PREVENTION OF ACUTE PANCREATITIS DURING ENDOSCOPIC TRANSPAPILLARY INTERVENTIONS

Aim. To identify the major risk factors of acute postoperative pancreatitis, to determine optimal volume of drug prevention, to study the possibility of intravenous administration of octreotide 600 mcg/ml in transpapillary endoscopic interventions.

Material and Methods. In group I (72 patients) prevention of acute post-manipulation pancreatitis prior to endoscopic transpapillary interventions included intravenous administration of octreotide 600 mcg diluted in 60 ml 0.9% sodium chloride solution (NaCl). On the day of endoscopic intervention octreotide was administered fractionally 200 mcg 3 times per day. In group II (78 patients) acute pancreatitis was prevented by subcutaneous injection of octreotide 100 mcg before endoscopic intervention and subsequent 3-fold subcutaneous injection of 100 mcg on the day of surgery.

Results. Risk factors of acute pancreatitis are young age, difficult cannulation of major duodenal papilla, atypical papillosphincterotomy, contrast injection into pancreatic duct. It is proved that intravenous administration of octreotide 600 mcg/ml reduces the risk of acute pancreatitis and transient hyperamylasemia from 16.7% and 19.2% to 11.1% and 16.7% respectively compared with conventional subcutaneous injection (100 mcg). Thus, it reduces the duration (p < 0.016) and severity of hyperamylasemia (p < 0.005).

Conclusion. Intravenous administration of octreotide 600 mcg/day is more effective and convenient compared with conventional scheme to prevent acute postmanipulation pancreatitis.

1. Boboyev B.D., Makhmadov F.I., Ikromov B.A. Minimally invasive methods in the diagnosis and treatment of choledocholithiasis. Novosti khirurgii. 2011; 19 (6): 59–63. (In Russian)

2. Vetshev P.S. Obstructive jaundice: causes and diagnostic approaches (lecture). Annaly khirurgicheskoy gepatologii. 2011; 16 (3): 50–57. (In Russian)

3. Kahaleh M., Freeman M. Prevention and management of postendoscopic retrograde cholangiopancreatography complications. Clinical Endoscopy. 2012; 45 (3): 305. doi: 10.5946/ce.2012.45.3.305.

4. Bystrov S.A., Zhukov B.N. Minimally invasive interventions for acute cholecystitis complicated by obstructive jaundice. Medicinskij al'manah. 2011; 15 (2): 87–89. (In Russian)

5. Fedorov A.G., Davydova S.V., Klimov A.E. Complications of endoscopic transpapillary interventions and methods for their prevention and treatment: literature review. Neotlozhnaya medicinskaya pomoshch'. 2012; 14 (3): 29–35. (In Russian)

6. Deviere J. Pancreatic stents. Gastrointest. Endosc. Clin. North Am. 2011; 21 (3): 499–510. doi: 10.1016/j.giec.2011.04.011.

7. Stoyko Yu.M., Ivanov S.V., Zubritskiy V.F., Levchuk A.L., Obukhovskiy B.I., Rozberg E.P., Kontorshchikova E.S. Prevention of complications after endoscopic transpapillary interventions in patients with choledocholithiasis. Vestnik Nacional'nogo mediko-khirurgicheskogo centra im. N.I. Pirogova. 2010; 5 (4): 29–32. (In Russian)

8. Jowell P., Branch M., Fein S., Edward D., Kilari R., Robuck G., Almada Ph., Baillie J. Intravenous synthetic secretin reduces the incidence of pancreatitis induced by endoscopic retrograde cholangiopancreatography. Pancreas. 2011; 40 (4): 533–539. doi: 10.1097/mpa.0b013e3182152eb6.

9. Anderson M.A., Fisher L., Jain R., Evans J.A., Appalaneni V., Ben-Menachem T., Cash B.D., Decker G.A., Early D.S., Fanelli R.D. Complications of ERCP. ASGE Standards of Practice Committee. Gastroint. Endosc. 2012; 75 (3): 467–473.

10. Sakai Y. Clinical usefulness and current problems of pancreatic duct stenting for preventing post-ERCP pancreatitis. World J. Clin. Cas. 2014; 2 (9): 426. doi: 10.12998/wjcc.v2.i9.426.

11. Dumonceau J., Andriulli A., Elmunzer B.J., Mariani A., Meister T., Deviere J., Marek T., Baron T.H., Hassan C., Testoni P.A., Kapral C. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: Prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010; 42 (06): 503–515. doi: 10.1055/s-0029-1244208.

12. Tammaro S. Post-endoscopic retrograde cholangio-pancreatography pancreatitis: Is time for a new preventive approach? World J. Gastroenterol. 2012; 18 (34): 4635. doi: 10.3748/wjg.v18.i34.4635.

13. Katsinelos P., Fasoulas K., Chatzimavroudis G., Beltsis A., Terzoudis S., Paroutoglou G., Zavos C., Kountouras J. Combination of diclofenac plus somatostatin in the prevention of post-ERCP pancreatitis: a randomized, double-blind, placebo-controlled trial. Endoscopy. 2011; 44 (01): 53–59. doi: 10.1055/s-0031-1291440.

14. Glomsaker T., Hoff G., Kvaloy J., Soreide K., Aabakken L., Soreide J. Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography. Br. J. Surg. 2012; 100 (3): 373–380. doi: 10.1002/bjs.8992.

15. Chen J., Wang X., Liu X., Li W., Dong M., Suo Z., Ding P. Risk factors for post-ERCP pancreatitis: a systematic review of clinical trials with a large sample size in the past 10 years. Eur. J. Med. Res. 2014; 19 (1): 26. doi: 10.1186/2047-783x-19-26.

16. Ding X., Chen M., Huang S., Zhang S., Zou X. Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis. Gastrointest. Endosc. 2012; 76 (6): 1152–1159. doi: 10.1016/j.gie.2012.08.021.

17. Wong L. Prevention of post-ERCP pancreatitis. World J. Gastrointest. Pathophysiol. 2014; 5 (1): 1. doi: 10.4291/wjgp.v5.i1.1.

18. Korkmaz H., Temel Т. Incidence, risk factors, recognition and prevention of post-ERCP pancreatitis. Internat. J. Mevlana Med. Sci. 2013; 1 (1): 4–9.

19. Ito K., Fujita N., Noda Y., Kobayashi G., Obana T., Horaguchi J., Takasawa O., Koshita S., Kanno Y., Ogawa T. Risk factors for post-ERCP pancreatitis in high risk patients who have undergone prophylactic pancreatic duct stenting: A multicenter retrospective study. Internal Med. 2011; 50 (24): 2927–2932. doi: 10.2169/internalmedicine.50.6235.

20. Elmunzer B.J., Scheiman J.M., Lehman G.A., Chak A., Mosler P., Higgins P.D., Hayward R.A., Romagnuolo J., Elta G.H., Sherman S., Waljee A.K., Repaka A., Atkinson M.R., Cote G.A., Kwon R.S., McHenry L., Piraka C.R., Wamsteker E.J., Watkins J.L., Korsnes S.J., Schmidt S.E., Turner S.M., Nicholson S., Fogel E.L. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. New Engl. J. Med. 2012; 366 (15): 1414–1422. doi: 10.1056/nejmoa1111103.