الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 146 |  |  |
| | | from | 146 | | |
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems, Post-ERCP pancreatitis (PEP) is the most common complications of ERCP, The reported incidence of PEP complication is 1–40 %, is defined as acute pancreatitis
occurring following an ERCP procedure, This consists of the development of new pancreatic-type abdominal pain associated with hyperamylasemia of three times the upper limit of normal, occurring 24 h after an ERCP requiring
hospital admission. The underlying pathogenesis of PEP is thought to be multifactorial, including difficult biliary access caused by biliary sphincter hypertension, repeated inadvertent pancreatic duct cannulation and contrast injection and secondary prolonged papillary edema and thermal injury caused by sphincterotomy. There are many strategies for preventing PEP, or decreasing its severity as: Pharmacological Methods for Preventing Post-ERCP Pancreatitis, much more favorable results have been recently reported with the use of non-steroidal anti-inflammatory drugs (NSAIDs), rectal administration of diclofenac has shown promise in preventing PEP, also Somatostatin is a drug considered to have a beneficial effect on PEP prevention. It inhibits the secretory functions of the pancreas. It can also restrain the motility of the sphincter of Oddi. This combined action can contribute to PEP prevention.
Cannulation using a guide wire rather than contrast-directed cannulation is considered a valuable technique in preventing PEP. A guide wire was used to facilitate selective biliary access and to reduce complications caused by prolonged cannula manipulation or contrast injection into the pancreatic duct.
The aim of this study is to evaluate pharmacological methods and using WGC for prevention of PEP.
We conducted a prospective study of 40 patients were subjected for ERCP whose were presented to Menoufia University Hospitals suffered from obstructive jaundice during the period between December 2015 to February 2017, The patients were separated into two groups, Each group contains 20 Patients, group A is a control group that were operated with traditional methods and group B is a case group subjected to pharmacological methods for preventing PEP and used WGC.
As regard to sex there is no significant difference between two groups, in group A females are 13 cases (65%) and males are 7 cases (35%) while in group B females are 14 cases (70%) and males are 6 cases (30%) with p value is 0.736, also there is no significant difference between two groups according to age, in group A the Mean ± SD age is 49.75 ± 9.03 and the median is 49.50 while in group B the Mean ± SD age is 50.85 ± 10.81 and the median is 50.0,with p value is 0.736.
The Demographic characteristics among the studied sample of Patients (n=40) demonstrated that there was increased percentage of obstructive jaundice. In females (67.5%) than males (32.5%). In this study group B showed decreasing in ERCP duration as minimal duration was 30 min, maximum duration was 60 min, median 35.50 min and mean was 38.15 ± 7.20 while group A showed higher ERCP duration as minimal duration was 50 min, maximum duration was 115 min, median 65 min and mean was 72.75 ± 21.15, the p value was <0.001.
In our study, 40 patients were subjected to ERCP, in 38 cases (95%) ERCP succeeded in relieving biliary obstruction; while it failed in 2 cases (5%).There was no mortality.
also in group B 20 cases (100%) showed normal level of serum amylase post ERCP (<90 U/L) while in group A 14 cases (70%) showed normal level of serum amylase and 6 cases ( 30%) showed hyperamylasaemia ( > 90 U/L), the p value was 0.020.
According to definition of PEP, the incidence PEP in group A was 3 cases (15 %),with using Ranson criteria, Revised Atlanta Criteria and Balthazar CT severity index, 2 patients had mild pancreatitis and 1 patient had moderate Pancreatitis while there is no incidence of PEP among group B. We noted that using somatostatin, rectal NSAIDs and wire-guided biliary cannulation technique, reduced incidence of PEP and hyperamylasaemia.