Endoscopic retrograde cholangiopancreatography‐related adverse events in Korea: A nationwide assessment

Jang, Dong Kee; Kim, Jungmee; Paik, Chang Nyol; Kim, Jung Wook; Lee, Tae Hee; Jang, Jun‐Bock; Yoon, Seung Bae

doi:10.1002/ueg2.12186

Cited by 13 publications

(11 citation statements)

References 20 publications

(34 reference statements)

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“…[19][20][21] Post-EPT bleeding and perforation varied from 0.02% to 11% and 0.06% to 0.72%, respectively. [21][22][23] Finally, the failure rate of cannulation is reported as ranging from 16% to 24%. [24][25][26] The performance indicators, including cannulation and complication rates, were similar between 2019 and 2021 and compatible with the previous studies.…”

Section: Discussionmentioning

confidence: 99%

Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study

Chang

Hou

et al. 2022

Journal of the Chinese Medical Association

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Background: Coronavirus disease 2019, known as a widespread, aerosol spreading disease, has affected >549 000 000 people since 2019. During the lockdown period, dramatic reduction of elective endoscopic procedures, including endoscopic retrograde cholangiopancreatography, had been reported worldwide, leading to delayed diagnosis and treatment. Nevertheless, whether patients' hospital stays and complication rate of endoscopic retrograde cholangiopancreatography (ERCP) during the lockdown period were influenced by the pandemic still remains controversial. Methods: Patients who diagnosed with obstructive jaundice and acute cholangitis in the lockdown period, May 16 to July 26, 2021, were compared to the same prepandemic period in 2019. Results: A total of 204 patients in 2019 and 168 patients in 2021 were diagnosed with acute biliary cholangitis or obstructive jaundice, and 82 of the patients in 2019 and 77 patients in 2021 underwent ERCP (p = 0.274). Patients whose quick Sequential Organ Failure Assessment (qSOFA) score was ≥ 2 occurred more during the lockdown period than during the normal period (24/77, 31.1% vs 12/82, 14.6%; p = 0.013). The initial laboratory data, including, total bilirubin (4.12 in 2021 vs 3.08 mg/dL in 2019; p = 0.014), gamma-glutamyl transferase (378 in 2021 vs 261 U/L in 2019; p = 0.009), and alkaline phosphatase (254 in 2021 vs 174 U/L in 2019; p = 0.002) were higher during the lockdown period compared to 2019. Hospital stay was statistically significant longer in the lockdown period (11 days [7.00-22.00] in 2021 vs 8 days in 2019 [6.00-12.00]; p value = 0.02). Multivariate analysis showed that qSOFA ≥ 2 (hazard ratio [HR] = 3.837, 95% confidence interval [CI] = 1.471-10.003; p = 0.006), and malignant etiology (HR = 2.932, 95% CI = 1.271-6.765; p = 0.012) were the statistically significant factors for a prolonged hospital stay, which was defined as hospital stay >21 days. ERCP-related complications and mortality rate were not statistically different between the two periods. Conclusion: Patients from May 16 to July 26, 2021, the lockdown period, had longer hospital stays and higher biliary tract enzyme levels, which indicated more severe disease. Nevertheless, ERCP could be safely and successfully performed even during the medical level 3 alert lockdown period without causing an increase in procedure-related complications and mortality.

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Section: Discussionmentioning

confidence: 99%

Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study

Chang

Hou

et al. 2022

Journal of the Chinese Medical Association

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“…Consequently, patients are faced with risks such as complicated acute pancreatitis, hemorrhage, and duodenal perforation, as well as intestinal fluid reflux and stone recurrence caused by damage to the sphincter of Oddi. Hence, ERCP-based stone extraction should be selected with caution [ 17 , 18 ]. With the popularization of laparoscopy and choledochoscopy plus the advancement of laparoscopic suturing and knotting techniques, T-tube drainage following laparoscopic CBD exploration has emerged as an essential treatment for choledocholithiasis.…”

Section: Discussionmentioning

confidence: 99%

“…In the PC group, 4-0 or 5-0 absorbable sutures (Ethicon, Inc., Somerville, NJ, USA) were used to close the CBD using an intermittent everting suture technique. In the TD group, a silicone T-tube of appropriate size (16)(17)(18)(19)(20)(21)(22) was inserted into the CBD, followed by closure using the same suture technique. The abdominal cavity was repeatedly flushed with normal saline, and the operation was completed after inserting a drainage tube through the foramen of Winslow.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Safety and Feasibility of Primary Closure Following Laparoscopic Common Bile Duct Exploration for Treatment of Choledocholithiasis

Xiang

Liu

et al. 2022

World j. surg.

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Background T-tube drainage following laparoscopic common bile duct (CBD) exploration may lead to T-tube displacement and water–electrolyte disorders, affecting patients’ quality of life. In particular, biliary peritonitis may develop in a small number of patients after T-tube removal, requiring reoperation. This prospective cohort study was performed to investigate the safety and feasibility of primary closure following laparoscopic CBD exploration for the treatment of choledocholithiasis. Methods Patients who were treated for choledocholithiasis by laparoscopic CBD exploration with primary closure from January 2019 to March 2022 comprised the PC group (n = 145). Patients who were treated for choledocholithiasis by laparoscopic CBD exploration with T-tube drainage during this period comprised the TD group (n = 153). Perioperative and follow-up outcomes were collected and statistically analyzed. Results The TD and PC groups showed significant differences in the operation time (124.6 ± 40.8 vs. 106 ± 36.4 min, P = 0.000) and postoperative hospital stay (7.1 ± 2.6 vs. 5.9 ± 2.0 days, P = 0.000). No significant difference was observed in terms of blood loss, the ratio of conversion to laparotomy, and postoperative parameters. Preoperative albumin and total bilirubin levels were the risk factors of bile leakage after surgery. No patients developed CBD stricture or carcinogenesis, The rates of residual and recurrent stones in the TD and PC groups were 1.97% vs. 1.40% and 1.31% vs. 1.40%, respectively, with no significant difference (P = 1.000 for both). Conclusions Primary closure following laparoscopic CBD exploration is safe and feasible for selected patients with choledocholithiasis.

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“…The current study clearly highlights all these difficulties. Automated nationwide prospective registration of endoscopic procedures and outcomes may be the only reliable solution, as already successfully implemented in some countries (21)(22)(23)(24). This also accounts for the registration of anaesthesiology-related AE (25,26).…”

Section: Discussionmentioning

confidence: 99%

How to track and register adverse events and incidents related to gastrointestinal endoscopy

Casa¹,

Monino²,

Deprez³

et al. 2022

AGEB

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Background and study aims: Gastrointestinal endoscopic procedures have evolved significantly in the last sixty years revolutionising the approach to the diagnostic and therapeutic spheres of medicine. Despite the advantages of using natural orifices to the bowel, adverse events (AE) may occur following endoscopy. Systematic AE registration is an objective in every realm of quality medicine. Despite the obvious advantage as a quality indicator, tracking endoscopy-related AE is not evident. The current study aimed at tracking all AE of all endoscopic procedures during a 3-month period. The three methods used were voluntary reporting by the endoscopist and by the patient in parallel with retrospective data analysis of patients’ electronic medical records to allow capture of all AE and comparison of the three methods. Patients and methods: During a 3-month period endoscopists and patients were requested to report any possible AE. At the end of the period, a systematic review of all patient files was performed to track all AE related to the endoscopic procedure or the endoscopyrelated anaesthesia. In total 2668 endoscopic procedures were reviewed. Results: The total AE rate was 1.95%. Only half (51.9%) of all AE were voluntarily reported by endoscopists, the other half were extracted from the electronic medical record. There were no patient-reported AE. Although the majority (66.7%) of unreported AE were mild, these findings illustrate that voluntary AE reporting is unreliable. However, the retrospective tracking process proved to be difficult and time-consuming. Conclusions: The current study highlighted that systematic registration of all endoscopy-related AE is feasible, but challenging because of multiple hurdles. More practical methods are warranted to obtain reliable and long-term data as part of endoscopy quality measures.

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Endoscopic retrograde cholangiopancreatography‐related adverse events in Korea: A nationwide assessment

Cited by 13 publications

References 20 publications

Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study

Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study

Safety and Feasibility of Primary Closure Following Laparoscopic Common Bile Duct Exploration for Treatment of Choledocholithiasis

How to track and register adverse events and incidents related to gastrointestinal endoscopy

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