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Wang R, Wang W, Ma K, Duan X, Wang F, Huang M, Zhang W, Liang T. Variation in Tacrolimus Trough Concentrations in Liver Transplant Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: A Retrospective, Observational Study. Front Pharmacol 2020; 11:1252. [PMID: 32973503 PMCID: PMC7466563 DOI: 10.3389/fphar.2020.01252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022] Open
Abstract
Objective High variabilities in tacrolimus (TAC) exposure are still problems that confuse physicians. TAC trough levels (TAC Cmin) fluctuated considerably after endoscopic retrograde cholangiopancreatography (ERCP) treatment in several liver transplant (LT) patients. We aimed to investigate the variation regularity of TAC Cmin post-ERCP and related factors. Methods This study was a retrospective, observational study conducted at the First Affiliated Hospital of Zhejiang University in China. From October 2017 to January 2019, 26 LT patients that received ERCP were included (73 TAC Cmin measures). The absolute difference and the variation extent in TAC Cmin pre- and post-ERCP were analyzed. Patients were divided into mild and obvious variation groups, and the differences were compared. Results The TAC Cmin in LT patients significantly increased in the first three days post-ERCP (p<0.05) and increased by more than 20% in 18 out of 26 (69.2%) patients. The mean extent of variation in TAC Cmin was 45.1% (95% confidence interval [CI]: 28.3–81.3%) and 31.4% (95% CI: 9.7–53.1%) on days 1 and 3 post-ERCP, respectively. The increasing TAC Cmin gradually returned to baseline within a week (p>0.05). The daily TAC dose and total bile acid (TBA) level were significantly higher (p<0.05) in patients with obvious variation in TAC Cmin. The differences in other demographics, clinical characteristics, variation in laboratory data, and serum amylase levels between the two groups were not significant. Conclusion The TAC Cmin significantly increased in LT patients during the first three days after ERCP, and the level returned to baseline within a week. The daily TAC dose and TBA levels may be related to this increase. Frequent drug concentration monitoring should be executed in the early phase post-ERCP, especially in patients with related factors.
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Affiliation(s)
- Rongrong Wang
- Department of Clinical Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Weili Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kuifen Ma
- Department of Clinical Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Duan
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangfang Wang
- Department of Pharmacy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mingzhu Huang
- Department of Clinical Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Park CH, Jung JH, Hyun B, Kan HJ, Lee J, Kae SH, Jang HJ, Koh DH, Choi MH, Chung MJ, Bang S, Park SW. Safety and efficacy of early feeding based on clinical assessment at 4 hours after ERCP: a prospective randomized controlled trial. Gastrointest Endosc 2018; 87:1040-1049.e1. [PMID: 28964747 DOI: 10.1016/j.gie.2017.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The optimal timing of refeeding after ERCP is unknown. Some practices keep the patient fasting for 24 hours after ERCP, whereas others resume feeding earlier. We aimed to evaluate the risk of post-ERCP pancreatitis (PEP) in patients who initiate early feeding, based on their clinical assessment, including serum amylase testing performed at 4 hours after ERCP. METHODS Patients who were scheduled for ERCP were recruited. Patients without abdominal pain and tenderness and a serum amylase level within 1.5-fold the upper limit of normal at 4 hours after ERCP were randomly assigned to either the 4-hour fasting or 24-hour fasting group. Patients from the 4-hour fasting group started oral intake 4 hours after ERCP, whereas those from the 24-hour fasting group fasted for 24 hours after ERCP. RESULTS Among the 276 enrolled, PEP was identified in 3 (2.2%) from the 4-hour fasting group and in 5 (3.6%) from the 24-hour fasting group, with a rate difference of -1.4% (1-sided 97.5% confidence interval, -∞ to 2.5%). Four-hour fasting was non-inferior to 24-hour fasting in terms of PEP incidence. The total medical costs for treatment-related ERCP were significantly lower in the 4-hour fasting group than in the 24-hour fasting group (1157.20 ± 311.90 vs 1311.20 ± 410.70 U.S. dollars; P = .032). CONCLUSION Early feeding in patients without abdominal pain and tenderness and a serum amylase level <1.5-fold the upper limit of normal at 4 hours after ERCP does not increase the incidence of PEP after ERCP and decreases medical costs. (Clinical trial registration number: KCT0002354.).
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Affiliation(s)
- Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jang Han Jung
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Bomi Hyun
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Hye Ji Kan
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Sea Hyub Kae
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Hyun Joo Jang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Dong Hee Koh
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Min Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seungmin Bang
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Republic of Korea
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Ferreira LE, Topazian MD, Harmsen WS, Zinsmeister AR, Baron TH. Dietary approaches following endoscopic retrograde cholangiopancreatography: A survey of selected endoscopists. World J Gastrointest Endosc 2010; 2:397-403. [PMID: 21191513 PMCID: PMC3010470 DOI: 10.4253/wjge.v2.i12.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 11/25/2010] [Accepted: 12/02/2010] [Indexed: 02/05/2023] Open
Abstract
AIM: To describe the dietary recommendations of experienced endoscopists for patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and the factors that influence these recommendations.
METHODS: Selected U.S. endoscopists with ERCP experience were surveyed by e-mail. A questionnaire with three hypothetical ERCP cases of patients at low, medium and high risk for development of post-ERCP pancreatitis (PEP) was shown. For each scenario, respondents were asked to recommend a post-procedure diet and time to first oral intake. Respondents were also asked about the effect of various clinical factors on their recommendations, including risk of PEP.
RESULTS: 97/187 selected ASGE members (51.9%) responded. When risk of PEP was either low, medium or high, 53%, 88% and 96% recommended a diet of clear liquids/NPO respectively, and 2%, 5% and 18% recommended delaying first oral intake until the following day. About 88% of respondents gave the same type of diet to patients at high as those with moderate-risk of PEP (P = 0.04). However, 37% and 43% of respondents gave different types of diet to patients at low vs moderate-risk and low-risk vs high-risk of PEP respectively (P < 0.001). No statistically significant associations were found regarding the effect of other clinical factors or respondent demographics.
CONCLUSION: Most experienced endoscopists limit diet to NPO/clear liquids after ERCP for patients at high or moderate risk of post-ERCP pancreatitis. About half allow a low-fat or regular diet in patients at low risk.
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Affiliation(s)
- Lincoln Evvc Ferreira
- Lincoln EVVC Ferreira, Department of Medicine, Digestive Endoscopy Unit Hospital Universitario da Universidade Federal de Juiz de For a, Juiz de Fora, MG 36036247, Brasil
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Abstract
AIM Endoscopic sphincterotomy is an efficient means of treating sphincter of Oddi dysfunction (SOD), but it is associated with a morbidity rate of 20%. The aim of this study was to assess how frequently endoscopic sphincterotomy was performed to treat SOD in a group of patients with a 1-year history of medical management. METHODS A total of 59 patients, who had been cholecystectomized 9.3 years previously on average, were included in this study and they all underwent biliary scintigraphy. Medical treatment was prescribed for 1 year. Endoscopic sphincterotomy was proposed for patients whose medical treatment had been unsuccessful. RESULTS Eleven patients were rated group 1 on the Milwaukee classification scale, 34 group 2 and 14 group 3. The hile-duodenum transit time (HDTT) was lengthened in 32 patients. The medical treatment was efficient or fairly efficient in 45% of the group 1 patients, 67% of the group 2 patients, and 71.4% of the group 3 patients (P=0.29). Only 14 patients out of the 21 whose medical treatment was unsuccessful agreed to undergo endoscopic sphincterotomy. HDTT was lengthened in 11 of the 14 patients undergoing endoscopic sphincterotomy and in 21 of the 45 non-endoscopic sphincterotomy patients (P=0.03). Twelve of the 14 patients who underwent endoscopic sphincterotomy were cured. CONCLUSION In this prospective series of patients with a 1-year history of medical management, only 23% of the patients with suspected SOD underwent endoscopic sphincterotomy although 54% had an abnormally long HDTT.
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Barthet M, Vitton V. [Sphincter of Oddi dysfunction]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2005; 29:832-8. [PMID: 16294153 DOI: 10.1016/s0399-8320(05)86355-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Marc Barthet
- Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20
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Wang D, Li ZS, Zhang WJ, Pan X, Sun ZX, Zou XP. Value and safety of ERCP and endoscopic treatment for acute biliary pancreatitis. Shijie Huaren Xiaohua Zazhi 2003; 11:1550-1553. [DOI: 10.11569/wcjd.v11.i10.1550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the value and safety of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic treatment in acute biliary pancreatitis.
METHODS Ninety-one patients with acute biliary pancreatitis including 13 patients with severe acute biliary pancreatitis in the ERCP group underwent ERCP and endoscopic therapy. 15 patients with severe acute biliary pancreatitis were not treated by either surgery, endoscopy or early ERCP in the control group. Etiological factors, therapeutic effects and complications were observed in all the patients of the two groups.
RESULTS In ERCP group, ERCP showed biliary tract disease in 56 cases, common bile duct stones in 26, cholecyst stone in 17, microcholelith in 4, cholangitis in 9, larger diverticula around the papilla in 3, papillitis in 5, pancreatic diverticulum in 2, and normal in 25. 46 cases of biliary tract disease were treated by endoscopy including papillosphincterotomy, endoscopic nasal biliary drainage and endoscopic dilatation of the accessory papilla. There were no significant differences in the recovery days of serum amylase back to normal between ERCP group (3.4±1.6 d) and control group (4.5±2.8 d), but the mean days of disappearance of abdominal pain (4.4±2.0 d), fever (5.0±3.4 d), abnormal white blood cell count (6.5±5.4 d) and hospitalization (21.9±8.4 d) were significantly shorter in the ERCP group than in the control group (8.4±6.1 d, 16.1±19.0 d, 19.1±19.3 d, 41.3±20.0 d, P<0.05). Complication rate (53.9%) and mortality rate (0%) in ERCP group were lower than those of control group (80.0%, 23.1% P<0.05). 17 cases had early complication (18.7%) in ERCP group. Of them, biliary tract infection occurred in 2 cases (2.2%), retroperitoneal pneumatosis in 1 case (1.1%), bleeding of digestive tract in 1 case (1.1%), deterioriation of pancreatitis in 13 cases. 15 patients were cured by medication treatment. Operations were performed in one patient. One patient died.
CONCLUSION ERCP and endoscopic therapy are safe and effective for patients with acute pancreatitis.
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Affiliation(s)
- Dong Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
| | - Wen-Jun Zhang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
| | - Xue Pan
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
| | - Zhen-Xing Sun
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
| | - Xiao-Ping Zou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
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