A Prospective Trial of Aggressive Hydration Strategy to Reduce Post-ERCP Pancreatitis
Post-ERCP Acute PancreatitisPostendoscopic retrograde cholangiopancreatography pancreatitis is the most frequent and serious complication of ERCP procedures, occurring in approximately 5-15% of unselected patients. Pharmacologic prevention of post-ERCP pancreatitis has been the topic of several investigations in recent years. Hydration is considered a mainstay of treatment for acute pancreatitis. We perform multicenter, prospective, randomized trial to investigate whether intravenous vigorous hydration with lactated Ringer's solution reduces the risk of post-ERCP pancreatitis. Inclusion criteria : consecutive patients older than 18 years who are scheduled to undergo diagnostic or therapeutic ERCP will be recruited. Patients will be randomly assigned in a 1:1 ratio to receive either vigorous hydration (treatment arm) or standard hydration (standard arm). Randomization will be performed in a double blinded fashion using computer-generated random numbers. Treatment arm (vigorous hydration arm); Initial bolus of lactated Ringer's solution at 10 mL/kg over 1 hour prior to ERCP Intravenous lactated Ringer's solution at a rate of 3 mL/kg/h during the procedure and continued for 8 hours. At the end of ERCP, post-procedure bolus of lactated Ringer's solution at 10 mL/Kg over 1hour Standard arm (standard hydration arm); Patients will receive lactated Ringer's solution at the start of the ERCP and the fluids will be administered at a rate of 1.5 ml/kg/h during the procedure and for 8hours after ERCP. The primary endpoint was development of post-ERCP pancreatitis, which define as increased pancreatic pain (more than 3 on a visual analogue pain scale) and hyperamylasemia (three times the upper limit of normal). The secondary endpoint included the development of asymptomatic hyperamylasemia, severity of pancreatitis, and fluid overload.
Randomized Trial of Rectal Indomethacin and Papillary Spray of Epinephrine Versus Rectal Indomethacin...
Post-ERCP Acute PancreatitisThis research is being done to see if using a combination of rectal indomethacin and epinephrine spray during endoscopy, can prevent pancreatitis that may occur after ERCP (a type of gastrointestinal endoscopy).
A Prospective Study of The Complement Depletion in Patients With Severe Abdominal Sepsis
Severe SepsisPancreatitis3 moreThe role of complement system in bridging innate and adaptive immunity has been confirmed in various invasive pathogens. The aim of this study is to investigate the alteration of complement C3 in patients with severe abdominal sepsis and evaluate the role of complement C3 depletion in prognosis of such patients. The relationship between complement C3 depletion and adaptive immunity is studied meanwhile.
Post ERCP Pancreatitis Prevention in Average Risk Patients
PancreatitisDiclophenac potassium and ceftazidime are commercially available drugs that are used in various clinical situations. They are safe and known for years. Diclophenac potassium and Ceftazidime have been used in some studies for the prophylaxis and treatment of pancreatitis and Post-ERCP Pancreatitis (PEP). Diclophenac potassium, together with indometacin is currently standard treatment for prevention of (PEP) while ceftazidime is possible alternative treatment for patients with contraindications for nonsteroidal medicines. The aim of the study is to evaluate the efficacy of Ceftazidime for the prophylaxis of PEP.
Topical Pancreatic Duct Lidocaine for Prevention of Post-ERCP Pancreatitis
PancreatitisThe purpose of this study is to determine if lidocaine is effective in reducing the incidence of post-ERCP pancreatitis.
Can Aprotinin Reduce Pancreatitis After Scoliosis Surgery
PancreatitisPancreatitis is caused by an acute injury on the pancreas. This illness is associated with abdominal pain, vomiting or even fever. We have recently reported a high rate of acute pancreatitis developing in children who undergo posterior spinal fusion for scoliosis (to correct spinal curve). We showed that the amount of blood loss during the surgery is related to the incidence of pancreatitis. In addition, some markers that monitor tissue injury are elevated after the surgery and significantly higher in the patients who develop acute pancreatitis later. We propose that if blood loss and tissue injury could be reduced, then the incidence of pancreatits may be less in these children. Therefore we plan to use a drug Aprotinin to just do that. Aprotinin has been used to reduce blood loss in patients undergoing posterior spinal surgery, the same population we propose to study. If it turns out that Aprotinin can reduce blood loss or/and the damage to the pancreas, thus pancreatitis, it will diminish the pain and discomfort, and shorten hospital stay in these children. The results from this study will guide medical care in these children in the future.
TOF-18F-FDG-PET/CT in Patients With Suspected Pancreatic Cancer
Pancreatic CancerPancreatitis1 moreAim of the prospective study is a better differentiation of benign and malignant lesions in the pancreas in patients with suspected pancreatic cancer using images 30 and 90 min p.i. (post injectionen) and a diagnostic CT (computed tomography) scan of the abdomen within the Time of Flight (TOF)-18F-FDG-PET/CT and thus an improvement of the quality of PET/CT findings.
Endoscopic Large Caliber Drainage vs. Complete Necrosectomy for Treatment of Walled-off Pancreatic...
Necrotizing PancreatitisThe purpose of this study is to determine optimal treatment strategies for symptomatic walled-off pancreatic necrosis( WON).
Early Treatment With Dexamethasone in Mild Acute Pancreatitis
Patients With Acute PancreatitisThis pilot trial will evaluate the following in patients with acute pancreatitis: Safety profile of early treatment with intravenous dexamethasone Impact of dexamethasone on systemic inflammation in patients with acute pancreatitis Provide preliminary data on potential impact of early treatment with steroids on clinical outcomes
Early Pancreatic Duct Stent Removal in Preventing Post-endoscopic Pancreatitis
Acute PancreatitisTemporary pancreatic duct stent placement during endoscopic retrograde cholangiopancreatography (ERCP) has been recommended for post-endoscopic pancreatitis (PEP) prophylaxis in high risk patients, including those in whom accidental pancreatic duct cannulation has occurred. However, the optimal duration of stent placement remains an open question. The investigators aim is to assess if immediate stent removal is effective in the prevention of PEP after accidental pancreatic duct cannulation.