The effect of simple topical and intravenous general anesthesia on the occurrence of pancreatitis after ERCP surgery:a retrospective analysis / 临床外科杂志

Objective To investigate the effects of simple topical anesthesia and intravenous general anesthesia on the occurrence of pancreatitis after ERCP.Methods 400 Patients who underwent ERCP due to pancreaticobiliary duct disease in our hospital from January 2021 to March 2023 were selected and divided into two groups:Simple topical anesthesia group and intravenous general anesthesia group,200 cases in each group.The levels of venous pancreatic amylase and abdominal symptoms and signs were recorded in the two groups before operation and 3 h and 24 h after operation.The observation results were hyperamylaseemia and postoperative pancreatitis at 3 h and 24 h after operation.Results The incidence of postoperative pancreatitis after ERCP was higher in the superficial anesthesia group than in the intravenous general anesthesia group(7.5％and 2.0％,respectively;P＜0.05),there was statistical significance;The level of serum pancreatic amylase(198±216)U/L in intravenous general anesthesia group was significantly lower than that in superficial anesthesia group(379±327)U/L at 3h after surgery(P＜0.05).The level of serum pancreatic amylase(129±98)U/L in intravenous general anesthesia group was lower than that in superficial anesthesia group(187±156)at 24h after surgery(P＜0.05).The incidence of hyperamylasemia was 15.5％(31/200 cases)in the 3h postoperative intravenous general anesthesia group,lower than that in the simple surface anesthesia group(34.5％)(69/200 cases),and 5.5％(11/200 cases)in the 24h postoperative intravenous general anesthesia group,lower than that in the simple surface anesthesia group(19.0％)(38/200 cases)(P＜0.05).Conclusion Compared with simple surface anesthesia,intravenous general anesthesia can reduce the level of serum amylase after ERCP,and can reduce the occurrence of pancreatitis after ERCP.

Observation on the preventive effect of indwelling pancreatic duct guide wire through nasobiliary drainage tube for post-ERCP pancreatitis in cholelithiasis patients with small-caliber pancreatic duct / 中华肝胆外科杂志

Objective:To evaluate the preventive effect of indwelling pancreatic duct guide wire through nasobiliary drainage catheter for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in cholelithiasis patients with small-caliber pancreatic duct.Methods:The clinical data of 127 patients with gall bladder and common bile duct stones undergoing ERCP and elective laparoscopic cholecystectomy in the Cholelithiasis Center of Shanghai East Hospital Affiliated to Tongji University from January 2019 to June 2023 were analyzed retrospectively, including 55 males and 72 females, aged (56.95±10.86) years old. According to the preventive methods of PEP, patients were divided into the guide wire group (indwelling pancreatic duct guide wire through nasobiliary drainage catheter), stenting group (nasobiliary catheter with 5Fr 5 cm single pigtail pancreatic duct stent) and conventional group (nasobiliary catheter). The incidence of post-ERCP hyperamylasemia (PEH) and PEP were compared.Results:The incidence of PEH in the guide wire group was lower than that in the conventional group [17.8% (8/45) vs. 43.5% (10/23), P=0.023], and also lower than that in the stenting group [17.8% (8/45) vs. 32.2% (19/59)], despite no statistical significance ( P=0.337). The incidences of PEH were comparable in the stenting group and conventional group [32.2% (19/59) vs. 43.5% (10/23), P=0.096)]. The incidence of PEP in the guide wire group was lower than that in both the stenting group [6.7% (3/45) vs. 23.7% (14/59), P=0.030]. and conventional group [6.7% (3/45) vs. 30.4% (7/23), P=0.025]. The incidences of PEP were comparable in the stenting and conventional group [23.7% (14/59) vs. 30.4% (7/23), P=0.532]. Conclusion:Compared to the preventive pancreatic duct stenting, indwelling pancreatic duct guide wire through nasobiliary drainage catheter can effectively prevent the PEH and PEP in high-risk patients with a small-caliber pancreatic duct.

Macroamilasemia en el Hospital Víctor Lazarte Echegaray de Trujillo, Perú: reporte de un caso / Macroamylasemia at the Hospital Víctor Lazarte Echegaray in Trujillo (Peru): Case report

Resumen La macroamilasemia debe sospecharse en todo paciente con aumento catalítico de amilasa α plasmática persistente y sin clínica de dolor abdominal, descartando otras etiologías de patología pancreáticas y extrapancreática. La macroamilasemia se caracteriza por la unión de complejos de amilasa α con inmunoglobulina, más frecuente inmunoglobulina A; pueden presentarse 3 tipos de macroamilasemia. Es importante realizar el diagnóstico diferencial de otras patologías que puedan causar el aumento de la amilasa y así evitar los procedimientos innecesarios. Se presenta el caso de un paciente de 53 años, de sexo femenino, que ingresó a emergencia por clínica de dolor abdominal y hiperamilasemia, que fue diagnosticada inicialmente de pancreatitis aguda.

Abstract Macroamylasemia should be suspected in any patient with a persistent catalytic increase of plasma α-amylase but no other clinical signs of abdominal pain after ruling out other causes of pancreatic and extra-pancreatic disease. The binding of α-amylase complexes with immunoglobulin, most commonly immunoglobulin A, characterizes this condition. Macroamylasemia is classified into three kinds. To prevent unnecessary procedures, it is critical to make a differential diagnosis of other conditions that can cause amylase increase. The present article reports the case of a 53-year-old female patient who was admitted to the emergency room with abdominal pain and hyperamylasemia, who was initially diagnosed with acute pancreatitis.

Incidence rates of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting and related risk factors / 临床肝胆病杂志

ObjectiveTo investigate the clinical characteristics and risk factors of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting (PTBS). MethodsA retrospective analysis was performed for the clinical data of 249 patients with malignant biliary obstruction who were admitted to Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, and underwent PTBS from March 2016 to February 2020, and according to the presence or absence of postoperative hyperamylasemia or acute pancreatitis, the patients were divided into two groups to analyze incidence rate, severity, and related risk factors. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for the factors with P＜0.1 in the univariate analysis to investigate independent risk factors for hyperamylasemia and acute pancreatitis after PTBS. ResultsAfter PTBS, 55 patients (221%) patients had abnormally elevated serum amylase, among whom 26 (10.4%) were diagnosed with hyperamylasemia and 29 (11.7%) were diagnosed with acute pancreatitis. All patients with acute pancreatitis had mild manifestations. The multivariate logistic regression analysis showed that age ≤60 years (odds ratio ［OR］=2.2, 95% confidence interval ［CI］: 1.07-4.52, P=0033), iodine-125 seed strand implantation (OR=2.8, 95%CI: 1.21-6.45, P=0.016), biliary stent placement across the papilla (OR=6.3, 95%CI: 2.85-1405, P＜0.001), and visualization of the pancreatic duct during surgery (OR=13.9, 95%CI: 5.64-3403, P＜0.001) were risk factors for hyperamylasemia and acute pancreatitis after PTBS. ConclusionHyperamylasemia and acute pancreatitis are relatively common complications after PTBS. Age ≤60 years, iodine-125 seed strand implantation, biliary stent placement across the papilla, and visualization of the pancreatic duct during surgery are independence risk factors for hyperamylasemia and acute pancreatitis after PTBS.

Clinical significance of hyperamylasemia / 第二军医大学学报

Elevated serum amylase is a common clinical syndrome which can be caused by a variety of causes. Hyperamylasemia is diagnosed as elevation of serum amylase level 3 or more times of upper limit of the normal value, and there are no obvious clinical symptoms such as upper abdominal pain. Hyperamylasemia can occur in a variety of diseases. Isozyme analysis can improve the specificity of diagnosis and has high diagnostic value. Clinically, the patients with hyperamylasemia shall be examined properly to make a definite diagnosis and symptomatic treatment as soon as possible.

The impact of aging on post-ERCP pancreatitis and its severity / 中华肝胆外科杂志

Objective@#To study the impact of aging on pancreatic atrophy, fibrosis and exocrine hypofunction in patients with post-ERCP pancreatitis (PEP) and its severity.@*Methods@#A retrospective study was conducted on 786 patients who underwent ERCP at the Affiliated Zhongshan Hospital of Dalian University from June 2011 to April 2018. Patients who were aged over 75 years were grouped into the elderly group while those aged less than 75 years were grouped into the younger group. The incidences and severity of post-ERCP pancreatitis in the two groups were analyzed.@*Results@#In the elderly group, there were 308 patients. The average age was (81.8±4.8) years. In the younger group, there were 478 patients. The average age was (57.7±12.0) years. The average operation time for the elderly group was (52.5±14.1) minutes, and that for the younger group was (50.7±14.9) minutes. There were no significant differences in operation time and in the related factors between the two groups (P>0.05). There was no significant difference in the rates of hyperamylasemia between the two groups (29.9% vs 30.1%, P>0.05). The overall rate of PEP was 11.3% (89/786). In the elderly group, the rate of PEP was 6.5% (20/308), which was significantly lower than that in the younger group (χ2=11.765, P<0.05). The rates of mild, moderate and severe PEP in the elderly group was significantly lower than those in the younger group (all P<0.05). Hyperamylasemia and pancreatitis in the 2 groups were alleviated after conservative treatment.@*Conclusions@#Aging (≥75 years) resulted in pancreatic atrophy, fibrosis, exocrine hypofunction which had a protective effect on PEP.

The impact of aging on post-ERCP pancreatitis and its severity / 中华肝胆外科杂志

0bjective To study the impact of aging on pancreatic atrophy,fibrosis and exocrine hy-pofunction in patients with post.ERCP pancreatitis(PEP)and its severity.Methods A retrospective study was conducted on 786 patients who underwent ERCP at the Affiliated Zhongshan Hospital of Dalian Universi-ty from June 201 1 to April 2018.Patients who were aged over 75 years were grouped into the elderly group while those aged less than 75 years were grouped into the younger group.The incidences and severity of post-ERCP pancreatitis in the two groups were analyzed.Results In the elderly group,there were 308 patients.The average age was(8 1.8±4.8)years.In the younger group,there were 478 patients.The average age was(57.7±12.0)years.The average operation time for the elderly group was(52.5±14.1)minutes,and that for the younger group was(50.7±14.9)minutes.There were no significant differences in opera-tion time and in the related factors between the two groups(P＞0.05).There was no significant difference in the rates of hyperamylasemia between the two groups(29.9％vs 30.1％,P＞0.05).The overall rate of PEP was 11.3％(89/786).In the elderly group,the rate of PEP was6.5％(20/308),which was signifi-cantly lower than that in the younger group(x2=11.765,P＜0.05).The rates of mild,moderate and severe PEP in the elderly group was significantly lower than those in the younger group(all P＜0.05).Hyperamylasemia and pancreatitis in the 2 groups were alleviated after conservative treatment.Conclusions Aging(≥75 years)resulted in pancreatic atrophy,fibrosis,exocrine hypofunction which had a protective effect on PEP.

Analysis of prognostic factors for hyperamylasemia following pancreaticoduodenectomy / 中华外科杂志

Objective@#To investigate the prognostic factors of hyperamylasemia following pancreaticoduodenectomy (PD) .@*Methods@#Clinical data of 359 patients were collected prospectively who underwent PD by the same group at Changhai Hospital of Navy Medical University from January 2017 to June 2018.There were 212 males and 147 females.The median age was 63 years old (range: 23 to 82 years old) .According to whether the patient′s serum amylase was greater than 120 U/L at 0 or 1 day after surgery,the patients were divided into hyperamylasemia group and non-hyperamylasemia group. Univariate analysis and multivariate analysis were used to find out the prognostic factors of hyperamylasemia after PD.@*Results@#Of the 359 patients, 238 cases (66.3%) developed hyperamylasemia.The incidence rate of clinically related pancreatic fistula (15.1% vs.2.5%, P<0.01) , grade B/C post pancreatectomy hemorrhage (8.8% vs. 2.5%, P<0.01) , and surgical site infection (9.2% vs. 3.3%, P=0.04) was significantly higher in the hyperamylasemia group.The severity of complications (CD grade≥Ⅲ: 11.3% vs.4.1%, P=0.023) and postoperative hospital stay (11 days vs. 9 days, P=0.001) were higher in the hyperamylasemia group.In the multivariate analysis, the main pancreatic duct diameter (MPD) ≤3 mm (OR=4.469, 95% CI: 2.563-7.793, P<0.01) , pathological type of disease (pancreatic cancer or pancreatitis) (OR=0.230, 95% CI: 0.122-0.436, P<0.01) and soft texture of pancreas (OR=3.297, 95%CI: 1.930-5.635, P<0.01) were independent prognostic factors for hyperamylasemia.@*Conclusions@#Post-PD hyperamylasemia increased the incidence and severity of postoperative complications after PD.MPD≤3 mm, soft texture of pancreas and pathological type of disease were independent prognostic factors of hyperamylasemia.

The effect analysis of standardized nursing trainingin reducing the incidence rate of post-endoscopic retrograde cholangiopanography pancreatitis / 中国实用护理杂志

Objective To investigate the effectiveness and feasibility of standardized nursing training in reducing the incidence rate of post-endoscopic retrograde cholangiopanography(ERCP) pancreatitis. Methods A total of 521 patients were collected from January 2015 to June 2016 in ERCP therapy as control group.The patients in this group did not have standardized nursing training.A total of 289 patients were selected from July 2016 to April 2017 in ERCP therapy as intervention group.The patients in this group were carried out the standardized nursing training. The incidence of hyperamylasemia and post-ERCP pancreatitis was observed in two groups. Results The incidence of hyperamylasemia and post-ERCP pancreatitis was 12.09%(63/521),7.87%(41/521)in control group,and 7.61% (22/289), 3.11% (9/289) in intervention group,the difference was statistically significant between two groups(χ2=3.972,7.258,P<0.05 or 0.01). Conclusions The standard nursing training and intraoperative coordination can reduce its risk factors, and to reduce the post-ERCP pancreatitis and hyperamylasemia has important meaning and function.

Bayesian Network Meta-analysis of Somatostatin and Protease Inhibitors for the Prevention of Post-ERCP Pancreatitis and Hyperamylase / 中国药房

OBJECTIVE:To evaluate the clinical efficacy of somatostatin and protease inhibitors in the prevention of post-ERCP pancreatitis(PEP)and hyperamylasemia(PEHA). METHODS:Retrieved from databases as Cochrane Library, PubMed,Embase,RCTs about therapeutic efficacy of somatostatin and protease inhibitors in the prevention of PEP were included. EndNote X8 software was used to eliminate duplicate documents,and the quality of included studies was evaluated according to Cochrane System Evaluator Manual version 5.3.3. Bayesian network Meta-analysis was conducted by MCMC method with R 3.4.3 software Gemtc 0.8 program package. Risk of bias was evaluated by using Rev Man 5.3 software,and risk of publication was evaluated by using Stata 14.0 software draws funnel map. RESULTS:A total of 33 RCTs were included,involving 10 576 patients,somatostatin,gabexate,ulinastatin,nafamostat. Network Meta-analysis showed that in the prevention of PEP,the order of curative effect was as follows:somatostatin(intravenous bolus)>nafamostat>ulinastatin>somatostatin(high-dose intravenous drip)>gabexate,somatostatin(low-dose intravenous drip)was ineffective. In the prevention of PEHA,the order of probability being somatostatin(high-dose intravenous drip)>somatostatin(intravenous bolus)>ulinastatin. Only nafamostat was effective in preventing PEP in high-risk patients. CONCLUSIONS:Compared with somatostatin(low-dose intravenous drip)and gabexate,somatostatin(intravenous bolus)and somatostatin(high-dose intravenous drip),ulinastatin,nafamostat can more effectively prevent PEP. Nafamostat cannot prevent PEHA,but can prevent PEP in high risk patients.

Clinical Observation of Small Dose of Octreotide for Preventing Hyperamylasemia and Acute Pancreatitis after Endoscopic Retrograde Cholangiopancreatography / 中国药房

OBJECTIVE:To observe clinical effects and safety of small dose of octreotide for preventing hyperamylasemia and acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).METHODS:One hundred and twenty ERCP pa tients were selected from our hospital during Oct.2014-Jan.2015 and then divided in to observation group and control group in accordance with random number table,with 60 cases in each group.Both groups were given Diazepam tablet 10 mg+Meperidine hydrochloride tablet 100 mg+Phenobarbital scopolamine tablet 2 tablets 0.5 h before surgery for sedation and analgesia,and routine acid suppression and anti-infective therapy.Observation group was additionally given Octreotide acetate injection 0.1 mg hypodermically and then given Octreotide acetate injection 0.1 mg immediately after surgery,8 h after surgery.The levels of serum amylase and blood glucose were observed in 2 groups,and the occurrence of postoperative complication and ADR were recorded.RESULTS:Before operation,there was no statistical significance in the levels of serum amylase and blood glucose between 2 groups (P＞ 0.05).After operation,the level of serum amylase in control group was significantly higher than in observation group,with statistical significance (P＜0.05).There was no statistical significance in blood glucose level between 2 groups after operation (P＞0.05).The incidence of hyperamylasemia and ADR in observation group was significantly lower than in control group,with statistical significance (P＜0.05),and there was no statistical significance in the incidence of acute pancreatitis between 2 groups after operation (P＞0.05).CONCLUSIONS:Small dose of octreotide can effectively reduce the level of serum amylase and the incidence of hyperamylasemia after ERCP with good safety.

Effect of Prophylactic Pancreatic Duct Stenting on Post-ERCP Pancreatitis in Patients With Risk Factors / 胃肠病学

Background:Pancreatitis is the main complication of ERCP,and a variety of risk factors will increase its risk. Studies showed that temporary pancreatic duct stent can reduce the incidence of post-ERCP pancreatitis (PEP). Aims:To study the efficacy and safety of prophylactic pancreatic duct stenting on preventing PEP in patients with risk factors. Methods:Patients undergone ERCP and accompanied with one or more PEP-associated risk factors from November 2013 to November 2016 at Huaibei People's Hospital were enrolled,and were divided randomly into pancreatic duct stenting group (observation group)and non-stenting group (control group). Serum levels of amylase at 4,24 and 48 hours after the procedure and incidence of PEP were compared between the two groups. Results:A total of 297 patients were enrolled, and 147 patients were in observation group,and 150 patients in control group. No significant differences in gender,age and ERCP disease spectrum were found between the two groups (P > 0. 05). Incidence of PEP was significantly decreased in observation group than in control group (6. 1％ vs. 16. 0％,P 0. 05). Conclusions:Prophylactic pancreatic duct stenting may decrease the incidence of PEP in patients accompanied with PEP-associated risk factors, especially could decrease the severity of PEP. However, the incidence of hyperamylasemia is not decreased.

Cost-effectiveness Analysis of 4 Kinds of Protease Inhibitor Preventing Hyperamylasemia and Pancreatitis after ERCP of Choledocholithiasis Patients / 中国药房

OBJECTIVE:To evaluate the economics of somatostatin,ulinastatin,octreotide and gabexate preventing hyperamy-lasemia and pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). METHODS:Medical records of 316 cho-ledocholithiasis patients underwent ERCP were selected from our hospital during Jul. 2008-Apr. 2016,and then divided into blank control group(58 cases),somatostatin group(64 cases),ulinastatin group(65 cases),octreotide group(68 cases)and gabexate group (61 cases) according to the use of protease inhibitor. Before ERCP,blank control group received routine treatment as fast-ing,parenteral nutrition support,acid suppression,etc. Based on it,other 4 drug groups received prophylactic drug use according to package inserts 6 h before ERCP. The incidence of hyperamylasemia and pancreatitis after ERCP,VAS scores 3,24,48 h after surgery and the occurrence of ADR were compared among 5 groups. The cost-effectiveness analysis was used to evaluate the eco-nomics of therapy plans in each group. RESULTS:Compared with blank control group,hospitalization time of somatostatin group, ulinastatin group,octreotide group and gabexate group were shortened significantly;the incidence of hyperamylasemia and pancre-atitis were significantly decreased;VAS score 3,24,48 h after surgery were significantly decreased,with statistical significance (P0.05). The cost-effectiveness ratio of somatostatin group was the lowest and has cost-effec-tiveness advantage. The results were supported by incremental cost-effectiveness and sensitivity analysis. CONCLUSIONS:Soma-tostatin,ulinastatin,octreotide and gabexate can significantly prevent the occurrence of hyperamylasemia and pancreatitis after ER-CP,and relieve pain with good safety. Somatostatin can achieve the best therapeutic efficacy at the lowest cost,so it is the best plan for hyperamylasemia and pancreatitis after ERCP.

The Incidence, Associated Factors and Clinical Impact of Hyperamylasemia in Self-poisoning Patients

PURPOSE: This study was conducted to investigate the incidence, associated factors and clinical impact of hyperamylasemia in self-poisoning patients. METHODS: This study was based on a toxicology case registry of patients treated from 2009 to 2013 at a tertiary care university hospital. We retrospectively investigated the demographics, clinical variables, laboratory variables and intoxicants. Hyperamylasemia was defined as an elevation in serum amylase level to above the upper normal limit within 24 hours after admission. We analyzed the predisposing factors and clinical outcomes of patients in the hyperamylasemia group. RESULTS: Hyperamylasemia was identified in 49 (13.3%) of the 369 patients. Using multivariate logistic regression, the odds ratios for HA were 3.384 (95% confidence interval, 1.142-8.013, p=0.014), 3.261 (95% confidence interval, 1.163-9.143, p=0.025) and 0.351 (95% confidence interval, 0.154-0.802, p=0.013) for pesticides, multi-drug use and sedatives, respectively. In the hyperamylasemia group, the peak amylase levels during 72 hours were correlated with the peak lipase levels (r=0.469, p=0.002) and peak aspartate aminotransferase levels (r=0.352, p=0.013). Finally, none of these patients had confirmed acute pancreatitis. CONCLUSION: Hyperamylasemia occurred rarely in these self-poisoning patients, and pesticide and multi-drug use were independent predictors of hyperamylasemia. Peak amylase levels were correlated with the peak lipase and aspartate aminotransferase levels.

Risk factor analysis for hyperamylasemia after open-heart surgery / 心血管康复医学杂志

Objective: To analyze relative risk factors of hyperamylasemia after open-heart surgery, and provide basis for clinical prevention and treatment. Methods: A total of 521 adult patients, who received open-heart surgery under general anesthesia and low temperature in our hospital from Jan 1, 2013 to Jun 30, 2013, were selected. The 2ml peripheral venous blood was taken in each patient instant after ICU hospitalization, 24h, 48h and 72h after surgery, then serum was separated and measured for serum amylase level by Somogyi method. According to the measured results of serum amylase level, patients were divided into hyperamylasemia group (serum amylase≥500U/dl, n=76) and non- hyperamylasemia group (serum amylase<500 U/dl, n=445). Single factor and gradual Logistic regression analysis were used to analyze risk factors of hyperamylasemia in patients after open-heart surgery. Results: Gradual Logistic regression analysis indicated that cardiopulmonary bypass (CPB) time and hypotension during operation, renal dysfunction and infection after operation were independent risk factors for postoperative hyperamylasemia (OR=1.02~4.12, P<0.05 or <0.01). Conclusion: During perioperative treatment of open-heart surgery, shortening CPB time, avoiding hypotension during surgery, protecting renal function and preventing infection may reduce morbidity of postoperative hyperamylasemia and improve prognosis of patients.

Risk factors for hyperamylasemia after endoscopic retrograde cholangiopancreatography / 临床肝胆病杂志

Objective Toinvestigatetheriskfactorsforthedevelopmentofpost-endoscopicretrogradecholangiopancreatographypancrea-titisandhyperamylasemia(PEPH)afterendoscopicretrogradecholangiopancreatography(ERCP).Methods Theclinicaldataof233pa-tients who underwent therapeutic ERCP from January 2012 to December 2014 in our hospital and met the inclusion criteria were analyzed ret-rospectively.Basic information including age,sex,drinking history,single stone,triglyceride,and nationality was extracted,and detailed information on intraoperative procedure,intraoperative diagnosis,and complications for ERCP was carefully recorded.Chi-square test was applied for comparison of categorical data between groups,and Logistic regression analysis were applied to determine the risk factors for the developmentofPEPH.Results TheincidenceofPEPHwas26.6%(62/233).Univariateanalysisshowedthatfemalesex(χ2=3.320, P=0.045),drinking history (χ2 =6.108,P=0.010),common bile duct stenosis (χ2 =5.767,P=0.012),single stone (χ2 =9.121, P=0.020),juxta-ampullary duodenal diverticula (χ2 =28.170,P<0.001),and abnormal triglyceride (χ2 =54.717,P<0.001) might be the risk factors for PEPH,and these factors differed significantly between the two groups.Multivariate analysis showed that female sex (OR=1.616,P=0.025)drinking history (OR=2.360,P=0.010),common bile duct stenosis (OR=2.163,P=0.012),juxta-ampullary duodenal diverticula (OR=5.502,P<0.001),and abnormal triglyceride (OR=12.924,P<0.001)were independent risk fac-torsforPEPH.Conclusion Femalesex,drinkinghistory,commonbileductstenosis,juxta-ampullaryduodenaldiverticula,andabnor-mal triglyceride are independent risk factors for PEPH,and targeted preventive measures for such high-risk populations can effectively re-duce the incidence of PEPH.

Cyclooxygenase-2 selective inhibitors in preventing post-endoscopic retrograde cholangiopancreatog-raphy pancreatitis and hyperamylasemia / 中华消化内镜杂志

Objective To study the effects of cyclooxygenase( COX)?2 selective inhibitors on post?endoscopic retrograde cholangiopancreatography ( ERCP ) pancreatitis ( PEP ) and hyperamylasemia for common bile duct stones. Methods A total of 128 patients with normal serum amylase underwent ERCP from June 2014 to February 2015 in our hospital and were given corresponding drugs to prevent PEP.The pa?tients were divided randomly into four groups:combination group( n=33) , celecoxib group( n=34) , nitro?glycerin group(n=32) and control group(n=29). The serum amylase(AMS), C?reactive protein(CRP) and direct bilirubin( Dbil) after ERCP were measured. Abdominal pain was observed, and the incidence of PEP and post?ERCP hyperamylasemia were recorded. Results The incidence of PEP in combination group, celecoxib group were lower than those in nitroglycerin group and the control group ( 3?03%, 2?94% VS 15?63%, 17?24%),but the difference was not statistically significant(P=0?078).The incidence of post?ERCP hyperamylasemia in combination group and celecoxib group were lower than that in the control group ( 3?03%,5?88% VS 31?03%) with statistically significant difference( P=0?003, P=0?010) . There was no significant difference between nitroglycerin group ( 25%) and control group. The abdominal pain grades of combination group and celecoxib group were lower than those in nitroglycerin group and control group with significant difference(P<0?05). Celecoxib may reduce CRP after ERCP(P=0?001) and nitroglycerin may reduce Dbil after ERCP(P=0?016). Conclusion Celecoxib may reduce the incidence of hyperamylasemia and can help to reduce the abdominal pain and inflammatory reactions after ERCP . Nitroglycerin can help to reduce the Dbil after ERCP .

Pancreatic duct stent preventing post endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients / 第二军医大学学报

Objective To evaluate the preventive effect of pancreatic duct stent against post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and hyperamylasemia in high-risk patients. Methods A total of 160 patients with high-risk PEP underwent ERCP therapy between Jan. 2013 and Dec. 2014 and were retrospectively analyzed. The patients were divided into pancreatic duct stent group (n =82) and-control group (n=78) according to whether receiving pancreatic duct stent or not. Abdominal pain was evaluated after ERCP. The levels of serum amylase were detected at 3 h and 24 h after ERCP. The incidences of PEP and hyperamylasemia were compared between the two groups. Results The serum amylase levels at 3 h and 24 h after ERCP in pancreatic duct stent group were significantly lower than those in control group ([184. 89±257. 33] U/L vs [305. 35±371. 81] U/L, P<0. 05; [268. 07±344. 73] U/L vs [465. 86±639. 94] U/L, P< 0. 05). The incidences of PEP and hyperamylasemia in pancreatic duct stent group were also significantly lower than those in control group (2. 4% [2/82] vs 11. 5% [9/78], P<0. 05; 17. 1% [14/82] vs 30. 8% [24/78], P<0. 05). The incidence of abdominal pain and abdominal pain score were (19. 5% [16/82], [1. 24 + 0. 58]) in pancreatic duct stent group, which were significantly lower than those in control group (43. 6% [34/78], [1. 68±0. 97]) (P = 0. 001). Conclusion Pancreatic duct stent can effectively prevent PEP and hyperamylasemia in high-risk patients following ERCP.

Efficacy of nasal biliary drainage in the prevention of post-ERCP pancre-atitis / 中国现代医生

Objective To observe efficacy of endoscopic biliary drainage (ENBD) in the preventionand treatment of post-ERCP pancreatitis and hyperamylasemia. Methods A total of 120 patients with choledocholithiasis who underwent ERCP from May 2013 to May 2015 were included in the study. ENBD was performed in 60 patients(test group), and the other 60 patients who didn't undergo nasal biliary drainage were designated as control group. Results The incidence rates of PEP and hyperamylasemia in the test group were 1.7% and 20.0%, respectively, significantly lower than those in the control group 13.3%and 50.0%. Conclusion ENBD can be effective in preventing post-ERCP acute pancreatitis and hyperamylasemia occurred.

Amylase-Producing Primary Peritoneal Carcinoma / 대한내과학회지

A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body but is not due to the local presence of cancer cells. Thus, successful treatment of the underlying tumor often improves such syndromes. Amylase-producing lung cancer, multiple myeloma, and ovarian cancer are reported only rarely. In Korea, no cases of hyperamylasemia have been reported in patients with primary peritoneal carcinoma. We report an interesting case of hyperamylasemia suspected to have been induced by primary peritoneal carcinoma. The patient's amylase isoenzyme patterns indicated salivary-type amylase. Hyperamylasemia was reduced in parallel with the response to chemotherapy. These data confirmed the diagnosis of amylase-producing primary peritoneal carcinoma.