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Liu C, Tian L, Ze X, Yang T, Wang L, Li Z. Injection of carbon dioxide instead of iodinated contrast to display the common bile duct during endoscopic retrograde cholangiopancreatography. J Minim Access Surg 2024:01413045-990000000-00088. [PMID: 39388215 DOI: 10.4103/jmas.jmas_286_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/01/2024] [Indexed: 10/15/2024] Open
Abstract
ABSTRACT Common bile duct (CBD) stones are usually caused by biliary tract infection, biliary stricture, duodenal peripapillary diverticulum, Oddis sphincter dysfunction, and so on. Treatment is preferably with endoscopic retrograde cholangiopancreatography (ERCP), where an iodine-containing contrast agent is injected into the CBD to display the stone under fluoroscopy and then to confirm complete removal of the stone(s). We described a 65-year-old woman with CBD stones who had undergone cardiac pacemaker implantation and was allergic to iodinated contrast media. We performed ERCP + lithotomy + stent implantation under local anesthesia, with injection of carbon dioxide instead of iodinated contrast into the CBD, and successfully visualized the stones under fluoroscopy and then confirmed complete removal of them. The patient was generally in good condition without complications. Thus, we have demonstrated in this case report that carbon dioxide can be used as a safe, economical, and effective alternative to iodinated contrast agent during ERCP.
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Affiliation(s)
- Cui Liu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lingyun Tian
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xingyu Ze
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- Department of Gastroenterology, Digestive Endoscopy Center, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, China
| | - Ting Yang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Luowei Wang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
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Huang Y, Kruse RL, Ding H, Itani MI, Morrison J, Wang ZZ, Selaru FM, Kumbhari V. Parameters of biliary hydrodynamic injection during endoscopic retrograde cholangio-pancreatography in pigs for applications in gene delivery. PLoS One 2021; 16:e0249931. [PMID: 33909609 PMCID: PMC8081268 DOI: 10.1371/journal.pone.0249931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/27/2021] [Indexed: 11/23/2022] Open
Abstract
The biliary system is routinely accessed for clinical purposes via endoscopic retrograde cholangiopancreatography (ERCP). We previously pioneered ERCP-mediated hydrodynamic injection in large animal models as an innovative gene delivery approach for monogenic liver diseases. However, the procedure poses potential safety concerns related mainly to liver or biliary tree injury. Here, we sought to further define biliary hydrodynamic injection parameters that are well-tolerated in a human-sized animal model. ERCP was performed in pigs, and hydrodynamic injection carried out using a novel protocol to reduce duct wall stress. Each pig was subjected to multiple repeated injections to expedite testing and judge tolerability. Different injection parameters (volume, flow rate) and injection port diameters were tested. Vital signs were monitored throughout the procedure, and liver enzyme panels were collected pre- and post-procedure. Pigs tolerated repeated biliary hydrodynamic injections with only occasional, mild, isolated elevation in aspartate aminotransferase (AST), which returned to normal levels within one day post-injection. All other liver tests remained unchanged. No upper limit of volume tolerance was reached, which suggests the biliary tree can readily transmit fluid into the vascular space. Flow rates up to 10 mL/sec were also tolerated with minimal disturbance to vital signs and no anatomic rupture of bile ducts. Measured intrabiliary pressure was up to 150 mmHg, and fluid-filled vesicles were induced in liver histology at high flow rates, mimicking the changes in histology observed in mouse liver after hydrodynamic tail vein injection. Overall, our investigations in a human-sized pig liver using standard clinical equipment suggest that ERCP-guided hydrodynamic injection will be safely tolerated in patients. Future investigations will interrogate if higher flow rates and pressure mediate higher DNA delivery efficiencies.
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Affiliation(s)
- Yuting Huang
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, United States of America
| | - Robert L. Kruse
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Hui Ding
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mohamad I. Itani
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jonathan Morrison
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Zack Z. Wang
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Florin M. Selaru
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail: (VK); (FMS)
| | - Vivek Kumbhari
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Gastroenterology & Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, United States of America
- * E-mail: (VK); (FMS)
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Endoscopic Retrograde Cholangiopancreatography-Related Complications and Their Management Strategies: A "Scoping" Literature Review. Dig Dis Sci 2020; 65:361-375. [PMID: 31792671 DOI: 10.1007/s10620-019-05970-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/16/2019] [Indexed: 12/12/2022]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a well-known procedure with both diagnostic and therapeutic utilities in managing pancreaticobiliary conditions. With the advancements of endoscopic techniques, ERCP has become a relatively safe and effective procedure. However, as ERCP is increasingly being utilized for different advanced techniques, newer complications have been noticed. Post-ERCP complications are known, and mostly include pancreatitis, infection, hemorrhage, and perforation. The risks of these complications vary depending on several factors, such as patient selection, endoscopist's skills, and the difficulties involved during the procedure. This review discusses post-ERCP complications and management strategies with new and evolving concepts.
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Kim YS, Choi YH, Cho YJ, Lee S, Yoon SH, Park CM, Kang HR. Incidence of Breakthrough Reaction in Patients with Prior Acute Allergic-Like Reactions to Iodinated Contrast Media according to the Administration Route. Korean J Radiol 2018. [PMID: 29520194 PMCID: PMC5840065 DOI: 10.3348/kjr.2018.19.2.352] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study assessed the risk of acute allergic-like reactions (AARs) after extravascular administration of iodinated contrast media (ICM) in at-risk patients compared with that after intravascular ICM administration. Materials and Methods From July 2012 to January 2016, 264 patients with a history of moderate or severe reactions to ICM, with re-exposure to ICM intravascularly or extravascularly were included. The incidence of recurrent AARs after ICM re-exposure were assessed according to the administration routes by reviewing electronic medical records and comparison between the two routes. Results Among 264 patients, 244 patients had been subsequently exposed to ICM intravascularly, 7 patients via an extravascular route and 13 patients with dual re-exposure. Of 257 patients with intravascular ICM re-exposure, 87 (33.9%) had mild to severe recurrent AARs and 143 (19.5%) cases of recurrent AARs occurred among 733 cases of intravascular ICM re-exposure on a case-by-case basis. However, there was no case of recurrent ARR after extravascular administration of ICM in 20 patients (45 cases) with ICM administrated extravascularly. Conclusion For high-risk patients with a history of moderate or severe reactions to ICM, AARs upon extravascular administration of ICM are significantly infrequent compared with intravascular ICM administration.
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Affiliation(s)
- Yeon Soo Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Hye Ryun Kang
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
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Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, Eloubeidi MA, Fanelli RD, Faulx AL, Gurudu SR, Kothari S, Lightdale JR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85:32-47. [PMID: 27546389 DOI: 10.1016/j.gie.2016.06.051] [Citation(s) in RCA: 463] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 02/07/2023]
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Rew SJ, Lee DH, Park CH, Jeon J, Kim HS, Choi SK, Rew JS. Comparison of intraductal ultrasonography-directed and cholangiography-directed endoscopic retrograde biliary drainage in patients with a biliary obstruction. Korean J Intern Med 2016; 31:872-9. [PMID: 27097771 PMCID: PMC5016288 DOI: 10.3904/kjim.2015.291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/16/2016] [Accepted: 01/23/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic retrograde biliary drainage (ERBD) has become a standard procedure in patients with a biliary obstruction. Intraductal ultrasonography (IDUS) has emerged as a new tool for managing extrahepatic biliary diseases. IDUS-directed ERBD can be performed without conventional cholangiography (CC). The goal of this study was to assess the effectiveness and safety of IDUS-directed ERBD compared to CC-directed ERBD in patients with an extrahepatic biliary obstruction. METHODS A total of 210 patients who had undergone IDUS-directed ERBD (IDUS-ERBD, n = 105) and CC-directed ERBD (CC-ERBD, n = 105) between October 2013 and April 2014 were analyzed retrospectively. The primary outcome measure was the procedural success rate. Secondary outcome measures included clinical outcomes, total procedure time, radiation exposure time, and overall complication rates. RESULTS The total technical success rate of ERBD was 100% (105/105) in the IDUS-ERBD and CC-ERBD groups. Mean procedure time was slightly prolonged in the IDUS-ERBD group than that in the CC-ERBD group (32.1 ± 9.9 minutes vs. 28.4 ± 11.6 minutes, p = 0.023). Mean radiation exposure time was one-third less in the IDUS-ERBD group than that in the CC-ERBD group (28.0 ± 49.3 seconds vs. 94.2 ± 57.3 seconds, p < 0.001). No significant differences in complication rates were detected between the groups. CONCLUSIONS IDUS-ERBD was equally effective and safe as CC-ERBD in patients with an extrahepatic biliary obstruction. Although IDUS-ERBD increased total procedure time, it significantly decreased radiation exposure.
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Affiliation(s)
| | | | - Chang-Hwan Park
- Correspondence to Chang-Hwan Park, M.D. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6296 Fax: +82-62-228-1330 E-mail:
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Tziatzios G, Gkolfakis P, Papanikolaou IS, Dimitriadis G, Triantafyllou K. An unusual case of prolonged post-endoscopic retrograde cholangiopancreatography jaundice. Hepatobiliary Pancreat Dis Int 2016; 15:220-2. [PMID: 27020640 DOI: 10.1016/s1499-3872(15)60402-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of choledocholithiasis, various complications have been described. We herein report the first case of prolonged post-ERCP jaundice due to toxicity of the contrast agent Iobitridol (®XENETIX, Guerbet, Roissy CdG Cedex, France) in a patient who underwent ERCP with sphincterectomy and common bile duct stone removal. While clinical improvement and normalization of aminotransferases and cholestatic enzymes after the procedure, an unexplained increase of direct bilirubin was noticed. A second ERCP was performed one week later, excluding possible remaining choledocholithiasis. Nevertheless, serum direct bilirubin increased further up to 15 mg/dL. Other potential causes of direct hyperbilirubinemia were ruled out and patient's liver biopsy was compatible with drug-induced liver toxicity. Additionally, the cause-result time connection between the use of Iobitridol and bilirubin increase indicated the possibility of a toxic effect related to the repeated use of the particular contrast agent. Iobitridol, a contrast agent, can induce prolonged direct hyperbilirubinemia.
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Affiliation(s)
- Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine and Research Institute, "Attikon" University General Hospital, Medical School, University of Athens, Athens, Greece.
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8
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Lim SU, Park CH, Kee WJ, Lee JH, Rew SJ, Park SY, Kim HS, Choi SK, Rew JS. Intraductal Ultrasonography without Radiocontrast Cholangiogramin Patients with Extrahepatic Biliary Disease. Gut Liver 2016; 9:540-6. [PMID: 25963077 PMCID: PMC4477999 DOI: 10.5009/gnl14200] [Citation(s) in RCA: 6] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Intraductal ultrasonography (IDUS) has been performed as an adjunct to endoscopic retrograde cholangiography (ERC) during radiocontrast cholangiography (RC). Radiation exposure during RC poses a health risk to both patients and examiners. We evaluated the feasibility of IDUS without RC in various extrahepatic biliary diseases. METHODS IDUS was performed with the insertion of an IDUS probe from the papilla of Vater to the confluent portion of the common hepatic duct without fluoroscopy. The technical success rate and procedure-related complications were evaluated retrospectively. RESULTS Wire-guided IDUS without RC was performed in 105 patients. The mean age was 66.5 years, and 50 (47.6%) were male. The IDUS diagnoses included choledocholithiasis (73, 69.5%), benign biliary stricture (11, 10.5%), choledocholithiasis with biliary pancreatitis (9, 8.6%), bile duct cancer (5, 4.8%), pancreatic cancer (1, 0.9%), and others (6, 5.7%). After IDUS, 66 (62.8%) underwent stone removal, 19 (18.1%) underwent biliary drainage, and 7 (6.6%) underwent brush cytology and biopsy. No significant complications such as perforation or severe pancreatitis occurred. CONCLUSIONS IDUS without RC was a feasible and safe approach in patients with various extrahepatic biliary diseases. We anticipate a potentially important role of IDUS in various ERC procedures because it lacks the hazards of RC.
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Affiliation(s)
- Sung-Uk Lim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Chang-Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Won-Ju Kee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Jeong-Hyun Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Soo-Jung Rew
- Department of Internal Medicine, Gwangju Christian Hospital, Gwangju, Korea
| | - Seon-Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Sung-Kyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Jong-Sun Rew
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Korea
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Draganov PV, Suarez AL, Cotton PB. Variability in management of ERCP-related contrast media reaction. Gastrointest Endosc 2015; 82:973-4. [PMID: 26472008 DOI: 10.1016/j.gie.2015.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 07/07/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida
| | - Alejandro L Suarez
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
| | - Peter B Cotton
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
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Wu W, Faigel DO, Sun G, Yang Y. Non-radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy. Dig Endosc 2014; 26:691-700. [PMID: 24861135 DOI: 10.1111/den.12307] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/07/2014] [Indexed: 12/19/2022]
Abstract
Gallstone diseases are common during pregnancy. In most cases, patients are asymptomatic and do not require any treatment. However, choledocholithiasis, cholangitis, and gallstone pancreatitis may potentially become life-threatening for both mother and fetus and often require urgent intervention. Although endoscopic retrograde cholangiopancreatography (ERCP) has become the standard technique for removing common bile duct stones, it is associated with ionizing radiation that could carry teratogenic risk. Non-radiation ERCP (NR-ERCP) is reported to be effective without incurring this risk. Two techniques have been described to confirm bile duct cannulation: bile aspiration and image guidance. With bile aspiration, biliary cannulation is confirmed by applying suction to the cannula to yield bile, thus confirming an intrabiliary position. Image guidance involves using ultrasound or direct visualization (choledochoscopy) to confirm selective biliary cannulation or duct clearance. Once cannulation is achieved, the stones are removed using standard ERCP techniques and tools. Case series and retrospective studies have reported success rates of up to 90% for NR-ERCP with complication rates similar to standard ERCP. Pregnancy outcomes are not adversely affected by NR-ERCP, but whether the avoidance of radiation carries benefit for the baby is unknown. Prospective comparative trials are lacking. NR-ERCP is technically demanding and should be attempted only by skilled biliary endoscopists in properly equipped and staffed health-care institutions, in a multidisciplinary setting.
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Affiliation(s)
- Wenming Wu
- Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing, China; Department of Gastroenterology and Hepatology, General Hospital of Ji'nan Military Command Region, Ji'nan, China
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Young Bang J, Coté GA. Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chavalitdhamrong D, Donepudi S, Pu L, Draganov PV. Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography. Dig Endosc 2014; 26:15-22. [PMID: 24118211 DOI: 10.1111/den.12178] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/21/2013] [Indexed: 02/06/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has become a primary tool for the treatment of biliary and pancreatic ductal diseases. It is essential for the endoscopist carrying out the ERCP to have a thorough understanding of the potential adverse events. Typically, endoscopists are well familiar with common adverse events such as post-ERCP pancreatitis, cholangitis, post-sphincterotomy bleeding, post-sphincterotomy perforation, and sedation-related cardiopulmonary compromises. However, there are other less common adverse events that arecritical to promptly recognize in order to provide appropriate therapy and prevent disastrous outcomes. This review focuses on the presentation and management of the less common and rare adverse events of an ERCP from the perspective of the practicing endoscopist.
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Affiliation(s)
- Disaya Chavalitdhamrong
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, USA
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Mergener K. Complications of endoscopic and radiologic investigation of biliary tract disorders. Curr Gastroenterol Rep 2011; 13:173-181. [PMID: 21258972 DOI: 10.1007/s11894-011-0179-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The investigation and treatment of disorders of the human biliary tree depend considerably on invasive endoscopic and radiologic procedures. These are associated with a significant risk of complications, some of which can be fatal. This review looks at these complications through the lens of 40 years of publications in the medical literature, and identifies the strengths and weaknesses of their current classification, diagnosis, and treatment.
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Affiliation(s)
- Klaus Mergener
- GI Hospitalist Program, Digestive Health Specialists, 3209 South 23rd Street, Suite 340, Tacoma, WA 98405, USA.
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Draganov PV, Forsmark CE. Prospective evaluation of adverse reactions to iodine-containing contrast media after ERCP. Gastrointest Endosc 2008; 68:1098-101. [PMID: 19028218 DOI: 10.1016/j.gie.2008.07.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 07/19/2008] [Indexed: 12/10/2022]
Abstract
BACKGROUND The incidence of contrast media reactions administered at the time of ERCP is unknown. Despite the lack of formal recommendations, numerous types of prophylactic regimens are routinely used in patients with a history of prior reactions to intravascular contrast media. OBJECTIVE Our purpose was to document the incidence of contrast media reactions at the time of ERCP and to determine whether various perceived risk factors are predictive of adverse reactions. DESIGN Prospective study. SETTING Tertiary academic center. PATIENTS A total of 601 patients undergoing ERCP as clinically indicated. INTERVENTIONS ERCP done with full-strength high osmolality contrast media. No prophylactic medications were given to any patient. MAIN OUTCOME MEASUREMENTS Adverse reactions to contrast media. RESULTS Six hundred one patients were enrolled. Eighty patients had prior documented reactions to intravascular contrast media (39 mild, 21 moderate, 20 severe). Of the 80 patients, 15 additionally reported shellfish allergy, and 46 reported allergic diathesis. Of the 521 patients with no prior reaction to intravascular contrast, 215 reported other history of allergic reaction. Forty-nine were allergic to shellfish, and 166 had underlying allergic diathesis. At ERCP, 277 patients had cholangiograms, 48 pancreatograms, and 276 both. The average volume of contrast per ERCP was 22 mL. No adverse reactions associated with the administration of contrast media at the time of ERCP were observed in any of the patients. CONCLUSIONS The incidence of adverse reaction to iodine-containing contrast media administered at the time of ERCP even in patients considered to be at high risk is exceedingly low. The use of prophylactic regimens before ERCP appears to be unnecessary.
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Affiliation(s)
- Peter V Draganov
- Division of Gastroenterology, University of Florida, Gainesville, Florida 32610, USA
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Massey JC, Gokhale JA, Kay CL, Griffith JP. A case of common bile duct stones, failed ERCP and sensitivity to iodine contrast media: what contrast media should we use for an on-table cholangiogram? Ann R Coll Surg Engl 2008; 90:615. [PMID: 18837121 DOI: 10.1308/rcsann.2008.90.7.615a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J C Massey
- Department of Surgery, Bradford Royal Infirmary, Bradford, UK.
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Ardolino A, Aarvold A, Southgate JJ. A technique for supporting the hand during surgery. Ann R Coll Surg Engl 2008; 90:615. [PMID: 18837122 DOI: 10.1308/rcsann.2008.90.7.615b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Ardolino
- Department of Orthopaedics and Trauma, Poole Hospital, Poole, UK.
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Mishkin D, Carpenter S, Croffie J, Chuttani R, DiSario J, Hussain N, Liu J, Somogyi L, Tierney W, Petersen BT. ASGE Technology Status Evaluation Report: radiographic contrast media used in ERCP. Gastrointest Endosc 2005; 62:480-4. [PMID: 16185956 DOI: 10.1016/j.gie.2005.07.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Ju YM, Kim MH, Lee SK, Seo DW, Min YI, Kim JY. Comparative cytotoxicity of low-osmolar nonionic and high-osmolar ionic contrast media to dog gallbladder epithelial cells. Gastrointest Endosc 2002; 55:382-6. [PMID: 11868013 DOI: 10.1067/mge.2002.121595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most studies of the adverse effects of x-ray contrast media used in ERCP have focused on post-ERCP pancreatitis. However, the biliary epithelial cells are also exposed to contrast media during ERCP and acute cholangitis is also a serious complication of ERCP. The present study compared the cytotoxicity with gallbladder epithelial cells of ionic and nonionic contrast agents. METHODS A high-osmolar ionic contrast agent (meglumine ioxithalamate) and a low-osmolar nonionic contrast agent (iopromide) were tested. Monolayer cell cultures of dog gallbladder epithelial cells were used. The cells were exposed to the 2 contrast agents with increasing iodine concentration and osmolality for 2 days. Cell number, S-phase fraction, aneuploidy, and supernatant LDH activities were measured each day. RESULTS Cell growth was more severely inhibited by ioxithalamate than iopromide (p < 0.05) and strongly dependent on the osmolality of contrast agent. The cytostatic effect estimated by S-phase fraction was more pronounced for ioxithalamate. Chromosomal damage determined by aneuploidy was more frequently detected with ioxithalamate. CONCLUSIONS High-osmolar ionic contrast media are more cytotoxic than low-osmolar nonionic contrast media to gallbladder epithelial cells. Animal and clinical studies are needed to estimate the clinical implications of these findings.
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Affiliation(s)
- Young-Min Ju
- Division of Gastroenterology, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
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Mosca S, Secondulfo M, Defez M, Calise F. Air contrastography technique for successful urgent ERCP in a high risk allergic patient. Am J Gastroenterol 2001; 96:3458-60. [PMID: 11774984 DOI: 10.1111/j.1572-0241.2001.05356.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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