AIM: To investigate the correlations between serum amylase levels, intestinal permeability (IP), and pancreatic injury and to explore the mechanisms responsible for hyperamylasemia in double-balloon enteroscopy (DBE).
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
Background:Post-ERCP pancreatitis(PEP)is significantly influenced by the reflux of duodenal fluid.While gastrointestinal decompression represents a fundamental approach in acute pancreatitis management,the effectivene...Background:Post-ERCP pancreatitis(PEP)is significantly influenced by the reflux of duodenal fluid.While gastrointestinal decompression represents a fundamental approach in acute pancreatitis management,the effectiveness of immediate duodenal decompression following ERCP to prevent PEP remains uncertain.This study aimed to investigate the impact of immediate duodenal decompression after ERCP on reducing the incidence of hyperamylasemia and PEP.Methods:This retrospective study encompassed patients with native papilla who underwent therapeutic ERCP for choledocholithiasis at the Department of Gastroenterology,Chun’an Branch of Zhejiang Provincial People’s Hospital(Zhejiang,China)between January 2020 and June 2023.Based on the immediate placement of a duodenal decompression tube post-ERCP,patients were categorized into two groups:the duodenal decompression group and the conventional procedure group.Primary outcomes included the incidence of PEP and hyperamylasemia.Results:A total of 195 patients were enrolled(94 in the duodenal decompression group and 101 in the conventional procedure group).Baseline clinical and procedural characteristics exhibited no significant differences between the two groups.PEP occurred in 2 patients(2.1%)in the duodenal decompression group,in contrast to 11 patients(10.9%)in the conventional procedure group(Risk difference[RD]8.8%;95%confidence interval[CI]1.7%-16.5%,P=0.014).Hyperamylasemia was observed in 8 patients(8.5%)in the duodenal decompression group,compared to 20 patients(19.8%)in the conventional procedure group(RD 11.3%;95%CI 1.4%-21.0%;P=0.025).Patients with PEP in both groups showed improvement after receiving active treatment.No severe cases of PEP occurred in either group,and no serious adverse events related to duodenal catheter decompression were reported.Conclusion:Immediate duodenal decompression following ERCP demonstrates an effective reduction in the incidence of hyperamylasemia and PEP.展开更多
Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and hyperamylasemia remain inconclusive. This study aimed to examine whether high-do...Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and hyperamylasemia remain inconclusive. This study aimed to examine whether high-dose, long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia. Methods This was a randomized, placebo-controlled pilot trial. One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions： pre-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour prior to ERCP; n=36）, post-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour after ERCP; n=47）, or placebo （saline for 24 hours, starting 1 hour prior to ERCP; n=41）. Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6, 24, and 48 hours after ERCP. Results The three groups did not differ in age, gender, medical history, or ERCP procedure （catheterization using contrast or guidewire, pancreatic duct visualization, procedure time, or procedure type）. The rate of PEP was 13.7% （17/124） in the overall study sample and 16.7% （6/36）, 10.6% （5/47）, and 14.6% （6/41） in the pre-ERCP somatostatin, post- ERCP somatostatin, and placebo groups, respectively （P=0.715）. The rate of post-ERCP hyperamylasemia was 19.4% （7/36）, 21.3% （10/47）, and 46.3% （19/41） in the pre-ERCP somatostatin, post-ERCP somatostatin, and placebo groups, respectively （P=0.011）. Conclusions High-dose, long-term continuous infusion （0.5 mg/h for 24 hours） of somatostatin, performed as either a pre- or post-ERCP, can reduce the incidence of hyperamylasemia, but not PEP.展开更多
文摘AIM: To investigate the correlations between serum amylase levels, intestinal permeability (IP), and pancreatic injury and to explore the mechanisms responsible for hyperamylasemia in double-balloon enteroscopy (DBE).
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.
基金Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project(No.2023ZL266).
文摘Background:Post-ERCP pancreatitis(PEP)is significantly influenced by the reflux of duodenal fluid.While gastrointestinal decompression represents a fundamental approach in acute pancreatitis management,the effectiveness of immediate duodenal decompression following ERCP to prevent PEP remains uncertain.This study aimed to investigate the impact of immediate duodenal decompression after ERCP on reducing the incidence of hyperamylasemia and PEP.Methods:This retrospective study encompassed patients with native papilla who underwent therapeutic ERCP for choledocholithiasis at the Department of Gastroenterology,Chun’an Branch of Zhejiang Provincial People’s Hospital(Zhejiang,China)between January 2020 and June 2023.Based on the immediate placement of a duodenal decompression tube post-ERCP,patients were categorized into two groups:the duodenal decompression group and the conventional procedure group.Primary outcomes included the incidence of PEP and hyperamylasemia.Results:A total of 195 patients were enrolled(94 in the duodenal decompression group and 101 in the conventional procedure group).Baseline clinical and procedural characteristics exhibited no significant differences between the two groups.PEP occurred in 2 patients(2.1%)in the duodenal decompression group,in contrast to 11 patients(10.9%)in the conventional procedure group(Risk difference[RD]8.8%;95%confidence interval[CI]1.7%-16.5%,P=0.014).Hyperamylasemia was observed in 8 patients(8.5%)in the duodenal decompression group,compared to 20 patients(19.8%)in the conventional procedure group(RD 11.3%;95%CI 1.4%-21.0%;P=0.025).Patients with PEP in both groups showed improvement after receiving active treatment.No severe cases of PEP occurred in either group,and no serious adverse events related to duodenal catheter decompression were reported.Conclusion:Immediate duodenal decompression following ERCP demonstrates an effective reduction in the incidence of hyperamylasemia and PEP.
文摘Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and hyperamylasemia remain inconclusive. This study aimed to examine whether high-dose, long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia. Methods This was a randomized, placebo-controlled pilot trial. One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions： pre-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour prior to ERCP; n=36）, post-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour after ERCP; n=47）, or placebo （saline for 24 hours, starting 1 hour prior to ERCP; n=41）. Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6, 24, and 48 hours after ERCP. Results The three groups did not differ in age, gender, medical history, or ERCP procedure （catheterization using contrast or guidewire, pancreatic duct visualization, procedure time, or procedure type）. The rate of PEP was 13.7% （17/124） in the overall study sample and 16.7% （6/36）, 10.6% （5/47）, and 14.6% （6/41） in the pre-ERCP somatostatin, post- ERCP somatostatin, and placebo groups, respectively （P=0.715）. The rate of post-ERCP hyperamylasemia was 19.4% （7/36）, 21.3% （10/47）, and 46.3% （19/41） in the pre-ERCP somatostatin, post-ERCP somatostatin, and placebo groups, respectively （P=0.011）. Conclusions High-dose, long-term continuous infusion （0.5 mg/h for 24 hours） of somatostatin, performed as either a pre- or post-ERCP, can reduce the incidence of hyperamylasemia, but not PEP.
