Does periampullary diverticulum affect ERCP cannulation and post-procedure complications? an up-to-date meta-analysis

Mu, Peilei; Yue, Ping; Li, Fangwei; Lin, Yanyan; Liu, Ying; Meng, Wenbo; Zhou, Wence; Li, Xun

doi:10.5152/tjg.2020.19058

Cited by 12 publications

(15 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Song et al [ 31 ] reported that recurrent bile duct stones were more likely to be brown pigmented stones than cholesterol-based stones. This may be because pigment-based stones are often related to bacterial infection, and the formation of biliary sludge will contribute to recurrent stone formation over time[ 32 - 34 ]. The brown pigmented stones that form as a result of bacterial infection are soft and easy to fragment and generate abundant debris.…”

Section: Discussionmentioning

confidence: 99%

Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study

Lin¹,

Wang²,

Yue³

et al. 2021

WJG

Self Cite

View full text Add to dashboard Cite

BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct (CBD) stones, which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography. AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy. METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large (> 1.2 cm) CBD stones. After occlusion cholangiography confirmed CBD stone clearance, peroral cholangioscopy (POC) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via POC were graded on a 5-point scale (score 1, worst; score 5, best). Scores were documented after only stone removal (control) and after irrigation with 50 mL and 100 mL saline, respectively. The stone composition was analyzed using infrared spectroscopy. RESULTS Between October 2018 and January 2020, 47 patients had CBD clearance scores of 2.4 ± 1.1 without saline irrigation, 3.5 ± 0.7 with 50 mL irrigation, and 4.6 ± 0.6 with 100 mL irrigation ( P < 0.001). Multivariate analysis showed that CBD diameter > 15 mm [odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.01-0.49; P = 0.007] and periampullary diverticula (PAD) (OR = 6.51, 95%CI: 1.08-39.21; P = 0.041) were independent risk factors for residual stones. Bilirubin pigment stones constituted the main residual stones found in patients with PAD ( P = 0.004). CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy, especially in patients with PAD and/or a dilated (> 15 mm) CBD. Pigment residual stones are soft and commonly found in patients with PAD. Additional saline irrigation may be required to remove retained stones.

show abstract

Section: Discussionmentioning

confidence: 99%

Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study

Lin¹,

Wang²,

Yue³

et al. 2021

WJG

Self Cite

View full text Add to dashboard Cite

show abstract

“…The characteristics of our patients with perforation were compatible with the risk factors in the literature, but a statistical analysis could not be performed due to the low number of patients. 13,14,45 This study was conducted in a center with a high number of ERCP performed every year. In addition, our institution is a tertiary center where complex cases are referred to.…”

Section: Discussionmentioning

confidence: 99%

“…4 In addition, precut sphincterotomy, intramural contrast injection, and the presence of periampullary diverticulum (PAD) were associated with post-ERCP perforation. 13,14 Analyzing the factors that predict AEs developing after ERCP may be very important in reducing procedure-associated morbidity and mortality by defining patients that would be at high risk. The number of studies in which all complications are evaluated and risk factors are analyzed in the same patient group is few.…”

mentioning

confidence: 99%

Post-ERCP Complication Analysis of an Experienced Center

Aykut

Pala

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Background/Aim: Post-ERCP pancreatitis (PEP), post-sphincterotomy bleeding (PSB), and Post-ERCP perforation are the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Identification of risk factors for post-ERCP complications is critical for postoperative follow-up. This study aimed to evaluate the most common post-ERCP complication risk factors in an experienced center. Methods/Design: The sample consisted of 1288 patients with naive papillae. Demographic characteristics, patient-related risk factors, procedure-related risk factors and postoperative complications were recorded. Results: Patients had a mean age of 61.5±18.4 years. The prevalence of PEP, PSB, and post-ERCP perforation was 7.9%, 11.9%, and 0.5%, respectively. Among patient-related factors, female sex (OR 1.672 95% Cl 1.046 to 2.672) and narrowing of the choledochal diameter (OR 2.910 95% Cl 1.830 to 4.626) were associated with PEP. From procedure-related factors; precut sphincterotomy (OR 2.172 95% Cl 1.182 to 3.994), difficult cannulation (OR 5.110 95% Cl 2.731 to 9.560), pancreatic cannulation (OR 5.692 95% Cl 0.994 to 32.602) and postprocedure residual stone (OR 2.252 95% Cl 1.403 to 3.614) were found to be associated with PEP. The successful procedure (OR 0.378 95% Cl 0.204 to 0.699) had a protective effect on PEP. Choledocholithiasis indication (OR 3.594 95% Cl 1.444 to 8.942) and small papilla (OR 2.042 95% Cl 1.170 to 3.562) were associated with the development of PSB. Choledochal stenosis, periampullary-diverticulum, oral anticoagulant, and oral antiaggregant use were not associated with the development of PSB. Of the patients with post-ERCP perforation, 85.7% had difficult cannulation, 57.1% had precut sphincterotomy, and 28.6% had periampullary-diverticulum. Conclusion: Female sex, biliary stricture, precut sphincterotomy, difficult cannulation, pancreatic cannulation, and postoperative residual stone were associated with PEP. Choledocholithiasis indication and the presence of small papilla were associated with PSB.

show abstract

“…ERCP işlemine bağlı erken komplikasyon sıklığı açısından gruplar benzerdi (PAD olmayan grupta n=21, %3.1, PAD (12). PAD hastalarında kanülasyon başarısındaki zaman içerisinde gözlenen bu artış yeni geliştirilen cihazların sağladığı teknik avantajlar ile birlikte gelişen manipülasyon teknikleri ve ERCP konusunda deneyim artışı ile ilişkili olarak değerlendirilebilir.…”

Section: Gereç Ve Yöntemunclassified

“…ERCP esnasında PAD olan hastalarda PAD olmayan hastalara göre kanülasyon oranı ve komplikasyon riski konusunda literatürde az sayıda çalışma mevcut olup veriler çelişkilidir. Eski tarihli çalışmalar çoğunlukla PAD'lerin ERCP esnasında kanülasyon zorluğu oluşturduğunu ve komplikasyon riskini artırdığını gösterirken (6-8), son zamanlarda yapılan bazı çalışmalar ise ek kanülasyon tekniklerine daha çok ihtiyaç duyulmakla birlikte kanülasyon oranı ve komplikasyon sıklığının benzer olduğunu raporlamıştır (9)(10)(11)(12). Ayrıca papillanın divertiküle göre yönünün de kanülasyon başarısını etkilediği gösterilmiştir (10).…”

Section: Introductionunclassified

Periampüller divertikül endoskopik retrograd kolanjiyopankreatografide kanülasyon başarısı ve komplikasyon sıklığını etkiler mi?

Toka

Tokmak²

2020

Akademik Gastroenteroloji Dergisi

View full text Add to dashboard Cite

Giriş ve Amaç: Periampüller divertiküller, endoskopik retrograd kolanjiyopankreatografi işlemi esnasında özellikle yaşlı hastalarda sık rastlanan anomalilerdir. Periampüller divertiküllerin endoskopik retrograd kolanjiyopankreatografide teknik başarı ve komplikasyonlar üzerine etkisi ile ilgili yapılan çalışmaların sonuçları ise çelişkilidir. Çalışmamızda periampüller divertikülü olan ve olmayan hastalar arasında endoskopik retrograd kolanjiyopankreatografi işlemi esnasında kanülasyon başarısı ve erken komplikasyonları karşılaştırmayı ve bunları etkileyen faktörleri değerlendirmeyi amaçladık. Gereç ve Yöntem: 2018-2020 yılları arasında endoskopik retrograd kolanjiyopankreatografi yapılan hastalar retrospektif olarak çalışmaya alındı. Hastalar periampüller divertikülü olmayan (n=574) ve olan (n=137) şeklinde iki gruba ayrıldı. Hastaların tıbbi kayıtları incelenerek her iki grup demografik ve klinik özellikleri, endoskopik retrograd kolanjiyopankreatografi işlem özellikleri, komplikasyon ve mortalite oranları açısından karşılaştırıldı. Bulgular: Ortalama yaşı 61.2±17.7, 465'i (%57.3) kadın olan 811 hastaya yapılan toplam 973 endoskopik retrograd kolanjiyopankreatografi işlemi incelendi. Kanülasyon başarısı periampüller divertikülü olmayan grupta %97, periampüller divertikülü olan grupta %97.1 (p=0.96) saptandı. Endoskopik retrograd kolanjiyopankreatografide seans sayısı, işlem başarısı, koledok taşı varlığı, taş çıkarmak için büyük balon ile papilla dilatasyon ihtiyacı ve biliyer stent konulma oranları açısından gruplar benzerdi (p >0.05). Periampüller divertikül bulunmayan grupta kanülasyon için ön kesi ihtiyacı daha yüksekti (sırasıyla; %25 vs %14.6, p=0.01). Endoskopik retrograd kolanjiyopankreatografiye bağlı erken komplikasyonlar açısından ise gruplar arasında farklılık saptanmadı (periampüller divertikülü olmayanlarda n=21, %3.1, periampüller divertikülü olanlarda n=5, %3.6, p=0.75). Sonuç: Endoskopik retrograd kolanjiyopankreatografi esnasında periampüller divertikül saptanması kanülasyon önünde bir engel olarak görülmemeli, hatta ön kesi ihtiyacını azaltarak kanülasyonu kolaylaştırabileceği dikkate alınmalıdır. Çalışmamızın sonuçları periampüller divertiküllerin varlığının işleme bağlı komplikasyonlar açısından ek risk oluşturmadığını göstermektedir.

show abstract

Does periampullary diverticulum affect ERCP cannulation and post-procedure complications? an up-to-date meta-analysis

Abstract: Stem cells for pancreatitis 425 Gastric injury and bacterial overgrowth 433 The effect of visceral fat on SMA configuration 451 Antiplatelet agents in ulcerative colitis 459 Differentiation of BMSCs into intestinal ce 466 GERDOFF ® efficacy in patients with GERD

Cited by 12 publications

References 41 publications

Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study

Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study

Post-ERCP Complication Analysis of an Experienced Center

Periampüller divertikül endoskopik retrograd kolanjiyopankreatografide kanülasyon başarısı ve komplikasyon sıklığını etkiler mi?

Contact Info

Product

Resources

About