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Query: UMLS:C0001339 (acute pancreatitis)
 10,593 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The value of endoscopic retrograde cholangiopancreatography (ERCP) in a surgical unit was established by analysing 200 consecutive studies. The selective success rate was 80%. The groups of indications were jaundice (27%), postcholecystectomy pain (22%), recurrent acute pancreatitis (19%), complicated attack of acute pancreatitis (14%), and other (18%). A normal ERC was found and operation thus avoided in 26% of cases with persistent jaundice. In patients with postcholecystectomy pain pathological findings were found in 50% and half of them were operated upon. In pancreatitis demonstration of the pancreatic ducts and grading of the disease facilitated selection of the treatment and enabled preoperative planning of the surgical procedure. The pancreas was resected in 13 of 59 cases with diagnostic ERP. In pancreatic carcinoma ERCP led directly to diagnosis, but only two (ampullary carcinomas) out of ten were operable. The overall complication rate was 4%, including one case of fatal haemorrhagic pancreatitis.
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PMID:Endoscopic retrograde cholangiopancreatography in a surgical unit. 67 99

Functional tests and ERP were performed in patients with chronic and acute pancreatitis and papillary stenosis; both diseases differ considerably as can be shown by both, pancreatography and degree of functional impairment. The different classification types of pancreatitis are based upon the Marseille Symposium. The ERP is the only x-ray procedure which allows the diagnosis of intrapapillar pancreatic duct stenosis. The ERP significantly improves diagnosis of the early stages of papillary stenosis of the pancreas. Neither secretin-pancreozymin test nor ERP are indicated in cases of primary chronic calcifying pancreatitis; in chronic relapsing calcifying pancreatitis they should be used for preoperative diagnostic purposes.
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PMID:[Pancreatitis and papillary stenosis: endoscopic retrograde pancreatography (ERP) vs. exocrine functional tests (author's transl)]. 102 76

In a nonblind nonrandomized clinical trial two groups of patients who were undergoing ERCP - A (n = 182) with antibiotic prophylaxis and B (n = 220) without an antibiotic--were compared on a prospective basis. The efficacy of properly timed prophylaxis with a therapeutically effective antibiotic had previously been established by a pilot study and a definitive trial based on HPLC assays of endoscopic biopsy specimens taken from the duodenal papilla. In Group A (n = 182) there was hyperamylasaemia without a leucocytic reaction in only 18 (14.75%) of the ERP patients and two (3.33%) of the ERC patients, but in Group B (no antibiotic - n = 220) this change was detected in 48 (35.29%) of the ERP patients and 12 (14.28%) of the ERC patients (P = 0.00018 and 0.043 respectively). Hyperamylasaemia with a leucocytic reaction occurred in only one patient with ERP from Group A (0.82%) as compared with 15 patients (11.02%) from the untreated group (P = 0.00047). These results were highly significant. There were three cases of subclinical pancreatitis and two of acute pancreatitis--all of them in the control group. Although these results were not statistically significant (because the number of cases was too small), they are clearly consistent with the growing tendency towards using antibiotic cover. On the basis of these results we regard antibiotic prophylaxis during ERCP as a sensible precaution, and in patients with any concurrent disease which heightens the risk it is essential.
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PMID:[Comparative studies of preventive antibiotic administration in ERCP]. 162 7

An analysis of the ERP findings in 31 patients with acute pancreatitis enable us to define the terminology of the pancreatogram in these diseases. Irregularities of the ducts indicate previous damage to the organ. A frequent phenomenon is thinning of lateral branches, which can be explained by compression due to oedema. Early parenchymal staining indicates abnormal permeability of the duct epithelium. Cavities are an expression of acute pseudo-cysts. A sign characteristic of alcoholic pancreatitis is the presence of contrast defects due to protein plugs and due to increased viscosity of pancreatic secretions. These observations confirm the theory that protein precipitates due to abnormal secretions play an important role in acute pancreatitis.
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PMID:[Endoscopic retrograde pancreatography (ERP) in acute alcoholic and biliary pancreatitis]. 185 40

Cases of pancreas divisum (PD) were reviewed in our patients and 19 Japanese and 14 English series during the past 10 yr to see any significant association of PD with certain diseases. PD was diagnosed in 20 (0.64%) among our 3121 patients with successful endoscopic pancreatograms (ERP). Of 20 PD patients, acute pancreatitis in one, chronic pancreatitis in two, ampullary cancer in one, and cholelithiasis in five were diagnosed. Incidences of PD were 2.6% (1/38) in acute pancreatitis, 0.8% (2/248) in chronic pancreatitis, 0% (0/100) in pancreatic cancer, 20% (1/5) in ampullary cancer, and 0.8% (5/615) in cholelithiasis. The incidences were similar to overall incidences of ours and other Japanese series (0.69% of 36,171 patients). Higher incidences of acute pancreatitis (12.9% of 559) and pancreatic cancer (5.5% in 448) may result from the higher overall incidence (4.6% in 16,257) in English series. The relationship between pancreatitis and PD has been controversial, but our present data suggest that PD is a coincidental finding and not a predisposing factor to pancreatitis in Japan.
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PMID:Pancreas divisum. A predisposing factor to pancreatitis? 269 89

Cannulation of the papilla of Vater was successful in 49 out of 65 cases (75.4%) and digital imaging of the pancreas in 38% of cases. Visualisation of the pancreatic duct with D-ERP was comparable to that of conventional ERCP. Absent or faint opacification of the parenchyma was seen in 39.5% of patients. Both methods were equally effective for the diagnosis of pancreatic tumours. D-ERP was better than ERCP for the diagnosis of chronic pancreatitis. Two patients (4.1%) had clinical evidence of mild acute pancreatitis following pancreatic duct injections.
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PMID:Digitalised endoscopic retrograde pancreatography (D-ERP): a comparison with ERCP. 283 99

Pancreas divisum is the most frequent congenital ductal anomaly of the pancreas: it occurs in 5-10% of the population. In the majority of patients, this congenital anomaly is of no clinical importance. In a certain subset of patients, however, pancreas divisum is clinically important as a cause of abdominal pain, acute recurrent pancreatitis or chronic obstructive pancreatitis. The authors, experience on endoscopic drainage of the minor papilla is reported. In the history of patient 1., three episodes of recurrent pancreatitis and permanent upper abdominal pain were explored. ERP revealed a pancreas divisum and a mild irregularity and dilation of the dorsal pancreatic duct. A 7 F stent (length: 6 cm) was implanted in the dorsal pancreatic duct following a papillotomy on the stenotic minor papilla. A repeated Lundh test revealed a 58% improvement in the exocrine pancreatic function. No recurrence of pancreatitis has been observed in spite of the moderate continuous abdominal pain. In patient 2., ERP demonstrated a pancreas divisum and a severely dilated dorsal pancreatic duct as causes of the previous permanent abdominal pain. An 8 F stent (length: 5 cm) was inserted through the minor papilla without endoscopic sphincterotomy. A significant improvement in exocrine pancreatic function (70%) ensued. No abdominal pain has since been observed. In conclusion, dorsal pancreatic duct stenting (mainly in cases involving a dilated pancreatic duct) seems to have a beneficial effect in patients with both recurrent acute pancreatitis or chronic obstructive pancreatitis evoked by pancreas divisum.
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PMID:[Endoscopic therapy of pancreas divisum]. 984 61

Until the mid eighties ERCP and EPT were considered to be contraindicated in acute pancreatitis, because of possible aggravation of active pancreatitis or induction of new attacks of pancreatitis. This attitude was revised with the new knowledge obtained from four prospective randomised studies, which compared the effects of endoscopic treatment with conservative management of acute pancreatitis. Although the four studies are not strictly comparable their results indicate that there is no advantage to ERCP +/- EPT over conservative treatment alone in mild biliary pancreatitis. In severe biliary pancreatitis, however, ERCP with EPT reduced the number of purulent cholangitis and incidence of morbidity and in one study mortality was also significantly reduced. There is evidence, that ERCP + EPT may be important in a deteriorating acute mild pancreatitis, in the smouldering type of pancreatitis and in pancreatitis with persistent cholostasis. To avoid recurrent severe pancreatitis in patients unfit for surgery without bile duct stones but with gallbladder stones, EPT is recommended. ERCP and EPT in acute severe biliary pancreatitis during the first trimester of pregnancy have been successfully performed in four patients. Sludge and microlithiasis may be the cause of recurrent "idiopathic" pancreatitis and ERCP + EPT is effective especially in cholecystectomised patients. Furthermore in patients with recurrent pancreatitis due to malformations, such as pancreas divisum, ERP and minor-papillotomy produced similar results to surgical treatment. Acute pancreatitis in patients with pancreatic duct stones or ductal leaks may be treated by ERP and EPT in selected patients. Alcoholic, metabolic and infectious pancreatitis remain within the domain of conservative treatment.
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PMID:Acute pancreatitis--ERCP/endoscopic papillotomy (EPT) yes or no? 1107 90