药物和内镜干预预防内镜后逆行胆管胰腺炎。

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Research Pub Date : 2023-06-01 DOI:10.14740/gr1620
Emmanuel Palomera-Tejeda, Mihir Prakash Shah, Bashar M Attar, Hassam Shah, Bharosa Sharma, Roberto Oleas, Vikram Kotwal, Seema Gandhi, Hemant Raj Mutneja
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引用次数: 0

摘要

背景:内镜逆行胰胆管造影后胰腺炎(PEP)是内镜逆行胰胆管造影(ERCP)后最常见的严重并发症。直肠非甾体类抗炎药(NSAIDs)和胰管支架置入术(PDS)是证据更充分、疗效更好的预防干预措施;然而,PEP仍然是发病率、死亡率和经济负担的重要来源。长期使用他汀类药物被认为是一种既便宜又相对安全的预防方法。然而,证据是相互矛盾的。我们的目的是评估内镜和药物干预的影响,包括慢性他汀类药物和阿司匹林的使用,对PEP的发展。方法:一项回顾性队列研究评估了2015年1月至2018年3月在芝加哥库克县约翰·h·斯特罗格小医院接受ERCP的连续患者。采用logistic回归进行单因素和多因素分析。结果:共纳入681例ercp。12例(1.76%)发生PEP。单因素、多因素和亚组分析均未显示慢性他汀类药物或阿司匹林使用与PEP之间有任何关联。PDS和直肠吲哚美辛对胰管注射患者有保护作用。胰管注射、女性和年轻年龄与较高的风险相关。只有在单因素分析中,乳头切除史与较低的风险相关(P值均< 0.05)。结论:长期使用他汀类药物和阿司匹林似乎对预防ERCP胰腺炎没有额外的好处。直肠非甾体抗炎药和适当患者选择后的PDS仍然是主要的预防措施。与报道的数据相比,我们中心的发病率较低,这可以解释为直肠吲哚美辛和PDS的高发率,使用无创诊断方式进行患者选择,以及内窥镜医师的专业知识。
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Pharmacological and Endoscopic Interventions for Prophylaxis of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.

Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) represents the most common serious complication after endoscopic retrograde cholangiopancreatography (ERCP). Rectal non-steroidal anti-inflammatory drugs (NSAIDs) and pancreatic duct stenting (PDS) are the prophylactic interventions with more evidence and efficacy; however, PEP still represents a significant source of morbidity, mortality, and economic burden. Chronic statin use has been proposed as a prophylactic method that could be cheap and relatively safe. However, the evidence is conflicting. We aimed to evaluate the impact of endoscopic and pharmacological interventions including chronic statin and aspirin use, on the development of PEP.

Methods: A retrospective cohort study evaluated consecutive patients undergoing ERCP at John H. Stroger, Jr. Hospital of Cook County in Chicago from January 2015 to March 2018. Univariate and multivariate analyses were performed using logistic regression.

Results: A total of 681 ERCPs were included in the study. Twelve (1.76%) developed PEP. Univariate, multivariate, and subgroup analyses did not show any association between chronic statin or aspirin use and PEP. PDS and rectal indomethacin were protective in patients undergoing pancreatic duct injection. Pancreatic duct injection, female sex, and younger age were associated with a higher risk. History of papillotomy was associated with lower risk only in the univariate analysis (all P values < 0.05).

Conclusion: Chronic use of statins and aspirin appears to add no additional benefit to prevent ERCP pancreatitis. Rectal NSAIDs, and PDS after appropriate patient selection continue to be the main prophylactic measures. The lower incidence at our center compared with the reported data can be explained by the high rates of rectal indomethacin and PDS, the use of noninvasive diagnostic modalities for patient selection, and the expertise of the endoscopists.

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Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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