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Bi YZ, Yan SJ, Zhou LM, Sun Y, Zhang J. Instant duodenal decompression after endoscopic retrograde cholangiopancreatography can effectively reduce the incidence of post-ERCP pancreatitis and hyperamylasemia. Gastroenterol Rep (Oxf) 2024; 12:goae025. [PMID: 38586538 PMCID: PMC10997411 DOI: 10.1093/gastro/goae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/29/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background Post-ERCP pancreatitis (PEP) is significantly influenced by the reflux of duodenal fluid. While gastrointestinal decompression represents a fundamental approach in acute pancreatitis management, the effectiveness of immediate duodenal decompression following ERCP to prevent PEP remains uncertain. This study aimed to investigate the impact of immediate duodenal decompression after ERCP on reducing the incidence of hyperamylasemia and PEP. Methods This retrospective study encompassed patients with native papilla who underwent therapeutic ERCP for choledocholithiasis at the Department of Gastroenterology, Chun'an Branch of Zhejiang Provincial People's Hospital (Zhejiang, China) between January 2020 and June 2023. Based on the immediate placement of a duodenal decompression tube post-ERCP, patients were categorized into two groups: the duodenal decompression group and the conventional procedure group. Primary outcomes included the incidence of PEP and hyperamylasemia. Results A total of 195 patients were enrolled (94 in the duodenal decompression group and 101 in the conventional procedure group). Baseline clinical and procedural characteristics exhibited no significant differences between the two groups. PEP occurred in 2 patients (2.1%) in the duodenal decompression group, in contrast to 11 patients (10.9%) in the conventional procedure group (Risk difference [RD] 8.8%; 95% confidence interval [CI] 1.7%-16.5%, P = 0.014). Hyperamylasemia was observed in 8 patients (8.5%) in the duodenal decompression group, compared to 20 patients (19.8%) in the conventional procedure group (RD 11.3%; 95% CI 1.4%-21.0%; P = 0.025). Patients with PEP in both groups showed improvement after receiving active treatment. No severe cases of PEP occurred in either group, and no serious adverse events related to duodenal catheter decompression were reported. Conclusion Immediate duodenal decompression following ERCP demonstrates an effective reduction in the incidence of hyperamylasemia and PEP.
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Affiliation(s)
- Yu-Zhen Bi
- Department of Gastroenterology, Chun’an Country First People’s Hospital (Zhejiang Provincial People’s Hospital, Chun’an Branch), Hangzhou, Zhejiang, P. R. China
| | - Si-Jia Yan
- Department of Gastroenterology, Chun’an Country First People’s Hospital (Zhejiang Provincial People’s Hospital, Chun’an Branch), Hangzhou, Zhejiang, P. R. China
| | - Li-Min Zhou
- Department of Gastroenterology, Chun’an Country First People’s Hospital (Zhejiang Provincial People’s Hospital, Chun’an Branch), Hangzhou, Zhejiang, P. R. China
| | - Yan Sun
- Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, P. R. China
| | - Jun Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, P. R. China
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Mikalsen IM, Breder S, Medhus AW, Folseraas T, Aabakken L, Ånonsen KV. ERCP for the initial management of malignant biliary obstruction - real world data on 596 procedures. Scand J Gastroenterol 2024; 59:369-377. [PMID: 37994406 DOI: 10.1080/00365521.2023.2282375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
AIMS To evaluate outcomes of ERCP as first-line management in patients with malignant biliary obstruction (MBO) of all causes and stages, reflecting a real-life setting. METHODS Retrospective observational study of patients with ERCP as the first-line management of MBO at Oslo University Hospital between 2015 and 2021. Primary outcome measure was a ≥ 50% decrease from the pre-procedural bilirubin within 30 days after ERCP. Secondary outcome measures were technical success of ERCP, complications and overall mortality. RESULTS A total of 596 patients were included, median age 70 years. ASA score was ≥ III in 67% of patients. The most common cancers causing MBO were pancreatic cancer (52%), metastatic lesions (20%) and cholangiocarcinoma (16%). The primary outcome measure was achieved in 62% of patients. With endoscopic access, overall technical success was 80% with 85% for the distal extrahepatic group, 71% for the perihilar, 40% for the intrahepatic and 53% for multiple level MBOs. Reinterventions were performed in 27% of the patients. Complications occurred in 15% of the patients, including post-ERCP pancreatitis in 9%. Most complications were of minor/moderate severity (81%). Overall mortality was 33% within the first 90 days. Patients deceased by the end of the study period (83%) had median survival of 146 days (range 1-2,582 days). CONCLUSIONS ERCP has a high rate of clinical effect and technical success in the management of both distal extrahepatic and perihilar MBO. Our data indicate that ERCP is a valid option in the first-line management of MBO.
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Affiliation(s)
- I M Mikalsen
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - S Breder
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - A W Medhus
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - T Folseraas
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - L Aabakken
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - K V Ånonsen
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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Sung MJ, Jo JH, Lee HS, Park JY, Bang S, Chung MJ. Comparison of Physician-Controlled Maneuver and Assistant-Controlled Maneuver during Endoscopic Retrograde Cholangiopancreatography. Yonsei Med J 2024; 65:34-41. [PMID: 38154478 PMCID: PMC10774649 DOI: 10.3349/ymj.2023.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE Cannulation of the major papilla is the most challenging part of endoscopic retrograde cholangiopancreatography (ERCP) for which physician-controlled wire-guided cannulation (PCWGC) and assistant-controlled wire-guided cannulation (ACWGC) are used as the cannulation techniques. PCWGC can reportedly save up to about 30% of the labor cost by reducing the number of assistants. This study aims to compare the safety and efficacy of PCWGC and ACWGC. MATERIALS AND METHODS Of the 2151 patients aged >20 years (4193 cases) who underwent ERCP at Yonsei University Medical Center between January 2015 and December 2016, 989 were included in this study. RESULTS Among efficacy outcomes, cannulation success rate, rate of precut sphincterotomy (PCWGC vs. ACWGC: 21.3% vs. 25.9%), bile duct cannulation time (PCWGC vs. ACWGC: median 3.0 minutes vs. 3.6 minutes), and total procedure time (PCWGC vs. ACWGC: median 13.6 minutes vs. 13.1 minutes) were not significantly different. Among safety outcomes, lower rates of post-ERCP pancreatitis were observed with PCWGC than with ACWGC (PCWGC vs. ACWGC: 5.8% vs. 8.8%, p=0.128). Among other post-ERCP adverse events (bleeding, perforation, and cholangitis), the difference was not significant between the groups. Radiation exposure (total dose area product, PCWGC vs. ACWGC: median 1979.9 µGym² vs. 2062.0 µGym², p=0.194) and ERCP cost excluding labor cost (PCWGC vs. ACWGC: $1576 vs. $1547, p=0.606) were not significantly different. CONCLUSION Requiring less assistants, PCWGC showed comparable efficacy and safety to ACWGC. PCWGC can be considered as an alternative option, especially in facilities lacking manpower and resources.
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Affiliation(s)
- Min Je Sung
- Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jung Hyun Jo
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Seung Lee
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Youp Park
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seungmin Bang
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Hirota M, Itoi T, Morizane T, Koiwai A, Yasuda I, Ryozawa S, Mukai S, Ikeura T, Irisawa A, Iwasaki E, Katanuma A, Kitamura K, Takenaka M, Ito T, Masamune A, Mayumi T, Takeyama Y. Post-procedure serum amylase or lipase levels predict post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of diagnostic test accuracy studies and utility assessment. Dig Endosc 2023. [PMID: 37921041 DOI: 10.1111/den.14718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES To clarify the clinical utility of measuring serum pancreatic enzymes after endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of predicting post-ERCP pancreatitis (PEP) by a meta-analysis of diagnostic test accuracy studies. METHODS Studies on the prediction accuracy of PEP by serum amylase or lipase measured 2, 3, and 4 hours after ERCP were collected. A literature search was performed in PubMed and the Cochrane Library database for studies published between January 1980 and March 2023. The quality of individual studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. Data were analyzed using Meta-DiSc 2.0 software. RESULTS We searched databases and identified 20 observational studies (12,313 participants). PEPs were defined according to criteria by Cotton or modified Cotton, revised Atlanta criteria, or the Japanese criteria. Meta-analysis of 8 studies (4,389 participants) showed pooled sensitivity of 71.1% (95% confidence interval (CI): 56.1-82.5) and pooled specificity of 91.2% (95% CI: 85.9-94.6) for serum amylase cutoff value at 3 times the upper limit of normal (ULN). Another meta-analysis of 5 studies (1,970 participants) showed pooled sensitivity of 85.8% (95% CI: 61.9-95.7) and pooled specificity of 85.3% (95% CI: 81.9-88.1) for serum lipase cutoff value at 3 times ULN. DISCUSSION Despite a high risk of bias due to various reference standards, this updated meta-analysis and the utility assessment by a decision tree showed utility of serum amylase or lipase levels more than 3 times ULN measured 2 to 4 hours after ERCP for predicting PEP.
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Affiliation(s)
- Morihisa Hirota
- Division of Gastroentrology, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai city, Miyagi, 983-8536, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshio Morizane
- Center of Gastroenterology and inflammatory Bowel Disease, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura city, Kanagawa, 247-0056, Japan
| | - Akinobu Koiwai
- Division of Gastroentrology, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai city, Miyagi, 983-8536, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Tsukasa Ikeura
- Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shin-machi, Hirakata City, Osaka, 573-1010, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Katsuya Kitamura
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hachioji Medical Center, 1163 Tate-machi, Hachioji City, Tokyo, 193-0998, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
| | - Tetsuhide Ito
- Neuroendocrine Tumor Centre, Fukuoka Sanno Hospital, International University of Health and Welfare, 3-6-45 Momochihama, Sawara-ku, Fukuoka, 814-0001, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai City, Miyagi, 980-8574, Japan
| | - Toshihiko Mayumi
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, 1-1-10 Sanjo, Minami-ku, Nagoya City, Aichi, 457-8510, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
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Chiriac S, Sfarti CV, Stanciu C, Cojocariu C, Zenovia S, Nastasa R, Trifan A. The Relation between Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis and Different Cannulation Techniques: The Experience of a High-Volume Center from North-Eastern Romania. Life (Basel) 2023; 13:1410. [PMID: 37374192 DOI: 10.3390/life13061410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/03/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Despite numerous advances that have aimed to increase the safety of endoscopic retrograde cholangiopancreatography (ERCP), post-ERCP pancreatitis (PEP) still remains a major issue. We aimed to assess the rate of PEP as well as the relation to the cannulation techniques in our unit, a high-volume center in north-eastern Romania. METHODS ERCPs performed in our unit from March to August 2022 were retrospectively included. Data concerning demographic information, presence of difficult cannulation, the technique used for cannulation, as well as immediate complications, were gathered from the electronic database. RESULTS 233 ERCPs were included. PEP was diagnosed in 23 (9.9%) of cases. Precut sphincterotomy (PS), transpancreatic sphincterotomy (TPBS), and a combination of TPBS and PS were performed in 6.4%, 10.3%, and 1.7% of cases, respectively, while an Erlangen precut papillotomy was performed in one case. Both in patients with PS and TPBS the rate of PEP was 20%. When the two techniques were associated, the rate of PEP was 25%. TPBS and PS represented risk factors for PEP (OR 1.211 for a CI of 0.946-1.551, p = 0.041, and OR 1.124 for a CI of 0.928-1.361, p = 0.088, respectively). No PEP-associated deaths were found. CONCLUSIONS Both PS and TPBS presented a similar risk of PEP.
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Affiliation(s)
- Stefan Chiriac
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Catalin Victor Sfarti
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Camelia Cojocariu
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Sebastian Zenovia
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Robert Nastasa
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Anca Trifan
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
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Toyonaga H, Hayashi T, Yamazaki H, Hama K, Iwano K, Nakamura R, Ando R, Shimizu T, Ishii T, Kin T, Takahashi K, Katanuma A. Efficacy of pancreatic duct stenting to prevent postendoscopic retrograde cholangiopancreatography pancreatitis after covered self-expandable metal stent deployment. Dig Endosc 2023; 35:369-376. [PMID: 36129765 DOI: 10.1111/den.14442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/20/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Although covered self-expandable metal stents (CSEMSs) are associated with the risk of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis due to pancreatic duct (PD) orifice obstruction, they are often used for biliary drainage treatment in malignant biliary obstruction (MBO). This study aimed to investigate the efficacy of PD stenting in preventing post-ERCP pancreatitis after CSEMS implantation. METHODS This retrospective cohort study analyzed 554 patients with transpapillary CSEMS for MBO. Patients with noninitial deployment, benign disease, CSEMS deployment above the papilla, surgically altered anatomy, uncovered self-expandable metal stents, multiple thin self-expandable metal stents, and unavailable procedure videos were excluded. Logistic regression analysis estimated the association between PD stenting and post-ERCP pancreatitis incidence. We adjusted for age, sex, pancreatitis history, prophylactic rectal nonsteroidal anti-inflammatory drug use, naïve papilla, MBO etiology, and prolonged biliary cannulation time. RESULTS Among 554 patients, 67 (12.1%) experienced post-ERCP pancreatitis. Post-ERCP pancreatitis was recorded in 13.7% of patients in the non-PD stenting and 4.3% in the PD stenting groups. Pancreatic duct stenting was associated with lower risks of post-ERCP pancreatitis (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.099-0.79; P = 0.028). In multivariable analysis, the association between PD stenting and lower post-ERCP pancreatitis incidence was consistent (OR 0.19; 95% CI 0.062-0.58; P = 0.0034). CONCLUSIONS Pancreatic duct stenting could reduce the risk of post-ERCP pancreatitis after CSEMSs.
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Affiliation(s)
- Haruka Toyonaga
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Hajime Yamazaki
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuki Hama
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Kosuke Iwano
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Risa Nakamura
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Ryo Ando
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Takao Shimizu
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Tatsuya Ishii
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | | | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
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Yang H, Yang Z, Hong J. Post-ERCP pancreatitis occurs more frequently in self-expandable metallic stents than multiple plastic stents on benign biliary strictures: a meta-analysis. Ann Med 2022; 54:2439-2449. [PMID: 36799364 PMCID: PMC9467625 DOI: 10.1080/07853890.2022.2105395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The occurrence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) after using covered self-expandable metallic stents (CSEMS) and multiple plastic stents (MPS) in the therapy of benign biliary strictures (BBS) remains ambiguous, this analysis aimed to evaluate the outcomes. CONCLUSIONS Compared with MPS, CSEMS caused a significantly higher incidence of PEP but fewer ERCP procedures, while the rate of stricture resolution, recurrence, and overall adverse events were comparable. Prevention methods of PEP should be further evaluated in BBS when undergoing CSEMS placement. METHODS A systematic search of electronic databases (PubMed, Web of Science and Cochrane Library) was conducted for randomised controlled trials (RCTs), and the included studies were published between 2008 and 2021. The primary outcome was PEP, while the secondary outcomes were stricture resolution, recurrence, overall adverse events, costs, and ERCP sessions. Pooled effect sizes were calculated with the random-effects model or fixed-effects model depending on the heterogeneity. RESULTS Six RCTs contained 444 patients (221 with CSEMS, 223 with MPS) finally included in the meta-analysis. The present analysis shows that compared to MPS, PEP is more likely to occur in CSEMS (OR [odds ratio] = 3.34, 95% confidence intervals [CI]:1.44-7.77, p = .005). CSEMS needs fewer ERCP sessions (Mean Deviation [MD]: -1.56; 95%CI:-2.66, -0.46], p = .006). The difference in stricture resolution and recurrence was not significant between the two stent types (OR = 0.87, 95%CI: 0.49-1.56, p = .64; and OR = 2.3, 95%CI: 0.68-7.76, p = .18). The incidence of overall adverse events was comparable between CSEMS and the MPS group (OR = 1.49, 95% CI: 0.97-2.29, p = .07). SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022314864. Key messagesCSEMS and MPS placement remain a mainstay for patients with BBS, and severe complications after stent placement have not been compared.The incidence of PEP was higher after deployment of CSEMS compared to MPS.Prevention methods of PEP should be evaluated in BBS when undergoing CSEMS placement.
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Affiliation(s)
- Hui Yang
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhenzhen Yang
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Junbo Hong
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
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Pin F, Conti Bellocchi MC, Crinò SF, Bernardoni L, Facciorusso A, Gabbrielli A. Double guide-wire technique versus transpancreatic biliary sphincterotomy for difficult biliary cannulation: Real life experience from a referral center. Dig Liver Dis 2022; 54:1548-53. [PMID: 35931625 DOI: 10.1016/j.dld.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND During ERCP for biliary indication, when a difficult bile duct (BD) cannulation occurs, with unintended access to the main pancreatic duct (PD), both double guidewire technique (DGW) and transpancreatic biliary sphincterotomy (TPBS) can be performed. We aimed to compare the technical success and adverse events (AEs) rate of these techniques. METHODS A retrospective analysis of patients with naïve papillae referred to the Pancreas Institute of Verona from January 2016 and July 2021 to undergo ERCP for biliary indications was performed. RESULTS Overall, 202 patients (53.5% males, mean age 67.2 years) were evaluated (96 DGW, 106 TPBS). Malignant biliary stricture was the most common ERCP indication (78.2%). The rate of success in deep biliary cannulation was significantly higher in the DGW group (94.8%) compared to TPBS (79.2%) at the first attempt (p = 0.001). This result was also confirmed in the subgroup of patients with malignant distal stricture (72/77, 93.5% vs 63/80, 78.8%, p = 0.01). No significant difference in AEs rate, particularly in PEP incidence was found between the two groups. CONCLUSIONS DGW demonstrated a higher success rate and similar safety profile compared with TPBS in difficult biliary cannulation. Based on this retrospective study, DGW should be preferred over TPBS in case of unintended PD cannulation. Further prospective studies are needed to confirm our results.
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Gondran H, Musquer N, Perez-Cuadrado-Robles E, Deprez PH, Buisson F, Berger A, Cesbron-Métivier E, Wallenhorst T, David N, Cholet F, Perrot B, Quénéhervé L, Coron E. Efficacy and safety of endoscopic papillectomy: a multicenter, retrospective, cohort study on 227 patients. Therap Adv Gastroenterol 2022; 15:17562848221090820. [PMID: 35480299 PMCID: PMC9036320 DOI: 10.1177/17562848221090820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic papillectomy is a minimally invasive treatment for benign tumors of the ampulla of Vater or early ampullary carcinoma. However, reported recurrence rates are significant and risk factors for recurrence are unclear. OBJECTIVE The aims of this study were to evaluate the efficacy and safety of endoscopic papillectomy and to identify risk factors for recurrence and adverse events. METHODS All patients who underwent endoscopic papillectomy at five tertiary referral centers between January 2008 and December 2018 were included. Recurrence was defined as the detection of residue on one of the follow-up endoscopies. Treatment success was defined as the absence of tumor residue on the last follow-up endoscopy. RESULTS A total of 227 patients were included. The resections were en bloc in 64.8% of cases. The mean lesion size was 20 mm (range: 3-80) with lateral extension in 23.3% of cases. R0 resection was achieved in 45.3% of cases. The recurrence rate was 30.6%, and 60.7% of recurrences were successfully treated with additional endoscopic treatment. Finally, treatment success was achieved in 82.8% of patients with a median follow-up time of 22.3 months. R1 resection, intraductal invasion, and tumor size > 2 cm were associated with local recurrence. Adverse events occurred in 36.6% of patients and included pancreatitis (17.6%), post-procedural hemorrhage (11.0%), perforation (5.2%), and biliary stenosis (2.6%). The mortality rate was 0.9%. CONCLUSION Endoscopic papillectomy is an effective and relatively well-tolerated treatment for localized ampullary tumors. In this series, R1 resection, intraductal invasion, and lesion size > 2 cm were associated with local recurrence.
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Affiliation(s)
- Hannah Gondran
- Institut des Maladies de l’Appareil Digestif (IMAD), CHU Nantes, Nantes, France
| | - Nicolas Musquer
- Institut des Maladies de l’Appareil Digestif (IMAD), CHU Nantes, Nantes, France
| | - Enrique Perez-Cuadrado-Robles
- Service de gastroentérologie, Hôpital européen Georges Pompidou, Assistance publique des hôpitaux de Paris, Paris, France,Service d’hépato-gastro-entérologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Pierre Henri Deprez
- Service d’hépato-gastro-entérologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Arthur Berger
- Service d’hépato-gastro-entérologie, CHU Angers, Angers, France
| | | | - Timothee Wallenhorst
- Service des Maladies de l’Appareil Digestif, CHU Pontchaillou, Université de Rennes 1, Rennes, France
| | - Nicolas David
- Service d’hépatogastroen térologie, La Cavale Blanche, CHRU Brest, Brest, France
| | - Franck Cholet
- Service d’hépatogastroen térologie, La Cavale Blanche, CHRU Brest, Brest, France
| | - Bastien Perrot
- Biostatistics and Methodology Unit, Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Lucille Quénéhervé
- Service d’hépatogastroen térologie, La Cavale Blanche, CHRU Brest, Brest, France
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10
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Fernandes J, Canena J, Alexandrino G, Figueiredo L, Rafael M, Moreira M, Araújo T, Lourenço L, Horta D, Familiari P, Dinis-Ribeiro M, Lopes L. Outcomes of single-endoscopist-performed needle-knife fistulotomy for selective biliary access in 842 consecutive patients: learning curve and changes over a 14-year period in a retrospective study. Scand J Gastroenterol 2021; 56:1363-1370. [PMID: 34355615 DOI: 10.1080/00365521.2021.1958369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Needle-knife fistulotomy (NKF) has emerged as the preferred precut technique. From a late strategy, NKF has shifted to an early rescue technique and has been used recently as a primary method for biliary access. It is unknown how these changes have affected NKF outcomes. We analyzed the outcomes of NKF over time in a large cohort of patients. METHODS Multicenter retrospective cohort study of 842 patients who underwent NKF for biliary access between 2006 and 2019. Patients were divided into four study periods according to a late or early cannulation strategy and to the use of post-ERCP pancreatitis prophylaxis (Period 1-Period 4). We assessed outcomes of NKF, learning curves and shifts over time. RESULTS Bile duct access was obtained in 88.0% of the patients. The initial cannulation rate increased significantly from 77.5% in P1 to 92.0% in P4 (p < .001). An endoscopist can obtain 80% success rate after performing 100 NKF procedures (95% CI: 0.79-0.86) and a 95% success rate after 830 procedures (95% CI: 0.92-0.98). Adverse events and pancreatitis were observed in 6.5% and 4.9% of patients respectively. The rate of pancreatitis was not significantly different during the 4 periods (p = .190). A decline in the pancreatitis rate was observed from 2006 until 2016 (no trainees) and then an increase until 2019 (trainees involved). The presence of trainees increased the rate of pancreatitis in the last period by 9.9%. CONCLUSIONS The success of NKF has increased significantly over the years, initially in a rapid manner and then more slowly. It is associated with a low rate of complications, which tend to decrease with experience. The involvement of trainees is associated with an increased rate of pancreatitis.
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Affiliation(s)
- João Fernandes
- Department of Gastroenterology, Santa Luzia Hospital, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jorge Canena
- Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal.,Department of Gastroenterology, Nova Medical School/Faculty of Medical Sciences, Lisbon, Portugal.,Cintesis, Center for Health Technology and Services Research, Porto, Portugal
| | - Gonçalo Alexandrino
- Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
| | - Luísa Figueiredo
- Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
| | - Maria Rafael
- Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
| | - Marta Moreira
- Department of Gastroenterology, Santa Luzia Hospital, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Tarcísio Araújo
- Department of Gastroenterology, Santa Luzia Hospital, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Luís Lourenço
- Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
| | - David Horta
- Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal.,Department of Gastroenterology, Nova Medical School/Faculty of Medical Sciences, Lisbon, Portugal
| | - Pietro Familiari
- Digestive Endoscopy Unit, Agostino Gemelli University Hospital, Rome, Italy
| | - Mário Dinis-Ribeiro
- Digestive Endoscopy Unit, Agostino Gemelli University Hospital, Rome, Italy.,Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Luís Lopes
- Department of Gastroenterology, Santa Luzia Hospital, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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11
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Weng M, Wang L, Weng H, Gu J, Wang X. Utility of endoscopic retrograde cholangiopancreatography in infant patients with conservational endoscopy. Transl Pediatr 2021; 10:2506-2513. [PMID: 34765474 PMCID: PMC8578769 DOI: 10.21037/tp-21-406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/14/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The indications for endoscopic retrograde cholangiopancreatography (ERCP) in infant patients (age <1 year) differ from those in adults. A paucity of data and concerns about the potential lower effectiveness and more adverse effects limit its utility, even in tertiary care centres. In this study, we retrospectively analysed the indications, success rates, and adverse effects of ERCP in these groups. METHODS From June 2014 to March 2018, 17 ERCPs were performed in 15 children [median age: 10.4 months (6-12 months); median weight: 6.6 kg (3.3-10.7 kg)]. A conventional duodenoscope was utilized in all procedures. All patients were followed up as inpatients. RESULTS Fifteen therapeutic and two diagnostic procedures were managed by licensed paediatric endoscopist. Successful cannulation was obtained in all patients (100%). A high proportion (47.1%) of pancreaticobiliary maljunction (PBM) and therapeutic procedures (88.2%) were identified. Two cases of mild pancreatitis were recorded, accounting for 12.5% of the post-ERCP pancreatitis (PEP) rate. By multivariable analysis, recurrent acute pancreatitis and pancreatic duct (PD) cannulation/injection were identified as PEP-related risk factors. All complications were managed conservatively. CONCLUSIONS ERCP in infant patients (0.5< age <1 year) could be safely completed by conservational endoscopy. A high proportion of PBM and therapeutic procedures were identified in our study cohort. The overall adverse-event rate was acceptable, and no serious complication occurred. The PEP-related independent risk factors included recurrent acute pancreatitis and PD cannulation/injection.
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Affiliation(s)
- Mingzhe Weng
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lubing Wang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai, China
| | - Hao Weng
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Gu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuefeng Wang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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Fung BM, Pitea TC, Tabibian JH. Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: Definitions, Risk Factors, and Implications. Eur Med J Hepatol 2021; 9:64-72. [PMID: 34621527 PMCID: PMC8494185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Over the past 50 years, endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred minimally invasive method of treating a vast array of pancreatobiliary diseases. An initial sine qua non for ERCP success is selective ductal cannulation. Despite significant progress in the optimisation of ERCP methods and accessories, selective biliary cannulation using conventional techniques remains unsuccessful in approximately 15% of native papilla cases. Furthermore, difficult biliary cannulation has been associated with an increased risk of post-ERCP pancreatitis, among other adverse events. Here, in the first of a two-part series, the authors provide a primer on standard biliary cannulation techniques and discuss the definition, risk factors, and implications of difficult biliary cannulation. The second part of the series will provide an overview of the existing advanced techniques used in cases of difficult biliary cannulation as well as the approach to their selection.
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Affiliation(s)
- Brian M. Fung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine – Phoenix, Arizona, USA
- Banner – University Medical Center Phoenix, Arizona, USA
| | | | - James H. Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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13
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Tomoda T, Kato H, Miyamoto K, Matsumi A, Ueta E, Fujii Y, Saragai Y, Yamazaki T, Uchida D, Matsumoto K, Horiguchi S, Tsutsumi K, Okada H. Efficacy of low dose rectal diclofenac for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: Propensity score-matched analysis. Dig Endosc 2021; 33:656-662. [PMID: 32881078 DOI: 10.1111/den.13828] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute pancreatitis is a major adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Rectal administration of non-steroidal anti-inflammatory drugs (NSAIDs) decreases the incidence of post-ERCP pancreatitis (PEP). However, the efficacy of low dose rectal NSAIDs for preventing PEP remains controversial. METHODS We performed a retrospective study of 301 patients with native papilla and a body weight of <50 kg who underwent ERCP between September 2010 and October 2019. After July 2016, a 25 mg dose of rectal diclofenac was routinely administered within 15 min before ERCP (NSAIDs group, n = 72) and the control group (n = 229) consisted of patients undergoing ERCP before this date without treatment. We compared the incidence of PEP between the two groups using propensity score matching. RESULTS A total of 66 pairs of patients in each group were selected. The patients and procedural-related factors were similar in both groups. In total, 15 patients (11.4%) developed PEP: 12.1% (8/66) in the NSAIDs group and 10.6% (7/66) in the control group (Odds ratio (OR) 1.2; 95% confidence interval (CI) 0.4-3.5; P = 0.78). There was no significant difference in incidence of other adverse events related to ERCP between the two groups. CONCLUSIONS Prophylactic administration of a 25 mg dose of rectal diclofenac did not reduce the incidence of PEP in patients with a native papilla and a body weight of <50 kg in this study and a certain dose of rectal NSAIDs, such as a 100-mg dose, should be administered regardless of body weight to prevent PEP.
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Affiliation(s)
- Takeshi Tomoda
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Kazuya Miyamoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Akihiro Matsumi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Eijiro Ueta
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Yuuki Fujii
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Yousuke Saragai
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Tatsuhiro Yamazaki
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Daisuke Uchida
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Kazuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Koichiro Tsutsumi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
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14
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Kadokura M, Takenaka Y, Yoda H, Yasumura T, Okuwaki T, Tanaka K, Amemiya F. Asymptomatic Common Bile Duct Stones Are Associated with Increased Risk of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. JMA J 2021; 4:141-147. [PMID: 33997448 PMCID: PMC8118962 DOI: 10.31662/jmaj.2020-0123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Common bile duct stones (CBDS) are a common disease that can cause biliary complications, including cholangitis, obstructive jaundice, and biliary pancreatitis. Regardless of the presence or absence of symptoms, endoscopic removal of CBDS is generally recommended, but endoscopic retrograde cholangiopancreatography (ERCP) is a high-risk procedure with complications, such as post-ERCP pancreatitis (PEP). As few reports have addressed the risk of PEP by focusing on asymptomatic CBDS, the purpose of this study is to examine the incidence of PEP for asymptomatic CBDS. Methods: This retrospective study included data from 302 patients with naive papilla who underwent therapeutic ERCP for CBDS between January 2012 and December 2019 at our hospital. Univariate and multivariate logistic regression models were used to investigate independent risk factors for PEP. Results: Of the 302 patients, 32 were asymptomatic, and the remaining 270 were symptomatic. Five asymptomatic patients (15.6%) suffered from mild PEP, whereas 10 (3.7%) symptomatic patients suffered from PEP (9 were mild, and 1 was severe). Univariate analysis identified deep cannulation time more than 10 min, endoscopic papillary balloon dilation (EPBD), and asymptomatic CBDS as risk factors for PEP, whereas multivariate analysis revealed deep cannulation time more than 10 min (odds ratio (OR), 6.67; p < 0.001), EPBD (HR, 5.70; p < 0.001), and asymptomatic CBDS (HR, 5.49; p < 0.001) as independent risk factors for PEP. Conclusions: A wait-and-see approach may be an option for the management of asymptomatic CBDS. EPBD may be avoided, especially in case of asymptomatic or if difficult for bile duct cannulation.
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Affiliation(s)
- Makoto Kadokura
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu, Japan
| | - Yumi Takenaka
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu, Japan
| | - Hiroki Yoda
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu, Japan
| | - Tomoki Yasumura
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu, Japan
| | - Tetsuya Okuwaki
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu, Japan
| | - Keisuke Tanaka
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu, Japan
| | - Fumitake Amemiya
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu, Japan
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15
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Bhatt H. Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: An Updated Review of Current Preventive Strategies. Clin Exp Gastroenterol 2021; 14:27-32. [PMID: 33564256 PMCID: PMC7866941 DOI: 10.2147/ceg.s276361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography, with incidence rates as high as 16% in some centers. Recent studies have also shown an upward trend in hospitalization due to endoscopic retrograde cholangiopancreatography-related pancreatitis. Early interventions taken before, during, and after the procedure can significantly reduce the risk of pancreatitis and decrease morbidity and mortality of the patients. To select appropriate patients for endoscopic retrograde cholangiopancreatography, in-depth knowledge of the patient-related and procedure-related risk factors is required. This updated clinical review outlines various pharmacological agents and surgical methods used for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Current evidence supports the use of rectal non-steroidal anti-inflammatory drugs and pancreatic stent placement as an effective preventive strategy. Further research is needed to compare these preventive modalities to improve patient outcomes after endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
- Harshil Bhatt
- Goshen Hospital, Goshen, IN, USA.,Indiana University School of Medicine, South Bend, IN, USA
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16
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Dubravcsik Z, Hritz I, Szepes A, Madácsy L. Prophylactic stents in the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. Orv Hetil 2021; 162:31-38. [PMID: 33388737 DOI: 10.1556/650.2021.31934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Az endoszkópos retrográd cholangiopancreatographiát (ERCP) követő pancreatitis (PEP) incidenciája a magas kockázatú betegcsoportban 14,7%. Célkitűzés: A munkacsoportunk által szerzett tapasztalatok elemzése. Módszerek: A profilaktikus pancreassztentes (PPS), magas kockázatú betegek adatait tartalmazó prospektív adatbázisunkat elemeztük retrospektív módon. Az adatokat a PEP-incidencia és a súlyosság tekintetében összehasonlítottuk a korábbi, hasonlóan magas kockázatú, sztent nélküli beteganyagunkkal, illetve a sztenteléssel kapcsolatos szövődményeket és a különböző sztenttípusokat is elemeztük. A Cotton-kritériumok szerint értékeltük a PEP-t. Eredmények: A 317, magas kockázatú betegből 288 esetben (90,9%) volt sikeres a PPS-implantáció. A sztent nélküli kontrollcsoportba 121, magas kockázatú beteget választottunk be. A sikeresen sztentelt betegekben a PEP incidenciája 10,0% volt. Ez és a PEP súlyossága (enyhe: 8,3%, középsúlyos: 1,4%, súlyos: 0,3%) is szignifikánsan alacsonyabb volt a PPS nélküli beteganyaghoz (PEP: 31,4%, enyhe: 15,7%, középsúlyos: 10,7%, súlyos: 5,0%) és a sikertelenül sztentelt betegekhez (PEP: 41,3%, enyhe: 24,1%, középsúlyos: 13,8%, súlyos: 3,4%) képest. Az utóbbi két csoport közötti különbség nem volt szignifikáns. A sztenttel kapcsolatos szövődmények közül a leggyakrabban a korai sztentkicsúszást (5/288 beteg, 1,74%) és a proximalis sztentmigrációt (3/288 beteg, 1,04%) észleltük. A sztenttípusok közül a legkedvezőbb mellékhatás-profilúnak a Freeman-típusú, belső füllel és külső "pigtail" véggel ellátott sztenteket találtuk. Következtetés: A profilaktikus pancreassztentelés hatékonyan csökkenti a PEP incidenciáját, és a súlyosságát az enyhébb esetek felé tolja el. Alkalmazása viszonylag egyszerű, azonban ismerni kell használatának megfelelő technikáját, időben történő eltávolításának és a szövődmények felismerésének fontosságát. Eredményeink és a nemzetközi ajánlások alapján magas PEP-rizikójú betegekben a PPS rutinszerű alkalmazása minden ERCP-laborban ajánlott. Orv Hetil. 2021; 162(1): 31-38. SUMMARY INTRODUCTION The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP). Its incidence in the high-risk patient population is 14.7%. OBJECTIVE To analyze 10 years experiences of our working group. METHODS We retrospectively analyzed our prospective database of high-risk patients treated with prophylactic pancreatic stents (PPS) including the period between 2009 and 2014. We compared PEP incidence and severity findings with our historical data of pre-PPS period of similarly high-risk patients (no-stent group), furthermore analyzed the complications of PPS insertion and different stent types. PEP was defined and categorized according to the Cotton criteria. RESULTS In 317 high-risk patients, PPS implantation was successful in 288 cases (90.9%). The no-stent group comprised of 121 patients. Incidence and the severity of PEP in the successfully stented group (all: 10.0%; mild: 8.3%, moderate: 1.4%, severe: 0.3%) were significantly lower compared to the no-stent group (all: 31.4%; mild: 15.7%, moderate: 10.7%, severe: 5.0%) and the unsuccessfully stented group (all: 41.3%; mild: 24.1%, moderate: 13.8%, severe: 3.4%). The difference between the latter two groups was not significant. Only early dislodgment (5/288 patients, 1.74%) and proximal migration (3/288 patients, 1.04%) were observed as stent-related complications. Freeman type (single inner flange, outer pigtail end) stent was the best based on the complication profile. CONCLUSION Prophylactic pancreatic stenting effectively lowers the incidence and severity of PEP. We should recognize the proper technic of its application and the importance of proper timing of its extraction and identification of complications. Utilization of PPSs in high-risk patients is strongly recommended in every ERCP center. Orv Hetil. 2021; 162(1): 31-38.
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Affiliation(s)
- Zsolt Dubravcsik
- 1 Bács-Kiskun Megyei Kórház, Belgyógyászat, Gasztroenterológia, Kecskemét, Nyíri út 38., 6000
| | - István Hritz
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Sebészeti Klinika, Invazív Endoszkópos Centrum, Budapest
| | - Attila Szepes
- 1 Bács-Kiskun Megyei Kórház, Belgyógyászat, Gasztroenterológia, Kecskemét, Nyíri út 38., 6000
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17
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Pan G, Yang K, Gong B, Deng Z. Analysis of the Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Children With Symptomatic Pancreas Divisum. Front Pediatr 2021; 9:761331. [PMID: 34796156 PMCID: PMC8592933 DOI: 10.3389/fped.2021.761331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in children with symptomatic pancreas divisum (PD). Aim: To investigate the safety and efficacy of ERCP in the treatment of children with symptomatic PD. Methods: We performed a retrospective analysis on children with PD who were treated with ERCP at Shanghai Children's Medical Center between June 2015 and May 2020. Pertinent patient, clinical and procedural data were collected to assess the therapeutic effects and identify the risk factors for post-ERCP pancreatitis (PEP). Results: Overall, 114 ERCPs were performed in 46 children with PD. With a median follow-up of 28.5 months (12-71 months), 40 (87.0%) children achieved clinical remission, the median number of acute pancreatitis episodes decreased from four times per year pre-operatively to once per year post-operatively (P < 0.001), and the nutritional score improved post-operatively (P = 0.004). The incidence of PEP was 7.9%, and female sex, stone extraction, and gene mutations were identified as possible risk factors for PEP on univariate analysis. However, there was no statistical significance on multivariate analysis (P > 0.05). Conclusion: Therapeutic ERCP is an effective and safe intervention for children with symptomatic PD.
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Affiliation(s)
- Guixian Pan
- Department of Gastroenterology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaihua Yang
- Department of Gastroenterology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Biao Gong
- Department of Gastroenterology, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhaohui Deng
- Department of Gastroenterology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ishii S, Isayama H, Ushio M, Takahashi S, Yamagata W, Takasaki Y, Suzuki A, Ochiai K, Tomishima K, Kanazawa R, Saito H, Fujisawa T, Shiina S. Best Procedure for the Management of Common Bile Duct Stones via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety. J Clin Med 2020; 9:E3808. [PMID: 33255554 DOI: 10.3390/jcm9123808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Endoscopic management of common bile duct stones (CBDS) is standard; however, various techniques are performed via the papilla, and the best procedure in terms of both efficacy and safety has not been determined. Methods: Endoscopic procedures were classified into five categories according to endoscopic sphincterotomy (EST) and balloon dilation (BD): (1) EST, (2) endoscopic papillary BD (≤10 mm) (EPBD), (3) EST followed by BD (≤10 mm) (ESBD), (4) endoscopic papillary large BD (≥12 mm) (EPLBD), and (5) EST followed by large BD (≥12 mm) (ESLBD). We performed a literature review of prospective and retrospective studies to compare efficacy and adverse events (AEs). Each procedure was associated with different efficacy and AE profiles. Results: In total, 19 prospective and seven retrospective studies with a total of 3930 patients were included in this study. For EST, the complete stone removal rate at the first session, rate of mechanical lithotripsy (ML), and rate of overall AEs in EST were superior to EPBD, but a higher rate of bleeding was found for EST. Based on one retrospective study, complete stone removal rate at the first session, rate of ML, and rate of overall AEs were superior for ESBD vs. EST, and the rate of bleeding for the former was also lower. Complete stone removal rate at the first session and rate of ML for ESLBD were superior to those for EST, with no significant difference in rate of AEs. For EST vs. EPLBD, complete stone removal rate at the first session and rate of ML were superior for the latter. For EPLBD vs. ESLBD, the efficacy and safety were similar. Conclusions: ESBD is considered the best procedure for the management of small CBDS, but strong evidence is lacking. For large CBDS, both ESLBD and EPLBD are similar.
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Lee SH, Lee JM, Han NY, Kim MJ, Park BJ, Sung DJ, Sim KC. Predicting cannulation difficulty in endoscopic retrograde cholangiopancreatography using CT image findings: a decision-tree analysis. Acta Radiol 2020; 61:1484-1493. [PMID: 32208743 DOI: 10.1177/0284185120909334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP) is associated with increased complications; therefore, its prediction is important. PURPOSE To identify radiologic risk factors of difficult cannulation during ERCP based on computed tomography (CT) findings and to develop a predictive model for a difficult cannulation. MATERIAL AND METHODS A total of 171 patients with native papilla who underwent both enhanced CT and ERCP were recruited. Two radiologists independently measured the distal common bile duct (CBD) diameter and choledochoduodenal (CD) angle and analyzed CT images for presence of CBD stone and papilla bulging, size and type of periampullary diverticulum (PAD), and duodenal segment in which major papilla was located. Multivariate logistic regression analysis and decision-tree analysis were performed to identify risk factors for difficult cannulation. RESULTS Thirty-nine patients underwent a difficult cannulation. The multivariate logistic regression analysis revealed that a smaller CBD diameter, presence of papilla bulging, location of the major papilla other than the descending duodenum, a smaller CD angle, and a higher worrisome PAD score were statistically relevant factors for difficult cannulation (P < 0.049). In the decision-tree analysis, a higher worrisome PAD score was the strongest predictor of difficult cannulation, followed by the presence of papilla bulging, smaller CD angle, and a smaller CBD diameter. The predictive model had an 82.5% overall predictive accuracy. CONCLUSION The CT findings-based decision-tree analysis model showed a high accuracy in predicting cannulation difficulty and may be helpful for making pre-ERCP strategy.
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Affiliation(s)
- Sun Hwa Lee
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Min Lee
- Department of Internal Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Na Yeon Han
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ju Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Beom Jin Park
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Deuk Jae Sung
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ki Choon Sim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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20
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Köseoğlu H, Solakoğlu T, Başaran M, Özer Sarı S, Tahtacı M, Yaman S, Selvi E, Ersoy O. Risk factors for post-ERCP pancreatitis: it depends on the ERCP indication. Acta Gastroenterol Belg 2020; 83:598-602. [PMID: 33321017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive modality, and has a high risk of causing post-ERCP pancreatitis (PEP). Risk factors of PEP have been investigated and conflicting results are present for most risk factors. The aim of this study was to evaluate the risk factors for PEP and to determine whether the risk factors differ due to the ERCP indication. PATIENTS AND METHODS A retrospective study was conducted which included 666 patients with 968 ERCP procedures. Some risk factors were evaluated for PEP, and they were also evaluated separately for patients with bile duct stones and patients who underwent ERCP for other reasons than bile duct stones. RESULTS In patients with bile duct stones detected on ERCP ; female gender, lower diameter of the common bile duct, placing a biliary plastic stent and not having a cholecystectomy history were risk factors for PEP, whereas in patients without bile duct stones the only risk factor for PEP was not having a prior endoscopic sphincterotomy. CONCLUSIONS Our study revealed that PEP risk factors depend on the indication of ERCP. To the best of our knowledge our study is the first study defining cholecystectomy as a protective factor for PEP in patients with bile duct stones and endoscopic sphincterotomy history as a protective factor for PEP in patients without bile duct stones. Our study also showed that female gender, lower diameter of the common bile duct and placing a plastic biliary stent were risk factors for PEP in patients with bile duct stones.
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Affiliation(s)
- H Köseoğlu
- Department of Gastroenterology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - T Solakoğlu
- Department of Gastroenterology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - M Başaran
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - S Özer Sarı
- Department of Gastroenterology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - M Tahtacı
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - S Yaman
- Department of Internal Medicine, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - E Selvi
- Department of Gastroenterology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - O Ersoy
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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21
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Ishii S, Fujisawa T, Ushio M, Takahashi S, Yamagata W, Takasaki Y, Suzuki A, Okawa Y, Ochiai K, Tomishima K, Kanazawa R, Saito H, Shiina S, Isayama H. Evaluation of the safety and efficacy of minimal endoscopic sphincterotomy followed by papillary balloon dilation for the removal of common bile duct stones. Saudi J Gastroenterol 2020; 26:290342. [PMID: 32719239 PMCID: PMC8019135 DOI: 10.4103/sjg.sjg_162_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/03/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIM A sufficiently open papilla is needed to remove common bile duct stones (CBDS) but endoscopic sphincterotomy (EST) requires a high level of skill and is difficult with endoscopic papillary balloon dilation (EPBD). The main adverse event of EST is bleeding and perforation and that of EPBD is post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. To reduce these adverse events we employed minimal EST followed by papillary dilation (ESBD), and retrospectively evaluated its efficacy and safety compared with EST. PATIENTS AND METHODS CBDS patients who underwent EST (n = 114) or ESBD (n = 321) at Juntendo University Hospital from January 2009 to December 2018 were consecutively enrolled, retrospectively. The exclusion criteria were large-balloon dilation (≥ 12 mm), large CBDS (>12 mm), and previous EST/EPBD. We compared the overall stone removal rate, incidence of adverse event, procedure time, number of ERCP procedures, and rate of mechanical lithotripsy (ML) between the two groups. RESULTS Complete stone removal was successful in both ESBD and EST group. However, the rate of multiple ERCP sessions was significantly lower (35.1% vs. 12.8%, P < 0.001), procedure time was shorter (31.6 vs. 25.8 min, P = 0.01), and rate of ML was lower (16.7% vs. 7.8%, P = 0.01) in ESBD group. Bleeding was significantly more frequent in the EST group (9.6% vs. 1.2%, P < 0.001), particularly acute bleeding (7.9% vs. 0.9%, P < 0.001). CONCLUSIONS ESBD is more efficient and safer in the management of CBD stones than EST. A prospective randomized study comparing ESBD with EST is needed to establish this combination technique.
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Affiliation(s)
- Shigeto Ishii
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Toshio Fujisawa
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Mako Ushio
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Sho Takahashi
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Wataru Yamagata
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Takasaki
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Akinori Suzuki
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshihiro Okawa
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazushige Ochiai
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ko Tomishima
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryo Kanazawa
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
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22
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Kalantzis I, Poulou A, Papatheodorou A, Gkoumas K. Rectal versus intramuscular diclofenac in prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: experience of a Greek tertiary referral center. Ann Gastroenterol 2020; 33:412-417. [PMID: 32624663 PMCID: PMC7315719 DOI: 10.20524/aog.2020.0487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/15/2019] [Indexed: 01/31/2023] Open
Abstract
Background: Independent patient-related and procedure-related factors increase the risk of pancreatitis after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis [PEP]). Non-steroidal anti-inflammatory drugs (NSAIDs) have demonstrated efficacy in reducing the incidence of PEP. This study investigated the difference in the incidence of PEP between intramuscular and rectal prophylactic administration of diclofenac before ERCP. Methods: We performed a retrospective analysis of data from 516 patients who underwent ERCP during the period 2014-2017. The route of diclofenac administration (rectal or intramuscular), patient-related and procedure-related risk factors, as well as serum amylase levels 18 h after the endoscopic procedure and immediate bleeding during ERCP were recorded and evaluated. Results: The overall incidence of PEP was 4.5%, without significant differences between the rectal (5.2%) and intramuscular (3.9%) routes of administration. The factor that appeared to be of significance was pre-cut sphincterotomy, since patients who underwent that procedure showed a higher probability of PEP (P=0.05; odds ratio 2.67, 95% confidence interval). Intraprocedural bleeding was almost twice as frequent in the rectal compared to the intramuscular group. Pancreatic stent placement did not appear to be statistically significant in the prevention of PEP, either alone or in combination with diclofenac administration. Conclusions: The results of our study did not reveal any statistically significant difference between the rectal or intramuscular administration of diclofenac in the prevention of PEP, contradicting the results of the majority of studies and meta-analyses published so far. One of the known risk factors associated with increased risk of PEP was also confirmed.
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Affiliation(s)
- Ioannis Kalantzis
- Department of Gastroenterology (Ioannis Kalantzis, Androniki Poulou, Konstantinos Gkoumas)
| | - Androniki Poulou
- Department of Gastroenterology (Ioannis Kalantzis, Androniki Poulou, Konstantinos Gkoumas)
| | - Athanasios Papatheodorou
- Department of Radiology (Athanasios Papatheodorou), Korgialeneio-Mpenakeio Hellenic Red Cross Hospital, Athens, Greece
| | - Konstantinos Gkoumas
- Department of Gastroenterology (Ioannis Kalantzis, Androniki Poulou, Konstantinos Gkoumas)
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23
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Katoh T, Kawashima K, Fukuba N, Masuda S, Kobatake H, Masaki K, Araki Y, Kawano K, Nishi K, Takenaka M, Ishihara S, Kinoshita Y. Low-dose rectal diclofenac does not prevent post-ERCP pancreatitis in low- or high-risk patients. J Gastroenterol Hepatol 2020; 35:1247-1253. [PMID: 31788849 DOI: 10.1111/jgh.14948] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The most common adverse event following an endoscopic retrograde cholangiopancreatography (ERCP) procedure is post-ERCP pancreatitis (PEP). Rectal nonsteroidal anti-inflammatory drug (NSAID) administration has shown promise to reduce the risk of PEP in high-risk patients. However, in contrast to high-risk patients, the role of NSAID administration in patients with low risk remains controversial. METHODS We performed a prospective, single-center, single-blinded, two-arm parallel group, randomized controlled trial to clarify the efficacy of low dose (50 mg) rectal NSAID administration for preventing PEP in at-risk patients. Patients scheduled to undergo ERCP were randomized into two groups, those with and without rectal administration of diclofenac. Patients in the diclofenac group received 50 mg of rectal diclofenac 30 min before undergoing ERCP. The primary endpoint was rate of PEP. RESULTS A total of 303 were randomized into the study groups. Four patients declined participation following randomization, and another two were withdrawn. As a result, a total of 147 patients were assigned to the diclofenac group and 150 to the control group. The baseline and procedural characteristics were similar in both groups. The primary endpoint of PEP occurrence was seen in 13 of 297 patients (4.4%), including eight (5.4%) in the diclofenac group and five (3.3%) in the control group (P = 0.286). Additionally, those results were not significantly different when patients were classified as low or high risk. CONCLUSIONS Prophylactic low-dose rectal diclofenac did not reduce the incidence of PEP following ERCP in patients classified as low or high risk.
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Affiliation(s)
- Takao Katoh
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, 137-1 Shioya, Sumoto, Hyogo, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine, Izumo City General Medical Center, Izumo, Shimane, Japan
| | - Shigeto Masuda
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, 137-1 Shioya, Sumoto, Hyogo, Japan
| | - Hiroko Kobatake
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, 137-1 Shioya, Sumoto, Hyogo, Japan
| | - Kousaku Masaki
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, 137-1 Shioya, Sumoto, Hyogo, Japan
| | - Yasuhiro Araki
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, 137-1 Shioya, Sumoto, Hyogo, Japan
| | - Koichiro Kawano
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, 137-1 Shioya, Sumoto, Hyogo, Japan
| | - Katsuhisa Nishi
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, 137-1 Shioya, Sumoto, Hyogo, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.,Department of Medicine, Steel Memorial Hirohata Hospital, Himeji, Hyogo, Japan
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24
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Ikarashi S, Kawai H, Hayashi K, Kohisa J, Sato T, Nozawa Y, Morita S, Oka H, Sato M, Aruga Y, Yoshikawa S, Terai S. Risk factors for walled-off necrosis associated with severe acute pancreatitis: A multicenter retrospective observational study. J Hepatobiliary Pancreat Sci 2020; 27:887-895. [PMID: 32506672 DOI: 10.1002/jhbp.787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/02/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study aimed to identify the risk factors for walled-off necrosis (WON) associated with severe acute pancreatitis (SAP). METHODS This retrospective study was conducted in eight institutions in Japan between 2014 and 2017. We analyzed WON incidence, patient characteristics, and risk factors for WON in patients with SAP who were observed for >28 days. RESULTS Of 134 patients with SAP, WON occurred in 40 (29.9%). Male sex (P = .045), body mass index (BMI) ≥25 (P < .001), post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (P = .020), and disseminated intravascular coagulation (DIC) (P = .001) were more frequent in the WON group than in the non-WON group. On admission, the frequency of white blood cell counts ≥ 12 000/µL (P = .037) and hypoenhanced pancreatic lesion on computed tomography (P = .047) were significantly higher in the WON group. In multivariate analysis, BMI ≥ 25 (odds ratio [OR] 5.73, 95% confidence interval [CI] 1.95-16.8; P = .002), post-ERCP (OR 8.08, 95% CI 1.57-41.7; P = .013), and DIC (OR 3.52, 95% CI 1.20-10.4; P = .022) were independent risk factors for WON. CONCLUSIONS High BMI, post-ERCP pancreatitis, and DIC are risk factors for the development of WON associated with SAP.
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Affiliation(s)
- Satoshi Ikarashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hirokazu Kawai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.,Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Shibata, Japan
| | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Junji Kohisa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.,Department of Gastroenterology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Toshifumi Sato
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Shibata, Japan
| | - Yujiro Nozawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Shinichi Morita
- Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine Niigata University Hospital, Minami-Uonuma, Japan
| | - Hiromitsu Oka
- Department of Internal Medicine, Nagaoka Chuo General Hospital, Nagaoka, Japan
| | - Munehiro Sato
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata, Japan
| | - Yukio Aruga
- Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Japan
| | - Seiichi Yoshikawa
- Department of Gastroenterology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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25
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Balan GG, Arya M, Catinean A, Sandru V, Moscalu M, Constantinescu G, Trifan A, Stefanescu G, Sfarti CV. Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study. J Clin Med 2020; 9:jcm9061637. [PMID: 32481755 PMCID: PMC7356786 DOI: 10.3390/jcm9061637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/09/2020] [Accepted: 05/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) has been one of the most intensely studied endoscopic procedures due to its overall high complication rates when compared to other digestive endoscopy procedures. The safety and outcome of such procedures have been linked to multiple procedure- or patient-related risk factors. The aim of our study is to evaluate whether the morphology of the major duodenal papilla influences the ERCP outcomes and complication rates. METHODS A total of 322 patients with a native papilla have been included in the study over an eight month period. Morphology of the papilla has been classified into normal papilla and four anatomical variations (Type I-IV). All patients have been prospectively monitored over a 15 day period after ERCP. Procedural outcomes and complication rates have been registered. RESULTS Morphology of the papilla influences both overall complication rates (95%CI, p = 0.0066) and post-ERCP pancreatitis rates (95%CI, p = 0.01001) in univariate analysis. Type IV papillae have proven to be independent risk factors for post-ERCP pancreatitis in multivariate analysis (OR = 12.176, 95%CI, p = 0.005). Type I papillae have been significantly linked to difficult cannulation (AUC = 0.591, 95%CI, p = 0.008); Conclusions: In the monitored cohort morphology of the major duodenal papilla has significantly influenced both ERCP outcomes and post-procedural complication rates.
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Affiliation(s)
- Gheorghe G. Balan
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.G.B.); (M.M.); (A.T.); (C.V.S.)
| | - Mukul Arya
- New York Presbitarian Brooklyn Methodist Hospital, New York, NY 11215, USA;
| | - Adrian Catinean
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Vasile Sandru
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
- Correspondence: (V.S.); (G.S.)
| | - Mihaela Moscalu
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.G.B.); (M.M.); (A.T.); (C.V.S.)
| | - Gabriel Constantinescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Anca Trifan
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.G.B.); (M.M.); (A.T.); (C.V.S.)
| | - Gabriela Stefanescu
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.G.B.); (M.M.); (A.T.); (C.V.S.)
- Correspondence: (V.S.); (G.S.)
| | - Catalin Victor Sfarti
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.G.B.); (M.M.); (A.T.); (C.V.S.)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Geng C, Li X, Li Y, Song S, Wang C. Nonsteroidal anti-inflammatory drugs alleviate severity of post-endoscopic retrograde cholangiopancreatography pancreatitis by inhibiting inflammation and reducing apoptosis. J Gastroenterol Hepatol 2020; 35:896-904. [PMID: 32064683 DOI: 10.1111/jgh.15012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM The prophylactic effect of nonselective nonsteroidal anti-inflammatory drugs on post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis has been observed for a long time. However, whether the selective nonsteroidal anti-inflammatory drugs possess similar abilities and the mechanisms by which nonsteroidal anti-inflammatory drugs work remain unclear. The present study aimed to determine the protective effects of nonsteroidal anti-inflammatory drugs on post-ERCP pancreatitis in a rat model and examine underlying mechanisms. METHODS Thirty-two female rats were equally and randomly divided into four groups: the sham group, post-ERCP pancreatitis model group, indomethacin-pretreated group, and parecoxib-pretreated group. Indomethacin or parecoxib was delivered 30 min prior to surgery; 24 h after post-ERCP pancreatitis establishment, the rats were sacrificed. Serum amylase and lipase activities, inflammatory cytokine release, pancreatic histopathological scores, neutrophil infiltration, and the expression pattern cyclooxygenase at the protein level and pancreatic apoptosis were quantified and analyzed. RESULTS Both indomethacin and parecoxib inhibited the activities of serum amylase and lipase and reduced the severity of pancreatic histopathology. Mechanistically, both drugs decreased the expression level of cyclooxygenase 2; however, they had no influence on the cyclooxygenase 1 protein level. Moreover, they reduced inflammatory cytokine release, neutrophil infiltration into the pancreas, and NF-κB p65 activation. Notably, we found that apoptotic cells in the pancreas were remarkably diminished after the administration of both nonsteroidal anti-inflammatory drugs. CONCLUSIONS Both selective and nonselective nonsteroidal anti-inflammatory drugs exert protective effects against post-ERCP pancreatitis by restraining inflammation and reducing acinar cell apoptosis through the inhibition of cyclooxygenase 2.
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Affiliation(s)
- Chong Geng
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao Li
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Yanni Li
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Shuailing Song
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Chunhui Wang
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
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Maruyama H, Shiba M, Ishikawa-Kakiya Y, Kato K, Ominami M, Fukunaga S, Otani K, Hosomi S, Tanaka F, Kamata N, Taira K, Nagami Y, Yamagami H, Tanigawa T, Watanabe T, Yamamoto A, Kabata D, Shintani A, Fujiwara Y. Positive correlation between pancreatic volume and post-endoscopic retrograde cholangiopancreatography pancreatitis. J Gastroenterol Hepatol 2020; 35:769-776. [PMID: 31618801 DOI: 10.1111/jgh.14878] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/16/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains the most common and serious adverse event associated with ERCP. Risk factors for PEP have been described in various reports. However, risk factors have not been quantified to date. The aim of this study was to investigate the risk factors for PEP by quantification of pancreatic volume using pre-ERCP images. METHODS Overall, 800 patients were recruited from April 2012 to February 2015 for this study. There were 168 patients who satisfied the inclusion criteria. Measurement of pancreatic volume was achieved using the volume analyzer SYNAPSE VINCENT in all cases and was used to evaluate the risk factors for PEP. RESULTS According to the criteria established by the consensus guidelines (Cotton classification), 17 patients (10.1%) were classified as having mild disease, 4 (2.4%) as having moderate disease, and 5 (3.0%) as having severe disease. Multivariate model analysis showed that a large pancreatic volume was a significant risk factor for PEP (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.06-1.13; P < 0.001). In addition, the association between the pancreatic volume and the severity of PEP was positively correlated (the effect of volume [per 1 mL]; OR 1.09, 95% CI 1.07-1.12; P < 0.001, the effect of volume [per 10 mL]; OR 2.27, 95% CI 1.72-3.00; P < 0.001). A larger pancreatic volume was significantly associated with a higher incidence of PEP. CONCLUSIONS A large pancreatic volume was identified as a risk factor for PEP. The results of this study suggest that pre-ERCP images might be useful for predicting PEP.
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Affiliation(s)
- Hirotsugu Maruyama
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masatsugu Shiba
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yuki Ishikawa-Kakiya
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kunihiro Kato
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masaki Ominami
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koji Otani
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Taira
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hirokazu Yamagami
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Rejeski J, Hines M, Jones J, Conway J, Mishra G, Evans J, Pawa R. Outcomes of precut sphincterotomy techniques in cases of difficult biliary access. Frontline Gastroenterol 2020; 12:113-117. [PMID: 33613942 PMCID: PMC7873550 DOI: 10.1136/flgastro-2019-101380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/17/2020] [Accepted: 02/17/2020] [Indexed: 02/04/2023] Open
Abstract
GOALS Our study aims to define success and complication rates of precut sphincterotomy with the needle-knife and transpancreatic papillary septotomy (TPS) techniques as experienced at a single, high-volume endoscopy centre. BACKGROUND Complication rates rise with increasing number of failed attempts at biliary cannulation; therefore, early precut sphincterotomy (PS) has been recommended. Selecting the ideal method for PS can be challenging and there is a paucity of data to help guide this decision. STUDY We performed a retrospective analysis over 37 months of endoscopic retrograde cholangiopancreatography (ERCP) experience at a single institution. We identified all ERCPs performed and stratified based on the presence of PS; if PS occurred, a thorough chart review was performed to identify success and complication rates. Patients received guideline-driven management for post-ERCP pancreatitis including rectal indomethacin and pancreatic duct stenting when appropriate. RESULTS We identified 1808 ERCP procedures performed during this time. Successful biliary cannulation was achieved in 1748 cases, yielding a success rate of 96.7% (Grades I-IV ERCP difficulty/complexity). PS was required in 232 cases (12.8%); we identified 88 TPS cases and 114 needle-knife precut sphincterotomy (NKPS) cases. Complications following PS procedures occurred in 9.1% of TPS patients and 11.4% of NKPS patients. Success rates for TPS and NKPS were 97.7% and 81.6%, respectively-a statistically significant difference (p<0.001). CONCLUSION This data supports TPS as a safe and effective option for biliary access in difficult cannulation settings when performed by experienced advanced endoscopists.
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Affiliation(s)
- Jared Rejeski
- Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Marc Hines
- Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Jason Jones
- Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Jason Conway
- Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Girish Mishra
- Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - John Evans
- Section of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Rishi Pawa
- Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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Dubravcsik Z, Hritz I, Szepes A, Madácsy L. Risk factors of post-ERCP pancreatitis in high-risk patients despite prevention with prophylactic pancreatic stents. Scand J Gastroenterol 2020; 55:95-99. [PMID: 31852319 DOI: 10.1080/00365521.2019.1701069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: To analyze risk factors of post-ERCP pancreatitis (PEP) in high risk patients in whom prophylactic pancreatic stents (PPSs) were intended to use to prevent endoscopic retrograde cholangiography (ERCP)-related complications.Patients and methods: Three hundred and seventeen high-risk patients for developing PEP were considered for preventive pancreatic stent placement in our endoscopy unit over 5 years. 5 Fr, 3-5 cm long PPSs were used. All data were collected in a predefined database. Development of PEP despite PPS placement was analyzed.Results: PEP occurred in 29 of 288 successfully stented patients (10.07%; 24 mild, four moderate, one severe). PPS was protective against all risks factors except for sphincter of Oddi dysfunction (SOD). PPS related complication rate was 2.78% (n = 8). Unsuccessful stenting occurred in 29 patients (9.15%), PEP developed in 41.38% (n = 12; seven mild, four moderate, one severe). Those patients who had more patient related risk factors were more likely to develop PEP despite preventive measures with PPS. On the contrary, PPS placement was less successful in patients who had more procedure related risk factors.Conclusions: PPS is protective against all risks factors of PEP except for SOD in high-risk patients. More vulnerable patients who have more patient-related risk factors are more likely to develop PEP despite PPS is used, while more complex procedures predispose to unsuccessful PPS placement in patients with more procedure-related risk factors. PPS insertion in high-risk patients is effective and safe preventive method and the procedure related complication rate is reasonably low.
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Affiliation(s)
- Zsolt Dubravcsik
- Department of Gastroenterology, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
| | - István Hritz
- Department of Gastroenterology, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
| | - Attila Szepes
- Department of Gastroenterology, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
| | - László Madácsy
- Department of Gastroenterology, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
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Goetz M, Andersen P, Bergman J, Frei N, Schmidt A, Kähler G, Martus P, Dechêne A. ERCP in babies: Low risk of post-ERCP pancreatitis - results from a multicentre survey. United European Gastroenterol J 2019; 8:77-80. [PMID: 32213056 DOI: 10.1177/2050640619874187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is rarely performed in newborns, and the risk of post-ERCP pancreatitis (PEP) has not been defined in this age group. We therefore performed a European multicentre analysis of PEP rates and risk factors in children aged ≤1 year. PATIENTS AND METHODS Based on a sample size estimation, 135 consecutive ERCPs in 126 children aged ≤1 year were evaluated from five European centres, and the first ERCP per child analysed. All ERCPs and clinical reports were reviewed manually for PEP and associated risk factors. All ERCPs were performed by endoscopists with high ERCP expertise. RESULTS No PEP was observed (0/126, 0.0%, CI 0-2.9%) despite the formal presence of multiple risk factors and despite lack of PEP prophylaxis (except one patient having received a pancreatic duct stent). The PEP rate was significantly lower than the PEP rate expected in adults with similar risk factors. CONCLUSIONS ERCP in children aged ≤1 year is safe in terms of PEP. The PEP risk is significantly lower in children aged ≤1 year than in adults, therefore no PEP prophylaxis seems to be needed in young children. Risk factors from adults may not apply to children under 1 year. Reluctance to perform diagnostic ERCP in suspected biliary anomalies should not be based on presumed PEP risk.
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Affiliation(s)
- Martin Goetz
- Innere Medizin I, Universitätsklinikum Tübingen, Tübingen, Germany.,Medizinische Klinik IV, Kliniken Böblingen, Böblingen, Germany
| | - Philipp Andersen
- Innere Medizin I, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jacques Bergman
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicola Frei
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Arthur Schmidt
- Department of Medicine II, Faculty of Medicine, University of Freiburg; Medical Centre, Freiburg, Germany
| | - Georg Kähler
- Central Interdisciplinary Endoscopy, Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Martus
- Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Universität Tübingen, Tübingen, Germany
| | - Alexander Dechêne
- Klinik für Innere Medizin 6, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg, Germany.,Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Germany
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32
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Miyatani H, Mashima H, Sekine M, Matsumoto S. Clinical features and management of painless biliary type sphincter of Oddi dysfunction. J Int Med Res 2019; 47:2940-2950. [PMID: 31122105 PMCID: PMC6683895 DOI: 10.1177/0300060519848628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/15/2019] [Indexed: 02/03/2023] Open
Abstract
Objective The objective of this study was to clarify the characteristics and management of painless biliary type sphincter of Oddi dysfunction (SOD). Methods From June 2002 to July 2018, 12 patients who had recurrent liver dysfunction with a dilated bile duct or acute cholestasis of unknown cause without biliary pain (painless SOD) were included in this study. These patients’ characteristics were compared with those of 36 patients with biliary type SOD based on the conventional definition (criteria-based SOD). Results Patients with painless SOD had significantly more prominent bile duct dilation than patients with criteria-based SOD (13.9 vs. 12.2 mm, respectively). Prophylactic biliary drainage was performed significantly more often in patients with painless SOD than criteria-based SOD (67% vs. 11%, respectively). The short-term effectiveness rate of endoscopic sphincterotomy, the symptom recurrence rate, and the incidence of adverse events were not significantly different between the two groups. Conclusions Painless SOD is a specific subtype of biliary SOD that causes recurring liver dysfunction or acute cholestasis without biliary pain. Endoscopic sphincterotomy was effective in the present study, but the relapse rate was as high as that in typical SOD.
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Affiliation(s)
- Hiroyuki Miyatani
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Omiya, Saitama, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Omiya, Saitama, Japan
| | - Masanari Sekine
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Omiya, Saitama, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Omiya, Saitama, Japan
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Sahar N, Ross A, Lakhtakia S, Coté GA, Neuhaus H, Bruno MJ, Haluszka O, Kozarek R, Ramchandani M, Beyna T, Poley JW, Maranki J, Freeman M, Kedia P, Tarnasky P. Reducing the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis using 4-Fr pancreatic plastic stents placed with common-type guidewires: Results from a prospective multinational registry. Dig Endosc 2019; 31:299-306. [PMID: 30506606 DOI: 10.1111/den.13311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Pancreatic plastic stents (PPS) can reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Prospective multicenter documentation of PEP rate after PPS placement is scarce. A new 4-Fr stent designed to be deployed over a 0.035-inch guidewire was used to assess the effectiveness of PEP prophylaxis. METHODS High-PEP-risk patients received a 4-Fr PPS for primary or secondary prophylaxis at seven centers in four countries. Patients were followed until spontaneous PPS migration, endoscopic stent removal, or for 4 months, whichever came first. Main outcome was PEP rate. RESULTS One hundred six (106) patients received PPS for PEP prophylaxis [61 (58%) primary, 45 (42%) secondary prophylaxis]. Median age was 54 years. Eighty-one (76%) PPS were placed using a 0.035-inch guidewire. By investigator choice 99 (93%) stents were single pigtail. Median stent length was 8 cm (range 3-12 cm). Technical success achieved in 100% of cases. Two patients in the primary prophylaxis group (3%, 95% CI 0.4-11%) experienced mild/moderate PEP. Seventy-eight PPS available for analysis underwent spontaneous migration after a median of 29 days. There were no reports of stent-induced ductal trauma. Post-hoc analysis of migration rate by PPS length showed no statistically significant trend. CONCLUSIONS Among high-risk patients in the primary prophylaxis group, observed rates of PEP are low (3%, 95% CI 0.4-11%) with the use of prophylactic 4-Fr pancreatic duct stents compatible with a 0.035-inch guidewire. This low rate is not unequivocally due to the prophylactic stent.
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Affiliation(s)
| | | | | | | | - Horst Neuhaus
- Evangelical Hospital Dusseldorf, Dusseldorf, Germany
| | - Marco J Bruno
- Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Oleh Haluszka
- Temple University Health System, Philadelphia.,Southern Arizona VA Health Care System, Tucson
| | | | | | - Torsten Beyna
- Evangelical Hospital Dusseldorf, Dusseldorf, Germany
| | - Jan W Poley
- Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jennifer Maranki
- Temple University Health System, Philadelphia.,Penn State Milton S. Hershey Medical Center, Hershey
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Abdelfatah MM, Koutlas NJ, Gochanour E, Hamed A, Ibrahim M, Barakat M, Mudireddy PR. Impact of body mass index on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ann Gastroenterol 2019; 32:298-302. [PMID: 31040628 PMCID: PMC6479648 DOI: 10.20524/aog.2019.0367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/11/2019] [Indexed: 01/19/2023] Open
Abstract
Background Pancreatitis is a potential major complication after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis; PEP). Obesity has been associated with increased severity of acute pancreatitis. However, the correlation between obesity and PEP is controversial. Therefore, our study aimed to clarify the relationship between body mass index (BMI) and the incidence and severity of PEP. Methods A retrospective cohort study was conducted to elucidate the relationship between BMI and PEP in all patients who underwent ERCP in a tertiary referral center between January 2009 and October 2016. Patient characteristics and procedure details were collected. PEP was defined by consensus criteria. Multivariate logistic regression was used to determine the association between BMI and PEP. Results The analysis included 2236 patients whose BMI was recorded and had adequate follow up (921 with BMI≥30 kg/m2, 1315 with BMI<30 kg/m2). PEP was diagnosed in 107 (4.8%) patients. PEP was seen in 49 obese patients (5.3%) and 58 non-obese patients (4.4%). In the univariate and multivariate analysis BMI≥30 kg/m2 was not associated with PEP (odds ratio 1.2, 95%CI 0.8-1.8; P=0.32). A subgroup analysis of different BMI subcategories found that BMI was not associated with the incidence or severity of PEP. Conclusion In the largest study to date, neither obesity nor low body weight increased the incidence or severity of PEP.
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Affiliation(s)
- Mohamed M Abdelfatah
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, East Carolina University, Greenville, NC (Mohamed M. Abdelfatah, Nicholas J. Koutlas, Eric Gochanour, Ahmed Hamed, Mariam Ibrahim, Prashant R. Mudireddy).,Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Emory University, Atlanta, GA (Mohamed M. Abdelfatah), USA
| | - Nicholas J Koutlas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, East Carolina University, Greenville, NC (Mohamed M. Abdelfatah, Nicholas J. Koutlas, Eric Gochanour, Ahmed Hamed, Mariam Ibrahim, Prashant R. Mudireddy)
| | - Eric Gochanour
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, East Carolina University, Greenville, NC (Mohamed M. Abdelfatah, Nicholas J. Koutlas, Eric Gochanour, Ahmed Hamed, Mariam Ibrahim, Prashant R. Mudireddy)
| | - Ahmed Hamed
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, East Carolina University, Greenville, NC (Mohamed M. Abdelfatah, Nicholas J. Koutlas, Eric Gochanour, Ahmed Hamed, Mariam Ibrahim, Prashant R. Mudireddy)
| | - Mariam Ibrahim
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, East Carolina University, Greenville, NC (Mohamed M. Abdelfatah, Nicholas J. Koutlas, Eric Gochanour, Ahmed Hamed, Mariam Ibrahim, Prashant R. Mudireddy)
| | - Mohamed Barakat
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Brooklyn Hospital Center, Bbrooklyn, NY (Mohamed Barakat), USA
| | - Prashant R Mudireddy
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, East Carolina University, Greenville, NC (Mohamed M. Abdelfatah, Nicholas J. Koutlas, Eric Gochanour, Ahmed Hamed, Mariam Ibrahim, Prashant R. Mudireddy)
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Smeets X, Bouhouch N, Buxbaum J, Zhang H, Cho J, Verdonk RC, Römkens T, Venneman NG, Kats I, Vrolijk JM, Hemmink G, Otten A, Tan A, Elmunzer BJ, Cotton PB, Drenth J, van Geenen E. The revised Atlanta criteria more accurately reflect severity of post-ERCP pancreatitis compared to the consensus criteria. United European Gastroenterol J 2019; 7:557-564. [PMID: 31065373 DOI: 10.1177/2050640619834839] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background and objective Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most prevalent complication after ERCP with an incidence of 3.5%. PEP severity is classified according to either the consensus criteria or the revised Atlanta criteria. In this international cohort study we investigated which classification is the strongest predictor of PEP-related mortality. Methods We reviewed 13,384 consecutive ERCPs performed between 2012 and 2017 in eight hospitals. We gathered data on all pancreatitis-related adverse events and compared the predictive capabilities of both classifications. Furthermore, we investigated the correlation between the two classifications and identified reasons underlying length of stay. Results The total sample consisted of 387 patients. The revised Atlanta criteria have a higher sensitivity (100 vs. 55%), specificity (98 vs. 72%) and positive predictive value (58 vs. 5%). There is a significant difference (p < 0.001) between the two classifications. In 124 patients (32%), the length of stay was influenced by concomitant diseases. Conclusion The revised Atlanta classification is superior in predicting mortality and better reflects PEP severity. This has important implications for researchers, clinicians and patients. For the diagnosis of PEP pancreatitis, the consensus criteria remain the golden standard. However, the revised Atlanta criteria are preferable for defining PEP severity.
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Affiliation(s)
- Xjnm Smeets
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N Bouhouch
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Buxbaum
- Division of Gastroenterology, University of Southern California, Los Angeles, CA, USA
| | - H Zhang
- Division of Gastroenterology, University of Southern California, Los Angeles, CA, USA
| | - J Cho
- Division of Gastroenterology, University of Southern California, Los Angeles, CA, USA
| | - R C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Teh Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - N G Venneman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - I Kats
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J M Vrolijk
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Gjm Hemmink
- Department of Gastroenterology and Hepatology, Isala Klinieken, Zwolle, The Netherlands
| | - A Otten
- Department of Gastroenterology and Hepatology, Isala Klinieken, Zwolle, The Netherlands
| | - Acitl Tan
- Department of Gastroenterology and Hepatology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - B J Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - P B Cotton
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
| | - Jph Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ejm van Geenen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Okuno M, Shiroko J, Taguchi D, Yamaguchi K, Takada J, Imai S, Sato H, Thanabashi S. The Effectiveness of the Rectal Administration of Low-dose Diclofenac for the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis. Intern Med 2018; 57:2289-2294. [PMID: 29607957 PMCID: PMC6148161 DOI: 10.2169/internalmedicine.0554-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective A 50-100-mg rectal dose of nonsteroidal anti-inflammatory drugs (NSAIDs; diclofenac or indomethacin) has been shown to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, this is higher than the recommended 25-mg dose that is commonly administered to Japanese patients. The objective of this study was to evaluate the safety and efficacy of 25-mg rectal dose of diclofenac in preventing PEP. Methods Between January 2016 and March 2017, a total of 147 patients underwent ERCP with or without the rectal administration of diclofenac (25 mg) 20 min before the procedure. A retrospective analysis was conducted to evaluate the efficacy and safety of this dose in preventing PEP. Results Thirteen patients (8.8%) developed PEP: 3 patients (4.1%) in the diclofenac group and 10 (13.7%) in the control group (p=0.0460). After ERCP, there were no cases of gastrointestinal hemorrhage, ulceration, acute renal failure, or death. A multivariate logistic regression analysis revealed that the non-administration of rectal diclofenac was a risk factor for PEP (odds ratio=3.530; 95% confidence interval=1.017-16.35; p=0.0468). Conclusions A 25-mg rectal dose of diclofenac might prevent PEP.
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Affiliation(s)
- Mitsuru Okuno
- Department of Gastroenterology, Takayama Red Cross Hospital, Japan
| | - Junko Shiroko
- Department of Gastroenterology, Takayama Red Cross Hospital, Japan
| | - Daisuke Taguchi
- Department of Gastroenterology, Takayama Red Cross Hospital, Japan
| | | | - Jun Takada
- Department of Gastroenterology, Takayama Red Cross Hospital, Japan
| | - Susumu Imai
- Department of Gastroenterology, Takayama Red Cross Hospital, Japan
| | - Hiroyuki Sato
- Department of Gastroenterology, Takayama Red Cross Hospital, Japan
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Leerhøy B, Shabanzadeh DM, Nordholm-Carstensen A, Jørgensen LN. Quality of life, performance status, and work capacity after post-endoscopic retrograde cholangiopancreatography pancreatitis. Scand J Gastroenterol 2018; 53:994-999. [PMID: 29978732 DOI: 10.1080/00365521.2018.1485730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study evaluated the long-term consequences of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) on health related quality of life (HRQOL), performance status, and work capacity. MATERIALS AND METHODS A follow-up study with prospective outcome measurements on patients with previous PEP and matched controls from a Danish cohort of 772 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). HRQOL was evaluated by the short form 36 health surveys, performance status by the Zubrod score, and work capacity by employment status. Multivariable models were applied to adjust for potential confounders. RESULTS Twenty-nine cases and 49 controls were included. Twelve (41%), eight (28%), and nine (31%) patients had mild, moderate, and severe PEP, respectively. Mean follow-up time was 4.8 ± 1.7 years. PEP was associated with long-term reduced mental HRQOL (-13.0 role-emotional score points, 95% CI: -25.4; -0.52). An increased Zubrod score representing reduced performance status was present in 12 of the 29 cases (41.4%) and in nine of the 49 controls (18.4%), p = .002. Reduced work capacity was present in 14 of the 29 cases (48.2%) and in 12 of the 49 controls (24.4%), p = .023. CONCLUSIONS This study indicates that PEP has a detrimental effect on long-term HRQOL, performance score, and work capacity.
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Affiliation(s)
- Bonna Leerhøy
- a Digestive Disease Center, Bispebjerg Hospital , University of Copenhagen , Copenhagen , Denmark
| | | | | | - Lars Nannestad Jørgensen
- a Digestive Disease Center, Bispebjerg Hospital , University of Copenhagen , Copenhagen , Denmark
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Abstract
Acute pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of the study was to review the current knowledge on the nomenclature, etiology, pathophysiology, clinical presentation, diagnostic workup, and risk stratification of post-ERCP pancreatitis (PEP). A structured search in PubMed and Scopus databases was performed using search terms related to the subject of diagnosis, pathophysiology, risk stratification of post-ERCP pancreatitis, including full text articles and abstracts in the English language. Several causes, operating both at a local and systemic level, might play an important role in the pathogenesis of PEP. Different patient-related risk factors can help predict post-ERCP pancreatitis; diagnosis depends on clinical presentation, imaging and laboratory investigations. As an outpatient procedure, post-ERCP pancreatitis may be safe in a selected group of low-risk patients. Further investigation of the etio-pathogenesis of post-ERCP pancreatitis is required in order to improve diagnosis and treatment. Early identification and severity stratification of post-ERCP pancreatitis greatly affects the patient's outcome. There is still controversy concerning the risk factors related to PEP. More studies are needed to clarify early and definite diagnosis, risk and severity stratification, as well as treatment of post-ERCP pancreatitis.
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Affiliation(s)
- Yegor Tryliskyy
- Clinical Surgery University of Edinburgh, Scotland, United Kingdom
- Department of General Surgery, Worthing Hospital, England, United Kingdom
| | - Gavin J Bryce
- Wishaw General Hospital, Lanarkshire, Scotland, United Kingdom
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Abstract
Pancreatitis is the most common and potentially devastating complication of endoscopic retrograde cholangiopancreatography (ERCP), resulting in significant morbidity, occasional mortality, and increased health-care expenditure. Accordingly, the prevention of post-ERCP pancreatitis (PEP) remains a major clinical and research priority. Strategies to reduce the incidence of PEP include thoughtful patient selection, appropriate risk-stratification, sound procedural technique, prophylactic pancreatic stent placement, and pharmacoprevention. Despite advances in all these areas, however, the incidence of PEP remains as high as 15% in high-risk cases. Thus, additional research towards the goal of eliminating PEP is necessary. Herein is an evidence-based review of strategies to prevent pancreatitis after ERCP, focusing on recent important developments in the field.
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Affiliation(s)
- B Joseph Elmunzer
- The Peter B. Cotton Endowed Chair in Endoscopic Innovation, Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, USA
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Terzoudis S, Gatopoulou A, Xanthis A, Anastasiadis S, Anastasiadou K, Georgakis N, Tzivras D, Kountouras J. The impact of age on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ann Gastroenterol 2017; 31:96-101. [PMID: 29333073 PMCID: PMC5759619 DOI: 10.20524/aog.2018.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background: With advancing age there is progressive pancreatic atrophy and fibrosis, leading to tissue destruction and chronic pancreatitis that has been found to be protective against post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, there are no reports regarding the potential effect of the aging pancreatic changes on the incidence and severity of PEP. Therefore, the aim of the present study was to investigate the impact of senile changes in the pancreas on the incidence and severity of PEP. Methods: A total of 2688 patients who underwent the first therapeutic ERCP at a single center were included in the final analysis of the study. Patients were classified into two groups: 1644 patients aged ≤75 years (mean age 61.56+1.26 years), group A; and 1044 patients aged >75 years (mean age 81.97+4.29 years), group B. Patients’ files were identified using a retrospective database linked to the endoscopy reporting system. Patients’ characteristic, endoscopic findings, details of intervention and rate and severity of PEP were evaluated. Results: No significant differences between the two groups were observed with regard to ERCP indication, patient- and technique-related risk factors for PEP, presence of periampullary diverticulum, and type of therapeutic intervention. The incidence of PEP was 5.2% in group A and 4% in group B (P=NS) with comparable grades of severity. All episodes of pancreatitis had full recovery with conventional treatment. One death occurred from respiratory arrest in each group of patients. Conclusion: This study shows that the pancreatic changes associated with aging do not influence the incidence and severity of PEP.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Georgia Lazaraki
- Department of Gastroenterology, Theagenion Anticancer Hospital (Georgia Lazaraki), Greece
| | - Grigoris Chatzimavroudis
- 2 Surgical, School of Medicine, Aristotle University of Thessaloniki, G. Gennimatas General Hospital (Grigoris Chatzimavroudis), Thessaloniki, Greece
| | - Sotiris Terzoudis
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Anthi Gatopoulou
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Andreas Xanthis
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Sotiris Anastasiadis
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Kiriaki Anastasiadou
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Nikos Georgakis
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Dimitris Tzivras
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Jannis Kountouras
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
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Miyatani H, Matsumoto S, Mashima H. Risk factors of post- endoscopic retrograde cholangiopancreatography pancreatitis in biliary type sphincter of Oddi dysfunction in Japanese patients. J Dig Dis 2017; 18:591-597. [PMID: 28898571 DOI: 10.1111/1751-2980.12541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/14/2017] [Accepted: 09/08/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Suspected sphincter of Oddi dysfunction (SOD) is a well-known risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). The indication of ERCP for suspected SOD patients was very low in Japan compared to other countries. Therefore, the risk of PEP may be different in Japanese SOD patients. The objective of this study was to evaluate the risk of PEP in suspected biliary type SOD in Japan. METHODS From December 1996 to January 2017, 72 patients were suspected as having biliary type SOD, by questionnaire, liver function tests, hepatobiliary scintigraphy, abdominal ultrasonography, upper gastrointestinal endoscopy, endoscopic ultrasonography and magnetic resonance cholangiopancreatography. Finally, 60 patients who underwent ERCP were included in this study, and the factors associated with PEP were evaluated. RESULTS The overall PEP rate was 23.3% (n = 14). Diagnostic ERCP alone for SOD did not increase the risk of PEP. The correlation of PEP incidence with pancreatic duct guidewire (PGW) technique and endoscopic sphincterotomy (EST) was indicated in univariate and multivariate analysis. Pancreatic stent placement was a risk in univariate analysis but not in multivariate analysis. CONCLUSIONS PGW technique and EST for biliary type SOD were important risk factors for PEP. Pancreatic stenting was ineffective for prevention of PEP.
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Affiliation(s)
- Hiroyuki Miyatani
- Department of Gastroenterology, Jichi Medical University, Saitama, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Jichi Medical University, Saitama, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Jichi Medical University, Saitama, Japan
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Tomoda T, Kato H, Mizukawa S, Muro S, Akimoto Y, Uchida D, Matsumoto K, Yamamoto N, Horiguchi S, Tsutsumi K, Okada H. A Multicenter, Prospective, Randomized Controlled Trial Evaluating the Efficacy of Rectal Diclofenac and Sublingual Nitrate as a Combined Prophylactic Treatment for Post-ERCP Pancreatitis. Acta Med Okayama 2017; 71:357-362. [PMID: 28824193 DOI: 10.18926/amo/55314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Acute pancreatitis is the major complication of endoscopic retrograde cholangiopancreatography(ERCP). A preliminary research suggested that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) with nitrate might reduce the incidence of post-ERCP pancreatitis (PEP) more effectively than NSAIDs alone. We conduct a two-arm, multicenter, prospective, randomized, superiority trial to evaluate the additional effect of nitrate for prevention of PEP. A total of 900 patients randomly receive 50 mg diclofenac suppository either alone or with 5 mg isosorbide dinitrate sublingual tablet. The primary endpoint is the occurrence of PEP. This study will clarify whether NSAIDs plus nitrate can prevent PEP.
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Affiliation(s)
- Takeshi Tomoda
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Felux J, Sturm E, Busch A, Zerabruck E, Graepler F, Stüker D, Manger A, Kirschner HJ, Blumenstock G, Malek NP, Goetz M. ERCP in infants, children and adolescents is feasible and safe: results from a tertiary care center. United European Gastroenterol J 2017; 5:1024-1029. [PMID: 29163969 DOI: 10.1177/2050640616687868] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/09/2016] [Indexed: 12/15/2022] Open
Abstract
Background Indications for endoscopic retrograde cholangiopancreatography (ERCP) in children differ from adults. Paucity of data and concerns about potential lower effectiveness and more side effects limit its use even in high volume centers. We retrospectively analyzed indications, success rates, limitations, and side effects of ERCPs in children <18 years. Methods From January 2012 to March 2015, 54 ERCPs were performed in 31 children (median age 11 (0-17) years; median weight 22 (3.3-142.7) kg) with suspected choledocholithiasis (n = 13 interventions in 9 patients), post-transplantation anastomotic stenosis (10/4), malignancy (10/5), chronic pancreatitis (7/1), biliary atresia (6/6), anomaly (2/2), leak (4/3), or primary sclerosing cholangitis (PSC) (2/1). All patients were followed up as inpatients. Results Thirty-six therapeutic and 18 diagnostic procedures were performed by adult ERCP expert endoscopists. Successful intervention was achieved in 90.7% of cases. Failed cannulation (n = 4) was associated with lower body weight (p = 0.023). In children younger than 1 year, ERCP was significantly more often diagnostic than in patients >1 year (p < 0.001). In three of six infants with suspected atresia, surgical exploration was avoided. Five complications were recorded (9.3%), and included four episodes of mild pancreatitis (7.4% post-ERCP pancreatitis (PEP) rate) and one cholangitis in PSC. A trend towards a protective effect of pancreatic stents on PEP was observed. All complications were managed conservatively. No complications were attributed to mechanical stress on the gastrointestinal tract. Conclusions ERCP in newborns, infants, and adolescents can be safely performed with high technical and clinical success. Endoscopists must be aware of differing spectrum of pediatric diseases. Failed cannulation was associated with lower body weight of young children. Complications were similar to rates reported in adults.
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Affiliation(s)
- Jasmin Felux
- Innere Medizin I, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Ekkehard Sturm
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Andreas Busch
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Florian Graepler
- Innere Medizin I, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Dietmar Stüker
- Allgemeine, Viszeral- und Transplantationsmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Andreas Manger
- Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Gunnar Blumenstock
- Klinische Epidemiologie und angewandte Biometrie, University of Tübingen, Tübingen, Germany
| | - Nisar P Malek
- Innere Medizin I, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Martin Goetz
- Innere Medizin I, Universitätsklinikum Tübingen, Tübingen, Germany
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Katsinelos T, Georgakis N, Anastasiadou K, Gatopoulou A, Zeglinas C, Psarras K, Kountouras J. Impact of nitroglycerin and glucagon administration on selective common bile duct cannulation and prevention of post-ERCP pancreatitis. Scand J Gastroenterol 2017; 52:50-55. [PMID: 27690682 DOI: 10.1080/00365521.2016.1228117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Easy common bile duct (CBD) cannulation is associated with low complication rate. This study aimed to investigate the potential impact of nitroglycerin and glucagon administration on selective CBD cannulation and prevention of post-ERCP pancreatitis. METHODS A prospective single center, double-blind randomized study in which a total of 455 patients were randomly assigned to CBD cannulation by receiving 6 puffs (2.4 mg) sublingual nitroglycerin and glucagon 1 mg intravenously (n = 227, group A) or 6 puffs sterile water and 20 mg hyoscine-n-butyl bromide intravenously (n = 228, group B). After ERCP, patients were followed for the development of drugs' side-effects and post-ERCP complications. RESULTS There were no statistically significant differences between the two groups regarding demographic data and ERCP findings. Success rate of selective CΒD cannulation was 95.15% in group A versus 82.29% in group B (p < .001). Time required for CBD cannulation was 2.82 ± 2.31 min in group A versus 4.27 ± 3.84 min in group B (p = .021). Needle-knife papillotomy was used in 11 (4.85%) patients of group A and 39 (17.11%) patients of group B (p = .001). The frequency of post-ERCP pancreatitis was significantly lower in group A than in group B (3.08% versus 7.46%, p = .037). No difference was observed between the two groups with regard to the occurrence of post-procedure hemorrhage. There was no procedure-related mortality; no adverse event related to the combination regimen was observed. CONCLUSIONS Combined nitroglycerin and glucagon administration achieves a high selective CBC cannulation rates with concomitant reduction of post-ERCP pancreatitis incidence. However, further relative large-scale studies are needed to confirm our findings before definite conclusions can be drawn (Clinical trial registration number: NT: 4321).
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Affiliation(s)
- Panagiotis Katsinelos
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece.,b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Georgia Lazaraki
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Grigoris Chatzimavroudis
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Taxiarchis Katsinelos
- c Department of Pharmacology , Medical School of Aristotle University , Thessaloniki , Greece
| | - Nikos Georgakis
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece.,b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Kyriaki Anastasiadou
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece.,b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Anthi Gatopoulou
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Christos Zeglinas
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Kyriakos Psarras
- b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Jannis Kountouras
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece.,b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
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Leerhøy B, Nordholm-Carstensen A, Novovic S, Hansen MB, Jørgensen LN. Effect of body weight on fixed dose of diclofenac for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Scand J Gastroenterol 2016; 51:1007-12. [PMID: 27160512 DOI: 10.3109/00365521.2016.1172338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to assess the influence of patient body weight on the clinical effect of 100 mg diclofenac administered as a single dose for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). MATERIALS AND METHODS All patients subjected to endoscopic retrograde cholangiopancreatography (ERCP) from 2009 to 2014 were evaluated for inclusion. In total, 772 patients were included of whom 378 (49%) received diclofenac prophylaxis. RESULTS In the diclofenac prophylaxis group, body weight was higher in patients with PEP (mean ± SD: 82 ± 18 kg) than in patients without PEP (74 ± 18 kg) (p = 0.029). In patients not receiving prophylaxis, body weight was not associated with the occurrence of PEP (mean ± SD: 77 ± 18 vs 75 ± 18 kg, respectively, p = 0.450). In an adjusted analysis, higher patient body weight was inversely associated with the clinical effect of 100 mg diclofenac for the prophylaxis of PEP. CONCLUSIONS High patient body weight was associated with a reduced effect of 100 mg diclofenac for prophylaxis of PEP.
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Affiliation(s)
- Bonna Leerhøy
- a Digestive Disease Center, Bispebjerg Hospital , University of Copenhagen , Copenhagen , Denmark
| | | | - Srdan Novovic
- b Department of Gastroenterology and Gastrointestinal Surgery , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Mark Berner Hansen
- a Digestive Disease Center, Bispebjerg Hospital , University of Copenhagen , Copenhagen , Denmark ;,c AstraZeneca, Research and Development , Gothenburg , Sweden
| | - Lars Nannestad Jørgensen
- a Digestive Disease Center, Bispebjerg Hospital , University of Copenhagen , Copenhagen , Denmark
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Uçar R, Biyik M, Uçar E, Polat İ, Çifçi S, Ataseven H, Demir A. Rectal or intramuscular diclofenac reduces the incidence of pancreatitis afterendoscopic retrograde cholangiopancreatography. Turk J Med Sci 2016; 46:1059-63. [PMID: 27513404 DOI: 10.3906/sag-1502-104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/04/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIM Acute pancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography (ERCP). We aimed to evaluate the efficacy of intramuscular diclofenac sodium for prophylaxis of post-ERCP pancreatitis (PEP) in comparison to the rectal form. MATERIALS AND METHODS One hundred and fifty consecutive patients who underwent ERCP were enrolled in this single-center, prospective, randomized controlled study. Patients were randomized into three groups. The first group received 75 mg of diclofenac sodium via intramuscular route and the second group received 100 mg of diclofenac sodium rectally 30-90 min before the procedure. The third group served as the control group. Patients were evaluated for post-ERCP pancreatitis with serum amylase levels and abdominal pain 24 h after the procedure. RESULTS The overall incidence of PEP was 6% (n = 9) and 2% (n = 1) in the intramuscular (IM) and rectal groups, respectively, and 14% in the control group (P = 0.014). Nineteen (12.7%) patients developed post-ERCP abdominal pain (8% in IM, 10% in rectal, and 20% in control group; P = 0.154). Twenty-five (16.6%) patients developed post-ERCP hyperamylasemia (10% in IM, 12% in rectal, and 24% in control group; P = 0.03). CONCLUSION Prophylaxis with diclofenac given rectally or intramuscularly is an effective option for the management of post-ERCP pancreatitis.
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Affiliation(s)
- Ramazan Uçar
- Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Murat Biyik
- Department of Gastroenterology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Esma Uçar
- Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - İlker Polat
- Division of Internal Medicine, Afyon State Hospital, Afyonkarahisar, Turkey
| | - Sami Çifçi
- Department of Gastroenterology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hüseyin Ataseven
- Department of Gastroenterology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Demir
- Department of Gastroenterology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Mukai S, Itoi T. Selective biliary cannulation techniques for endoscopic retrograde cholangiopancreatography procedures and prevention of post- endoscopic retrograde cholangiopancreatography pancreatitis. Expert Rev Gastroenterol Hepatol 2016; 10:709-22. [PMID: 26782710 DOI: 10.1586/17474124.2016.1143774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Numerous endoscopic retrograde cholangiopancreatography (ERCP) techniques have been reported to achieve selective biliary cannulation success. For standard biliary cannulation procedures, the wire-guided cannulation technique has been reported to reduce the rate of post-ERCP pancreatitis (PEP) and increase the biliary cannulation success rate, although conflicting reports exist. The pancreatic or double-guidewire technique and several precut techniques have been reported as useful techniques in difficult biliary cannulation cases. Although ERCP is a useful endoscopic procedure, the risk of adverse events, particularly post-ERCP pancreatitis, is inevitable. Previous studies and analyses have revealed the risk factors for PEP. The efficacy of prophylactic pancreatic duct stent placement and the administration of rectal nonsteroidal anti-inflammatory drugs for preventing PEP has also been reported. Herein, we reviewed reports in the literature regarding the current status of selective biliary cannulation techniques and PEP prevention.
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Affiliation(s)
- Shuntaro Mukai
- a Department of Gastroenterology and Hepatology , Tokyo Medical University , Tokyo , Japan
| | - Takao Itoi
- a Department of Gastroenterology and Hepatology , Tokyo Medical University , Tokyo , Japan
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Nalankilli K, Kannuthurai S, Moss A. A modern approach to ERCP: maintaining efficacy while optimising safety. Dig Endosc 2016; 28 Suppl 1:70-6. [PMID: 26684277 DOI: 10.1111/den.12592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging and complications such as post-ERCP pancreatitis (PEP) remain a concern. Modern ERCP techniques aim to maintain efficacy and improve safety. There are limited data regarding efficacy and safety of ERCP carried out by a newly qualified practitioner using modern techniques. The aim of the present study was to conduct an ERCP practice audit and compare it with an Australian national survey in order to review the evidence base underlying modern ERCP practice. METHODS All ERCP carried out by a newly qualified practitioner, using prospectively collected data, from September 2011 to May 2015, were audited. Outcomes were compared to an Australia-wide survey of ERCP practice. A literature review was carried out regarding recent developments in ERCP practice. RESULTS Audit results correlated well with national data. All 478 ERCP were therapeutic and had pre-procedure imaging. Wire-guided biliary cannulation was used. Success rate was 97%. Overall adverse-event rate was 0.8%. Choledocholithiasis was the predominant indication (72%). Biliary cannulation was successful in 338 of 348 naiive papillae. Of these, there were 53 (16%) difficult cannulations but the needle-knife sphincterotomy (NKS) rate was low compared to national data (13% vs 33%). Rate of dual-wire cannulation technique was higher (87% vs 30%). Pancreatic duct stenting (done in 32 cases [70% of dual-wire cannulation cases]) and rectal indomethacin (25%) were used to reduce PEP risk. CONCLUSIONS A newly qualified ERCP proceduralist achieved high success rates with minimal adverse events using modern techniques. Practice was consistent with national data, although dual-wire cannulation technique was preferred to NKS. Evidence base for modern ERCP techniques was reviewed. ERCP efficacy and safety should be monitored by practice audit.
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Affiliation(s)
- Kumanan Nalankilli
- Department of Endoscopic Services, Western Health, Melbourne,, Australia
| | | | - Alan Moss
- Department of Endoscopic Services, Western Health, Melbourne,, Australia.,Western Clinical School, University of Melbourne, Melbourne, Australia
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Abstract
OBJECTIVE With an increased use of endoscopic retrograde cholangiopancreatography (ERCP), post-ERCP complications have attracted much attention. We aimed to identify independent risk factors of post-ERCP pancreatitis (PEP) and hyperamylasemia, and to develop a simple scoring system of the factors contributing to the clinical prevention against PEP. METHODS A retrospective single-center analysis was performed in 4234 ERCP procedures between September 2007 and December 2012. Patient-related and procedure-related risk factors for PEP and post-ERCP hyperamylasemia were identified by univariate and multivariate regression analyses. A scoring system was developed based on the independent risk factors. RESULTS PEP occurred in 226 (5.3%) ERCP procedures and hyperamylasemia in 774 (18.3%) procedures. Female gender (odds ratio [OR] 1.449), first-time ERCP (OR 1.745), latent jaundice (OR 1.917), difficult cannulation (OR 3.317) and pancreatography (OR 1.823) were all proven to be significant risk factors for predicting PEP. In addition, difficult cannulation (OR 1.990) and pancreatography (OR 2.009), age <60 years (OR 1.294), prior diabetes (OR 0.614), biliary duct stent placement (OR 1.884) and nasobiliary drainage (OR 1.613) were associated with developing hyperamylasemia. Prophylactic pancreatic duct stent (PS) might prevent against PEP in significantly high-risk patients (score ≥6). CONCLUSIONS Both patient-related and procedure-related risk factors are important for predicting PEP and post-ERCP hyperamylasemia. Technical procedures, for example, PS, are necessary to prevent PEP in patients at the highest risk.
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Affiliation(s)
- Qi Bin He
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Te Xu
- Department of Vasculocardiology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jing Wang
- Department of Infectious Disease, The First People's Hospital of Changzhou, Changzhou, China
| | - Yun Hong Li
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Lei Wang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiao Ping Zou
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Gkagkalis S, Vasiliadis I, Papaeuthimiou A, Terzoudis S, Pilpilidis I, Zavos C, Kountouras J. Risk factors for therapeutic ERCP-related complications: an analysis of 2,715 cases performed by a single endoscopist. Ann Gastroenterol. 2014;27:65-72. [PMID: 24714755 DOI: 10.1097/sle.0000000000000012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is now the exclusive endoscopic therapeutic modality for biliary as well as pancreatic diseases. The aim of the present study was to investigate patient- and procedure-related risk factors for post-ERCP complications in a large-scale study of procedures performed by a single experienced endoscopist. METHODS This is a retrospective cohort study which included a total of 2,715 therapeutic ERCPs enrolled in the final analysis. Potential important patient- and procedure-related risk factors for overall post-ERCP complications, pancreatitis and post-endoscopic sphincterotomy (ES) bleeding were investigated by univariate and multivariate analyses. RESULTS Following the first therapeutic ERCP, 327 patients suffered complications; pancreatitis was observed in 132 (4.9%) patients, hemorrhage in 122 (4.5%) patients, cholangitis in 63 (2.3%) patients, perforation in 3 (0.11%) patients, and basket impaction in 7 (0.26%) patients. History of acute pancreatitis was more common in patients with post-ERCP complications (P<0.001). Female gender, young age (<40 years), periampullary diverticulum, suspected sphincter of Oddi dysfunction, metal stent placement, opacification of main pancreatic duct and suprapapillary fistulotomy were not found to be risk factors for overall post-ERCP complications and post-ERCP pancreatitis (PEP). Multivariate analysis showed a history of acute pancreatitis, difficult cannulation, needle-knife papillotomy, transpancreatic sphincterotomy, opacification of first and second class pancreatic ductules and acinarization as independent risk factors for overall complications and PEP, whereas antiplatelet and anticoagulation drug use were not found to be independent risk factors for post-ES bleeding. CONCLUSIONS The results of this study demonstrate that the endoscopist's experience reduces patient- and procedure-related risk factors for post-ERCP complications.
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