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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five years experience of Endoscopic Sphincterotomy (EST) in Japan has been analyzed in 468 collective cases from 25 centres. In the indication of EST, biliary tract stones were the main reason, and shared in 92.5% of the success of EST. Other applications were benign stenosis of the papilla of Vater, ascaris of the common bile duct and so on where these formed a small group in the indication of EST. Complete removal of stones had been observed spontaneously in 62.3% of the cases, and with the help of a basket or balloon catheter in 23.7% of successful EST. However, fourteen percent of EST had no effect on the delivery of gallstones. Complications during and after EST were observed in 8.5% of all cases where hemorrhage, pancreatitis and cholangitis were the main hazards. The mortality rate was 0.4%, a considerably low rate when the figure is simply compared with that of cases involving surgical intervention. Finally, the term of Endoscopic Sphincterotomy (EST) was proposed for this procedure because it proved to be the best expression of the actual procedure.
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PMID:Five years experience of endoscopic sphincterotomy in Japan: a collective study from 25 centres. 44 27

Fifty patients with choledochal calculus were treated by endoscopic sphincterotomy (EST) and forty-nine of them were cured. Stones were excreted in forty-six patients spontaneously and in two patients by basket. Stones disappeared in one patient after extracorporeal shock wave therapy. The complications included gastrointestinal hemorrhage (2%), pancreatitis (2%) and cholangitis (4.1%). Twelve of them were followed by barium meal after EST. The barium was found in biliary tract in one patient and pneumatosis in another one without any clinical symptoms. The authors suggest that EST could be an important nonoperative therapy in the treatment of choledochal calculus.
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PMID:[Endoscopic sphincterotomy in the treatment of choledochol calculus]. 139 68

An analysis of acute necrotizing pancreatitis (ANP) after endoscopic retrograde cholangiopancreatography (ERCP) was carried out. The incidence of ANP was 0.5% (5/914) for ERCP and 0.5% (2/370) for endoscopic sphincterotomies (EST). All the five patients were obese, middle-aged or older women. Four had a suspicion of common bile duct stones and the fifth a pancreatic tumour as an indication for ERCP. Two had most probably a functional sphincteric disorder and the third was without clear pathological findings. In the remaining two cases the bile duct cannulation failed and repeated pancreatic duct cannulation occurred; while in one case the pancreatic duct was not cannulated. The four pancreatographies were normal and without parenchymal opacification. Symptoms of acute pancreatitis started within 6 hours after ERCP. The pancreatitis was severe by Ranson criteria and necrotizing by evaluation at laparotomy. All the patients showed bacterial growth either in bile, blood or ascitic fluid early in the course of pancreatitis (E. coli, Str. faecalis or Klebsiella pneumoniae). The possible pathogenetic factors of post-ERCP ANP are discussed.
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PMID:Post-ERCP acute necrotizing pancreatitis. 246 49

The results of a study from 25 centers (= Series I: 1974-1980) covering 9041 endoscopic sphincterotomies (EST) were compared with those of a second study from 20 centers (= Series II: 1981-1986) covering 10177 cases. A change was seen in the indications during the past 5 years: While choledocholithiasis after cholecystectomy remained the main indication, EST is performed with increasing frequency in patients with common bile duct stones having their gallbladder in situ as a definitive method with low complications (only 0.61% emergency cholecystectomies): Circumscript papillary stenosis became quite a rare indication. The success rate of EST because of choledocholithiasis was not improved in spite of new techniques (stone-free common bile ducts in I: 84.06%, in II: 83.97%). The complication rate decreased from 7.55% to 5.04%. Types of complications did not change. Only perforations decreased, the rates of bleeding, cholangitis and pancreatitis remained the same. The mortality diminished from 1.12% to 0.60% (the figures remained twice as high in papillary stenosis than in choledocholithiasis). There was no change in the results of EST during the past 5 years. Follow-up studies using radiological methods show worse results (recurrent stones in II: 21.2%, in I: 5.8%, stenosis of EST in II: 6.1%, in I: 3.1%): Late results of EST because of papillary stenosis are still worse compared to those of choledocholithiasis. Therefore, in spite of increasing experience and introduction of new techniques the method became safer, but the therapeutic results did not appreciably improve.
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PMID:[Quo vadis endoscopic sphincterotomy?]. 272 64

Endoscopic sphincterotomy (EST) has been used as a treatment of 33 patients with bile duct stones and 3 patients with benign papillary stenosis. In 83% the papilla was cannulated and an adequate, 15 mm long, sphincterotomy was performed. In 72% the retained bile duct stones were extracted. All 3 patients with papillary stenosis had a free bile flow to the duodenum after the procedure and no complications were seen. Complications occurred in 4 patients (11%) with bile duct stones. The complications consisted of pancreatitis in 2 patients, bleeding in one patient and cholangitis in one patient. One of these patients died 5 days after the procedure because of extraperitoneal perforation of the duodenum accompanied by haemorrhagic pancreatitis. Although many of the patients were old and in poor condition endoscopic sphincterotomy was well tolerated when the procedure was uneventful. The method was usually painless and general anaesthesia was not required. The hospital stay after EST was 6.6 +/- 1 days on average.
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PMID:Fiberendoscopic cannulation of the papilla of Vater I. Sphincterotomy in the treatment of retained bile duct stones and benign papillary stenosis. 733 2

Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). In addition, serum pancreatic enzymes increase without clinical symptoms in about 40-50% of patients undergoing these endoscopic procedures. We evaluated the potential of octreotide, a long-acting somatostatin analogue, to prevent these complications in patients who underwent EST for choledocholithiasis. 151 patients were randomly allocated to two groups (A and B). Group A was given 0.1 mg of octreotide subcutaneously 120 and 30 min before EST and four hours after; group B was given a placebo. Serum amylases (normal range 20-220 IU/l) were measured before premedication and 4, 24, and 48 hours after the end of endoscopy. After EST, the increase in the mean serum amylase was greater in the control group, but the difference was statistically significant only at the 48-hour measurement. There were five cases of acute pancreatitis in each group, with a trend (but not statistically significant) toward less severe pancreatitis in the treated group. In the control group, one patient with acute pancreatitis died. In conclusion, octreotide does not seem to prevent acute post-EST pancreatitis.
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PMID:The use of a long-acting somatostatin analogue (octreotide) for prophylaxis of acute pancreatitis after endoscopic sphincterotomy. 753 55

It is meanwhile generally accepted that endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (EST) can be performed in acute pancreatitis without major complications. However, it is still unsettled if these techniques are useful in the treatment of patients with acute pancreatitis. Based on the available data ERC is obviously the best technique to define a biliary origin of acute pancreatitis. If biliary pancreatitis is suspected, there is an indication for short-term ERC and EST most probably only in patients with severe disease or difficult prognosis or suspicion of cholangitis, while in uncomplicated mild disease the treatment can be elective. In nonbiliary acute pancreatitis EST does not provide any advantage for the patient.
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PMID:[Papillotomy in acute pancreatitis: has the last word been spoken?]. 791 86

Endoscopic retrograde cholangiopancreatography (ERCP) is complicated by acute pancreatitis in up to 12% of the examinations. One possible mechanism for this complication is the cannulation-induced sphincter of Oddi spasm with temporary pancreatic duct obstruction. Nifedipine is known to relax the sphincter of Oddi, thus possibly inhibiting or reducing post-ERCP +/- endoscopic sphincterotomy (EST) pancreatic irritation. To test this hypothesis 166 adult patients undergoing ERCP +/- EST were randomized to receive nifedipine (n = 82) 20 mg 3 times at 8-hour intervals during the day of ERCP +/- EST or placebo (n = 84) in a double-blind manner. Clinical pancreatitis developed in 6 patients (4%), in 3 patients in each group. Necrotizing pancreatitis developed in 3 patients, 2 (2%) in the nifedipine group and 1 (1%) in the placebo group. Overall 60 patients (36%) needed medication for post-ERCP +/- EST epigastric pain, 27 (33%) in the nifedipine group and 33 (39%) in the placebo group. Of the 87 patients, who did not need any pain medication before ERCP +/- EST, 34 (39%) needed pain medication after ERCP +/- EST. 14/47 (30%) in the nifedipine group and 20/40 (50%) in the placebo group (p = 0.044). Serum total amylase activity (median) increased from 189 U/l (range 39-11,950 U/l) before ERCP +/- EST to 299 U/l (range 43-11,824 U/l) at 12 h (p < 0.001) and 247 U/l (range 34-15,950 U/l) at 24 h (p < 0.001), with no differences between the two groups. Median serum C-reactive protein concentration and blood leukocyte count remained unchanged in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prospective randomized trial of the effect of nifedipine on pancreatic irritation after endoscopic retrograde cholangiopancreatography. 831 38

Endoscopic sphincterotomy (EST) is an established method for treatment of retained or recurrent common bile duct (CBD) calculi after cholecystectomy. Present experience shows that few patients have recurrent biliary tract complications, but follow-up periods are most often short. EST was performed in 147 patients with bile duct calculi and remote cholecystectomy in our department from 1981 to 1992. In 8 of 147 patients (5.4%) complete removal of calculi failed. A total of 135 patients with a median age of 71 years (range 24-96 years) were eligible for a follow-up of 23 to 153 months (median 86 months). Thirty-seven patients have died without recurrent symptoms (a recurrent stone was revealed at postmortem examination in one patient), and four patients (two with calculi and two with cholangiocarcinoma) died with recurrent symptoms from the biliary tract. Ninety-four patients are alive; and with the exception of two who have had cholangitis without or with post-EST stenosis, respectively, they are all symptom-free. Jaundice, cholangitis, and biliary pancreatitis prior to EST were the only factors that significantly (p = 0.006, Fisher's exact test) predicted late biliary complications after EST in patients with recurrent calculi. These findings confirm that endoscopic treatment of CBD calculi in cholecystectomized patients has a low long-term rate (5 of 135; 3.7%) of recurrent nonmalignant bile duct disease (three patients with CBD calculi and two with cholangitis).
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PMID:Long-term follow-up after endoscopic treatment of bile duct calculi in cholecystectomized patients. 866 30

The pancreas commonly reacts to endoscopic papillosphincterotomy (EST) with a rise in serum amylase, and acute pancreatitis may also develop. The long-acting somatostatin analogue octreotide has recently been proposed for prevention of colangiopancreatography (ERCP)/EST-induced pancreatic reaction. Therefore, we tested the prophylactic effects of a subcutaneous 3-day administration of octreotide to 60 consecutive patients undergoing ERCP and EST. They were randomly allocated to receive either 200 micrograms octreotide t.i.d. for 3 days (30 cases) or placebo (control group, 30 cases) before the procedure. On the day of the examination, serum amylase levels were determined at baseline and 2, 4, 8, and 24 h thereafter. In the patients as a whole, the increases were statistically significant at 4 h (p < 0.01) and 8 h (p < 0.01). Epigastric pain occurred in 2 patients in the octreotide group and in 13 control subjects (p < 0.001). Even in some patients who had had previous episodes of relapsing pancreatitis, the rise in serum amylase was significantly lower in the octreotide group than in the control group at 4 h (p < 0.01), 8 h (p = 0.05), and 24 h (p = 0.05). Our data suggest that 3 days of prophylactic treatment with octreotide is effective for reducing the rise in serum amylase after EST/ERCP and could be proposed for patients with relapsing pancreatitis and other risk conditions before the Vater's papilla manipulation.
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PMID:Long-term prophylactic administration of octreotide reduces the rise in serum amylase after endoscopic procedures on Vater's papilla. 878 35


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