ERCP is more challenging in cases of acute biliary pancreatitis than in acute cholangitis – Analysis of the Hungarian ERCP registry data

Pécsi, Dániel; Gódi, Szilárd; Hegyi, Péter; Hanák, Lilla; Szentesi, Andrea; Altorjay, István; Bakucz, Tamás; Czakó, László; Kovács, György; Orbán-Szilágyi, Á; Pakodi, F; Patai, Árpád V.; Szepes, Zoltán; Gyökeres, T; Fejes, R; Dubravcsik, Zsolt; Vincze, Áron

doi:10.1016/j.pan.2020.11.025

Cited by 7 publications

(2 citation statements)

References 13 publications

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“…Also, Acosta, et al, reported that female was the predominant gender in the study (81% in the conservative group and 70% in the study group)[17]. Uy, et al and Pécsi, et al reported the same finding[18,19]. Halász, et al described that females constituted 57% of patients[20].…”

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confidence: 62%

randomized controlled trial for comparing the results of early endoscopic retrograde cholangiopancreatography and conservative treatment in patients with acute gallstone pancreatitis

Omaia,

Khalil,

Omar

et al. 2023

ijhs

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Introduction: Gallstone pancreatitis is one of the most dangerous complications of gallstone disease with a high risk of complications and death. Therefore, accurate diagnosis and timely management of acute gallstone pancreatitis are very important. Most guidelines recommend urgent ERCP in cases of biliary obstruction with cholangitis. However, the best time to perform an ERCP in patients suffering from acute gallstone pancreatitis without cholangitis is not universally agreed upon. Aim: The purpose of this study was to compare the outcomes of early ERCP versus conservative management in patients with acute gallstone pancreatitis in terms of complications, mortality, and length of hospital stays. Materials and Methods: A randomized controlled trial was carried out at the Suez Canal University Hospitals between January 2020 and January 2022. After meeting the inclusion criteria, forty patients were enrolled in this study and were allocated randomly into ERCP and Conservative groups. A written informed consent form was taken from all patients. Patient demographics, symptoms, and a detailed history were all collected. Laboratory tests were performed and reported. ERCP's findings were reported. A total of 40 patients were included in the study. The average age was 42 years in the ERCP group and 39 in the conservative group.

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confidence: 62%

randomized controlled trial for comparing the results of early endoscopic retrograde cholangiopancreatography and conservative treatment in patients with acute gallstone pancreatitis

Omaia,

Khalil,

Omar

et al. 2023

ijhs

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“…From a pathophysiologic perspective, rapid removal of gallstones can prevent worsening of pancreatitis. However, ABP has a higher rate of ERCP-related AEs than acute cholangitis due to more di cult cannulation and longer procedure times, so caution should be exercised when deciding to perform emergency ERCP 13,14 . In ABP, gallstones may also spontaneously drain into the duodenum as biliary pressure rises, supporting previous ndings that indiscriminate emergency ERCP is not optimal.…”

Section: Comparing Primary and Secondary Outcomes Based On Symptom On...mentioning

confidence: 99%

Increased ERCP-related adverse event from premature urgent ERCP following symptom onset in acute biliary pancreatitis with cholangitis

Lee,

Jang,

Park

et al. 2023

Preprint

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Acute biliary pancreatitis (ABP) with cholangitis requires endoscopic retrograde cholangiopancreatography (ERCP) within 24 hours to resolve ductal obstruction. However, this recommendation is based on the timing of emergency room (ER) visits. We wanted to determine the optimal timing of ERCP for ABP based on the timing of symptom onset, not the timing of the ER visit. We retrospectively reviewed 162 patients with ABP with cholangitis who underwent urgent ERCP (within 24 hours of ER admission). Area under the receiver operating characteristic (ROC) curve (AUC) was analyzed to determine differences in complication rates according to time from symptom onset. A difference in ERCP-related adverse events (AEs) was identified, and Youden’s J statistic was used to determine a cutoff time from symptom onset (18 hours). We compared mortality and complications based on this cutoff. Based on time to symptom onset, significantly higher rates of aspiration pneumonia (odds ratio [OR]: 4.00, 95% confidence interval [CI]: 1.15–13.92, P = 0.021) and post-ERCP hypotension (OR: 11.9, 95% CI: 1.39–101.33, P = 0.005) were observed in the ≤ 18-hour group than in the > 18-hour group. The study found that patients who underwent ERCP within 18 hours of symptom onset is associated with an increased risk of ERCP-related AEs.

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Nafamostat Reduces the Incidence of post‐ERCP Pancreatitis: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Horváth,

Kleiner,

Nagy

et al. 2023

Clin Pharma and Therapeutics

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Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). As the management of pancreatitis is limited, clinical approaches focus on the prevention of post‐ERCP pancreatitis (PEP). In theory, the serine protease inhibitor nafamostat can reduce circulating inflammatory mediators in pancreatitis. We aimed to investigate the effect of nafamostat in the prevention of PEP in this systematic review and meta‐analysis. The protocol for this review was registered in PROSPERO (CRD42022367988). We systematically searched 5 databases without any filters on September 26, 2022. The eligible population was adult patients undergoing ERCP. We compared the PEP preventive effect of nafamostat to placebo. The main outcome was the occurrence of PEP. We calculated the pooled odds ratios (ORs), mean differences, and corresponding 95% confidence intervals (95% CIs) and multilevel model. The risk of bias was assessed using the Rob2 tool. Seven randomized controlled trials involving 2,962 patients were eligible for inclusion. Nafamostat reduced the overall incidence rate of PEP (20 mg, OR: 0.50, 95% CI: 0.30–0.82 and 50 mg, OR: 0.48, 95% CI: 0.24–0.96). However, the occurrence of mild PEP was significantly reduced only in the subgroup receiving 20 mg nafamostat (OR, 0.49, 95% CI: 0.31–0.77). Overall, nafamostat therapy reduced moderate PEP in high‐risk patients (OR: 0.18, 95% CI: 0.0.4–0.84) and mild PEP in low‐risk patients (OR: 0.32, 95% CI: 0.17–0.61). Nafamostat is an effective therapy in the prevention of mild post‐ERCP pancreatitis. Further research is required to determine the cost‐effectiveness of this therapy.

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ERCP is more challenging in cases of acute biliary pancreatitis than in acute cholangitis – Analysis of the Hungarian ERCP registry data

Cited by 7 publications

References 13 publications

randomized controlled trial for comparing the results of early endoscopic retrograde cholangiopancreatography and conservative treatment in patients with acute gallstone pancreatitis

randomized controlled trial for comparing the results of early endoscopic retrograde cholangiopancreatography and conservative treatment in patients with acute gallstone pancreatitis

Increased ERCP-related adverse event from premature urgent ERCP following symptom onset in acute biliary pancreatitis with cholangitis

Nafamostat Reduces the Incidence of post‐ERCP Pancreatitis: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

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