654 results on '"Post ercp pancreatitis"'
Search Results
2. Selective indications of indomethacin and somatostatin, alone or in combination, and their preventive effects in patients at high risk for post-ERCP pancreatitis
- Author
-
Ping Qiu, Gui-Liang Wang, Jian-Bo Wen, Min Gong, Xing Li, and Zao-Xuan Wu
- Subjects
medicine.medical_specialty ,Somatostatin ,business.industry ,Internal medicine ,medicine ,In patient ,business ,Post ercp pancreatitis ,Gastroenterology - Published
- 2021
3. A 25 mg rectal dose of diclofenac for prevention of post-ERCP pancreatitis in elderly patients
- Author
-
Yoshihiro Nakamura, Hirotsugu Maruyama, Masami Nakatani, Daisuke Ikeda, Akira Higashimori, Yuki Mizuno, Takashi Fukuda, Yasuhiro Fujiwara, Kenichi Morimoto, Natsumi Maeda, and Toshio Watanabe
- Subjects
medicine.medical_specialty ,Diclofenac ,NSAIDs ,Indomethacin ,elderly patients ,Gastroenterology ,ジクロフェナク ,Inverse probability of treatment weighting ,Internal medicine ,medicine ,Humans ,post-endoscopic retrograde cholangiopancreatography pancreatitis ,inverse probability of treatment weighting ,Aged ,Retrospective Studies ,Cholangiopancreatography, Endoscopic Retrograde ,business.industry ,medicine.disease ,stomatognathic diseases ,Pancreatitis ,Post ercp pancreatitis ,business ,medicine.drug - Abstract
Objectives: A 50–100 mg rectal dose of diclofenac or indomethacin is recommended for prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP); however, limited data are available regarding the appropriate dose to prevent PEP in elderly patients. We aimed to evaluate the efficacy and safety of 25 mg diclofenac in preventing PEP in elderly patients. ......
- Published
- 2021
4. PREVENTION OF POST-ERCP PANCREATITIS IN HIGH-RISK PATIENTS
- Author
-
Viktor Mandrikov, Yury Vedenin, Alexander Popov, Andrej Ekstrem, and Mikhail Turovets
- Subjects
Cultural Studies ,History ,medicine.medical_specialty ,High risk patients ,Literature and Literary Theory ,business.industry ,Internal medicine ,medicine ,business ,Post ercp pancreatitis ,Gastroenterology - Abstract
Aim. To study the efficacy of thoracic epidural analgesia (TEA) for the prevention of post-ERCP pancreatitis in high-risk patients. Materials and methods. A parallel, blinded, randomized study. The first (TEA group) group included patients (n = 98) in whom thoracic epidural analgesia was used during endoscopic transpapillary interventions (ETI), the second (OAI group) group included patients (n = 97) in whom opioid analgesics and indomethacin (per rectum). Results. The study showed that acute pancreatitis was diagnosed significantly less frequently in patients with the TEA group than in patients with the OAI group (p = 0.0135). If in the TEA group post-ERCP pancreatitis (PEP) was verified in 3.1% (3/98) patients, in the OAI group — in 12.4% (12/97) patients. When TEA was used in high risk patients of developing post-ERCP pancreatitis, its incidence decreased from 23.3% (10/43) to 4.4% (2/46) observations (p = 0.0095). Conclusion. The use of TEA is an effective and justified method of prevention in patients at high risk of developing post-ERCP pancreatitis. In patients with a low risk of developing this complication, the use of TEA is inappropriate due to the invasiveness of the method.
- Published
- 2021
5. Underutilization of prophylactic rectal indomethacin and pancreatic duct stent for prevention of post-ERCP Pancreatitis
- Author
-
Dalbir S. Sandhu, Abbinaya Elangovan, Nisheet Waghray, Abdulfatah Issak, and Roy Ferguson
- Subjects
medicine.medical_specialty ,Original article ,business.industry ,Incidence (epidemiology) ,education ,MEDLINE ,RC799-869 ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Pancreatic duct stent ,Medicine ,Acute pancreatitis ,Pancreatitis ,030211 gastroenterology & hepatology ,Pharmacology (medical) ,In patient ,Diagnosis code ,business ,Post ercp pancreatitis - Abstract
Background and study aims Incidence of Post-ERCP pancreatitis (PEP) ranges from 1 % to 10 % in unselected patients and as high as 25 % to 30 % in high-risk patients. Rectal indomethacin administered before or immediately after an ERCP and prophylactic pancreatic duct stent placement (PPS) are associated with a reduction in the incidence of PEP. We sought to investigate the utilization rate for prophylactic rectal indomethacin and PPS in average and high-risk patients undergoing ERCP between 2014 and 2019. Patients and methods We performed a retrospective analysis in the IBM Explorys database, a pooled, national de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals across the United States from 2014 to 2019. Average and high-risk patients undergoing ERCP were identified using Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) diagnosis codes. PEP was defined by the presence of SNOMED CT diagnosis of acute pancreatitis and an inpatient admission within 5 days of an ERCP procedure. Results Out of 31,050 adults who had undergone ERCP from 2014 to 2019, only 10,500 individuals (33.8 %) had a PEP prophylaxis. Rectal indomethacin and PPS accounted for 82.4 % and 12.9 % respectively. Individuals with three risk factors had the highest PEP rates followed by individuals with two risk factors. Conclusions Only one-third of all patients undergoing ERCP received prophylaxis in the form of rectal indothemacin and/or PPS in this large population-based data. Increased implementation of prophylactic use is needed in patients undergoing ERCP as supported by current guidelines.
- Published
- 2021
6. Profilaktikus sztentek alkalmazása az endoszkópos retrográd cholangiopancreatographiát követő pancreatitis megelőzésében
- Author
-
Zsolt Dubravcsik, Attila Szepes, István Hritz, and László Madácsy
- Subjects
medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,General Medicine ,medicine.disease ,Gastroenterology ,03 medical and health sciences ,Patient population ,0302 clinical medicine ,Internal medicine ,medicine ,Pancreatitis ,Pancreatic stents ,030211 gastroenterology & hepatology ,business ,Post ercp pancreatitis - Abstract
Összefoglaló. Bevezetés: Az endoszkópos retrográd cholangiopancreatographiát (ERCP) követő pancreatitis (PEP) incidenciája a magas kockázatú betegcsoportban 14,7%. Célkitűzés: A munkacsoportunk által szerzett tapasztalatok elemzése. Módszerek: A profilaktikus pancreassztentes (PPS), magas kockázatú betegek adatait tartalmazó prospektív adatbázisunkat elemeztük retrospektív módon. Az adatokat a PEP-incidencia és a súlyosság tekintetében összehasonlítottuk a korábbi, hasonlóan magas kockázatú, sztent nélküli beteganyagunkkal, illetve a sztenteléssel kapcsolatos szövődményeket és a különböző sztenttípusokat is elemeztük. A Cotton-kritériumok szerint értékeltük a PEP-t. Eredmények: A 317, magas kockázatú betegből 288 esetben (90,9%) volt sikeres a PPS-implantáció. A sztent nélküli kontrollcsoportba 121, magas kockázatú beteget választottunk be. A sikeresen sztentelt betegekben a PEP incidenciája 10,0% volt. Ez és a PEP súlyossága (enyhe: 8,3%, középsúlyos: 1,4%, súlyos: 0,3%) is szignifikánsan alacsonyabb volt a PPS nélküli beteganyaghoz (PEP: 31,4%, enyhe: 15,7%, középsúlyos: 10,7%, súlyos: 5,0%) és a sikertelenül sztentelt betegekhez (PEP: 41,3%, enyhe: 24,1%, középsúlyos: 13,8%, súlyos: 3,4%) képest. Az utóbbi két csoport közötti különbség nem volt szignifikáns. A sztenttel kapcsolatos szövődmények közül a leggyakrabban a korai sztentkicsúszást (5/288 beteg, 1,74%) és a proximalis sztentmigrációt (3/288 beteg, 1,04%) észleltük. A sztenttípusok közül a legkedvezőbb mellékhatás-profilúnak a Freeman-típusú, belső füllel és külső „pigtail” véggel ellátott sztenteket találtuk. Következtetés: A profilaktikus pancreassztentelés hatékonyan csökkenti a PEP incidenciáját, és a súlyosságát az enyhébb esetek felé tolja el. Alkalmazása viszonylag egyszerű, azonban ismerni kell használatának megfelelő technikáját, időben történő eltávolításának és a szövődmények felismerésének fontosságát. Eredményeink és a nemzetközi ajánlások alapján magas PEP-rizikójú betegekben a PPS rutinszerű alkalmazása minden ERCP-laborban ajánlott. Orv Hetil. 2021; 162(1): 31–38. Summary. Introduction: The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP). Its incidence in the high-risk patient population is 14.7%. Objective: To analyze 10 years experiences of our working group. Methods: We retrospectively analyzed our prospective database of high-risk patients treated with prophylactic pancreatic stents (PPS) including the period between 2009 and 2014. We compared PEP incidence and severity findings with our historical data of pre-PPS period of similarly high-risk patients (no-stent group), furthermore analyzed the complications of PPS insertion and different stent types. PEP was defined and categorized according to the Cotton criteria. Results: In 317 high-risk patients, PPS implantation was successful in 288 cases (90.9%). The no-stent group comprised of 121 patients. Incidence and the severity of PEP in the successfully stented group (all: 10.0%; mild: 8.3%, moderate: 1.4%, severe: 0.3%) were significantly lower compared to the no-stent group (all: 31.4%; mild: 15.7%, moderate: 10.7%, severe: 5.0%) and the unsuccessfully stented group (all: 41.3%; mild: 24.1%, moderate: 13.8%, severe: 3.4%). The difference between the latter two groups was not significant. Only early dislodgment (5/288 patients, 1.74%) and proximal migration (3/288 patients, 1.04%) were observed as stent-related complications. Freeman type (single inner flange, outer pigtail end) stent was the best based on the complication profile. Conclusion: Prophylactic pancreatic stenting effectively lowers the incidence and severity of PEP. We should recognize the proper technic of its application and the importance of proper timing of its extraction and identification of complications. Utilization of PPSs in high-risk patients is strongly recommended in every ERCP center. Orv Hetil. 2021; 162(1): 31–38.
- Published
- 2021
7. ORAL N-ACETYL CYSTEINE VERSUS RECTAL INDOMETHACIN FOR PREVENTION OF POST ERCP PANCREATITIS: A MULTICENTER MULTINATIONAL RANDOMIZED CONTROLLED TRIAL
- Author
-
Pezhman ALAVINEJAD, Nguyen-Phuong Nhu TRAN, Omid ESLAMI, Omar El SHAARAWY, Ahmad HORMATI, Seied Saeed SEIEDIAN, Abazar PARSI, Mohammed Hussien AHMED, Nitin Shanker BEHL, Ali Akbar ABRAVESH, Quang Trung TRAN, Shivakumar VIGNESH, Saif SALMAN, Naemt SAKR, Tahmineh Farbod ARA, Eskandar HAJIANI, Seyed Jalal HASHEMI, Árpád V PATAI, Amna Subhan BUTT, and Sang Hyub LEE
- Subjects
Post ERCP pancreatitis ,NAC ,rectal indomethacin ,Gastroenterology ,indometacina retal ,Pancreatite pós-CPRE - Abstract
Background This multicenter multinational RCT designed to compare the efficacy of suppository indomethacin and NAC for prevention of PEP. Methods: During a 6-month period, all of the ERCP cases in seven referral centers were randomly assigned to receive either 1200 mg oral NAC, indomethacin suppository 100 mg, 1200 mg oral NAC plus indomethacin suppository 100 mg or placebo 2 hours before ERCP. The primary outcomes were the rate and severity of any PEP. Results: A total of 432 patients included (41.4% male). They were originally citizens of 6 countries (60.87% Caucasian). They were randomly allocated to receive either NAC (group A, 84 cases), rectal indomethacin (group B, 138 cases), NAC + rectal indomethacin (group C, 115 cases) or placebo (group D, 95 cases). The rate of PEP in groups A, B and C in comparison with placebo were 10.7%, 17.4%, 7.8% vs 20% (P=0.08, 0.614 & 0.01 respectively). The NNT for NAC, indomethacin and NAC + indomethacin was 11, 38 and 8 respectively. Conclusion: Oral NAC is more effective than rectal indomethacin when compared to placebo for prevention of PEP and the combination of NAC and Indomethacin had the lowest incidence of PEP and may have synergistic effect in preventing of PEP (IRCT20201222049798N1; 29/12/2020). RESUMO Contexto: Este estudo randomizado, controlado multicêntrico e multinacional foi projetado para comparar a eficácia da indometacina supositório e N-acetil cisteína (NAC) para prevenção de pancreatite pós colangiografia endoscópica. Métodos: Durante um período de 6 meses, todos os pacientes submetidos à CPRE em sete centros de referência foram aleatoriamente atribuídos para receber 1200 mg de NAC oral, supositório de indometacina 100 mg, 1200 mg de NAC oral mais supositório de indometacina 100 mg ou placebo 2 horas antes do procedimento. Os resultados primários foram a taxa e a gravidade de qualquer pancreatite pós procedimento (PPP). Resultados: Um total de 432 pacientes foram incluídos (41,4% do sexo masculino). Eram originalmente cidadãos de seis países (60,87% caucasianos). Foram alocados aleatoriamente para receber NAC (grupo A, 84 casos), indometacina retal (grupo B, 138 casos), NAC + indometacina retal (grupo C, 115 casos) ou placebo (grupo D, 95 casos). A taxa de PPP nos grupos A, B e C em comparação com o placebo foi de 10,7%, 17,4%, 7,8% vs 20% (P=0,08, 0,614 e 0,01, respectivamente). Conclusão A NAC oral é mais eficaz do que a indometacina retal quando comparado ao placebo para prevenção de PPP e a combinação de NAC e indometacina teve a menor incidência de PPP e pode ter efeito sinérgico na sua prevenção de PPP. (IRCT20201222049798N1; 29/12/2020).
- Published
- 2022
8. Monitoring adverse events after ERCP: Call me maybe?
- Author
-
Elizabeth M Brindise and Henning Gerke
- Subjects
Cholangiopancreatography, Endoscopic Retrograde ,medicine.medical_specialty ,business.industry ,Gastroenterology ,MEDLINE ,Text mining ,Risk Factors ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,business ,Intensive care medicine ,Post ercp pancreatitis ,Adverse effect ,Retrospective Studies - Published
- 2021
9. Diclofenac does not reduce the risk of acute pancreatitis in patients with primary sclerosing cholangitis after endoscopic retrograde cholangiography
- Author
-
Andrea Tenca, Marianne Udd, Outi Lindström, Leena Kylänpää, Martti Färkkilä, Kalle Jokelainen, Mia Rainio, Vilja Koskensalo, University of Helsinki, Faculty of Medicine, HUS Abdominal Center, II kirurgian klinikka, Gastroenterologian yksikkö, Helsinki University Hospital Area, Clinicum, Department of Surgery, Centre of Excellence in Complex Disease Genetics, and Department of Medicine
- Subjects
Male ,post endoscopic retrograde cholangiography pancreatitis ,CHOLANGIOPANCREATOGRAPHY PANCREATITIS ,Gastroenterology ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,Gastrointestinal endoscopy ,Cholangiopancreatography, Endoscopic Retrograde ,COMPLICATIONS ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,Primary sclerosing cholangitis ,Anti-Inflammatory Agents, Non-Steroidal ,NONSTEROIDAL ANTIINFLAMMATORY DRUGS ,Middle Aged ,EUROPEAN-SOCIETY ,3. Good health ,Treatment Outcome ,surgical procedures, operative ,Oncology ,030220 oncology & carcinogenesis ,Acute pancreatitis ,Female ,030211 gastroenterology & hepatology ,medicine.drug ,Adult ,medicine.medical_specialty ,Diclofenac ,Adolescent ,Cholangitis, Sclerosing ,Risk Assessment ,digestive system ,Young Adult ,03 medical and health sciences ,Administration, Rectal ,Internal medicine ,medicine ,Humans ,In patient ,METAANALYSIS ,Aged ,Retrospective Studies ,NSAIDS ,business.industry ,ESGE ,Original Articles ,3126 Surgery, anesthesiology, intensive care, radiology ,medicine.disease ,PREVENTION ,digestive system diseases ,stomatognathic diseases ,POST-ERCP PANCREATITIS ,Pancreatitis ,3121 General medicine, internal medicine and other clinical medicine ,Case-Control Studies ,Feasibility Studies ,Endoscopic retrograde cholangiography ,RECTAL INDOMETHACIN ,business ,Post ercp pancreatitis - Abstract
Background The European Society of Gastrointestinal Endoscopy recommends rectal indomethacin or diclofenac before endoscopic retrograde cholangiopancreatography (ERCP) to prevent post-ERCP pancreatitis. However, data on the prophylactic effect in patients with primary sclerosing cholangitis (PSC) are lacking. Methods This was a retrospective case-control study. In 2009-2018, a total of 2000 ERCPs were performed in 931 patients with PSC. Case procedures (N = 1000 after November 2013) were performed after administration of rectal diclofenac. Control procedures (N = 1000 before November 2013) were performed with the same indication but without diclofenac. Acute post-ERCP pancreatitis and other ERCP-related adverse events (AEs) were evaluated. Results Post-ERCP pancreatitis developed in 49 (4.9%) procedures in the diclofenac group and 62 (6.2%) procedures in the control group (p = 0.241). No difference existed between the groups in terms of the severity of pancreatitis or any other acute AEs. The risk of pancreatitis was elevated in patients with native papilla: 11.4% in the diclofenac group and 8.7% in the control group (p = 0.294). In adjusted logistic regression, diclofenac did not reduce the risk of pancreatitis (odds ratio (OR) = 1.074, 95% confidence interval 0.708-1.629, p = 0.737). However, in generalised estimation equations with the advanced model, diclofenac seemed to diminish the risk of pancreatitis (OR = 0.503) but not significantly (p = 0.110). Conclusion In this large patient cohort in a low-risk unit, diclofenac does not seem to reduce the risk of post-ERCP pancreatitis in patients with PSC. The trend in the pancreatitis rate after ERCP is decreasing. The evaluation of the benefits of diclofenac among PSC patients warrants a randomised controlled study targeted to high-risk patients and procedures.
- Published
- 2020
10. Inutility of endoscopic sphincterotomy to prevent pancreatitis after biliary metal stent placement in the patients without pancreatic duct obstruction
- Author
-
Kazunori Eto, Hiroaki Yamato, Itsuki Sano, Naoya Sakamoto, Yoko Taya, Hideyuki Ihara, Hajime Yamazaki, Shin Kato, Michihiro Ono, Nobuyuki Ehira, Masaki Kuwatani, Kimitoshi Kubo, Manabu Onodera, and Tsuyoshi Hayashi
- Subjects
Male ,medicine.medical_specialty ,Sphincterotomy, Endoscopic ,03 medical and health sciences ,0302 clinical medicine ,Japan ,hemic and lymphatic diseases ,medicine ,Humans ,In patient ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cholangiopancreatography, Endoscopic Retrograde ,Pancreatic duct ,business.industry ,Pancreatic Ducts ,Gastroenterology ,Middle Aged ,medicine.disease ,Pancreatic duct obstruction ,Surgery ,Stent placement ,Logistic Models ,medicine.anatomical_structure ,Pancreatitis ,Metals ,030220 oncology & carcinogenesis ,Female ,Stents ,030211 gastroenterology & hepatology ,business ,Post ercp pancreatitis - Abstract
Background: The incidence of post-ERCP pancreatitis (PEP) has been reported to be significantly higher in patients without main pancreatic duct (MPD) obstruction who undergo transpapillary biliary ...
- Published
- 2020
11. Thoracic epidural analgesia for the prevention of post-ERCP pancreatitis: a randomized study of 491 c
- Author
-
Viktor Mandrikov, Alexander Popov, Andrej Ekstrem, Mikhail Turovets, and Yuriy Vedenin
- Subjects
Cultural Studies ,History ,Literature and Literary Theory ,Thoracic epidural ,Randomized controlled trial ,business.industry ,law ,Anesthesia ,Medicine ,business ,Post ercp pancreatitis ,law.invention - Published
- 2020
12. Single‐stage retrograde endoscopic common bile duct stone removal might be sufficient in moderate acute cholangitis with a stone size ≤12 mm: A retrospective cohort study with propensity score matching
- Author
-
Wen-Chen Tai, Yi-Chun Chiu, Chung-Mou Kuo, Cheng-En Tsai, Seng-Kee Chuah, Chung-Huang Kuo, Kuo‐Tung Hung, Pao-Yuan Huang, Cheng-Kun Wu, Fai‐Meng Sou, Chih-Ming Liang, and Lung-Sheng Lu
- Subjects
medicine.medical_specialty ,Single stage ,business.industry ,Propensity score matching ,Medicine ,Common bile duct stone ,Retrospective cohort study ,General Medicine ,Stone size ,Post ercp pancreatitis ,business ,medicine.disease ,Surgery - Published
- 2020
13. Endoscopic Retrograde Cholangiopancreatography-Related Complications and Their Management Strategies: A 'Scoping' Literature Review
- Author
-
Sumant Inamdar, Abhilash Perisetti, Benjamin Tharian, Kemmian D. Johnson, Ragesh Thandassery, Hemant Goyal, and Priya A. Jamidar
- Subjects
medicine.medical_specialty ,Cholangitis ,Physiology ,Perforation (oil well) ,Postoperative Hemorrhage ,Infections ,digestive system ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Transplant surgery ,Risk Factors ,Internal medicine ,Cholecystitis ,medicine ,Humans ,Duodenoscopes ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Patient Selection ,General surgery ,Anti-Inflammatory Agents, Non-Steroidal ,Pancreatic Ducts ,Gastroenterology ,Hepatology ,medicine.disease ,digestive system diseases ,Anti-Bacterial Agents ,Disinfection ,surgical procedures, operative ,Pancreatitis ,Intestinal Perforation ,030220 oncology & carcinogenesis ,Equipment Contamination ,Stents ,030211 gastroenterology & hepatology ,business ,Post ercp pancreatitis - Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a well-known procedure with both diagnostic and therapeutic utilities in managing pancreaticobiliary conditions. With the advancements of endoscopic techniques, ERCP has become a relatively safe and effective procedure. However, as ERCP is increasingly being utilized for different advanced techniques, newer complications have been noticed. Post-ERCP complications are known, and mostly include pancreatitis, infection, hemorrhage, and perforation. The risks of these complications vary depending on several factors, such as patient selection, endoscopist's skills, and the difficulties involved during the procedure. This review discusses post-ERCP complications and management strategies with new and evolving concepts.
- Published
- 2019
14. Intramuscular Diclofenac as Prophylaxis for Post ERCP Pancreatitis
- Author
-
Avila G, Sandoval L, and Sánchez A
- Subjects
Diclofenac ,business.industry ,Anesthesia ,medicine ,General Medicine ,business ,Post ercp pancreatitis ,medicine.drug - Published
- 2019
15. Analysis of the Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Children With Symptomatic Pancreas Divisum
- Author
-
Biao Gong, Kaihua Yang, Zhaohui Deng, and Guixian Pan
- Subjects
Pancreas divisum ,medicine.medical_specialty ,Endoscopic retrograde cholangiopancreatography ,endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Therapeutic effect ,medicine.disease ,Pediatrics ,efficacy and safety ,RJ1-570 ,Surgery ,post-ERCP pancreatitis ,children ,Pediatrics, Perinatology and Child Health ,medicine ,Retrospective analysis ,Acute pancreatitis ,Pancreatitis ,pancreas divisum ,Post ercp pancreatitis ,business ,Original Research - Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in children with symptomatic pancreas divisum (PD).Aim: To investigate the safety and efficacy of ERCP in the treatment of children with symptomatic PD.Methods: We performed a retrospective analysis on children with PD who were treated with ERCP at Shanghai Children's Medical Center between June 2015 and May 2020. Pertinent patient, clinical and procedural data were collected to assess the therapeutic effects and identify the risk factors for post-ERCP pancreatitis (PEP).Results: Overall, 114 ERCPs were performed in 46 children with PD. With a median follow-up of 28.5 months (12–71 months), 40 (87.0%) children achieved clinical remission, the median number of acute pancreatitis episodes decreased from four times per year pre-operatively to once per year post-operatively (P < 0.001), and the nutritional score improved post-operatively (P = 0.004). The incidence of PEP was 7.9%, and female sex, stone extraction, and gene mutations were identified as possible risk factors for PEP on univariate analysis. However, there was no statistical significance on multivariate analysis (P > 0.05).Conclusion: Therapeutic ERCP is an effective and safe intervention for children with symptomatic PD.
- Published
- 2021
16. Hurdles in ERCP Trials: Do We Need to Change the Diagnostic Criteria for Post-ERCP Pancreatitis?
- Author
-
Gregory A. Cote and Bradford Chong
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Gastroenterology ,medicine ,MEDLINE ,Post ercp pancreatitis ,business - Published
- 2022
17. Precut biliary sphincterotomy in ERCP: Don’t reach for the needle-knife quite so fast!
- Author
-
Martin L. Freeman and Matthew R. Krafft
- Subjects
Cholangiopancreatography, Endoscopic Retrograde ,Pancreatic duct ,medicine.medical_specialty ,business.industry ,Gastroenterology ,MEDLINE ,law.invention ,Surgery ,Sphincterotomy, Endoscopic ,medicine.anatomical_structure ,Pancreatitis ,Randomized controlled trial ,law ,Biliary sphincterotomy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Needle knife ,Biliary Tract ,Post ercp pancreatitis ,business - Published
- 2021
18. Prognosis and risk factors of ERCP pancreatitis in elderly
- Author
-
Oktay Tekesin, Galip Ersoz, Ömer Özütemiz, Nevin Oruc, and Erhan Ergin
- Subjects
medicine.medical_specialty ,Complications ,Efficacy ,Demographics ,Science ,Diseases ,Pathogenesis ,digestive system ,Biochemistry ,Article ,Age ,Medical research ,Bile-Duct Stones ,Sphincterotomy ,Internal medicine ,Medicine ,Risk factor ,Signs and symptoms ,Endoscopic Retrograde Cholangiopancreatography ,Cancer ,Multidisciplinary ,Endoscopic retrograde cholangiopancreatography ,APACHE II ,medicine.diagnostic_test ,business.industry ,Biliary ,Gastroenterology ,Health care ,medicine.disease ,Therapeutic Ercp ,digestive system diseases ,surgical procedures, operative ,Risk factors ,Acute Cholangitis ,Pancreatitis ,Safety ,business ,Post ercp pancreatitis ,Sphincter oddi dysfunction ,Biomarkers - Abstract
Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and
- Published
- 2021
19. Reply
- Author
-
Shin Kato and Masaki Kuwatani
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Gastroenterology ,medicine ,MEDLINE ,business ,Post ercp pancreatitis - Published
- 2022
20. Dilated main pancreatic duct can be a negative predictor of pancreatitis related to biliary SEMS insertion across the papilla
- Author
-
Atsushi Tsuji, Yusuke Asai, Masahiro Umemura, Kazuhito Kawata, Yuzo Sasada, Yurimi Takahashi, Ken Sugimoto, Masafumi Nishino, Takanori Yamada, Eri Shimura, and Yasuhiko Saida
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,digestive system ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Self-expandable metallic stent ,medicine ,Humans ,Adverse effect ,Biliary Tract ,Retrospective Studies ,Pancreatic duct ,Cholangiopancreatography, Endoscopic Retrograde ,business.industry ,Gastroenterology ,Pancreatic Ducts ,Stent ,medicine.disease ,digestive system diseases ,Surgery ,Major duodenal papilla ,surgical procedures, operative ,medicine.anatomical_structure ,Pancreatitis ,030220 oncology & carcinogenesis ,Quality of Life ,030211 gastroenterology & hepatology ,Stents ,Post ercp pancreatitis ,business - Abstract
Post-ERCP pancreatitis (PEP) after self-expandable metallic stent (SEMS) insertion across the papilla of Vater is an important adverse event that affects the patient's quality of life (QOL). We examined the predictive factors of PEP after SEMS insertion to treat obstructive jaundice due to malignancy.Ninety patients who underwent biliary SEMS insertion for biliary obstruction due to malignancy at Iwata City Hospital between 2010 and 2018 were reviewed. We evaluated the relationship between the incidence of PEP after biliary SEMS insertion and clinical factors. We measured the thickness of the pancreatic parenchyma and diameter of the main pancreatic duct (MPD) at the left side of the corpus vertebrae.Mild and severe PEP were diagnosed in 10 (11.1%) and 1 (1.1%) patients, respectively. Only the thickness of the pancreatic parenchyma and diameter of MPD significantly differed between the PEP and non-PEP groups. The incidence of PEP among patients whose thickness of the pancreatic parenchyma at the left side of the corpus vertebrae was less than 9.5 mm (0%) on computed tomography was lower than that in patients whose thickness was 9.5 mm or greater (34.4%). Similarly, a wider (5 mm or more) diameter of MPD (4.3%) reduced the incidence of PEP compared with a narrower diameter (40.0%). Logistic regression analysis revealed that the probability of PEP decreases 3.91 times for every 1-mm increase in MPD diameter (95% CI 1.23-12.4,Based on our study, a dilated MPD is a negative predictive factor of pancreatitis related to biliary SEMS insertion.
- Published
- 2021
21. Post-ESWL and post-ERCP pancreatitis in patients with chronic pancreatitis: Do they share the same risks?
- Author
-
Zhuan Liao, Jia-Hui Zhu, Nan Ru, Wen-Bin Zou, Zhao-Shen Li, Ji-Yao Guo, Hui Chen, Yang-Yang Qian, Liang-Hao Hu, and Jun Pan
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Gastroenterology ,Internal medicine ,Lithotripsy ,Pancreatitis, Chronic ,medicine ,Humans ,In patient ,Adverse effect ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,Hepatology ,medicine.diagnostic_test ,business.industry ,Pancreatic Ducts ,medicine.disease ,Extracorporeal shock wave lithotripsy ,Steatorrhea ,medicine.anatomical_structure ,Treatment Outcome ,Pancreatitis ,Surgery ,medicine.symptom ,Post ercp pancreatitis ,business ,Pancreas - Abstract
BACKGROUND Endoscopic intervention combined with extracorporeal shock wave lithotripsy (ESWL) is recommended as the first line therapy for large pancreatic stones, yet both can cause adverse events. The aim of the study was to identify the risk factors for post-procedural pancreatitis. METHODS Consecutive patients with chronic pancreatitis and pancreatic stones treated with both ESWL and subsequent endoscopic retrograde cholangiopancreatography (ERCP) from October 2016 to December 2019 were prospectively enrolled. Multivariate logistic analyses were performed to detect risk factors for post-ESWL and post-ERCP pancreatitis (PEP). RESULTS A total of 714 patients (507 males, 45.60 ± 12.52 years) were included in this study. A total of 80 patients (11.2%) developed post-ESWL pancreatitis,while 33 patients (4.6%) suffered from PEP. Steatorrhea (P = .018), multiple stones (P = .043), and stones located at the head combined with the body or tail of the pancreas (P = .015) were identified as independent protective factors for post-ESWL pancreatitis. The history of acute exacerbations (P = .013), post-ESWL pancreatitis (P
- Published
- 2021
22. Aggressive Hydration With Ringer's Lactate in the Prevention of Post-ERCP Pancreatitis: A Meta-Analysis
- Author
-
Hyder Osman Mirghani and Samar Aljohani
- Subjects
ringer's lactate ,post-ercp pancreatitis (pep) ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Cochrane Library ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Internal Medicine ,Ringer's lactate ,business.industry ,General Engineering ,Gastroenterology ,Stent ,endoscopic retrograde cholangiopancreatography (ercp) ,Odds ratio ,medicine.disease ,Meta-analysis ,Anesthesia ,Pancreatitis ,aggressive hydration ,Post ercp pancreatitis ,business ,Complication ,030217 neurology & neurosurgery ,Family/General Practice - Abstract
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a dangerous complication and occurs in a considerable number of patients. However, since well-randomized controlled trials investigating aggressive hydration with Ringer's lactate are lacking, this meta-analysis assessed the role of aggressive hydration with Ringer's lactate alone or in combination with other therapies in the prevention of PEP. We searched PubMed, Cochrane Library, and Google Scholar for relevant articles. The search engine was set to randomize controlled trials and prospective cohorts assessing Ringer's lactate in PEP prevention either alone or in combination with non-steroidal anti-inflammatory drugs (NSAIDs) and stent. The keywords "aggressive hydration," "Ringer's lactate," "post-ERCP pancreatitis," "NSAIDs," "stent placement," and "somatostatin analogs" were used. The search was limited to a study on humans published in English with no limitation to the study period. Two hundred and six articles were retrieved. Only eight articles fulfilled the inclusion criteria. The studies showed a reduction of post-ERCP pancreatitis using aggressive hydration with Ringer's lactate alone (odds ratio 0.23, 95% CI 0.13 - 0.40, P-value < 0.001, I2 for heterogeneity = 0%, P-value = 0.61, Chi-square value 1.83, and degrees of freedom (df) 3. In addition, the combination of Ringer's lactate with stents or NSAIDs was superior to Ringer's lactate alone (odds ratio 0.63, 95% CI 0.41 - 0.98, P-value < 0.04, I2 for heterogeneity = 0%, P-value = 0.48, Chi-square value 2.47, and df 3). Aggressive hydration with Ringer's lactate alone was effective in the prevention of PEP with a superior effect when combined with stents and NSAIDs.
- Published
- 2021
23. Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions
- Author
-
Arvind J. Trindade, Nichol S. Martinez, Sumant Inamdar, Petros C. Benias, Stephanie Izard, Calvin Lee, Sheila N. Firoozan, and Divyesh V. Sejpal
- Subjects
medicine.medical_specialty ,Original article ,business.industry ,medicine.medical_treatment ,Biliary obstructions ,Stent ,Retrospective cohort study ,RC799-869 ,Biliary Stenting ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,Surgery ,Self Expandable Metal Stents ,Pancreatic duct stent ,Medicine ,Pancreatitis ,Pharmacology (medical) ,business ,Post ercp pancreatitis - Abstract
Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.
- Published
- 2021
24. 897 Aggressive Hydration With Lactated Ringer for Prevention of Post-ERCP Pancreatitis: A Systematic Review and Meta-Analysis
- Author
-
Swathi Paleti, Sravan Jeepalyam, Tarun Rustagi, Venkat Nutalapati, and Shilpa Junna
- Subjects
Hepatology ,business.industry ,Anesthesia ,Meta-analysis ,Gastroenterology ,Medicine ,Post ercp pancreatitis ,business - Published
- 2019
25. Managing Difficult Cannulations in Endoscopic Retrograde Cholangiopancreatography: A Prospective Randomized Control Trial Study of Precut Needle Knife Sphincterotomy versus Transpancreatic Sphincterotomy Technique
- Author
-
Surachai Siripornadulsilp and Nisit Tongsiri
- Subjects
Transpancreatic precut sphicterotomy ,Medicine (General) ,medicine.medical_specialty ,law.invention ,ERCP ,R5-920 ,Randomized controlled trial ,needle knife sphicterotomy ,difficult cannulation ,time for successful cannulation ,law ,Transpancreatic ,medicine ,Needle knife ,lcsh:R5-920 ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Endoscopy ,Surgery ,Pancreatitis ,Post ercp pancreatitis ,business ,lcsh:Medicine (General) - Abstract
Objective: To evaluate the success rate of cannulations and rate of procedure-related complications between needle knife sphincterotomy (NKS) and transpancreatic sphincterotomy (TPS) techniques, and to evaluate the most effective cannulation time to proceed with NKS or TPS. Methods: This study recruited 52 patients with inaccessible bile ducts by the standard cannulation at Khon Kaen Hospital from May 2012 to May 2015. Patients were randomly allocated to the NKS group (N=21) or the TPS group (N=21). Successful cannulations, and complications between NKS and TPS were collected and assessed. Results: Successful cannulations by TPS and NKS were achieved in 14 cases (53.8%) and 13 cases (50%) respectively (p value = 0.781). Post ERCP pancreatitis was found in 2 cases using TPS, and in 3 cases using NKS. There were 3 cholangitis cases in TPS group, and 2 cholangitis cases in NKS group. Perforations were found in 3 cases and 1 case in TPS and NKS group, respectively. There were 4 deaths in this study, one case in TPS group and 3 cases in NKS group. Complications and mortality between TPS and NKS were not statistically significant (P>0.05). After 40 minutes of the ERCPs, there was less chance for a successful cannulation. Unsuccessful cannulations between TPS and NKS was not statistically different according to the Kaplan-Meier analysis. Conclusion: TPS and NKS are able to increase successful cannulations. There are no significant differences in the cannulation success rate and rate of complications between the TPS and NKS. The appropriate time to terminate a cannulation in difficult cases is found to be 40 minutes.
- Published
- 2019
26. Preventative Effect of Nafamostat Mesilate Infusion into the Main Pancreatic Duct on Post-ERCP Pancreatitis in a Porcine Model: Initial Pilot Study
- Author
-
Don Haeng Lee, Jin-Seok Park, Joon Mee Kim, and Seok Jeong
- Subjects
medicine.medical_specialty ,Swine ,Pilot Projects ,Guanidines ,Gastroenterology ,Necrosis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Animals ,Humans ,Infusions, Parenteral ,Protease Inhibitors ,Protease inhibitor (pharmacology) ,Adverse effect ,Cholangiopancreatography, Endoscopic Retrograde ,Pancreatic duct ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Pancreatic Ducts ,Nafamostat mesilate ,medicine.disease ,digestive system diseases ,Benzamidines ,Disease Models, Animal ,surgical procedures, operative ,medicine.anatomical_structure ,Pancreatitis ,030220 oncology & carcinogenesis ,Swine, Miniature ,030211 gastroenterology & hepatology ,Surgery ,business ,Post ercp pancreatitis - Abstract
Background and Aim: Post endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis is not an uncommon adverse event but may not be avoidable. Various pharmacological and endoscopic te...
- Published
- 2019
27. Post ERCP pancreatitis - A prospective study
- Author
-
Arunkumar Mohanraj and Thangapprakasam P
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Medicine ,Post ercp pancreatitis ,business ,Prospective cohort study - Published
- 2019
28. The revised Atlanta criteria more accurately reflect severity of post-ERCP pancreatitis compared to the consensus criteria
- Author
-
H Zhang, J Cho, Niels G. Venneman, Xjnm Smeets, A Otten, Ejm van Geenen, Robert C. Verdonk, Teh Römkens, Gjm Hemmink, Badih Joseph Elmunzer, P B Cotton, J.P.H. Drenth, J.M. Vrolijk, N Bouhouch, Acitl Tan, James Buxbaum, and I Kats
- Subjects
Adult ,Male ,medicine.medical_specialty ,Consensus ,education ,Consensus criteria ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,Severity of Illness Index ,03 medical and health sciences ,Postoperative Complications ,All institutes and research themes of the Radboud University Medical Center ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14] ,Humans ,Medicine ,Aged ,Retrospective Studies ,Cholangiopancreatography, Endoscopic Retrograde ,business.industry ,Incidence ,Incidence (epidemiology) ,Gastroenterology ,Original Articles ,Middle Aged ,medicine.disease ,digestive system diseases ,Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11] ,surgical procedures, operative ,Pancreatitis ,Oncology ,030220 oncology & carcinogenesis ,cardiovascular system ,Acute pancreatitis ,Female ,030211 gastroenterology & hepatology ,business ,Post ercp pancreatitis ,Complication ,circulatory and respiratory physiology - Abstract
BACKGROUND AND OBJECTIVE: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most prevalent complication after ERCP with an incidence of 3.5%. PEP severity is classified according to either the consensus criteria or the revised Atlanta criteria. In this international cohort study we investigated which classification is the strongest predictor of PEP-related mortality. METHODS: We reviewed 13,384 consecutive ERCPs performed between 2012 and 2017 in eight hospitals. We gathered data on all pancreatitis-related adverse events and compared the predictive capabilities of both classifications. Furthermore, we investigated the correlation between the two classifications and identified reasons underlying length of stay. RESULTS: The total sample consisted of 387 patients. The revised Atlanta criteria have a higher sensitivity (100 vs. 55%), specificity (98 vs. 72%) and positive predictive value (58 vs. 5%). There is a significant difference (p
- Published
- 2019
29. S1018 Rectal NSAIDs Decrease Post-ERCP Pancreatitis (PEP) in Unselected Patients - Comprehensive Meta-Analysis of Randomized Controlled Trials
- Author
-
Bashar J. Qumseya, Varun Angajala, Thu A. Mai, Robyn Rosasco, Selena Zhou, James Buxbaum, Aneesa Chowdhury, and Andrew Foong
- Subjects
medicine.medical_specialty ,Hepatology ,Randomized controlled trial ,business.industry ,law ,Meta-analysis ,Internal medicine ,Gastroenterology ,Medicine ,business ,Post ercp pancreatitis ,law.invention - Published
- 2021
30. Update on the Prevention of Post-ERCP Pancreatitis
- Author
-
Han Zhang, James Buxbaum, and Jaehoon Cho
- Subjects
medicine.medical_specialty ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Disease ,medicine.disease ,digestive system ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Increased risk ,030220 oncology & carcinogenesis ,Sphincter of Oddi dysfunction ,medicine ,Performed Procedure ,Pancreatitis ,030211 gastroenterology & hepatology ,business ,Adverse effect ,Post ercp pancreatitis - Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed procedure to manage pancreaticobiliary disease. Post-ERCP pancreatitis (PEP) is the most common adverse event of ERCP with a significant burden of morbidity and cost. Appropriate indication and counseling is mandatory especially for patients at increased risk for PEP such as those with suspected sphincter of Oddi dysfunction, pancreatic indications, and a prior history of PEP. Guidewire-facilitated deep cannulation is favored over contrast injection. High-quality trials support the use of rectal administered non-steroidal anti-inflammatory agents and pancreatic duct stent placement for high-risk patients. There is emerging evidence favoring the use of rectal NSAIDs and aggressive hydration in average-risk patients though further studies are required. There is also growing interest in the use of combination therapies as well such as pancreatic stents in combination with NSAIDs. The initial step towards PEP prevention involves careful patient selection and informed decision-making. Endoscopists should use several approaches to mitigate the risk of PEP, including guidewire-assisted cannulation, pancreatic stent placement, and rectal NSAIDs use for high-risk patients. The exact role of aggressive hydration and combination therapies needs to be further investigated.
- Published
- 2018
31. How to Avoid Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis
- Author
-
Bonna Leerhøy and B. Joseph Elmunzer
- Subjects
medicine.medical_specialty ,Ringer's Lactate ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Administration, Rectal ,medicine ,Humans ,Intensive care medicine ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Patient Selection ,Anti-Inflammatory Agents, Non-Steroidal ,Gastroenterology ,medicine.disease ,Pancreatitis ,030220 oncology & carcinogenesis ,Risk stratification ,Stents ,030211 gastroenterology & hepatology ,Complication ,business ,Post ercp pancreatitis - Abstract
Pancreatitis remains the most common and potentially devastating complication of endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Recent advances in prophylaxis have improved but not eliminated this problem, underscoring the importance of ongoing research toward this goal. This review aims to provide an evidence-based approach to post-ERCP pancreatitis prevention through patient selection, risk stratification, procedural technique, and multimodality prophylaxis, and discusses ongoing and future research initiatives in this important area.
- Published
- 2018
32. Prevention of post-ERCP pancreatitis: the search continues
- Author
-
Evan L. Fogel and Jeffrey J. Easler
- Subjects
Cholangiopancreatography, Endoscopic Retrograde ,medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Anti-Inflammatory Agents, Non-Steroidal ,Gastroenterology ,MEDLINE ,Non steroidal ,Article ,Text mining ,Pancreatitis ,Pharmaceutical Preparations ,medicine ,Humans ,Stents ,Post ercp pancreatitis ,business - Published
- 2021
33. Lactated Ringer’s Solution in Combination with Rectal Indomethacin for Prevention of Post-ERCP Pancreatitis: A Prospective Randomized, Double-Blinded, Controlled Trial
- Author
-
I Ararem, D Kezoula, Mt Medkour, A Bousseloub, K Amalou, and F Belghanem
- Subjects
Randomized controlled trial ,business.industry ,law ,Double blinded ,Anesthesia ,Medicine ,Ringer's solution ,business ,Post ercp pancreatitis ,law.invention - Published
- 2021
34. Guide-Wire Cannulation and Acute Post Ercp-Pancreatitis in Cases with Narrow Intrapancreatic Part of Common Bile Duct
- Author
-
A Kiosov and A Steshenko
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,Common bile duct ,business.industry ,Medicine ,business ,Post ercp pancreatitis ,Surgery - Published
- 2021
35. Impact Of Chronic Statin-Use On The Risk Of Post-Ercp Pancreatitis With Or Without Rectal Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
- Author
-
M Razpotnik, G Essler, J Weber-Eibel, DP Edlinger, S Bota, and M Peck-Radosavljevic
- Subjects
medicine.medical_specialty ,Non steroidal anti inflammatory ,business.industry ,Internal medicine ,medicine ,Statin treatment ,Post ercp pancreatitis ,business ,Gastroenterology - Published
- 2021
36. A Randomised Trial of Aggressive Fluid Hydration to Prevent Post-ERCP Pancreatitis (FLUYT)
- Author
-
Niels G. Venneman, W van de Vrie, Abha Bhalla, Hester C. Timmerhuis, Devica S Umans, H. van Goor, Nora D L Hallensleben, J.P.H. Drenth, P van der Schaar, D. W. da Costa, TR de Wijkerslooth, RL Sperna Weiland, M.G. Besselink, JE van Hooft, Marco J. Bruno, B van Eijck, Lubbertus C. Baak, Adriaan C.I.T.L. Tan, Tessa E H Römkens, Matthijs P. Schwartz, R.C. Verdonk, CJ Sperna Weiland, RL van Wanrooij, Wietske Kievit, Annet M. C. J. Voorburg, Alexander C. Poen, SM van Dijk, M Hadithi, Ben J.M. Witteman, H.C. van Santvoort, E. J. M. van Geenen, Tom C.J. Seerden, Yolande C.A. Keulemans, Paul Fockens, Willem J. Thijs, J.M. Vrolijk, and Xavier J N M Smeets
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,business ,Post ercp pancreatitis ,Surgery - Published
- 2021
37. Post-ERCP Pancreatitis Is Not Influenced By The Time To Ercp In Non-Ercp Emergencies
- Author
-
B Miutescu, Alina Popescu, Ioan Sporea, R Tripcea, I Ratiu, Camelia Gianina Foncea, Tudor Moga, and Ghiuchici Am
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Medicine ,business ,Post ercp pancreatitis - Published
- 2021
38. Aggressive hydration and post-ERCP pancreatitis–Authors' reply
- Author
-
Joost P.H. Drenth, Christina J Sperna Weiland, Devica S Umans, Xavier J N M Smeets, and Erwin J M van Geenen
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Gastroenterology ,Medicine ,Post ercp pancreatitis ,business - Published
- 2021
39. Cannulation attempts and the development of post-ERCP pancreatitis
- Author
-
Yoon Suk Lee
- Subjects
Cholangiopancreatography, Endoscopic Retrograde ,medicine.medical_specialty ,Pancreatitis ,business.industry ,General surgery ,Gastroenterology ,medicine ,MEDLINE ,Humans ,Radiology, Nuclear Medicine and imaging ,Post ercp pancreatitis ,business ,Catheterization - Published
- 2021
40. Network meta-analysis of prophylactic pancreatic stents and non-steroidal anti-inflammatory drugs in the prevention of moderate-to-severe post-ERCP pancreatitis
- Author
-
Péter Novák, Zsolt Dubravcsik, István Hritz, B Keczer, Barbara D. Lovasz, and László Madácsy
- Subjects
medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,education ,Population ,Network Meta-Analysis ,MEDLINE ,Placebo ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Cholangiopancreatography, Endoscopic Retrograde ,education.field_of_study ,Hepatology ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Gastroenterology ,medicine.disease ,Pancreatitis ,Pharmaceutical Preparations ,030220 oncology & carcinogenesis ,Meta-analysis ,Pancreatic stents ,030211 gastroenterology & hepatology ,Stents ,Post ercp pancreatitis ,business - Abstract
Background There is an ongoing debate that non-steroidal anti-inflammatory drugs (NSAID) or prophylactic pancreatic stents (PPS) are more beneficial in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). In our present network meta-analysis, we aimed to compare PPSs to rectal NSAIDs in the prevention of moderate and severe PEP in average- and high-risk patients. Methods We performed a systematic search for randomized controlled trials (RCT) from MEDLINE (via PubMed), Embase and Cochrane Central databases. RCTs using prophylactic rectal NSAIDs or PPSs in patients subjected to ERCP at average- and high-risk population were included. The main outcome was moderate and severe PEP defined by the Cotton criteria. Pairwise Bayesian network meta-analysis was performed, and interventions were ranked based on surface under cumulative ranking (SUCRA) values. Results Seven NSAID RCTs (2593 patients), and 2 PPS RCTs (265 patients) in the average-risk, while 5 NSAID RCTs (1703 patients), and 8 PPS RCTs (974 patients) in the high-risk group were included in the final analysis. Compared to placebo, only PPS placement reduced the risk of moderate and severe PEP in both patient groups (average-risk: RR = 0.07, 95% CI [0.002–0.58], high-risk: RR = 0.20, 95% CI [0.051–0.56]) significantly. Rectal NSAID also reduced the risk, but this effect was not significant (average-risk: RR = 0.58, 95% CI [0.22–1.3], high-risk: RR = 0.58, 95% CI [0.18–2.3]). Based on SUCRA, PPS placement was ranked as the best preventive method. Conclusion Prophylactic pancreatic stent placement but not rectal NSAID seems to prevent moderate-to-severe PEP better both, in average- and high-risk patients.
- Published
- 2020
41. Emerging Therapies to Prevent Post-ERCP Pancreatitis
- Author
-
Michael L. Kochman and Nikhil R. Thiruvengadam
- Subjects
medicine.medical_specialty ,Ringer's Lactate ,Indomethacin ,education ,Lower risk ,Gastroenterology ,Tacrolimus ,Clinical study ,03 medical and health sciences ,0302 clinical medicine ,Administration, Rectal ,Internal medicine ,Humans ,Medicine ,Cholangiopancreatography, Endoscopic Retrograde ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Pancreatic Ducts ,General Medicine ,Nitro Compounds ,medicine.disease ,surgical procedures, operative ,Pancreatitis ,030220 oncology & carcinogenesis ,cardiovascular system ,Stents ,030211 gastroenterology & hepatology ,Transplant patient ,business ,Post ercp pancreatitis ,Immunosuppressive Agents ,circulatory and respiratory physiology - Abstract
The aim of this review is to evaluate emerging, novel therapies for the prevention of post-ERCP pancreatitis. Rectal indomethacin reduces the risk of pancreatitis in low- and average-risk patients, who comprise the majority of patients undergoing ERCP. An 8-h protocol of aggressive lactated Ringer’s reduces the risk of pancreatitis in average-risk patients. Sublingual nitrate may provide additional benefit to rectal NSAIDs in preventing PEP. A tacrolimus trough > 2.5 ng/mL was recently shown to be associated with a lower risk of PEP in liver transplant patients undergoing ERCP. Routine usage of rectal indomethacin in all patients undergoing ERCP reduces the risk of PEP. Pancreatic-duct stents reduce the risk of PEP in high-risk patients. There is emerging data that aggressive hydration with lactated Ringer’s and nitrates may further reduce PEP. Tacrolimus is a promising potential agent to prevent PEP but needs further clinical study.
- Published
- 2020
42. Efficacy of Combining Aggressive Hydration With Rectal Indomethacin in Preventing Post-ERCP Pancreatitis: A Systematic Review and Network Meta-Analysis
- Author
-
Chakradhar Reddy, Dhruvil Radadiya, Kalpit Devani, and Bhaumik Brahmbhatt
- Subjects
medicine.medical_specialty ,Indomethacin ,Network Meta-Analysis ,Gastroenterology ,law.invention ,Diclofenac ,Randomized controlled trial ,law ,Administration, Rectal ,Internal medicine ,medicine ,Humans ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Odds ratio ,medicine.disease ,Pancreatitis ,Meta-analysis ,Post ercp pancreatitis ,Complication ,business ,medicine.drug - Abstract
Postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography pancreatitis (ERCP). No randomized controlled trial (RCT) has compared the efficacy of the American Society of Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy recommended interventions for PEP prevention. We assessed the effectiveness of these interventions using network meta-analysis. PubMed, EMBASE, and Cochrane databases were searched to identify RCTs investigating guideline-recommended interventions and their combinations [rectal nonsteroidal anti-inflammatory drugs (NSAIDs): indomethacin or diclofenac, pancreatic stent (PS), aggressive hydration (AH), sublingual nitrate) for PEP prevention. We performed direct and Bayesian network meta-analysis, and the surface under the cumulative ranking curve to rank interventions. Subgroup network meta-analysis for high-risk populations was also performed. We identified a total of 38 RCTs with 10 different interventions. Each intervention was protective against PEP on direct and network meta-analysis compared with controls. Except AH+diclofenac and NSAIDs+ sublingual nitrate, AH+indomethacin was associated with a significant reduction in risk of PEP compared with PS [odds ratio (OR), 0.09; credible interval (CrI), 0.003-0.71], indomethcin+PS (OR, 0.09; CrI, 0.003-0.85), diclofenac (OR, 0.09; CrI, 0.003-0.65), AH (OR, 0.09; CrI, 0.003-0.65), sublingual nitrate (OR, 0.07; CrI, 0.002-0.63), and indomethacin (OR, 0.06; CrI, 0.002-0.43). AH with either rectal NSAIDs or sublingual nitrate had similar efficacy. AH+indomethacin was the best intervention for preventing PEP with 95.3% probability of being ranked first. For high-risk patients, although the efficacy of PS and indomethacin were comparable, PS had an 80.8% probability of being ranked first. AH+indomethacin seems the best intervention for preventing PEP. For high-risk patients, PS seems the most effective strategy. The potential of combination of interventions need to be explored further.
- Published
- 2020
43. ID: 3520660 RISK FACTORS AND PREVENTIVE MEASURES FOR POST-ERCP PANCREATITIS IN BILIARY ERCP: A MULTICENTER PROSPECTIVE COHORT STUDY IN JAPAN
- Author
-
Takashi Kawamura, Takumi Onoyama, Toshiharu Ueki, Chishio Noguchi, Toshiro Katayama, Tokuhiro Matsubara, Akira Mitoro, Mamoru Takenaka, Kazuya Matsumoto, Hisakazu Matsumoto, Saiko Marui, Shujiro Yazumi, Masahiro Tsujimae, Hideki Kamada, Akira Kurita, Koichi Fujita, Kazunori Hasegawa, Keiji Hanada, Toru Maruo, Masanori Asada, Satoki Yasumura, Hirofumi Kawamoto, Atsuhiro Masuda, Ichiro Moriyama, Akihito Okazaki, Ken Hirao, Takeshi Tomoda, Takashi Tamura, Ryoji Takada, and Hiroko Nebiki
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Prospective cohort study ,Post ercp pancreatitis - Published
- 2021
44. ID: 3524324 PREDICTION OF POST-ERCP PANCREATITIS USING POST-PROCEDURE AMYLASE AND LIPASE LEVELS: A SYSTEMATIC REVIEW AND METAANALYSIS
- Author
-
Mahesh Gajendran, Hemant Goyal, Rupinder Mann, Sumant Inamdar, Smit Deliwala, Mark M. Aloysius, Benjamin Tharian, Sonali Sachdeva, Abhilash Perisetti, and Aman Ali
- Subjects
medicine.medical_specialty ,biology ,business.industry ,Post-Procedure ,Gastroenterology ,Internal medicine ,biology.protein ,Medicine ,Radiology, Nuclear Medicine and imaging ,Amylase ,Lipase ,business ,Post ercp pancreatitis - Published
- 2021
45. ID: 3520219 A RANDOMIZED TRIAL OF AGGRESSIVE FLUID HYDRATION TO PREVENT POST-ERCP PANCREATITIS (FLUYT)
- Author
-
Harry van Goor, Willem J. Thijs, Hester C. Timmerhuis, Erwin-Jan M. van Geenen, Muhammed Hadithi, Abha Bhalla, Sven M. van Dijk, David W da Costa, Lubbertus C. Baak, J.M. Vrolijk, Xavier J N M Smeets, Ruud L. Sperna Weiland, Tom C.J. Seerden, Ben J.M. Witteman, Yolande C.A. Keulemans, Nora D L Hallensleben, Hjalmar C. van Santvoort, Marc G. Besselink, Alexander C. Poen, Jeanin E. van Hooft, Adriaan C.I.T.L. Tan, Tessa E H Römkens, Paul Fockens, Christa J. Sperna Weiland, Roy L.J. van Wanrooij, W van de Vrie, Wietske Kievit, Devica S Umans, Robert C. Verdonk, Joost P.H. Drenth, Thomas R. de Wijkerslooth, Marco J. Bruno, Matthijs P. Schwartz, Brechje C van Eijck, Annet M. C. J. Voorburg, Peter J. van der Schaar, and Niels G. Venneman
- Subjects
medicine.medical_specialty ,Randomized controlled trial ,law ,business.industry ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Post ercp pancreatitis ,law.invention ,Surgery - Published
- 2021
46. Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: An Updated Review of Current Preventive Strategies
- Author
-
Harshil Bhatt
- Subjects
pancreatic stent ,medicine.medical_specialty ,Preventive strategy ,Endoscopic retrograde cholangiopancreatography ,endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,rectal non-steroidal anti-inflammatory drugs ,business.industry ,General surgery ,Gastroenterology ,Review ,medicine.disease ,Pancreatic stent ,Surgical methods ,03 medical and health sciences ,ERCP ,0302 clinical medicine ,post-ERCP pancreatitis ,030220 oncology & carcinogenesis ,medicine ,Pancreatitis ,030211 gastroenterology & hepatology ,Complication ,business ,Post ercp pancreatitis - Abstract
Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography, with incidence rates as high as 16% in some centers. Recent studies have also shown an upward trend in hospitalization due to endoscopic retrograde cholangiopancreatography-related pancreatitis. Early interventions taken before, during, and after the procedure can significantly reduce the risk of pancreatitis and decrease morbidity and mortality of the patients. To select appropriate patients for endoscopic retrograde cholangiopancreatography, in-depth knowledge of the patient-related and procedure-related risk factors is required. This updated clinical review outlines various pharmacological agents and surgical methods used for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Current evidence supports the use of rectal non-steroidal anti-inflammatory drugs and pancreatic stent placement as an effective preventive strategy. Further research is needed to compare these preventive modalities to improve patient outcomes after endoscopic retrograde cholangiopancreatography.
- Published
- 2020
47. Pharmacological Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Where Do We Stand Now?
- Author
-
Nkechi A Okam, Mst Khaleda Khatun, Wiqas Ahmad, Chenet Torrilus, Nusrat Jahan, and Dibyata Rana
- Subjects
medicine.medical_specialty ,post ercp pancreatitis and nsaids ,pharmacologic prophylaxis in post ercp pancreatitis ,education ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Intravenous hydration ,Internal medicine ,medicine ,Internal Medicine ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,General Engineering ,Gastroenterology ,medicine.disease ,Nafamostat ,Systematic review ,Inclusion and exclusion criteria ,cardiovascular system ,post ercp pancreatitis ,Pancreatitis ,Complication ,business ,030217 neurology & neurosurgery ,circulatory and respiratory physiology - Abstract
Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most frequently occurring complication of endoscopic retrograde cholangiopancreatography (ERCP). PEP is associated with significant morbidity and mortality; that is why the prevention of PEP is essential. Pharmacoprevention holds a central position in PEP prophylaxis. The current literature explores the efficacy of various pharmacological agents in preventing PEP, their routes of administration, and the correct administration timing. Data was collected on PubMed using regular keywords, the latter yielded 2077 papers. After applying inclusion and exclusion criteria, 218 papers were selected and screened and 28 studies were finally chosen after the removal of duplicate and irrelevant studies. The selected 28 articles comprised 25 randomized clinical trials and three systematic reviews. The study concludes that rectal non-steroidal anti-inflammatory drugs (NSAIDs) administered before ERCP are effective in preventing PEP in high-risk patients. The efficacy of rectal NSAIDs in low to medium risk group is not well established. A combination of rectal NSAIDs and intravenous hydration provides improved prophylaxis against PEP in high-risk patients than NSAIDs alone. Nafamostat, sublingual nitrates, and intravenous hydration are potential alternatives in patients with contraindications to NSAIDs.
- Published
- 2020
48. Primary precut sphincterotomy to reduce post-ERCP pancreatitis
- Author
-
Vikas Pandey, Shamshersingh Chauhan, Mayur Gattani, and Gaurav Singh
- Subjects
Cholangiopancreatography, Endoscopic Retrograde ,medicine.medical_specialty ,business.industry ,Gastroenterology ,MEDLINE ,Precut sphincterotomy ,Surgery ,Sphincterotomy, Endoscopic ,Pancreatitis ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,business ,Post ercp pancreatitis - Published
- 2020
49. Risk Factors for post-Endoscopic Retrograde Cholangiopancreatography Abdominal Pain in Patients without post-ERCP Pancreatitis
- Author
-
Jun Cao, Mengjie Chen, Xiaoping Zou, Ruhua Zheng, Lei Wang, and Yuling Yao
- Subjects
Abdominal pain ,medicine.medical_specialty ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,education ,Surgery ,cardiovascular system ,Medicine ,In patient ,medicine.symptom ,business ,Post ercp pancreatitis ,circulatory and respiratory physiology - Abstract
Background: Most of the studies on the abdominal pain associated with endoscopic retrograde cholangiopancreatography (ERCP) are aimed at solving the pain during the procedure. Post-ERCP abdominal pain has rarely been investigated,and few studies have focused on the characteristics and risk factors of post-ERCP abdominal pain without post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).This study aimed to identify risk factors of post-ERCP abdominal pain without PEP and investigate characteristics of the abdominal pain in non-PEP patients.Methods: From August 6th, 2019, to January 15th, 2020, data of patients who underwent ERCP were retrospectively collected. The characteristics of the abdominal pain after ERCP were recorded and compared between PEP and non-PEP patients. Multivariate analysis was conducted to identify risk factors of non-PEP abdominal pain. Results: Data from 616 ERCP procedures were retrospectively investigated in this study, among which 51(8.28%) patients presented post-ERCP abdominal pain without PEP and 45 (7.31%) patients developed PEP. Multivariate analysis found that 5 risk factors were associated with non-PEP abdominal pain: female gender (OR:2.137), upper abdominal surgery history (OR:1.948), first time ERCP (OR:4.735), elevated serum γ-glutamyl transferase (𝛾-GT) (OR:2.570) and elevated serum direct bilirubin (DBIL) (OR:2.932). Visual analogue sale (VAS) score of PEP abdominal pain was higher than that of non-PEP pain group (P=0.05). There were no significant differences in the time of the onset of the pain, pain relief time, pain frequency, use of analgesic medicine, hospital stay and mortality between PEP and non-PEP pain group(PConclusion: This study indicated that female gender, upper abdominal surgery history, first time ERCP, elevated 𝛾-GT and elevated DBIL were independent risk factors for post-ERCP abdominal pain without PEP. Abdominal pain was severer in PEP patients than non-PEP patients.
- Published
- 2020
50. Fluid type and volume reduce risk of post-ERCP pancreatitis and length of hospital stay in high-risk patients: a secondary analysis of the INDIEH trial*
- Author
-
Rajesh Goud, Rajesh Gupta, Mohan K. Ramchandani, Zaheer Nabi, Vikesh K. Singh, Mouen A. Khashab, Rakesh Kalapala, Rakesh Kochhar, Venkata S. Akshintala, Manohar Reddy, Rupjyoti Talukdar, Saroj K. Sinha, Jahangeer Basha, Vijay K. Rai, Ayesha Kamal, D. Nageshwar Reddy, Anthony N. Kalloo, Manu Tandan, Mahesh K. Goenka, Sundeep Lakhtakia, G.V. Rao, and B. Joseph Elmunzer
- Subjects
Original article ,High risk patients ,business.industry ,Incidence (epidemiology) ,education ,medicine.disease ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,030220 oncology & carcinogenesis ,Anesthesia ,Secondary analysis ,medicine ,cardiovascular system ,Pancreatitis ,Fluid type ,030211 gastroenterology & hepatology ,Pharmacology (medical) ,lcsh:Diseases of the digestive system. Gastroenterology ,lcsh:RC799-869 ,Post ercp pancreatitis ,business ,Hospital stay - Abstract
Background and study aims Impact of intravenous fluid administration on prophylaxis against post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been rigorously evaluated among patients at high-risk for PEP. Patients and methods Effect of volume and type of fluid administered on PEP incidence was studied through a secondary analysis of high-risk patients who underwent endoscopic retrograde cholangopancreatography (ERCP) as a part of a randomized controlled trial in which all patients received rectal indomethacin. Periprocedural fluid was defined as fluid infused during and after ERCP. Results A total 960 patients were randomized during the trial, of whom 476 (49.6 %) received periprocedural fluids (mean volume = 1245 mL [± 629]). There was a trend towards a lower incidence of PEP in patients who received periprocedural fluid vs. those who did not (5.2 % vs. 8.0 %, P = 0.079). Among those receiving fluids, those who did not develop PEP received a higher mean volume of fluid vs. who developed PEP (1012 ± 725 mL vs. 752 ± 783 mL, P = 0.036). Among 174 patients (37 %) who received LR, patients who did not develop PEP received a higher mean volume of LR vs. those who developed PEP (570 ± 559 mL vs. 329 ± 356 mL, P = 0.006). Length of hospital stay decreased as the volume of periprocedural volume administration increased (r = 0.16, P Conclusion Higher fluid volume and lactated Ringerʼs use during the periprocedural period was associated with a decreased risk of PEP and length of hospital stay beyond rectal indomethacin in high risk patients.
- Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.