Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors examined the possibilities of the endoscopic treatment of acute gallstone pancreatitis on the basis of the results of retrospective investigation of 19 middle-european endoscopic centers. There were altogether 11,830 EST in these centers; in 261 out of them the indication of EST was acute gallstone pancreatitis. They consider the exact and early diagnosis very important that can be based on the typical clinical and laboratory signs and ultrasonography. The ERCP reassures the final diagnosis and at the same time the therapeutic solution--EST--can also be realized. This took place within the first 48 hours. The results were favourable, in 90.4%, the complaints decreased significantly within 24 hours. The complication rate was 4.9%, and the mortality rate was 1.9%. These results are better than those of the conservative therapy.
 ...
PMID:[Endoscopic treatment of acute biliary pancreatitis]. 222 86

Endoscopic sphincterotomy and removal of common bile duct stones were performed in 17 patients with acute gallstone pancreatitis. The procedure was successful in 16 patients (94.1%). The overall complications were 17.7 per cent (3 patients) without serious conditions. EST in acute gallstone pancreatitis is a safe and important procedure in the management of acute gallstone pancreatitis. This symptoms, and normalization of the laboratory technique can provide effective drainage, relief of findings in acute gallstone pancreatitis.
 ...
PMID:Endoscopic sphincterotomy in the treatment of acute gallstone pancreatitis. 228 92

During the period February 1981--February 1986 101 poor-risk patients with common bile duct stones were treated with EST (endoscopic sphincterotomy). 51 of the patients had no previous gallbladder surgery. The first year 7 complications occurred among 11 patients, including 3 deaths. The following four years we had a total of 8 complications among 90 patients, including 1 death. The complications consisted of: Bleeding needing transfusion (n = 5), pancreatitis (n = 5), cholangitis (n = 2), perforation (n = 2), impaction of the Dormia basket (n = 1). Fourty-five patients were discharged without cholecystectomy. Two patients later underwent elective cholecystectomy. Four patients developed symptoms requiring cholecystectomy. The remaining 39 patients have not required any further treatment for their gallstone disease. This study demonstrates that EST in experienced hands is a safe and effective method even in extremely poor-risk patients and that EST might be used as the sole treatment of common bile duct stones in this type of patients without previous cholecystectomy. The few complications are mostly mild and can be managed conservatively.
 ...
PMID:Endoscopic sphincterotomy in poor-risk patients. 367 24

The authors operated on fifty-four patients for gallstone disease associated with acute edematous pancreatitis in the years 1988-1993. The patients were operated on in the first admission, after the symptoms of pancreatitis had run their course and after normalization of amylase-concentration. Preoperative EST was successful in 7%. Depending on the results of routine intraoperative cholangiomanometry choledochotomy was carried out in 11% of the cases. There were no surgical technical difficulties in operations performed in the same admission. At the onset of pancreatitis the authors consider it right to apply one of the objective prognostic scoring systems suitable to predict the severity and prognosis of pancreatitis. Then, depending on its result and the risks of the planned intervention, ERCP-EST is proposed, leaving the gallbladder "in situ" and, either traditional, or laparoscopic cholecystectomy is also permissible.
 ...
PMID:[Management of cholelithiasis associated with acute edematous pancreatitis]. 776 Oct 73

Endoscopic retrograde cholangio-pancreatography presents the only method which not only produces exact results concerning the morphology of the pancreatic and biliary ducts but also enables therapeutic access to these structures. In childhood ERCP is indicated if other non invasive diagnostic procedures do not help to establish a diagnosis or if further informations concerning indication or planning of an operation can be expected. In 25 children and 13 adolescents ERCP established the correct diagnosis in 95%. The success rate in newborns after the second month reaches 90%. For children before the age of 2 months a pediatric duodenoscope with a diameter of 7-9 mm is necessary. In obstructive jaundice, after trauma of the upper abdomen and especially in pancreatitis of unknown origin ERCP should be performed liberally, because a lot of exploratory laparotomies can be prevented, and significant findings for operative intervention can be collected. Moreover the causes of pancreatitis can be evaluated and treated definitely. With EST impressive improvements in the clinical course of obstructive jaundice, cholangitis and acute pancreatitis even in children and adolescents can be reached. In our own series 9 children (3 acute biliary pancreatitis, 3 chronic obstructive pancreatitis, 1 acute pancreatitis, 2 biliary duct stones with cholangitis or ampullary stenosis) were treated successfully without any significant complications. In acute pancreatitis an ERCP should be performed as early as possible (during 24-48 hours after onset of symptoms) because only in this instance the etiologic factors can be evaluated reliably and using endoscopic sphincterotomy of the sphincter proprius choledochi and/or the sphincter proprius pancreatis be treated adequately and with the lowest risk in time.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Indications, findings and complications of ERCP in pediatrics]. 831 Jul 29

Pathogenesis, diagnosis, predicting severity, and treatment of acute biliary pancreatitis are reviewed. Clinical characteristics, treatment and outcome were investigated in 23 patients with severe, acute biliary pancreatitis. Conservative treatment is successful in most of patients with acute biliary pancreatitis. Surgical treatment for biliary stones should be followed by an initial conservative treatment. However, in patients with severe pancreatitis, who has poor prognosis, intensive care is necessary and surgical treatment must be adequately performed, in failure of active medical treatments. In these cases, the timing of operation is important. When biliary lesions, acute septic cholangitis or impacted ampullary stones, are responsible for the severe condition, and can't be treated by a medical procedure, such as PTCD or EST, surgical treatment of the biliary tract should be considered.
 ...
PMID:[Acute biliary pancreatitis]. 836 10

Somatostatin and the long acting analogue octreotide have been proposed as a therapeutic agent in acute pancreatitis and for the prophylaxis of pancreatic damage by ERCP and EST for their ability to reduce exocrine pancreatic secretion. However, clinical trials could not show significant beneficial effects in acute pancreatitis and ERCP. In patients undergoing EST, data remained controversial, most authors describing positive effects of prophylaxis. In this study we investigated the use of octreotide prophylaxis to reduce EST-induced pancreatic damage in a randomised, double blind trial. 94 consecutive ERCP/EST-patients were randomised to receive either octreotide 200 microgram s.c. or placebo 3 times daily, starting the night before endoscopic procedures. In 59 patients EST was performed. Blood samples were collected before and 40 min, 2 hrs, 6 hrs, 24 hrs, 48 hrs and 72 hrs after the endoscopic procedures. Samples were analysed for pancreatic serum enzymes, acute phase proteins and blood counts. A clinical pain score was investigated. Post-EST-pancreatitis (amylase > 3x upper limit and persistent abdominal pain) was diagnosed in 3 patients in the treatment group, in 4 patients in the placebo group. There were no significant differences in the time-courses of serum enzymes or acute phase proteins in-between the groups, nor in the pain-score. According to these data, prophylactic octreotide application does not prevent acute pancreatic damage induced by endoscopic sphincterotomy.
 ...
PMID:Octreotide in the prevention of pancreatic damage induced by endoscopic sphincterotomy. 1079 51

The rate of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be approximately 10%-33%, depending on the patient's age. Development of Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Surgery and improvement of diagnostic procedures have influenced new approaches to the management of common bile duct stones in association with gallstones. At present available minimally-invasive treatments of cholecysto-choledocal lithiasis include: single-stage laparoscopic treatment, perioperative endoscopic treatment and endoscopic treatment alone. Published data evidence that, associated endoscopic-laparoscopic approach necessitates increased number of procedures per patient while single-stage laparoscopic treatment is associated with a shorter hospital stay. However, current data does not suggest clear superiority of any one approach with regard to success, mortality, morbidity and cost-effectiveness. Considering the variety of therapeutic options available for management, a critical appraisal and decision-making is required. Endoscopic retrograde cholangiopancreatography/EST should be adopted on a selective basis, i.e., in patients with acute obstructive suppurative cholangitis, severe biliary pancreatitis, ampullary stone impaction or severe comorbidity. In a setting where all facilities are available, decision in the selection of the therapeutic option depends on the patients, the number and size of choledocholithiasis stones, the anatomy of the cystic duct and common bile duct, the surgical history of patients and local expertise.
...
PMID:Minimally invasive treatment of cholecysto-choledocal lithiasis: The point of view of the surgical endoscopist. 2397 17