Intraoperative endoscopic retrograde cholangio-pancreatography: A useful tool in the hands of the hepatobiliary surgeon

Nakeeb, Ayman El; Sultan, Ahmed; Hamdy, Emad; Hanafy, Ehab El; Atef, Ehab; Salah, Tarek; Geidie, Ahmed A El; Kandil, Tharwat; Shobari, Mohamed El; Ebidy, Gamal El

doi:10.3748/wjg.v21.i2.609

Cited by 14 publications

(11 citation statements)

References 36 publications

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“…Multivariate analysis revealed that young patients aged <35 years old, a CBD diameter >10 mm, and the number of pancreatic cannulations were independent risk factors for the development of PEP. 19 In the current study, PEP was noted significantly more in the ERCP group than it was in the conservative group. In all cases, pancreatitis was self-limiting by conservative treatment.…”

Section: Discussionsupporting

confidence: 39%

“…18 Even with strict selection criteria, >10% of pre-operative ERCP are normal, and the possibility of occurrence of post-ERCP pancreatitis varies between 1% and 13.5%. 19 Unnecessary pre-ERCP can be avoided in many cases by managing CBDS with conservative treatment, which is effective in most of cases. This conservative management avoids the risks inherent in ERCP and unnecessary preoperative ERCP.…”

Section: Discussionmentioning

confidence: 99%

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Retrospective Study of Clinical Outcome in 25 Patients of Common Bile Duct Calculi

Khanderia¹

2019

IJCMR

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Introduction: Management of common bile duct stones (CBDS) presents a surgical challenge since it is the major cause of hepatobiliary morbidity and complications. The aim of the study was to evaluate the best line of treatment for CBD stone and complications related to every approach. Material and Methods:This retrospective study includes patients with CBDS who were treated with conservative treatment or endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). Primary outcome was successful clearance of common bile duct and secondary outcomes were complications, total cost and hospital stay. Results:Out of 25 patients, 13 were treated by ERCP (Endoscopic Retrograde Cholangio Pancreatography) and 12 by Conservative approach. There was complete clearance of CBDS in 10 (76%) cases out of 13, in the endoscopic retrograde cholangiopancreatography (ERCP) group and in the remaining 3 patients, the Common bile duct stone was removed by the trans-cystic exploration. In the conservative group, there was complete clearance of CBDS in 8 (66%) cases, and in the remaining 4 (33%)patients, the common bile duct stone was removed by the transcystic exploration.Conclusion: Management of CBDS represents a surgical challenge. CBDS increases the technical difficulty of ERCP and increases the risk of PEP. Conservative management of CBDS avoids the risks associated with ERCP and is also effective in clearing CBDS so one should consider a conservative line of treatment in CBDS in order to decrease the cost and avoid unnecessary ERCP.

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Section: Discussionsupporting

confidence: 39%

Section: Discussionmentioning

confidence: 99%

Retrospective Study of Clinical Outcome in 25 Patients of Common Bile Duct Calculi

Khanderia¹

2019

IJCMR

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“…Rábago describe para la laparoendoscopía una tasa deéxito entre 69,2 % y 100 % con un promedio de 92,3 %. Una duración media de 35 minutos para la CPRE+EE intraoperatoria y duración media de la cirugía de 104 minutos, con rangos de 75-200 minutos (EL NAKEEB, A. et al, 2015). La tasa media de conversión a cirugía abierta 4,7 %, morbilidad del 5,1 % (0 % -19 %) y una mortalidad extremadamente rara 0,37 % (RÁBAGO et al, 2011).…”

Section: Discussionunclassified

“…En la práctica quirúrgica actual, la exploración laparoscópi-ca de la vía biliar y la incorporación de procedimientos endoscópicos intraoperatorias en el diagnóstico y tratamiento de cálculos en el colédoco, mantienen las ventajas de la cirugía mínimamente invasiva, pero requieren recursos técni-cos, experiencia y adaptación del procedimiento a la cirugía o mínimamente invasiva, en donde el cirujano hepatobiliar, posea la competencia de resolución endoscópica (El NAKEEB et al, 2015;WEI et al,2003).…”

Section: Introductionunclassified

Evaluación costo efectividad del tratamiento en un solo tiempo de colelitiasis con coledocolitiasis mediante el uso de laparoscopia y su asociación con el abordaje laparo-endoscópico

Orquera

Páez

2018

prosciences

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Evaluación costo efectividad del tratamiento en un solo tiempo de colelitiasis con coledocolitiasis mediante el uso de laparoscopia y su asociación con el abordaje laparo-endoscópico Resumen: El tratamiento de colelitiasis con coledocolitiasis (CBD) en tiempoúnico es efectivo, más la relación costo efectividad del acceso exclusivo por laparoscopia es aún motivo de investigación siendo este nuestro objetivo. Métodos: análisis retrospectivo, transversal de pacientes operados laparoscópicamente por colelitiasis y coledocolitiasis en servicios públicos de salud, distribuidos en dos grupos: Grupo L (exploración laparoscópica de la vía biliar, Hospital Pablo Arturo Suárez -Quito (H.PAS). Grupo LE (exploración laparo endoscópica, Hospital de Clínicas de la Facultad de Medicina de Ribeirão Preto -Universidad de Sao Paulo (USP HCFMRP) período de junio 2016-junio 2017. Resultados: Los grupos fueron homogéneos para la mayoría de las variables epidemiológicas y clínicas antes de los procedimientos quirúrgicos, la efectividad del tratamiento quirúrgico valorado como aclaramiento del colédoco fue 100 % , la tasa de complicaciones precoces fueron equivalentes en los dos grupos (16,6 %); el tiempo quirúrgico en el G L fue 168,36 minutos (58,36 minutos DP), y en el G LE de 117,06 minutos (29,43 DP), p= 0,001; el período de internación fue 2,2 días (1,83 DP) en el Grupo I-L y para el Grupo LE 1. 1 días (1,83 DP) p= 0,01. La selección de casos en el GLE benefició a 14 pacientes tratados ambulatoriamente, con una efectividad de 100 % y un costo medio de atención hospitalaria de $1179,81 (DP $200,60), en comparación con los pacientes que requirieron hospitalización $ 1509,19 (DP $ 426,04) generando una diferencia de costos estadística significativa p=0,039. Concluimos que el tratamiento quirúrgico laparoendoscópico es costo efectivo.Palabras Clave-Coledocolitiasis. Laparoscopia. Esfinterotomía Endoscópica intraoperatoria. Análisis de costo efectividad.

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“…Endoscopic retrograde cholangiopancreatography (ERCP) is a useful tool for diagnosis and treatment of obstructive jaundice [1][2][3][4]. ERCP needs patient cooperation and adequate sedation.…”

Section: Introductionmentioning

confidence: 99%

Comparative study between magnesium sulphate and L-hyoscyamine on duodenal motility during ERCP under general anaesthesia: A prospective randomized study

Hefnawy

Nakeeb

2017

Egyptian Journal of Anaesthesia

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Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is a relatively complex procedure as compared with other endoscopy which needs longer duration, duodenal relaxation and good sedation. The aim of this study was to evaluate the efficacy and safety of magnesium sulphate as spasmolytic agent during ERCP under general anaesthesia. Design: A prospective randomized study. Setting: Delivery room, operating room and postoperative recovery area. Patients and method: Patients, who were treated for calcular obstructive jaundice by ERCP were randomized into two groups. The patients were randomized into two groups: G I, patients received 500 mg magnesium sulphate in 100 ml saline 15 min before induction and G II, patients received 0.5 mg L-hyoscyamine sulphate before induction of anaesthesia. Measurement: The primary outcome was duodenal relaxation during ERCP under general anaesthesia. Secondary outcomes include changes of heart rate, changes in oxygen saturation, time needed for cannulation, procedure difficulty, duration of the procedure, post-procedure complications, and the need of post-procedure analgesia. Results: Duodenal motility score was found to be 0.85 ± 1.47 in GI and 2.2 ± 3.08 in GII (P = 0.0001). The number of patients who had no duodenal contraction was significantly more in GI. The success rate of biliary cannulation is significantly higher in GI than in GII (58 (100%) vs 54 (93.1%), P = 0.04). The duration of cannulation was significantly shorter in GI. The number of patients who developed pancreatitis, nausea and vomiting was significantly less in GI. The pulse rate was found to be statistically less in GI at different time follow-ups. Conclusion: Magnesium sulphate is a safe spasmolytic agent during general anaesthesia that improves the success rate of ERCP and it allows easy completion of the procedure by decreasing the duodenal motility. It decreases the duration of the procedure, subsequently shortens the period of anaesthesia and improves post procedure recovery. It reduces post ERCP pancreatitis, nausea and vomiting.

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Intraoperative endoscopic retrograde cholangio-pancreatography: A useful tool in the hands of the hepatobiliary surgeon

Abstract: The hepatobiliary surgeon should be trained on ERCP as the third hand to expand his field of therapeutic options.

Cited by 14 publications

References 36 publications

Retrospective Study of Clinical Outcome in 25 Patients of Common Bile Duct Calculi

Retrospective Study of Clinical Outcome in 25 Patients of Common Bile Duct Calculi

Evaluación costo efectividad del tratamiento en un solo tiempo de colelitiasis con coledocolitiasis mediante el uso de laparoscopia y su asociación con el abordaje laparo-endoscópico

Comparative study between magnesium sulphate and L-hyoscyamine on duodenal motility during ERCP under general anaesthesia: A prospective randomized study

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