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Takahashi H, Ohno E, Furukawa T, Yamao K, Ishikawa T, Mizutani Y, Iida T, Shiratori Y, Oyama S, Koyama J, Mori K, Hayashi Y, Oda M, Suzuki T, Kawashima H. Artificial intelligence in a prediction model for postendoscopic retrograde cholangiopancreatography pancreatitis. Dig Endosc 2024; 36:463-472. [PMID: 37448120 DOI: 10.1111/den.14622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES In this study we aimed to develop an artificial intelligence-based model for predicting postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). METHODS We retrospectively reviewed ERCP patients at Nagoya University Hospital (NUH) and Toyota Memorial Hospital (TMH). We constructed two prediction models, a random forest (RF), one of the machine-learning algorithms, and a logistic regression (LR) model. First, we selected features of each model from 40 possible features. Then the models were trained and validated using three fold cross-validation in the NUH cohort and tested in the TMH cohort. The area under the receiver operating characteristic curve (AUROC) was used to assess model performance. Finally, using the output parameters of the RF model, we classified the patients into low-, medium-, and high-risk groups. RESULTS A total of 615 patients at NUH and 544 patients at TMH were enrolled. Ten features were selected for the RF model, including albumin, creatinine, biliary tract cancer, pancreatic cancer, bile duct stone, total procedure time, pancreatic duct injection, pancreatic guidewire-assisted technique without a pancreatic stent, intraductal ultrasonography, and bile duct biopsy. In the three fold cross-validation, the RF model showed better predictive ability than the LR model (AUROC 0.821 vs. 0.660). In the test, the RF model also showed better performance (AUROC 0.770 vs. 0.663, P = 0.002). Based on the RF model, we classified the patients according to the incidence of PEP (2.9%, 10.0%, and 23.9%). CONCLUSION We developed an RF model. Machine-learning algorithms could be powerful tools to develop accurate prediction models.
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Affiliation(s)
- Hidekazu Takahashi
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Fujita Health University Graduate School of Medicine, Aichi, Japan
| | - Taiki Furukawa
- Department of Medical IT, Nagoya University Hospital, Aichi, Japan
| | - Kentaro Yamao
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | | | - Shintaro Oyama
- Department of Medical IT, Nagoya University Hospital, Aichi, Japan
| | - Junji Koyama
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kensaku Mori
- Department of Intelligent Systems, Nagoya University Graduate School of Informatics, Aichi, Japan
| | - Yuichiro Hayashi
- Department of Intelligent Systems, Nagoya University Graduate School of Informatics, Aichi, Japan
| | - Masahiro Oda
- Information Strategy Office, Information and Communications, Nagoya University, Aichi, Japan
| | - Takahisa Suzuki
- Department of Gastroenterology, Toyota Memorial Hospital, Aichi, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
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Wu Z, Xiao G, Wang G, Xiong L, Qiu P, Tan S. Effects of Somatostatin and Indomethacin Mono or Combination Therapy on High-risk Hyperamylasemia and Post-pancreatitis Endoscopic Retrograde Cholangiopancreatography Patients: A Randomized Study. Surg Laparosc Endosc Percutan Tech 2023; 33:474-479. [PMID: 37523580 PMCID: PMC10545056 DOI: 10.1097/sle.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/17/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive technique widely used to diagnose and treat pancreatic and biliary diseases; however, it is linked with imminent hyperamylasemia and post-ERCP pancreatitis (PEP). Somatostatin and indomethacin are the classic recommended drugs used for PEP prevention. OBJECTIVE To elucidate the effects of somatostatin and indomethacin mono or in combination to prevent hyperamylasemia and PEP in high-risk individuals. METHODS Altogether 1458 patients who underwent ERCP in our hospital from January 2016 to May 2022 were included in this investigation and categorized into 4 groups based on the treatment regimen: placebo, indomethacin, somatostatin, and indomethacin + somatostatin. The pre operation and post operation (at 6, 12, and 24 h) hospitalization cost, length of stay, the occurrence of hyperamylasemia and PEP, levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-8, and VAS pain score were determined in the 4 groups. In all the groups, VAS and IL-6, TNF-α, and IL-8 levels substantially increased in the pretreatment and decreased sequentially from 6 to 24 h post operation. The individuals in the indomethacin revealed substantially reduced hyperamylasemia, VAS, and levels of IL-6, TNF-α, and IL-8, 6 h post operation, whereas the hospitalization fee, length of stay, PEP incidence, VAS, levels of IL-6, TNF-α, and IL-8, 12 and 24 h post operation were not statistically important in comparison with the individuals who received placebo therapy. The somatostatin and the indomethacin + somatostatin groups indicated markedly alleviated hospitalization fee, length of stay, the occurrence of hyperamylasemia and PEP, VAS, and the levels of IL-6, TNF-α, and IL-8 at 6, 12, and 24 h post operation compared with the placebo cohort. Furthermore, compared with the indomethacin group, the above-determined factors notably reduced at 6, 12, and 24 h post operation in somatostatin and indomethacin + somatostatin groups. It was also observed that the indomethacin + somatostatin group has substantially decreased the occurrence of hyperamylasemia, VAS score, and levels of IL-6, TNF-α, and IL-8, 6 hours post operation, while at 12 and 24 h post operation, the hospitalization fee, length of stay and incidence of PEP, VAS, levels of IL-6, TNF-α, and IL-8 were not statistically important compared with the somatostatin group. It is also worth noting that the side effects of both drugs are rare and mild. RESULTS For high-risk PEP patients, indomethacin and somatostatin can efficiently alleviate post-operative hyperamylasemia and improve their life standard within 6 hours and 24 hours, respectively. Indomethacin is suitable for individuals who underwent simple, short-duration ERCP with expected mild post-operative abdominal pain, whereas somatostatin is given to patients with complicated, long-duration ERCP and expected severe post-operative abdominal pain. Their combinational therapy produces a synergistic effect and can reduce the incidence of hyperamylasemia, thereby improving patients' quality of life within 6 h and is also effective against individuals who received a more complicated, longer-duration ERCP and were expected to have severer and longer post-operative abdominal pain.
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Affiliation(s)
- Zaoxuan Wu
- Department of Digestive Internal Medicine, Southern Medical University Pingxiang Hospital, Pingxiang, People’s Republic of China
| | - Gui Xiao
- Department of International School of Nursing, Hainan Medical University, Haikou, People’s Republic of China
| | - Guiliang Wang
- Department of Digestive Internal Medicine, Southern Medical University Pingxiang Hospital, Pingxiang, People’s Republic of China
- Department of Pathophysiology, Laboratory of Shock, Xiangya School of Medicine, Central South University, Changsha, Hunan, People’s Republic of China
| | - Liumei Xiong
- Department of Digestive Internal Medicine, Southern Medical University Pingxiang Hospital, Pingxiang, People’s Republic of China
| | - Ping Qiu
- Department of Digestive Internal Medicine, Southern Medical University Pingxiang Hospital, Pingxiang, People’s Republic of China
| | - Sipin Tan
- Department of Pathophysiology, Laboratory of Shock, Xiangya School of Medicine, Central South University, Changsha, Hunan, People’s Republic of China
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Predictive factors of needle-knife pre-cut papillotomy failure in patients with difficult biliary cannulation. Sci Rep 2022; 12:4942. [PMID: 35322178 PMCID: PMC8943021 DOI: 10.1038/s41598-022-09117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/15/2022] [Indexed: 02/08/2023] Open
Abstract
Predictors of needle-knife pre-cut papillotomy (NKP) failure for patients with difficult biliary cannulation has not been reported. Between 2004 and 2016, 390 patients with difficult biliary cannulation undergoing NKP were included in this single-center study. Following NKP, deep biliary cannulation failed in 95 patients (24.4%, NKP-failure group) and succeeded in 295 patients (75.6%, NKP-success group). Patient and technique factors were used to identify the predictors of initial NKP failure. Compared with the NKP-success group, periampullary diverticulum (28.4% vs. 18%, p = 0.028), surgically altered anatomy (13.7% vs. 7.1%, p = 0.049), number of cases performed by less experienced endoscopists, and bleeding during NKP (38.9% vs. 3.4%, p < 0.001), were significantly more frequent in the NKP-failure group. On multivariate analysis, surgically altered anatomy (OR 2.374, p = 0.045), endoscopists’ experience (OR 3.593, p = 0.001), and bleeding during NKP (OR 21.18, p < 0.001) were significantly associated with initial failure of NKP. In conclusion, NKP is a highly technique-sensitive procedure, as endoscopists’ experience, bleeding during NKP, and surgically altered anatomy were predictors of initial NKP failure.
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Cheng C, Tang K, Cheng S, Fang H, Shiue S, Suk F, Lien G, Wu M. Comparison of endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy in clearing large common bile duct stones: A systematic review and meta‐analysis of randomized controlled trials. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chao‐Ling Cheng
- Graduate Institute of Clinical Medicine, College of Medicine Taipei Medical University Taipei Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Kung‐Pei Tang
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Sheng‐Wei Cheng
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Hua‐Chen Fang
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Sheng‐Jie Shiue
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Fat‐Moon Suk
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Gi‐Shih Lien
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Ming‐Shun Wu
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
- Integrative Therapy Center for Gastroenterologic Cancers, Wan Fang Hospital Taipei Medical University Taipei Taiwan
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Wu ZX, Wang GL, Qiu P, Gong M, Li X, Wen JB. Selective indications of indomethacin and somatostatin, alone or in combination, and their preventive effects in patients at high risk for post-ERCP pancreatitis. Shijie Huaren Xiaohua Zazhi 2021; 29:1222-1229. [DOI: 10.11569/wcjd.v29.i21.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used minimally invasive technique for the diagnosis and treatment of biliary and pancreatic disorders. However, some patients may suffer post-ERCP pancreatitis (PEP). Somatostatin and indomethacin are the classical drugs for the prevention of PEP. There is still controversy over the use of somatostatin and indomethacin, alone or in combination, in this context.
AIM To investigate the selective indications of indomethacin and somatostatin, alone or in combination, and their preventive effects in patients at high risk for PEP.
METHODS A prospective analysis was performed on 729 patients at high risk for PEP at our hospital from January 2017 to December 2020. They were randomly divided into four groups according to factorial design: Placebo group, indomethacin group, somatostatin group, and indomethacin + somatostatin group. Hyperamylasemia, PEP, visual analogue scale (VAS) score, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and IL-8 concentrations, and the incidence of side effects were compared among the four groups.
RESULTS Compared with the placebo group, the incidence of PEP, hospitalization cost, and length of hospital stay showed no significant difference, but the incidence of hyperamylasemia, VAS score within 6 h after operation, and the TNF-α, IL-6 and IL-8 concentrations significantly decreased in the indomethacin group. Compared with the placebo group or indomethacin group, hospitalization cost, hospitalization time, the incidence of hyperamylasemia, the incidence of PEP, VAS score at 6 h, 12 h, and 24 h after operation, and the TNF-α, IL-6, and IL-8 concentrations after operation significantly decreased in the somatostatin group. Compared with the indomethacin + somatostatin group, the cost of hospitalization, length of hospitalization, incidence of hyperamylase blood, incidence of PEP, VAS score at 6 h, 12 h and 24 h after operation, and the TNF-α, IL-6 and IL-8 concentrations after operation significantly decreased in the indomethacin + somatostatin group. Compared with the somatostatin group, the incidence of PEP, hospitalization cost, and length of hospital stay in the indomethacin + somatostatin group showed no significant difference, but the incidence of hyperamylasemia, VAS score, and TNF-α, IL-6, and IL-8 concentrations within 6 h after operation significantly decreased. The VAS and TNF-α, IL-6, and IL-8 concentrations at 12 h to 24 h after operation showed no statistically significant differences.
CONCLUSION For patients at high risk for PEP, indomethacin can reduce the incidence of postoperative hyperamylasemia and improve the quality of life of patients in a short period of time. It is suitable for patients undergoing simple, short-duration ERCP procedure with expected mild postoperative abdominal pain. Somatostatin can reduce the incidence of postoperative hyperamylasemia, improve the patients' quality of life and the incidence of PEP over a long period of time, and reduce the cost of hospitalization. It is suitable for patients with complicated, long-duration ERCP operation with expected severe postoperative abdominal pain. The combination of indomethacin and somatostatin has a synergistic effect in reducing the incidence of hyperamylasemia and improving patients' quality of life within 6 h after operation, and it is suitable for patients with more complicated, longer-duration ERCP operation with expected severe and longer postoperative abdominal pain.
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Affiliation(s)
- Zao-Xuan Wu
- Department of Gastroenterology, Southern Medical University Affiliated Pingxiang Hospital, Pingxiang 337000, Jiangxi Province, China
| | - Gui-Liang Wang
- Department of Gastroenterology, Southern Medical University Affiliated Pingxiang Hospital, Pingxiang 337000, Jiangxi Province, China
| | - Ping Qiu
- Department of Gastroenterology, Southern Medical University Affiliated Pingxiang Hospital, Pingxiang 337000, Jiangxi Province, China
| | - Min Gong
- Department of Gastroenterology, Southern Medical University Affiliated Pingxiang Hospital, Pingxiang 337000, Jiangxi Province, China
| | - Xing Li
- Department of Gastroenterology, Southern Medical University Affiliated Pingxiang Hospital, Pingxiang 337000, Jiangxi Province, China
| | - Jian-Bo Wen
- Department of Gastroenterology, Southern Medical University Affiliated Pingxiang Hospital, Pingxiang 337000, Jiangxi Province, China
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Barreto SG, Habtezion A, Gukovskaya A, Lugea A, Jeon C, Yadav D, Hegyi P, Venglovecz V, Sutton R, Pandol SJ. Critical thresholds: key to unlocking the door to the prevention and specific treatments for acute pancreatitis. Gut 2021; 70:194-203. [PMID: 32973069 PMCID: PMC7816970 DOI: 10.1136/gutjnl-2020-322163] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/01/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
Abstract
Acute pancreatitis (AP), an acute inflammatory disorder of the exocrine pancreas, is one of the most common gastrointestinal diseases encountered in emergency departments with no specific treatments. Laboratory-based research has formed the cornerstone of endeavours to decipher the pathophysiology of AP, because of the limitations of such study in human beings. While this has provided us with substantial understanding, we cannot answer several pressing questions. These are: (a) Why is it that only a minority of individuals with gallstones, or who drink alcohol excessively, or are exposed to other causative factors develop AP? (b) Why do only some develop more severe manifestations of AP with necrosis and/or organ failure? (c) Why have we been unable to find an effective therapeutic for AP? This manuscript provides a state-of-the-art review of our current understanding of the pathophysiology of AP providing insights into the unanswered clinical questions. We describe multiple protective factors operating in most people, and multiple stressors that in a minority induce AP, independently or together, via amplification loops. We present testable hypotheses aimed at halting progression of severity for the development of effective treatments for this common unpredictable disease.
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Affiliation(s)
- Savio George Barreto
- Division of Surgery and Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Aida Habtezion
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Anna Gukovskaya
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Medicine, West Los Angeles VA Healthcare Center, Los Angeles, California, USA
| | - Aurelia Lugea
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Christie Jeon
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhiraj Yadav
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter Hegyi
- First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine and First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Viktória Venglovecz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Robert Sutton
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Stephen J Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Nawaz MH, Sarwar S, Nadeem MA. Post-ERCP Pancreatitis: Risk factors and role of NSAIDs in primary prophylaxis. Pak J Med Sci 2020; 36:426-431. [PMID: 32292447 PMCID: PMC7150400 DOI: 10.12669/pjms.36.3.1804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: To determine efficacy of diclofenac suppository in reducing post-ERCP pancreatitis (PEP) and identify risk factors for PEP. Methods: This is a placebo-based prospective study at Department of Medicine & Gastroenterology, Services Institute of Medical Sciences / Services Hospital, Lahore performed from January 2018 to June 2019. Patients were randomized to receive diclofenac suppository or glycerine suppository before ERCP. Both groups were compared for PEP using chi square x2 test while risk factors for PEP were determined using binary logistic regression. Results: Total of 165 patients with mean age 49.1(±15.2) and male to female ratio 1/1.6 (63/102) were included. Among 82 (49.7%) patients in diclofenac group, 8 (9.7%) developed pancreatitis while 19(22.9%) of 83(50.3%) in placebo group had PEP (p value 0.02). After multivariate analysis, age>45 years (p value 0.014, OR 3.2), Bilirubin >3 mg/dl (p value 0.004 OR 3.58), time to cannulation> 5 minutes (p value<0.000 OR 9.2), use of precut (p value< 0.000 OR 4.9), pancreatic duct cannulation (p value 0.000 OR 5.46) and total procedure time >30 minutes (p value 0.01 OR 3.92) were risk factors for PEP. Conclusion: Pre-procedure Diclofenac suppository reduces post-ERCP pancreatitis. Age > 45 years, serum bilirubin > 3 mg/dl, cannulation time > 5 minutes, use of precut, pancreatic duct cannulation and procedure time > 30 minutes are risk factors for post-ERCP pancreatitis.
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Affiliation(s)
- Muhammad Haseeb Nawaz
- Dr. Muhammad Haseeb Nawaz, MBBS, Post Graduate Resident, Medical Unit-III, Department of Medicine & Gastroenterology, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Shahid Sarwar
- Dr. Shahid Sarwar, MBBS, FCPS (Med), FCPS (Gastroenterol), MCPS-HPE, FRCP (Edin) Associate Professor, Medical Unit-III, Department of Medicine & Gastroenterology, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Muhammad Arif Nadeem
- Prof. Dr. Muhammad Arif Nadeem MBBS, FCPS (Medicine), Medical Unit-III, Department of Medicine & Gastroenterology, Services Institute of Medical Sciences, Lahore, Pakistan
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High-dose NSAIDs and pancreatitis after ERCP: more is not always better. Lancet Gastroenterol Hepatol 2019; 5:95-97. [PMID: 31780276 DOI: 10.1016/s2468-1253(19)30359-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 10/14/2019] [Indexed: 12/11/2022]
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Lyu Y, Wang B, Cheng Y, Xu Y, Du W. Comparative Efficacy of 9 Major Drugs for Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: A Network Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2019; 29:426-432. [DOI: 10.1097/sle.0000000000000707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Pekgöz M. Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment. World J Gastroenterol 2019; 25:4019-4042. [PMID: 31413535 PMCID: PMC6689803 DOI: 10.3748/wjg.v25.i29.4019] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/19/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided.
AIM To study the published evidence and systematically review the literature on the prevention and treatment for PEP.
METHODS A systematic literature review on the prevention of PEP was conducted using the electronic databases of ISI Web of Science, PubMed and Cochrane Library for relevant articles. The electronic search for the review was performed by using the search terms “Post endoscopic retrograde cholangiopancreatography pancreatitis” AND “prevention” through different criteria. The search was restricted to randomized controlled trials (RCTs) performed between January 2009 and February 2019. Duplicate studies were detected by using EndNote and deleted by the author. PRISMA checklist and flow diagram were adopted for evaluation and reporting. The reference lists of the selected papers were also scanned to find other relevant studies.
RESULTS 726 studies meeting the search criteria and 4 relevant articles found in the edited books about ERCP were identified. Duplicates and irrelevant studies were excluded by screening titles and abstracts and assessing full texts. 54 studies were evaluated for full text review. Prevention methods were categorized into three groups as (1) assessment of patient related factors; (2) pharmacoprevention; and (3) procedural techniques for prevention. Most of studies in the literature showed that young age, female gender, absence of chronic pancreatitis, suspected Sphincter of Oddi dysfunction, recurrent pancreatitis and history of previous PEP played a crucial role in posing high risks for PEP. 37 studies designed to assess the impact of 24 different pharmacologic agents to reduce the development of PEP delivered through various administration methods were reviewed. Nonsteroidal anti-inflammatory drugs are widely used to reduce risks for PEP. Rectal administration of indomethacin immediately prior to or after ERCP in all patients is recommended by European Society for Gastrointestinal Endoscopy guidelines to prevent the development of PEP. The majority of the studies reviewed revealed that rectally administered indomethacin had efficacy to prevent PEP. Results of the other studies on the other pharmacological interventions had both controversial and promising results. Thirteen studies conducted to evaluate the efficacy of 4 distinct procedural techniques to prevent the development of PEP were reviewed. Pancreatic Stent Placement has been frequently used in this sense and has potent and promising benefits in the prevention of PEP. Studies on the other procedural techniques have had inconsistent results.
CONCLUSION Prevention of PEP involves multifactorial aspects, including assessment of patients with high risk factors for alternative therapeutic and diagnostic techniques, administration of pharmacological agents and procedural techniques with highly precise results in the literature.
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Affiliation(s)
- Murat Pekgöz
- Department of Gastroenterology, VM Medical Park Bursa Hospital, Bursa 16022, Turkey
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Li DF, Zhou CH, Wang LS, Yao J, Zou DW. Is ERCP-BD or EUS-BD the preferred decompression modality for malignant distal biliary obstruction? A meta-analysis of randomized controlled trials. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:953-960. [DOI: 10.17235/reed.2019.6125/2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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