الفهرس 
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Abstract
In an endoscopic procedure known as endoscopic retrograde cholangio-pancreatography (ERCP) the biliary and pancreatic ducts are examined using a side-viewing duodenoscope inserted into the duodenum. An injection of a contrast material is used to allow for radiologic imaging of the bile and pancreatic ducts. In 1968, Mc-Cune was the first to describe it. In order for the process to be successful and safe, the endoscopy crew must be properly trained and equipped, as well as the endoscopist must be properly supervised and sedated.
Pancreatitis is a frequent condition that can lead to serious complications and even death. Pancreatitis is a common ailment, with more than 300,000 individuals being hospitalised each year. This field’s most recent breakthroughs must be explained to the doctor.
ERCP pancreatitis is characterised as a new start of abdominal discomfort following ERCP that is linked with amylase levels that are three times the normal range.
Pancreatitis during endoscopic retrograde cholangiopancreatography (ERCP) is made more likely by difficult cannulation (PEP) According to some theories, patients with difficult cannulations could benefit from early precut sphincterotomy procedure, which is thought to increase biliary cannulation success and decrease the risk of PEP.
Sphincterotomy of the pancreas is frequently followed with pancreatic stenting to reduce both early restenosis and pancreatitis following ERCP. Following a precut sphincterotomy, a pancreatic stent can greatly reduce the risk of pancreatitis.
After an ERCP surgery with a difficult biliary cannulation, administering 100mg of rectal indomethacin might help minimise post-ERCP pancreatitis.
individuals with obstructive jaundice who were at risk of developing post-ERCP pancreatitis were studied in a prospective controlled comparative research that comprised patients with mostly calcular obstructive jaundice.
Patients were categorised into three groups in our study: After 7 minutes of biliary cannulation trials, 30 patients in group I will have their sphincterotomies pre-cut. 30 patients in group II will have a pancreatic duct stent inserted following pancreatic duct manipulation. Patients in group III will receive rectal indomethacin (100mg) as soon as their ERCP surgery is complete, in order to help them cope with the operation’s difficult biliary cannulation.
The inclusion criteria for all three groups were identical, including age >18 years, difficult biliary cannulation, elevated serum bilirubin levels, abdominal imaging demonstrating biliary dilatation, and the presence of bile duct stones as detected by cholangiography during ERCP as well as patients with biliary obstruction. Excluding patients or controls having a history of pancreatitis or other medical conditions that might make ERCP unsafe, such as allergy to contrast dye or a recent heart attack.
A full medical history and physical examination were performed on each of the three groups following consent and approval, as well as a battery of tests prior to ERCP. These included a complete blood count (CBC) various liver function tests (SGOT, ALP, SGPT) as well as coagulation profile tests (PT, PC, INR) and an abdominal ultrasound.
There were complications following the ERCP operation, which included (Pancreatitis – Bleeding – Perforation) CBC and serum lipase were utilised to assess the patient’s recovery after ERCP.
Following the cannulation of the pancreatic duct, PDS reduced post-ERCP pancreatitis by 13.3%. After cannulation of the pancreatic duct during ERCP, it is recommended that PDS be performed. This study provides direct data in support of that suggestion. There have been no reports of bleeding or perforation as a result of pancreatic duct stent implantation in the post-ERCP pancreatitis management.
There have been reports of bleeding and perforation with early precut sphincterotmy, which is considered an effective approach for lowering the incidence of post-ERCP pancreatitis to (26.7 percent)
Post-ERCP pancreatitis is reduced by 83.3 percent with rectal indomethacin (no significant reduction in post ERCP pancreatitis )
Based on the findings of this study, it is suggested that:
It is safe and practical to perform prophylactic pancreatic duct stenting following difficult duct cannulation, which greatly minimises post-ERCP complications.
Early precut sphincterotomy is thought to be an effective approach for reducing post-ERCP pancreatitis, but there have been reports of bleeding and perforation.
Post-ERCP pancreatotis is not reduced by rectal indomethacin treatment.