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Incidence of post-ERCP pancreatitis from direct pancreatic juice collection in hereditary pancreatitis and familial pancreatic cancer before and after the introduction of prophylactic pancreatic stents and rectal diclofenac.
Nicholson, James A; Greenhalf, William; Jackson, Richard; Cox, Trevor F; Butler, Jane V; Hanna, Thomas; Harrison, Sara; Grocock, Christopher J; Halloran, Christopher M; Howes, Nathan R; Raraty, Michael G; Ghaneh, Paula; Johnstone, Marianne; Sarkar, Sanchoy; Smart, Howard L; Evans, Jonathan C; Aithal, Guruprasad P; Sutton, Robert; Neoptolemos, John P; Lombard, Martin G.
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  • Nicholson JA; From the *National Institute for Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital; †Liverpool Clinical Trials Unit; Departments of ‡Gastroenterology, and §Radiology, Royal Liverpool University Hospital, Liverpool; and ║Digestive Diseases Biomedical Research Unit, National Institute for Health Research Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.
Pancreas ; 44(2): 260-5, 2015 Mar.
Article en En | MEDLINE | ID: mdl-25438071
OBJECTIVES: Individuals from hereditary pancreatitis (HP) and familial pancreatic cancer (FPC) kindreds are at increased risk of developing pancreatic cancer. Premalignant molecular changes may be detected in pancreatic juice collected by endoscopic retrograde cholangiopancreatography (ERCP). The objective was to determine the risk of post-ERCP pancreatitis (PEP). METHODS: A prospective study (1999-2013) was undertaken of 80 ERCPs (24 in HP and 56 in FPC) from 60 individuals and the impact of PEP prophylaxis using a self-expelling pancreatic stent and 50 mg diclofenac per rectum from 2008. RESULTS: There was no PEP in the HP cohort and 13 (23.2%) PEP from 56 procedures in the FPC cohort (P = 0.0077). Up to 2008 PEP had occurred in 7 (43.8%) of 16 procedures in FPC individuals versus none of 18 procedures in HP individuals (P = 0.0021). After the introduction of prophylaxis, the incidence of PEP fell to 6 (15.0%) of 40 procedures in FPC individuals (P = 0.0347).The odds ratio (95% confidence interval) was 0.23 (0.06-0.84) in favor of prophylaxis (0.035). CONCLUSIONS: Individuals with HP are at minimal risk for PEP. Although the risk of PEP in individuals with FPC can be reduced by using prophylactic self-expelling stents and diclofenac, it remains too high for routine screening.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Jugo Pancreático / Neoplasias Pancreáticas / Pancreatitis / Stents / Antiinflamatorios no Esteroideos / Diclofenaco / Colangiopancreatografia Retrógrada Endoscópica / Pancreatitis Crónica Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Pancreas Asunto de la revista: GASTROENTEROLOGIA Año: 2015 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Jugo Pancreático / Neoplasias Pancreáticas / Pancreatitis / Stents / Antiinflamatorios no Esteroideos / Diclofenaco / Colangiopancreatografia Retrógrada Endoscópica / Pancreatitis Crónica Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Pancreas Asunto de la revista: GASTROENTEROLOGIA Año: 2015 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos