Clinical Study of Early Endoscopic Management for 46 Patients with Acute Biliary Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIN Anqin , HUANG Xiaojun , WANG Wei , FENG Yanhu , LIU Ziyan.

The Second Hospital of Lanzhou University, Gansu Province Key Laboratory of Digestive Tumors, Lanzhou 730030, ChinaCorresponding Author: HUANG Xiao-jun, E-mail： huangxj62@163.com;

Corresponding author：

Keywords：

Acute biliary pancreatitis; ERCP; Endoscope

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Objective 　To study the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) and early endoscopic management for acute biliary pancreatitis.
Methods 　Ninety-one patients with acute biliary pancreatitis were divided into ERCP group (46 cases) and control group (45 cases) according to the therapy methods. All patients were given positive conventional treatment, the patients of the ERCP group accepted endoscopic therapy within 48 h after hospitalization. The curative effects of two groups were observed, and the related indexes, such as time of abdominal pain relief, temperature to normal, leukocytes to normal, liver function to normal, 　average time in hospital, and mortality were compared between two groups.
Results 　Among 46 patients by ERCP diagnosis, there were 27 cases of common duct stone (CDS), 6 cases of cholecystolithiasis, 3 cases of great diverticulum at duodenal papilla side, 4 cases of suppurative cholangitis, 3 cases of stenosis in bile common duct inferior 　segment and 3 cases of no abnormality. Among 27 cases of CDS, 20 patients had endoscopic sphincterotomy (EST), 4 had duodenal 　papilla artifistulation, 20 had calculus removed by once basket and aerocyst, and 7 patients with suppurative cholangitis and great stone saccepted EST or macadam after stabilization. The cases of great diverticulum at duodenal papilla side and cases of stenosis in bile common duct inferior segment accepted EST, the cases of suppurative cholangitis 　accepted endoscopic nasobiliary drainage (ENBD), and all accepted ENBD. The time of abdominal pain relief, temperature to normal, leukocytes to normal, liver function to normal, and the average time in hospital in the 　ERCP group were significantly shorter than those in the control group (P lt;0.05). The blood 　amylase to normal time and mortality had no significant differences between two groups (P gt;0.05).
Conclusion 　The early endoscopic management for patients with acute biliary pancreatitis can clear etiology, reduce the time in hospital and be minimally invasive, safe, and effective.

Citation： JIN Anqin,HUANG Xiaojun,WANG Wei,FENG Yanhu,LIU Ziyan.. Clinical Study of Early Endoscopic Management for 46 Patients with Acute Biliary Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(10): 1001-1005. doi: Copy

1.	龚锦文, 周桂霞, 王惠玲. 早期临床干预策略在阻断胰腺炎重症化进程中的作用 [J]. 中国普外基础与临床杂志, 2009; 16(10): 838-840.
2.	中华医学会外科病学分会胰腺外科学组. 重症急性胰腺炎诊治草案 [J]. 中华消化杂志, 2001; 21(10): 622-623.
3.	董亮, 康焰. 早期肠内营养在重症急性胰腺炎治疗中的应用 [J]. 中国普外基础与临床杂志, 2008; 15(8): 567-570.
4.	祝伊琳, 陈江华. 连续性血液净化治疗急性重症胰腺炎的进展 [J]. 国际移植与血液净化杂志, 2007; 5(2): 1-4.
5.	张文俊, 李兆申, 许国铭, 等. 短期腹腔灌洗对重症急性胰腺炎的治疗价值 [J]. 胃肠病学, 2004; 9(6): 344-346.
6.	姚欣敏, 刘牧, 李云涛, 等. 早期反复间断血滤治疗重症急性胰腺炎的临床研究 [J]. 中国普外基础与临床杂志, 2008; 15(5): 352-357.
7.	姚欣敏, 李云涛, 黄德全, 等. 多种微创方法联合个体化治疗重症急性胰腺炎 [J]. 中国普外基础与临床杂志, 2010; 17(6): 586-590.
8.	曾普元, 殷相文, 周国华. ERCP 在急性胆源性胰腺炎中的应用 [J]. 中国内镜杂志, 2004; 10(10): 46-48.
9.	柴琛, 曹农, 李强, 等. 内镜治疗急性胆源性胰腺炎的系统评价 [J]. 世界华人消化杂志, 2010; 18(4): 404-408.
10.	于澜, 姚欣敏, 胡先典, 等. 经内镜治疗急性胆源性胰腺炎30例报道 [J]. 中国普外基础与临床杂志, 2007; 14(4): 396-398.
11.	中华医学会消化病学分会胰腺疾病学组.中国急性胰腺炎诊治指南(草案) [J]. 中华消化杂志, 2004; 24(3): 190-192.
12.	徐克成, 江石湖．消化病现代治疗 [M]. 上海: 上海科技教育出版社, 2001: 574.
13.	Ricci F, Castaldini G, de Manzoni G, et al. Treatment of gallstone pancreatitis: six-year experience in a single center [J]. World J Surg, 2002; 26(1): 85-90.
14.	Kaw M, Al-Antably Y, Kaw P. Management of gallstone pancreatitis: cholecystectomy or ERCP and endoscopic sphincterotomy [J]. Gastrointest Endosc, 2002; 56(1): 61-65.
15.	柏愚, 李兆申. 急性胆源性胰腺炎内镜治疗进展 [J]. 胰腺病学, 2006; 6(1): 58-61．.
16.	Neoptolemos JP, Carr-Locke DL, London NJ, et al. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones [J]. Lancet, 1988; 2(8618): 979-983.
17.	Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health State-of-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14-16, 2002 [J]. Gastrointest Endosc, 2002; 56(6): 803-809.
18.	Working Party of the British Society of Gastroenterology; Association of Surgeons of Great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of Upper GI Surgeons of Great Britain and Ireland. UK guidelines for the management of acute pancreatitis [J]. Gut, 2005; 54(Suppl Ⅲ): iii1-iii9.
19.	Isogai M, Yamaguchi A, Harada T, et al. Cholangitis score: a scoring system to predict severe cholangitis in gallstone pancreatitis [J]. J Hepatobiliary Pancreat Surg, 2002; 9(1): 98-104.
20.	许洪伟, 徐麟, 冯凯, 等．经内镜治疗急性胆源性胰腺炎的临床价值 [J]. 中华消化杂志, 2007; 24(6): 427-430．.
21.	Shah RJ, Martin SP. Endoscopic retrograde cholangiopancreatography in the diagnosis and management of pancreatic diseases [J]. Curr Gastroenterol Rep, 2000; 2(2): 133-145.
22.	Fiocca F, Santagati A, Ceci V, et al. ERCP and acute pancreatitis [J]. Eur Rev Med Pharmacol Sci, 2002; 6(1): 13-17.
23.	Besselink MG, van Minnen LP, van Erpecum KJ, et al. Beneficial effects of ERCP and papillotomy in predicted severe biliary pancreatitis [J]. Hepatogastroenterology, 2005; 52(61): 37-39.
24.	蔡雪军. 内镜治疗急性胆源性胰腺炎36例疗效分析 [J]. 临床和实验医学杂志, 2008; 7(7): 57-58.
25.	刘宇斌, 周子浩, 王卫东, 等. 急诊内镜技术在重型急性胆源性胰腺炎早期治疗中的应用 [J]. 实用医学杂志, 2005; 21(18): 2066-2067.

1. 　龚锦文, 周桂霞, 王惠玲. 早期临床干预策略在阻断胰腺炎重症化进程中的作用 [J]. 中国普外基础与临床杂志, 2009; 16(10): 838-840.
2. 　中华医学会外科病学分会胰腺外科学组. 重症急性胰腺炎诊治草案 [J]. 中华消化杂志, 2001; 21(10): 622-623.
3. 　董亮, 康焰. 早期肠内营养在重症急性胰腺炎治疗中的应用 [J]. 中国普外基础与临床杂志, 2008; 15(8): 567-570.
4. 　祝伊琳, 陈江华. 连续性血液净化治疗急性重症胰腺炎的进展 [J]. 国际移植与血液净化杂志, 2007; 5(2): 1-4.
5. 　张文俊, 李兆申, 许国铭, 等. 短期腹腔灌洗对重症急性胰腺炎的治疗价值 [J]. 胃肠病学, 2004; 9(6): 344-346.
6. 　姚欣敏, 刘牧, 李云涛, 等. 早期反复间断血滤治疗重症急性胰腺炎的临床研究 [J]. 中国普外基础与临床杂志, 2008; 15(5): 352-357.
7. 　姚欣敏, 李云涛, 黄德全, 等. 多种微创方法联合个体化治疗重症急性胰腺炎 [J]. 中国普外基础与临床杂志, 2010; 17(6): 586-590.
8. 　曾普元, 殷相文, 周国华. ERCP 在急性胆源性胰腺炎中的应用 [J]. 中国内镜杂志, 2004; 10(10): 46-48.
9. 　柴琛, 曹农, 李强, 等. 内镜治疗急性胆源性胰腺炎的系统评价 [J]. 世界华人消化杂志, 2010; 18(4): 404-408.
10. 　于澜, 姚欣敏, 胡先典, 等. 经内镜治疗急性胆源性胰腺炎30例报道 [J]. 中国普外基础与临床杂志, 2007; 14(4): 396-398.
11. 　中华医学会消化病学分会胰腺疾病学组.中国急性胰腺炎诊治指南(草案) [J]. 中华消化杂志, 2004; 24(3): 190-192.
12. 　徐克成, 江石湖．消化病现代治疗 [M]. 上海: 上海科技教育出版社, 2001: 574.
13. 　Ricci F, Castaldini G, de Manzoni G, et al. Treatment of gallstone pancreatitis: six-year experience in a single center [J]. World J Surg, 2002; 26(1): 85-90.
14. 　Kaw M, Al-Antably Y, Kaw P. Management of gallstone pancreatitis: cholecystectomy or ERCP and endoscopic sphincterotomy [J]. Gastrointest Endosc, 2002; 56(1): 61-65.
15. 　柏愚, 李兆申. 急性胆源性胰腺炎内镜治疗进展 [J]. 胰腺病学, 2006; 6(1): 58-61．.
16. 　Neoptolemos JP, Carr-Locke DL, London NJ, et al. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones [J]. Lancet, 1988; 2(8618): 979-983.
17. 　Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health State-of-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14-16, 2002 [J]. Gastrointest Endosc, 2002; 56(6): 803-809.
18. 　Working Party of the British Society of Gastroenterology; Association of Surgeons of Great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of Upper GI Surgeons of Great Britain and Ireland. UK guidelines for the management of acute pancreatitis [J]. Gut, 2005; 54(Suppl Ⅲ): iii1-iii9.
19. 　Isogai M, Yamaguchi A, Harada T, et al. Cholangitis score: a scoring system to predict severe cholangitis in gallstone pancreatitis [J]. J Hepatobiliary Pancreat Surg, 2002; 9(1): 98-104.
20. 　许洪伟, 徐麟, 冯凯, 等．经内镜治疗急性胆源性胰腺炎的临床价值 [J]. 中华消化杂志, 2007; 24(6): 427-430．.
21. 　Shah RJ, Martin SP. Endoscopic retrograde cholangiopancreatography in the diagnosis and management of pancreatic diseases [J]. Curr Gastroenterol Rep, 2000; 2(2): 133-145.
22. 　Fiocca F, Santagati A, Ceci V, et al. ERCP and acute pancreatitis [J]. Eur Rev Med Pharmacol Sci, 2002; 6(1): 13-17.
23. 　Besselink MG, van Minnen LP, van Erpecum KJ, et al. Beneficial effects of ERCP and papillotomy in predicted severe biliary pancreatitis [J]. Hepatogastroenterology, 2005; 52(61): 37-39.
24. 　蔡雪军. 内镜治疗急性胆源性胰腺炎36例疗效分析 [J]. 临床和实验医学杂志, 2008; 7(7): 57-58.
25. 　刘宇斌, 周子浩, 王卫东, 等. 急诊内镜技术在重型急性胆源性胰腺炎早期治疗中的应用 [J]. 实用医学杂志, 2005; 21(18): 2066-2067.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study of Early Endoscopic Management for 46 Patients with Acute Biliary Pancreatitis

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