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Complications of endoscopic retrograde cholangiopancreatography: A study in a small ERCP unit
García-Cano Lizcano,J; González Martín,J. A; Morillas Ari?o,J; Pérez Sola,A;
Revista Espa?ola de Enfermedades Digestivas , 2004, DOI: 10.4321/S1130-01082004000300002
Abstract: backgrounds and aim: endoscopic retrograde cholangiopancreatography (ercp) is an established procedure to drain the biliary and pancreatic ducts. nevertheless, there are complications which seem to be more common in centers performing less than 200 ercps per year. sometimes, however, due to the distribution of health resources, it is necessary to perform this technique in centers with a smaller number of procedures. we present the experience of ercp-related complications in a small unit. material and methods: this is a retrospective study on prospective data recorded during six years (1997-2002). in this period, two endoscopists working together performed 507 ercps, which yields an approximately average of 84 procedures per year. results: in 507 ercps performed during this period of time, 55 complications arose (10.85%), and four patients died (0.79%) as a consequence of the procedure. there were 28 pancreatitis (5.5%), eight post-sphincterotomy bleeding events (1.6%), seven bilioduodenal perforations (1.4%), eight sepsis episodes of biliary origin (1.6%), and other 4 different complications. there were 418 (82.4%) successful ercps -either diagnostic or therapeutic-, which gave rise to 46 (11%) complications. there were 89 (17.6%) failed diagnostic or therapeutic ercps, which gave rise to 9 (10.11%) complications (p = 0.8 between both groups). thirty five (7%) ercps were exclusively diagnostic and caused 6 (17%) complications. the 187 procedures performed for coledocho-lithiasis originated 14 (7.4%) complications, and represented the group with the lowest morbidity rate (p = 0.04). conclusions: the complications rate in our center is within the range of reported figures. ercps performed for choledoco-lithiasis was associated with the lowest complications rate. the risk-benefit ratio in the anticipated, purely diagnostic ercp must be carefully weighed due to its morbidity.
What Are the Predictors of Post-ERCP Pancreatitis, and How Useful Are They?  [cached]
Sultan S,Baillie J
JOP Journal of the Pancreas , 2002,
Abstract: Acute pancreatitis is one of the major complications of ERCP. It is of paramount importance that we accurately identify which patients will go on to develop post-ERCP pancreatitis. As most ERCPs are performed on an outpatient basis, early evaluation can allow safe discharge of the majority of patients who will not develop post-ERCP pancreatitis or develop only mild symptoms that will be self-limited. Alternatively, early detection of those patients who will go on to develop moderate or severe post-ERCP pancreatitis can guide decisions regarding hospital admission and aggressive management and can help direct the use of targeted therapies that have the potential to prevent or mitigate pancreatic inflammation. Thus, significant efforts have focused on trying to identify predictors of post-ERCP pancreatitis. These parameters can be organized into three categories of tests: 1) pancreatic enzymes as markers of pancreatic injury: serum amylase/urine amylase; 2) markers of proteolytic activation: trypsinogen, trypsinogen activation peptide; 3) markers of systemic inflammation: C-reactive protein, various interleukins such as IL-6 and IL-10. A serum amylase level greater than 4-5 times the upper reference limit in conjunction with clinical symptoms has been shown to be an accurate and reliable predictor of post-ERCP pancreatitis. However, the exact timing and level of amylase elevation remains debatable. Urine testing of amylase and trypsinogen-2 in post-ERCP patients has also been shown to be highly sensitive and specific for detecting pancreatitis. The main advantage of these urinary markers is that they are available as rapid dipstick tests. Serum trypsinogen-2 levels have also been studied in post-ERCP pancreatitis patients; high levels seem to correlate with severity of disease. Among the markers of systemic inflammation, serum CRP is an accurate and readily available laboratory test for predicting severity of post-ERCP pancreatitis, but it appears to be helpful at 24-48 hours and, therefore, is not an early marker. Several other markers remain investigational and have not yet found wide clinical applicability.
A comparative study of combination octreotide plus methylprednisolone with octreotide and placebo on prevention of post-endoscopic retrograde cholangiopancreatography (ERCP)pancreatitis  [cached]
. Katsinelos P.,. Christodoulou K.,Pilpilidis I.,Xiarchos P.
Annals of Gastroenterology , 2007,
Abstract: SUMMARY This study compares the effect of the combination of octreotide plus methylprednisolone with octreotide and placebo on biochemical and clinical parameters of endoscopic retrograde cholangiopancreatograpy (ERCP) induced pancreatitis. Two hundred and twenty two patients were randomised to receive either octreotide plus methylprednisolone, octreotide or placebo. There was no difference in the median serum amylase at 2 to 24 hours after ERCP in the three groups. Clinical pancreatitis, developed in 11 patients -one in the octretode plus methylprednisolone, four in the octretode and six in the placebo groups, although there was no statistically significant difference between the three groups. This study suggests a tendency that octreotide plus methylprednisolone may protect against ERCP- induced pancreatitis. Key words: Octreotide, Methylprednisolone, Hyperamylasemia, Pancreatitis, Endoscopic Retrograde Cholangiopancreatography. Abbreviations: Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Sphincterotomy (ES)
Comparison of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Magnetic Resonance Cholangiopancreatography (MRCP) in Bile Duct Imaging  [PDF]
Mehmet Ali Ery?lmaz, ?mer Karahan, ?smet Tolu, Ahmet Oku?, Serden Ay, Bar?? Sevin?, Ahmet Hakan Hal?c?
Surgical Science (SS) , 2012, DOI: 10.4236/ss.2012.310097
Abstract: Purpose: The aim of this study was to compare magnetic resonance cholangiopancreatography (MRCP) with endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing bile duct pathologies. Materials and Methods: We documented the data of 171 patients with both ERCP and MRCP between January 2009 and December 2010 at the Konya Education and Research Hospital. Results: Of the 171 patients, 100 (58.5%) were female and 71 (41.5%) were male. The median age was 63 (55 to 89). ERCP was used to diagnose bile duct stones in 102 (59%) patients, bile duct tumour in 14 (8%) patients, hydatic cysts opening up to the bile duct in 4 (2%) patients and bile duct stenosis in 3 (1.8%) patients. For the detection of bile duct stones, MRCP had a sensitivity of 92%, a specificity of 74% and a diagnostic accuracy of 83%. For bile duct tumours, MRCP had a sensitivity of 85%, a specificity of 98% and a diagnostic accuracy rate of 92%. Conclusion: In our centre, the results of MRCP and ERCP were similar for the last two years. However, MRCP was superior with respect to diagnosis as it was cheaper and non-invasive. Thus, ERCP should be preferred for therapeutic processes.
Es la edad un factor que incide en las complicaciones por CPRE? Does age influence complications of endoscopic retrograde cholangiopancreatography (ERCP)?  [cached]
Martín Gómez Zuleta,Cristian Melgar,Víctor Arbeláez
Revista Colombiana de Gastroenterologia , 2010,
Abstract: Introducción. Con la mejoría en las condiciones de vida, el promedio de edad es hoy en día mayor, razón por la cual cada vez tenemos que enfrentarnos a pacientes ancianos, quienes tienen una mayor incidencia de patología hepatobiliar y necesitan una CPRE. La pregunta es, si este grupo de edad tiene una mayor frecuencia de complicaciones que le dificulten el acceso a este importante examen. Métodos. Se trata de un estudio prospectivo de casos y controles de las CPRE realizado durante un periodo de 5 a os (2004-2009). Las intervenciones se realizaron en el Hospital El Tunal de Bogotá-Colombia, por endoscopistas con experiencia mayor a 500 procedimientos anuales. La edad del paciente mayor o menor a 80 a os fue tomada como variable de predicción y el desarrollo de pancreatitis post-CPRE, perforación, hemorragia o depresión respiratoria fueron tomadas como variables de desenlace. Resultados. Durante el periodo de 5 a os se realizaron 71 (33,8%) CPRE en pacientes con 80 a os o más, las cuales se parearon de forma aleatoria con 139 (66,2%) pacientes que tuvieran 79 a os o menos (grupo control). La mortalidad en ambos grupos no tuvo una diferencia significativa. Murieron tres pacientes en el grupo de estudio y dos en el grupo control. Las complicaciones relacionadas con el procedimiento no tuvieron una diferencia global estadísticamente significativa, aunque en el grupo de ancianos hubo más perforaciones. Conclusión. Podemos se alar que los pacientes con edad mayor o igual a los 80 a os tienen una tasa similar de complicaciones que los pacientes menores cuando son llevados a CPRE a pesar de tener una mayor presencia de comorbilidades como la HTA. Introduction. As living conditions improve average ages increase daily. For this reason we see more and more older patients who have a greater incidence of hepatobiliary pathologies, and who need ERCP (Endoscopic retrograde cholangiopancreatography). The main question is that, if this age-group has a greater frequency of complications, it makes their access to this important examination more difficult. Methods. A five year long prospective study of ERCP cases and controls was performed from 2004 to 2009. Procedures were performed at the ‘El Tunal’ Hospital in Bogota, Colombia. They were done by specialists who perform more than 500 procedures every year. Age greater or less than 80 years old was the predictor variable used, and ERCP complications were outcome variables. These included pancreatitis, perforation, hemorrhaging and respiratory depression. Results. During the 5 year period 71 ERCPs (33.8%) were performed o
Method of prevention of acute pancreatitis after diagnostic and therapeutic endoscopic retrograde cholangiopancreatography  [PDF]
Tolstokorov A.S.,Sarkisyan Z.О.,Goch Е.М.,Volchkov A.S.
Saratov Journal of Medical Scientific Research , 2012,
Abstract: Objective of the study: Prevention of acute pancreatitis after diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Material and Methods. Analysis of the results of diagnostic and therapeutic ERCP, of the patients treated at Saratov Regional clinical hospital f during the period from 2006 to 2010. Results, lincrease in pancreatic amylase levels in blood above 50 U/l till ERCP is a risk factor for development of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Conclusion. The above-stated follows to the background of increased pancreatic amylase levels in blood, performance of endoscopic retrograde cholangiopancreatography led to the development of acute pancreatitis.
Complications in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS): analysis of 7-year physician-reported adverse events  [cached]
Niv Y,Gershtansky Y,Kenett RS,Tal Y
Drug, Healthcare and Patient Safety , 2011,
Abstract: Yaron Niv1, Yael Gershtansky2, Ron S Kenett3, Yossi Tal2, Shlomo Birkenfeld41Department of Gastroenterology, Rabin Medical Center, Petach Tikva, Israel; 2Medical Risk Management, The Madanes Group, Tel Aviv, Israel; 3The KPA Group, University of Torino, Turin, Italy; 4Clalit Health Services, Tel Aviv, IsraelIntroduction: The number of malpractice claims against physicians and health institutes is increasing continuously in Israel as in the rest of the Western world, and has become a serious financial burden.Aim: In this study we analyzed the reports of gastroenterologists on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) adverse events to the risk management authority between January 1, 2000 and December 31, 2006.Methods: All the reported adverse events associated with ERCP and EUS of health institutes and covered by Madanes Insurance Agency were summarized and analyzed. Clinical and epidemiological details about the patients, procedures, and adverse events were coded into an Excel worksheet, discussed, and evaluated.Results: Forty-two cases of ERCP and EUS adverse events were reported. There were nine cases of men (21.4%) and the average age was 69.3 ± 14.3 years. During this period, 10,647 procedures were performed by the institutes concerned and the number of adverse events was 20.2 to 67.8 per year for 10,000 procedures. Perforation occurred in one out of 367 procedures, bleeding in one out of 5323 procedures, teeth trauma in one out of 5323 procedures, and respiratory complications in one out of 10,647 procedures.Conclusion: This is the first study in Israel about physicians' reports of ERCP and EUS adverse events. Physicians reported only about severe adverse events with high rate of mortality and morbidity.Keywords: ERCP, EUS, defensive medicine, perforation, bleeding, sedation, risk management, patient safety
Complications in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS): analysis of 7-year physician-reported adverse events
Niv Y, Gershtansky Y, Kenett RS, Tal Y, Birkenfeld S
Drug, Healthcare and Patient Safety , 2011, DOI: http://dx.doi.org/10.2147/DHPS.S21369
Abstract: mplications in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS): analysis of 7-year physician-reported adverse events Original Research (2637) Total Article Views Authors: Niv Y, Gershtansky Y, Kenett RS, Tal Y, Birkenfeld S Published Date June 2011 Volume 2011:3 Pages 21 - 25 DOI: http://dx.doi.org/10.2147/DHPS.S21369 Yaron Niv1, Yael Gershtansky2, Ron S Kenett3, Yossi Tal2, Shlomo Birkenfeld4 1Department of Gastroenterology, Rabin Medical Center, Petach Tikva, Israel; 2Medical Risk Management, The Madanes Group, Tel Aviv, Israel; 3The KPA Group, University of Torino, Turin, Italy; 4Clalit Health Services, Tel Aviv, Israel Introduction: The number of malpractice claims against physicians and health institutes is increasing continuously in Israel as in the rest of the Western world, and has become a serious financial burden. Aim: In this study we analyzed the reports of gastroenterologists on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) adverse events to the risk management authority between January 1, 2000 and December 31, 2006. Methods: All the reported adverse events associated with ERCP and EUS of health institutes and covered by Madanes Insurance Agency were summarized and analyzed. Clinical and epidemiological details about the patients, procedures, and adverse events were coded into an Excel worksheet, discussed, and evaluated. Results: Forty-two cases of ERCP and EUS adverse events were reported. There were nine cases of men (21.4%) and the average age was 69.3 ± 14.3 years. During this period, 10,647 procedures were performed by the institutes concerned and the number of adverse events was 20.2 to 67.8 per year for 10,000 procedures. Perforation occurred in one out of 367 procedures, bleeding in one out of 5323 procedures, teeth trauma in one out of 5323 procedures, and respiratory complications in one out of 10,647 procedures. Conclusion: This is the first study in Israel about physicians' reports of ERCP and EUS adverse events. Physicians reported only about severe adverse events with high rate of mortality and morbidity.
NSAIDs for prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: Ready for prime time?  [cached]
Mansour A Parsi
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i30.3936
Abstract: Acute pancreatitis is the most common and the most fearful complication of endoscopic retrograde cholangiopancreatography (ERCP). Prevention of post-ERCP pancreatitis has therefore been of great interest to endoscopists performing ERCP procedures. So far, only pancreatic duct stenting during ERCP and rectal administration of a non-steroidal anti-inflammatory drug (NSAID) prior to or immediately after ERCP have been consistently shown to be effective for prevention of post-ERCP pancreatitis. This commentary focuses on a short discussion about the rates, mechanisms, and risk factors for post-ERCP pancreatitis, and effective means for its prevention with emphasis on the use of NSAIDs including a recent clinical trial published in The New England Journal of Medicine by Elmunzer et al[11].
The Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Management of Intra-Biliary Rupture of Liver Hydatid Cysts (IBRH): Follow-Up of 12 Cases  [PDF]
Mohammad Abdulrahman Alshekhani, Taha A. Alkarbuli, Naser Abdullah Mohammed Alqazi, Hiwa A. Hussein, Qalandar H. Kasnazan, Ali Hussein Ali
Case Reports in Clinical Medicine (CRCM) , 2014, DOI: 10.4236/crcm.2014.39117
Abstract: Background: Intra-biliary rupture of hydatid cyst [IBRH] is not a rare complication of hydatid disease of the liver and surgery until recently is the only definitive treatment. With the introduction of ERCP preoperatively or postoperatively there was a great reduction in the operative complications. There were reports in which the ERCP was the sole treatment of this condition. Objective: To evaluate role of ERCP in the management of cases of IBRH. Design: A retrospective study of 7 cases of IBRH and prospective study of 5 cases of IBRH managed by ERCP. Setting: The ERCP Unit of Kurditan Center for Gastroenterology & Hepatology, Asulaimaneyah-Iraqi, Kurdistan, Iraq. Main Outcome Measurements: Improvement in the symptoms, obstructive liver functions pattern and ultrasonic findings in these patients following ERCP management. Methods: This is a study of 12 cases of IBRH managed by ERCP in the Kurdistan Center of Gastroenterology (KCGE) in Asulaimaneyah-Iraq, from 2007-2010. Seven cases of these were studied retrospectively from the available information on the center computers and on follow-up of these patients, while the other five patients were studied prospectively during the study period. We collected the available information: laboratory investigations, trans-abdominal ultrasonography (TAUS), computed tomography (CT) or magnetic resonance images (when available), before and after ERCP. We depended on the liver functions, trans-abdominal ultrasound and the clinical presentation before and after the ERCP; some patients were contacted via mobile phone for follow-up. Results: Cases were more males than females (58% vs 42%); most were from the ages between 30 - 50 years. The clinical presentation was fever, jaundice, itching and right hypochondrial pain in most patients. The liver function tests were obstructive pattern with elevated direct bilirubin and alkhaline phosphates in most patients. The trans-abdominal ultrasound revealed dilated common bile duct and single liver cyst in most patients and 2 or 3 cysts in others. The ERCP management led to improvement in clinical, laboratory and ultrasonic findings in 6 patients and in these 6 patients ERCP was the only procedure needed and proved by follow-up of these patients for 1 year in 4 patients and 2 years in the other 2 patients, especially in those with hydatid mebranes seen at ERCP and those with cholangiographic evidence of communication with the cyst; surgery was needed in 5 cases and one patient died from septic shock. Conclusions: ERCP is an important management strategy for patients with IBRH,
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