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Endoscopy. Sep;46(9) doi: /s Epub Aug Prophylaxis of post-ERCP pancreatitis: European Society of. Epub Sep 3. Post-ERCP pancreatitis (PEP) is the most frequent one, with an incidence ranging from 3 to O objetivo foi estudar os fatores de risco associados à PPC em doentes submetidos a CPRE com profilaxia por indometacina. It addresses the prophylaxis of post-endoscopic retrograde cholangiopancreatography the case of high risk for post-ERCP pancreatitis.

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Pancreatitis Post Cpre Epub

More article options. ePub · Statistics. Outline. Abstract; Keywords; Resumen; Palabras Retrospective study of duodenal perforations after ERCP diagnosed at a Se analizaron las siguientes variables: edad; sexo; motivo de la CPRE; tipo de . The most frequent post-ERCP complications are pancreatitis, perforation. Epub Jun ERCP in elderly However, post-ERCP pancreatitis was significantly less frequent in the older patients (>80 years) (% vs %; P CPRE chez les personnes âgées?. La frecuencia y la etiología de la pancreatitis aguda (PA) varían de acuerdo a la . hipertrigliceridemia en 47 sujetos (7,80%), post-CPRE en 13 individuos (2.

Debido a su baja incidencia probablemente haya sido en el pasado infradiagnosticada. Palabras clave: Pancreatitis. ABSTRACT Groove pancreatitis is a type of chronic pancreatitis that affects the area between the pancreatic head, the duodenum and the common bile duct and can simulate, mask or coexist with pancreatic carcinoma. It should be considered in the differential diagnosis of pancreatic masses or duodenal stenosis. It is a rare disease but is probably underdiagnosed. Several names are used to refer to it in the literature, a fact that makes it difficult to extract precise information. Here we present an exhaustive review of the relevant literature on the entity and discuss its clinical features, diagnosis and therapy. Key words: Groove pancreatitis. Computed tomography.

In our series, as other authors describe, 5,10—12 periampullary perforations are more frequent.

Acta Gastroenterológica Latinoamericana

Nevertheless, authors like Howard et al. The suspicion of perforation during the procedure is a relevant factor to achieve an early diagnosis and decide which patients will benefit from a conservative treatment. It allows treatment to begin as early as possible and it is related to the better morbidity and mortality results, 1,5,12,13 contrary to late diagnosis.

Four of our patients had a late diagnosis and 3 of them presented a worse clinical course.

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Two patients were diagnosed with sepsis 2 and 4 days after the procedure, and passed away after 7 and 9 days, respectively. One patient, diagnosed after 12h and urgently operated on, presented a retroperitoneal collection and choleperitoneum. Therefore, she required an admission in the ICU. Patients with retroperitoneal collections seem to have a worse prognosis and should require urgent surgical intervention.

The identification may alert the physician in order to attempt to reduce the risk. Such data are also similar to other studies.

All of our cases presented retropneumoperitoneum, though Genszlinger et al. The presence of massive subcutaneous emphysema, pneumomediastinum or pneumothorax has been defined as a predictive sign of probable bad evolution with conservative treatment.

Some authors support an early surgical management. In our environment, the decision to adopt a conservative treatment or a surgical treatment was based on findings observed during ERCP, the symptoms of patients and complementary tests. It is worldwide accepted that the patients with intraperitoneal duodenal perforations must undergo surgery immediately.

The surgical technique shall depend on the size of perforation, duodenal condition and clinical situation of the patient. The 3 patients with type I duodenal perforations were early diagnosed and operated on, which allowed a simple closure of the duodenal defect. Other surgical alternatives are duodenostomy, pyloric exclusion with gastrojejunostomy or feeding jejunostomy. The management of periampullary perforations is a matter of discussion.

Seven out of 12 periampullary perforations were treated conservatively.

Nevertheless, Howard et al. Some supportive arguments are the scarce findings during the surgical intervention, without identification of perforation in most of the cases. However, in the latter, the decision was based on old age or the existence of an inoperable neoplasia. Perhaps, some of these patients could have been eligible for the conservative treatment of the perforation. However, this statement should be cautiously made due to the retrospective character of the study.

Miller et al. Other authors 5,14,17 suggest the use of self-expandable stents or nasobiliary tubes for the treatment of periampullary perforations diagnosed during the procedure. Over the years, there has been a change in the treatment of post-ERCP perforations, with selective conservative treatment as the current trend. Considering our experience as well as other authors experience, 1 we could conclude that, as a general rule, patients with type I duodenal perforation will require immediate surgery, with variations in the surgical technique at the moment of diagnosis, duodenal condition and the symptoms of the patient.

Patients with periampullary or bile duct perforation can be considered for a selective conservative treatment. The following are supportive factors: early diagnosis, absence of sepsis and collections, free intra-abdominal fluid or great leak of oral dye in abdominal CT scan.

Besides, patients that undergo a conservative management may benefit from subsequent elective surgery with lower morbidity and mortality rates.

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Randomized trial of endoscopic sphincterotomy with balloon dilation versus endoscopic sphincterotomy alone for removal of bile duct stones.

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Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Large size balloon dilation of the ampulla after biliary sphincterotomy can facilitate endoscopic extraction of difficult bile duct stones.

J Clin Gastroenterol ; Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones.


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