Effects in the control of edema of the papilla of Vater by epinephrine saline irrigation after endoscopic retrograde cholangiopancreatography in an endoscopy center in Japan, 2003 to 2007: exploratory retrospective analysis to evaluate the characteristics of eligible patients with a focus on serum amylase levels.
OBJECTIVE
To evaluate the effects of localized irrigation with epinephrine saline after endoscopic retrograde cholangiopancreatography (ERCP).


METHODS
One hundred and fourteen patients who underwent ERCP in our institute were treated with or without irrigation using epinephrine diluted in saline after ERCP to prevent post-ERCP pancreatitis. The serum amylase levels, white blood cell counts, and urine amylase levels were measured at 24 and 48 hours after ERCP.


RESULTS
The treatment resulted in improvements in all items. A univariate analysis of the explanatory variables between the treatment and untreated groups revealed the treatment to be effective, but not statistically significant. Gender and cannulation of the pancreatic duct were the only variables with significant partial regression coefficients in the multiple regression model with all explanatory variables (p=0.045). When a stratified analysis was conducted using gender as a moderator variable, the treatment became a significant preventive factor (p=0.038), and cannulation of the pancreatic duct was a significant risk factor (p=0.027) in female patients.


CONCLUSIONS
We suggest that irrigating with epinephrine saline into the papilla may be effective for preventing pancreatitis in female patients who received ERCP with cannulation of their pancreatic duct.
Nakaji
Konosuke
K
Aishinkai Nakae Hospital Endoscopy Center, Wakayama. ko_9.so-pa1bm2is@akk.view21.net
Suzumura
Shigeo
S
Nakae
Yukinori
Y
Kojima
Kensaku
K
Kumamoto
Mitsutaka
M
Kozu
Tomonaga
T
D000322:Adrenergic Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology*; D000681:Amylases / Q000097:blood*; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003137:Common Bile Duct Diseases / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D004487:Edema / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000517:prevention & control; D012044:Regression Analysis; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D000681:Amylases; D004837:Epinephrine