A comparative analysis of acute pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography

Objective To investigate the clinical features of patients with acute pancreatitis versus hyperamylasemia after endoscopic retrograde cholangiopancreatography( ERCP) and related influencing factors,and to provide a basis for preventing disease progression. Methods A retrospective analysis was performed for the clinical data of 117 patients who underwent ERCP in Renmin Hospital of Wuhan University from January 2017 to August 2019,and all patients were given the preventive use of diclofenac sodium suppository before surgery. After surgery,77 patients developed hyperamylasemia and 40 developed acute pancreatitis,and the two groups were compared in terms of clinical features and influencing factors. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; a multivariate logistic regression analysis was used to investigate the independent risk factors for post-ERCP pancreatitis( PEP). Results There were significant differences between the two groups in preoperative levels of alkaline phosphatase( ALP)( Z =-2. 518,P = 0. 012),gamma-glutamyl transpeptidase( Z =-2. 313,P = 0. 021),total bilirubin( TBil)( Z =-2. 978,P = 0. 003),and direct bilirubin( Z =-3. 069,P = 0. 002) and presence or absence of guide wire insertion into the pancreatic duct during surgery( χ2= 4. 176,P = 0. 041). Further logistic regression analysis showed that the number of times of guide wire insertion into the pancreatic duct ≥3( odds ratio [OR]= 2. 469,95% confidence interval [CI]: 1. 199-5. 188,P = 0. 047),ALP< 125 U/L( OR = 5. 499,95% CI: 1. 452-18. 830,P = 0. 012),and TBil < 22 umol/L( OR = 4. 249,95% CI: 1. 023-17. 648,P =0. 046) were independent risk factors for PEP. Conclusion Although patients are given the preventive use of diclofenac sodium suppository before surgery,the patients with normal levels of ALP and TBil before surgery and repeated guide wire insertion into the pancreatic duct during surgery are more likely to develop PEP,which should be taken seriously by surgeons. Early intervention measures before and after surgery based on patients' conditions can reduce the progression of post-ERCP hyperamylasemia to PEP,reduce the development of moderate-to-severe PEP,and improve patients' prognosis.