| BackgroundIn recent years,with the continuous development of endoscopic operation and instrumentation,ERCP is more widely applied in clinical experience and now become an important means of diagnosis and treatment of biliary and pancreatic diseases.Although ERCP is a minimally invasive technique of complex operation,it also has a variety of adverse reactions and complications after operation.Hyperamylasemia and post ERCP pancreatitis are the most common complications and difficult to avoid,which undoubtedly increase the sufferings of patients.Therefore,it is great significant to find effective drugs to prevent the occurrence of hyperamylasemia and PEP.At present,many studies have confirmed that indomethacin suppositories administration can prevent hyperamylasemia and PEP.However,there are few reports about whether the administration of different time periods affects the occurrence of hyperamylasemia and PEP.ObjectiveThe aim of the present study is to evaluate the clinical effect of indomethacin suppositories administration at different time points on the prevention of post-ERCP hyperamylasemia and pancreatitis and find the best time for administration.At the same time,the related factors is also discussed.Methods120 patients in Tai’an City central hospital from December 2016 to December 2017 with biliary and pancreatic disease treated with ERCP were recruited.Accordi-ng to random number table method,120 patients were randomly divided into three groups(40 cases in each group).The group A(100mg rectal indomethacin suppositorirs was administrated half an hour before ERCP),group B(100mg rectal indomet-hacin suppositorirs was administrated ten minutes after ERCP)and group C(alone group,which did not give100 mg rectal indomethacin suppositorirs).The level of s-erum amylase were measured of 24 h,48h and 72 h after ERCP,and the incidence of hyperamylasemia and PEP were analyzed,and observed the best time of indom-ethacin suppositories administration for the prevention of post-ERCP hyperamylasemia and analyzed the correlation factors of the hyperamylasemia and PEP with pati-ents.Results1.All patients were successfully completed operation.The serum amylase-levels of 24,48 and 72 hours after ERCP in the group A was(133.12±58.09),(108.03±33.77),(98.37±15.12),the group B was(150.17±80.45),(114.28±36.63),(99.88±16.16),were lower than those of control groups C(217.85±134.93),(134.67±37.63),(110.48±17.40)(p<0.05).The case with PEP in the group A and B respectively were 1(2.5%)and 3(7.5%),were lower than those of control groups C 7(17.5%)(p<0.05).The case with hyperamylasemia in the group A and B respectively were 10(25%)and 11(27.5%),were lower than those of control groups C 20(50%)(p<0.05).The same effectively of 100 mg Indomethacin suppositories half hour before ERCP or ten minutes after ERCP can reduce the incidence of PEP and hyperamylasemia.(p>0.05).2.Around 120 patients,the patients of bile duct stones with hyperamylasemia respectively was in the group A 9(39.13%),B 9(45.00%),C 15(71.43%),the patients of bile duct tumor with hyperamylasemia respectively was in the group A 1(5.88%),B 1(10.00%),C 5(26.32%),there was statistically different.(p<0.05)3.Around 120 patients,the incidence of hyperamylasemia with EST and EST combined EPBD in the group A respectively were(27.27%,22.22%),the group B were(33.33%,21.05%)and the group C were(52.17%,47.06%),the incidence of hyperamylasemia with EST combined ballon dilatation in the three group was same than that in single EST.(p>0.05)4.The incidence of hyperamylasemia of ERCP was statistically significant between duodenal diverticulum and notduodenal diverticulun in each group.(p>0.05)Conclusion1.Indomethacin suppositories administration can reduce the incidence of PEP and hyperamylasemia.The same effectively of 100 mg Indomethacin suppositories administration half hour before ERCP or ten minutes after ERCP.2.Patients with bile duct stones have are more likely to have hyperamylasemia than patients who with bile duct tumor.3.Compared with operation process,the EST combined with EPBD may have not higher incidence of hyperamylasemia compared to single EST.4.Patients with duodenal diverticulum are more likely to have hyperamylasemia and indomethacin suppositories administration can reduce the incidence of hyperamylasemia. |
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