Treatment of non-biliary severe acute pancreatitis by endoscopic sphincterotomy

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Author:
ZHANG Xiao-feng(Department of Gastroenterology,Hangzhou First People's Hospital,Hangzhou 310006,China)
ZHANG Xiao(Department of Gastroenterology,Hangzhou First People's Hospital,Hangzhou 310006,China)
YANG Jian-feng(Department of Gastroenterology,Hangzhou First People's Hospital,Hangzhou 310006,China)
FAN Zhen(Department of Gastroenterology,Hangzhou First People's Hospital,Hangzhou 310006,China)
LV Wen(Department of Gastroenterology,Hangzhou First People's Hospital,Hangzhou 310006,China)
GUO Ying-hui(Department of Gastroenterology,Hangzhou First People's Hospital,Hangzhou 310006,China)
LIN Xiu-ying(Department of Gastroenterology,Hangzhou First People's Hospital,Hangzhou 310006,China)
Journal Title:
CHINESE JOURNAL OF PANCREATOLOGY
Issue:
Volume 9, Issue 05, 2009
DOI:
10.3760/cma.j.issn.1674-1935.2009.05.003
Key Word:
Pancreatitis; acute necrotizing; Sphincterotomy; endoscopic; Therapy; Endoscopic nosalbiliary drainage

Abstract: Objective To investigate the role of endoscopic sphincterotomy(EST)and endoscopic nasobiliary drainage(ENBD)in the treatment of non-biliary severe acute pancreatitis(SAP).Methods 73 patients were randomly divided into the endoscopic treatment group(35 cases)and control group(38 cases).The patients in control group received non-surgical treatment.EST plus ENBD were performed in patients in the endoscopic treatment group 72h within hospitalization.Serum levels of amylase before EST and 1d,3 d,7 d after EST were measured;the ease of pain and recovery of bowel function were documented;the mortality rate,complication rate,surgery rote and hospital stay were also observed.Results The successful cannulation rate in the EST group was 94.3%(33/35),and there was no procedure related complication.Serum levels of amylase before EST and 1d,3 d,7 d after EST were(1376±131)U/L,(675±49)U/L,(238±49)U/L,(75±13)U/L,the serum levels of amylase before EST and 1d after EST in the EST group were not significantly different from those in the control group,but the corresponding values at 3 d,7 d were significantly lower than those in the control group(P<0.01).The apparent effective rate and total effective rate of pain relief was 37.1%and 48.6%.which was significantly higher than those in the control group (26.3%and 28.9%,P<0.05).There was no mortality in both groups.The complication rate in the EST group within 30 d was 14.3%,which was signiilcanfly higher than that in the control group(44.7%,P<0.01).The gurgery rate in EST group was 2.86%,which was significantly lower than that in the control group (21.1%,P<0.05).The hospital stay in EST group was(27.6±4.0)d,which was significantly shorter than that in the control group[(41.7±5.9)d,P<0.05].Conclusions EST and ENBD treatment for non-biliary SAP was superior to non-surgical treatment within 72 h of symptom onset with excellent safety and feasibility profile.

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