الفهرس 
Conclusion and Recommendation
Statistical Analysis of resultsOnly 14 pages are availabe for public view
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Abstract
Endoscopic retrograde cholangio-pancreatography
(ERCP) remains one of the most complex endoscopic
procedures in the non-surgical management of several
pancreatobiliary diseases. It is now widely accepted as a
therapeutic modality; its application, however, is limited
because of the technical difficulty and unavoidable incidence
of complications. That include pancreatitis, bleeding,
cholangitis, cholecystitis, and perforation; of these, postERCP pancreatitis (PEP) is the most frequent.
The pathophysiology of PEP is not well understood.
Mechanical, hydrostatic, chemical, enzymatic, allergic,
thermal, cytokine and microbiological factors have all been
proposed as causes.
Several drugs have been used to prevent PEP, but their
results are controversial. Among these, somatostatin have
shown some promises.
The decreased production and release of somatostatin
play also an important role in pancreatitis. This is caused by
a decreased count of D cells in the antrum, activation of H3
receptors on D cells due to N alpha-methyl histamine production by H. pylori.This study was conducted to assess identify the role of
H. pylori infection in the pathogenesis of post ERCP
pancreatitis.
This study was carried out at the ERCP unit of Ain
Shams University and specialized Hospitals on 80 patients
with different causes of obstructive jaundice requiring ERCP.
Patients were divided according to H. pylori infection into
group (A): including 25 H.pylori positive patients, and group
(B): including 55 H. pylori negative patients.
The aim of the study was to identify the association
between H. Pylori infection and somatostatin deficiency and
its relation with occurrence of post ERCP pancreatitis.
All patients were subjected to full history taking,
physical examination, laboratory investigations including
complete blood count, total and direct bilirubin, AST, ALT,
PT, INR, baseline values of serum amylase and lipase, H.
Pylori stool antigen and serum somatostatin level as well as
abdominal ultrasonography.
Then patients underwent ERCP after a 12h fast, and
were monitored in the ward for 24 hours with special
emphasis on any symptom or sign suggestive of acute
pancreatitis together with measuring serum amylase and
lipase 6 hours after the procedure.In the present study there was no statistically
significant difference between both groups as regard age,
sex, different indications of ERCP and different laboratory
findings except for AST, ALT and platelet that were
statistically significantly higher in group (B) than in
group(A). Moreover, Somatostatin level was found to be higher
in group (A) than in group (B) and this difference was
statistically insignificant.
Regarding the incidence of PEP, The present study
also demonstrated that the incidence of PEP was 12% (3
patients in group A) and 10.9% (6 patients in group B) with
an overall incidence of 11.2% of our studied group.
While as regard ERCP related maneuvers like precut
papillotomy, it was done in 3 patients (33.3%) among PEP
positive group and in 20 patients (28.2%) among PEP
negative group of patient, so incidence of PEP in our study in
patients who underwent precut papillotomy was 13%,
compared with 10.5% in patients who didn’t. yet this
difference was statistically non significant.
Regarding CBD stent application, it was done in 7
patients (77.8%) among PEP positive group and in 43
patients (60.6%) among PEP negative group of patient, yet
this difference was statistically non significant.As regard post ERCP amylase and lipase levels
patients who experienced PEP had higher levels of post
ERCP amylase and lipase than patients who didn’t experience
PEP and this differences were statistically highly significant.
Regarding the correlation between somatostatin and
occurrence of PEP the present study showed that patients
who experienced PEP had a statistically significant lower
somatostatin level than patients who didn’t experience PEP.