AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to ...AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to two groups:a study group(n=85)who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography(ERCP)and a control group(n=85)receiving an oral placebo at the same times.Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis.Serum amylase levels were classified as normal(<150 IU/L)or hyperamylasemia(>151 IU/L).Episodes of PEP were classified following Ranson's criteria and CT severity index.RESULTS:Gender distribution was similar between groups.Mean age was 53.5±18.9 years for study group and 52.8±19.8 years for controls.Also,the distribution of benign pathology was similar between groups.Hyperamylasemia was more common in the control group(P=0.003).Mild PEP developed in two patients from the study group(2.3%)and eight(9.4%) from control group(P=0.04),seven episodes were observed in high-risk patients of the control group(25%) and one in the allopurinol group(3.3%,P=0.02).Risk factors for PEP were precut sphincterotomy(P=0.02),pancreatic duct manipulation(P=0.002)and multiple procedures(P=0.000).There were no deaths or side effects.CONCLUSION:Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.展开更多
AIM: To clarify the relationship between the change of serum amylase level and post-ERCP pancreatitis. METHODS: Between January 1999 and December 2002, 1291 ERCP-related procedures were performed. Serum amylase concen...AIM: To clarify the relationship between the change of serum amylase level and post-ERCP pancreatitis. METHODS: Between January 1999 and December 2002, 1291 ERCP-related procedures were performed. Serum amylase concentrations were measured before the procedure and 3, 6, and 24 h afterward. The frequency and severity of post-ERCP pancreatitis and the relationship between these phenomena and the change in amylase level were estimated. RESULTS: Post-ERCP pancreatitis occurred in 47 patients (3.6%). Pancreatitis occurred in 1% of patients with normal amylase levels 3 h after ERCP, and in 1%, 5%, 20%, 31% and 39% of patients with amylase levels elevated 1-2 times, 2-3 times, 3-5 times, 5-10 times and over 10 times the upper normal limit at 3 h after ERCP, respectively (level < 2 times vs ≥ 2 times, P < 0.001). Of the 143 patients with levels higher than the normal limit at 3 h after ERCP followed by elevation at 6 h, pancreatitis occurred in 26%. In contrast, pancreatitis occurred in 9% of 45 patients with a level higher than two times the normal limit at 3 h after ERCP followed by a decrease at 6 h (26% vs 9%, P < 0.05). CONCLUSION: Post-ERCP pancreatitis is frequently associated with an increase in serum amylase level greater than twice the normal limit at 3 h after ERCP with an elevation at 6 h. A decrease in amylase level at 6 h after ERCP suggests the unlikelihood of development of post-ERCP pancreatitis.展开更多
Background and aims:Biopsy of the ampulla of Vatermay be performed to evaluate for ampullary adenomas,suspected ampullary tumors and immunohistological staining for autoimmune pancreatitis.Ampullary biopsies are commo...Background and aims:Biopsy of the ampulla of Vatermay be performed to evaluate for ampullary adenomas,suspected ampullary tumors and immunohistological staining for autoimmune pancreatitis.Ampullary biopsies are commonly performed at the time of endoscopic retrograde cholangiopancreatography(ERCP).Due to the well-established complication rate following ERCP,the contribution of ampullary biopsy as a potential independent risk factor would require a controlled comparison.Methods:A matched-pairs,case-control analysis was performed for patients undergoing ERCP with or without ampullary biopsy.The analysis involved a retrospective review of adult patients at a tertiary-care center who underwent ampullary biopsies during ERCP compared(via procedural complexity)with a matched control group who underwent ERCP without ampullary biopsies.Results:Of 159 procedures involving ampullary biopsy,54 ERCPs that met the inclusion criteria were performed with ampullary biopsy and included in the analysis cohort.This cohort was compared with 54 patients undergoing ERCP without ampullary biopsy,matched by American Society for Gastrointestinal Endoscopy(ASGE)grade of procedural complexity.There were no patients with sphincter of Oddi dysfunction.Ampullary biopsies suggested a diagnosis in 75.9% of the procedures including 12 adenomas,5 adenocarcinomas and 1 intraductal papillary mucinous neoplasm.Including major and minor complications,the overall complication rate with biopsy(9.3%)was equivalent to the complication rate in the control group without ampullary biopsy(9.3%,P>0.99).The incidence of post-procedure pancreatitis was not significantly different between the two groups(5.6% vs 3.7%,P=0.6).Age and pancreatic duct manipulation,but not ampullary biopsy,were associated with complications on multivariate analysis in the study population.Conclusions:Ampullary biopsy performed during ERCP had a high diagnostic yield and was not associated with an increased rate of post-procedure complications or pancreatitis when compared with ERCP alone.展开更多
基金Supported by Economic resources of the Department of Gastroenterology and Endoscopythe Research Unit in Clinical Epidemiology
文摘AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to two groups:a study group(n=85)who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography(ERCP)and a control group(n=85)receiving an oral placebo at the same times.Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis.Serum amylase levels were classified as normal(<150 IU/L)or hyperamylasemia(>151 IU/L).Episodes of PEP were classified following Ranson's criteria and CT severity index.RESULTS:Gender distribution was similar between groups.Mean age was 53.5±18.9 years for study group and 52.8±19.8 years for controls.Also,the distribution of benign pathology was similar between groups.Hyperamylasemia was more common in the control group(P=0.003).Mild PEP developed in two patients from the study group(2.3%)and eight(9.4%) from control group(P=0.04),seven episodes were observed in high-risk patients of the control group(25%) and one in the allopurinol group(3.3%,P=0.02).Risk factors for PEP were precut sphincterotomy(P=0.02),pancreatic duct manipulation(P=0.002)and multiple procedures(P=0.000).There were no deaths or side effects.CONCLUSION:Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.
文摘AIM: To clarify the relationship between the change of serum amylase level and post-ERCP pancreatitis. METHODS: Between January 1999 and December 2002, 1291 ERCP-related procedures were performed. Serum amylase concentrations were measured before the procedure and 3, 6, and 24 h afterward. The frequency and severity of post-ERCP pancreatitis and the relationship between these phenomena and the change in amylase level were estimated. RESULTS: Post-ERCP pancreatitis occurred in 47 patients (3.6%). Pancreatitis occurred in 1% of patients with normal amylase levels 3 h after ERCP, and in 1%, 5%, 20%, 31% and 39% of patients with amylase levels elevated 1-2 times, 2-3 times, 3-5 times, 5-10 times and over 10 times the upper normal limit at 3 h after ERCP, respectively (level < 2 times vs ≥ 2 times, P < 0.001). Of the 143 patients with levels higher than the normal limit at 3 h after ERCP followed by elevation at 6 h, pancreatitis occurred in 26%. In contrast, pancreatitis occurred in 9% of 45 patients with a level higher than two times the normal limit at 3 h after ERCP followed by a decrease at 6 h (26% vs 9%, P < 0.05). CONCLUSION: Post-ERCP pancreatitis is frequently associated with an increase in serum amylase level greater than twice the normal limit at 3 h after ERCP with an elevation at 6 h. A decrease in amylase level at 6 h after ERCP suggests the unlikelihood of development of post-ERCP pancreatitis.
文摘Background and aims:Biopsy of the ampulla of Vatermay be performed to evaluate for ampullary adenomas,suspected ampullary tumors and immunohistological staining for autoimmune pancreatitis.Ampullary biopsies are commonly performed at the time of endoscopic retrograde cholangiopancreatography(ERCP).Due to the well-established complication rate following ERCP,the contribution of ampullary biopsy as a potential independent risk factor would require a controlled comparison.Methods:A matched-pairs,case-control analysis was performed for patients undergoing ERCP with or without ampullary biopsy.The analysis involved a retrospective review of adult patients at a tertiary-care center who underwent ampullary biopsies during ERCP compared(via procedural complexity)with a matched control group who underwent ERCP without ampullary biopsies.Results:Of 159 procedures involving ampullary biopsy,54 ERCPs that met the inclusion criteria were performed with ampullary biopsy and included in the analysis cohort.This cohort was compared with 54 patients undergoing ERCP without ampullary biopsy,matched by American Society for Gastrointestinal Endoscopy(ASGE)grade of procedural complexity.There were no patients with sphincter of Oddi dysfunction.Ampullary biopsies suggested a diagnosis in 75.9% of the procedures including 12 adenomas,5 adenocarcinomas and 1 intraductal papillary mucinous neoplasm.Including major and minor complications,the overall complication rate with biopsy(9.3%)was equivalent to the complication rate in the control group without ampullary biopsy(9.3%,P>0.99).The incidence of post-procedure pancreatitis was not significantly different between the two groups(5.6% vs 3.7%,P=0.6).Age and pancreatic duct manipulation,but not ampullary biopsy,were associated with complications on multivariate analysis in the study population.Conclusions:Ampullary biopsy performed during ERCP had a high diagnostic yield and was not associated with an increased rate of post-procedure complications or pancreatitis when compared with ERCP alone.
