NSAIDs预防内镜逆行胰胆管造影术后胰腺炎的研究进展

Somatostatin versus endoscopic nasal biliary drainage in the prevention of post-ERCP pancreatitis and hyperamylasemia

AIM: To investigate the preventive effect of somatostatin versus endoscopic nasal biliary drainage (ENBD) on post-ERCP pancreatitis (PEP) and hyperamylasemia.

METHODS: A total of 110 patients were enrolled and randomly divided into 3 groups to receive somatostatin, ENBD or placebo. Incidences of PEP, hyperamylasemia and adverse reactions were observed.

RESULTS: The overall incidences of PEP and hyperamylasemia were 17.2% (19/110) and 4.54% (5/110), respectively. The levels of serum amylase at 6 h in the somatostatin group and ENBD group were significantly lower than that in the control group (467 IU/L ± 63 IU/L 501 IU/L ± 405 IU/L vs 1 323 IU/L ± 46 IU/L, both P < 0.05), while the levels of serum amylase at 24 h showed no significant differences among the three groups (P > 0.05). The time to disappearance of abdominal symptoms, the time to recovery of blood parameters, and average length of hospital stay in the somatostatin group and ENBD group were significantly shorter than those in the control group (all P < 0.05). The costs were significantly lower in the somatostatin group than in the ENBD group (P < 0.05).

CONCLUSION: Both somatostatin and ENBD can effectively prevent post-ERCP pancreatitis and hyperamylasemia, and somatostatin is associated with lower medical expenses.

Advances in understanding the role of cytokines in the pathogenesis of acute pancreatitis after endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool for the diagnosis and treatment of pancreatobiliary disease. Acute pancreatitis (AP) is the most common complication of ERCP. The pathogenesis of post-ERCP AP has not been completely elucidated. Recent studies suggest that inflammatory cytokines play an important role in the evolution of AP from mild to severe form. Identification of specific proinflammatory markers that can rapidly and reliably predict the progression of post-ERCP pancreatitis has been a major focus of research. Attempts to block the inflammatory cascade have been carried out by using an anti-inflammatory cytokine in some clinical trials. In this article, we will review the recent advances in understanding the role of cytokines in the pathogenesis of post-ERCP AP.