Kronik pankreatit’te endoskopik tedavi: tek merkez sonuçları

Amaç: Kronik pankreatit (KrP), asiner ve adacık hücre kaybı, parankimal fibrozis ile karakterize pankreasın geri dönüşümsüz hasarı ile karakterizedir. KrP tedavisinde endokrin ve ekzokrin yetersizlik tablosu göz önüne alınarak en az invaziv olan konservatif yöntemler ile başlanmaktadır. Günümüzde cerrahi tedavi süreçlerin komplikasyonları ve mali sonuçları, endoskopik tedavi yöntemlerini öne çıkarmış olup KrP tedavisinde endoskopik tedavi yöntemleri önemli bir yer edinmiştir. Bu çalışmadaki amaç ERCP ile tedavi uygulanmış KrP hastaların insidansını, klinik prezentasyonlarını, ERCP işlemi detaylarını ve ERCP sonraki kısa ve uzun (3 yıllık takip) dönem sonuçlarını gösterebilmektir.Gereç ve Yöntem: Ankara Eğitim ve Araştırma Hastanesi Gastroenteroloji Kliniği ERCP Ünitesi’nde, 15 Ocak 2016 ile 15 Ocak 2017 tarihleri arasında yapılan ERCP işlemleri geriye yönelik tarandı. Yaş sınırı gözetmeksizin KrP nedeniyle ERCP yapılan hastalar belirlendi. Hastaların demografik verileri, KrP etiyolojisi, yapılan ERCP işleminin tedavi endikasyonu, pankreatik stent implantasyonları, kaç kez ERCP yapıldığı, ağrının düzelmesi ve ERCP işlemi ile ilişkili komplikasyonlar kaydedildi.Bulgular: ERCP uygulanan toplam 1037 hasta çalışma için araştırıldı. Bu hastalar içinde toplam 14 KrP hastası saptandı. Hastaların ERCP'de ortalama koledok çapı 8,42 mm olarak pankreatik kanal 6 mm olarak bulunmuştur. Dokuz (%64,28) hastaya pankreatik stent uygulanmış olup 5 (%35,71) hastada post-ERCP pankreatit gözlendi. Üç yıllık takipte 4 hastaya 1 defa, 9 hastaya 2 defa ve 1 hastaya 3 defa ERCP uygulanmış olup hastalardaki ortalama ERCP oranı 1,78 idi. Sonuç: KrP'de tıbbi tedaviye cevap vermeyen ağrı, nüks veya lokal komplikasyonların varlığında ERCP invaziv olmakla birlikte vazgeçilmez tedavi yöntemidir.

Anahtar Kelimeler:

Kronik pankreatit, tedavi, ERCP

Endoscopic treatment of chronic pancreatitis: single center results

Aim: Chronic pancreatitis (CP) is irreversible damage of the pancreas characterized by acinar and islet cell loss and parenchymal fibrosis of pancreas. Treatmet of CP is accociated with stage of endocrine and exocrine insufficiency and started with conservative minimal invasive procedures. Because of complications surgical treatment procedures and financial results, endoscopic treatment methods have an important role in the management of CP. The aim of this study is to identify and describe the incidence, clinical presentation, endoscopic retrograde cholangiopancreatography (ERCP) procedures details and the complication short and long (3-year follow-up) results of CP patients undergoing ERCP.Material and Method: The ERCP procedures were held in Gastroenterology Endoscopy Unit between 15 Jenuary 2016 and 15 Jenuary 2017 and were retrospectively evaluated. Consecutive patients with all age diagnosed with CP was screened for eligibility for inclusion in this study. Patients were compared with the demographic characteristics, etiology of CP, treatment indications of the ERCP procedure, pancreatic stent implants, how many times ERCP was done, pain manangement and ERCP realted complication.Results: A total of 1037 consecutive patients who underwent ERCP were scanned retrospectivle. Fourteen CP patients fulfilling the criteria of study. In CP patients the average diameter of the common bile duct was 8.42 mm and the pancreatic duct 6 mm was found at ERCP. Nine (64.28%) patients aplied pancreatic stenting and 5 (35.71%) patients had post-ERCP pancreatitis. ERCP procedures was applied to 4 patients 1 time, 9 patients 2 times, and in 1 patient 3 times at 3 years follow-up. The mean ERCP ratio in the CP patients was 1.78.Conclusion: ERCP is an indispensable treatment management in the patient of CP which presence of abdominal pain, recurrence or local complications that do not respond to medical treatment. Keywords: Chronic pancreatitis, treatment, ERCP

Keywords:

Chronic pancreatitis, treatment, ERCP,

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