SS  Vol.6 No.2 , February 2015
Effect of Post-ERCP Pancreatitis on Perioperative Factors of Pancreaticoduodenectomy

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed for biliary drainage and examination of the biliary and pancreatic duct before pancreaticoduodenectomy (PD). The influence of preoperative post-ERCP pancreatitis on PD is unknown. The aim of this study was to evaluate the relation between post-ERCP pancreatitis before PD and surgical outcomes of PD. Methods: We examined 38 patients who underwent PD. The relations between post-ERCP pancreatitis before PD and perioperative factors of PD such as patient characteristics, operative findings, and postoperative course were evaluated with univariate and multivariate analyses. Results: Post-ERCP pancreatitis was observed in 12 (37.5%) of the 38 patients. Univariate analyses showed operative procedure (P = 0.034), operation time (P = 0.004), blood loss (P = 0.031), C-reactive protein (P = 0.043), and delayed gastric emptying (P = 0.035) to be significantly associated with post-ERCP pancreatitis. Multivariate analyses showed operation time (OR, 1.017; 95%CI, 1.000 - 1.034; P = 0.049) and delayed gastric emptying (OR, 18.72; 95%CI, 1.139 - 307.6; P = 0.040) to be significantly associated with post-ERCP pancreatitis. Conclusions: Post-ERCP pancreatitis was associated with prolonged operation time and delayed gastric emptying in patients undergoing PD.

Cite this paper
Hirashita, T. , Matsumoto, T. , Izumi, K. , Ikebe, M. , Yano, T. , Muto, Y. and Matsuo, S. (2015) Effect of Post-ERCP Pancreatitis on Perioperative Factors of Pancreaticoduodenectomy. Surgical Science, 6, 35-41. doi: 10.4236/ss.2015.62006.

[1]   Vandervoort, J., Soetikno, R.M., Tham, T.C., Wong, R.C., Ferrari Jr., A.P., Montes, H., Roston, A.D., Slivka, A., Lichtenstein, D.R., Ruymann, F.W., Van Dam, J., Hughes, M. and Carr-Locke, D.L. (2002) Risk Factors for Complications after Performance of ERCP. Gastrointestinal Endoscopy, 6, 652-656.

[2]   Silviera, M.L., Seamon, M.J., Porshinsky, B., Prosciak, M.P., Doraiswamy, V.A., Wang, C.F., Lorenzo, M., Truitt, M., Biboa, J., Jarvis, A.M., Narula, V.K., Steinberg, S.M. and Stawicki, S.P. (2009) Complications Related to Endoscopic Retrograde Cholangiopancreatography: A Comprehensive Clinical Review. Journal of Gastrointestinal and Liver Diseases, 18, 73-82.

[3]   Jeurnink, S.M., Siersema, P.D., Steyerberg, E.W., Dees, J., Poley, J.W., Haringsma, J. and Kuipers, E.J. (2011) Predictors of Complications after Endoscopic Retrograde Cholangiopancreatography: A Prognostic Model for Early Discharge. Surgical Endoscopy, 25, 2892-2900.

[4]   Cheng, C.L., Sherman, S., Watkins, J.L., Barnett, J., Freeman, M., Geenen, J., Ryan, M., Parker, H., Frakes, J.T., Fogel, E.L., Silverman, W.B., Dua, K.S., Aliperti, G., Yakshe, P., Uzer, M., Jones, W., Goff, J., Lazzell-Pannell, L., Rashdan, A., Temkit, M. and Lehman, G.A. (2006) Risk Factors for Post-ERCP Pancreatitis: A Prospective Multicenter Study. American Journal of Gastroenterology, 101, 139-147.

[5]   Freeman, M.L. (2002) Adverse Outcomes of ERCP. Gastrointestinal Endoscopy, 56, S273-S282.

[6]   Trede, M. and Schwall, G. (1988) The Complications of Pancreatectomy. Annals of Surgery, 207, 39-47.

[7]   R?ty, S., Sand, J., Lantto, E. and Nordback, I. (2006) Postoperative Acute Pancreatitis as a Major Determinant of Postoperative Delayed Gastric Emptying after Pancreaticoduodenectomy. Journal of Gastrointestinal Surgery, 10, 1131-1139.

[8]   Balzano, G., Zerbi, A., Capretti, G., Rocchetti, S., Capitanio, V. and Di Carlo, V. (2008) Effect of Hospital Volume on Outcome of Pancreaticoduodenectomy in Italy. British Journal of Surgery, 95, 357-362.

[9]   Seiler, C.A., Wagner, M., Bachmann, T., Redaelli, C.A., Schmied, B., Uhl, W., Friess, H. and Büchler, M.W. (2005) Randomized Clinical Trial of Pylorus-Preserving Duodenopancreatectomy versus Classical Whipple Resection—Long Term Results. British Journal of Surgery, 92, 547-556.

[10]   Yeo, C.J., Cameron, J.L., Lillemoe, K.D., Sohn, T.A., Campbell, K.A., Sauter, P.K., Coleman, J., Abrams, R.A. and Hruban, R.H. (2002) Pancreaticoduodenectomy with or without Distal Gastrectomy and Extended Retroperitoneal Lymphadenectomy for Periampullary Adenocarcinoma, Part 2: Randomized Controlled Trial Evaluating Survival, Morbidity, and Mortality. Annals of Surgery, 236, 355-366.

[11]   Braga, M., Capretti, G., Pecorelli, N., Balzano, G., Doglioni, C., Ariotti, R. and Di Carlo, V. (2011) A Prognostic Score to Predict Major Complications after Pancreaticoduodenectomy. Annals of Surgery, 254, 702-708.

[12]   Tani, M., Kawai, M., Hirono, S., Ina, S., Miyazawa, M., Shimizu, A. and Yamaue, H. (2010) A Prospective Randomized Controlled Trial of Internal versus External Drainage with Pancreaticojejunostomy for Pancreaticoduodenectomy. American Journal of Surgery, 199, 759-764.

[13]   Roder, J.D., Stein, H.J., Bottcher, K.A., Busch, R., Heidecke, C.D. and Siewert, J.R. (1999) Stented versus Nonstented Pancreaticojejunostomy after Pancreatoduodenectomy: A Prospective Study. Annals of Surgery, 229, 41-48.

[14]   Tani, M., Terasawa, H., Kawai, M., Ina, S., Hirono, S., Uchiyama, K. and Yamaue, H. (2006) Improvement of Delayed Gastric Emptying in Pylorus-Preserving Pancreaticoduodenectomy: Results of a Prospective, Randomized, Controlled Trial. Annals of Surgery, 43, 316-320.

[15]   Murakami, Y., Uemura, K., Sudo, T., Hayashidani, Y., Hashimoto, Y., Nakagawa, N., Ohge, H. and Sueda, T. (2008) An Antecolic Roux-en Y Type Reconstruction Decreased Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy. Journal of Gastrointestinal Surgery, 12, 1081-1086.

[16]   Cotton, P.B., Lehman, G., Vennes, J., Geenen, J.E., Russell, R.C., Meyers, W.C., Liguory, C. and Nickl, N. (1991) Endoscopic Sphincterotomy Complications and Their Management: An Attempt at Consensus. Gastrointestinal Endoscopy, 37, 383-393.

[17]   Bassi, C., Dervenis, C., Butturini, G., Fingerhut, A., Yeo, C., Izbicki, J., Neoptolemos, J., Sarr, M., Traverso, W. and Buchler, M. (2005) Postoperative Pancreatic Fistula: An International Study Group (ISGPF) Definition. Surgery, 138, 8-13.

[18]   van Berge Henegouwen, M.I., van Gulik, T.M., Allema, J.H., Rauws, E.A., Obertop, H. and Gouma, D.J. (1997) Delayed Gastric Emptying after Standard Pancreaticoduodenectomy versus Pylorus-Preserving Pancreaticoduodenectomy: An Analysis of 200 Consecutive Patients. Journal of the American College of Surgeons, 185, 373-379.

[19]   Masci, E., Toti, G., Mariani, A., Curioni, S., Lomazzi, A., Dinelli, M., Minoli, G., Crosta, C., Comin, U., Fertitta, A., Prada, A., Passoni, G.R. and Testoni, P.A. (2001) Complications of Diagnostic and Therapeutic ERCP: A Prospective Multicenter Study. American Journal of Gastroenterology, 96, 417-423.

[20]   Miedema, B.W., Sarr, M.G., van Heerden, J.A., Nagorney, D.M., Mc Ilrath, D.C. and Ilstrup, D. (1992) Complications Following Pancreaticoduodenectomy: Current Management. Archives of Surgery, 127, 945-949.

[21]   Hackert, T., Hinz, U., Hartwig, W., Strobel, O., Fritz, S., Schneider, L., Werner, J. and Büchler, M.W. (2013) Pylorus Resection in Partial Pancreaticoduodenectomy: Impact on Delayed Gastric Emptying. American Journal of Surgery, 206, 296-299.

[22]   Braasch, J.W., Deziel, D.J., Rossi, R.L., Watkins Jr., E. and Winter, P.F. (1986) Pyloric and Gastric Preserving Pancreatic Resection: Experience with 87 Patients. Annals of Surgery, 204, 411-418.

[23]   van der Gaag, N.A., Kloek, J.J., de Castro, S.M., Busch, O.R., van Gulik, T.M. and Gouma, D.J. (2009) Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status. Journal of Gastrointestinal Surgery, 13, 814-820.

[24]   Kimmings, A.N., van Deventer, S.J., Obertop, H., Rauws, E.A., Huibregtse, K. and Gouma, D.J. (2000) Endotoxin, Cytokines, and Endotoxin Binding Proteins in Obstructive Jaundice and after Preoperative Biliary Drainage. Gut, 46, 725-731.

[25]   Sewnath, M.E., Karsten, T.M., Prins, M.H., Rauws, E.J., Obertop, H. and Gouma, D.J. (2002) A Meta-Analysis on the Efficacy of Preoperative Biliary Drainage for Tumors Causing Obstructive Jaundice. Annals of Surgery, 236, 17-27.

[26]   van der Gaag, N.A., Rauws, E.A., van Eijck, C.H., Bruno, M.J., van der Harst, E., Kubben, F.J., Gerritsen, J.J., Greve, J.W., Gerhards, M.F., de Hingh, I.H., Klinkenbijl, J.H., Nio, C.Y., de Castro, S.M., Busch, O.R., van Gulik, T.M., Bossuyt, P.M. and Gouma, D.J. (2010) Preoperative Biliary Drainage for Cancer of the Head of the Pancreas. New England Journal of Medicine, 362, 129-137.