Prevention and treatment of pancreatitis after endoscopic interventions on the bile duct
DOI:
https://doi.org/10.11603/2414-4533.2023.2.13994Keywords:
endoscopic retrograde cholangiopancreatography, complications, post-manipulation pancreatitis, mechanical jaundiceAbstract
The aim of the work: verification of the mechanisms and factors of the development of pancreatitis after ERCP and a summary of the efforts made to prevent and treat this complication.
Materials and Methods. According to the results of treatment of 1214 patients, a detailed analysis of the structure of nosological units, which most often lead to the development of mechanical jaundice, was carried out. The observation group included 481 men and 733 women, the age of the patients ranged from 21 to 87 years and the average was 63.5 years. The average duration of jaundice at the pre-hospital stage was 23.9 days. The total number of complications that occurred during the intervention or in the postoperative period was 68 observations (5.61 %). Attempts at endoscopic correction of jaundice were unsuccessful in 26 patients (2.14 %), due to the deformation of the postbulbar part of the duodenum owing to the invasion of pancreatic neoplasms or Billroth operation II in anamnesis.
Results and Discusssion. The role of factors that may occur the development of post-ERCP pancreatitis was determined. The causes of occurrence of intra- and post-ERCP complications were studied. The emphasis is placed on finding ways to prevent the development of post-ERCP pancreatitis. Treatment tactics for managing patients with post-ERCP pancreatitis are based on the recommendations of the European Society of Endoscopists. We would like to underline that the algorithm for the management of patients in whom the technical prerequisites for the development of post-ERCP pancreatitis arose during surgery has not been finalized. The experience of medical prophylaxis accumulated in the literature does not ensure a favorable course of the postoperative period in all cases, primarily this applies to patients of high-risk groups, in whom we observe a difficult course with an unfavorable outcome. Despite the recognized effectiveness of nonsteroidal anti-inflammatory drugs, 2 % of patients develop severe post-ERCP pancreatitis.
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