scholarly journals Epinephrine in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Preliminary Study

2018 ◽  
Vol 12 (1) ◽  
pp. 125-136 ◽  
Author(s):  
Behzad Hatami ◽  
Seyed Mohammad Hossein Kashfi ◽  
Mohammad Abbasinazari ◽  
Ehsan  Nazemalhosseini Mojarad ◽  
Mohammad Amin Pourhoseingholi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Univariate Analysis ◽  
Combination Group ◽  
Endoscopic Retrograde ◽  
Significant Difference ◽  
Blinded Manner ◽  
Group A ◽  
Group B ◽  
Double Blinded

Background: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The incidence of post-ERCP pancreatitis (PEP) ranges between 15 and 20% among patients at high risk of developing PEP. The efficacy of indomethacin administration in the prevention of PEP is rather debatable. In the present randomized trial study, we evaluated whether or not the combination of indomethacin and epinephrine in comparison to the single administration of indomethacin differs in the pathogenesis and prevention of post-ERCP pancreatitis. Patients and Methods: One hundred and ninety-two patients were randomized in a double-blinded manner into 3 groups: the epinephrine group (group A), the indomethacin group (group B), and the combined epinephrine and indomethacin group (group C). After the procedure, patients were evaluated for the PEP development. Results: During the procedure, 66 patients were randomized to the epinephrine group (group A), 68 cases to the indomethacin group (group B), and 58 individuals to the indomethacin-epinephrine group (group C). The mean age of patients in the epinephrine group was 59.59 ± 15.680 years, in the indomethacin group it was 58.06 ± 17.125 years, and in the combination group it was 59.62 ± 15.369 years. In the present study, we did not observe a significant difference between the 3 groups in sex, age, pre-ERCP amylase, lipase, and patient and procedure risk factors including pancreatic duct (PD) dilation (p = 0.404), PD cannulation (p = 0.329), and difficult cannulation (p = 0.076) among others. PEP developed in 7 of the 192 individuals (3.6%), 6 PEP cases occurred in the indomethacin group and 1 in the epinephrine group (p = 0.016). Univariate analysis of risk factors for PEP in patients with and without pancreatitis revealed no significant difference between the pancreatitis group and the non-pancreatitis group. Conclusion: In comparison to the administration of indomethacin alone, a single application of epinephrine and the combination of epinephrine and indomethacin seem to be effective in reducing the cases of PEP. A further randomized clinical trial with a larger sample size is required to confirm the efficacy of our medication in the prevention of pancreatitis after ERCP.

scholarly journals Comparison of Recovery Time of Propofol and Midazolam with Propofol Alone for Sedation in Endoscopic Retrograde Cholangiopancreatography

2021 ◽  
Vol 15 (5) ◽  
pp. 1024-1027
Author(s):  
Asma Samreen ◽  
Aamir Waseem ◽  
Muhammad Azam ◽  
Itrat Hussain Kazmi ◽  
Aamir Bashir ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Recovery Time ◽  
Controlled Trial ◽  
P Value ◽  
Time Data ◽  
Endoscopic Retrograde ◽  
Intravenous Anesthetic ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Procedural sedation is required for multiple short duration procedures outside of the operating rooms especially in radiology and endoscopy suites. Intravenous anesthetic agent with rapid recovery profile is desirable in such circumstances. This study aims to compare two regimens of intravenous anesthetic agents. Aim: To compare the mean recovery time of propofol and midazolam with propofol alone for sedation in endoscopic retrograde cholangiopancreatography. Study Design: Randomized controlled trial. Settings: Department of Anesthesia, Shalamar Hospital, Lahore. Study Duration: June 2017 to December 2017. Methods: A total of 70 adult patients aged 20-60 years undergoing ERCP under sedation were included. Patients were given a combination of propofol and midazolam in group A while propofol alone was given in group B. After procedure, pts were transferred to recovery room and were followed for assessment of recovery time. Data were analyzed in SPSS vr 21, Independent t-test was applied & p-value ≤0.05 was considered statistically significant. Results: Significant difference was found in mean recovery time amongst both the groups. Mean recovery time in Group A (propofol and midazolam) was 19.29±4.50 minutes while in Group B (propofol alone) was 26.66±3.70 minutes showing statistically significant result with p-value = 0.0001. Conclusion: We conclude that mean recovery time with propofol plus midazolam is shorter as compared to propofol alone for sedation in ERCP. Keywords: Propofol, midazolam, sedation outside operation theatre.

scholarly journals Feasibility of Non-Anesthesiologist-Administered Propofol Sedation for Emergency Endoscopic Retrograde Cholangiopancreatography

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Nobuhito Ikeuchi ◽  
Takao Itoi ◽  
Takuji Gotoda ◽  
Chika Kusano ◽  
Shin Kono ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Acute Cholangitis ◽  
Careful Monitoring ◽  
Endoscopic Retrograde ◽  
Serious Adverse Events ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Technical Safety

Background. The safety of non-anesthesiologist-administered propofol (NAAP) sedation in emergent endoscopic retrograde cholangiopancreatography (ERCP) has not been fully clarified. Thus, the aim of this study was to assess the safety of NAAP sedation in emergent ERCP.Materials and Methods. We retrospectively analyzed 182 consecutive patients who had obstructive jaundice and who underwent ERCP under NAAP sedation. The patients were divided into Group A (with mild acute cholangitis or without acute cholangitis) and Group B (moderate or severe acute cholangitis). And technical safety and adverse events were assessed.Results. The adverse events were hypoxia (31 cases), hypotension (26 cases), and bradycardia (2 cases). There was no significant difference in the rate of each adverse event of hypoxia and bradycardia in either group. Although the rate of transient hypotension associated in Group B was higher than that in Group A, it was immediately improved with conservative treatment. Moreover, there were no patients who showed delayed awakening, or who developed other complications.Conclusions. In conclusion, NAAP sedation is feasible even in emergent ERCP. Although some transient adverse events (e.g., hypotension) were observed, no serious adverse events occurred. Thus, propofol can be used in emergent ERCP but careful monitoring is mandatory.

scholarly journals Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojia Chen ◽  
Fan Wang ◽  
Jing Liu ◽  
Wenhui Tao ◽  
Zhang Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Univariate Analysis ◽  
Balloon Dilation ◽  
Endoscopic Papillary Balloon Dilation ◽  
Endoscopic Retrograde ◽  
Therapeutic Success ◽  
Surgically Altered Anatomy

Abstract Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI 2.693–466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

scholarly journals CO2 or air cholangiography reduces the risk of post-ERCP cholangitis in patients with Bismuth type IV hilar biliary obstruction

2020 ◽  
Author(s):  
wenhui zhang ◽  
Peng peng Ding ◽  
lei liu ◽  
yanling wang ◽  
wenhui lai ◽  
...  
Keyword(s):  
Liver Function Tests ◽  
Complication Rates ◽  
Endoscopic Retrograde ◽  
Type Iv ◽  
Significant Difference ◽  
Group A ◽  
Hilar Biliary Obstruction ◽  
The Mean ◽  
Malignant Hilar Obstruction ◽  
Group B

Abstract Background: Endoscopic biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is the most common form of palliation for malignant hilar obstruction. However, ERCP in such cases is associated with a risk of cholangitis. The incidence of post-ERCP cholangitis is particularly high in Bismuth type IV hilar obstruction, and this risk is further increased when the contrast injected for cholangiography is not drained. The present study aims to compare the incidence of cholangitis associated with the use of a contrast agent, air and CO2 for cholangiography in type IV hilar biliary lesions. Methods: The clinical data of consecutive 70 patients with type IV hilar obstruction, who underwent ERCP from October 2013 to November 2017, were retrospectively analyzed. These patients were divided into three groups based on the agent used for cholangiography: group A, contrast (n=22); group B, air (n=18); group C, CO2 (n=30). These three methods of cholangiography were chronologically separated. Prior to the ERCP, MRCP was obtained from all patients to guide the endoscopic intervention. Results: At baseline, there was no significant difference in terms of the patient’s age, gender, symptoms and liver function tests among the three groups (P>0.05). The complication rates were significantly higher in group A than in groups B and C (63.6% vs. 26.7% and 27.8%, P<0.05). The incidence of post-ERCP cholangitis was significantly higher in group A (P<0.05), while the incidence of post-ERCP pancreatitis and bleeding were similar in the three groups. After the ERCP, the mean hospital stay was shorter in groups B and C, when compared to group A (P<0.05). However, there was no significant difference in the 30-day mortality rate among the three groups (P>0.05). Furthermore, there was no significant difference between groups B and C in terms of primary end points. Conclusion: CO2 or air cholangiography during ERCP for type IV hilar obstruction is associated with reduced risk of post-ERCP cholangitis, when compared to conventional contrast agents.

Antibiotic Prophylaxis Before Dental Procedures Can Reduce ONJ Incidence.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3613-3613 ◽  
Author(s):  
Vittorio Montefusco ◽  
Francesca Gay ◽  
Francesco Spina ◽  
Maria Teresa Ambrosini ◽  
Massimo Maniezzo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Zoledronic Acid ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Low Risk ◽  
Dental Procedure ◽  
Dental Procedures ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Osteonecrosis of the jaw (ONJ) is a frequent complication in bisphosphonate-treated multiple myeloma (MM) patients. The pathogenesis is unclear, and major risk factors are duration of bisphosphonate treatment and dental procedures. The histology of osteonecrotic bone shows osteomyelitis and inflammatory infiltrates, and, in most cases, presence of Actynomycetes. Since dental procedures are a major risk factor for ONJ development and oral microflora can be involved in the pathogenesis of the disease, we conducted a retrospective observational trial comparing ONJ occurrence and related risk factors in two groups of MM patients, who received zoledronic acid treatment at two Italian hematological centres. In one centre all patients systematically received as antibiotic prophylaxis amoxicillin-clavulanate 1 gm bid or levofloxacin 500 mg once a day starting from one day before to 3 days after any dental procedure (group A, 52 patients), while in the other centre patients did not receive any prophylaxis (group B, 61 patients). Dental procedures were categorized according to their invasivity and their supposed probability to cause ONJ. Extractions, implants, and professional cleanings were considered at high risk, while fillings were considered low risk procedures. Thirty-three group A patients (63%) and 32 group B patients (52%) received high risk procedures; 4 group A patients (8%) and 5 group B patients (8%) received low risk procedures, while 15 (29%) and 24 (39%) patients, respectively, had a denture. The duration of zoledronic acid exposure differed significantly between the two groups, with a median of 26 months for A patients and 12 months for B patients (p&lt;0.0001). In group A no cases of ONJ were observed, while in group B 8 cases (13%) of ONJ were diagnosed, with a significant difference between the two groups (p=0.007). There was a temporal correlation between dental procedure and ONJ, with a median time of 60 days (range 37–990). The relative risk of ONJ after a dental procedure was 4.8 (p=0.01). The pooled analysis of the two groups showed that age, sex, transplant procedure, and thalidomide therapy did not correlate with ONJ. In both groups the presence of dentures was not associated with ONJ. While in group B incidence of ONJ is consistent with data reported in the literature, which range between 7% and 11%, group A patients had an unexpected low occurrence of this complication, despite a significantly longer exposure to zoledronic acid. This finding suggests a possible role of antibiotic prophylaxis in protecting from ONJ after dental procedures. Further, our observation, along with the correlation between dental procedures and ONJ development, can contribute to the proposal of a comprehensive model of ONJ pathogenesis: trauma of the alveolar bone modified by bisphosphonates induces a bacterial translocation with a subsequent induction of infection, inflammation and necrosis. In this perspective, since antibiotic prophylaxis is a simple and low cost precaution, it’s reasonable to propose it as part of standard care to zoledronic acid treated MM patients before any dental procedure.

scholarly journals Catheter-free Period Over 2 Days Is Associated with Better Outcome in Catheter-related Bloodstream Infection due to Candida

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S54-S55
Author(s):  
Takahiro Matsuo ◽  
Nobuyoshi Mori ◽  
Eri Hoshino ◽  
Aki Sakurai ◽  
Keiichi Furukawa
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Univariate Analysis ◽  
Venous Catheter ◽  
Antifungal Drugs ◽  
Optimal Timing ◽  
Exact Test ◽  
Group A ◽  
Group B ◽  
Catheter Related Bloodstream Infection

Abstract Background Regardless of active antifungal drugs, mortality of candidemia remains high. Although it is well-known that central venous catheter (CVC) is one of the most important risk factors of candidemia and should be removed immediately, little is known about optimal timing of CVC replacement after removal. Here, we analyzed contributing risk factors associated with 30-day mortality for catheter-related bloodstream infection (CRBSI) due to candida and optimal timing of CVC replacement. Methods We conducted a retrospective cohort study at St. Luke#129; fs International Hospital between 2004 and 2015. We compared each clinical component in patients who died within 30 days and were alive at 30 days. Also, catheter-free period (from removal to replacement) was compared between group A and B. Fisher#129; fs exact test and Mann–Whitney U test were used in univariate analysis and multivariate linear regression was used for controlling confoundings. Results Among 228 patients (pts) with candidemia, 166 patients (73%) were on CVC at diagnosis. Of them, 144 patients (65%) removed CVC after the result of candidemia. Seventy-one patients (31%) replaced CVC. Fifteen patients (6%) died within 30 days (group A) and 56 patients (25%) were alive at 30 days (group B). Median age was 74 in group A and 72 in group B (P = 0.331) (Table 1). In univariate analysis, hematological malignancy (OR 6.75, 95% CI 1.01–44.9) and CVC replacement &lt; 2-days after removal (OR 5.63, 95% CI 1.16–27.3) showed statistically significant increase in group A vs group B (Table 2). In multivariate analysis, CVC replacement &lt; 2-days was independently associated with 30-day mortality (Table 3). Conclusion This is the first study to demonstrate the optimal timing of CVC replacement in CRBSI due to candida. CVC replacement &lt; 2 days was an independent risk factor for 30-day mortality. Disclosures All authors: No reported disclosures.

scholarly journals The Efficacy of Intranasal Desmopressin as an Adjuvant in the Acute Renal Colic Pain Management

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Kambiz Masoumi ◽  
Ali Asgari Darian ◽  
Arash Forouzan ◽  
Hassan Barzegari ◽  
Fakher Rahim ◽  
...  
Keyword(s):  
Pain Management ◽  
Drug Administration ◽  
Renal Colic ◽  
Combination Group ◽  
Sodium Diclofenac ◽  
Significant Difference ◽  
Acute Renal Colic ◽  
Group A ◽  
Intranasal Desmopressin ◽  
Group B

The aim of this study was to compare analgesic effect of intramuscular (IM) sodium diclofenac and intranasal desmopressin combination with IM sodium diclofenac alone in patients with acute renal colic. In this randomized double-blind clinical trial, all patients aged 18 to 55 years who were diagnosed as acute renal colic and met the inclusion and exclusion criteria were randomized into two groups to receive 40 μg intranasal desmopressin spray and 75 mg IM sodium diclofenac combination (Group A) or 75 mg IM sodium diclofenac alone (Group B). The pain score of patients was assessed using a visual analogue scale (VAS) at baseline, 15, 30, 45, and 60 minutes after administration. Of all 159 patients who were assessed for eligibility finally, the results of 120 patients were analyzed. There was no significant difference regarding age and gender between two groups. The baseline VAS score was not significantly different between two groups (P=0.44). The Mean ± SD scores of two groups reduced 15 minutes after drug administration, but this decrease was significantly more in Group A compared with Group B (P=0.02). This pattern continued in minutes 30, 45, and 60 of drug administration. Our results showed that desmopressin could be used as an effective adjuvant in acute renal colic pain management.

scholarly journals Analysis of the Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Children With Symptomatic Pancreas Divisum

2021 ◽  
Vol 9 ◽  
Author(s):  
Guixian Pan ◽  
Kaihua Yang ◽  
Biao Gong ◽  
Zhaohui Deng
Keyword(s):  
Risk Factors ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Pancreas Divisum ◽  
Medical Center ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Median Number ◽  
Therapeutic Effects ◽  
Endoscopic Retrograde ◽  
Pancréas Divisum

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in children with symptomatic pancreas divisum (PD).Aim: To investigate the safety and efficacy of ERCP in the treatment of children with symptomatic PD.Methods: We performed a retrospective analysis on children with PD who were treated with ERCP at Shanghai Children's Medical Center between June 2015 and May 2020. Pertinent patient, clinical and procedural data were collected to assess the therapeutic effects and identify the risk factors for post-ERCP pancreatitis (PEP).Results: Overall, 114 ERCPs were performed in 46 children with PD. With a median follow-up of 28.5 months (12–71 months), 40 (87.0%) children achieved clinical remission, the median number of acute pancreatitis episodes decreased from four times per year pre-operatively to once per year post-operatively (P &lt; 0.001), and the nutritional score improved post-operatively (P = 0.004). The incidence of PEP was 7.9%, and female sex, stone extraction, and gene mutations were identified as possible risk factors for PEP on univariate analysis. However, there was no statistical significance on multivariate analysis (P &gt; 0.05).Conclusion: Therapeutic ERCP is an effective and safe intervention for children with symptomatic PD.

scholarly journals CO2 or air cholangiography reduces the risk of post-ERCP cholangitis in patients with Bismuth type IV hilar biliary obstruction

2020 ◽  
Author(s):  
wenhui zhang ◽  
Peng peng Ding ◽  
lei liu ◽  
yanling wang ◽  
wenhui lai ◽  
...  
Keyword(s):  
Liver Function Tests ◽  
Complication Rates ◽  
Endoscopic Retrograde ◽  
Type Iv ◽  
Significant Difference ◽  
Group A ◽  
Hilar Biliary Obstruction ◽  
The Mean ◽  
Malignant Hilar Obstruction ◽  
Group B

Abstract Background: Endoscopic biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is the most common form of palliation for malignant hilar obstruction. However, ERCP in such cases is associated with a risk of cholangitis. The incidence of post-ERCP cholangitis is particularly high in Bismuth type IV hilar obstruction, and this risk is further increased when the contrast injected for cholangiography is not drained. This study aims to compare the incidence of cholangitis associated with the use of contrast agent, air and CO2 for cholangiography in type IV hilar biliary lesions. Methods: The clinical data of consecutive 70 patients with type IV hilar obstruction, who underwent ERCP from October 2013 to November 2017, was retrospectively analyzed. These patients were divided into three groups based on the agent used for cholangiography: group A, contrast (n=22); group B, air (n=18); group C, CO2 (n=30). These three methods of cholangiography were chronologically separated. Prior to the ERCP, MRCP was obtained from all patients to guide the endoscopic intervention. Results: At baseline, there was no significant difference in the patient’s age, gender, symptoms and liver function tests among the three groups (P>0.05). The complication rates was significantly higher in group A than in groups B and C (63.6% vs. 26.7% and 27.8%, P<0.05). The incidence of post-ERCP cholangitis was significantly higher in group A (P<0.05), while the incidence of post-ERCP pancreatitis and bleeding were similar in the three groups. After ERCP, the mean hospital stay was shorter in groups B and C, when compared to group A (P<0.05). There was no significant difference in the 30-day mortality rate among the three groups (P>0.05). Furthermore, there was no significant difference between group B and C in terms of primary end points. Conclusion: CO2 or air cholangiography during ERCP for type IV hilar obstruction is associated with reduced risk of post-ERCP cholangitis, when compared to conventional contrast agents.

Procedure and Patient-Related Risk Factors for Post-ERCP Pancreatitis Associated with Prophylactic Pancreatic Stent and Rectal Indomethacin

2020 ◽  
Author(s):  
Hossein Ghalehnoei ◽  
Ahmad Hormati ◽  
Amir Houshang Mohammad Alizadeh ◽  
Sajjad Ahmadpour ◽  
Hassan Abedi
Keyword(s):  
Risk Factors ◽  
Pancreatic Duct ◽  
Univariate Analysis ◽  
Pancreatic Stent ◽  
Endoscopic Retrograde ◽  
Significant Incidence ◽  
Related Risk ◽  
Significant Difference ◽  
Prophylactic Pancreatic Duct Stents ◽  
Rectal Indomethacin

Abstract Background: Pancreatitis is one of the most crucial complications following endoscopic retrograde cholangiopancreatography (ERCP). The purpose of the current study was to investigate a potential procedure and patient-related risk factors for post-ERCP pancreatitis (PEP) in two groups: prophylactic pancreatic stent and rectal indomethacin.Methods: Two different prophylactic modalities were planned and complications were assessed based on defined inclusion criteria. In this study, the patients were evaluated for the procedure and patient-related risk factors in post-ERCP pancreatitis in the recipient groups of the prophylactic pancreatic stent or rectal indomethacin.Results: Pancreatitis was confirmed in 27 of all 175 selected patients after ERCP. By univariate analysis, two variables were significant with the development of PEP. Regarding the patient-related risk factors, unique subjects with common bile duct(CBD) dilated 10mm were more exposed to an increased chance of PEP (p=0. 015); meanwhile, other factors didn’t correlate with the increased possibility of PEP in both groups. The only procedure-related risk factor for PEP was deep cannulation of the pancreatic duct in both groups during the procedure with an incremental significant incidence of pancreatitis (p=0.005). Prophylactic pancreatic stent and rectal indomethacin showed no effects on reducing post ERCP pancreatitis. Additionally, there was no significant difference between these two strategies in the rate of PEP.Conclusion: Prophylactic pancreatic duct stents and administration of rectal indomethacin cannot have particular methods for reducing the occurrence of PEP. The increase in time of deep cannulation and the presence of CBD dilation <10mm could be considered as important risk factors.

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