Friday, March 29, 2019

Methods for Prevention of Post-ERCP Pancreatitis

Methods for Prevention of Post-ERCP PancreatitisPrevention of post endoscopic retrograde cholangiopancreatography pancreatitis scamPancreatitis is the most common and weighty complication of ERCP. Several risk factors hold out that help to formation and progress pancreatitis. These risk factors may be factors that ar related to patient, and factors that related to Procedure, or factors related to operator. All of the risk factors should be considered and as far as possible may be take down with attention to pathogenesis of the development of post-ERCP pancreatitis. These pathogenesis atomic number 18 include sphincter spasm, infection, contrast toxicity and pancreatic secretion that induce activation of proteolytic enzymes and inflammatory process. roughly of methods and pharmacological agent assessed for foilion pathogenesis pathway to decline post-ERCP pancreatitis.IntroductionIn about 75 percent of patients after endoscopic retrogradecholangiopancreato-graphy (ERCP) may turn over elevation in serum amylase yet acute clinical pancreatitis (defined as a clinical syndrome of abdominal hurting and hyperamylasemia) is less common. However, acute pancreatitis is the central complication of ERCP and rent to pay attention it to prevent from its morbidity and mortality 1.Mechanism for post ERCP pancreatitisThe exact appliance for PEP is unknown. It needs to be a trigger event that turn on the inflammatory process, that stinker be the fallowing thermal injury from sphincterotomy, mechanical obstruction to outflow of the pancreatic secretions , papillary edema from attempted multiple tricknulations, sphincterotomy etc., injury from guide wire, chemical substance injury of the contrast, microbiological injury due to introduction of duodenal flora into the pancreas etc 2. fortune Factors for Post-ERCP PancreatitisIt is important to identify cases in which there are high risks for pancreatitis that we can prevent the complications of the prophylactic me thod such as pancreatic stenting or pharmacological prophylaxis. Assessment of both patient- and procedure-related factors is necessary to detect the high-risk cases ( duck 1) 3.Table 1 Risk Factors for Post-ERCP Pancreatitis 3.Definition of post ERCP pancreatitisTo diagnose PEP need to be at least two of the following criteriaEpigastric pain with radiation to the back,Elevation of amylase and / or lipase at least 3 measure higher than normal.Radiological imaging that suggests pancreatitis.Amylase and lipase may have an elevation scorn the patients does not has any symptom. Radiological imaging is helpful when the diagnosis is trying 4.Methods and pharmacologic legal profession of post-ERCP pancreatitisA. the Following techniques should be adhered to in order to subside the risk of post-ERCP pancreatitis1. Endoscopic techniques2. Cannulation3. Electrocautery4. Pancreatic stentingB. Pharnacologic prophylamsNonsteroidal anti-inflammatory drugssteroidal anti-inflammatory agentsOth er anti-inflammatory agents Allopurinol semapimod- interleukin 10- pentoxifylline- Platelet-activating factor-EpinephrineInhibitors of pancreatic secretion Somatostatin- Somatostatin unite with diclofenac- octerotide- calcitoninAgents that stimulate pancreatic secretion and restrict sphincter timberland SecretinAgents that reduce of sphincter tone nifedipine-Nit counts-Glyceryl trinitrate botulinum toxin-topical lidocaineInhibitors of protease activation Gabexate mesilate- Nafamostat- Ulinastatin- C1-inhibitor- heparinAntioxidants N-acetylcysteine- Sodium selenite- Beta- CaroteneAntimicrobial agentsAntimetabolites 5-FU (5 Fluoro Uracil)5.Some of the drugs that tested in unalike trials are described belowPharmacological Prevention for Post-ERCP PancreatitisSince the introduction of ERCP, numerous pharmacologic drugs have been assessed to prevent post-ERCP pancreatitis based on their pharmacologic mechanism and their number on one or more of the factors associated with pancreatic injury (Figure 1) 6.1- NSAIDsNSAIDs (diclofenac or indomethacin) are the most drugs that are using for stripe of post-ERCP pancreatitis 7.The European Society of Gastrointestinal Endoscopy recommends routine rectal administration of 100 mg diclofenac or indomethacin for stripe of post-ERCP pancreatitis 8.2- Glyceryl trinitrateGlyceryl trinitrate reduces sphincter of Oddi pressure and may uses to prevent post-ERCP pancreatitis. ManuelMoret in his lease assessed that could transdermal glyceryl trinitrate be effective in the prevention of post-ERCP pancreatitis? The results of his study rise that transdermal glyceryl trinitrate patch significantly reduces post-ERCP pancreatitis 7.3- Nifedipinecalcium channel inhibitors can prevent the development of experimental pancreatitis.Nifedipine is from the calcium channel blocker drugs and its effect is reducing sphincter spasm.Part do randomized, placebo-controlled trial to determine whether the calcium channel blocker nifedipine preven ts post-ERCP pancreatitis. Nifedipine or placebo was administered before and within 6 hours after ERCP.This study failed to show significant effect of nifedipine in the prevention of post-ERCP pancreatitis 8.4-AntibioticsInfections that occur when ERCP is through can activation proteolytic enzymes and lead to pancreatitis. Now there is this drumhead that antibiotics can use in the prevention of post-ERCP pancreatitis. One prospective randomized controlled trial showed that the ceftazidime administration before ERCP significantly decreased the relative relative incidence of post-ERCP pancreatitis in the control group that did not receive antibiotic 9.The persona of the study is questionable because the control group did not received no antibiotic 10.5- RisperidoneUlinastatin inhibited systemic inflammatory responses and may benefit for prevention post-ERCP pancreatitis.Tsujino assessed the effect of risperidone (a selective serotonin 2A antagonist) combined with ulinastatin for t he prevention of PEP in high-risk patients.In a multicenter, randomized, controlled trial, patients were randomly compared to administration ulinastatin with or without risperidone.The incidence of PEP was not significantly different between two groups, but pancreatic enzymes level were significantly lower in the risperidone+ulinastatin group as compared with ulinastatin alone 11.6- IndomethacinIndometacin is from nonstroidal antiinflamatory drugs that are used for prevention of post-ERCP pancreatitis.Joseph Elmunzer in a multicenter, randomized, placebo-controlled, double-blind clinical trial assigned patients that were high risk for post-ERCP pancreatitis to receive a single dose of indomethacin or placebo immediately after ERCP. Among patients at high risk for post-ERCP pancreatitis, rectal indomethacin significantly reduced the incidence of the post-ERCP pancreatitis 12.Yaghoobi also assigned one meta-analysis to assessed rectal indomethacin for the prevention of post-ERCP pancr eatitis. This meta-analysis showed that the rate of pancreatitis was significantly lower when using indomethacin as compared with placebo. 13.7- CorticosteroidCorticosteroids are anti-inflammatory drugs and may be able to decrease the risk of post-ERCP pancreatitis.In a prospective randomized controlled multicentre study, administration of prednisone did not reduce the incidence of pancreatitis rather than placebo 14.8- N-acetyl CysteineN-acetyl Cysteine can reduce inflammation and may be useful in post-ERCP pancreatitis.Pezhman Alavi Nejad wants to evaluate efficacy of N-acetyl Cysteine for the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis. He assigned a prospective double blind randomized study. in that respect were significant reduce in the prevalence of acute pancreatitis between the groups. This study shows that NAC could be used for the prevention of post-ERCP pancreatitis 15.9- AprepitantAprepitant is one drug from the classification of neurok inin-1 sensory receptor antagonists. Upendra Shah wants to assess the efficacy of aprepitant at preventing post-ERCP pancreatitis in high risk patients. A randomized, double-blind, placebo controlled trial assigned. Patients received either placebo or oral aprepitant. Aprepitant could not decrease the incidence of post-ERCP pancreatitis against placebo 16.pancreatic stentsAbhishek Choudhary assessed a meta-analysis and to determined effect of pancreatic stents for prevention of post-ERCP pancreatitis.This meta-analysis of the RCTs showed that pancreatic stent placement reduces the incidence pancreatitis and hyperamylasemia 17.ConclusionConsidering the fact that pancreatitis is the most important of the ERCP complications we should pay attention the methods for prevention of post-ERCP pancreatitis. Pancreatic stents are useful for this aim. From the pharmacologic agents, Glyceryl trinitrate, Indometacin and N-acetyl Cysteine could significantly decrease the incidence of post-ERCP pa ncreatitis. Other drug that assessed in this appraise article such as Nifedipine, Risperidone, Corticosteroids, and Aprepitant did not show significant effect for prevention of post-ERCP pancreatitis.

No comments:

Post a Comment