Chinese Medicine Enema Prevents Pancreatitis And Hyperamylaseemia After ERCP And Its Influence On Inflammatory Factors

ObjectiveWith the rapid development of endoscopic operation technology and equipment,the role of endoscopic retrograde cholangiopancreatography ERCP in the diagnosis and treatment of biliary and pancreatic diseases is more and more significant,especially for the treatment of common bile duct stones.It has important therapeutic value for patients who are unable to undergo surgery.Although ERCP is a minimally invasive surgery,it still has some damages to the patient.Its postoperative complications are often difficult to avoid and has become a problem that doctors and patients need to face together.PEP and PEH are complications caused by multiple factors which are common and may endanger the lives of the patients.In recent years,the international guidelines recommend indomethacin,which is a kind of NSAIDs,as a preventive medication for PEP.However,it increases the risk of ulcers,bleeding,perforation,etc.for patients with digestive diseases.At present,clinical research on the use of traditional Chinese medicine to prevent PEP is a research hotspot.Qingyuan Tang has been proved by a large number of clinical studies to have effects on the prevention and treatment of pancreatitis.This study is a non-inferior trial test and randomized controlled trial which using indomethacin suppository as a control drug.This study was to evaluate the clinical efficacy of Qingyi Lidan mixture in preventing PEP and PEH.This study was to explore the relationship between its preventive effect and the inflammatory factors interleukin-6,interleukin-8 and interleukin-10.MethodsAll cases in this study were enrolled from hospitalized patients who underwent ERCP surgery at the Digestive Endoscopy Center of the DongFang Hospital of Beijing University of Chinese Medicine.Patients were randomized according to a random number table.There was no significant difference in age and gender between the two groups.A total of 65 patients were included,33 in the Chinese medicine group and 32 in the western medicine group.The traditional Chinese medicine group was treated with Qingyi Lidan mixture 100ml retention enema for 30 min 2 hours before ERCP.The western medicine group was given 0.1 g of indomethacin suppository,and the suppository was inserted into anus 2 hours before ERCP.The operation process of ERCP was recorded,including the times of biliary cannulation,the developing of pancreatic duct after contrast agent injected,the use of equipment,the duration of operation,etc.Recording the changes of IL-6,IL-8,IL-10 and serum amylase before operation,4 hours and 24 hours after operation;recording symptoms such as abdominal pain and abdominal bloating.According to the diagnostic criteria of PEP and PEH,the number of complication cases in the two groups was recorded.The VAS was used in evaluating abdominal pain severity.The data were statistically analyzed by SPSS20.0 software.Results1)There was no significant difference in the incidence of PEP and PEH between the traditional Chinese medicine group and the western medicine group(P>0.05).The results suggested that the Qingyi Lidan mixture is no less effective than indomethacin for the prevention of PEP and PEH.The results suggested that the preventive effect of the two group is equivalent;2)There was no significant difference in serum amylase level between the Chinese medicine group and the western medicine group at 4h and 24h after operation(P>0.05).There was no significant difference in the changes of serum amylase between the two groups at 4h and 24h after and before operation.(P>0.05).The results suggested that the effect for reducing the serum amylase of the two group is equivalent;3)There were no significant differences in terms of IL-6 and IL-8 between the two groups before operation,4h after operation and 24h after operation and its changes after and before operation.(P>0.05).The results suggest that the effect of Chinese medicine Qingyi Lidan mixture on regulating the level of IL-6 and IL-8 is similar to that of indomethacin..There was no significant differences in terms of IL-10 between the two groups before operation,4h after operation and 24h after operation and changes between 4h after and before operation(P>0.05).The level of IL-10 in the Chinese medicine group was significantly higher than that in the western medicine group 24h after operation.(P<0.05).The results suggest that the raise of IL-10 of Chinese medicine group at 24h after surgery was higher than the western medicine group;4)The severity of abdominal pain in the Chinese medicine group was significantly lower than that in the western medicine group at 4h and 24h after operation(P<0.05).The results suggested that the Chinese medicine group can relieve the postoperative abdominal pain more effectively than the western medicine group;5)There was a statistically significant difference in exhaust time after operation between the two groups(P<0.05).The exhaust time of patients in the Chinese medicine group was significantly shorter than that of the western medicine group.There was a statistically significant difference in the number of abdominal bloating between the two groups(P<0.05).There was no significant difference in the incidence of abdominal bloating between the two groups(P>0.05).The results suggested that the Chinese medicine group was better than that of the western medicine group in relieving abdominal bloating.Conclusion1.The efficacy of traditional Chinese medicine Qingyi Lidan Mixture in preventing PEP and PEH in patients with common bile duct stones is comparable to that of western medicine indomethacin;2.The Qingyi Lidan Mixture can effectively reduce the incidence of PEP and PEH in patients with common bile duct stones.It promotes the patient to exhaust earlier and more effective in reducing abdominal pain and bloating at 4h and 24h after operation than western medicine.3.The effect of Chinese medicine Qingyi Lidan mixture on regulating the level of IL-6 and IL-8 is similar to that of indomethacin.The Chinese medicine Qingyi Lidan mixture significantly increased the increase of IL-10 at 24h after operation.It could regulate immune function and reduce the inflammatory response.