Oktreotid proflaksisinin post-ERCP pankreatit gelişimi ve biyokimyasal parametreler üzerine etkisi
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Dosyalar
Tarih
2010
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Oktreotid proflaksisinin post-ERCP pankreatit gelişimi ve serum enzim düzeylerine olan etkisini, diğer risk faktörleri ile birlikte değerlendirmek ve araştırmaktır. Materyal ve metod: Tek merkezli ve prospektif olarak yapılan çalışmamıza diagnostik ve terapötik amaçlı ERCP endikasyonu konulan 116 hasta dahil edildi. Hastalar sözlü ve yazılı onamları alındıktan sonra 2 grupta randomize edildi. 1. gruptaki 50 hastaya işlemden 24 saat önce 8 saat ara ile 0.5 mg Oktreotid (Sandostatin 0.5 mg, Novartis, Basel, Switzerland) subkutan yolla uygulandı. Bu grup oktreotid grubu olarak isimlendirildi. 2. gruptaki 66 hastaya ise herhangi bir tedavi verilmedi ve kontrol grubu olarak kabul edildi. İşlem sonrası hospitalizasyon gerektiren inatçı ve şiddetli karın ağrısı ile beraber normalin üst sınırının en az 3 katı kadar yüksek amilaz değerleri ve bu değerlerin en az 24 saat sürmesi post-ERCP pankreatit kriteri olarak ele alındı. Oktreotid ve kontrol grubu post-ERCP pankreatit ve post-ERCP hiperamilazemi açısından karşılaştırıldı. Bulgular: Çalışmaya 63'ü kadın, 53'ü erkek toplam 116 hasta katıldı. Çalışmaya katılan hastaların yaşları 24-87 arasında değişmekteydi. Pre-klinik özellikler bakımından oktreotid ve kontrol grubu birbirine benzerdi. İşlem özellikleri bakımından oktreotid grubunda işlemin total süresi daha uzun, kanülasyon girişim sayısı daha fazla idi. Buna karşın yine oktreotid grubunda endoskopik papillotomi ve koledoğun balonla sıvazlanması işlemi daha fazla idi. Post-ERCP hiperamilazemi ve karın ağrısı gelişiminde her iki grup arasında farklılık yoktu. Çalışmaya alınan tüm hastalar değerlendirildiğinde pankreatik kanala guide girişi ve opak madde enjeksiyonunun, koledoğa stent konmasının PEP riskini artırdığı; endoskopik papillotomi yapılması ve koledoğun balonla temizlenmesinin ise PEP riskini azalttığı gözlendi. PEP gelişimi açısından her iki grup arasında istatistiksel bir anlam olmasa da, klinik açıdan bakıldığında oktreotid grubunda PEP oranı % 6, kontrol grubunda ise % 12,1 idi. Sonuç: Proflaktik olarak yüksek doz (3x0.5 mg) oktreotid verilmesi; ERCP sonrası gelişen pankreatit, hiperamilazemi ve karın ağrısı gelişim riskini istatistiksel olarak azaltmıyor gibi gösterse de bu hasta sayısının azlığından kaynaklanmaktadır. Fark istatistiksel anlamlılık göstermese de kontrol grubunda PEP oranının, oktreotid grubuna göre 2 kat daha fazla olması yüksek doz oktreotid proflaksisinin PEP gelişimini önleyebileceğini düşündürmektedir
Objective: The role of prophylactic octreotide on post-ERCP pancreatitis development and serum enzyme levels, with other risk factors Materials and methods: A prospective study was conducted at a single tertiary care hospital. We had 116 patients with indications of diagnostic and therapeutic ERCP. Patients were randomized in two groups after verbal and written in formed consents. The first group was named as octreotide group and had 50 patients. We applied 0.5 mg octreotide (Sandostatin 0.5 mg, Novartis, Basel, Switzerland) 24 hours before ERCP procedure three times, subcutaneously. The second group was 66 patients and nonmedication was applied and named as control group. Our post-ERCP pancreatitis criterias were obstinate and severe abdominal pain thats needs hospitalization after procedure with amylase levels at least three times of upper limit that continuous at least twenty-four hours. Octreotide and control groups were compared for post-ERCP pancreatitis and post-ERCP hyperamylasemia. Results: We involved a total of 115 patients in this study, 63 women and 53 men. Their ages were between 24 to 87 years. Pre-clinical properties were similar in octreotide and control groups. Enstrumantation time was long in octreotide group and canulation interventions were more in numbers than control group. Also again in octreotide group endoscopic papillotomy and clearance of the choledoc with balloon was more in numbers than control group. No significant difference observed between post-ERCP hyperamylasemia and abdominal pain development. When all the patients evaluated, it was seen that PEP development risk increased with instrumentation of pancreatic canal and contrast agent injection, stent implantation to choledoc and diminished with endoscopic papillotomy and clearance of chloedoc with balloon. No significant difference was observed statistically in PEP development but clinical significance was observed; in octreotide group PEP rate was % 6 and in control group % 12.1. Conclusion: Even prophylactic high dose 3x0.5 mg octreotide injection not seems to effect development of post-ERCP pancreatitis, abdominal pain and hyperamylasemia, this condition is due to small number of the patients. There is not significant statistically difference but in control group PEP rate was two times more than octreotide group, so high dose octreotide prophylacsis may prevent PEP development.
Objective: The role of prophylactic octreotide on post-ERCP pancreatitis development and serum enzyme levels, with other risk factors Materials and methods: A prospective study was conducted at a single tertiary care hospital. We had 116 patients with indications of diagnostic and therapeutic ERCP. Patients were randomized in two groups after verbal and written in formed consents. The first group was named as octreotide group and had 50 patients. We applied 0.5 mg octreotide (Sandostatin 0.5 mg, Novartis, Basel, Switzerland) 24 hours before ERCP procedure three times, subcutaneously. The second group was 66 patients and nonmedication was applied and named as control group. Our post-ERCP pancreatitis criterias were obstinate and severe abdominal pain thats needs hospitalization after procedure with amylase levels at least three times of upper limit that continuous at least twenty-four hours. Octreotide and control groups were compared for post-ERCP pancreatitis and post-ERCP hyperamylasemia. Results: We involved a total of 115 patients in this study, 63 women and 53 men. Their ages were between 24 to 87 years. Pre-clinical properties were similar in octreotide and control groups. Enstrumantation time was long in octreotide group and canulation interventions were more in numbers than control group. Also again in octreotide group endoscopic papillotomy and clearance of the choledoc with balloon was more in numbers than control group. No significant difference observed between post-ERCP hyperamylasemia and abdominal pain development. When all the patients evaluated, it was seen that PEP development risk increased with instrumentation of pancreatic canal and contrast agent injection, stent implantation to choledoc and diminished with endoscopic papillotomy and clearance of chloedoc with balloon. No significant difference was observed statistically in PEP development but clinical significance was observed; in octreotide group PEP rate was % 6 and in control group % 12.1. Conclusion: Even prophylactic high dose 3x0.5 mg octreotide injection not seems to effect development of post-ERCP pancreatitis, abdominal pain and hyperamylasemia, this condition is due to small number of the patients. There is not significant statistically difference but in control group PEP rate was two times more than octreotide group, so high dose octreotide prophylacsis may prevent PEP development.
Açıklama
Anahtar Kelimeler
Endoskopi-gastrointestinal, Oktreotid, Octreotide, Pankreatit, Pancreatitis
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Arıcıgil, D. (2010). Oktreotid proflaksisinin post-ERCP pankreatit gelişimi ve biyokimyasal parametreler üzerine etkisi. Selçuk Üniversitesi, Yayımlanmış tıpta uzmanlık tezi, Konya.
