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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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.
In our series, as other authors describe, 5,10—12 periampullary perforations are more frequent.
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.
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.
The use of endoscopic techniques is currently soaring Fig. Sia la coledoco-duodenostomia sia la colecisto-gastrostomia ecoendoguidate sono attualmente oggetto di studi prospettivi e comparativi. International consensus guidelines for endoscopic papillary large-balloon dilation.
Gastrointest Endosc ; Yang XM, Hu B. Endoscopic sphincterotomy plus large-balloon dilation vs endoscopic sphincterotomy for choledocholithiasis: a meta-analysis. World J Gastroenterol ; Large balloon dilation post endoscopic sphincterotomy in removal of difficult common bile duct stones: a literature review.
Randomized trial of endoscopic sphincterotomy with balloon dilation versus endoscopic sphincterotomy alone for removal of bile duct stones.
Gastroenterology ; Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones. Endoscopic papillary balloon dilation and endoscopic sphincterotomy for bile duct stones: long-term outcomes in a prospective randomized controlled trial.
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.
Tips in biliary stone removal using endoscopic papillary large balloon dilation. J Hepatobiliary Pancreat Sci ; E Efficacy and safety of endoscopic papillary balloon dilation using cap-fitted forward-viewing endoscope in patients who underwent Billroth II gastrectomy.
Clin Endosc ; Double-balloon enteroscopy for ERCP in patients with Billroth II anatomy: results of a large series of papillary large-balloon dilation for biliary stone removal. Endosc Int Open ; 3: EE A novel approach for endoscopic papillary balloon dilation with the guidewire left in the pancreatic duct to ensure pancreatic stenting.
Hepatogastroenterology ; Urakami Y. Endoscopy ; SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study with video. Digital single-operator cholangiopancreatoscopy soc in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience with video.
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Single-operator pancreatoscopy is helpful in the evaluation of suspected intraductal papillary mucinous neoplasms IPMN. Pancreatology ; ERCP-guided cholangioscopy using a single-use system: nationwide register-based study of its use in clinical practice. Peroral direct cholangioscopy PDCS using routine straight-view endoscope: first report.
Endoscopy ; 9: Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol ; Clinical evaluation of a prototype multi-bending peroral direct cholangioscope. Dig Endosc ; Plastic biliary stents for benign biliary diseases. Gastrointest Endosc Clin N Am ; , viii. Endotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up.
Endoscopic management with multiple plastic stents of anastomotic biliary stricture following liver transplantation: long-term results. Endoscopy Feb 9. Successful management of benign biliary strictures with fully covered self-expanding metal stents. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial.