ERCP iþleminde nitroderm TTS kullanýmýnýn precut, selektif kanülasyon ve kanama üzerine etkisi

AMAÇ: Çalýþmanýn amacý týkanma ikteri ile kliniðimize baþvuran ve endoskopik retrograd kolanjiyopankreatografi (ERCP) yapýlan hastalarda profilaktik nitrogliserin yama kullanýmýnýn iþlem sýrasýnda ve sonrasýnda meydana gelebilecek pankreatit, kanama, perforasyon gibi komplikasyonlar, iþlem süresi, hastanede yatýþ süresi, precut ve selektif kanülasyon oranlarý ile mortalite üzerine etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Hastalar hastane veri tabaný kullanýlarak geriye dönük olarak taranmýþtýr. Acil þartlarda yapýlan ve çalýþmanýn sonucunu etkileyebilecek ilaç kullanýmý olan hastalar, 18 yaþýndan küçük hastalar, genel durumu bozuk olan hastalar çalýþma dýþý býrakýlmýþtýr. Nitrogliserin yama kullanýlan ve kullanýlmayan hasta gruplarýnda ilacýn morbidite, mortalite, iþlem süresi, hastanede kalýþ süresi ve kanülasyon teknikleri üzerine etkisi araþtýrýlmýþtýr.
BULGULAR: Nitrogliserin kullanmanýn precut olasýlýðýný 2.28 kat azaltýrken [adjOR=2.28, CI95% 1.486-3.514, (p<0.001)], peroperatif kanamayý 3.4 kat azalttýðý (OR=3.4, 95CI%=1.99-5.83, p<0.001) gözlenmiþtir. Nitrogliserin uygulanmayan grupta %75.1 selektif kanülasyon olmuþken nitroderm uygulanan grupta bu oran %87.3 olarak belirlenmiþtir (p<0.001). Regresyon modelinde nitroderm varlýðýnýn selektif kanülasyon olasýlýðýný 2.21 kat arttýrdýðý (adjOR=2.21, 95CI%=1.44-3.41, p<0.001) gözlenmiþtir. Mortalite üzerine nitrogliserin kullanýmý, özgeçmiþinde malignite öyküsü, taþ ve çamur varlýðý, cinsiyet, yaþ, postop pankreatit ve perop kanama deðiþkenlerinin etkisi regresyon analizi ile deðerlendirilmiþ olup yaþýn mortaliteyi 1.09 artýrdýðý (OR=1.09, 95CI%= 1.01-1.17, p=0.023) gözlenmiþtir.
TARTIÞMA: ERCP iþleminde profilaktik selektif kanülasyon oranýný artýrdýðý, precut oranýný, peroperatif kanamayý, hastanede kalýþ süresini ve iþlem süresini kýsalttýðý gösterilmiþtir.

The effect of using nitroderm TTS in ERCP on precut, selective cannulation, and bleeding

BACKGROUND: The aim of the study was to investigate the use of prophylactic nitroglycerin patch in patients who applied to our clinic with occlusion icter and underwent endoscopic retrograde cholangiopancreatography (ERCP) for complications such as pancreatitis, bleeding, perforation that may occur during and after the procedure, duration of the procedure, length of hospitalization, precut and selective cannulation rates, and mortality.
METHODS: Patients were searched retrospectively using the hospital database. Patients under the age of 18, patients with poor general condition and patients treated under emergency conditions were excluded from the study. The effects of the drug on morbidity, mortality, duration of procedure, length of hospital stay, and cannulation techniques were investigated in patient groups with and without nitroglycerin patch.
RESULTS: It was observed that using nitroglycerin decreased the precut probability by 2.28 times (p<0.001), and decreased periop-erative bleeding by 3.4 times (p<0.001). 75.1% selective cannulation was observed in the group not administered nitroglycerin, this rate was determined as 87.3% in the group administered nitroderm(p<0.001). In the regression model, it was observed that the presence of nitroderm increased the probability of selective cannulation 2.21 times (p<0.001). The effects of nitroglycerin use on mortality, patient’s history of malignancy, presence of stones and mud, gender, age, post-operative pancreatitis, and perioperative bleeding variables were evaluated by regression analysis, and age increased mortality by 1.09 (p=0.023).
CONCLUSION: It has been shown that the use of prophylactic nitroglycerin patch in ERCP procedure increases the prophylactic selective cannulation rate, shortens the precut rate, pre-operative bleeding, hospital stay, and procedure time.