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3. Comparison of severity of pancreatitis with and without diclofenac sodium in post ERCP patients.

Author

Gul, Zaid, Ather, Hafiz Mughees, Saleem, Amir, Mehmood, Arfan, Tahir, Furqan, and Chattha, Hussain Tariq

Subjects
*DICLOFENAC, *MEDICAL sciences, *PANCREATITIS, *RANDOMIZED controlled trials, *OBSTRUCTIVE jaundice
Abstract

Objective: To compare the diclofenac sodium intramuscular prophylaxis given with standard treatment in patients having ERCP was compared with standard treatment alone with respect to frequency and severity of pancreatitis within 48 hours after the procedure. Study Design: Randomized Controlled Trial. Setting: Department of Gastroenterology, Hepatology, and GI Endoscopy, SZABMU, Pakistan Institute of Medical Sciences, Islamabad. Period: August 2021 and April 2022. Material & Methods: The study enrolled 160 patients with obstructive jaundice with or without pruritus (20-70 years). Each group consisted of 80 patients. A prophylactic dose of 75 mg of diclofenac sodium was administered intramuscularly to Group A in addition to standard treatment, while standard treatment was given to Group B alone. The standard treatment for PEP was antibiotics (Cefoperazone/Sulbactam 2g IV) for both groups. IV dormicum (midazolam) was given to both groups as sedation. All patients were tested for lipase and amylase after the procedure to detect any complications. They were also monitored for abdominal pain at 4 and 24 hours after the procedure. Results: In patients of Group A (n=80), the mean age was 47.1 years ± 8.4 SD, whereas in patients in Group B (n=80), the mean age was 47.5 years ± 7.4 SD. In Group A, 3.8% of patients (n=3/80) developed PEP, while 11% (n=11/80) developed PEP (p=0.025). Intramuscular diclofenac sodium was more efficient at preventing PEP when compared to the control group on standard treatment alone, on all of the following parameters: (1) the proportion of patients that did not develop PEP, (2) the rate of patients that developed PEP, and (3) the average quantity of days that patients were sick. In both groups A and B, the PEP diagnosis was mild and the patients were discharged within 2-3 days of diagnosis. PEP efficacy was not significantly different across age groups or genders in both treatment groups (p>0.05). Conclusion: Diclofenac sodium is significantly more effective than standard treatment alone for intramuscular pancreatitis prophylaxis after ERCP. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Patient-related post-ERCP pancreatitis (PEP) risk factors between two groups of patients: Prophylactic pancreatic stent and rectal indomethacin

Author

Hossein Ghalehnoei, Ahmad Hormati, Amir Houshang Mohammad Alizadeh, Sajjad Ahmadpour, and Seyed Hassan Abedi

Subjects
ercp, post ercp pancreatitis, pancreatic duct stent, rectal indomethacin, Internal medicine, RC31-1245
Abstract

Background: Pancreatitis is one of the most crucial complications following endoscopic retrograde cholangiopancreatography (ERCP). The purpose of the current study was to investigate patient-related post-ERCP pancreatitis (PEP) risk factors in two groups of patients: prophylactic pancreatic stent and rectal indomethacin. Methods: Two different prophylactic modalities were planned and complications were assessed based on the defined inclusion criteria. In this study, the patients were evaluated for the procedure and patient-related risk factors in post-ERCP pancreatitis in the recipient groups of the prophylactic pancreatic stent and rectal indomethacin. Results: Pancreatitis was confirmed in 27 of all 170 selected patients after ERCP. By univariate analysis, two variables were significant with the development of PEP. Regarding the patient-related risk factors, unique subjects with common bile duct (CBD) dilated 10mm were more exposed to an increased chance of PEP (P=0. 015); meanwhile, other factors did not correlate with the increased possibility of PEP in both groups. The only procedure-related risk factor for PEP was the deep cannulation of the pancreatic duct in both groups during the procedure with an incremental significant incidence of pancreatitis (P=0.005). Comparison of prophylactic pancreatic stent and rectal indomethacin showed no effects in term of post ERCP pancreatitis reduction. Additionally, there was no significant difference between these two strategies in the rate of PEP. Conclusion: Prophylactic pancreatic duct stents and administration of rectal indomethacin cannot have particular approaches for reducing the possible occurrence of PEP. The increase in time of deep cannulation and the presence of CBD dilation

Published
2022

7. Trans-papillary bilio-pancreatic stenting: When how and which stent

Author

Annalisa Cappello, Rosario Landi, Christian Gerges, Vincenzo Cennamo, Guido Costamagna, and Andrea Tringali

Subjects
endoscopic retrograd colangiopancreatography, stent, malignant biliary stenosis, benign biliary stenosis, chronic panceatitis, post ERCP pancreatitis, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Nowadays, stenting malignant biliary stenosis (extrahepatic or hilar), benign biliary stenosis, and pancreatic duct stenosis in chronic pancreatitis as well as stenting for prophylaxis of post- endoscopic retrograde cholangiopancreatography pancreatitis and for failed extraction of biliary stones or endoscopic papillectomy are the many common challenges for a bilio-pancreatic endoscopist. The purpose of this review is to provide a practical approach to bilio-pancreatic stenting indications and techniques. Having a thorough understanding of stenting indications and techniques, for a bilio-pancreatic endoscopist means being able to develop a tailored approach for each clinical scenario depending on the type of stent used. Biliary stents, in fact, vary in diameter, length, and composition, making it possible to give each patient personalized treatment.

Published
2023
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8. Patient-related post-ERCP pancreatitis (PEP) risk factors between two groups of patients: Prophylactic pancreatic stent and rectal indomethacin.

Author

Ghalehnoei, Hossein, Hormati, Ahmad, Mohammad Alizadeh, Amir Houshang, Ahmadpour, Sajjad, and Abedi, Seyed Hassan

Subjects
INDOMETHACIN, PANCREATITIS, RECTAL administration, PANCREATIC duct, ENDOSCOPIC retrograde cholangiopancreatography, NECROTIZING pancreatitis
Abstract

Background: Pancreatitis is one of the most crucial complications following endoscopic retrograde cholangiopancreatography (ERCP). The purpose of the current study was to investigate patient-related post-ERCP pancreatitis (PEP) risk factors in two groups of patients: prophylactic pancreatic stent and rectal indomethacin. Methods: Two different prophylactic modalities were planned and complications were assessed based on the defined inclusion criteria. In this study, the patients were evaluated for the procedure and patient-related risk factors in post-ERCP pancreatitis in the recipient groups of the prophylactic pancreatic stent and rectal indomethacin. Results: Pancreatitis was confirmed in 27 of all 170 selected patients after ERCP. By univariate analysis, two variables were significant with the development of PEP. Regarding the patient-related risk factors, unique subjects with common bile duct (CBD) dilated 10mm were more exposed to an increased chance of PEP (P=0. 015); meanwhile, other factors did not correlate with the increased possibility of PEP in both groups. The only procedurerelated risk factor for PEP was the deep cannulation of the pancreatic duct in both groups during the procedure with an incremental significant incidence of pancreatitis (P=0.005). Comparison of prophylactic pancreatic stent and rectal indomethacin showed no effects in term of post ERCP pancreatitis reduction. Additionally, there was no significant difference between these two strategies in the rate of PEP. Conclusion: Prophylactic pancreatic duct stents and administration of rectal indomethacin cannot have particular approaches for reducing the possible occurrence of PEP. The increase in time of deep cannulation and the presence of CBD dilation <10mm could be considered as important risk factors. [ABSTRACT FROM AUTHOR]

Published
2022
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9. 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, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

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).

Published
2022
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10. Reduced risk of post ERCP pancreatitis in statin users

Author

Yousaf Bashir Hadi, Syeda Fatima Naqvi, Abdelhai Abdelqader, Justin Kupec, and John Nasr

Subjects
Post ERCP pancreatitis, Pancreatitis, Statin, Endoscopy, Pancreas, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Abstract Background One of the most feared complications of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence of 3.5 to 15%, is post ERCP pancreatitis (PEP). Given the role of statins in the reduction of systemic and pancreatic intraluminal inflammation, we hypothesized that the use of statins may lower the risk of PEP. Methods A retrospective cohort study of all patients undergoing ERCP at West Virginia University during the years 2016 and 2017 was performed. Possible association of collected variables with PEP was assessed with Univariate tests and multivariable logistic regression analyses. Results A total of 1162 ERCPs were included. Mean age was 60.12 years (SD: 17.5). 51.3% of the participants were female. Two hundred and sixty-three participants underwent more than one ERCP during the study period. Seven hundred and ninety-nine ERCPs (78.8%) were conducted in participants who were not taking a statin medication at the time of ERCP, while 363 participants were on statin medications at the time of ERCP; 118 and 245 participants were taking high dose statins (atorvastatin 40–80 mg or rosuvastatin 20 mg), and low/medium dose statins (all other statin regimens) at the time of the procedure, respectively. The overall incidence of PEP in the cohort was 7.3%. In the non-statin and statin groups, 9.5 and 3.4% of participants developed PEP, respectively. On univariate analysis, young age, no statin use, history of PEP, and endoscopic sphincterotomy were found to be significantly associated with the development of PEP. In a binary logistic regression model, young age (P = 0.033), history of PEP (P = 0.0001, OR 2.41, 95% CI: 1.05–5.51) and endoscopic sphincterotomy (P = 0.038, OR 2.85, 95% CI: 1.7–4.78) were found to be associated with increased risk of PEP. Statin usage was found to be protective against PEP, (OR 0.35, 95% CI: 0.18–0.69). Conclusion Chronic statin usage is protective against post ERCP pancreatitis, and our findings suggest a potential role of these drugs as prophylactic agents. Randomized controlled trials are needed to establish any potential clinical application.

Published
2020
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11. Management of ERCP complications.

Author

Pal P and Ramchandani M

Subjects
Humans, Cholangitis etiology, Cholangitis therapy, Pancreatitis etiology, Pancreatitis therapy, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Postoperative Complications therapy, Postoperative Complications etiology, Postoperative Complications diagnosis
Abstract

Managing complications of ERCP poses a significant clinical challenge to endoscopists. ERCP complications can occur even after all preventive measures, which can lead to significant morbidity and even mortality. Major complications include pancreatitis, bleeding, perforation, cholangitis, and sedation-related adverse events. Early recognition of post-ERCP pancreatitis (PEP) is feasible by monitoring clinical parameters and specific cutoffs of serum amylase and lipase at 2-6 h post-ERCP. Pancreatic stenting for PEP is not recommended and can increase the incidence of infected necrosis in addition to being technically challenging. Post-sphincterotomy bleeds can be treated by diluted epinephrine with or without thermal therapy, or mechanical therapy (clips or fully covered metallic stents) failing which angiographic embolization and rarely open surgical vessel ligation may be warranted. Post-ERCP perforations can lead to significant morbidity and are usually treated with endoscopic closure of the defect, diverting bile flow, draining collections, and reducing fluid load at the site of perforation failing which surgery may be warranted. Broad-spectrum antibiotics with endoscopic or radiologic drainage of undrained segments help treat post-ERCP cholangitis. Hypoxia and hypertension are the most common sedation-related adverse events without long-term consequences except aspiration pneumonia (<0.5%). Awareness with a high index of suspicion is crucial for timely diagnosis and management of uncommon post-ERCP complications., Competing Interests: Declaration of competing interest None of the authors has any conflicts of interest related to this article/work to declare. No writing assistance was taken. No Grant/Funding was provided. There is no financial disclosure for any of the author related to this manuscript., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Published
2024
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12. Reduced risk of post ERCP pancreatitis in statin users.

Author

Hadi, Yousaf Bashir, Naqvi, Syeda Fatima, Abdelqader, Abdelhai, Kupec, Justin, and Nasr, John

Subjects
*PANCREATITIS, *ENDOSCOPIC retrograde cholangiopancreatography, *LOGISTIC regression analysis, *UNIVARIATE analysis, *RANDOMIZED controlled trials, *MULTIVARIABLE testing
Abstract

Background: One of the most feared complications of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence of 3.5 to 15%, is post ERCP pancreatitis (PEP). Given the role of statins in the reduction of systemic and pancreatic intraluminal inflammation, we hypothesized that the use of statins may lower the risk of PEP.Methods: A retrospective cohort study of all patients undergoing ERCP at West Virginia University during the years 2016 and 2017 was performed. Possible association of collected variables with PEP was assessed with Univariate tests and multivariable logistic regression analyses.Results: A total of 1162 ERCPs were included. Mean age was 60.12 years (SD: 17.5). 51.3% of the participants were female. Two hundred and sixty-three participants underwent more than one ERCP during the study period. Seven hundred and ninety-nine ERCPs (78.8%) were conducted in participants who were not taking a statin medication at the time of ERCP, while 363 participants were on statin medications at the time of ERCP; 118 and 245 participants were taking high dose statins (atorvastatin 40-80 mg or rosuvastatin 20 mg), and low/medium dose statins (all other statin regimens) at the time of the procedure, respectively. The overall incidence of PEP in the cohort was 7.3%. In the non-statin and statin groups, 9.5 and 3.4% of participants developed PEP, respectively. On univariate analysis, young age, no statin use, history of PEP, and endoscopic sphincterotomy were found to be significantly associated with the development of PEP. In a binary logistic regression model, young age (P = 0.033), history of PEP (P = 0.0001, OR 2.41, 95% CI: 1.05-5.51) and endoscopic sphincterotomy (P = 0.038, OR 2.85, 95% CI: 1.7-4.78) were found to be associated with increased risk of PEP. Statin usage was found to be protective against PEP, (OR 0.35, 95% CI: 0.18-0.69).Conclusion: Chronic statin usage is protective against post ERCP pancreatitis, and our findings suggest a potential role of these drugs as prophylactic agents. Randomized controlled trials are needed to establish any potential clinical application. [ABSTRACT FROM AUTHOR]

Published
2020
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13. Safety of rectal indomethacin (100 mg) for the prevention of post-ERCP pancreatitis in the Japanese population: A single-center prospective pilot study

Author

Kotaro Takeshita, Mamoru Takenaka, Takumi Ichinona, Satoshi Asai, Eisuke Akamine, and Naoki Fujimoto

Subjects
Cholangiopancreatography, Endoscopic Retrograde, medicine.medical_specialty, Hepatology, business.industry, Anti-Inflammatory Agents, Non-Steroidal, Indomethacin, Gastroenterology, MEDLINE, Pilot Projects, Japanese population, Single Center, Japan, Pancreatitis, Internal medicine, Humans, Medicine, Prospective Studies, business, Post ercp pancreatitis
Published
2022

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

23. 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

24. 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

26. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. Prevention of post endoscopic retrograde cholangiopancreatography pancreatitis

Author

Nalini M. Guda

Subjects
ercp, post ercp pancreatitis, pancreatic stents, post ercp complications, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Post ERCP pancreatitis (PEP) is a common problem. Knowledge of patient and procedure related risk factors along with appropriate measures aimed at reduction of risk have been successful in reducing both the incidence and the severity. Prophylactic pancreatic duct stenting has definitely reduced the incidence and the severity of PEP in high risk patients. There are some emerging data on the use of non steroidal anti inflammatory agents though this is not widely adapted in practice. Key is to avoid procedures with marginal indications and use of non invasive/less invasive procedures.

Published
2012
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37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

48. 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

50. 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

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