Endoscopic retrograde cholangio-pancreatography practice in district general hospitals in North East England: a Northern Regional Endoscopy Group (NREG) study

Chatterjee, Shivani; Rees, Colin; Dwarakanath, AD; Barton, Richard G.; Macdonald, C; Greenaway, John; Gregory, W. Thomas; Reddy, A. L. Narasimha; Nylander, D

doi:10.4997/jrcpe.2011.221

Cited by 18 publications

(15 citation statements)

References 7 publications

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“…The completion rate (a topic of interest for the setting of quality assurance measures for ERCP) at the first ERCP in this study initially seems low (59%) compared with other reports of 80% 1 2. However, those studies were on patient groups with 92% grade 1 stones—compared with just 33% in our cohort.…”

Section: Discussioncontrasting

confidence: 62%

“…In general, our study confirmed these expectations—thus validating stone size as one of the measures of degree of difficulty. However, there was another important difference in ERCP management of CBD stones between this study and other published studies; our patients—and specifically the patients with large CBD stones—were significantly older than those of previously published series 1 2. In an area with high background levels of social deprivation, the comorbidities of these older patients would be a significant factor leading to potential complications.…”

Section: Discussioncontrasting

confidence: 52%

“…This cohort had an unusually high prevalence of larger CBD stones compared with previously published series 1. Over two-thirds of patients in this series of consecutive patients referred for ERCP had CBD stones >10 mm, compared with only 8% in other published series.…”

Section: Discussionmentioning

confidence: 45%

“…Where the size of the largest stone was recorded or measurable, difficulty of procedure (grade 1 or 2) could be assigned 1 6. Stone size was either recorded or measured on imaging review in 79 of the ERCPs.…”

Section: Resultsmentioning

confidence: 99%

“…Techniques in ERCP have improved over the past decade and studies report that 85–95% of all CBD stones can be effectively managed by conventional ERCP methods 1 2. This includes stenting in older patients with significant comorbidities.…”

Section: Introductionmentioning

confidence: 99%

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Biliary boulders

Steed

Lau

Glass

et al. 2014

Frontline Gastroenterol

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Objective To examine the outcome of endoscopic retrograde cholangiopancreatography (ERCP) in the management of common bile duct (CBD) stones. Design A retrospective review of 100 consecutive ERCPs performed for CBD stones. Results 100 ERCPs were performed on 84 patients with a median cohort age of 77. Completion in this cohort, as defined by duct clearance, was achieved in 65% of cases. Completion rates fell rapidly after two ERCPs. 33% of the cohort had small stones <10 mm, and 67% had stones >10 mm. Size, but not number of stones, affected the completion rate and frequency of complications (16%). Presence of periampullary diverticulum did not affect completion or complication rates. MR cholangiopancreatography (MRCP) had a 90% sensitivity for detecting CBD stones compared with 56% for CT. Discussion and conclusions ERCP remains a high-risk procedure with a significant complication rate when performed to deal with CBD stones. MRCP should be the second choice of investigation for CBD stones. This cohort had an unusually high number of larger stones at ERCP of 67% compared with other published UK cohorts of 8%, and this was reflected in the completion and complication rate. BACKGROUNDCommon bile duct (CBD) stones are often the reason for performing a therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Techniques in ERCP have improved over the past decade and studies report that 85-95% of all CBD stones can be effectively managed by conventional ERCP methods.1 2 This includes stenting in older patients with significant comorbidities. Incomplete CBD stone extraction can leave a patient at risk of recurrent cholangitis, gallstone pancreatitis and biliary obstruction, all of which are associated with a significant mortality and comorbidity in elderly patients. A large multicentre analysis showed that

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Section: Discussioncontrasting

confidence: 62%

Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 45%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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