Role of immunoglobulin G4 immunostaining of duodenal papillary tissue for diagnosis of autoimmune pancreatitis monitored anesthesia care in endoscopic retrograde cholangiopancreatography patients

Abstract

Background We aim to assess tissue immunoglobulin G4 (IGg4) in obstructive jaundiced patients following endoscopic retrograde cholangiopancreatography under monitored anesthesia care. Patients and methods Ketofol (1: 1) containing 2 ml ketamine (50 mg/ml) and 10 ml propofol (10 mg/ml) was titrated to maintain bispectral index (BIS) range of 60–70 in 24 patients receiving intravenous bolus doses of Ketofol (0.5 mg/kg ketamine and 0.5 mg/kg propofol). Clinical, laboratory, and radiological data were gathered. Immunohistochemistry staining of tissue IGg4 and histological evaluation of inflammation, dysplasia, and reactive atypia were estimated. Results Mean baseline values of heart rate, mean arterial pressure (MAP), oxygen saturation (O 2 Sat), and BIS were (85.38±11.08 beat/min, 94.38±14.16 mmHg, 97.08±1.35%, and 94.75±1.45), respectively. Mean intraprocedure values of heart rate, MAP, O 2 Sat, and BIS were (85.15± 10.20 beat/min, 85.86±13.35 mmHg, 97.42±1.27% and 65.44±2.86), respectively. Recovery time was (9.54 ±2.40 min). Only two (8.33%) patients developed desaturation, no patients developed bradyarrhythmia or hypotension. Patients showed IgG4 positive staining in cases that was significantly associated with reactive atypia. Conclusion IGg4-related illness should be evaluated in all cases with duodenal masses in which no cancer is identified. During endoscopic retrograde cholangiopancreatography, ketofol-guided BIS sedation elicited superior monitored anesthesia care with excellent safety, as seen by stable vital signs and absence of apparent problems.