Resumen
Introduction: The most common complication of endoscopic retrograde cholangiopancreatography (ERCP) is pancreatitis, its incidence is 5-7% overall and this number rises to 10 to 15% in high-risk patients. The American Society of Gastrointestinal Endoscopy recommends drug prophylaxis to prevent post-ERCP pancreatitis (PEP) in centers where the incidence exceeds this number or patients at high risk of presenting this complication; therefore, the epidemiology in each center where this procedure is performed needs to be known. Objectives: To ascertain the epidemiology of PEP in procedures performed in the San Juan de Dios General Hospital (HGSD) and identify risk factors. Methodology: Fifty three (53) patients who underwent
ERCP in HGSD were followed during 48 hours. Patients who presented typical abdominal pain, serum amylase and lipase were measured; if they showed more than 5 folds the upper normal value, post-ERCP pancreatitis (PEP) was diagnosed. Data from both the patient and the procedure were obtained and therefore the incidence of this complication was assumed, the risk factors was also determined. Results: Data from 53 patients undergoing ERCP was obtained: 38 women and 15 men. The average age was 44.86 years (+ 14.98). The most common risk factor was sphincterotomy in 40 patients. Only one patient developed post-ERCP pancreatitis (1.88%). Pancreatitis was mild without any other complications. The main indication for ERCP was choledocholithiasis in 24 patients. Discussion: Drug prophylaxis should be given only to high-risk
patients due to a low risk of incidence of pancreatitis is 1.88%, which is within the limits accepted by the American Society of Gastrointestinal Endoscopy. Conclusion: The incidence of post-ERCP pancreatitis is within acceptable limits but larger studies need to be carried out in order to know the incidence of PEP in
high-risk patients.
Citas
Matthew E. Feurer, Douglas G. Adler Medscape, Post-ERCP Pancreatitis, Review of Current Preventive Strategies, Disclosures, Curr Opin Gastroenterol. ; 28(3):280-286. 2012
B. Joseph Elmunzer, M.D.et al N Engl J Med a Randomized Trial of Rectal Indomethacin to Prevent Post-ERCP Pancreatitis”. U.S. Cooperative for Outcomes Research in Endoscopy (USCORE) 2012; 366:1414-1422/April 12, 2012DOI: 10.1056/NEJMoa1111103
Chi-Liang Cheng et al., M.D The American Journal of Gastroenterology, Risk Factors for Post-ERCP Pancreatitis: A Prospective Multicenter Study, Am J Gastroenterol. 2006; 101(1):139-147.
Masci E, Mariani A, Curioni S, Testoni PA. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopy 2003; 35:830-4.
Freeman ML, Nelson DB, Sherman S, Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335:909–918.
Masci E, Toti G, Mariani A, Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001; 96:417– 423
Debenedet AT, Raghunathan TE, Wing JJ, Alcohol use and cigarette smoking as risk factors for post endoscopic retrograde cholangiopancreatography pancreatitis. Clin Gastroenterol Hepatol 2009; 7:353e4– 358e4
Cheng C.L., Sherman S., Watkins J.L., et al: Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol 2006; 101: pp. 139-147
V. S. Akshintala et al. MEDSCAPE Pharmacological Prophylaxis against Post-ERCP Pancreatitis Aliment Pharmacol Ther. 2013; 38(11-12):1325-1337.
Cockeram A. Canadian Association of Gastroenterology Practice Guideline for clinical competence in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography. Can J Gastroenterol.1997;11:535–8.pubmed
Elmunzer B.J., Waljee A.K., Elta G.H., et al: A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut 2008; 57: pp. 1262-1267
Ahmad D et al The effect of indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis. PubMed 2014 Apr; 43(3):338-42
Testoni PA, Bagnolo F. Pain at 24 hours associated with amylase levels greater than 5 times the upper normal limit as the most reliable indicator of post-ERCP pancreatitis. Gastrointest Endosc 2001; 53:33.
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