PREVENTION AND TREATMENT OF PANCREATITIS AFTER ENDOSCOPIC SURGERY ON THE BILE DUCT.

Abstract

Up-to-date endoscopic correction methods for obstructive diseases of the pancreatic-biliary system occupy a leading position among the arsenal of methods to treat mechanical jaundice. The purpose of the paper is to verify the mechanisms and factors promoting pancreatitis development after endoscopic retrograde cholangiopancreatography (ERCP) and to summarize the efforts to prevent and treat this complication. Materials and methods. A detailed analysis of the structure of nosological units resulting in frequent development of mechanical jaundice was made by the results of treatment of 1214 patients. Results and discussion. The role and place of possible factors promoting development of post-ERCP pancreatitis are determined. The causes of development of intra- and post-ERCP complications are studied. Attention is focused on finding ways to prevent the development of post-ERCP pancreatitis. The therapeutic tactics of management of patients with post-ERCP pancreatitis were carried out according to the recommendations of the European Association of Endoscopic Surgeons (EAES). It should be noted that the algorithm of patient management who during surgery presented technical preconditions of development of post-ERCP pancreatitis is not finally formulated. The experience of administration of pharmacological prevention found in literature is indicative of the fact that it does not provide favorable course of the postoperative period in all cases. First of all, it refers to the patients with high risks who develop severe development followed by unfavorable results. Despite a recognized effectiveness of non-steroidal anti-inflammatory drugs, 2% patients develop severe post-ERCP pancreatitis.