Treatment outcomes of endoscopic pancreatic sphincterotomy combined with pancreatic duct stent for acute recurrent pancreatitis caused by biliary microlithiasis / 中华消化内镜杂志

Objective To investigate the clinical efficiency of endoscopic pancreatic sphincterotomy ( EPS) combined with pancreatic duct stent for acute recurrent pancreatitis ( ARP ) caused by biliary microlithiasis. Methods A total of 71 patients were diagnosed as having ARP resulting from biliary microlithiasis from April 2005 to November 2016, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to different endoscopic therapy, EPS ( n=34) and EST group (n=37), respectively. The rate of pancreatitis recurrence, post-ERCP pancreatitis (PEP) and biliary complications were compared by Chi-square test and the influencing factors of recurrence were evaluated by survival analysis. Results The follow-up time ranged from 2 to 108 months ( median 21. 5 months) in EPS group and ranged from 5 to 120 months ( median 39 months) in EST group. Twelve months after endoscopic therapy, 2 patients in EPS group and 5 in EST group suffered recurrent pancreatitis(χ2=0. 461, P=0. 497). Recurrence occurred in 13 patients in 60 months after endoscopic therapy, 4 patients in EPS group and 9 in EST group. Cox regression analysis indicated different endoscopic treatment ( RR=6. 808, 95%CI: 1. 389-33. 356, P=0. 018) and type 2 diabetes ( RR=0. 134, 95%CI:0. 029-0. 608, P=0. 009) were statistically significant factors. There were no significant difference in incidence of PEP (20. 6% in EPS group, 10. 8% in EST group,χ2=1. 294, P=0. 255) and biliary complications between two groups (11. 8% in EPS group, 24. 3% in EST group, χ2=1. 869, P=0. 172). Conclusion EPS combined with pancreatic stenting is effective for acute recurrent pancreatitis caused by microlithiasis. Type 2 diabetes may also lead to recurrence of acute pancreatitis.

Treatment outcomes of endoscopic pancreatic sphincterotomy combined with pancreatic duct stent for acute recurrent pancreatitis caused by biliary microlithiasis / 中华消化内镜杂志

Objective To investigate the clinical efficiency of endoscopic pancreatic sphincterotomy ( EPS) combined with pancreatic duct stent for acute recurrent pancreatitis ( ARP ) caused by biliary microlithiasis. Methods A total of 71 patients were diagnosed as having ARP resulting from biliary microlithiasis from April 2005 to November 2016, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to different endoscopic therapy, EPS ( n=34) and EST group (n=37), respectively. The rate of pancreatitis recurrence, post-ERCP pancreatitis (PEP) and biliary complications were compared by Chi-square test and the influencing factors of recurrence were evaluated by survival analysis. Results The follow-up time ranged from 2 to 108 months ( median 21. 5 months) in EPS group and ranged from 5 to 120 months ( median 39 months) in EST group. Twelve months after endoscopic therapy, 2 patients in EPS group and 5 in EST group suffered recurrent pancreatitis(χ2=0. 461, P=0. 497). Recurrence occurred in 13 patients in 60 months after endoscopic therapy, 4 patients in EPS group and 9 in EST group. Cox regression analysis indicated different endoscopic treatment ( RR=6. 808, 95%CI: 1. 389-33. 356, P=0. 018) and type 2 diabetes ( RR=0. 134, 95%CI:0. 029-0. 608, P=0. 009) were statistically significant factors. There were no significant difference in incidence of PEP (20. 6% in EPS group, 10. 8% in EST group,χ2=1. 294, P=0. 255) and biliary complications between two groups (11. 8% in EPS group, 24. 3% in EST group, χ2=1. 869, P=0. 172). Conclusion EPS combined with pancreatic stenting is effective for acute recurrent pancreatitis caused by microlithiasis. Type 2 diabetes may also lead to recurrence of acute pancreatitis.

Endoscopic Intervention through Endoscopic Retrograde Cholangiopancreatography in the Management of Symptomatic Pancreas Divisum: A Long-Term Follow-Up Study

BACKGROUND/AIMS: To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of symptomatic pancreas divisum (PD) and to discuss whether ERCP procedures and outcomes in younger patients differ from those of adults. METHODS: Symptomatic patients with PD were included in the study and divided into underaged (age ≤17 years) and adult (age ≥18 years) group. The clinical information of each patient was reviewed, and then the patients were contacted by telephone or their medical records were reviewed to determine their long-term follow-up outcomes. RESULTS: A total of 141 procedures were performed in 82 patients (17 underaged and 65 adult patients). The ERCP indications included abdominal pain (39.02%), pancreatitis (12.20%), recurrent pancreatitis (36.59%), and other discomfort (12.20%). The endoscopic interventions included endoscopic pancreatic sphincterotomy in 44.68% of the patients, bouginage in 26.95%, pancreatic ductal stone extraction in 19.15%, endoscopic nasopancreatic drainage in 21.99%, and endoscopic retrograde pancreatic drainage in 56.74%. After a median follow-up of 41 months, the overall response rate was 62.32%. Between the underaged group and the adult group, significant differences were not observed in the ERCP procedures, complications and long-term follow-up results. CONCLUSIONS: ERCP is a safe and effective treatment for symptomatic PD. Based on the details, complications, and follow-up results, the ERCP procedure did not present differences between the underaged and adult groups.

Clinical Application and Safety of Endoscopic Pancreatic Sphincterotomy in 339 Cases / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic pancreatic sphincterotomy (EPST) has been performed more frequently in recent years. However, it is less widely practiced than biliary sphincterotomy due to lack of firm scientific data regarding its indication and safety. The aims of this study are to evaluate EPST with regard to indications, complications, and safety. METHODS: We retrospectively reviewed and analyzed the results of EPST performed in three hundred thirty nine patients from January 2000 to April 2004.RESULTS: Complications occurred in 37 patients (10.7%) which included pancreatitis, hemorrhage, perforation, cholangitis, sepsis, and stenosis of sphincterotomy site. They were successfully managed by medical treatment. No mortalities were reported. CONCLUSIONS: EPST is a relatively safe procedure in various pancreatic diseases. Incidence of long-term complications awaits further investigations. EPST enlarges our endotherapeutic armamentarium and deserves additional evaluation.