Erkan PARLAK, Selçuk DİŞİBEYAZ, Mehmet İBİŞ, Mehmet ARHAN, Mevlüt KURT, Semih SEZER, Nurgül ŞAŞMAZ, Burhan ŞAHİN

Karaciğer sirozu olan hastalarda endoskopik retrograd kolanjiopankreatografi uygulanması

Giriş ve Amaç: Sirotik hastalarda biliyer hastalıklarda cerrahi dışında alternatif olarak endoskopik retrograd kolanjiyopankreatografinin zaman zaman yapılabilmesi gerekmektedir. Bu tür hastalarda endoskopik retrograd kolanjiyopankreatografi sırasında yapılacak sfinkterotominin endoskopik sfinkterotomi kanamasından korkulmaktadır. Bu çalışma kliniğimizde karaciğer sirozlu hastalara yapılan endoskopik retrograd kolanjiyopankreatografinin endikasyonlarını ve sonuçlarını tartışmak amacıyla yapılmıştır. Gereç ve Yöntem: 11 hastaya (5 Kadın, 6 Erkek), (Child-pugh sınıf A, 2; B, 5; C, 4 kişi) Haziran 2005-Eylül 2008 tarihleri arasında endoskopik retrograd kolanjiyopankreatografi yapılmıştır. İşlem öncesi her hastaya antibiyotik profilaksisi yapılmış ve INR değerleri 1.5'in altına çekilmeye çalışılmıştır. Tüm hastalara Blended cut-koagülasyon (25 watt/15 watt) tercih edilmiştir. Bulgular: On hastada endoskopik sfinkterotomi yapıldı, 2 taşlı hastada ilave balon dilatasyonu yapıldı. Taşı olan 5 hastanın hepsinden taşlar çıkartıldı Bir hastada endoskopik sfinkterotomi yapılmadan stent takıldı. ChildPugh sınıf C ve malign biliyer darlığı olan bir hastada işlem sırasında başlayan özofagus varis kanaması dışında endoskopik retrograd kolanjiyopankreatografi işlemi ile ilişkili komplikasyon izlenmedi. Bu kanama da skleroterapi ile durduruldu. Endoskopik sfinkterotomi yerinde kanama ve pankreatit gözlenmedi. Sonuç: Sirotik hastalarda endoskopik sfinkterotomi koledokolitiazis ve malign biliyer darlıkda güvenli ve etkili bir şekilde kullanılmaktadır.

Anahtar Kelimeler:

Endoskopik retrograd kolanjiopankreatografi, siroz

Endoscopic retrograde cholangiopancreatography in patients with liver cirrhosis

Background and Aims: Cirrhotic patients with biliary disease may sometimes require endoscopic retrograde cholangiopancreatography as an alternative to surgery. Endoscopic retrograde cholangiopancreatography in such patients runs the risk of bleeding after sphincterotomy. This study was undertaken in our clinic with the aim of discussing the indications and outcome of endoscopic retrograde cholangiopancreatography in cirrhotic patients. Materials and Methods: Eleven patients (5 female, 6 male) with cirrhosis (Child-Pugh Class A, 2; B, 5; C, 4 patients) underwent endoscopic retrograde cholangiopancreatography between June 2005 and September 2008. Prior to each procedure, antibiotic prophylaxis was given, and attempts were made to maintain an international normalized ratio of less than 1.5. For all patients, blended cut-coagulation (25 watt/15 watt) was preferred. Results: Sphincterotomy was performed in 10 patients, while balloon dilatation was reserved for 2 patients with stones. Stones were successfully extracted in all 5 patients with choledocholithiasis. One of the patients with ChildPugh Class C cirrhosis, who had a malignant biliary stricture, started bleeding from esophageal varices, this being the only endoscopic retrograde cholangiopancreatography-related complication encountered in all patients. Hemostasis in this case was achieved by sclerotherapy. No bleeding from the sphincterotomy site or pancreatitis was observed in any of the patients. Conclusions: Sphincterotomy for choledocholithiasis and malignant biliary strictures is safe and effective, even in cirrhotic patients.

Keywords:

Endoscopic retrograde cholangiopancreatography, cirrhosis,

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