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Incidence of post-ERCP pancreatitis from direct pancreatic juice collection in hereditary pancreatitis and familial pancreatic cancer before and after the introduction of prophylactic pancreatic stents and rectal diclofenac.
- Source :
-
Pancreas [Pancreas] 2015 Mar; Vol. 44 (2), pp. 260-5. - Publication Year :
- 2015
-
Abstract
- Objectives: Individuals from hereditary pancreatitis (HP) and familial pancreatic cancer (FPC) kindreds are at increased risk of developing pancreatic cancer. Premalignant molecular changes may be detected in pancreatic juice collected by endoscopic retrograde cholangiopancreatography (ERCP). The objective was to determine the risk of post-ERCP pancreatitis (PEP).<br />Methods: A prospective study (1999-2013) was undertaken of 80 ERCPs (24 in HP and 56 in FPC) from 60 individuals and the impact of PEP prophylaxis using a self-expelling pancreatic stent and 50 mg diclofenac per rectum from 2008.<br />Results: There was no PEP in the HP cohort and 13 (23.2%) PEP from 56 procedures in the FPC cohort (P = 0.0077). Up to 2008 PEP had occurred in 7 (43.8%) of 16 procedures in FPC individuals versus none of 18 procedures in HP individuals (P = 0.0021). After the introduction of prophylaxis, the incidence of PEP fell to 6 (15.0%) of 40 procedures in FPC individuals (P = 0.0347).The odds ratio (95% confidence interval) was 0.23 (0.06-0.84) in favor of prophylaxis (0.035).<br />Conclusions: Individuals with HP are at minimal risk for PEP. Although the risk of PEP in individuals with FPC can be reduced by using prophylactic self-expelling stents and diclofenac, it remains too high for routine screening.
- Subjects :
- Administration, Rectal
Adult
Biomarkers, Tumor genetics
Female
Genetic Testing
Humans
Incidence
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Pancreatic Neoplasms genetics
Pancreatitis diagnosis
Pancreatitis epidemiology
Pancreatitis, Chronic genetics
Predictive Value of Tests
Prospective Studies
Registries
Risk Assessment
Risk Factors
Treatment Outcome
United Kingdom epidemiology
Anti-Inflammatory Agents, Non-Steroidal administration & dosage
Cholangiopancreatography, Endoscopic Retrograde adverse effects
Diclofenac administration & dosage
Pancreatic Juice chemistry
Pancreatic Neoplasms diagnosis
Pancreatitis prevention & control
Pancreatitis, Chronic diagnosis
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1536-4828
- Volume :
- 44
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Pancreas
- Publication Type :
- Academic Journal
- Accession number :
- 25438071
- Full Text :
- https://doi.org/10.1097/MPA.0000000000000246