الفهرس 
Anatomy of the Biliary SystemOnly 14 pages are availabe for public view
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Abstract
Since its introduction in 1968, endoscopic retrograde cholangio-pancreatography (ERCP) has become a commonly performed endoscopic procedure. The diagnostic and therapeutic utility of ERCP has been demonstrated for a variety of disorders including choledocholithiasis, the diagnosis and management of biliary and pancreatic neoplasms, and the postoperative management of biliary perioperative complications.
Reported complication rates vary widely in the published literature because of differences in study design, patient population, and definitions of complications.
Pancreatitis is the most common serious ERCP complication. Although transient increase in serum pancreatic enzymes may occur in as many as 75% of patients, such an increase does not necessarily constitute pancreatitis.
Many trials were adopted to reduce frequency and severity of post ERCP pancreatitis; these included:
• Pharmacological prophylaxis: The list of pharmacological agents that have been tested for prophylaxis of post-ERCP pancreatitis is long and variable e.g. rectal diclofenac, antibiotics, heparin, corticosteroids, nifedipine, octreotide, lidocaine spray, secretin, and cytokine-inhbitors. The efficacy of allopurinol and other antioxidants were studied in prevention of post ERCP pancreatitis.
• Stenting of the pancreatic duct: There is overwhelming evidence that temporary stenting of the pancreatic duct can reduce the risk of pancreatitis after ERCP.
The aim of this study was to prospectively evaluate the use of allopurinol in the prevention of post – ERCP pancreatitis in patients underwent ERCP in Ain Shams Specialized hospital, for this purpose two groups were studied during the period between January 2011 to December 2014.
• group 1: 50 patients who received allopurinol tablets before the ERCP procedure (300 mg 15 hours before the procedure and another dose of 300mg of allopurinol 3 hours before the procedure) (Study group).
• group 2: 50 patients who underwent ERCP without allopurinol prophylaxis (Control group).
All included patients signed an informed consent before enrolment in the study. The patients were subjected to close follow-up after the procedure during which all complications occurring within this period were recorded.
Pancreatitis was only present in 4 patients who all belonged to the control group. However using statistical analysis, there was no statistically significant difference between both groups.
Asymptomatic elevation of serum amylase was present in 65 patients, 19 patients from group 1 and 46 patients from group 2 with statistically significant difference between the two groups.
Regarding risk factors; female gender, younger age, precut needle sphincterotomy, unintended pancreatic duct cannulation and injection appeared to be significant risk factors of pancreatitis.
Allopurinol protected against post ERCP asymptomatic hyperamylesemia, vomiting, hospitalization, and elevations of ALT with statistically significant difference between the two groups. Also post ERCP pancreatitis but was statistically insignificant.