Adverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials

Funari, Mateus Pereira; Ribeiro, Igor Braga; Bernardo, Wanderley Marques; Brunaldi, Vítor Ottoboni; Rezende, Daniel T.; Resende, Ricardo H.; Marco, Michele O. De; Franzini, Tomazo; Moura, Eduardo Guimarães Hourneaux de

doi:10.1016/j.clinre.2019.12.009

Cited by 12 publications

(32 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This can result in mechanical damage to the duct or ampoule. Thermal injury to the electrocautery current can also produce edema of the pancreatic orifice, leading to obstruction of the duct, impairing the emptying of pancreatic secretions[ 11 ].…”

Section: Pathogenesismentioning

confidence: 99%

See 1 more Smart Citation

Pancreatitis after endoscopic retrograde cholangiopancreatography: A narrative review

Ribeiro¹,

Monte²,

Neto³

et al. 2021

WJG

Self Cite

View full text Add to dashboard Cite

Acute post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a feared and potentially fatal complication that can be as high as up to 30% in high-risk patients. Pre-examination measures, during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events. Several studies have debated on the subject, however, numerous topics remain controversial, such as the effectiveness of prophylactic medications and the amylase dosage time. This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.

show abstract

Section: Pathogenesismentioning

confidence: 99%

“…However, this modality may have a lower incidence of pancreatitis. Monopolar mode causes higher rates of pancreatitis compared to bipolar mode[ 11 ].…”

Section: Preventionmentioning

confidence: 99%

Pancreatitis after endoscopic retrograde cholangiopancreatography: A narrative review

Ribeiro¹,

Monte²,

Neto³

et al. 2021

WJG

Self Cite

View full text Add to dashboard Cite

show abstract

“…In a recent systematic review including 25 randomized controlled trials (RCTs), incidence of PEP in patients with common bile duct stones who underwent ERCP was comparable between endoscopic papillary balloon dilation, endoscopic sphincterotomy (ES), and the combination of large balloon dilation and endoscopic sphincterotomy [9]. In another systematic review, evaluating the safety of different modes of electrical current during biliary sphincterotomy revealed that pure cut carries a lower risk of PEP while the monopolar mode is associated with a higher risk of PEP [10]. There is no difference in PEP with use of carbon dioxide insufflation compared to ambient air insufflation [11].…”

Section: Introductionmentioning

confidence: 99%

Post-endoscopic retrograde cholangiopancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

Background and study aims Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Multiple drugs and techniques have been studied for the prevention of PEP. Topical epinephrine has shown mixed results and is still not widely accepted as an alternative for prevention of PEP. We performed a systematic review and meta-analysis to evaluate the efficacy of topical epinephrine in preventing PEP. Methods A comprehensive literature review was conducted by searching Cochrane library database, Embase and PubMed up to August 2019, to identify all studies that evaluated use of topical epinephrine alone or in conjunction with other agents for prevention of PEP. Outcomes included prevention of PEP with use of topical epinephrine and evaluation of whether addiing epinephrine provides any additional benefit in preventing PEP. All analysis was conducted using Revman 5.3. Results Eight studies, including six randomized controlled trials and two observational studies with 4123 patients, were included in the meta-analysis. Overall, there was no difference in incidence of PEP in patients who underwent ERCP and were treated with epinephrine spray versus those who were not, RR = 0.63 (CI 0.32–1.24) with heterogeneity (I2 = 72 %). However, on a subgroup analysis, topical epinephrine significantly decreases the risk of PEP when compared to placebo alone (means no intervention was done including no rectal indomethacin)., RR = 0.32 (0.18–0.57). In another subgroup analysis, there was no statistically significant difference in using topical epinephrine along with rectal indomethacin in preventing PEP compared to rectal indomethacin alone RR = 0.87 (0.46–1.64). Conclusion Topical epinephrine does not provide any additional benefit in preventing PEP when used in conjunction with rectal indomethacin. In subgroup analysis, topical epinephrine appeared to decrease risk of PEP in the absence of rectal indomethacin, and could be considered when rectal indomethacin is unavailable or if there is a contraindication to its use.

show abstract

“…9 Given the progressive nature of the disease and a median survival after diagnosis of 10-12 years without liver transplantation, early diagnosis with magnetic resonance cholangiography or endoscopic retrograde endoscopic cholangiography (ERCP) remains key, 6,[10][11][12][13] mainly due to their proven safety. [14][15][16][17][18] Most guidelines, including those of the European Association for the Study of the Liver /European Society of Gastrointestinal Endoscopy 19 and of the British Society of Gastroenterology, recommend ERCP for diagnosis only if therapeutic interventions or biopsies are required during the procedure, due to its invasive nature. Although liver transplantation remains the treatment of choice for advanced diseases and represents the only curative therapy for PSC, patients with dominant extra-hepatic biliary strictures may potentially benefit from endoscopic management.…”

mentioning

confidence: 99%

Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis

et al. 2021

Self Cite

View full text Add to dashboard Cite

Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease of the hepatobiliary system, characterized by pro-gressive inflammation, fibrosis, and stricturing of the intraand extra-hepatic bile ducts. [1][2][3] Histopathologically, PSC is characterized by inflammation and fibrosis of the intra-and extra-hepatic ductal epithelium, which can ultimately progress to end-stage liver disease and cirrhosis, and increase the risk for cholangiocarcinoma. 4,5 The presentation of PSC is highly variable, ranging from asymptomatic in the early stages, to recurrent episodes of cholangitis with fever, jaundice, pruritus, abdominal pain and fatigue. However, median survival tends to be significantly decreased in patients who are symptomatic at the time of diagnosis. 6,7 Epidemiological studies of PSC have reported a prevalence rate of approximately 1 per 10,000, and incidence rates between 0.4 and 2.0 per 100,000 per year in Northern Europe and the US. 8 PSC conforms to the definition of rare diseases, affecting less than 200,000 individuals in the

show abstract

Adverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials

Cited by 12 publications

References 50 publications

Pancreatitis after endoscopic retrograde cholangiopancreatography: A narrative review

Pancreatitis after endoscopic retrograde cholangiopancreatography: A narrative review

Post-endoscopic retrograde cholangiopancreatography pancreatitis prevention using topical epinephrine: systematic review and meta-analysis

Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About