Post-ERCP pankreatitinde risk faktörleri
Küçük Resim Yok
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmanın amacı 2013 ve 2018 seneleri arasında tarafımızca yapılmış endoskopik retrograd kolanjiopankreatikografi işlemleri sonrasında gelişen pankreatitlerin insidansını, risk faktörlerini ve anlamlı risk faktörlerinin pankreatit ağırlığına etkisini araştırmaktı. 18 yaşının üzerinde, belirtilen tarihler içinde endoskopik retrograd kolanjiyopankreatikografi yapılmış ve işlem esnasında papilla ile etkileşime girilmiş 822 hasta çalışmaya dahil edildi. Hastalara ait veriler retrospektif olarak hastane arşivi, hasta kayıt programı ve hastaların dosyalarından toplandı. Hastaların cinsiyeti, yaşı, işlem öncesi serum amilaz ve lipaz değerleri ve pankreatit geçmişi gibi özellikleri, işlemin ise önkesi yapılıp yapılmadığı, pankreatik kanülasyon olup olmadığı gibi verileri toplandı. Olguların 105'inin endoskopik retrograd kolanjiyopankreatikografi sonrası pankreatiti geçirdiği, endoskopik retrograd kolanjiyopankreatikografi sonrası pankreatitinin insidansının %12,7 olduğu; geçirilmiş pankreatitin, geçirilmiş endoskopik retrograd kolanjiyopankreatikografi sonrası pankreatitinin, sfinkter Oddi disfonksiyonunun; hastaya önkesi, biliyer stent uygulanmasının; pankreatik kanülasyonun ve biliyer kanülasyonda zorlanılmasının bu hastalığa yakalanma riskini arttırdığı gösterildi. Çalışmamızda; cinsiyet, yaş, Tip II diyabet, hastanın kolesistektomize olması, kolanjit geçmişi, endoskopik retrograd kolanjiyopankreatikografi geçmişi, periampullar tümör varlığı, divertikül ilişkili papilla varlığı, koledok kanülasyonu, işlem esnasında görülen kanama faktörlerinin endoskopik retrograd kolanjiyopankreatikografi sonrası pankreatiti riskini arttırmadığı izlendi. 41 Yeni bilgi olarak kist hidatik hastalarına palyasyon amacıyla yapılan işlemlerde pankreatit riskinin artmadığı ve pankreatit riskinin Amerikan Anestezistler Derneği skorlarıyla ilişkisiz olduğu bulundu. Biliyer kanülasyonu zor olan hastalarda ve daha önceden endoskopik retrograd kolanjiyopankreatikografi sonrası pankreatiti geçirmiş hastalarda hastalığın seyrinin diğer gruplara göre daha ağır olduğu gösterildi. Sonuçlara dayanılarak tarafımızca; pankreatik kanülasyondan elden geldiğince kaçınılması, biliyer stent uygulanan hastalarda daha seçici davranılması, daha önceden pankreatit ve endoskopik retrograd kolanjiyopankreatikografi sonrası pankreatiti geçmişi olan hastalarda kesin endikasyon harici endoskopik retrograd kolanjiyopankreatikografi işleminden kaçınılması önerilmektedir.
The aim of the study was to investigate the incidence, risk factors and the effect of significant risk factors to the severity of the pancreatitis that manifested after endoscopic retrograd cholangiopancreaticography practices done between years 2013 and 2018 by ourselves. 822 patients over the age of 18, that went through endoscopic retrograd cholanjiopancreaticography procedure between the stated dates and, which were performed any papilla interaction during the procedure were included to the study. Data belonging to patients were gathered from hospital archives, patient record program and patient files. Data of patient's characteristics like sex, age, before-procedure serum amilase and lipase values; and procedure's features like if precut was performed or not, if pancreatic cannulation was done or not were gathered. It was shown that 105 of the cases went through post endoscopic retrograd cholanjiopancreaticography pancreatitis, incidence for pancreatitis after endoscopic retrograd cholanjiopancreaticography is %12,7; and previous pancreatitis; previous post endoscopic retrograd cholanjiopancreaticography pancretitis, sfincter Oddi disfunction, application of pre-cut or biliary stent to the patient, pancreatic cannulation and difficulty in biliary cannulation increases the risk of getting this disease. In our study it was seen that; sex, Type II diabetes, patient cholesystectomized, previous cholangitis, previous endoscopic retrograd cholanjiopancreaticography, 43 periampullary tumour existence, existence of diverticulum involved papilla, cannulation of choledoc, and bleeding seen through procedure doesn't increase the risk of post endoscopic retrograd cholanjiopancreaticography pancreatitis. As new data, it was found that procedures done to the cyst hydatid patients for paliation the pancreatitis risk doesn't increase and the pancreatitis risk is not related to the American Society of Anesthesiologists scores. It was shown that the disease's severity were heavier in patients with harder biliary cannulation and with previous post endoscopic retrograd cholanjiopancreaticography pancreatitis. According to the results; we suggest avoiding pancreatic cannulation as much as one can, being more selective in patients with application of biliary stent, and avoiding endoscopic retrograd cholanjiopancreaticography in patients with previous pancreatitis or post endoscopic retrograd cholanjiopancreaticography pancreatitis without precise indication. Key words: endoscopic retrograd cholanjiopancreaticography, pancreatitis, risk factors, severity
The aim of the study was to investigate the incidence, risk factors and the effect of significant risk factors to the severity of the pancreatitis that manifested after endoscopic retrograd cholangiopancreaticography practices done between years 2013 and 2018 by ourselves. 822 patients over the age of 18, that went through endoscopic retrograd cholanjiopancreaticography procedure between the stated dates and, which were performed any papilla interaction during the procedure were included to the study. Data belonging to patients were gathered from hospital archives, patient record program and patient files. Data of patient's characteristics like sex, age, before-procedure serum amilase and lipase values; and procedure's features like if precut was performed or not, if pancreatic cannulation was done or not were gathered. It was shown that 105 of the cases went through post endoscopic retrograd cholanjiopancreaticography pancreatitis, incidence for pancreatitis after endoscopic retrograd cholanjiopancreaticography is %12,7; and previous pancreatitis; previous post endoscopic retrograd cholanjiopancreaticography pancretitis, sfincter Oddi disfunction, application of pre-cut or biliary stent to the patient, pancreatic cannulation and difficulty in biliary cannulation increases the risk of getting this disease. In our study it was seen that; sex, Type II diabetes, patient cholesystectomized, previous cholangitis, previous endoscopic retrograd cholanjiopancreaticography, 43 periampullary tumour existence, existence of diverticulum involved papilla, cannulation of choledoc, and bleeding seen through procedure doesn't increase the risk of post endoscopic retrograd cholanjiopancreaticography pancreatitis. As new data, it was found that procedures done to the cyst hydatid patients for paliation the pancreatitis risk doesn't increase and the pancreatitis risk is not related to the American Society of Anesthesiologists scores. It was shown that the disease's severity were heavier in patients with harder biliary cannulation and with previous post endoscopic retrograd cholanjiopancreaticography pancreatitis. According to the results; we suggest avoiding pancreatic cannulation as much as one can, being more selective in patients with application of biliary stent, and avoiding endoscopic retrograd cholanjiopancreaticography in patients with previous pancreatitis or post endoscopic retrograd cholanjiopancreaticography pancreatitis without precise indication. Key words: endoscopic retrograd cholanjiopancreaticography, pancreatitis, risk factors, severity
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Gastroenteroloji, Gastroenterology ; Genel Cerrahi
