Pilot study of urgent endoscopic intervention without fluoroscopy on patients with severe acute biliary pancreatitis in the intensive care unit.
OBJECTIVE
The effect of early endoscopic intervention (EI; within 72 hours) remains a controversial subject. This prospective study was aimed to evaluate the efficacy of early EI without fluoroscopy on severe acute biliary pancreatitis (SABP) in the intensive care unit (ICU).


METHODS
Fifty-three patients with SABP + ampullary obstruction in the ICU were divided randomly into 2 groups: conservative treatment in the ICU (CTI arm) and CTI + EI without the aid of fluoroscopy (CTI + EI arm). Decreased Acute Physiology and Chronic Health Evaluation II score was the major parameter to assess treatment efficacy.


RESULTS
Endoscopic treatments including sphincterotomy + stone removal (17 cases) and nasobiliary drainage (4 cases) were successfully performed in all 21 enrolled patients without the aid of fluoroscopy in the ICU. Compared with CTI, CTI + EI significantly resulted in decreased (3.86 +/- 2.08 vs 6.57 +/- 1.54) Acute Physiology and Chronic Health Evaluation II score at day 10, P < 0.05. No deaths were observed in the CTI + EI, whereas the CTI arm had 2 mortalities.


CONCLUSIONS
Urgent EI without fluoroscopy is possible to be performed by endoscopists with the experience from high volume of procedures and is beneficial for the patients with SABP in the ICU or community hospital.
Chen
Ping
P
Departments of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.
Hu
Bing
B
Wang
Chunhui
C
Kang
Yan
Y
Jin
Xiaodong
X
Tang
Chengwei
C
D000208:Acute Disease; D000368:Aged; D001660:Biliary Tract Diseases / Q000150:complications*; D001662:Biliary Tract Surgical Procedures; D002681:China; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004724:Endoscopy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic