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Endoscopic retrograde cholangiopancreatography with rendezvous cannulation reduces pancreatic injury

Swahn, Fredrik ; Regnér, Sara LU orcid ; Enochsson, Lars ; Lundell, Lars ; Permert, Johan ; Nilsson, Magnus ; Thorlacius, Henrik LU and Arnelo, Urban (2013) In World Journal of Gastroenterology 19(36). p.6026-6034
Abstract
AIM: To examine whether rendezvous endoscopic retrograde cholangiopancreatography (ERCP) is associated with less pancreatic damage, measured as leakage of proenzymes, than conventional ERCP. METHODS: Patients (n = 122) with symptomatic gallstone disease, intact papilla and no ongoing inflammation, were prospectively enrolled in this case-control designed study. Eighty-one patients were subjected to laparoscopic cholecystectomy and if intraoperative cholangiography suggested common bile duct stones (CBDS), rendezvous ERCP was performed intraoperatively (n = 40). Patients with a negative cholangiogram constituted the control group (n = 41). Another 41 patients with CBDS, not subjected to surgery, underwent conventional ERCP. Pancreatic... (More)
AIM: To examine whether rendezvous endoscopic retrograde cholangiopancreatography (ERCP) is associated with less pancreatic damage, measured as leakage of proenzymes, than conventional ERCP. METHODS: Patients (n = 122) with symptomatic gallstone disease, intact papilla and no ongoing inflammation, were prospectively enrolled in this case-control designed study. Eighty-one patients were subjected to laparoscopic cholecystectomy and if intraoperative cholangiography suggested common bile duct stones (CBDS), rendezvous ERCP was performed intraoperatively (n = 40). Patients with a negative cholangiogram constituted the control group (n = 41). Another 41 patients with CBDS, not subjected to surgery, underwent conventional ERCP. Pancreatic proenzymes, procarboxypeptidase B and trypsinogen-2 levels in plasma, were analysed at 0, 4, 8 and 24 h. The proenzymes were determined in-house with a double-antibody enzyme linked immunosorbent assay. Pancreatic amylase was measured by an enzymatic colourimetric modular analyser with the manufacturer's reagents. All samples were blinded at analysis. RESULTS: Post ERCP pancreatitis (PEP) occurred in 3/41 (7%) of the patients cannulated with conventional ERCP and none in the rendezvous group. Increased serum levels indicating pancreatic leakage were significantly higher in the conventional ERCP group compared with the rendezvous ERCP group regarding pancreatic amylase levels in the 4- and 8-h samples (P = 0.0015; P = 0.03), procarboxypeptidase B in the 4- and 8-h samples (P < 0.0001; P < 0.0001) and trypsinogen-2 in the 24-hour samples (P = 0.03). No differences in these markers were observed in patients treated with rendezvous cannulation technique compared with patients that underwent cholecystectomy alone (control group). Post procedural concentrations of pancreatic amylase and procarboxypeptidase B were significantly correlated with pancreatic duct cannulation and opacification. CONCLUSION: Rendezvous ERCP reduces pancreatic enzyme leakage compared with conventional ERCP cannulation technique. Thus, laparo-endoscopic technique can be recommended with the ambition to minimise the risk for post ERCP pancreatitis. (C) 2013 Baishideng. All rights reserved. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Common bile duct stones, Procarboxypeptidase B, Trypsinogen-2, Pancreatic amylase, Intraoperative endoscopic retrograde, cholangiopancreatography
in
World Journal of Gastroenterology
volume
19
issue
36
pages
6026 - 6034
publisher
WJG Press
external identifiers
  • wos:000324909700010
  • scopus:84885604562
  • pmid:24106403
ISSN
1007-9327
DOI
10.3748/wjg.v19.i36.6026
language
English
LU publication?
yes
id
3d07179e-b28c-49a0-8779-369b6b69b112 (old id 4172530)
date added to LUP
2016-04-01 11:02:20
date last changed
2022-04-28 03:53:18
@article{3d07179e-b28c-49a0-8779-369b6b69b112,
  abstract     = {{AIM: To examine whether rendezvous endoscopic retrograde cholangiopancreatography (ERCP) is associated with less pancreatic damage, measured as leakage of proenzymes, than conventional ERCP. METHODS: Patients (n = 122) with symptomatic gallstone disease, intact papilla and no ongoing inflammation, were prospectively enrolled in this case-control designed study. Eighty-one patients were subjected to laparoscopic cholecystectomy and if intraoperative cholangiography suggested common bile duct stones (CBDS), rendezvous ERCP was performed intraoperatively (n = 40). Patients with a negative cholangiogram constituted the control group (n = 41). Another 41 patients with CBDS, not subjected to surgery, underwent conventional ERCP. Pancreatic proenzymes, procarboxypeptidase B and trypsinogen-2 levels in plasma, were analysed at 0, 4, 8 and 24 h. The proenzymes were determined in-house with a double-antibody enzyme linked immunosorbent assay. Pancreatic amylase was measured by an enzymatic colourimetric modular analyser with the manufacturer's reagents. All samples were blinded at analysis. RESULTS: Post ERCP pancreatitis (PEP) occurred in 3/41 (7%) of the patients cannulated with conventional ERCP and none in the rendezvous group. Increased serum levels indicating pancreatic leakage were significantly higher in the conventional ERCP group compared with the rendezvous ERCP group regarding pancreatic amylase levels in the 4- and 8-h samples (P = 0.0015; P = 0.03), procarboxypeptidase B in the 4- and 8-h samples (P &lt; 0.0001; P &lt; 0.0001) and trypsinogen-2 in the 24-hour samples (P = 0.03). No differences in these markers were observed in patients treated with rendezvous cannulation technique compared with patients that underwent cholecystectomy alone (control group). Post procedural concentrations of pancreatic amylase and procarboxypeptidase B were significantly correlated with pancreatic duct cannulation and opacification. CONCLUSION: Rendezvous ERCP reduces pancreatic enzyme leakage compared with conventional ERCP cannulation technique. Thus, laparo-endoscopic technique can be recommended with the ambition to minimise the risk for post ERCP pancreatitis. (C) 2013 Baishideng. All rights reserved.}},
  author       = {{Swahn, Fredrik and Regnér, Sara and Enochsson, Lars and Lundell, Lars and Permert, Johan and Nilsson, Magnus and Thorlacius, Henrik and Arnelo, Urban}},
  issn         = {{1007-9327}},
  keywords     = {{Common bile duct stones; Procarboxypeptidase B; Trypsinogen-2; Pancreatic amylase; Intraoperative endoscopic retrograde; cholangiopancreatography}},
  language     = {{eng}},
  number       = {{36}},
  pages        = {{6026--6034}},
  publisher    = {{WJG Press}},
  series       = {{World Journal of Gastroenterology}},
  title        = {{Endoscopic retrograde cholangiopancreatography with rendezvous cannulation reduces pancreatic injury}},
  url          = {{http://dx.doi.org/10.3748/wjg.v19.i36.6026}},
  doi          = {{10.3748/wjg.v19.i36.6026}},
  volume       = {{19}},
  year         = {{2013}},
}