Résumé
La fréquence des pancréatites après CPRE est surtout fonction de l’éventuel geste de sphinctérotomie associé et de l’expérience de l’endoscopiste. Le diagnostic est habituellement facile à condition d’écarter la perforation rétro-duodénale. La tomodensitométrie constitute le progrès majeur de ces dernières années. La chirurgie n’a pratiquement plus sa place dans le traitement curatif qui est médical mais reste le plus souvent symptomatique et contemplatif. C’est dire l’intérêt de la prévention. Celle-ci dépend des facteurs de risque:
-
— facteurs mécaniques avec un risque important lors des injections répétées du Wirsung;
-
cfacteurs chimiques avec une préférence pour l’utilisation de produits de contraste de faible osmolalité;
-
— facteurs bactériens mais aucune étude ne démontre l’efficacité d’une antibiothérapie préventive locale ou générale;
-
— facteurs enzymatiques mais les inhibiteurs de protéase se sont révélés de peu d’efficacité;
-
— facteurs thermiques avec un risque nettement accru lors des pré-coupes;
-
— facteurs divers tels les antécédents de pancréatite aiguë post-CPRE qui imposent des règles préventives supplémentaires. La bonne connaissance de ces facteurs permet la mise en pratique de quelques règles préventives simples.
Summary
The frequency of pancreatitis after ERCP depends on whether there is associated sphincterotomy and on the experience of the endoscopist. The diagnosis is usually easy to make providing that there is no retro-duodenal perforation. Tomodensitometry has been the major step forward in the last few years. Surgery has practically no longer any place in curative treatment. Treatment is medical but for the most part only treats symptoms and observes the progress of the illness. This underlines the importance of prevention which depends on the risk factors:
-
— mechanical factors with a high risk due to : repeated injections of Wirsung duct;
-
— chemical factors with a preference for the use of contrast products with low osmolality;
-
— bacterial factors but no study has shown the effectiveness of local or general preventive antibiotherapy;
-
— enzymes factors but protease inhibitors have not appeared to be very effective, thermal factors with a clearly increased risk during pre-cuts;
-
— other factors such as acute pancreatitis antecedents after ERCP which call for further preventive rules. A good knowledge of these factors lead to the the setting up of a few simple preventive rules.
Références
BILBAO M.K., DOTTER C.T., LEE T.G., KATON R.M. — Complications of endoscopic retrograde cholangiopancreatography: a study of 10,000 cases.Gastroenterology, 1976,70, 314–320.
CONN M., GOLDENBERG A., CONCEPTION L., MANDELI J. — The effect of ERCP on circulating enzymes and pancreatic protease inhibitors.Am. J. Gastroenterol., 1991,86, 1011–1014.
COTTON P.B. — Pre-cut papillotomy a risky technique for experts only.Gastrointest. Endosc., 1989,35, 578–579.
COTTON P.B., LEHMAN G., VENNES J., GEENEN J.E., RUSSELL R.C.G., MEYERS W.C., LIGUORY C., NICKL N. — Endoscopic sphincterotomy complications and their management: an attempt at consensus.Gastrointest. Endosc., 1991,37, 383–393.
ESCOURROU J., DELVAUX M., BUSCAIL L., FREGEVU J., FREXINOS J., RIBET A. — Clinical results of endoscopic sphincterotomy: comparison of two activity periods in the same endoscopy unit.Gastrointest. Endosc., 1990,36, 205–206.
HAMILTON I., LINTOTT D.J., ROTHWELL J., AXON A.T.R. — Acute pancreatitis following endoscopic retrograde cholangiopancreatography.Clin. Radiol., 1983,34, 543–546.
KOBAYASHI T., FUKUCHI S., SAWANO S., YAMADA N., IKENAGA T., SUGIMOTO T. — Changes in serum isoamylase activities after fibergastroduodenoscopy and colonoscopy.Endoscopy, 1979,2, 133–137.
KOSAREK R.A. — Balloon dilation of the sphincter of Oddi.Endoscopy, 1988,20, 207–210.
LA FERLA G., GORDON S., ARCHIBALD M., MURRAY W.R. — Hyperamylasemia and acute pancreatitis following endoscopic retrograde cholangiopancreatography.Pancreas, 1986,1, 60–63.
MATSUNAGA E., SATO Y., NAKASHIMA H. — Prophylactic effects of FOY in post-ERCP pancreatitis.Gendai Iryo, 1979,11, 1213–1216.
NEOPTOLEMOS J.P., LONDON N.J., CARR-LOCKE D.L., BAILEY I.A., JAMES D., FOSSARD D.P. — Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones.Lancet, 1988,2, 979–983.
SHERMAN S., LEHMAN G. — ERCP and endoscopic shincterotomy-induced pancreatitis.Pancreas, 1991,6, 350–367.
SKUDE G., WEHLIN L., MARUYAMA T., ARIYAMA J. — Hyperamylasemia after duodenoscopy and retrograde cholangiopancreatography.Gut, 1976,17, 127–132
SVENBERG T., HAGGMARK T., STRANDVIK B., SLESAK P. — Haemorrhagic pancreatitis after ERCP in patients with alpha 1-antitrypsin deficiency.Lancet, 1988,1, 772
VARLEY P.F., ROHRMANN C.A., SILVIS S.E., VENNES J.A. — The normal endoscopic pancreatogram.Radiology, 1976,118, 295–300.
Author information
Authors and Affiliations
About this article
Cite this article
Caucanas, J.P., Lapuelle, J., Cassigneul, J. et al. Pancréatite après cholangiopancréatographie rétrograde par voie endoscopique (CPRE). Acta Endosc 24, 247–255 (1994). https://doi.org/10.1007/BF02969606
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF02969606