Hyperamylasemia Research Articles

Pancreatic Involvement in the Course of Inflammatory Bowel Disease in Children-A Multi-Center Study.

The coexistence of inflammatory bowel disease (IBD) with pancreatic pathology is rare in children. A retrospective analysis of data from 1538 children diagnosed with IBD in 2014-2021 was conducted to determine the frequency and causes of pancreatitis and asymptomatic hyperlipasemia (HL) or hyperamylasemia (HA) in this group of patients. Among the 176 children (11.4%) with pancreatic involvement (PI), acute pancreatitis (AP) was diagnosed in 77 children (43.8%), and HA or HL was observed in 88 children (50.0%). Only a few patients were diagnosed with autoimmune or chronic pancreatitis (6.2%). PI was observed at the time of the IBD diagnosis in 26.1% of the cases. A total of 54.5% of the patients had moderate to severe IBD, and 96% had colonic involvement at the time of diagnosis of PI. Idiopathic PI was the most common (57%), followed by drug-induced PI (37%) and azathioprine (AZA). In patients with AZA-induced AP, the successful introduction of 6-mercaptopurine (6-MP) to therapy was noted in 62.5% of the children. Our results suggest that routine monitoring of pancreatic enzymes in patients with IBD should be performed, especially after the initiation of the AZA treatment. The presence of transient HA/HL in IBD does not necessarily indicate pancreatic pathology.

Hyperamylasemia Caused by the Hantaan Virus: A Retrospective Study of 101 Patients with Hemorrhagic Fever with Renal Syndrome in West China.

Background Hyperamylasemia (HA) is an inconspicuous manifestation of hemorrhagic fever with renal syndrome (HFRS) in Baoji city, West China. Hantaan virus (HTNV) is the only pathogen-caused HFRS in this region, but the knowledge about HA in the local HFRS patients has been limited. The aim of this study was to investigate the characteristics of HA and its predictive risk factors for doctors to engage in timely monitoring and dealing with the possible serious changes prewarned by HA in the early stages of the disease to improve the final outcome. Methods All HFRS patients with and without HA (HA and nHA groups, respectively) were treated in Baoji People's Hospital. The clinical characteristics between the two groups were compared by Student's t-test or Chi-square test. The risk factors for prognosis were measured by the logistic regression analysis. The predictive effects of prognosis in clinical and laboratory parameters were analyzed by the receiver operating characteristic curves. Results 46.53% of the patients demonstrated HA, among which 71.7% were severe and critical types of HFRS, greater than that in the nHA group (19.57%, P < 0.001). The hospitalization day and the general incidence of acute pancreatitis (AP) were longer or greater in the HA group than in the nHA group (P < 0.01). Age and the time from the onset of the first symptom to the patient being admitted to hospital (TOA) were the predictive risk factors for HA. The best cut-off values were the age of 54 years and TOA of 5.5 days. Conclusion HTNV-induced HA is a common clinical presentation of HFRS patients in West China. It can increase the severity, the hospitalization days of patients, and the incidence of AP in HFRS. Age and TOA constituted independent risk factors for HA caused by HTNV.

Effect of pancreatic stent combined with somatostatin on the prevention of acute pancreatitis after endoscopic retrograde cholangiopancreatography

Objective: To explore whether the use of pancreatic stent combined with somatostatin can produce the synergistic effect of preventing acute pancreatitis (AP) and hyperamylasemia (HP) after endoscopic retrograde cholangiopancreatography (ERCP). Methods: From January 2019 to December 2019, the clinical data of 325 patients with ERCP were analyzed retrospectively in cholelithic center of Shanghai East Hospital Affiliated to Tongji University. According to the different methods of AP prevention, the patients were divided into the observation group (pancreatic stent and somatostatin) and the control group (pancreatic stent) and the incidence of AP and HP were compared. Results: In the observation group, there were 5 cases of AP (3.65%) and 10 cases of HP (7.30%). In the control group, there were 7 cases of AP (3.72%) and 19 cases of HP (10.11%). The incidence of AP and HP in the observation group was lower than that in the control group, but the differences were not statistically significant (χ²=0.001, P=0.972; χ²=0.768, P=0.381). Conclusion: The use of pancreatic stent combined with somatostatin will not produce the synergistic effect of preventing AP and HP after ERCP.

The impact of aging on post-ERCP pancreatitis and its severity

Objective To study the impact of aging on pancreatic atrophy, fibrosis and exocrine hypofunction in patients with post-ERCP pancreatitis (PEP) and its severity. Methods A retrospective study was conducted on 786 patients who underwent ERCP at the Affiliated Zhongshan Hospital of Dalian University from June 2011 to April 2018. Patients who were aged over 75 years were grouped into the elderly group while those aged less than 75 years were grouped into the younger group. The incidences and severity of post-ERCP pancreatitis in the two groups were analyzed. Results In the elderly group, there were 308 patients. The average age was (81.8±4.8) years. In the younger group, there were 478 patients. The average age was (57.7±12.0) years. The average operation time for the elderly group was (52.5±14.1) minutes, and that for the younger group was (50.7±14.9) minutes. There were no significant differences in operation time and in the related factors between the two groups (P>0.05). There was no significant difference in the rates of hyperamylasemia between the two groups (29.9% vs 30.1%, P>0.05). The overall rate of PEP was 11.3% (89/786). In the elderly group, the rate of PEP was 6.5% (20/308), which was significantly lower than that in the younger group (χ2=11.765, P<0.05). The rates of mild, moderate and severe PEP in the elderly group was significantly lower than those in the younger group (all P<0.05). Hyperamylasemia and pancreatitis in the 2 groups were alleviated after conservative treatment. Conclusions Aging (≥75 years) resulted in pancreatic atrophy, fibrosis, exocrine hypofunction which had a protective effect on PEP. Key words: Pancreatitis; Hyperamylasemia; Cholangiopancreatography, endoscopic retrograde; Jaundice, obstructive; Biliary strictures

Association of juxtapapillary duodenal diverticulum with pancreaticobiliary diseases and with diagnosis and treatment of endoscopy

Objective To study the relationship between juxtapapillary duodenal diverticulum (JPDD) and pancreaticobiliary diseases, and the effect of JPDD on the diagnosis and treatment of ERCP. Methods A retrospective analysis was performed on data of 1 230 patients who had received ERCP in general surgery departments of Shengjing Hospital of China Medical University from January 2012 to January 2017. The patients were divided into JPDD group (n=360) and non-JPDD group (n=870) according to whether JPDD was found. Patients with JPDD were divided into intradiverticular papilla group (n=41) and non-intradiverticular papilla group (n=319) according to whether the papilla located in diverticulum. The incidence of pancreaticobiliary diseases, success rate of cannulation, success rate of stones removal, and incidence of postoperative complications among each group were compared by using chi-square test or Fisher′s exact probability. P<0.05 was statistically significant. Results The incidence of choledocholithiasis, primary choledocholithiasis and recurrent choledocholithiasis were 87.78% (316/360) , 31.11% (112/360) , and 6.67% (24/360) , respectively, in the JPDD group, and 75.52% (657/870) , 19.08% (166/870) , and 4.02% (35/870) , respectively, in the non-JPDD group. There were significant differences between the two groups (χ2=23.158, P 0.05) . The incidence of recurrent choledocholithiasis in the intradiverticular papilla group and the non-intradiverticular papilla group were 14.63% (6/41) and 5.64% (18/319) , respectively, with significant difference (χ2=4.721, P=0.030) . There were no significant differences between the two groups in the incidence of choledocholithiasis and primary choledocholithiasis, the success rate of cannulation and complete stones removal during the first ERCP session, as well as the incidence of postoperative hemorrhage, pancreatitis and hyperamylasemia (all P>0.05) . Conclusion JPDD is associated with the occurrence of primary choledocholithiasis. JPDD patients, especially the patients with intradiverticular papilla, are more likely to have recurrent choledocholithiasis after ERCP treatment. Key words: Cholangiopancreatography, endoscopic retrograde; Juxtapapillary duodenal diverticulum; Intradiverticular papilla

Prophylactic value of aggressive hydration with lactated Ringer′s solution during the perioperative period for post-ERCP pancreatitis: a meta-analysis

Objective To evaluate aggressive hydration with lactated Ringer′s solution for prophylaxis of post-ERCP pancreatitis(PEP) during the perioperative period. Methods CNKI, VIP, Wangfang, Pubmed, Embase and Cochrane Library were searched for randomized controlled trials(RCTs)on aggressive hydration with lactated Ringer′s solution for preventing PEP published from the setup time of databases to June 2018. According to the inclusion and exclusion criteria, RCTs were selected by two researchers, data were extracted and methodological quality was assessed independently. Revman 5.3 was used to perform the meta-analysis.The heterogeneity among the included RCTs was analyzed by using the Q test and the chi-square test. The funnel plots, the risk of bias graph and the risk of bias summary were used to evaluate publication bias. Results A total of 10 RCTs with 1 727 patients were included.Meta-analysis showed that 10 RCTs had no significant heterogeneity (P=0.10, I2=39%), aggressive hydration with lactated Ringer′s solution could reduce the incidence of PEP(OR=0.37, 95%CI: 0.26-0.53, P<0.000 01). Hyperamylasemia incidence was included in 6 RCTs, and the results showed that aggressive hydration with lactated Ringer′s solution could reduce the incidence of hyperamylasemia (OR=0.41, 95%CI: 0.27-0.64, P<0.000 01). A total of 4 RCTs compared the incidence of abdominal pain after ERCP between the experimental group and the control group. Meta-analysis showed that aggressive hydration with lactated Ringer′s solution could reduce the incidence of abdominal pain (OR=0.32, 95%CI: 0.15-0.68, P=0.003). Conclusion Aggressive hydration with lactated Ringer′s solution can effectively prevent PEP and other complications. Key words: Pancreatitis; Lactated Ringer′s solution; Aggressive hydration; Meta-analysis

Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis and the Effect of Octreotide Combined with Nonsteroidal Anti-Inflammatory Drugs on Preventing Its Occurrence.

BackgroundThe aim of this study was to explore the risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and investigate the effect of octreotide combined with nonsteroidal anti-inflammatory drugs on preventing its occurrence.Material/MethodsA total of 139 patients undergoing ERCP in our hospital from May 2016 to April 2017 were retrospectively analyzed, and divided into an observation group (n=67) (octreotide + indomethacin) and a control group (n=72) (no preventive drugs). The preoperative and postoperative inflammatory cytokines such as tumor necrosis factor-α (TNF)-α, interleukin-6 (IL-6) and IL-8, and serum amylase levels were measured, and the incidence of pancreatitis and hyper amylasemia were monitored.ResultsSerum amylase level was increased significantly 3 hours after operation in both groups with significantly higher level in the control group compared to the observation group. After 24 hours, serum amylase in the observation group was decreased to preoperative level, whereas it was still higher than preoperative in the control group (P<0.05). Regarding the levels of TNF-α, IL-6, IL-8, and visual analogue scale, they were significantly increased in both groups after operation with significantly higher levels in the control group compared to the observation group (P<0.05). Furthermore, logistic regression analysis showed that difficult intubation, pancreatic duct angiography, surgery for a long time, and the history of previous pancreatitis were risk factors for post-ERCP pancreatitis (P<0.05).ConclusionsDifficult intubation, pancreatic duct angiography, surgery for a long time, and the history of previous pancreatitis were risk factors for post-ERCP pancreatitis. Octreotide combined with non-steroidal anti-inflammatory drugs can reduce the pain of patients with abdominal pain as well as the incidence of postoperative pancreatitis, indicating that they might be effective preventative approaches for pancreatitis.

Clinical value of double guidewire technique for perforation of duodenal papilla by guidewire in endoscopic retrograde cholangiopancreatography

Objective To evaluate the efficacy and safety of double guidewire technique in perforation of duodenal papilla caused by guide wire during endoscopic retrograde cholangiopancreatography (ERCP) intubation. Methods A retrospective analysis was performed on data of 57 patients whose duodenal papilla were perforated by guidewire in ERCP from January 2008 to September 2016. Among the 57 patients, 30 patients were cannulated with double guidewire technique (double guidewire group) and 27 patients were performed with traditional technique (standard group) for continue. The biliary intubation success rate, intubation time, and post-ERCP complication rate were compared between the two groups. Results The rate of successful intubation of the double guidewire group was significantly higher than that of the standard group[96.7% (29/30) VS 74.1% (20/27), χ2=5.545, P=0.019]. The intubation time of the double guidewire group was significantly shorter than that of the standard group (21.8±7.8 min VS 40.7±8.4 min, t=8.076, P=0.000). The double guidewire group had a similar incidence of post-ERCP complication compared to the standard group[13.3% (4/30) VS 11.1% (3/27), χ2=0.292, P=0.596], and the complication in two groups was hyperamylasemia. Conclusion Double guidewire technique is safe and effective for difficult biliary cannulation because of perforation of duodenal papilla with a higher success rate and less time compared to classic technique. Key words: Cholangiopancreatography, endoscopic retrograde; Cannulation; Bile ducts; Duodenal papilla

Applied occasion of indomethacin on preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

Objective To investigate the optimal timing of indomethacin administration on prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Methods The patients were randomly divided into the preoperative group and the postoperative group, and given 100 mg indomethacin in rectum within 30 min before and after ERCP, respectively. The serum levels of amylase and lipase were measured preoperatively and 4 h, 24 h postoperatively. The incidences of postoperative complications such as acute pancreatitis, hyperamylasemia, gastrointestinal bleeding, and perforation were assessed. Results A total of 340 patients were enrolled in this study from June 2014 to June 2017. The preoperative group consisted of 163 patients, including 11 cases (6.75%) with post-ERCP pancreatitis (PEP) and 32 cases (19.63%) with hyperamylasemia. Meanwhile, 177 patients constituted the postoperative group, with 25 cases (14.12%) with PEP and 55 cases (31.07%) with hyperamylasemia. The incidences of PEP and hyperamylasemia were significantly lower in the preoperative group than that in the postoperative group (P=0.027 and P=0.016, respectively). Conclusion Preoperative use of indomethacin can better reduce the incidence of PEP than postoperative administration, without incidence increase of other complications. Key words: Indomethacin; Cholangiopancreatography, endoscopic retrograde; Pancreatitis; Hyperamlasemia; Prevention

Effects of predictive nursing on the postoperative complications after endoscopic retrograde cholangio-pancreatography

Objective To analyze the complications after endoscopic retrograde cholangio-pancreatography (ERCP) and nursing countermeasures. Methods A total of 84 patients who were hospitalized in the General Surgery Department of the First People's Hospital of Neijiang with the diagnosis of choledocholithiasis from Octorber 2014 to October 2016 for ERCP were recruited in the study. All the subjects were randomly divided into control group (n=44) and experimental group (n=40) . The control group were given routine perioperative nursing, while the experimental group were given predictive nursing on the basis of routine nursing. Hospitalization time, postoperative complications and nursing satisfaction were compared between the two groups. Results The incidence rate of postoperative complication was 5.00% in the experimental group, which was lower than that of the control group (27.27%) (P<0.05) . The hospitalization time of the experimental group was lower than that of the control group, and the nursing satisfaction was higher. All the differences were statistically significant (P<0.05) . Conclusions Postoperative complications such as acute pancreatitis, hyperamylasemia, biliary tract infection, gastrointestinal bleeding and perforation are easy to occur after ERCP. Predictive nursing can effectively reduce the incidence of postoperative complications, shorten hospitalization time and improve patient satisfaction. Key words: Cholangiopancreatography, endoscopic retrograde; Postoperative complications; Predictive nursing

Clinical study in safety of enteral nutrition in critically ill children with pancreatic hyperpancreorrhea

Objective To investigate the safety and efficacy of enteral nutrition in critically ill children with hyperpancreorrhea including hyperamylasemia and hyperlipasemia in order to provide the rationale of nutritional support for such critically ill children. Methods A total of 90 critically ill children with hyperpancreorrhea admitted in pediatric intensive care unit were enrolled for prospective study in a period from January 2014 to December 2015. The patients were randomly(random number) divided into fasting group (n=30), and in those with fasting time exceeded three days, intravenous nutrition was given; ordinary milk group (n=30) and special milk group (n=30) and in this group, those with age 1 year were given small hundred peptides in addition to the basis of routine treatment. Clinical data and biochemical findings in different groups were analyzed by χ2test, t test, F test or non-parametric test to evaluate the safety and efficacy of enteral nutrition in critically ill children with hyperpancreorrhea. Results (1) There were statistically significant differences in rates of nutrition support-related symptoms such as diarrhea, electrolyte imbalance, blood glucose disorder among groups (χ2=6.975,6.074,6.300, P=0.031,0.048,0.043). (2) There were statistically significant difference in rates of serum amylase or lipase levels more than upper limit on the third day among different groups ( χ2=7.081, P=0.029). There was no statistically significant difference in rates of fecal elastase-1 0.05). There was statistically significant difference in procalcitonin on the 7th day among different groups (H=6.251, P=0.044). There was statistically significant difference in oxygenation index on the 3rd day among different groups (F=3.119, P=0.049). There was statistically significant difference in lactate on the 7th day among different groups (F=6.449, P=0.040). There was statistically significant differences in albumin on the 3rd day and on the 7th among different groups (F=5.451, P=0.006; H=24.861, P<0.01). (3) There were statistically significant differences in PICU stay and hospital stay among different groups (F=3.222,3.891, P=0.045; 0.024). There was statistically significant difference in survival rate among different groups ( χ2=6.240, P=0.044). Conclusions Early and right enteral nutrition was safe and effective for critically ill children with hyperpancreorrhea, and the special milk powder such asr AiReShu and small hundred peptides suitable for children with hyperpancreorrhea could effectively support nutrition for critically ill children with hyperpancreorrhea, improve the status of illness, promote disease recovery, shorten hospital stay and improve the prognosis. Key words: Critically ill children; Pancreatic hyperenzymemia; Sepsis; Enteral nutrition; Nutritional support; Safety; Efficacy; Prognosis

The Combination of Pancreas Texture and Postoperative Serum Amylase in Predicting Pancreatic Fistula Risk

The presence of HA on POD 0 or POD 1 is more predictive than soft pancreas texture or small pancreas duct size alone.

Clinical value of SpyGlass DS cholangioscopy in diagnosis and treatment of patients with biliary tract diseases (with video)

Objective To evaluate the clinical application value of SpyGlass DS cholangioscopy in diagnosis and therapy of patients with biliary tract diseases. Methods Seven patients with biliary tract diseases were examined and treated with SpyGlass DS system. Three patients with large choledocholithiasis underwent laser lithotripsy under SpyGlass DS system, and then the broken stones were removed by ERCP. Four patients with indeterminate bile duct stricture underwent SpyGlass DS examination and SpyGlass DS-guided biopsies if necessary. Results SpyGlass DS cholangioscopy was successfully performed in all patients with a mean procedure time of 12.6 min. Complete stone clearance was achieved in 3 patients with large biliary stones. Of the 4 patients with indeterminate biliary stricture, 2 underwent SpyGlass DS-guided biopsies and were diagnosed as malignant biliary tumor; the other 2 patients were diagnosed as inflammatory bile duct stenosis after visualizing the target lesions without biopsy. Two patients developed hyperamylasemia after the procedure, and recovered spontaneously. Conclusion SpyGlass DS cholangioscopy can provide accurate diagnosis in indeterminate biliary strictures and facilitate therapy in patients with challenging biliary stones. Key words: Choledocholithiasis; Bile duct stenosis; SpyGlass DS cholangioscopy; Lithotripsy, laser

The effect analysis of standardized nursing trainingin reducing the incidence rate of post-endoscopic retrograde cholangiopanography pancreatitis

Objective To investigate the effectiveness and feasibility of standardized nursing training in reducing the incidence rate of post-endoscopic retrograde cholangiopanography(ERCP) pancreatitis. Methods A total of 521 patients were collected from January 2015 to June 2016 in ERCP therapy as control group. The patients in this group did not have standardized nursing training. A total of 289 patients were selected from July 2016 to April 2017 in ERCP therapy as intervention group. The patients in this group were carried out the standardized nursing training. The incidence of hyperamylasemia and post-ERCP pancreatitis was observed in two groups. Results The incidence of hyperamylasemia and post-ERCP pancreatitis was 12.09% (63/521), 7.87% (41/521) in control group, and 7.61% (22/289), 3.11% (9/289) in intervention group, the difference was statistically significant between two groups (χ2=3.972,7.258, P < 0.05 or 0.01). Conclusions The standard nursing training and intraoperative coordination can reduce its risk factors, and to reduce the post-ERCP pancreatitis and hyperamylasemia has important meaning and function. Key words: Cholangiopancreatography, endoscopic retrograde; Pancreatitis; Hyperamylasemia; Postoperative complications; Nursing training

Value of antibiotic prophylaxis after endoscopic retrograde cholangio-pancreatography

Objective To investigate the effects of antibiotic prophylaxis on post-operation complications after endoscopic retrograde cholangio-pancreatography (ERCP). Methods From January 1st, 2011 to December 31st, 2013, 1 951 patients undergoing ERCP were enrolled and divided into postoperative antibiotic prophylaxis group (antibiotics group, 630 cases) and postoperative non-antibiotic treatment group (non-antibiotics group, 1 321 cases). Complications after ERCP were compared between the two groups. Chi square test, single factor analysis and multiple factor analysis were performed for statistical analysis. Results Among the 1 951 patients, 277 patients had postoperative complications: 101 patients (5.18%) with post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP), 54 patients (2.77%) with hyperamylasemia, 134 patients (6.87%) with biliary infection, eight patients (0.41%) with hemorrhage, one patient (0.05%) with intestinal obstruction and one patient (0.05%) with perforation. The incidence of postoperative biliary infection of antibiotics group was 4.44%(28/630), which was lower than that of non-antibiotics group (8.02%, 106/1 321), and the difference was statistically significant (χ2=8.546, P=0.030). The incidences of PEP of antibiotics group and non-antibiotics group were 4.92% (31/630) and 5.30% (70/1 321), respectively. The incidences of postoperative hyperamylasemia of antibiotics group and non-antibiotics group were 3.02%(19/630) and 2.65%(35/1 321), respectively. The incidences of upper gastrointestinal hemorrhage were 3.02%(19/630) and 2.65%(35/1 321), respectively. The incidences of intestinal obstruction were 0(0/630) and 0.08%(1/1 321), respectively, while the incidences of perforation post-operation were 0.16%(1/630) and 0(0/1 321), respectively, and the differences were not statistically significant (all P>0.05). Cholangiocarcinoma (odd ratios (OR)=2.93, 95% confidence interval (CI) 1.88 to 4.56, P<0.01) and repeated ERCP during hospitalization (OR=2.53, 95% CI 1.63 to 3.93, P<0.01) were the independent risk factors of cholangitis after operation. However, endoscopic sphincterotomy (OR=0.65, 95%CI 0.44 to 0.97, P=0.030) and antibiotics prophylaxis (OR=0.64, 95%CI 0.39 to 0.95, P=0.030) were the protective factors. Conclusions Antibiotic prophylaxis after ERCP can reduce the occurrence of postoperative cholangitis. Paitents with cholangiocarcinoma, repeated ERCP procedures during hospitalization or without endoscopic sphincterotomy should be recommended for antibiotic prophylaxis. Key words: Cholangiopancreatography, endoscopic retrograde; Antibiotic prophylaxis; Complications

Complications of therapeutic endoscopic retrograde cholangiopancreatography in patients with metabolic syndrome

Objective To investigate the complications of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with metabolic syndrome and their prevention. Methods Clinical data of 300 patients who underwent therapeutic ERCP in the First Affiliated Hospital of Soochow University from March 2013 to January 2016 were analyzed retrospectively. Among these patients, 100 of them (group A) had metabolic syndrome and 200 others (group B) did not. Age, sex and post-operative hyperamylasemia, acute pancreatitis, infection of biliary tract and upper gastrointestinal bleeding of two groups were compared. In addition, effects of BMI, TG, BP and FPG on the occurrence of complications in group A were analyzed. Results No difference was found in age and sex between group A and B (P>0.05), but group A had higher incidences of post-operative hyperamylasemia[16.0%(16/100) VS 6.0%(12/200)], acute pancreatitis[14.0%(14/100) VS 4.0%(8/200)], infection of biliary tract[12.0%(12/100) VS 4.0%(8/200)] and upper gastrointestinal bleeding [8.0%(8/100) VS 1.0%(2/200)](P<0.05). Meanwhile, patients had higher incidences of complications (post-operative hyperamylasemia, acute pancreatitis, infection of biliary tract and upper gastrointestinal bleeding) when BMI[56.10%(46/82) VS 22.22%(4/18)], TG[56.41%(44/78) VS 27.27%(6/22)], BP[64.29%(27/42) VS 39.66%(23/58)] or FPG[54.44%(49/90) VS 10.00%(1/10)] increased in group A (P<0.05). Conclusion Patients with metabolic syndrome have a higher incidence of complications after therapeutic ERCP than patients without. Therefore, careful preparation, post-operative observation and intervention are essential when patients with metabolic syndrome undergo therapeutic ERCP. Key words: Cholangiopancreatography, endoscopic retrograde; Metabolic syndrome; Complications

Risk factors for ERCP-related complications: a review of 1 951 cases

Objective To investigate the risk factors for post-ERCP complications. Methods Data of the patients who underwent ERCP in the First Affiliated Hospital of Nanchang University from 1 January 2011 to 31 December 2013 were retrospectively analyzed. Post-ERCP complications were analyzed by univariate and multivariate analyses. Results A total of 277 patients out of 1 951 developed complications, 101(5.18%) pancreatitis, 54(2.77%) hyperamylasemia (not including pancreatitis), 134(6.87%) biliary infection, 8 (0.41%) hemorrhage, 1 (0.05%) obstruction and 1 (0.05%) perforation. Multivariate analyses showed cholangiocarcinoma (P=0.002, OR=2.39, 95%CI: 1.38-4.14), long operation time(>60 min) (P=0.020, OR=3.77, 95%CI: 1.23-11.53) and endoscopic sphincterotomy (EST)(P=0.008, OR=2.56, 95%CI: 1.28-5.14) and entrance of guidewire to pancreatic duct (P=0.012, OR=1.43, 95%CI: 1.08-1.87) were independent risk factors for PEP. Cholangiocarcinoma(P<0.01, OR=2.93, 95%CI: 1.88-4.56), multiple times of ERCP during the period of hospitalization(P<0.01, OR=2.53, 95%CI: 1.63-3.93) were independent risk factors for post-cholangitis. However, EST (P=0.03, OR=0.65, 95%CI: 0.44-0.97) and antibiotics prophylaxis after ERCP (P=0.03, OR=0.64, 95%CI: 0.39-0.95) were protective factors for post-cholangitis. Conclusion Cholangiocarcinoma, endoscopic sphincterotomy, long operation time(>60 min) and entrance of guidewire to pancreatic duct were independent risk factors for PEP. Cholangiocarcinoma and multiple ERCP during the period of hospitalization are independent risk factors for post-cholangitis. EST and antibiotics prophylaxis after ERCP might reduce the occurrence of cholangitis. Key words: Endoscopic retrograde cholangiopancreatography; Post-ERCP pancreatitis; Biliary infection; Risk factors

Therapeutic effect of fully covered self-expandable metal stents on benign biliary stricture

Objective To evaluate the efficacy and safety of fully covered self-expandable metal stents (FCSEMS) implanted by endoscopic retrograde cholangiopancreatography (ERCP) for patients with benign biliary stricture (BBS). Methods The clinical data of 38 patients with BBS underwent ERCP and FCSEMS placement between January 2012 and January 2016 were retrospectively recorded. Success rate of BBS, adverse events related to ERCP and stricture recurrence were analyzed. Results A total of 38 patients underwent FCSEMS placement with a mean time of stent in dwelling for 8 months (range: 3-13months). During follow-up after the stent was removed, death of 1 patient after liver transplantation was due to unrelated cause. The mean follow-up time was 13 months (range: 2-52 months) for other patients. Stricture recurrence occurred in 6 patients, including 2 cases of gallstone-related biliary strictures, 1 case of chronic pancreatitis-related biliary strictures, 2 cases of liver transplantation-related biliary strictures, and 1 case of post surgical-related biliary strictures. Stricture resolution occurred in 31 cases with 83.8% (31/37) success rate, including 90.0% (18/20) gallstone-related biliary strictures, 75.0% (3/4) chronic pancreatitis-related biliary strictures, 80.0% (8/10) liver transplantation-related biliary strictures, and 66.7% (2/3) post surgical-related biliary strictures. The incidence of post-ERCP complications was 21.1% (8/38), including mild pancreatitis in 5 case, hyperamylasemia in 2 cases, cholangitis in 1 case. All patients were cured by conservative treatment. Conclusion FCSEMS are effective and safe for BBS. Further studies are needed to assess the indwelling time of FCSEMS, whether FCSEMS are superior to multiple plastic stents and the different efficacy of FCSEMS for BBS caused by different etiology. Key words: Cholangiopancreatography, endoscopic retrograde; Bile ducts, stenosis; Efficiency; Safety; Fully covered self-expandable metal stent

Evaluation of direct peroral cholangioscopy by freehand intubation for diagnosis and therapy of biliary diseases

Objective To evaluate the feasibility and safety of direct peroral cholangioscopy (DPCS) by freehand intubation using routine straight-view endoscope for diagnosis and therapy of biliary diseases. Methods Patients with unexplained choledochal stenosis and choledocholithiasis underwent standard ERCP. Native papilla was dilated using endoscopic papillary large balloon dilation (EPLBD) according to the size of papilla and the diameter of common bile duct. DPCS was performed using routine straight-view endoscope, and biopsy or laser lithotripsy was performed according to imaging of DPCS. General data of patients, procedure of ERCP, diagnosis of DPCS, and complications were recorded. Serum amylase after 2 hours and 24 hours, total bilirubin, direct bilirubin, leukocyte count, neutrophilic granulocyte percentage, and C-reactive protein were measured. Results A total of 15 patients underwent DPCS, including 5 cases of huge common bile duct stones and 10 cases of common bile duct stricture.The diameter of common bile duct ranged from 1.5 cm to 2.5 cm. Single EPLBD was required in 3 cases, endoscopic sphincteropapillotomy and EPLBD was required in 12 cases to facilitate DPCS.DPCS was successfully completed in 14 cases, including 11 cases in distal common bile duct, 3 cases in proximal common bile duct. Among the 14 cases, 4 cases used ordinary gastroscope, and 10 cases used ultrathin gastroscope. Laser lithotripsy was successfully completed in 4 choledocholithiasis patients. DPCS was successfully completed in 9 patients of common bile duct stenosis. The reasons of stenosis included 5 calculi, 2 normal, 1 scar and 2 adenoma. There were 1 case of cholangitis and 4 cases of hyperamylasemia after operation.No procedure related death occurred. Conclusion Freehand DPCS using ordinary gastroscope or ultrathin gastroscope is feasible and safe, and may be clinically useful for diagnosis and therapy of unexplained choledocholithiasis and common bile duct stenosis. Key words: Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Lithotripsy, laser; Direct peroral cholangioscopy

Analysis of related factors associated with abnormal pancreatic ultrasound findings in critically ill children

Objective To analyze the clinical features of critically ill children with abnormal pancreatic ultrasound findings in order to explore the related risk factors for offering evidence-based diagnosis of pancreatic damage secondary to critical illness. Methods A prospective study was performed in 531 critically ill children admitted to pediatric intensive care unit(PICU) of 17 children’ hospitals from January 2012 to March 2014. All patients were divided into control group(513 cases) and abnormal group(18 cases) according to the pancreatic ultrasound findings.Comparison of clinical features and biochemical indicators were made between two groups. The related risk factors associated with abnormal pancreatic ultrasound findings were analyzed by using Logistic regression analysis. ROC curves were used to evaluate the role of amylase and lipase in the diagnose of abnormal pancreatic ultrasound findings. Results The incidence of abnormal pancreatic ultrasound findings in critically ill children was 3.39%, the average age of abnormal group was significantly older than that in control group (P<0.01). There were not statistically significant differences in gender and primary disease between two groups. The incidence of hypotension was 22.2% and the incidence of abdominal muscle tension was 16.7% in abnormal group, which were statistically higher than those in control group (P<0.05). The levels of calcium, albumin of abnormal group were significantly lower than those in control group (P<0.01), and levels of serum amylase, lipase, lactate dehydrogenase in abnormal group were significantly higher than those in control group (P<0.01). The risk factors associated with abnormal pancreatic ultrasound findings were age, blood pressure, calcium, amylase. Area under the ROC curve of abnormal pancreatic ultrasound findings determined by amylase and lipase were 0.803 and 0.745, respectively (P<0.05). The sensitivity was 0.667, specificity was 0.881 when the serum amylase was 101.5 U/L, the sensitivity was 0.722, specificity was 0.928 when the serum lipase was 96.9 U/L. Conclusions The incidence of abnormal pancreatic ultrasound findings was rather low in critically ill children. The risk factors associated with abnormal pancreatic ultrasound findings were hypotension, hypocalcemia, and hyperamylasemia. The elevated serum amylase and lipase might be the most likely factors associtaed with abnormal pancreatic ultrasound findings. Key words: Critically ill children; Pancreatic damage; Pancreatic ultrasound; Amylase; Lipase