Background: Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic modality to a primarily therapeutic procedure for pancreatic as well as biliary disorders. However, several complications were described post-procedure such as pancreatitis, perforation, cholangitis, post-sphincterotomy bleeding, etc. Data concerning variation in laboratory values before and after ERCP and its clinical significance with respect to endoscopic findings and possible complications is lacking in the literature. Aim: To analyze the clinical significance of laboratory values in patients before and after ERCP. Methods: From a total of 723 patients, 363 with different sets of findings on ERCP were eligible to be included in the study and were divided into 8 different groups. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), Gamma-glutamyl transferase (GGT), Alkaline phosphatase (ALKP), bilirubin, amylase, lipase, c-reactive protein (CRP), white blood count (WBC), neutrophil, lymphocyte, monocyte, eosinophils, basophils, platelets counts and creatinine were determined preoperatively as well as postoperatively in these patients. Results: AST and direct bilirubin showed a significant difference in all patients between pre and post-ERCP (p-value<0.01 and p-value<0.05, respectively). Liver tests were significantly higher in the malignant obstruction group than in the bile duct stones group (P <0.05) and decrease more significantly (P <0.05) after the procedure. A significant increase in lipase (p-value<0.05) among all groups was found, and interestingly, the lymphocytic count showed a significant decrease (p-value<0.01). Conclusion: In conclusion, (1) ERCP significantly decreases AST, direct bilirubin, lymphocytes, and monocytes count post procedure among all stratified groups of obstructive etiology thus proving its therapeutic value for biliary system obstructions. (2) Higher baseline disturbances in laboratory values at T0, especially in liver function tests such as ALT, AST, GGT, and ALKP as well as a bigger decrease in lymphocyte count at T1 are noted to be linked with malignant obstructions (tumor group), rather than benign obstructions (stone, sludge, stone+ sludge, and stricture). (3) Finally, stone and stricture groups are at the highest risk of post-ERCP pancreatitis owing to those groups having the highest pancreatic enzyme levels post ERCP, and thus should be the best candidates for a pre-ERCP pharmacologic prophylaxis (such as diclofenac, etc) and post ERCP close monitoring.
Selective internal radiation therapy (SIRT) is an emerging therapeutic modality in patients with unresectable hepatocellular carcinoma or liver metastases. However, complications can occur due to migration of radiation microspheres such as gastrointestinal ulcer, cholecystitis, bleeding, pancreatitis, and many others. A 50-year-old woman with stage IV breast cancer who underwent radioembolization for unresectable hepatic metastasis 6 months ago presented to our hospital with 1 month history of nausea, vomiting, with food intolerance, and weight loss. Esophagogastroduodenoscopy showed large deep duodenal bulbar ulcer along with antral ulcerations and edematous gastropathy. Biopsies revealed typical black, duodenal yttrium-90 sphere, documenting radiation injury. After she was discharged on proton pump inhibitor, the patient came back 1 month later for exacerbation of symptoms; computed tomography scan of the abdomen showed gastric outlet obstruction. Although there is no consensus in treating radiation-induced ulcers, physicians should be aware of this complication in patient who underwent SIRT presenting for abdominal pain.
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