Risk Factors for Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography: A Meta-Analysis

Masci, E.; Mariani, Alberto; Curioni, Simona; Testoni, Pier Alberto

doi:10.1055/s-2003-42614

Cited by 350 publications

(89 citation statements)

References 14 publications

(22 reference statements)

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“…Technique-related factors have also been reported, including repeated and traumatic papillary cannulation, pancreatic sphincterotomy, biliary dilation without prior sphincterotomy, biliary sphincterotomy and precut (6,8). Protective factors include advanced age, malignant stricture and chronic pancreatitis (5).…”

Section: Endoscopic Retrograde Cholangiopancreatography (Ercp) Is a Dmentioning

confidence: 99%

Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

2018

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Objective: rectal diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that is used to prevent pancreatitis in high-risk patients during endoscopic retrograde cholangiopancreatography (ERCP). The European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of prophylaxis with indomethacin or diclofenac in all patients undergoing ERCP, including those at low or intermediate risk of pancreatitis. A study to investigate the efficacy of this recommendation was performed.Methods: this was a mixed cohort study. A total of 1,512 ERCP procedures performed in our institution from January 2009 to July 2016 were included in the study. Until June 2012, 718 patients did not receive diclofenac. Subsequently, 794 patients without contraindications received 100 mg of rectal diclofenac at the onset of the procedure.Risk factors for post-ERCP pancreatitis (PEAP) and PEAP cases defined using consensus criteria were recorded.Results: a total of 47 PEAP events (3.1%) were reported, 3.4% in the diclofenac group and 2.8% in the non-diclofenac group (p = 0.554); 26.1% of patients had risk factors for PEAP. In the diclofenac group, PEAP developed in 4.4%, 0.5% and 2.6% of subjects with intact papillae, prior sphincterotomy and extended sphincterotomy, respectively. The results were similar for the non-diclofenac group: 4% with intact papillae, 0.9% with prior sphincterotomy, and 2.5% with extended sphincterotomy, respectively. PEAP severity was similar in both groups.Conclusions: rectal diclofenac before ERCP did not prevent the development of post-ERCP acute pancreatitis in non-selected consecutive patients.

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Section: Endoscopic Retrograde Cholangiopancreatography (Ercp) Is a Dmentioning

confidence: 99%

Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

2018

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“…Results are mean ± SEM (n = 6 for each treatment) and are expressed as percentage over basal (set at 100%). Results of statistical analysis are shown as * P \ 0.05 and ** P \ 0.01 with respect to control group and # P \ 0.05 with respect to saline group during ERCP [45]. In this sense, it has been recently demonstrated that a technique that facilitates cannulation of the common bile duct prevents development of post-ERCP-AP [47].…”

Section: Discussionmentioning

confidence: 95%

“…Although the exact cause of pancreatic damage after ERCP is unknown, many studies have demonstrated that AP is a major and potentially serious complication of ERCP occurring in 1-10% of patients [42][43][44]. It has been described that pancreatic duct manipulation during ERCP could lead to injury and pancreatic juice flow obstruction [45]. Moreover, hydrostatic injury, which may occur as a result of contrast overinjection, could be a cause of pancreatitis after diagnostic ERCP [46].…”

Section: Discussionmentioning

confidence: 99%

Saline Infusion Through the Pancreatic Duct Leads to Changes in Calcium Homeostasis Similar to Those Observed in Acute Pancreatitis

et al. 2008

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This work focuses on studying the early events associated with pancreatic damage after retrograde infusion through the pancreatic duct in rats. We have analyzed changes in calcium homeostasis and secretory response in pancreatic acini from rats with taurocholate-induced acute pancreatitis. Moreover, in order to test whether pancreatic duct manipulation can trigger damage inside pancreatic acinar cells, we have studied both parameters in acini from animals infused with saline. Our study demonstrates that taurocholate causes evident damage to acinar cells, impairing both calcium homeostasis and secretory response to CCK. In saline, a significant decrease in calcium cytosolic response to CCK was observed. Calcium disturbances similar to those observed in acute pancreatitis appear before secretion blockade and inflammation processes in saline treated rats. These results could be interesting since pancreatitis is associated to clinical procedures that require duct manipulation such as endoscopic retrograde cholangiopancreatography.

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“…Several retrospective studies and prospective randomized trail have failed to demonstrate the benefit of PBD on postoperative outcomes after pancreaticoduodenectomy in jaundiced patients with pancreatic head cancer [3][4][5][6][13][14][15][16][17][18][19][20]. However some meta-analysis and reviews have shown that this strategy was associated with higher rate of postoperative complications [12,13,[19][20][21][22][23].…”

Section: Discusionmentioning

confidence: 99%

Preoperative Biliary Drainage of Jaundiced Patients with Pancreatic Head Cancer: A Routine or Selective Strategy

F¹,

Toutouzas²,

Mubaminyi³

et al. 2017

Pancreat Disord Ther

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to explore the biliary tree and to decrease jaundice preoperatively. Numerous randomized controlled trials have addressed the issue of preoperative biliary drainage and its impact on perioperative and postoperative results [3,4]. However, reports on outcomes of pancreatoduodenectomy following PBD have been conflicting. Some studies have underlined increased pre-operative, intra-operative and postoperative complications related to PBD such as bleeding, pancreatitis, duodenal perforation, cholangitis, cholecystitis, cardiopulmonary events and miscellaneous [5][6][7][8][9][10][11][12]. In contrast, others have noted no adverse effect on perioperative and postoperative outcomes and on the other hand, some authors have even noticed amelioration of postoperative outcomes with this strategy's application [3].Based on these considerations, the role of preoperative biliary drainage remains a matter of controversies. To assess its effects on postoperative outcomes, we performed this retrospective study. Material and MethodsThis is a retrospective study, comparing preoperative biliary drainage with surgery alone in 200 jaundiced patients with pancreatic Keywords: Obstructive jaundice; Pancreatic head cancer; Preoperative biliary drainage; Post-operative outcomes IntrodutionPancreatic cancer is an aggressive neoplastic disease, with overall 5-years survival rate from all stages of less than 5%, making it, the 4th cause of cancer related death in the United States of America. Despite the innovation of diagnostic and therapeutic modalities during the year 2013 it was estimated that approximately [45] 2200 people were diagnosed with pancreatic adenocarcinoma and 38,460 died from it. With the majority of patients presenting with unrespectable tumor, locally advanced or metastatic disease and around 80% of patients are jaundiced [1]. For those with respectable tumor without evidence of metastasis, pancreaticoduodenectomy is the only option for cure, whereas radiation therapy, chemotherapy, and other newer experimental therapeutic modalities such as anti-hormonal therapy or systemic use of anti-pancreatic cancer cell monoclonal antibodies have not led to substantial prognostic improvements.Obstructive jaundice is thought to increase the risk of perioperative and postoperative complications [2]. Experimental studies performed on mice assigned to biliary ligation to induce obstructive jaundice showed significant complications in these animals such as coagulopathy, Cholangitis, hepatic dysfunction, intestinal barrier derangement, immunity dysfunction, wound healing retardation, renal dysfunction, cardio-pulmonary insufficiencies as well as endotoxemia. Understanding well the pathophysiology of obstructive jaundice related complications in 1935 Sir A.O. Whipple first introduced the concept of preoperative biliary drainage in jaundiced patients with pancreatic head cancer in order to improve postoperative outcomes. Subsequently, Carter contributed with a percutaneous trans hepatic-cholangiography (PTC). In the late 1960s, McCune propo...

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Risk Factors for Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography: A Meta-Analysis

Cited by 350 publications

References 14 publications

Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

Saline Infusion Through the Pancreatic Duct Leads to Changes in Calcium Homeostasis Similar to Those Observed in Acute Pancreatitis

Preoperative Biliary Drainage of Jaundiced Patients with Pancreatic Head Cancer: A Routine or Selective Strategy

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