Year 2018 Vol. 26 No 3

GENERAL & SPECIAL SURGERY

I. YA. KLETSKO, O.I. KUSHNIRUK

RISK FACTORS OF ACUTE PANCREATITIS AFTER THERAPEUTIC ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Objective. To identify significant risk factors for the development of acute pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography.
Methods. The significance of risk factors for post-manipulation pancreatitis was analyzed based on the results of 1801 therapeutic endoscopic retrograde cholangiopancreatographies performed in the clinic. To confirm the diagnosis of pancreatitis, to assess the severity stage the Cotton criteria were used. We analyzed the age and gender factors, the influence of the sphincter of Oddi syndrome in association with microlithiasis and parapapillary diverticulum, the ways of the transpapillary access, papillosphincterotomy and balloon dilatation. Possibilities of the intervention were evaluated in the absence of signs of biliary hypertension, and concrements more than 10 mm. The ratio of the chances of occurrence of the event in different periods was determined, with a calculation of 95% confidence interval.
Results. Acute pancreatitis developed in 19 (1.05%) patients. Among them, 7 (36.8%) had a severe destructive form. All cases of pancreatitis were diagnosed after primary intervention (OR 11.81, 95% CI 0.71-196.06, p = 0.011). Significant predictors of pancreatitis after transpapillary interventions were: young patients <40 years (OR 7.54, 95% CI 3.10-18.43, p = 0.00007), more often it occurred in women (OR 5.58, 95 % CI 1.22-17.35, p = 0.008), the presence of microcholedocholithiasis and concrements up to 10 mm in size (OR 4.42, 95% CI 1.23-12.44, p = 0.01), the syndrome of sphincter of Oddi dysfunction (OR 2.80, 95% CI 1.05-6.88, p = 0.03), interventions in the absence of obvious diagnostic signs of biliary hypertension (OR 2.80, 95% CI 1.16-6.96; p = 0.02).
Conclusions. Patient-related risk factors for pancreatitis development after therapeutic cholangiopancreatography remain a weak spot for its comprehensive prevention. The risk of developing acute pancreatitis rises 5-10 times if the patient has three or more factors. Atypical methods of papillosphincterotomy are not the significant risk factors for the development of pancreatitis when performed by an experienced specialist. It is necessary to adhere to the principle of multistage in carrying out complex or prolonged transpapillary X-ray endoscopic operations.

Keywords: endoscopic retrograde cholangiopancreatography, complications, post-ERCP pancreatitis, risk factors; guidewire-assisted cannulation
p. 301-310 of the original issue
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Address for correspondence:
290059, Ukraine,
Lviv, Mikolaychuk Str., 9,
Danylo Halytsky Lviv
National Medical University,
Department of Radiation Diagnostics
of the Faculty of Postgraduate Education
Tel. mobile: +380 93 750-98-24,
e-mail: iv17@ukr.net,
Ivan Ya. Kletsko
Information about the authors:
Kletsko Ivan Ya., Assistant of the Department of Radiation Diagnostics of the Faculty of Postgraduate Education, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0001-8942-0754
Kushniruk Oleksiy I., PhD, Associate Professor of the Department of Surgery and Endoscopy of the Faculty of Postgraduate Education, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-3812-9339
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