Pancreatitis endoscopic retrograde cholangiopancreatography

Only one study to date has been conducted on the treatment of acute pancreatitis with antioxidants. Clemens et al. (1991) were unable to show any difference in the incidence or severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in a prospective, randomized, double-blind, placebo-controlled trial of allopurinol. However, Salim (1991) performed a similar trial of the effect of allopurinol and DMSO in patients with pain from recurrent pancreatitis, and found significant benefit. On the basis that depletion of antioxidants is important in the pathogenesis of chronic pancreatitis, the administration of a cocktail of antioxidants was assessed for its effect on pain in this disease. Treatment with a combination of organic selenium, d-carotene, vitamins C and E, and methionine was of benefit in the initial pilot study, and in a placebo-controlled trial (San-dilands etal., 1990 Uden et al., 1990). 

O In the Western hemisphere, acute pancreatitis is caused mainly by ethanol use/abuse and gallstones. Other common causes of acute pancreatitis include hypertriglyceridemia, endoscopic retrograde cholangiopancreatography (ERCP), and autodigestion due to early activation of pancreatic enzymes. Numerous medications have also been implicated as causes of acute pancreatitis (Table 20-1). 

FIGURE 20-2. Algorithm for evaluation and treatment of acute pancreatitis. ERCP, endoscopic retrograde cholangiopancreatography. (From Berardi RR, Montgomery PA. Pancreatitis. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 726, with permission.)... 

FIGURE 28-1. Algorithm of guidelines for evaluation and treatment of acute pancreatitis. (ERCP, endoscopic retrograde cholangiopancreatography.)... 

Removal of biliary tract gallstones with endoscopic retrograde cholangiopancreatography or surgery usually resolves AP and reduces the risk of recurrence. Surgery may be indicated in AP to treat pseudocyst, pancreatic abscess, and to drain the pancreatic bed if hemorrhagic or necrotic material is present. 

Ayub K, Imada R, Slavin J. Endoscopic retrograde cholangiopancreatography in gallstone-associated acute pancreatitis. Cochrane Database Syst Rev 2004. 

D7. Dieviere, J., Moine, O., VanLaethem, J.L.,Eisendrath, P., Ghilain, A., Severs, N., andCohard, M., Interleukin 10 reduces the incidence of pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography. Gastroenterology 120, 498-505 (2001). 

Goebel C, Hardt P, Doppl W, Temme H, Hackstein N, Klor HU. Frequency of pancreatitis after endoscopic retrograde cholangiopancreatography with iopromid or iotro-lan a randomized trial. Eur Radiol 2000 10(4) 677-80. 

Endoscopic retrograde cholangiopancreatography is used to visualize and remove bile duct stones in patients with gallstone pancreatitis. 

The concentrations of GST in normal bile have been compared with the concentrations of the enzymes found in bile obtained using endoscopic retrograde cholangiopancreatography from two patients with cholangiocarcinoma and one patient with pancreatic cancer (H53). The concentrations of B, and Bj were not significantly different in the cancer patients when compared with concentrations... 

Michael was scheduled for endoscopic retrograde cholangiopancreatography (ERCP). (An ERCP involves cannulation of the common bile duct—and, if necessary, the pancreatic duct— through a tube placed through the mouth and stomach and into the upper small intestine.) With this technique, a stone can be snared in the common duct and removed to relieve an obstruction. 

In a review of 17 studies in 3618 patients of somatostatin and octreotide prophylaxis for pancreatitis during endoscopic retrograde cholangiopancreatography (ERCP), there was minimal information on adverse events, but there was one case of an allergic reaction [68 ]. 

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