Diclophenac potassium versus cephtazidime for reduction of post ERCP pancreatitis in average risk patients-randomised controlled trial- interim analysys

Abstract

Background: ERCP is important role to diagnose and treat diseases of biliary system and pancreas. On the other hand, techniques related to ERCP require higher expertise than gansrointertinal endoscopy. As a Japanese retorospective study, ERCP has been shown higher incidence of complications. Especially in cases of perforation, it has demonstrated high mortality, 7-18%. Therefore, it is crucial to avoid misjudgments of the timing of operation and to avoid persisting conservative therapy. Aims: We review ERCP related perforation required surgical treatment from the points of diagnosis and treatment. Patients & methods: We reviewed 4 cases of ERCP related perforation with surgical therapy during January 2010 and September 2013. Results: ERCP methods were applied to 1678 cases. Complications were observed in 28.7% including post-ERCP pancreatitis, stent problem, hyperamylasemia, cholecystitis, cyst infection, and perforation. Perforation was observed in 6 cases; 4 cases required surgical intervention. ERCPwas applied for 2 common bile duct stone cases, one detailed examination of papilla of duodenum, andonehemorrhagic cholecystitis. Perforationswereobserved in duodenum in 2 cases, pancreas in 1 case and unspecified site in 1 case. Causes included injuriesassociatedwith2balloondilationcases,onemanipulationof endoscopy and guide wire maneuvering for stent placement. Surgical procedures were abdominal drainages; with 2 T-tube drainage cases; with 2 cholecystectomy cases;with 2 gastrostomy cases; andwith 2 enterostomy cases. Conclusion: When perforation occured, we need to detect and diagnose it early. It is also a key to success that judging necessity and timing of surgical operation is made without persisting conventional methods.