預防內視鏡逆行性膽胰管造影術引發的胰臟炎之臨床指引

內視鏡逆行性膽胰管造影術（endoscopic retrograde cholangiopancreatography, ERCP）廣泛用於診斷和治療胰臟和膽道系統疾病，術後最常見的併發症是胰臟炎（post-ERCP pancreatic, PEP），可能延長病人住院時間並增加醫療支出，因此進行適當的預防便成了一項重要課題。PEP的預防可以從三大面向著手，分別為：病人風險的評估、預防藥物的使用、醫療技術相關措施的選用。本篇文章整理出目前美國、歐洲、日本、台灣相關的臨床指引中有提到的預防策略，進一步引用最新的研究文獻以供臨床人員參考，期望降低PEP的發生率，讓病人有更安全的醫療環境。

關鍵字

內視鏡逆行性膽胰管造影術；胰臟炎

並列摘要

Endoscopic retrograde cholangiopancreatography(ERCP)is widely used to diagnose and manage pancreaticobiliary disorders in clinical practice. However, post-ERCP pancreatitis(PEP)is the most common adverse event attributing to the procedure that prolongs hospital stay and increases medical expenses. Thus, proper preventive strategies become an important issue. Prevention for PEP involves multiple aspects, including assessment of patient related factors, administration of pharmacological agents and suitable procedural techniques. This article collected the clinical practices and recommendations mentioned in the relevant guidelines from the American Society for Gastrointestinal Endoscopy, the European Society of Gastrointestinal Endoscopy, the Japanese Society of Gastroenterology, and the Taiwan Pancreas Society. In addition, we have cited the latest research literatures for reference in attempt to reduce the incidence of PEP and promote a patient safety medical environment.

並列關鍵字

endoscopic retrograde cholangiopancreatography ； pancreatitis

參考文獻

Kochar B, Akshintala VS, Afghani E, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 2015;81:143-9.e9. https://doi.org/10.1016/j.gie.2014.06.045

Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991;37:383-93. https://doi.org/10.1016/S0016-5107(91)70740-2

Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11. https://doi.org/10.1136/gutjnl-2012-302779

ASGE Standards of Practice Committee; Chandrasekhara V, Khashab MA, Muthusamy VR, et al. Adverse events associated with ERCP. Gastrointest Endosc 2017;85:32-47. https://doi.org/10.1016/j.gie.2016.06.051

Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020;52:127-49. https://doi.org/10.1055/a-1075-4080

延伸閱讀

楊昌學（2002）。經內視鏡逆行性膽胰管攝影術開啟膽胰疾病診斷治療之鑰。健康世界，(196)，48-50。https://doi.org/10.6454/HW.200204.0010
Lin, C. Y., Bora, D., Tai, W. C., Lin, T. L., Li, W. F., Liu, C. Y., Chen, C. L., & Wang, C. C. (2011). 經內視鏡逆行性膽胰管攝影術後合併十二指腸憩室出血：病例報告和文獻回顧. 中華民國急救加護醫學會雜誌, 22(4), 164-169. https://doi.org/10.30018/JECCM.201112.0003
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Ito, K., Fujita, N., Noda, Y., Kobayashi, G., Obana, T., Horaguchi, J., Koshita, S., & Kanno, Y. (2010). Endosonography-Guided Pancreatic Duct Drainage for Chronic Pancreatitis: A Case Report and Review. Diagnostic and Therapeutic Endoscopy, 2010(), 87-91. https://doi.org/10.1155/2010/517864
Hsiao, M. C., Ng, C. J., Chiu, T. F., Lee, K. T., Kuan, J. T., & Chen, J. C. (2006). Acute Pancreatitis: Influence of Gender on Etiology and Outcome of Patients in the Emergency Department. Journal of Emergency Medicine, Taiwan, 8(2), 54-59. https://www.airitilibrary.com/Article/Detail?DocID=15623386-200606-8-2-54-59-a

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