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Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?

BACKGROUND/AIMS: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because the severity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). METHODS: A total of 148 patients with ABP were included to...

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Autores principales: Hasegawa, Sho, Koshita, Shinsuke, Kanno, Yoshihide, Ogawa, Takahisa, Sakai, Toshitaka, Kusunose, Hiroaki, Kubota, Kensuke, Nakajima, Atsushi, Noda, Yutaka, Ito, Kei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Gastrointestinal Endoscopy 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8652157/
https://www.ncbi.nlm.nih.gov/pubmed/34038997
http://dx.doi.org/10.5946/ce.2020.271
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author Hasegawa, Sho
Koshita, Shinsuke
Kanno, Yoshihide
Ogawa, Takahisa
Sakai, Toshitaka
Kusunose, Hiroaki
Kubota, Kensuke
Nakajima, Atsushi
Noda, Yutaka
Ito, Kei
author_facet Hasegawa, Sho
Koshita, Shinsuke
Kanno, Yoshihide
Ogawa, Takahisa
Sakai, Toshitaka
Kusunose, Hiroaki
Kubota, Kensuke
Nakajima, Atsushi
Noda, Yutaka
Ito, Kei
author_sort Hasegawa, Sho
collection PubMed
description BACKGROUND/AIMS: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because the severity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). METHODS: A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile duct stones (CBDSs) in the ECM group. RESULTS: No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of the severity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severe cholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, <i>p</i>=0.048). In patients in the ECM group, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and 92%, respectively, for magnetic resonance cholangiopancreatography. CONCLUSIONS: EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rate of worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need for elective EI.
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spelling pubmed-86521572021-12-20 Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them? Hasegawa, Sho Koshita, Shinsuke Kanno, Yoshihide Ogawa, Takahisa Sakai, Toshitaka Kusunose, Hiroaki Kubota, Kensuke Nakajima, Atsushi Noda, Yutaka Ito, Kei Clin Endosc Original Article BACKGROUND/AIMS: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because the severity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). METHODS: A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile duct stones (CBDSs) in the ECM group. RESULTS: No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of the severity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severe cholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, <i>p</i>=0.048). In patients in the ECM group, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and 92%, respectively, for magnetic resonance cholangiopancreatography. CONCLUSIONS: EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rate of worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need for elective EI. Korean Society of Gastrointestinal Endoscopy 2021-11 2021-05-27 /pmc/articles/PMC8652157/ /pubmed/34038997 http://dx.doi.org/10.5946/ce.2020.271 Text en Copyright © 2021 Korean Society of Gastrointestinal Endoscopy https://creativecommons.org/licenses/by-nc/3.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Hasegawa, Sho
Koshita, Shinsuke
Kanno, Yoshihide
Ogawa, Takahisa
Sakai, Toshitaka
Kusunose, Hiroaki
Kubota, Kensuke
Nakajima, Atsushi
Noda, Yutaka
Ito, Kei
Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?
title Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?
title_full Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?
title_fullStr Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?
title_full_unstemmed Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?
title_short Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?
title_sort endoscopic interventions for the early and remission phases of acute biliary pancreatitis: what are the more concrete and practical situations for performing them?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8652157/
https://www.ncbi.nlm.nih.gov/pubmed/34038997
http://dx.doi.org/10.5946/ce.2020.271
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