RESUMO
Endoscopic retrograde cholangiopancreatography [ERCP] can be mentioned as the most complex endoscopic procedure and is widely used for diagnosis and treatment of biliary and pancreatic diseases. Pancreatitis is the most common complication following ERCP, which may be life threatening. This article presents an old woman diagnosed as having post-ERCP pancreatitis without increasing in serum amylase level. A 69-year-old woman with a history of cholecystectomy a few years earlier, was presented with abdominal pain in epigastric region. Abdominal sonography revealed a dilated common bile duct [[CBD], 11 mm in diameter]] so MRCP [Magnetic Resonance Cholangiopancreatography] was performed for diagnosis. There were several stones in CBD, so the patient underwent therapeutic ERCP. Six hours after the procedure, she complained of severe abdominal pain in the right upper quadrant [RUQ] and tenderness. Serum amylase was 51 mg/dL. An abdominal computed tomography revealed pancreatitis
Pancreatitis is the most common complication after ERCP, which presents with abdominal pain in the RUQ and increase in serum amylase level more than 3 fold of normal upper limit. In this case, pancreatitis occurred without laboratory findings consistent with the diagnosis, which is not a common occurrence
RESUMO
Background: common bile duct [CBD] stones exist among 12% of patients with cholelithiasis. They may result in some complications including pancreatitis and cholangitis. The common therapeutical method is endoscopic sphincterotomy during ERCP[Endoscopic Retrograde Cholangio-Pancreatography] and stones removal. This method does not have a reasonable success rate for stones with a diameter larger than 15 mm and may cause serious complications. The aim of this study was to evaluate the CBD stenting method in the treatment of large CBD stones
Materials and Methods: this study was performed on 32 patients who presented to the ERCP unit of Shahid Beheshti hospital in Qom with large CBD stones. Success rate in CBD clearing and rate of some complications including rupture of CBD, pancreatitis, and cholangitis were evaluated after the first ERCP for stent replacement, and the second for its removal
Results: the success rate in complete CBD clearing was 93.8%. A reduction in size and number of stones was seen during a 2-month period, which was statistically significant. No case of CBD rupture and cholangitis was detected and the incidence of pancreatitis was 18.8%
Conclusion: CBD stenting has a reasonable success rate for reducing the size and number of CBD stones