitis Risk factor Asymptomatic common bile duct stone

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Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis

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World Journal of Gastrointestinal Endoscopy 2016年第20期8卷 777-784页

作者： Shiro Hayashi Tsutomu Nishida Hiromi Shimakoshi Akiyoshi Shimoda Takahiro Amano Aya Sugimoto Kei Takahashi Kaori Mukai Tokuhiro Matsubara Masashi Yamamoto Sachiko Nakajima Koji Fukui Masami Inada Department of Gastroenterology and Hepatology Toyonaka Municipal Hospital

AIM To estimate the efficacy of 2 h post-endoscopic retrograde cholangiopancreatography(ERCP) serum amylase levels and other factors for predicting postERCP *** This was a retrospective,single-center cohort study of consecutive patients who underwent ERCP from January 2010 to December *** amylase levels were measured 2 h post-procedure,and patient- and procedure-related pancreatitis(PEP) risk factors wereanalyzed using a logistic *** A total of 1520 cases(average age 72 ± 12 years,60% male) were initially enrolled in this study,and 1403 cases(725 patients) were ultimately analyzed after the exclusion of 117 ***-five of these cases developed *** established a 2 h serum amylase cutoff level of two times the upper limit of normal for predicting *** analysis revealed that a cannulation time of more than 13 min [odds ratio(OR) 2.28,95%CI:1.132-4.651,P=0.0210] and 2 h amylase levels greater than the cutoff level(OR=24.1,95%CI:11.56-57.13,Ppost-ERCP serum amylase levels and cannulation times represents a valuable marker for identifying patients at high risk for PEP.

关键词： Serum amylase levels Cannulation time post-endoscopic retrograde cholangiopancreatography pancreatitis Predictor

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Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis using pancreatic stents: A review of efficacy, diameter and length

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World Journal of Meta-Analysis 2019年第6期7卷 259-268页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of Medicine Fukushima 9601247Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 9601295Japan

Although endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the diagnosis and treatment of pancreaticobiliary diseases, post-ERCP pancreatitis (PEP) is the most frequent adverse event that can sometimes be fatal. However, prophylactic pancreatic stent (PS) insertion has been performed to prevent PEP in high-risk patients. In some randomized controlled trials (RCTs) and meta-analyses, the efficacy of prophylactic PS insertion has been shown to prevent PEP. In addition, several types of stents have been used to decrease PEP. In this review, we introduce the details of these RCTs and meta-analyses and reveal the specifications for stent placement, for example, the stent diameter and length and the pancreatic region into which the stent should be inserted.

关键词： endoscopic retrograde cholangiopancreatography post-endoscopic retrograde cholangiopancreatography pancreatitis Prophylactic pancreatic stent

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Usefulness of serum lipase for early diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis

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World Journal of Gastrointestinal Endoscopy 2019年第9期11卷 477-485页

作者： Masayoshi Tadehara Kosuke Okuwaki Hiroshi Imaizumi Mitsuhiro Kida Tomohisa Iwai Hiroshi Yamauchi Toru Kaneko Rikiya Hasegawa Eiji Miyata Yusuke Kawaguchi Hironori Masutani Wasaburo Koizumi Department of Gastroenterology Kitasato University School of Medicine

BACKGROUND post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)is new onset acute pancreatitis after *** complication is sometimes *** such,PEP should be diagnosed early so that therapeutic interventions can be carried *** lipase(s-Lip)is useful for diagnosing acute ***,its usefulness for diagnosing PEP has not been sufficiently *** This study aimed to retrospectively examine the usefulness of s-Lip for the early diagnosis of *** We retrospectively examined 4192 patients who underwent ERCP at our two hospitals over the last 5 *** primary outcomes were a comparison of the areas under the receiver operating characteristic(ROC)curves(AUCs)of s-Lip and serum amylase(s-Amy),s-Lip and s-Amy cutoff values based on the presence or absence of PEP in the early stage after ERCP via ROC curves,and the diagnostic properties[sensitivities,specificities,positive predictive values(PPV),and negative predictive value(NPV)]of these cutoff values for PEP *** Based on the eligibility and exclusion criteria,804 cases were *** the entire course,PEP occurred in 78 patients(9.7%).It occurred in the early stage after ERCP in 40 patients(51.3%)and in the late stage after ERCP in 38 patients(48.7%).The AUCs were 0.908 for s-Lip[95%confidence interval(CI):0.880-0.940,P<0.001]and 0.880 for s-Amy(95%CI:0.846-0.915,P<0.001),indicating both are useful for early *** comparing the AUCs,s-Lip was found to be significantly more useful for the early diagnosis of PEP than s-Amy(P=0.023).The optimal cutoff values calculated from the ROC curves were 342 U/L for s-Lip(sensitivity,0.859;specificity,0.867;PPV,0.405;NPV,0.981)and 171 U/L for s-Amy(sensitivity,0.859;specificity,0.763;PPV,0.277;NPV,0.979).CONCLUSION S-Lip was significantly more useful for the early diagnosis of *** s-Lip after ERCP could help diagnose PEP earlier;hence,therapeutic interventions can be provided earlier.

关键词： endoscopic retrograde cholangiopancreatography post-endoscopic retrograde cholangiopancreatography pancreatitis Pancreatitis Lipase Amylase

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Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation

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World Journal of Gastroenterology 2013年第1期19卷 108-114页

作者： Young Wook Yoo Sang-Woo Cha Woong Cheul Lee Sae Hee Kim Anna Kim Young Deok Cho Department of Internal Medicine Gastroenterology and Hepatobiliary CenterCheongju St.Mary's HospitalCheongju 360-568South Korea Department of Internal Medicine Soonchunhyang University College of MedicineInstitute for Digestive ResearchDigestive Disease CenterSoonchunhyang University HospitalSeoul 140-743South Korea Division of Gastroenterology Department of Internal MedicineEulji University College of MedicineEulji University HospitalDaejeon 302-799South Korea

AIM:To compare the outcomes between doubleguidewire technique(DGT) and transpancreatic precut sphincterotomy(TPS) in patients with difficult biliary ***:This was a prospective,randomized study conducted in single tertiary referral hospital in *** January 2005 and September 2010.A total of 71 patients,who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved,were randomized into DGT(n = 34) and TPS(n = 37) *** or TPS was done for selective biliary *** measured the technical success rates of biliary cannulation,median cannulation time,and procedure related ***:The distribution of patients after randomization was balanced,and both groups were comparable in baseline characteristics,except the higher percentage of endoscopic nasobiliary drainage in the DGT group(55.9% vs 13.5%,P post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis was 38.2% vs 10.8%,P post-procedure pancreatitis was significantly higher in the DGT *** the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups;DGT group vs TPS group:14.7% vs 16.2%,P post-procedure pancreatitis was significantly higher in the DGT group.

关键词： endoscopic retrograde cholangiopancreatography post-endoscopic retrograde cholangiopancreatography pancreatitis Duoble guidewire technique Transpancrestic precut sphincterotomy

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