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Petersen BD, Nørregaard C, Krøijer R, Floyd A, Ploug M. Laparoscopic-Assisted ERCP in Gastric Bypass Patients-No Stones Left Unturned: A Single Center Retrospective Cohort Study. Obes Surg 2024; 34:2999-3004. [PMID: 38839634 PMCID: PMC11289228 DOI: 10.1007/s11695-024-07268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/28/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE The long-term need for biliary duct intervention following Roux-en-Y gastric bypass surgery (RYGB) is uncertain. We investigated the rate of laparoscopic assisted retrograde cholangiopancreatography (LAERCP) following RYGB. Also, the pre-LAERCP diagnostic workup together with the true rate of choledocholithiasis in patients with or without prior cholecystectomy was investigated. MATERIALS AND METHODS Retrospective cohort study of RYGB and LAERCP performed at the Hospital South West Jutland, University Hospital of Southern Denmark, from 1 January 2013 to 31 May 2022. RESULTS One percent of patients (n = 13) with a history of RYGB (n = 1363) underwent LAERCP at our facility during a median follow-up of 60.6 months. The stone extraction rate was 66.7% in patients with in situ gallbladder and 12.5% in patients with prior cholecystectomy. Cannulation of the common bile duct was achieved in 96.7% of cases. Postoperative complications were observed in 22.6% of the cases. CONCLUSION Approximately 1% of RYGB patients needed LAERCP during a median follow-up of 5 years. In patients with a history of cholecystectomy, the LAERCP rate of stone extraction was very low (12.5%).
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Affiliation(s)
- B D Petersen
- Department of Surgical Gastroenterology, Hospital South West Jutland, Region of Southern Denmark, Finsensgade 35, Skolebakken 141, 6705, Esbjerg, Denmark.
| | - C Nørregaard
- Department of Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - R Krøijer
- Department of Surgical Gastroenterology, Hospital South West Jutland, Region of Southern Denmark, Finsensgade 35, Skolebakken 141, 6705, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - A Floyd
- Department of Surgical Gastroenterology, Hospital South West Jutland, Region of Southern Denmark, Finsensgade 35, Skolebakken 141, 6705, Esbjerg, Denmark
| | - M Ploug
- Department of Surgical Gastroenterology, Hospital South West Jutland, Region of Southern Denmark, Finsensgade 35, Skolebakken 141, 6705, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Aahlin EK. Sanering av gallesteiner i ett steg. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2024; 144:24-0244. [PMID: 38832608 DOI: 10.4045/tidsskr.24.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
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Prevost GA, Huber C, Schnell B, Candinas D, Wiest R, Schnüriger B. Feasibility and safety of intraoperative bile duct clearance by antegrade transcystic balloon sphincteroplasty: A prospective observational pilot study. J Trauma Acute Care Surg 2024; 96:666-673. [PMID: 37962117 DOI: 10.1097/ta.0000000000004196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Concomitant cholecystolithiasis and choledocholithiasis are common. Standard treatments are endoscopic retrograde cholangiography (ERC) followed by cholecystectomy or laparoendoscopic rendezvous. Endoscopic retrograde cholangiography has drawbacks, such as post-ERC pancreatitis or bleeding, and potentially more than one intervention is required to address common bile duct (CBD) stones. Safety and feasibility of an intraoperative antegrade transcystic single-stage approach during cholecystectomy with balloon sphincteroplasty and pushing of stones to the duodenum has not been evaluated prospectively. The aim of this pilot study was to evaluate this procedure regarding safety, feasibility, and stone clearance rate. METHODS Prospective single-center intervention study (SUPER Reporting-Guideline). Main inclusion criterion was confirmed choledocholithiasis (stones ≤6 mm) at intraoperative cholangiography. Success of the procedure was defined as CBD stone clearance at intraoperative control cholangiography, absence of symptoms and no elevated cholestasis parameters at 6 weeks follow-up. Simon's two-stage design was used to determine sample size. RESULTS From January 2021 to April 2022, a total of 57 patients fulfilled the final inclusion criteria and were included. Mild pancreatitis or cholangitis were present upon admission in 15 (26%) and 15 (26%) patients, respectively. Median number of CBD-stones was 1 (1-6). Median stone diameter was 4 mm (0.1-6 mm). Common bile duct stone clearance was achieved in 54 patients (94%). The main reason for failed CBD clearance was the inability to push the guidewire along the biliary stone into the duodenum. Median intervention time was 28 minutes (14-129 minutes). While there was no postoperative pancreatitis, two patients (3.5%) had asymptomatic hyperlipasemia 4 hours postoperatively. CONCLUSION Intraoperative CBD stone clearance by antegrade balloon sphincteroplasty appears to be safe and highly feasible. Its overall superiority to the current standards warrants evaluation by a randomized controlled trial. LEVEL OF EVIDENCE Therapeutic/Care Management, Level V.
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Affiliation(s)
- Gian Andrea Prevost
- From the Department of Visceral Surgery and Medicine (G.A.P., C.H., Bi.S., D.C., R.W., Be.S.), Inselspital, University Hospital Bern, University of Bern, Bern; and Department of Surgery (G.A.P.), Kantonsspital Graubünden, Chur, Switzerland
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4
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dos Santos JS, Kemp R, Orquera AGM, Gaspar AF, Júnior JRL, Queiroz LTA, Avezum VAPAF, Ardengh JC, Sankarankutty AK, Lima LS. The Safety and Cost Analysis of Outpatient Laparoendoscopy in the Treatment of Cholecystocholedocholithiasis: A Retrospective Study. J Clin Med 2024; 13:460. [PMID: 38256593 PMCID: PMC10816273 DOI: 10.3390/jcm13020460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The advantages of single-stage treatment of cholecystocholedocholithiasis are well established, but the conditions for carrying out treatment on an outpatient basis require a review of concepts and practices of medical corporations. OBJECTIVE To evaluate the practice of treating cholecystocholedocholithiasis by laparoendoscopy on an outpatient basis with cost analysis. METHOD A retrospective study was conducted on patients with cholecystocholedocholithiasis treated by combined laparoscopic cholecystectomy and endoscopic choledocholithotomy from January 2015 to January 2019. After collecting data from physical and digital medical records, the patients were divided into two groups-AR (n = 42)-ambulatory regimen and HR (n = 28)-hospitalization regimen-which were compared in terms of demographic, clinical and treatment variables and their results, as well as in terms of costs. RESULTS The mean age of the AR group was lower than that of the HR group and the physical status of the AR patients was better when assessed according to the American Society of Anesthesiologists (ASA) (p = 0.01). There was no difference between groups regarding the risk of choledocholithiasis (p = 0.99). For the AR group, the length of stay was shorter: 11.29 h × 65.21 h (p = 0.02), as was the incidence of postoperative complications assessed by applying the Clavien-Dindo classification: 3 (7.1%) × 11 (39.2%) (p < 0.01). The total mean costs were higher for the HR group (USD 2489.93) than the AR group (USD 1650.98) (p = 0.02). CONCLUSION Outpatient treatment of cholecystocholedocholithiasis by laparoendoscopy is safe and viable for most cases, has a lower cost and can support the reorientation of training and practice of hepatobiliary surgeons.
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Affiliation(s)
- José Sebastião dos Santos
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (R.K.); (A.K.S.)
| | - Rafael Kemp
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (R.K.); (A.K.S.)
| | - Alicia Guadalupe Mendoza Orquera
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
| | - Alberto Facury Gaspar
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
- University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (J.R.L.J.); (J.C.A.)
| | - Jorge Resende Lopes Júnior
- University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (J.R.L.J.); (J.C.A.)
| | - Lucas Tobias Almeida Queiroz
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
| | - Víctor Antônio Peres Alves Ferreira Avezum
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
| | - José Celso Ardengh
- University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (J.R.L.J.); (J.C.A.)
- Digestive Endoscopy Service, Hospital Moriah, São Paulo 04084-002, Brazil
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo 04021-001, Brazil
| | - Ajith Kumar Sankarankutty
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (R.K.); (A.K.S.)
| | - Leonardo Santos Lima
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
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Hedström J, Nilsson J, Andersson B. Cholecystectomy and ERCP in pregnancy: a nationwide register-based study. Int J Surg 2024; 110:324-331. [PMID: 37800571 PMCID: PMC10793794 DOI: 10.1097/js9.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The objective was to examine the outcomes of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy and compare these outcomes with those in nonpregnant women of fertile age. SUMMARY BACKGROUND DATA Although both laparoscopic cholecystectomy and ERCP are considered safe and feasible in pregnant patients, there is still concern and uncertainty regarding gallstone intervention during pregnancy. This study aimed to investigate outcomes in pregnant patients compared to outcomes in nonpregnant patients. METHODS Data on all female patients aged 18-45 years were retrieved from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The patients were divided into groups according to intervention: cholecystectomy, ERCP, or a combination thereof. Differences between pregnant and nonpregnant patients were analyzed. RESULTS A total of 21 328 patients were included, with 291 cholecystectomy and 63 ERCP procedures performed in pregnant patients. At the 30-day follow-up, more complications after cholecystectomy were registered for pregnant patients. However, pregnancy was not a significant risk factor for adverse events when adjusting for previous complicated gallstone disease, intraoperative complications, emergency surgery, and common bile duct stones. There were no differences in outcomes when comparing cholecystectomy among the different trimesters. ERCP had no significant effect on outcomes at the 30-day follow-up. CONCLUSION Cholecystectomy, ERCP, and combinations thereof are safe during pregnancy.
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Affiliation(s)
| | - Johan Nilsson
- Department of Cardiothoracic Surgery, Skåne University Hospital
- Department of Translational Medicine, Lund University, Lund, Sweden
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Zhou B, Zhao L, Xing X, Wang H, Kuwantai A, Chen K. Risk factors for post‑retrograde cholangiopancreatography pancreatitis in patients with common bile duct stones: A meta‑analysis. Exp Ther Med 2024; 27:32. [PMID: 38125338 PMCID: PMC10731401 DOI: 10.3892/etm.2023.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/17/2023] [Indexed: 12/23/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has become a common treatment method for common bile duct stones. However, ERCP is also associated with a high risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Identification of risk factors is essential for reducing the incidence of PEP. The present study aimed to summarize the risk factors for PEP by performing a meta-analysis. Therefore, studies published between 2000 and 2022 were screened in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Digital Periodicals and the Weipu Database, with no language restrictions. Newcastle-Ottawa Scale was used to assess the quality of the included studies. Stata 17.0 software was utilized for the meta-analysis of 14 possible risk factors. Overall, 15 high-quality studies were included into the present meta-analysis. The results showed that female [odds ratio (OR), 1.42; 95% CI, 1.23-1.64), age <60 years (OR, 1.53; 95% CI, 1.06-2.21), difficult intubation (OR, 4.87; 95% CI, 2.73-8.68), ≥3 cannulation attempts (OR, 9.64; 95% CI, 4.16-22.35), cannulation time ≥10 min (OR, 2.37; 95% CI, 1.67-3.35), history of pancreatitis (OR, 2.95; 95% CI, 1.06-5.51), pancreatic duct visualization (OR, 3.63; 95% CI, 2.47-5.34) and sphincter of Oddi dysfunction (OR, 5.72; 95% CI, 1.80-18.24) are potential risk factors for PEP (P<0.05). In conclusion, the present meta-analysis suggests that PEP can be affected by several risk factors, particularly the technique-related factors such as the frequency and time of cannulation. Therefore, effective precautions should be taken as early as possible to reduce the incidence of PEP.
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Affiliation(s)
- Bo Zhou
- Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region 830011, P.R. China
| | - Liyuan Zhao
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Xinfeng Xing
- Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region 830011, P.R. China
| | - Hai Wang
- Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region 830011, P.R. China
| | - Asihati Kuwantai
- Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region 830011, P.R. China
| | - Kai Chen
- Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region 830011, P.R. China
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Shabanzadeh DM, Christensen DW, Ewertsen C, Friis-Andersen H, Helgstrand F, Nannestad Jørgensen L, Kirkegaard-Klitbo A, Larsen AC, Ljungdalh JS, Nordblad Schmidt P, Therkildsen R, Vilmann P, Vogt JS, Sørensen LT. National clinical practice guidelines for the treatment of symptomatic gallstone disease: 2021 recommendations from the Danish Surgical Society. Scand J Surg 2022; 111:11-30. [PMID: 36000716 DOI: 10.1177/14574969221111027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Gallstones are highly prevalent, and more than 9000 cholecystectomies are performed annually in Denmark. The aim of this guideline was to improve the clinical course of patients with gallstone disease including a subgroup of high-risk patients. Outcomes included reduction of complications, readmissions, and need for additional interventions in patients with uncomplicated gallstone disease, acute cholecystitis, and common bile duct stones (CBDS). METHODS An interdisciplinary group of clinicians developed the guideline according to the GRADE methodology. Randomized controlled trials (RCTs) were primarily included. Non-RCTs were included if RCTs could not answer the clinical questions. Recommendations were strong or weak depending on effect estimates, quality of evidence, and patient preferences. RESULTS For patients with acute cholecystitis, acute laparoscopic cholecystectomy is recommended (16 RCTs, strong recommendation). Gallbladder drainage may be used as an interval procedure before a delayed laparoscopic cholecystectomy in patients with temporary contraindications to surgery and severe acute cholecystitis (1 RCT and 1 non-RCT, weak recommendation). High-risk patients are suggested to undergo acute laparoscopic cholecystectomy instead of drainage (1 RCT and 1 non-RCT, weak recommendation). For patients with CBDS, a one-step procedure with simultaneous laparoscopic cholecystectomy and CBDS removal by laparoscopy or endoscopy is recommended (22 RCTs, strong recommendation). In high-risk patients with CBDS, laparoscopic cholecystectomy is suggested to be included in the treatment (6 RCTs, weak recommendation). For diagnosis of CBDS, the use of magnetic resonance imaging or endoscopic ultrasound prior to surgical treatment is recommended (8 RCTs, strong recommendation). For patients with uncomplicated symptomatic gallstone disease, observation is suggested as an alternative to laparoscopic cholecystectomy (2 RCTs, weak recommendation). CONCLUSIONS Seven recommendations, four weak and three strong, for treating patients with symptomatic gallstone disease were developed. Studies for treatment of high-risk patients are few and more are needed. ENDORSEMENT The Danish Surgical Society.
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Affiliation(s)
| | | | - Caroline Ewertsen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Hans Friis-Andersen
- Department of Surgery, Regionshospitalet Horsens, Horsens, DenmarkInstitute for Clinical Medicine, Faculty of Health, University of Aarhus, Aarhus, Denmark
| | | | - Lars Nannestad Jørgensen
- Digestive Disease Center, Surgical Section, Bispebjerg Hospital, Copenhagen, DenmarkInstitute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Anders Christian Larsen
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, DenmarkDepartment of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Palle Nordblad Schmidt
- Department of Gastroenterology and Gastrointestinal Surgery, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Peter Vilmann
- Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DenmarkDepartment of Surgery, Herlev Gentofte Hospital, Herlev, Denmark
| | - Jes Sefland Vogt
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Tue Sørensen
- Digestive Disease Center, Surgical Section, Bispebjerg Hospital, Copenhagen, DenmarkInstitute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Liljegard S, Fredriksson Å, Manke T, Kylebäck A, Larsson PA, Haraldsson E. The Outcome of Laparoscopy-Assisted Transgastric Rendezvous ERCP During Cholecystectomy After Roux-en-Y Gastric Bypass Compared to Normal Controls. Obes Surg 2022; 32:3398-3402. [DOI: 10.1007/s11695-022-06246-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022]
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Georgiou K, Sandblom G, Alexakis N, Enochsson L. Intraoperative cholangiography 2020: Quo vadis? A systematic review of the literature. Hepatobiliary Pancreat Dis Int 2022; 21:145-153. [PMID: 35031229 DOI: 10.1016/j.hbpd.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/03/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography (IOC) in the detection and treatment of common bile duct injury (BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and reduced morbidity related to BDI and retained common bile duct stones was derived from large population-based cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting. DATA SOURCES A systematic literature search was conducted in 2020 to search for articles that contained the terms "bile duct injury", "critical view of safety", "bile duct imaging" or "retained stones" in combination with IOC. All identified references were screened to select population-based studies and observational studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias. RESULTS The search revealed 273 references. A total of 30 articles fulfilled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately. CONCLUSIONS IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defined outcome measures and sufficient statistical power are needed.
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Affiliation(s)
- Konstantinos Georgiou
- First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens 10679, Greece
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Department of Surgery, Karolinska Institutet, Södersjukhuset, Stockholm 17177, SE, Sweden
| | - Nicholas Alexakis
- First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens 10679, Greece
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå 90187, SE, Sweden.
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Syrén EL, Sandblom G, Enochsson L, Eklund A, Isaksson B, Österberg J, Eriksson S. Outcome of ERCP related to case-volume. Surg Endosc 2022; 36:5339-5347. [PMID: 34981237 PMCID: PMC9160106 DOI: 10.1007/s00464-021-08915-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022]
Abstract
Background and aims In some studies, high endoscopic retrograde cholangiopancreatography (ERCP) case-volume has been shown to correlate to high success rate in terms of successful cannulation and fewer adverse events. The aim of this study was to analyze the association between ERCP success and complications, and endoscopist and centre case-volumes. Methods Data were obtained from the Swedish National Register for Gallstone Surgery and ERCP (GallRiks) on all ERCPs performed for Common Bile Duct Stone (CBDS) (n = 17,873) and suspected or confirmed malignancy (n = 6152) between 2009 and 2018. Successful cannulation rate, procedure time, intra- and postoperative complication rates and post-ERCP pancreatitis (PEP) rate, were compared with endoscopist and centre ERCP case-volumes during the year preceding the procedure as predictor. Results In multivariable analyses of the CBDS group adjusting for age, gender and year, a high endoscopist case-volume was associated with higher successful cannulation rate, lower complication and PEP rates, and shorter procedure time (p < 0.05). Centres with a high annual case-volume were associated with high successful cannulation rate and shorter procedure time (p < 0.05), but not lower complication and PEP rates. When indication for ERCP was malignancy, a high endoscopist case-volume was associated with high successful cannulation rate and low PEP rates (p < 0.05), but not shorter procedure time or low complication rate. Centres with high case-volume were associated with high successful cannulation rate and low complication and PEP rates (p < 0.05), but not shorter procedure time. Conclusions The results suggest that higher endoscopist and centre case-volumes are associated with safer ERCP and successful outcome.
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Affiliation(s)
- Eva-Lena Syrén
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden. .,Centre for Clinical Research, Uppsala University, Region Västmanland, Uppsala, Sweden. .,Department of Surgery, Akademiska Hospital, Uppsala, Sweden.
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Arne Eklund
- Centre for Clinical Research, Uppsala University, Region Västmanland, Uppsala, Sweden.,Department of Surgery, Hospital of Västmanland, Västerås, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden.,Department of Surgery, Akademiska Hospital, Uppsala, Sweden
| | - Johanna Österberg
- Department of Surgery, Mora Hospital, Mora, Sweden.,Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Staffan Eriksson
- Centre for Clinical Research, Uppsala University, Region Västmanland, Uppsala, Sweden.,Department of Surgery, Hospital of Västmanland, Västerås, Sweden
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11
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Nakai Y, Kusumoto K, Itokawa Y, Inatomi O, Bamba S, Doi T, Kawakami T, Suzuki T, Suzuki A, Endoh B, Chikugo K, Mizumoto Y, Tanaka K. Emergency Endoscopic Retrograde Cholangiopancreatography Did Not Increase the Incidence of Postprocedural Pancreatitis Compared With Elective Cases: A Prospective Multicenter Observational Study. Pancreas 2022; 51:41-47. [PMID: 35195594 PMCID: PMC8865204 DOI: 10.1097/mpa.0000000000001958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/06/2021] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to identify the incidence of and risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after emergency endoscopic retrograde cholangiopancreatography (ERCP). METHODS We performed a prospective multicenter observational study of 3914 patients who underwent ERCP. We compared the incidence of PEP after emergency and elective ERCP. RESULTS A total of 3410 patients were enrolled in this study. Post-ERCP pancreatitis occurred in 44 of 800 patients (5.5%) and in 190 of 2418 patients (7.9%) in the emergency and elective groups, respectively. No significant difference was noted between the groups (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.52-1.03; P = 0.07). Multivariate analysis showed that the following factors increased the risk for PEP after emergency ERCP: contrast medium injection into the pancreatic duct (OR, 2.56; 95% CI, 1.30-5.03; P = 0.005), >4 cannulation attempts (OR, 5.72; 95% CI, 2.61-12.50; P < 0.001), and endoscopic papillary balloon dilatation (OR, 9.24; 95% CI, 2.13-40.10; P < 0.001). CONCLUSIONS No significant difference was noted in the incidence of PEP in patients after emergency and elective ERCP. We may prevent PEP even after emergency ERCP by avoiding contrast injection into the pancreatic duct, multiple cannulation attempts, and endoscopic papillary balloon dilatation.
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Affiliation(s)
- Yoshitaka Nakai
- From the Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto
| | - Kiyonori Kusumoto
- From the Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto
| | - Yoshio Itokawa
- From the Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto
| | - Osamu Inatomi
- Division of Gastroenterology, Department of Medicine
| | - Shigeki Bamba
- Division of Clinical Nutrition, Shiga University of Medical Science, Shiga
| | - Toshifumi Doi
- Department of Gastroenterology, Kyoto First Red Cross Hospital
| | - Takumi Kawakami
- Department of Gastroenterology, Kyoto First Red Cross Hospital
| | - Takahiro Suzuki
- Department of Gastroenterology, Kyoto First Red Cross Hospital
| | - Azumi Suzuki
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
| | - Bunji Endoh
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koki Chikugo
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yoshinori Mizumoto
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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Brañes A, Pérez G. Laparoendoscopic rendezvous procedure in a patient with situs inversus totalis: A case report and review of the literature. Clin Case Rep 2020; 8:2595-2599. [PMID: 33363786 PMCID: PMC7752348 DOI: 10.1002/ccr3.3240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022] Open
Abstract
Situs inversus totalis patients may be associated with difficulties in the diagnosis and treatment of surgical diseases. This case suggests that laparoendoscopic rendezvous procedure could be associated with a lower morbidity and length of hospital stay.
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Affiliation(s)
- Alejandro Brañes
- Digestive Surgery DepartmentSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Gustavo Pérez
- Digestive Surgery DepartmentSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
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Syrén EL, Sandblom G, Eriksson S, Eklund A, Isaksson B, Enochsson L. Postoperative rendezvous endoscopic retrograde cholangiopancreaticography as an option in the management of choledocholithiasis. Surg Endosc 2020; 34:4883-4889. [PMID: 31768727 PMCID: PMC7572344 DOI: 10.1007/s00464-019-07272-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rendezvous endoscopic retrograde cholangiopancreaticography (ERCP) is a well-established method for treatment of choledocholithiasis. The primary aim of this study was to determine how different techniques for management of common bile duct stone (CBDS) clearance in patients undergoing cholecystectomy have changed over time at tertiary referral hospitals (TRH) and county/community hospitals (CH). The secondary aim was to see if postoperative rendezvous ERCP is a safe, effective and feasible alternative to intraoperative rendezvous ERCP in the management of CBDS. METHODS Data were retrieved from the Swedish registry for cholecystectomy and ERCP (GallRiks) 2006-2016. All cholecystectomies, where CBDS were found at intraoperative cholangiography, and with complete 30-day follow-up (n = 10,386) were identified. Data concerning intraoperative and postoperative complications, readmission and reoperation within 30 days were retrieved for patients where intraoperative ERCP (n = 2290) and preparation for postoperative ERCP were performed (n = 2283). RESULTS Intraoperative ERCP increased (7.5% 2006; 43.1% 2016) whereas preparation for postoperative ERCP decreased (21.2% 2006; 17.2% 2016) during 2006-2016. CBDS management differed between TRHs and CHs. Complications were higher in the postoperative rendezvous ERCP group: Odds Ratio [OR] 1.69 (95% confidence interval [CI] 1.16-2.45) for intraoperative complications and OR 1.50 (CI 1.29-1.75) for postoperative complications. Intraoperative bleeding OR 2.46 (CI 1.17-5.16), postoperative bile leakage OR 1.89 (CI 1.23-2.90) and postoperative infection with abscess OR 1.55 (CI 1.05-2.29) were higher in the postoperative group. Neither post-ERCP pancreatitis, postoperative bleeding, cholangitis, percutaneous drainage, antibiotic treatment, ICU stay, readmission/reoperation within 30 days nor 30-day mortality differed between groups. CONCLUSIONS Techniques for management of CBDS found at cholecystectomy have changed over time and differ between TRH and CH. Rendezvous ERCP is a safe and effective method. Even though intraoperative rendezvous ERCP is the preferred method, postoperative rendezvous ERCP constitutes an acceptable alternative where ERCP resources are lacking or limited.
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Affiliation(s)
- Eva-Lena Syrén
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden.
- Centre of Clinical Research, Västmanland Hospital, Västerås, Sweden.
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Staffan Eriksson
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden
- Centre of Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Arne Eklund
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden
- Centre of Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden
| | - Lars Enochsson
- Sunderby Research Unit, Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Syrén EL, Enochsson L, Eriksson S, Eklund A, Isaksson B, Sandblom G. Cardiovascular complications after common bile duct stone extractions. Surg Endosc 2020; 35:3296-3302. [PMID: 32613302 PMCID: PMC8195933 DOI: 10.1007/s00464-020-07766-3] [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: 03/31/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Common bile duct stone (CBDS) is a common condition the rate of which increases with age. Decision to treat in particular elderly and frail patients with CBDS is often complex and requires careful assessment of the risk for treatment-related cardiovascular complications. The aim of this study was to compare the rate of postoperative cardiovascular events in CBDS patients treated with the following: ERCP only; cholecystectomy only; cholecystectomy followed by delayed ERCP; cholecystectomy together with ERCP; or ERCP followed by delayed cholecystectomy. METHODS The study was based on data from procedures for gallstone disease registered in the Swedish National Quality Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (GallRiks) 2006-2014. ERCP and cholecystectomy procedures performed for confirmed or suspected CBDS were included. Postoperative events were registered by cross-matching GallRiks with the National Patient Register (NPR). A postoperative cardiovascular event was defined as an ICD-code in the discharge notes indicating myocardial infarct, pulmonary embolism or cerebrovascular disease within 30 days after surgery. In cases where a patient had undergone ERCP and cholecystectomy on separate occasions, the 30-day interval was timed from the first intervention. RESULTS A total of 23,591 underwent ERCP or cholecystectomy for CBDS during the study period. A postoperative cardiovascular event was registered in 164 patients and death within 30 days in 225 patients. In univariable analysis, adverse cardiovascular event and death within 30 days were more frequent in patients who underwent primary ERCP (p < 0.05). In multivariable analysis, adjusting for history of cardiovascular disease or events, neither risk for cardiovascular complication nor death within 30 days remained statistically significant in the ERCP group. CONCLUSIONS Primary ERCP as well as cholecystectomy may be performed for CBDS with acceptable safety. More studies are required to provide reliable guidelines for the management of CBDS.
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Affiliation(s)
- Eva-Lena Syrén
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden. .,Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden.
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Sunderby Research Unit, Umeå University, SurgeryUmeå, Sweden
| | - Staffan Eriksson
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden.,Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Arne Eklund
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden.,Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, 751 35, Uppsala, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
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15
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Feng YL, Li J, Ye LS, Zeng XH, Hu B. Combined endoscopy/laparoscopy/percutaneous transhepatic biliary drainage, hybrid techniques in gastrointestinal and biliary diseases. World J Meta-Anal 2020; 8:210-219. [DOI: 10.13105/wjma.v8.i3.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 02/06/2023] Open
Abstract
In recent years, a wide range of gastrointestinal endoscopy techniques have been developed, such as endoscopic submucosal dissection (ESD) and endoscopic retrograde cholangiopancreatography (ERCP). Although ESD and ERCP have an important role in gastrointestinal and biliary diseases, each technique has its limitations. Hybrid techniques that combine endoscopic and surgical procedures have emerged that have the advantages of different procedures and negate their limitations at the same time. Laparoscopic endoscopic cooperative surgery and modified laparoscopic endoscopic cooperative surgery combine ESD and laparoscopic techniques to resect submucosal tumors with minimum resection area. Air leak test by intraoperative endoscopy can effectively identify a mechanically insufficient anastomosis and decrease the complication rate. The rendezvous technique that combines percutaneous transhepatic biliary drainage and endoscopy can be performed as a rescue approach for the treatment of biliary obstruction, stenosis and bile duct injuries. For patients with simultaneous presence of stones in the gallbladder and the common bile duct, the laparo-endoscopic rendezvous technique can perform ERCP and laparoscopic cholecystectomy at the same time and reduces the risk of pancreatic injury caused by ERCP. Biliobiliary and bilioenteric anastomosis using magnetic compression anastomosis is another choice for biliary obstruction. The most common used approach to deliver the magnets is by percutaneous-peroral tract. Laparoscopic-assisted ERCP is a safe and highly effective therapy for patients who develop biliary diseases after Roux-en-Y gastric bypass surgery.
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Affiliation(s)
- Yi-Long Feng
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jing Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lian-Song Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xian-Hui Zeng
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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16
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Hallerbäck B, Enochsson L. A prospective nationwide study on the impact of the level of sedation on cannulation success and complications of endoscopic retrograde cholangiopancreatography. Ann Gastroenterol 2020; 33:299-304. [PMID: 32382234 PMCID: PMC7196618 DOI: 10.20524/aog.2020.0480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 01/31/2020] [Indexed: 01/14/2023] Open
Abstract
Background Difficult or unsuccessful cannulation of the papilla of Vater is associated with complications during endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to investigate whether deep sedation facilitates the cannulation and reduces the complication rate. Methods Nationwide data from ERCP procedures were registered prospectively in the web-based Swedish Registry for Gallstone Surgery and ERCP (GallRiks). These data were used for a case-control study comparing the outcomes when using propofol sedation (PS) or basic sedation (BS) with midazolam in combination with opioids. Results We analyzed 31,001 ERCP procedures in patients who had no previous ERCP. Of these, 14,907 were performed using PS and 16,094 using BS. The cannulation rate was higher in the PS group than the BS group: 89.0% vs. 86.7%, P<0.0001. The procedure time was longer in the PS group than in the BS group: 35.7 vs. 31.2 min, P<0.0001. The rate of intra-procedural complications was lower in the PS group than in the BS group: 2.9% vs. 3.7%, P<0.0001. The total frequency of post-procedural complications was 13.0% in the PS and 12.6% in the BS group (P=0.2607). The frequency of post-ERCP pancreatitis (PEP) was higher in the PS group than in the BS group: 4.6% vs. 4.0%, P=0.0136. Conclusions PS in ERCP leads to a significantly higher cannulation success rate and fewer intra-procedural complications, but there was no significant difference in total post-ERCP complications. The procedure time was longer, and PEP was more common in the PS group. A plausible explanation could be that deep sedation might lead to more aggressive attempts to cannulate the papilla, resulting in a higher risk for PEP.
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Affiliation(s)
- Bengt Hallerbäck
- Department Surgery, Northern Alvsborg Hospital, Trollhättan (Bengt Hallerbäck)
| | - Lars Enochsson
- Department Surgical and Perioperative Sciences, Umeå University, Sunderby Research Unit, Umeå (Lars Enochsson), Sweden
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17
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Søreide JA, Karlsen LN, Sandblom G, Enochsson L. Endoscopic retrograde cholangiopancreatography (ERCP): lessons learned from population-based national registries: a systematic review. Surg Endosc 2019; 33:1731-1748. [DOI: 10.1007/s00464-019-06734-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/06/2019] [Indexed: 02/07/2023]
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18
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Noel R, Arnelo U, Swahn F. Intraoperative versus postoperative rendezvous endoscopic retrograde cholangiopancreatography to treat common bile duct stones during cholecystectomy. Dig Endosc 2019; 31:69-76. [PMID: 29947437 DOI: 10.1111/den.13222] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/22/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The rendezvous postoperative endoscopic retrograde cholangiopancreatography (ERCP) technique has been introduced as a modification of the single-session rendezvous intraoperative ERCP procedure in the management of concurrent common bile duct stones during cholecystectomy. There are no reports on the impact of this modified technique on post-ERCP morbidity. The objective of the present study was to study and compare the rendezvous techniques in terms of procedure-associated morbidities, such as post-ERCP pancreatitis and postoperative infections. METHODS The Swedish National Registry for Gallstone Disease and ERCP was searched for ERCP procedures cross-matched with cholecystectomies for the same patient carried out for gallstone indications between 2008 and 2014. A total of 1770 rendezvous ERCP procedures were retrieved and included in this study. The ERCP procedures were considered rendezvous intraoperative or rendezvous postoperative, depending on whether the ERCP procedure was carried out during or after completing the cholecystectomy. RESULTS There were 1205 and 565 ERCP procedures in the rendezvous intraoperative and the rendezvous postoperative groups, respectively. The cohorts were similar in age and gender distribution. Overall complication rates were higher in the rendezvous postoperative group compared with the rendezvous intraoperative group (19.7% vs 14%, P = 0.004), involving specifically post-ERCP pancreatitis (6.4% vs 3.2% P = 0.003) and postoperative infections (4.4% vs 2.3% P = 0.028). Despite similar stone clearance rates, there were higher rates of retained stones in the rendezvous postoperative group (5.5% vs 0.6%, P < 0.001). CONCLUSIONS Single-session rendezvous intraoperative ERCP is superior to the rendezvous postoperative ERCP technique in terms of post-ERCP pancreatitis and postoperative infections.
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Affiliation(s)
- Rozh Noel
- Division of Surgery, CLINTEC, Karolinska Institutet and Centre for Digestive Diseases at Karolinska University Hospital, Stockholm, Sweden
| | - Urban Arnelo
- Division of Surgery, CLINTEC, Karolinska Institutet and Centre for Digestive Diseases at Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Swahn
- Department of Surgery, Skåne University Hospital at Lund, Lund University, Lund, Sweden
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Risk Factors for Post-ERCP Pancreatitis in High-Risk Patients Receiving Post-procedure Rectal Indomethacin. J Gastrointest Surg 2018; 22:1903-1910. [PMID: 29980976 DOI: 10.1007/s11605-018-3864-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/25/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Post-ERCP pancreatitis (PEP) is the most common adverse event of ERCP. Rectal indomethacin has been widely administered to decrease the incidence of PEP in high-risk patients. However, it cannot completely prevent the occurrence of PEP. The purpose of the study was to evaluate the risk factors for PEP in high-risk patients receiving post-ERCP indomethacin. METHODS From June 2012 to July 2015, patients undergoing ERCP and at high risk for PEP in three tertiary hospitals in China were enrolled. All patients received indomethacin after the procedure. Patient-related and procedure-related risk factors for PEP were collected. Logistic regression analysis was used to investigate the risk factors. RESULTS Seven hundred ninety patients at high risk for PEP received post-ERCP indomethacin. The incidence of overall PEP and moderate-to-severe PEP was 8.0 and 1.5%, respectively. In multivariate analysis, suspected sphincter of Oddi dysfunction (SOD) (OR 2.73; 95%CI 1.38-5.43; p = 0.004), the presence of hilar obstruction (OR 4.53; 95%CI 1.60-12.81; p = 0.004), number of cannulation attempts ≥ 13 (OR 2.00; 95%CI 1.07-3.77; p = 0.030), inadvertent pancreatic duct (PD) cannulation ≥ 1 (OR 2.26; 95%CI 1.04-4.90; p = 0.040), and pancreatic contrast injections ≥ 1 (OR 2.30; 95%CI 1.02-5.23; p = 0.046) were high risk factors for overall PEP. For moderate-to-severe PEP, suspected SOD (OR 4.67; 1.19-18.35; p = 0.027), the presence of hilar obstruction (OR 7.95; 1.39-44.97; p = 0.010), and more cannulation attempts (OR 3.71; 1.09-12.65; p = 0.036) were three independent risk factors. CONCLUSIONS A substantial number of high-risk patients had PEP even receiving post-ERCP rectal indomethacin. The independent risk factors included suspected SOD, hilar stricture, more cannulation attempts, inadvertent PD cannulation, and PD contrast injections. TRIAL REGISTRATION NCT02709421.
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20
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Minakari M, Sebghatollahi V, Sattari M, Fahami E. Serum amylase and lipase levels for prediction of postendoscopic retrograde cholangiopancreatography pancreatitis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:54. [PMID: 30057638 PMCID: PMC6040176 DOI: 10.4103/jrms.jrms_1100_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/13/2018] [Accepted: 03/15/2018] [Indexed: 01/16/2023]
Abstract
Background: The aim of the present study was to assess 2- and 4-h postendoscopic retrograde cholangiopancreatography (ERCP) serum amylase and lipase levels for prediction of post-ERCP, pancreatitis (PEP), and their predictive cutoff values. Materials and Methods: In this cross-sectional study, we evaluated serum amylase and lipase levels before the procedure, 2 h and 4 h after the procedure, and in patients with persisting abdominal pain, 24 h afterward. A total of 300 adult patients who underwent ERCP procedures from March 2014 to June 2015 in referral hospital in Isfahan were studied. The receiver operating characteristic analysis was applied to determine the predictive score of amylase and lipase levels for PEP 2 and 4 h after ERCP. Results: The 2-h serum amylase cutoff values of 241 IU/L (normal range: 28–100 IU/L) had a very high negative predictive value (NPV) (98.7%) but a poor positive predictive value (49.2%) for prediction of PEP (area under curve [AUC]: 0.947; 95% confidence interval [CI]: 0.914–0.979). Based on our results, the patients might be considered for supportive therapy of PEP with the 4-h serum amylase above the cut point of 839.5 IU/L with a specificity of 95.1% (AUC: 0.978; 95% CI: 0.964–0.992). In addition, the 2- and 4-h serum lipase levels at cut points of 216 IU/L (AUC: 0.954; 95% CI: 0.931–0.977) and 656.5 IU/L (AUC: 0.966; 95% CI: 0.945–0.986) (normal value <60 IU/L), respectively, had the best sensitivity (97.1%) and high NPVs (99.6%) for exclusion of PEP. Conclusion: Measurements of serum amylase and lipase 2- and 4-h post-ERCP might be useful in prediction of PEP.
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Affiliation(s)
- Mohammad Minakari
- Department of Internal Medicine, Division of Gastroenterology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Sebghatollahi
- Department of Internal Medicine, Division of Gastroenterology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Sattari
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elaheh Fahami
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Zhao ZH, Hu LH, Ren HB, Zhao AJ, Qian YY, Sun XT, Su S, Zhu SG, Yu J, Zou WB, Guo XR, Wang L, Li ZS, Liao Z. Incidence and risk factors for post-ERCP pancreatitis in chronic pancreatitis. Gastrointest Endosc 2017; 86:519-524.e1. [PMID: 28062312 DOI: 10.1016/j.gie.2016.12.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Almost all studies on post-ERCP pancreatitis (PEP) have mainly involved patients with biliary diseases rather than chronic pancreatitis (CP), and the concept that CP seems to be a protective factor associated with PEP has not been studied in detail. The aim of this study was to determine the incidence of PEP in patients with CP at different clinical stages and to identify the predictive and protective factors of PEP in a large cohort. METHODS In this observational cohort study, medical records of patients with CP (CP group) and biliary diseases (BD group) in a tertiary hospital from January 2011 to May 2015 were examined. The difference in the incidence of PEP between CP group and BD group and the risk of PEP at different clinical stages of CP were calculated by the χ2 test or the Fisher exact test. The predictive and protective factors for PEP were investigated by univariate and multivariate analysis. RESULTS In total, 2028 ERCP procedures were performed in 1301 patients with CP and 2000 procedures in 1655 patients with BD. The overall incidence of PEP in CP group (4.5%) was similar to that in the BD group (4.8%; P = .747). However, CP patients had significantly lower rates of moderate and severe attacks (0% vs 1.3%, P < .01). According to the M-ANNHEIM classification, the PEP incidences of CP at stages 0, I, II, III, and IV were 4.4%, 5.1%, 3.8%, 2.0%, and 2.0%, respectively. CP patients at stage Ia had the highest PEP incidence (8.0%) among all CP patients, significantly higher than that at stages Ib + Ic (3.9%) and II (3.8%). Female gender, history of acute pancreatitis, and prior PEP were independent risk factors of PEP, whereas extracorporeal shock wave lithotripsy was a protective factor. CONCLUSIONS Compared with BD patients, CP patients had similar incidence of PEP overall but lower grades of severity. The incidence of PEP in CP patients decreased significantly with disease progression. (Clinical trial registration number: NCT02781987.).
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Affiliation(s)
- Zhen-Hua Zhao
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China; Department of Gastroenterology, Jining NO. 1 People's Hospital, Jining, Shandong, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Hong-Bo Ren
- Department of Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - An-Jing Zhao
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Yang-Yang Qian
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Xiao-Tian Sun
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Song Su
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Shu-Guang Zhu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Jin Yu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Wen-Bin Zou
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Xiao-Rong Guo
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Lei Wang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China
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Mattila A, Mrena J, Kellokumpu I. Cost-analysis and effectiveness of one-stage laparoscopic versus two-stage endolaparoscopic management of cholecystocholedocholithiasis: a retrospective cohort study. BMC Surg 2017; 17:79. [PMID: 28683735 PMCID: PMC5501265 DOI: 10.1186/s12893-017-0274-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/28/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND One-stage laparoscopic common bile duct (CBD) stone clearance and laparoscopic cholecystectomy (LCBDE+LC) for cholecystocholedocholithiasis ( CCL) can be performed with similar short and long-term outcomes than two-stage endoscopic retrograde cholangiography followed by subsequent LC (ERCP+LC). This study examined retrospectively the outcome and hospital costs of one-stage versus two-stage treatment of CBD stones. METHODS From January 1999 and December 2014, 217 consecutive, elective patients underwent one-stage (LCBDE + LC ) or two-stage (ERCP + subsequent LC ) treatment for CBD stones. The data from the one-stage management was collected prospectively, and from the two-stage management retrospectively. The main measure of outcome was hospital costs, with the success of one-stage versus two-stage management, postoperative morbidity and postoperative stay as secondary outcome measures. RESULTS One-stage laparoscopic transcystic management was the least costly option compared to laparoscopic one-stage transductal approach (TC 5455€ versus TD 9364, p < 0.001) or two-stage management (6913 €, p = 0.02). Overall success rate of primary intervention (including conversions to open surgery) for CBD stone clearance was 96.9%, 97.0% and 98.3% after transcystic one-stage, transductal one-stage and two-stage approach, p = 0.79. Postoperative morbidity was 15.5% versus 7.5%, p = 0.64, and postoperative hospital stay median 2 days (IQR 2-5) versus 4.5 days ( IQR 3-7), p < 0.001 in the one-stage and two-stage management groups. CONCLUSIONS Our study shows that laparoscopic one-stage transcystic management of CCL results in high rate of CBD clearance, fewer procedures per patient, shorter hospital and lower costs than the two-stage management. Therefore the one-stage transcystic management seems to be an attractive strategy for the treatment of CCL depending on local resources and surgical expertise .
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Affiliation(s)
- Anne Mattila
- 0000 0004 0449 0385grid.460356.2Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40640 Jyväskylä, Finland
- 0000 0004 0449 0385grid.460356.2Department of Surgery, Central Hospital of Central Finland, 40640 Jyväskylä, Finland
| | - Johanna Mrena
- 0000 0004 0449 0385grid.460356.2Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40640 Jyväskylä, Finland
- 0000 0004 0449 0385grid.460356.2Department of Surgery, Central Hospital of Central Finland, 40640 Jyväskylä, Finland
| | - Ilmo Kellokumpu
- 0000 0004 0449 0385grid.460356.2Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40640 Jyväskylä, Finland
- 0000 0004 0449 0385grid.460356.2Department of Surgery, Central Hospital of Central Finland, 40640 Jyväskylä, Finland
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Laparoendoscopic Rendezvous for Concomitant Cholecystocholedocholithiasis: A Successful Modality Even in the Most Difficult Presentations Including Pregnancy. Case Rep Surg 2016; 2016:8618512. [PMID: 28116209 PMCID: PMC5220453 DOI: 10.1155/2016/8618512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/13/2016] [Indexed: 02/07/2023] Open
Abstract
Background. Laparoendoscopic rendezvous (LERV) technique is emerging as an attractive treatment option for concomitant cholecystocholedocholithiasis. In this paper, we report our experience in performing the LERV technique in patients with unusual presentations in terms of anatomical difficulty, pregnancy, multiple comorbid diseases, and postlaparotomy. We aim to highlight the effectiveness of the LERV technique in some clinical situations where conventional methods would fail or carry high risks in adequately managing concomitant cholecystocholedocholithiasis. Methods. Four patients diagnosed to have concomitant cholecystocholedocholithiasis with associated difficult presentation or comorbid diseases were treated using the LERV technique. One patient presented with difficult anatomy where ERCP failed at initial attempts. Another patient was pregnant (first trimester). A third patient had complex comorbid diseases (bronchial asthma, hypertension, congestive heart failure, and end-stage renal disease on regular hemodialysis). A fourth patient had previous laparotomy and sigmoidectomy for diverticular disease and had severe hospital phobia. Results. All patients tolerated the LERV technique very well; no intraoperative occurrence was reported. The mean operative time was 86.3 ± 17.2 minutes; mean time of the endoscopic part was 29.4 ± 3.57 minutes. The mean blood loss was 44.3 ± 18.2 mL (range 20–85). Residual stone, postoperative complications, postoperative morbidity, and postoperative mortality were 0 (0%). Postoperative short hospital stay was reported in all patients, average 3 days (range 2–4). Conclusion. LERV procedure is a safe and effective treatment option for the management of concomitant cholecystocholedocholithiasis, even in difficult situations where other methods would fail or carry high risks, or in patients presenting with severe comorbid diseases or pregnancy. This procedure may emerge as an attractive alternative option for high-risk patients. A patient's wishes may also influence the selection of this procedure. More scientific studies recruiting more patients should be done in order to standardize the LERV procedure.
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Sugimoto M, Takagi T, Suzuki R, Konno N, Asama H, Watanabe K, Nakamura J, Kikuchi H, Waragai Y, Takasumi M, Hikichi T, Ohira H. Influence of night duty on endoscopic therapy for bile duct stones. World J Gastroenterol 2016; 22:9387-9393. [PMID: 27895426 PMCID: PMC5107702 DOI: 10.3748/wjg.v22.i42.9387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the influence of night duty (ND) on endoscopic therapy for biliary duct stones.
METHODS The subjects consisted of 133 patients who received initial endoscopic therapy for biliary duct stones performed by eight endoscopists after they had been on (ND group, n = 34 patients) or not [day duty (DD) group, n = 99 patients]. Patient characteristics (age, gender, history of abdominal surgery, transverse diameter of the largest stone, number of stones), years of experience of the endoscopists, endoscopic procedures [sphincterotomy, papillary balloon dilation (EPBD), papillary large balloon dilation (EPLBD)], and outcomes of initial endoscopy (procedure time; rate of stone removal by the first endoscopist; procedure success rate by the first endoscopist: removal of stones or endoscopic retrograde biliary drainage; rate of final stone removal; final procedure success rate; complications; hospitalization after the procedure) were compared retrospectively between the two groups. History of abdominal surgery and treatment outcomes were also compared between the groups for each of the four endoscopists who performed most of the procedures in the ND group.
RESULTS There were no significant differences regarding the number of treatments performed by each endoscopist or the years of experience between the ND and DD groups. The frequency of endoscopic retrograde cholangiopancreatography procedures did not differ significantly between the groups. There were also no significant differences regarding patient characteristics: age, gender, history of abdominal surgery (ND 7: Billroth II 4, R-Y 3; DD 18: double tract reconstruction 1, Billroth I 3, Billroth II 6, R-Y 7, duodenoduodenostomy for annular pancreas 1), transverse diameter of largest stone, and number of stones between the two groups. Among the treatment procedures, the endoscopic sphincterotomy and EPBD rates did not differ significantly between the groups. However, EPLBD was performed more frequently in the ND group [47.1% (16/34) vs 19.2% (19/99)]. Regarding outcomes, there were no significant differences in the rate of stone removal, procedure success rate, complications (ND: pancreatitis 1; DD: pancreatitis 6, duodenal bleeding 1, decreased blood pressure 1, hypoxia 2), or hospitalization after the procedure. However, the procedure time was significantly longer in the ND group (71.5 ± 44.7 vs 54.2 ± 28.8). Among the four endoscopists, there were no significant differences in patient history of abdominal surgery, removal of stones, or procedure success rate. However, the procedure time for one endoscopist was significantly longer in the ND group.
CONCLUSION The time required for endoscopic therapy for bile duct stones might be influenced by ND.
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March B, Burnett D, Gani J. Single-stage laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography: is this strategy feasible in Australia? ANZ J Surg 2016; 86:874-877. [PMID: 27445110 DOI: 10.1111/ans.13676] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
Currently in Australasia, concomitant cholecystolithiasis and choledocholithiasis are usually managed with two procedures: laparoscopic cholecystectomy (LC) and pre or postoperative endoscopic retrograde cholangiopancreatography (ERCP). This approach exposes the patient to the risk of complications from the common bile duct stone(s) while awaiting ERCP, the risks of the ERCP itself (particularly pancreatitis) and the need for a second anaesthetic. This article explores the evidence for a newer hybrid approach, single stage LC and intraoperative ERCP (SSLCE) and compares this approach with the commonly used alternatives. SSLCE offers reduced rates of pancreatitis, reduced length of hospital stay and reduced cost compared with the two-stage approach and requires only one anaesthetic. There is a reduced risk of bile leak compared with procedures that involve a choledochotomy, and ductal clearance rates are superior to trans-cystic exploration and equivalent to the standard two-stage approach. Barriers to widespread implementation relate largely to operating theatre logistics and availability of appropriate endoscopic expertise, although when bile duct stones are anticipated these issues are manageable. There is compelling justification in the literature to gather prospective evidence surrounding SSLCE in the Australian Healthcare system.
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Affiliation(s)
- Brayden March
- Division of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - David Burnett
- Division of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
| | - Jon Gani
- Division of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Yu A, Huang Q, Liu CH, Lin XS, Xie F. Rendezvous technique for cholecysto-choledocholithiasis during laparoscopic cholecystectomy: A systemic review and meta-analysis. Shijie Huaren Xiaohua Zazhi 2016; 24:2563-2570. [DOI: 10.11569/wcjd.v24.i16.2563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To systematically evaluate the efficacy and safety of the rendezvous technique for cholecysto-choledocholithiasis during laparoscopic cholecystectomy (LC).
METHODS: From February 31, 2006 to February 31, 2016, RCTs evaluating the rendezvous technique for cholecysto-choledocholithiasis during laparoscopic cholecystectomy were retrieved from Cochrane Library, PubMed, Embase, CBM, CNKI database, Wanfang and VIP database. The data were extracted and analyzed using the RevMan 5.3.5 software.
RESULTS: Six RCTs were enrolled in the meta-analysis. Among 616 patients analyzed, the rendezvous technique was used in 307 patients and POERCP + LC in 309 patients. The results of meta-analysis showed significant differences between the rendezvous technique group and POERCP + LC group regarding stone clearance rate (OR = 2.24, 95%CI: 1.26-4.65, P = 0.08), cannulation failure rate (OR = 0.39, 95%CI: 0.18-0.83, P = 0.01), and overall morbidity (OR = 0.41, 95%CI: 0.22-0.75, P = 0.004). Sub-group analysis of morbidity also revealed significant differences between the rendezvous technique group and POERCP + LC group regarding post-ERCP pancreatitis (OR = 0.15, 95%CI: 0.05-0.44, P = 0.0005) and hyperamylasemia (OR = 0.18, 95%CI: 0.09-0.36, P = 0.0001), but the differences in the complication morbidity of LC and conversions rate were not significant (P > 0.05).
CONCLUSION: The rendezvous technique is superior to POERCP + LC in terms of stone clearance, cannulation success, complication morbidity of ERCP and hospital stay. Large, multicenter prospective randomized controlled trials are still needed to confirm the findings of this meta-analysis.
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Cantù P, Parzanese I, Melada E, Rossi G, Conte D, Penagini R. Response. Gastrointest Endosc 2016; 83:1304. [PMID: 27206598 DOI: 10.1016/j.gie.2016.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/15/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Paolo Cantù
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Parzanese
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Ernesto Melada
- Liver Transplant Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Rossi
- Liver Transplant Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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Saritas U, Ustundag Y. Post-ERCP pancreatitis after biliary cannulation with traditional rendezvous in patients with T-tube. Gastrointest Endosc 2016; 83:1303-4. [PMID: 27206595 DOI: 10.1016/j.gie.2016.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/14/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Ulku Saritas
- Medicana Ankara International Hospital, Gastroenterology Clinics, Ankara, Turkey
| | - Yucel Ustundag
- Bulent Ecevit University, Department of Internal Medicine, Gastroenterology Clinics, Zonguldak, Turkey
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Lammert F, Gurusamy K, Ko CW, Miquel JF, Méndez-Sánchez N, Portincasa P, van Erpecum KJ, van Laarhoven CJ, Wang DQH. Gallstones. Nat Rev Dis Primers 2016; 2:16024. [PMID: 27121416 DOI: 10.1038/nrdp.2016.24] [Citation(s) in RCA: 357] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gallstones grow inside the gallbladder or biliary tract. These stones can be asymptomatic or symptomatic; only gallstones with symptoms or complications are defined as gallstone disease. Based on their composition, gallstones are classified into cholesterol gallstones, which represent the predominant entity, and bilirubin ('pigment') stones. Black pigment stones can be caused by chronic haemolysis; brown pigment stones typically develop in obstructed and infected bile ducts. For treatment, localization of the gallstones in the biliary tract is more relevant than composition. Overall, up to 20% of adults develop gallstones and >20% of those develop symptoms or complications. Risk factors for gallstones are female sex, age, pregnancy, physical inactivity, obesity and overnutrition. Factors involved in metabolic syndrome increase the risk of developing gallstones and form the basis of primary prevention by lifestyle changes. Common mutations in the hepatic cholesterol transporter ABCG8 confer most of the genetic risk of developing gallstones, which accounts for ∼25% of the total risk. Diagnosis is mainly based on clinical symptoms, abdominal ultrasonography and liver biochemistry tests. Symptoms often precede the onset of the three common and potentially life-threatening complications of gallstones (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge on the genetics and pathophysiology of gallstones has expanded recently, current treatment algorithms remain predominantly invasive and are based on surgery. Hence, our future efforts should focus on novel preventive strategies to overcome the onset of gallstones in at-risk patients in particular, but also in the population in general.
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Affiliation(s)
- Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, 66424 Hamburg, Germany
| | - Kurinchi Gurusamy
- Royal Free Campus, University College London Medical School, 9th Floor, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Cynthia W Ko
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Juan-Francisco Miquel
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - Cees J van Laarhoven
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Q-H Wang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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Cantù P, Parzanese I, Melada E, Rossi G, Conte D, Penagini R. A new duodenal rendezvous technique for biliary cannulation in patients with T-tube after orthotopic liver transplantation (with video). Gastrointest Endosc 2016; 83:229-33. [PMID: 26234695 DOI: 10.1016/j.gie.2015.06.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Because a traditional rendezvous (RV) technique implies stretching of the papilla, possibly leading to post-ERCP pancreatitis, an alternative duodenal RV technique was evaluated. The aim was to assess the effectiveness, safety, and amount of time spent performing duodenal RV versus traditional RV cannulation in orthotopic liver transplantation patients with a T-tube. METHODS We retrospectively reviewed data from a prospective ERCP database held by our university hospital. Twenty patients with a T-tube who had undergone ERCP for biliary adverse events after orthotopic liver transplantation were included. The successful cannulation rate, the amount of time spent performing cannulation, the post-ERCP pancreatitis rate, and hyperamylasemia 24 hours after the procedure were recorded. RESULTS Successful cannulation was achieved by the duodenal RV technique in 9 of 10 patients (90%), taking 146 seconds (interquartile range 63-341 seconds) with a short learning curve effect. An unsuccessful duodenal RV procedure occurred because of the angulation of the hydrophilic tip of the guidewire while crossing the papilla, thus preventing cannulation. Successful cannulation was achieved by the traditional RV technique in all cases (N = 11), including the failed duodenal RV technique, taking 374 seconds (interquartile range 320-410 seconds) (P < .05 vs duodenal RV). However, no post-ERCP pancreatitis occurred after using the duodenal RV technique compared with 2 episodes of mild pancreatitis after using the traditional RV technique. Twenty-four hours after the procedure, the median amylasemia level was 84 IU/L (interquartile range 49-105 IU/L) and 265 IU/L (interquartile range 73-2945 IU/L) for the duodenal versus traditional RV techniques, respectively (P = not significant). CONCLUSIONS In patients with a T-tube after liver transplantation, the duodenal RV technique was not associated with post-ERCP pancreatitis, presumably because of the reduction of stress on the major papilla. Cannulation by using the duodenal RV technique was faster compared with the traditional RV technique. These preliminary data point out the use of the duodenal RV technique as the first option to choose in case of failed cannulation before attempting the traditional RV technique.
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Affiliation(s)
- Paolo Cantù
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Parzanese
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Ernesto Melada
- Liver Transplantation Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Rossi
- Liver Transplantation Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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Abstract
Inflammatory bowel disease (IBD) encompasses a group of disorders affecting the gastrointestinal tract characterized by acute and chronic inflammation. These are complex and multifactorial disorders that arise in part from a genetic predisposition. However, the increasing incidence of IBD in developing countries suggests that environmental factors, such as diet, are also critical components of disease susceptibility. Evidence suggests that consumption of a Western diet, enriched with saturated fat, refined carbohydrates, and food additives, is associated with increased IBD risk. Dietary components, such as omega-6 fatty acids, long-chain fatty acids, protein, and digestible carbohydrates, may contribute to IBD pathogenesis through altering intestinal microbiota, increasing intestinal permeability, and promoting inflammation; whereas omega-3 fatty acids, medium chain triglycerides, and nondigestible carbohydrates improve these parameters and intestinal health. However, the limited amount of prospective studies, small sample sizes, and the heterogeneity of disease subtype result in inconsistencies between studies and difficulty in conclusively determining the specific effects of diet on intestinal homeostasis. There are no standard clinical dietary recommendations for patients with IBD. However, exclusionary diet interventions have shown some efficacy in relieving symptoms or inducing remission, suggesting more research is needed to fully understand how diet influences disease behavior or combines with other IBD risk factors to promote disease. This review focuses on the associations of various dietary components and IBD risk in clinical studies and genetically susceptible IBD models.
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Abstract
Inflammatory bowel disease (IBD) is a complex, multi-factorial disease thought to arise from an inappropriate immune response to commensal bacteria in a genetically susceptible person that results in chronic, cyclical, intestinal inflammation. Dietary and environmental factors are implicated in the initiation and perpetuation of IBD; however, a singular causative agent has not been identified. As of now, the role of environmental priming or triggers in IBD onset and pathogenesis are not well understood, but these factors appear to synergize with other disease susceptibility factors. In previous work, we determined that the polysaccharide dietary additive, maltodextrin (MDX), impairs cellular anti-bacterial responses and suppresses intestinal anti-microbial defense mechanisms. In this addendum, we review potential mechanisms for dietary deregulation of intestinal homeostasis, postulate how dietary and genetic risk factors may combine to result in disease pathogenesis, and discuss these ideas in the context of recent findings related to dietary interventions for IBD.
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Key Words
- AIEC, adherent-invasive Escherichia coli
- CD, Crohn's disease
- CMC, carboxymethyl cellulose
- Crohn's disease
- DSS, dextran sulfate sodium
- FDA, Food and Drug Administration
- GRAS, Generally Recognized As Safe
- IBD, inflammatory bowel disease
- IBD-AID, inflammatory bowel disease-anti-inflammatory diet
- MDX, maltodextrin
- SCD, specific carbohydrate diet
- UC, ulcerative colitis
- anti-microbial defense
- diet
- dietary additive
- inflammatory bowel disease
- intestinal homeostasis
- maltodextrin
- mucosal defense
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Affiliation(s)
- Kourtney P Nickerson
- Mucosal Immunology and Biology Research Center; Division of Pediatric Gastroenterology and Nutrition; Massachusetts General Hospital; Boston, MA USA,Department of Pediatrics; Harvard Medical School; Boston, MA USA
| | - Rachael Chanin
- Mucosal Immunology and Biology Research Center; Division of Pediatric Gastroenterology and Nutrition; Massachusetts General Hospital; Boston, MA USA
| | - Christine McDonald
- Department of Pathobiology; Lerner Research Institute; Cleveland Clinic; Cleveland, OH USA,Department of Molecular Medicine; Cleveland Clinic Lerner College of Medicine at Case Western Reserve University; Cleveland, OH USA,Correspondence to: Christine McDonald;
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Huang L, Yu QS, Zhang Q, Liu JD, Wang Z. Comparison between double-guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation. Dig Endosc 2015; 27:381-7. [PMID: 25284147 DOI: 10.1111/den.12387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/22/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM The aim of the present study was to compare the effectiveness and complications of the double-guidewire technique (DWT) with the transpancreatic sphincterotomy (TPS) technique. METHODS From January 2013 to December 2014, 366 consecutive endoscopic retrograde cholangiopancreatography (ERCP) procedures were carried out. Of 366 procedures, 354 procedures were carried out in patients with native major papilla biliary cannulation. A total of 279 consecutive therapeutic ERCP were included in the study and data of included patients were collected retrospectively. One hundred and thirty-seven procedures (49.1%) were done with DWT and 142 procedures (50.9%) were done with TPS for patients with difficult cannulation. The results and complications of ERCP were compared. RESULTS Success rate of first-attempt cannulation was 62.0% in the DWT group and 81.0% in the TPS group (P = 0.00). Final rate of successful cannulation of the two biliary cannulation techniques was 86.9% and 90.8%, respectively (P = 0.09). Cannulation time in the DWT group was 7.8 ± 1.7 min compared with 3.7 ± 2.3 min in the TPS group (P = 0.00). Overall incidence of post-ERCP pancreatitis (PEP), hemorrhage, perforation and cholangitis was 1.8%, 1.1%, 0.4% and 1.1%, respectively. Adverse event rate was 2.19% in the DWT group and 7.04% in the TPS group (P = 0.04). CONCLUSIONS DWT and TPS procedures were safe and effective. Overall cannulation rate was similar between the groups. Although DWT had a longer cannulation time, it could be considered the preferred technique in patients with failed standard cannulation for lower adverse event rate.
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Affiliation(s)
- Long Huang
- Department of No. 1 Surgery, The First Hospital Affiliated to Anhui Chinese Medical University, Hefei, China
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Emilsson L, Lindahl B, Köster M, Lambe M, Ludvigsson JF. Review of 103 Swedish Healthcare Quality Registries. J Intern Med 2015; 277:94-136. [PMID: 25174800 DOI: 10.1111/joim.12303] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES In the past two decades, an increasing number of nationwide, Swedish Healthcare Quality Registries (QRs) focusing on specific disorders have been initiated, mostly by physicians. Here, we describe the purpose, organization, variables, coverage and completeness of 103 Swedish QRs. METHODS From March to September 2013, we examined the 2012 applications of 103 QRs to the Swedish Association of Local Authorities and Regions (SALAR) and also studied the annual reports from the same QRs. After initial data abstraction, the coordinator of each QR was contacted at least twice between June and October 2013 and asked to confirm the accuracy of the data retrieved from the applications and reports. RESULTS About 60% of the QRs covered ≥80% of their target population (completeness). Data recorded in Swedish QRs include aspects of disease management (diagnosis, clinical characteristics, treatment and lead times). In addition, some QRs retrieve data on self-reported quality of life (EQ5D, SF-36 and disease-specific measures), lifestyle (smoking) and general health status (World Health Organization performance status, body mass index and blood pressure). CONCLUSION Detailed clinical data available in Swedish QRs complement information from government-administered registries and provide an important source not only for assessment and development of quality of care but also for research.
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Affiliation(s)
- L Emilsson
- Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway
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A modified technique reduced operative time of laparoendoscopic rendezvous endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for concomitant gallstone and common bile ductal stone. Gastroenterol Res Pract 2014; 2014:861295. [PMID: 25024701 PMCID: PMC4082838 DOI: 10.1155/2014/861295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/13/2014] [Accepted: 05/23/2014] [Indexed: 01/11/2023] Open
Abstract
Laparoendoscopic rendezvous (LERV) endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC+ERCP/LERV) are considered an optimal approach for concomitant gallstones and common bile duct stones. The rendezvous technique is essential for the success of procedure. We applied two different LERV techniques, traditional technique and modified technique, in 60 consecutive cases from January 2011 to November 2012. 32 cases who underwent modified technique (group 1) from February 2012 to November 2012 were retrospectively compared to 28 cases (group 2) who underwent traditional technique from January 2011 to January 2012. There was no significant difference between two groups with respect to preoperative demographic features. Although the difference was not statistically significant, the procedure was successfully performed in 31 cases (96.9%) in group 1 and 24 cases (86.2%) in group 2. The mean operative time and time of endoscopic part were 82.6 ± 19.6 min and 26.5 ± 5.99 min in group 1 which were significantly shorter than those in group 2 (118.0 ± 23.1 min and 58.7 ± 13.3 min, resp.). There was no postoperative pancreatitis and mortality in both groups. The mean hospital stay, blood loss, incidence of complications, and residual stone were of no difference in both groups. This study proved that this modified technique can effectively reduce the operative time and time of endoscopic part of LC+ERCP/LERV compared with traditional technique.
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Chen LL, Bu P, Chen CW, Liu J, Chen J, Deng DH. Application of balloon suction radiography-assisted guidewire insertion in management of incarcerated stones in the common bile duct. Shijie Huaren Xiaohua Zazhi 2013; 21:3139-3141. [DOI: 10.11569/wcjd.v21.i29.3139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the application of balloon suction radiography-assisted guidewire insertion in endoscopic retrograde cholangiopancreatography (ERCP) in patients with incarcerated stones in the upper or middle segment of the common bile duct.
METHODS: Clinical data for 15 patients with incarcerated stones in the upper or middle segment of the common bile duct who underwent radiography-assisted guidewire insertion in ERCP at our hospital from June 2005 to January 2012 were retrospectively analzyed.
RESULTS: Radiography was successful in all 15 patients, and the guidewire went through the incarcerated stones in each patient. After ERCP, one patient developed acute pancreatitis and hyperamylasemia but recovered after receiving medical treatment for 2-5 d. No bleeding or perforation occurred.
CONCLUSION: Balloon suction radiography-assisted guidewire insertion can reduce operative time and improve the success rate and safety in patients with incarcerated stones in the common bile duct.
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