Early treatment of acute biliary pancreatitis by endoscopic papillotomy
| Autor: | Edward C. S. Lai, Shu-Sen Zheng, John Wong, Francis P. T. Mok, Sheung Tat Fan, Chung Mau Lo |
|---|---|
| Rok vydání: | 1993 |
| Předmět: |
Adult
Male medicine.medical_specialty Ampulla of Vater Pancreatic disease Adolescent Gallstones digestive system Sphincterotomy Endoscopic Cholelithiasis medicine Humans Aged Aged 80 and over Cholangiopancreatography Endoscopic Retrograde Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry General surgery General Medicine Middle Aged medicine.disease digestive system diseases Endoscopy Surgery medicine.anatomical_structure Treatment Outcome Pancreatitis Biliary tract Acute Disease Acute pancreatitis Female Emergencies Morbidity business |
| Zdroj: | The New England journal of medicine. 328(4) |
| ISSN: | 0028-4793 |
| Popis: | Most patients with acute biliary pancreatitis have stones in the biliary tract or ampulla of Vater. Because these stones may be passed spontaneously soon after a patient is admitted to the hospital, the importance of early operative removal is not known. We tested the hypothesis that endoscopic papillotomy within 24 hours of admission decreased the incidence of complications in patients with acute biliary pancreatitis.We studied 195 patients with acute pancreatitis who were randomly assigned to one of two groups: 97 patients underwent within 24 hours after admission emergency endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic papillotomy for ampullary and common-bile-duct stones, and 98 patients received initial conservative treatment and selective ERCP with or without endoscopic papillotomy only if their condition deteriorated.One hundred twenty-seven patients ultimately proved to have biliary stones. Emergency ERCP with or without endoscopic papillotomy resulted in a reduction in biliary sepsis as compared with conservative treatment (0 of 97 patients vs. 12 of 98 patients, P = 0.001). The decrease in biliary sepsis occurred both in patients predicted to have mild pancreatitis (0 of 56 patients in the group that received emergency ERCP vs. 4 of 58 patients in the conservative-treatment group, P = 0.14) and in patients predicted to have severe pancreatitis (0 of 41 patients vs. 8 of 40 patients, P = 0.008). In all patients who had unrelenting biliary sepsis, persistent ampullary or common-bile-duct stones were identified. There were no major differences in the incidence of local complications (10 patients in the group that received emergency ERCP vs. 12 patients in the conservative-treatment group) or systemic complications (10 patients vs. 14 patients) of acute pancreatitis between the two groups, but the hospital mortality rate was slightly lower in the group undergoing emergency ERCP with or without endoscopic papillotomy (5 patients vs. 9 patients, P = 0.4).Emergency ERCP with or without endoscopic papillotomy is indicated in the treatment of patients with acute pancreatitis. |
| Databáze: | OpenAIRE |
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