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This article is from BMC Anesthesiology , volume 12 . Abstract Background: ERCP practically requires moderate to deep sedation controlled by a combination of benzodiazepine and opiod. Propofol as a sole agent may cause oversedation. A combination (cocktail) of infused propofol, meperidine, and midazolam can reduce the dosage of propofol and we hypothesized that it might decrease the risk of oversedation. We prospectively compare the efficacy, recovery time, patient satisfactory, and side effects between cocktail and conventional sedations in patients undergoing ERCP. Methods: ERCP patients were randomized into 2 groups; the cocktail group (n = 103) and the controls (n = 102). For induction, a combination of 25 mg of meperidine and 2.5 mg of midazolam were administered in both groups. In the cocktail group, a bolus dose of propofol 1 mg/kg was administered and continuously infused. In the controls, 25 mg of meperidine or 2.5 mg/kg of midazolam were titrated to maintain the level of sedation. Results: In the cocktail group, the average administration rate of propofol was 6.2 mg/kg/hr. In the control group; average weight base dosage of meperidine and midazolam were 1.03 mg/kg and 0.12 mg/kg, respectively. Recovery times and patients’ satisfaction scores in the cocktail and control groups were 9.67 minutes and 12.89 minutes (P = 0.045), 93.1and 87.6 (P

This article is from Acta Informatica Medica , volume 22 . Abstract The goal:: The goal of this work was to give advantage to EUS as endoscopic method in diagnosis and following therapeutic treatment of pancreatic cancer in relation to radiological methods of CT and CTA. Material and Methods:: The study included 49 patients, 20 women and 29 men hospitalized at the Clinic for gastroenterohepatology, due to suspicion on pancreatic cancer during observed 2 years period. All cancers were histologically and cytologically confirmed. The patients underwent ERCP as a mandatory part of staging and all patients underwent endoscopic ultrasound as well as CT or CT angiography. Results:: Testing of differences was carried out using Fisher’s exact test in open-source software R. The following characteristics were tested: involvement of the blood vessels, lymph nodes, metastases, tumor size and duodenum infiltration. Results showed statistically significant difference at the 0.05 level for EUS, CT and CT angiography. Risk ratio showed that EUS is less effective in detecting infiltration of blood vessels within a malignant process then CTA where RR=0.52, CI 0.2–1.38, p-value=0.33. EUS and CTA are equal in the diagnosis of enlarged lymph nodes affected by malignancy where RR=1.3, CI 0.75–1.42, p-value=0.09. Comparison according to distant metastases showed that EUS is less effective compared to CT in approximately 30% of cases. In the diagnosis of duodenal infiltration EUS is in 5% of cases less accurate than the CT with the RR=0.95, CI 0.27–3.32, p-value=0.76, but the CTA method is more efficient because the comparison of EUS and CTA showed RR=12.52, CI 0.2–1.38, p-value=0.33. EUS as a diagnostic method is dominant in determining the size of malignant lesions located in the pancreas as compared to CT and CTA. Conclusion:: EUS as endoscopic method compared to CT and CTA is one of the more invasive methods of examination but due to its ability to be performed immediately, to locate a changes smaller than 5 mm and the target biopsy option, to measure the change and that in many cases determine the relationship of malignant lesions with blood vessels, along with visualization of the surrounding lymph nodes and metastases in neighboring organs, we may give this method an advantage over other methods in the preoperative staging of patients with pancreatic cancer.

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly used diagnostic and therapeutic method for diseases affecting the biliary and pancreatic ducts. The Enhanced Recovery After Surgery (ERAS) pathway is specifically designed to facilitate early recovery for patients undergoing major surgery. Several studies have demonstrated the effectiveness of ERAS in promoting post-ERCP patient recovery and reducing complications. However, to date, a comprehensive systematic review dedicated to investigating ERAS for ERCP has not been conducted. Hence, the objective of this study is to conduct a systematic review to assess the effectiveness of ERAS in patients undergoing ERCP.

ABSTRACT Aims: Gallstones are widespread in the adult population. In some patients, the stones are not confined to the gallbladder but are also found in the biliary tract. Although the treatment approach for this group of patients is controversial, the most widely accepted treatment is laparoscopic cholecystectomy (LC) after removal of the stones by endoscopic retrograde cholangiopancreaticography (ERCP). Opinions differ as to whether LC should be performed early or late. With this study, we wanted to shed light on this question based on our own clinical experience. Methods: A total of 100 patients who underwent LC in our clinic were included in the study. These patients were divided into two groups: 50 patients who underwent ERCP and early cholecystectomy (group 1) and 50 patients who underwent elective LC for gallstones (group 2). Patients who underwent ERCP for malignant or benign stricture, patients with porcelain sac, patients with previous abdominal surgery, patients who underwent emergency LC, patients younger than 18 years old, and patients with incomplete data, incomplete records, or patients whose necessary information could not be accessed were excluded. Results: There was no statistically significant difference between age and preoperative amylase levels. The mean length of hospital stay was 3.9±1.6 days in patients who underwent elective LC and 5.5±3.2 days in patients who underwent LC after ERCP. There was a statistically significant difference between postoperative amylase level, hemoglobin level and length of hospital stay (p

ABSTRACT Aims: Gallstones are widespread in the adult population. In some patients, the stones are not confined to the gallbladder but are also found in the biliary tract. Although the treatment approach for this group of patients is controversial, the most widely accepted treatment is laparoscopic cholecystectomy (LC) after removal of the stones by endoscopic retrograde cholangiopancreaticography (ERCP). Opinions differ as to whether LC should be performed early or late. With this study, we wanted to shed light on this question based on our own clinical experience. Methods: A total of 100 patients who underwent LC in our clinic were included in the study. These patients were divided into two groups: 50 patients who underwent ERCP and early cholecystectomy (group 1) and 50 patients who underwent elective LC for gallstones (group 2). Patients who underwent ERCP for malignant or benign stricture, patients with porcelain sac, patients with previous abdominal surgery, patients who underwent emergency LC, patients younger than 18 years old, and patients with incomplete data, incomplete records, or patients whose necessary information could not be accessed were excluded. Results: There was no statistically significant difference between age and preoperative amylase levels. The mean length of hospital stay was 3.9±1.6 days in patients who underwent elective LC and 5.5±3.2 days in patients who underwent LC after ERCP. There was a statistically significant difference between postoperative amylase level, hemoglobin level and length of hospital stay (p

Surgery for biliary tract disease is among the top 3 reasons for non-obstetrical surgery during pregnancy (1:1500 to 1:10,000 pregnancies). What is the data on ERCP during pregnancy? Is radiation exposure a concern? What does ACOG recommend regarding intraoperative fetal monitoring? In this podcast, we will cover the ACOG, and AGA recommendations for this procedure in pregnancy.

Aim: Endoscopic retrograde cholangio-pancreatography (ERCP) is a minimally invasive method used in the diagnosis and treatment of pancreatobiliary disorders. Endoscopic retrograde cholangio-pancreatography (ERCP) may lead to serious complications including pancreatitis, bleeding, cholangitis, and perforation. In this study, we compare our experience with post-ERCP complications with the literature.  Material and Method: A total of 339 patients who underwent ERCP, including 176 (51.9%) female and 163 (48.1%) male patients, were retrospectively evaluated. Hemogram, sedimentation, C-reactive protein, alkaline phosphatase, gama-glutamil-tranferase, total direct bilirubin, and amylase and lipase activities were recorded both be-fore and 24-72 h after ERCP. The rates of post-ERCP complications of pancreatitis, bleeding, and cholangitis rates were evaluated.  Results: A total of 339 patients who underwent ERCP, including 176 (51.9%) female and 163 (48.1%) male patients, were retrospectively evaluated. Of the 339 patients, pancreatitis occurred in 26 (7.6%), bleeding in 15 (4.4%), and cholangitis in 11 (3.2%). The patients with pancreatitis had a mean age of 56±17 years and the patients without pancreatitis had a mean age of 60±14 years; how-ever, no significant difference was found (p>0.05). The patients with bleeding had a mean age of 67±13 years and the patients without bleeding had a mean age of 59±15 years; a significant difference was found.  Discussion: The study shows that the incidence of post-ERCP bleeding increases with age. The most effective way of reducing ERCP complications in elderly patients is to avoid unnecessary ERCP.

This article is from Journal of Minimal Access Surgery , volume 10 . Abstract INTRODUCTION:: The ‘Rendezvous’ technique consists of laparoscopic cholecystectomy (LC) standards with intra-operative cholangiography followed by endoscopic sphincterotomy. The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. In this study, we intended to compare the two methods in a prospective randomised trial. MATERIALS AND METHODS:: From 2005 to 2012, we enrolled 83 patients with a diagnosis of cholecysto-choledocolithiasis. They were randomised into two groups. In ‘group-A’,41 patients were treated with two stages management, first by pre-operative endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct (CBD) clearance and second by LC. In ‘group-B’, 42 patients were treated with LC and intra-operative cholangiography; and when diagnosis of choledocholithiasis was confirmed, patients had undergone one stage management of by Laparo-endoscopic Rendezvous technique. RESULTS:: In arm-A and arm-B groups, complete CBD clearance was achieved in 29 and 38 patients, respectively. Failure of the treatment in arm-A was 29% and in arm-B was 9.5%. In arm-A, selective CBD cannulation was achieved in 33 cases (80.5%) and in arm-B in 39 cases (93%). In arm-Agroup, post-ERCP hyperamylasia was presented in nine patients (22%) and severe pancreatitis in five patients (12%) versus none of the patients (0%) in arm-B group, respectively. Mean post-operative hospital stay in arm-A and arm-B groups are 10.9 and 6.8 days, respectively. CONCLUSION:: One stage laparo-endoscopic rendezvous approach increases selective cannulation of CBD, reduces post-ERCP pancreatitis, reduces days of hospital stay, increases patient's compliance and prevents unnecessary intervention to CBD.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is an examination combining endoscopy and fluoroscopy that allows for the diagnosis and, especially, the treatment of diseases of the biliopancreatic system, and more specifically, obstructive jaundice of the bile ducts. The timing of ERCP depends on the etiology. The aim of our study is to investigate the evolving kinetics of cholestasis after ERCP.

Aim: Endoscopic retrograde cholangio-pancreatography (ERCP) should be performed as the first-line treatment after appropriate imaging and drainage in non-complete biliary tract injuries. Our aim is to present our treatment strategy in such injuries in a tertiary center with the aim of contributing to the literature.

ERCP下胆总管巨大结石激光碎石的护理研究 Nursing study of laser lithotripsy of giant bile duct stones under ERCP 作者： 王爽 1 郑红梅 1 高冬华 1 许冰 2 彭丹 2 作者单位： 1. 北京中医药大学东方医院 西院区 2. 北京中医药大学东方医院 脾胃肝胆科 通讯作者： 彭丹 Email:13717893741@163. com 提交时间： 2022-09-06 摘要: 目的 比较ERCP下双频双脉冲激光碎石与内镜下传统机械碎石治疗胆总管结石患者的疗效差异。方法 分析2018年5月至 2022年5月期间在北京中医药大学东方医院消化内镜中心行ERCP治疗并碎石的200例胆总管结石患者的临床资料，其中69例患者采用双频双脉冲激光碎石术（激光组），131例患者采用机械碎石（机械组），比较2组患者的取石成功率、手术时间、术后住院时间、并发症等情况。结果 2组患者一般情况、术前临床资料等基线资料基本一致（P>0.05）。2组患者术后出血、术后胰腺炎、穿孔并发症率比较差异均无统计学意义（P>0.05）。激光组的手术时间明显长于机械组（P Abstract: Objective To compare the efficacy of dual-frequency dual-pulse laser lithotripsy under ERCP and traditional endoscopic mechanical lithotripsy in the treatment of patients with common bile duct stones. Methods From May 2018 to May 2022, the clinical data of 200 patients with common bile duct stones who underwent ERCP treatment and lithotripsy at the Digestive Endoscopy Center of Dongfang Hospital of Beijing University of Traditional Chinese Medicine were retrospectively analyzed, of which 69 patients were treated with dual-frequency dual-pulse laser lithotripsy (laser group) and 131 patients were treated with mechanical lithotripsy (mechanical group), and the success rate of stone extraction, operation time, postoperative hospital stay time and complications of 2 groups of patients were compared. Results The baseline data such as general conditions and preoperative clinical data of the two groups were basically the same (P>0.05). There were no significant differences in postoperative bleeding, postoperative pancreatitis and perforation complication rates in the two groups (P>0.05). The surgical time in the laser group was significantly longer than that in the mechanical group (P ERCP 胆总管结石 激光碎石 护理 期刊： NursRxiv 分类： 护理学 >> 护理学 投稿状态： 已在期刊出版 引用： ChinaXiv:202209.00094 (或此版本 ChinaXiv:202209.00094V1 ) DOI:dx.doi.org/10.12209/issn2708-3845.20220818001 CSTR:32003.36.ChinaXiv.202209.00094.V1 推荐引用方式： 王爽,郑红梅,高冬华,许冰,彭丹.(2022).ERCP下胆总管巨大结石激光碎石的护理研究.NursRxiv.doi:dx.doi.org/10.12209/issn2708-3845.20220818001 版本历史 [V1] 2022-09-06 13:04:01 ChinaXiv:202209.00094V1 下载全文

This article is from Annals of Gastroenterology , volume 25 . Abstract None

This article is from Annals of Gastroenterology , volume 25 . Abstract None

This article is from Oncology Letters , volume 8 . Abstract Distal (lower) bile duct cancers arise in the lower half of the biliary tree closer to the small intestine. Biliary disease complicated with cholangiobronchopleural fistula, which may occur in cases of multiple hepatobiliary stones or biliary ascariasis-associated severe infection, has rarely been reported in the literature, particularly following endoscopic retrograde cholangiopancreatography (ERCP). The present study describes the case of a 60-year-old female with distal cholangiocarcinoma complicated with cholangiobronchopleural fistula after ERCP for this rare disease. This complication was likely due to the inability to control retrograde infection following ERCP and, thus, the infection was disseminated. This resulted in mixed infection involving the diaphragm and pleura, and further penetrating the bronchus. The patient was managed with pancreatoduodenectomy and has since remained in good health.

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly used diagnostic and therapeutic method for diseases affecting the biliary and pancreatic ducts. The Enhanced Recovery After Surgery (ERAS) pathway is specifically designed to facilitate early recovery for patients undergoing major surgery. Several studies have demonstrated the effectiveness of ERAS in promoting post-ERCP patient recovery and reducing complications. However, to date, a comprehensive systematic review dedicated to investigating ERAS for ERCP has not been conducted. Hence, the objective of this study is to conduct a systematic review to assess the effectiveness of ERAS in patients undergoing ERCP.

This article is from Experimental and Therapeutic Medicine , volume 8 . Abstract Somatostatin has been extensively studied for the prophylaxis of pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). However, the results remain controversial. The present retrospective cohort study aimed to investigate the efficacy of pre- and post-ERCP somatostatin administration in the prevention of post-ERCP pancreatitis (PEP). All ERCP procedures performed at one hospital between January 2009 and December 2012 were reviewed. They were divided into three groups based on somatostatin administration: pre-ERCP som group (somatostatin administration: 0.25 mg/h for 24 h, starting 1 h prior to ERCP), post-ERCP som group (somatostatin administration: 0.25 mg/h for 24 h, starting immediately following ERCP), and control group (no somatostatin administration). Out of a total of 304 cases, 81 received pre-ERCP somatostatin; 126 received post-ERCP somatostatin and 97 were not administered somatostatin. Pre-ERCP somatostatin was effective in reducing the incidence of PEP compared with that in the control group (4.9 vs. 16.5%; P=0.017). This benefit was significant in high-risk patients (8.9 vs. 26.0%; P=0.035), but not in low-risk patients (0 vs. 6.4%; P=0.254). Post-ERCP somatostatin was not effective in preventing PEP in high- or low-risk patients. In conclusion, pre-ERCP somatostatin may be effective in reducing the risk of PEP in high-risk patients, but not in low-risk patients. Post-ERCP somatostatin did not reveal a benefit in high- or low-risk patients. However, large randomized controlled trials are required to further confirm these findings.

1例ERCP下SpyGlass诊断胆道狭窄患者的护理体会 Nursing experience of a patient diagnosed with SpyGlass under ERCP in a patient with biliary stenosis 作者： 王爽 1 张荣旺 2 姚娜 2 张春双 2 彭丹 2 作者单位： 1. 北京中医药大学东方医院 西院区 2. 北京中医药大学东方医院 脾胃肝胆科 通讯作者： 彭丹 Email:13717893741@163. com 提交时间： 2022-10-21 摘要: 本文总结1例ERCP下SPYGLASS诊断胆道狭窄患者的护理体会，包括术前的心理护理、器械准备、患者准备，术中护理，术后一般护理、并发症护理等针对性护理措施。通过综合的护理模式充分的术前准备，密切的手术配合，细致的术后护理保障ERCP下SPYGLASS诊断胆道狭窄术的成功，减轻患者疼痛，改善患者病症，促进其康复。 Abstract: This paper summarizes the nursing experience of a patient diagnosed with biliary stenosis under SpyGlass under ERCP, including preoperative psychological care, instrument preparation, patient preparation, intraoperative nursing, postoperative general nursing, complication nursing and other targeted nursing measures. Through the comprehensive nursing model, full preoperative preparation, close surgical cooperation, and meticulous postoperative care ensure the success of SpyGlass diagnosis of biliary stenosis under ERCP, reduce patient pain, improve patient diseases, and promote their recovery. ERCP SpyGlass 胆道狭窄 护理 期刊： NursRxiv 分类： 护理学 >> 护理学 投稿状态： 已在期刊出版 引用： ChinaXiv:202211.00020 (或此版本 ChinaXiv:202211.00020V1 ) DOI:dx.doi.org/10.12209/issn2708-3845.20220910001 CSTR:32003.36.ChinaXiv.202211.00020.V1 推荐引用方式： 王爽,张荣旺,姚娜,张春双,彭丹.(2022).1例ERCP下SpyGlass诊断胆道狭窄患者的护理体会.NursRxiv.doi:dx.doi.org/10.12209/issn2708-3845.20220910001 版本历史 [V1] 2022-10-21 14:51:10 ChinaXiv:202211.00020V1 下载全文

This article is from European Journal of Medical Research , volume 19 . Abstract Background: Post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common and most severe complication associated with diagnostic and therapeutic ERCP. A multivariate analysis of risk factors for PEP is essential for identifying patients at high risk and subsequently choosing other suitable diagnoses. Methods: Pertinent publications were identified through systematic searches of MEDLINE, Elsevier, and Springer; we performed a systematic review of 12 clinical studies published in the past ten years, selected out of 451 reviewed articles, in which risk factors for pancreatitis were identified. Seven probable risk factors were evaluated, and outcomes expressed in the case of dichotomous variables, as an odds ratio (OR) (with a 95% confidence interval, 95% CI). Results: When the risk factors were analyzed, the OR for female gender was 1.40 (95% CI 1.24 to 1.58); the OR for previous PEP was 3.23 (95% CI 2.48 to 4.22); the OR for previous pancreatitis was 2.00 (95% CI 1.72 to 2.33); the OR for endoscopic sphincterotomy was 1.42 (95% CI 1.14 to 1.78); the OR for precut sphincterotomy was 2.11 (95% CI 1.72 to 2.59); the OR for Sphincter of Oddi dysfunction was 4.37 (95% CI 3.75 to 5.09); and the OR for non-prophylactic pancreatic duct stent was 2.10 (95% CI 1.63 to 2.69). Conclusions: It appears that female gender, previous PEP, previous pancreatitis, endoscopic sphincterotomy, precut sphincterotomy, Sphincter of Oddi dysfunction, and non-prophylactic pancreatic duct stent are the risk factors for post-ERCP pancreatitis.

ERCP+EST+胆管支架置入术治疗胆总管狭窄患者的护理研究 Nursing study of ERCP+EST+bile duct stenting in patients treating common bile duct stenosis 作者： 王爽 1 马广雨 1 车梦妍 1 贾海义 1 唐玲 2 作者单位： 1. 北京中医药大学东方医院西院区 2. 北京中医药大学东方医院护理部 通讯作者： 唐玲 Email:tangling9101@163. com 提交时间： 2022-09-06 摘要: 目的 探讨ERCP+EST+胆管支架置入术治疗胆总管狭窄的护理。方法 总结我科2020年1月-2021年12月收治的70例患者，采用ERCP+EST+胆管支架置入术的方法治疗胆总管狭窄。得出护理研究体会，包括术前护理、术中配合、术后护理等。结果 70例患者术前完善各项检查，做好患者及家属的心理护理、术中配合，术后的专科护理提高了手术成功率（占比92%），减少了术后并发症（占比4%）、缩短了住院时间（占比96%）、减少了住院费用（占比96%）起着非常重要的作用。结论 ERCP+EST+胆管支架置入术是目前治疗胆总管狭窄的最佳方案。加强术前护理，严格无菌操作，熟练掌握ERCP操作技术，医护默契的配合及术后的护理，是保证手术成功率的基础。 Abstract: Objective To investigate the care of ERCP+EST+bile duct stenting in the treatment of common bile duct stenosis. Methods A total of 70 patients admitted to our department from January 2020 to December 2021 were treated with ERCP+EST+ bile duct stenting. The nursing research experience is obtained, including preoperative nursing, intraoperative cooperation, postoperative nursing, etc. Results 70 patients improved their preoperative examinations, did a good job in psychological care and intraoperative cooperation between patients and their families, and postoperative specialized nursing improved the success rate of surgery (accounting for 92%), reduced postoperative complications (accounting for 4%), shortened the length of hospitalization (accounting for 96%), and reduced hospitalization costs (accounting for 96%). Conclusion ERCP+EST+bile duct stenting is the best treatment for common bile duct stenosis at present. Strengthening preoperative care, strict aseptic operation, proficiency in ERCP operation technology, tacit cooperation of medical care and postoperative care are the basis for ensuring the success rate of surgery. ERCP EST 胆管支架置入术 护理 期刊： NursRxiv 分类： 护理学 >> 护理学 投稿状态： 已在期刊出版 引用： ChinaXiv:202209.00076 (或此版本 ChinaXiv:202209.00076V1 ) DOI:dx.doi.org/10.12209/issn2708-3845.20220807001 CSTR:32003.36.ChinaXiv.202209.00076.V1 推荐引用方式： 王爽,马广雨,车梦妍,贾海义,唐玲.(2022).ERCP+EST+胆管支架置入术治疗胆总管狭窄患者的护理研究.NursRxiv.doi:dx.doi.org/10.12209/issn2708-3845.20220807001 版本历史 [V1] 2022-09-06 13:04:01 ChinaXiv:202209.00076V1 下载全文

This article is from Scientific Reports , volume 4 . Abstract This study aimed to determine the performance and long-term outcomes of therapeutic ERCP in very old patients. Patients aged or over 90 (Group A, n = 78) and consecutive sex-matched controls (Group B, n = 312) under 65 selected were compared. More patients in Group A had chronic concomitant diseases, but the success and complication rates were comparable. The follow-up of 61 patients (78.2%) in Group A were done, with a mean period of 27.5 (3–54) months. Seven patients survived; the main causes of death for the other patients were concomitant diseases (n = 43) and primary diseases (n = 11). In patients with choledocholithiasis, cases with complete extractions of stones in bile ducts survived longer than those without (30 vs. 24 months, P < 0.001). Therapeutic ERCP in patients aged 90 years or older is effective and safe. In patients with choledocholithiasis, complete clearance of stones is associated with longer survival time.

This article is from Pakistan Journal of Medical Sciences , volume 29 . Abstract Objective: This study compared the therapeutic benefits and complication rates of small endoscopic sphincterotomy plus large-balloon dilation (ESLBD) with those of endoscopic sphincterotomy (EST) alone for large bile duct stones.Methods: We compared prospectively ESLBD group (n=63) with conventional EST group (n=69) for the treatment of large bile duct stones (≥15mm). Mechanical lithotripsy was performed when the stone could not be removed using a normal basket. We compared the rates of stone removal, frequency of mechanical lithotripsy use, procedure-related complications, and recurrent stones.Results: A total of 132 patients were reviewed in the study. The mean age of the patients was 67.9 years. The two groups showed significant differences in complete stone removal during the first session (80.9 vs. 60.8%; P = 0.046), the use of mechanical lithotripsy (7.94 vs. 24.6%; P = 0.041), and less duration of admission (P =0.045). After ERCP, there were some instances of oozing in both groups, All patients recovered completely, 14 patients had recurrent common bile duct stones among the follow-up duration.Conclusion: The ESLBD technique seems to be a feasible and safe alternative technique for conventional EST and EBD and has no more Post-ERCP complications.

I want use the ERCP with 2 or 4 kg spools. So create a custom version with only two buffer wo spool holder.

I want use the ERCP with 2 or 4 kg spools. So create a custom version with only two buffer wo spool holder.

This article is from International Journal of Biomedical Science : IJBS , volume 9 . Abstract Background:: We aim to evaluate the metabolic and inflammatory responses after ERCP procedure in patients who have common bile duct stones. Methods:: Between September 2009 and October 2010, we studied prospectively 50 patients who diagnosed with common bile duct stones. Our study was included patients who had previously been suspected with common biliary duct stone via radiological and biochemical examinations. We investigated parameters of pro-inflammatory cytokines (IL-1β, IL-6, Il-8, IL-12, IFN-γ, TNF-α), anti inflammatory cytokines (IL-4, IL-10, IL-13), stress hormones (ACTH, cortisol, growth hormone, aldosterone) and acute phase reactant (CRP). All venous blood samples were taken firstly 1hr before endoscopic intervention as a control. After ERCP procedure, venous blood samples were taken two more times, the first in 1hr, the second in 24 hours. Results:: We performed ERCP successfully to 50 patients due to common bile duct stones. All of them had higher serum cytokine levels (p

This article is from Annals of Gastroenterology , volume 25 . Abstract Background: Fluoroscopy time (FT) in endoscopic retrograde cholangiopancreatography (ERCP) has a linear relationship with radiation exposure to endoscopist, personnel and patients. The aim of this prospective study was to investigate the factors influencing the FT during ERCP. Patients and Methods: Between January 2010 and August 2011, patients with naïve papilla undergoing therapeutic ERCP were included in the study. Patient and procedural factors affecting fluoroscopy duration were investigated. Results: During the study period 549 ERCP records were included in the final analysis. The mean procedural time and FT were 19.53±7.61 min and 48.82±26.43 sec, respectively. There was no effect of age or gender on FT. Univariate analysis showed choledocholithiasis (+17.92 sec; 95%CI: 12.73-23.11, p

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This article is from Annals of Gastroenterology , volume 27 . 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

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This article is from BMC Gastroenterology , volume 14 . Abstract Background: Numerous clinical trials to improve the success rate of biliary access in difficult biliary cannulation (DBC) during ERCP have been reported. However, standard guidelines or sequential protocol analysis according to different methods are limited in place. We planned to investigate a sequential protocol to facilitate selective biliary access for DBC during ERCP. Methods: This prospective clinical study enrolled 711 patients with naïve papillae at a tertiary referral center. If wire-guided cannulation was deemed to have failed due to the DBC criteria, then according to the cannulation algorithm early precut fistulotomy (EPF; cannulation time > 5 min, papillary contacts > 5 times, or hook-nose-shaped papilla), double-guidewire cannulation (DGC; unintentional pancreatic duct cannulation ≥ 3 times), and precut after placement of a pancreatic stent (PPS; if DGC was difficult or failed) were performed sequentially. The main outcome measurements were the technical success, procedure outcomes, and complications. Results: Initially, a total of 140 (19.7%) patients with DBC underwent EPF (n = 71) and DGC (n = 69). Then, in DGC group 36 patients switched to PPS due to difficulty criteria. The successful biliary cannulation rate was 97.1% (136/140; 94.4% [67/71] with EPF, 47.8% [33/69] with DGC, and 100% [36/36] with PPS; P 

This article is from Journal of Medicine and Life , volume 6 . Abstract Introduction. Endoscopic retrograde cholangiopancreatography (ERCP) is a complex endoscopic technique that evolved from a diagnostic to a mainly therapeutic procedure. This was due to the identification of post-procedural complications that can follow both simple ERCP and that associated with the instrumentation of the biliary and pancreatic ductals. The identification of post ERCP complications in a proportion of 5 to 10% of cases, with a mortality rate of 0.33%, imposed their analysis and study of risk factors involved in their occurrence. The significance of post ERCP complications reveals the necessity of their avoidance by adopting additional measures if risk factors are identified. Materials and methods. We have retrospectively analyzed 900 cases that underwent ERCP in the Surgery Department of "Sf. Ioan" Clinical Hospital in a period of 17 years. The complications of the procedure were studied. Among them, a special attention was given to post-ERCP acute pancreatitis (pERCP-AP), the most common complication that occurred in the study group. We also tried to find out and highlight the risk factors for this complication. Results. ERCP is a relatively safe invasive procedure, yet it has complications (8% of cases), some of them potentially fatal (mortality 0.43%). The most common complications after ERCP are acute pancreatitis (3.7%), papillary bleeding (1.04%), retroperitoneal duodenal perforation (0.69%) and biliary septic complications like acute cholecystitis and cholangitis (1.21%). Acute pancreatitis is by far the most common complication. Risk factors for its occurrence are difficult sphincterotomy with precut use, failure of CBD desobstruction, pancreatic sphincterotomy, repeated injection of contrast in the pancreatic ductal system, dysfunction of the sphincter of Oddi and the absence of changes of chronic pancreatitis. When risk factors are identified, the patients’ selection must be very strict and diagnostic ERCP should be avoided in favor of non-invasive diagnostic methods (MRI-cholangiography, echo-endoscopy).

This article is from Annals of Gastroenterology : Quarterly Publication of the Hellenic Society of Gastroenterology , volume 27 . Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure which carries a complication rate of 5-10%. Splenic injury is a very rare and potentially lethal complication following ERCP. We report a case of a 64-year-old man with a mass at the pancreatic head and obstructive jaundice, who sustained a splenic injury following ERCP. Six hours after the procedure, the patient presented with epigastric pain and hypotension. The abdominal CT scan revealed splenic hematoma. He was offered surgical treatment. Splenectomy was performed with enterogastrostomy.

Aim: Since post-ERCP pancreatitis (PEP) is considered the most common complication of ERCP, it has been the focus of research to explore its prevention. Identifying patients with high-risk factors for PEP is one of the most important aspects for PEP prevention. Patients with high-risk factors should be carefully evaluated and alternative treatment and diagnostic techniques may be preferred instead of ERCP. Our aim in this study is to determine the risk factors in patients who develop pancreatitis after endoscopic retrograde cholangiopancreatography procedure and to determine an early and appropriate diagnosis and treatment approach in these patients. Material and Method: 1100 ERCPs performed by a single operator were included in this study. Post-ERCP pancreatitis (PEP) developed in 222 patients after the procedure. ERCP indications, age, gender, clinical findings, comorbidities and imaging frequencies of the patients who developed PEP were recorded before and after the procedure. Result: 20.1% of the patient who underwent ERCP developed PEP. It was found that comorbidity and stent placement increased the development of PEP in patients who underwent ERCP. It was found that performing ERCP with the pre-incision method reduces the rate of PEP development. It was found that ERCP indications had no effect on the development of PEP. It was found that the rate of hospitalization in the intensive care unit increased in patients who developed PEP. It was found that the rate of PEP development decreased as operator experience increased. Discussion: The risk of PEP is multifactorial, and the effects of some risk factors can be minimized or completely eliminated. Different patient-related risk factors can help predict PEP.

This article is from PLoS ONE , volume 9 . Abstract Background: Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be efficacious to prevent pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, the target patients, the type of NSAID, the route of administration and the time of drug delivery remain unclear, as well as the potential efficacy in reducing the severity of pancreatitis, length of hospital stay and mortality. The objective of the study was to evaluate these questions by performing a systematic review and meta-analysis. Methods: Multiple searches were performed in the main databases. Randomized controlled trials (RCTs) comparing NSAIDs vs. placebo in the prevention of post-ERCP pancreatitis were included. Primary endpoint of the study was the efficacy for pancreatitis prevention. Sub-analyses were performed to determine the risk reduction in high and low risk patients, and to define optimal time, route of administration, and type of NSAID. Secondary endpoints were safety, moderate to severe pancreatitis prevention and reduction of hospital stay and mortality. Results: Nine RCTs enrolling 2133 patients were included. The risk of pancreatitis was lower in the NSAID group than in the placebo group (RR 0.51; 95%CI 0.39–0.66). The number needed to treat was 14. The risk of moderate to severe pancreatitis was also lower in the NSAID group. (RR 0.46; 95%CI 0.28–0.76). No adverse events related to NSAID use were reported. NSAIDs were effective in both high-risk and unselected patients (RR 0.53; 95%CI 0.30–0.93 and RR 0.57; 95%CI 0.37–0.88). In the subanalyses, only rectal administration of either indomethacin (RR 0.54; 95%CI 0.38–0.75) or diclofenac (RR 0.42; 95%CI 0.21–0.84) was shown to be effective. There were not enough data to perform a meta-analysis in hospital stay reduction. No deaths occurred. Conclusion: A single rectal dose of indomethacin or diclofenac before or immediately after ERCP is safe and prevents procedure-related pancreatitis both in high risk and in unselected patients.

This article is from Gastroenterology and Hepatology From Bed to Bench , volume 4 . Abstract Aim: The aim of this study was to analyze clinical findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography complications. Background: Endoscopic retrograde cholangiopancreatography has become a very common procedure for the evaluation and treatment of biliary and pancreatic diseases. Patients and methods: A retrospective review of 2447 endoscopic retrograde cholangiopancreatography procedures and their complications since Apr 2006 till Dec 2010 was conducted to identify their incidence, optimal management, and clinical outcomes. Results: 2447 endoscopic retrograde cholangiopancreatography procedures were performed. Overall, complications developed in 168 (6.9%) cases: perforation in 10 (0.4%), hemorrhage in 4 (0.16%) and mild to severe pancreatitis in 154 (6.3%). The patients mean age was 66± 6 yrs with females/ males of 1432(58.5%)/ 1015(41.5%). Abdominal pain, nausea, leukocytosis and hyperamylasemia were most common findings in these patients. Surgery was performed for 6 patients (0.24%). The most hospital station was 20 days: surgical group 7±2 days, pancreatitis 11± 4 days and average 6 days for others. Conclusion: Endoscopic retrograde cholangiopancreatography remains the endoscopic procedure that carries a high risk for morbidity and or mortality. The majority of events are of mild-to-moderate severity and when surgery should be done, it depends upon the clinicopathological condition and we don't advise pyloric exclusion, gastrojejunostomy and duodenal diversion for these patients.

This article is from Frontline Gastroenterology , volume 5 . Abstract Objective: In 2010, the European Society of Gastrointestinal Endoscopy delivered guidelines on the prophylaxis of postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP). These included Grade A recommendations advising the use of prophylactic pancreatic stent (PPS) and non-steroidal anti-inflammatory drugs (NSAIDs) in high-risk cases. Our study aim was to capture the current practice of UK biliary endoscopists in the prevention of PEP. Design: In summer 2012, an anonymous online 15-item survey was emailed to 373 UK consultant gastroenterologists, gastrointestinal surgeons and radiologists identified to perform ERCP. Results: The response rate was 59.5% (222/373). Of the respondents, 52.5% considered ever using PPS for the prevention of PEP. PPS users always attempted insertion for the following procedural risk factors: pancreatic sphincterotomy (48.9%), suspected sphincter of Oddi dysfunction (46.5%), pancreatic duct instrumentation (35.9%), previous PEP (25.2%), precut sphincterotomy (8.5%) and pancreatic duct injection (7.8%). Prophylactic NSAID use was significantly associated with attempts at PPS placement (p

ABSTRACT Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure for both the diagnosis and management of biliary and pancreatic ductal diseases. While it has been largely replaced by non-invasive imaging techniques for diagnostic purposes, ERCP remains the gold standard for therapeutic interventions. This study aims to retrospectively analyze the outcomes, adverse events, and success rates of ERCP procedures performed on 500 patients over two years. Methods: A retrospective review of 500 ERCP procedures performed at a single center over 24 months was conducted. Patient demographics, indications for ERCP, procedural outcomes, and adverse event rates were collected and analyzed. Success rates for therapeutic interventions, as well as risk factors for post-procedural adverse events, were identified. Results: The study revealed that 448 (89.6%) of ERCP procedures were successful in achieving the primary therapeutic goal (e.g., stone extraction, stent placement). Adverse events occurred in 93 (18.6%) of cases, with post-ERCP pancreatitis being the most common adverse event (n: 73, 14.6%). Risk factors associated with adverse events included previous cholecystectomy (p

This article is from Frontline Gastroenterology , volume 4 . Abstract More than 48 000 endoscopic retrograde cholangiopancreatographies (ERCP) are performed in the UK per annum; the majority within district general hospitals. The proposal for centralisation of ERCP services is based on evidence that technical success, length of stay and complication rates are related to the numbers of procedures performed. Local units wishing to continue their ERCP practice, must demonstrate that they are performing sufficient numbers of procedures in a safe, timely and competent fashion.