Öz
Aim:
Chronic pancreatitis (CP) is irreversible damage of the pancreas characterized
by acinar and islet cell loss and parenchymal fibrosis of pancreas. Treatmet of
CP is accociated with stage of endocrine and exocrine insufficiency and started
with conservative minimal invasive procedures. Because of complications surgical
treatment procedures and financial results, endoscopic treatment methods have
an important role in the management of CP. The aim of this
study is to identify and describe the incidence, clinical presentation, endoscopic
retrograde cholangiopancreatography (ERCP) procedures details and the
complication short and long (3-year follow-up) results of CP patients
undergoing ERCP.
Material
and Method: The ERCP procedures were held in
Gastroenterology Endoscopy Unit between 15 Jenuary 2016 and 15 Jenuary 2017 and
were retrospectively evaluated. Consecutive patients with all age diagnosed
with CP was screened for eligibility for inclusion in this study. Patients were compared with the demographic
characteristics, etiology of CP, treatment indications of the ERCP procedure,
pancreatic stent implants, how many times ERCP was done, pain manangement and
ERCP realted complication.
Results:
A total of 1037 consecutive patients who underwent ERCP were scanned
retrospectivle. Fourteen CP patients
fulfilling the criteria of study. In CP patients the average diameter of the
common bile duct was 8.42 mm and the pancreatic duct 6 mm was found at ERCP. Nine
(64.28%) patients aplied pancreatic stenting and 5 (35.71%) patients had
post-ERCP pancreatitis. ERCP procedures was applied to 4 patients 1 time, 9
patients 2 times, and in 1 patient 3 times at 3 years follow-up. The mean ERCP
ratio in the CP patients was 1.78.
Conclusion:
ERCP is an indispensable treatment management in the patient of CP which
presence of abdominal pain, recurrence or local complications that do not
respond to medical treatment.
Keywords:
Chronic
pancreatitis, treatment, ERCP
Anahtar Kelimeler
Kaynakça
- 1. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001; 120: 682-707.
- 2. Bockman DE, Boydston WR, Anderson MC. Origin of tubular complexes in human chronic pancreatitis. Am J Surg 1982; 144: 243-9.
- 3. Braganza JM, Lee SH, McCloy RF, McMahon MJ. Chronic pancreatitis. Lancet 2011; 377: 1184-97.
- 4. Oza VM, Kahaleh M. Endoscopic management of chronic pancreatitis. World J Gastrointest Endosc 2013; 5: 19-28.
- 5. Brock C, Nielsen LM, Lelic D, Drewes AM. Pathophysiology of chronic pancreatitis. World J Gastroenterol 2013; 19: 7231-40.
- 6. Sarles H. Cros RC, Bidart JM. A multicenter inquiry into the etiology of pancreatic diseases. Digestion 1979; 19: 110-25.
- 7. Ammann RW, Heitz PU, Klöppel G. Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 1996; 111: 224-31.
- 8. Dumonceau JM, Macias-Gómez C. Endoscopic management of complications of chronic pancreatitis. World J Gastroenterol 2013; 19: 7308-15.
- 9. DiMagno MJ, DiMagno EP. Chronic pancreatitis. Curr Opin Gastroenterol 2009; 25: 454-9.
- 10. Issa Y, van Santvoort HC, van Goor H, Cahen DL, Bruno MJ, Boermeester MA. Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A multidisciplinary Update. Dig Surg 2013; 30: 35-50.
- 11. Yoo BM, Lehman GA. Update on endoscopic treatment of chronic pancreatitis. Korean J Intern Med 2009; 24: 169-79.
- 12. Weber A, Schneider J, Neu B, Meining A, et al. Endoscopic stent therapy in patients with chronic pancreatitis: a 5-year follow-up study. World J Gastroenterol 2013; 19: 715-20.
- 13. Liao Z, Jin G, Cai D, et al. Guidelines: diagnosis and therapy for chronic pancreatitis. J Interv Gastroenterol 2013; 3: 133-6.
- 14. Pitchumoni CS. Pathogenesis and managenent of pain in chronic pancreatitis. World J Gastroenterol 2000; 6: 490-6.
- 15. Bockman DE, Buchler M, Malfertheiner P, Beger HG. Analysis of nerves in chronic pancreatitis. Gastroenterology 1988; 94: 1459-69.
- 16. Shen Y, Liu M, Chen M, Li Y, Lu Y, Zou X. Covered metal stent or multiple plastic stents for refractory pancreatic ductal strictures in chronic pancreatitis: Asystematic review. Pancreatology 2014; 14: 87-90.
- 17. Van der Gaag NA, van Gulik TM, Busch OR, et al. Functional and medical outcomes after tailored surgery for pain due to chronic pancreatitis. Ann Surg 2012; 255: 763-70.
Öz
Amaç: Kronik pankreatit (KrP), asiner
ve adacık hücre kaybı, parankimal fibrozis ile karakterize pankreasın geri
dönüşümsüz hasarı ile karakterizedir. KrP tedavisinde endokrin ve ekzokrin
yetersizlik tablosu göz önüne alınarak en az invaziv olan konservatif yöntemler
ile başlanmaktadır. Günümüzde cerrahi tedavi süreçlerin komplikasyonları ve
mali sonuçları, endoskopik tedavi yöntemlerini öne çıkarmış olup KrP
tedavisinde endoskopik tedavi yöntemleri önemli bir yer edinmiştir. Bu
çalışmadaki amaç ERCP ile tedavi uygulanmış KrP hastaların insidansını, klinik
prezentasyonlarını, ERCP işlemi detaylarını ve ERCP sonraki kısa ve uzun (3
yıllık takip) dönem sonuçlarını gösterebilmektir.
Gereç ve Yöntem: Ankara Eğitim ve Araştırma
Hastanesi Gastroenteroloji Kliniği ERCP Ünitesi’nde, 15 Ocak 2016 ile 15 Ocak
2017 tarihleri arasında yapılan ERCP işlemleri geriye yönelik tarandı. Yaş
sınırı gözetmeksizin KrP nedeniyle ERCP yapılan hastalar belirlendi. Hastaların
demografik verileri, KrP etiyolojisi, yapılan ERCP işleminin tedavi
endikasyonu, pankreatik stent implantasyonları, kaç kez ERCP yapıldığı, ağrının
düzelmesi ve ERCP işlemi ile ilişkili komplikasyonlar kaydedildi.
Bulgular: ERCP uygulanan toplam 1037 hasta
çalışma için araştırıldı. Bu hastalar içinde toplam 14 KrP hastası
saptandı. Hastaların ERCP'de ortalama
koledok çapı 8,42 mm olarak pankreatik kanal 6 mm olarak bulunmuştur. Dokuz (%64,28)
hastaya pankreatik stent uygulanmış olup 5 (%35,71) hastada post-ERCP
pankreatit gözlendi. Üç yıllık takipte 4 hastaya 1 defa, 9 hastaya 2 defa ve 1
hastaya 3 defa ERCP uygulanmış olup hastalardaki ortalama ERCP oranı 1,78 idi.
Sonuç: KrP'de tıbbi tedaviye cevap
vermeyen ağrı, nüks veya lokal komplikasyonların varlığında ERCP invaziv
olmakla birlikte vazgeçilmez tedavi yöntemidir.
Anahtar Kelimeler
Kaynakça
- 1. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001; 120: 682-707.
- 2. Bockman DE, Boydston WR, Anderson MC. Origin of tubular complexes in human chronic pancreatitis. Am J Surg 1982; 144: 243-9.
- 3. Braganza JM, Lee SH, McCloy RF, McMahon MJ. Chronic pancreatitis. Lancet 2011; 377: 1184-97.
- 4. Oza VM, Kahaleh M. Endoscopic management of chronic pancreatitis. World J Gastrointest Endosc 2013; 5: 19-28.
- 5. Brock C, Nielsen LM, Lelic D, Drewes AM. Pathophysiology of chronic pancreatitis. World J Gastroenterol 2013; 19: 7231-40.
- 6. Sarles H. Cros RC, Bidart JM. A multicenter inquiry into the etiology of pancreatic diseases. Digestion 1979; 19: 110-25.
- 7. Ammann RW, Heitz PU, Klöppel G. Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 1996; 111: 224-31.
- 8. Dumonceau JM, Macias-Gómez C. Endoscopic management of complications of chronic pancreatitis. World J Gastroenterol 2013; 19: 7308-15.
- 9. DiMagno MJ, DiMagno EP. Chronic pancreatitis. Curr Opin Gastroenterol 2009; 25: 454-9.
- 10. Issa Y, van Santvoort HC, van Goor H, Cahen DL, Bruno MJ, Boermeester MA. Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A multidisciplinary Update. Dig Surg 2013; 30: 35-50.
- 11. Yoo BM, Lehman GA. Update on endoscopic treatment of chronic pancreatitis. Korean J Intern Med 2009; 24: 169-79.
- 12. Weber A, Schneider J, Neu B, Meining A, et al. Endoscopic stent therapy in patients with chronic pancreatitis: a 5-year follow-up study. World J Gastroenterol 2013; 19: 715-20.
- 13. Liao Z, Jin G, Cai D, et al. Guidelines: diagnosis and therapy for chronic pancreatitis. J Interv Gastroenterol 2013; 3: 133-6.
- 14. Pitchumoni CS. Pathogenesis and managenent of pain in chronic pancreatitis. World J Gastroenterol 2000; 6: 490-6.
- 15. Bockman DE, Buchler M, Malfertheiner P, Beger HG. Analysis of nerves in chronic pancreatitis. Gastroenterology 1988; 94: 1459-69.
- 16. Shen Y, Liu M, Chen M, Li Y, Lu Y, Zou X. Covered metal stent or multiple plastic stents for refractory pancreatic ductal strictures in chronic pancreatitis: Asystematic review. Pancreatology 2014; 14: 87-90.
- 17. Van der Gaag NA, van Gulik TM, Busch OR, et al. Functional and medical outcomes after tailored surgery for pain due to chronic pancreatitis. Ann Surg 2012; 255: 763-70.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 10 Sayı: 3 |
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