Conservative management of cholestasis with and without fever in acute biliary pancreatitis  

作　　者：JoséSebastio Santos Rafael Kemp JoséCelso Ardengh Jorge Elias Jr 

机构地区：[1]Division of Digestive Surgery,Department of Surgery and Anatomy,Faculty of Medicine of Ribeiro Preto,University of So Paulo [2]Department of Internal Medicine,Faculty of Medicine of Ribeiro Preto,University of So Paulo

出　　处：《World Journal of Gastrointestinal Surgery》2012年第3期55-61,共7页世界胃肠外科杂志（英文版）（电子版）

基　　金：Supported by Fundo Waldemar Barnsley Pessoa

摘　　要：The presence of cholestasis in both mild and severe forms of acute biliary pancreatitis(ABP)does not justify,of itself,early endoscopic retrograde cholangiography(ERC)or endoscopic sphincterotomy(ES).Clinical support treatment of acute pancreatitis for one to two weeks is usually accompanied by regression of pancreatic edema,of cholestasis and by stone migration to the duodenum in 60%-88%of cases.On the other hand,in cases with both cholestasis and fever,a condition usually characterized as ABP associated with cholangitis,early ES is normally indicated.However,in daily clinical practice,it is practically impossible to guarantee the coexistence of cholangitis and mild or severe acute pancreatitis.Pain,fever and cholestasis,as well as mental confusion and hypotension,may be attributed to inflammatory and necrotic events related to ABP. Under these circumstances,evaluation of the bile duct by endo-ultrasonography(EUS)or magnetic resonance cholangiography(MRC)before performing ERC and ES seems reasonable.Thus,it is necessary to assess the effects of the association between early and opportune access to the treatment of local and systemic inflammatory/infectious effects of ABP with cholestasis and fever, and to characterize the possible scenarios and the subsequent approaches to the common bile duct,directed by less invasive examinations such as MRC or EUS.The presence of cholestasis in both mild and severe forms of acute biliary pancreatitis (ABP) does not justify, of itself, early endoscopic retrograde cholangiography (ERC) or endoscopic sphincterotomy (ES). Clinical support treatment of acute pancreatitis for one to two weeks is usually accompanied by regression of pancreatic edema, of cholestasis and by stone migration to the duodenum in 60%-88% of cases. On the other hand, in cases with both cholestasis and fever, a condition usually characterized as ABP associated with cholangitis, early ES is normally indicated. However, in daily clinical practice, it is practically impossible to guarantee the coexistence of cholangitis and mild or severe acute pancreatitis. Pain, fever and cholestasis, as well as mental confusion and hypotension, may be attributed to inflammatory and necrotic events related to ABP. Under these circumstances, evaluation of the bile duct by endo-ultrasonography (EUS) or magnetic resonance cholangiography (MRC) before performing ERC and ES seems reasonable. Thus, it is necessary to assess the effects of the association between early and opportune access to the treatment of local and systemic inflammatory/infectious effects of ABP with cholestasis and fever, and to characterize the possible scenarios and the subsequent approaches to the common bile duct, directed by less invasive examinations such as MRC or EUS.

关 键 词：Biliary pancreatitis CHOLESTASIS ENDOSCOPIC SPHINCTEROTOMY CHOLANGITIS Mortality Magnetic resonance CHOLANGIOPANCREATOGRAPHY ENDOSCOPIC retrograde CHOLANGIOGRAPHY ENDOSCOPIC ultrasonography Intensive care Health system regulation 

分 类 号：R576[医药卫生—消化系统]