Complications of Diagnostic and Therapeutic Ercp: A Prospective Multicenter Study

Masci, E.; Toti, G. L.; Mariani, Alberto; Curioni, Simona; Lomazzi, A.; Dinelli, M.; Minoli, Giorgio; Crosta, C.; Comin, U.; Fertitta, A. M.; Prada, Alberto; Passoni, G. Rubis; Testoni, Pier Alberto

doi:10.1111/j.1572-0241.2001.03594.x

Cited by 825 publications

(545 citation statements)

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“…Before considering an empiric biliary sphincterotomy for recurrent pancreatitis with or without abnormal liver function tests, the clinician must be aware of the possibility of an alternative etiology, such as sphincter of Oddi dysfunction, especially in women, young or middleaged patients, and patients who are postcholecystectomy, or do not have clearly documented gallstone disease. Empiric biliary sphincterotomy and even diagnostic ERCP in patients with recurrent pancreatitis, and especially those with suspected sphincter of Oddi dysfunction, are associated with significantly greater risk of post-ERCP pancreatitis, and are less likely to be of therapeutic benefit than for patients with biliary pancreatitis (246)(247)(248)(249)(250). ERCP in such patients may be best approached in the context of a more comprehensive evaluation using other imaging techniques including MRCP and EUS, and risk of post-ERCP pancreatitis may be reduced by placement of a temporary small-caliber pancreatic stent (207,265).…”

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

“…In the majority of patients with mild biliary pancreatitis, bile duct stones have passed by the time cholangiography is considered, such that routine ERCP prior to cholecystectomy is unnecessary and adds avoidable risk (246)(247)(248)(249)(250). For example, in a randomized trial in patients with mild gallstone pancreatitis with high suspicion of persisting common bile duct stones (elevated serum bilirubin, dilated common bile duct, or persistent hyperamylasemia) but without cholangitis, selective postoperative ERCP and CBD stone extraction was necessary in only approximately one in four such patients, and was associated with a shorter hospital stay, less cost, no increase in combined treatment failure rate, and significant reduction in ERCP use compared with routine preoperative ERCP (251).…”

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

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Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,662

980

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Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,662

980

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“…The incidence of post-ES bleeding varies from 0.76-2 to 10-48 % [8,15], depending on the definition applied. Post-ES bleeding is classified as immediate or delayed according to the time of presentation [8,15,16], and it is associated with increased morbidity and mortality [8,9,17]. Endoscopic treatments include injection treatment, thermal therapy, endoclips, and balloon tamponade, which can be applied individually or in combined treatments.…”

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confidence: 99%

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

Canena

Liberato²,

Horta

et al. 2012

Surg Endosc

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Background Fully covered self-expandable metal stents (FCSEMS) have been used as a rescue therapy for several benign biliary tract conditions (BBC). Long-term stent placement commonly occurs, and prolonged FCSEMS placement is associated with the majority of the complications reported. This study evaluated the duration of stenting and the efficacy and safety of temporary FCSEMS placement for three BBCs: refractory biliary leaks, postsphincterotomy bleeding, and perforations. Methods This was a retrospective case series with longterm follow-up of 25 patients who underwent FCSEMS placement for BBCs. This study included 17 patients with postcholecystectomy refractory biliary leaks who had previously undergone unsuccessful sphincterotomy and plastic stent placement, 4 patients with difficult-to-control postsphincterotomy bleeding, and 4 patients with a perforation following endoscopic sphincterotomy. Stents were removed according to clinical evidence of problem resolution. The review included stenting duration, safe FCSEMS removal, clinical efficacy, complications, and long-term outcomes. During the follow-up period, ERCP and cholangioscopy procedures were performed to exclude the possibility of bile duct lesion development. Results Complete resolution of the initial condition was achieved in all patients. Patients with biliary leaks had a median stent duration time of 16 days (range 7-28 days). Patients with bleeding had stents removed after a median time of 6 days (range 3-15 days). Patients with perforations had their stents removed after a median time of 29.5 days (range 21-30 days). There were no complications related to stenting. Conclusions Temporary placement of a FCSEMS for 30 days or less is an effective rescue therapy for refractory biliary leaks, difficult-to-control post-endoscopic sphincterotomy bleeding, and perforations. Duration of stenting should be different for each type of condition. Stents can be safely removed, and short-term stenting is associated with the absence of early and late complications.

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“…Early complications after ERCP include acute pancreatitis, bleeding, perforation, and infection (cholangitis and cholecystitis) Of these ERCP related complications, pancreatitis remain the most common with a reported incidence of 2 to 15% in multicenter prospective studies. [1][2][3][4][5] Most cases of post ERCP pancreatitis are mild, showing complete recovery in a few days. After severe ERCP related Pancreatitis however., secondary consequences (e.g.…”

Section: Introductionmentioning

confidence: 99%

A study on ulinastatin in preventing post ERCP pancreatitis

2017

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INTRODUCTIONERCP is widely performed for the diagnosis and management of various pancreaticobiliary diseases. Early complications after ERCP include acute pancreatitis, bleeding, perforation, and infection (cholangitis and cholecystitis) Of these ERCP related complications, pancreatitis remain the most common with a reported incidence of 2 to 15% in multicenter prospective studies.1-5 Most cases of post ERCP pancreatitis are mild, showing complete recovery in a few days. After severe ERCP related Pancreatitis however., secondary consequences (e.g. pancreatic pseudocyst and abscess) and multiorgan failure frequently develop: surgical intervention and prolonged hospital stay are usually required, and eventually the patient dies. In a reported series of 7,869 patients undergoing diagnostic or therapeutic ERCP, 3 patients (0.04%) died from severe post-ERCP Pancreatitis. The prevention of post ERCP pancreatitis has been a never-ending challenge ever since ERCP was introduced in clinical settings in the 1970s. The exact pathogenesis of post-ERCP pancreatitis has remained unclear but diverse factors, which include mechanical injury, hydrostatic injury, chemical and allergic injury. enzymatic Injury, infection and thermal injury have been postulated as causes of post ERCP pancreatitis.6-8 Many pharmacologic agents of different types he been used to prevent post ERCP pancreatitis on the assumption that they Pharmacologically inhibit one or more of the aforementioned factors associated with pancreatic damage. Irrespective of the etiology of acute pancreatitis, the activation of proteases enzymes starting with trypsinogen activation to trypsin in pancreatic acinar cells, has been considered to play an Initial role in the ABSTRACT Background: Pancreatitis remains the major complication of endoscopic retrograde cholangiopancreatography (ERCP), and hyperenzymemia after ERCP is common. Ulinastatin, a protease inhibitor, has proved effective in the treatment of acute pancreatitis. The aim of this study was to assess the efficacy of ulinastatin, compare to placebo study to assess the incidence of complication due to ERCPP procedure. Methods: In this study a randomized placebo controlled trial, patients undergoing the first ERCP was randomizing to receive ulinastatin one lakh units (or) placebo by intravenous infusion one hour before ERCP for ten minutes duration. Clinical evaluation, serum amylase, ware analysed before the procedure 4 hours and 24 hours after the procedure. Results: Total of 46 patients were enrolled (23 in ulinastatin and 23 in placebo group). The incidence of Hyper enzymemia is lower in ulinastatin group (13 %) than in placebo group (30.4%). Conclusions: Prophylactic short-term administration of ulinastatin one lakh units intravenously, one hour before ERCP procedure is effective when compared to placebo infusion.

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Complications of Diagnostic and Therapeutic Ercp: A Prospective Multicenter Study

Abstract: The results of our study further contribute to the assessment of risk factors for complications related to ERCP/ES. It is crucial to identify high risk patients to reduce complications of the procedures.

Cited by 825 publications

References 19 publications

Practice Guidelines in Acute Pancreatitis

Practice Guidelines in Acute Pancreatitis

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

A study on ulinastatin in preventing post ERCP pancreatitis

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