Complications of diagnostic and therapeutic ERCP

Cohen, Seth A.; Siegel, Jerome H.; Kasmin, Franklin

doi:10.1007/s002619900089

Cited by 94 publications

(59 citation statements)

References 37 publications

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“…Although endoscopic retrograde cholangiopancreatography (ERCP) is well accepted as a gold standard for evaluation of biliary anatomy, it poses substantial risks (5.5% risk of pancreatitis, 3-5% risk of perforation) (6) in otherwise healthy donors. Recently, MRCP has emerged as a non-invasive alternative imaging examination for evaluation of the biliary system and is performed with increasing frequency (7)(8)(9)(10).…”

mentioning

confidence: 99%

The utility of MRCP in preoperative mapping of biliary anatomy in adult‐to‐adult living related liver transplant donors

Limanond

Raman

Ghobrial

et al. 2004

Magnetic Resonance Imaging

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Purpose:To assess the utility of magnetic resonance cholangiopancreatography (MRCP) in preoperative mapping of biliary anatomy in adult-to-adult living related liver transplant (LRLT) donors. Materials and Methods:From 57 potential donors with preoperative MRCP, 27 cases (16 men, 11 women, age range 22-51 years, mean 37.2 years) underwent right lobe resection and had intraoperative cholangiography (IOC) for comparison. The MRCP and IOC reports were retrospectively reviewed in all 27 cases. The MRCP was performed on 1.5 Tesla MR magnets using breath-hold heavily T2-weighted sequences in axial/coronal thin sections, and variable-thickness rotating slabs. The accuracy of preoperative MRCP for biliary mapping in potential LRLT donors was analyzed compared to the IOC findings.Results: Of 27 donors, 26 (96.3%) had MRCP which showed adequate information of central intrahepatic biliary anatomy. Of these, 19 had normal bifurcation confirmed by IOC, and single biliary anastomosis was created in the recipient at transplantation. MRCP correctly predicted 17 of 19 normal cases (sensitivity for normals: 89.5%). In seven donors with variant biliary anatomy, two separate biliary anastomoses were performed in the recipient. MRCP correctly predicted five of seven variants (sensitivity for variants: 71.4%). Overall, MRCP had an accuracy 84.6% (22/26).Conclusions: MRCP has potential in the preoperative assessment of nondilated bile ducts in LRLT donors, however further improvements are desired to increase its quality and accuracy. ADULT-TO-ADULT living related liver transplantation (LRLT) using right hepatic lobe donation is widely accepted as an alternative life-saving treatment for patients with end-stage liver diseases. However, careful donor selection is essential to maximize the success and minimize the risk of postoperative complications in donors and recipients. Preoperative mapping of biliary anatomy is one of the critical assessments for donor selection and surgical planning. The variants of biliary anatomy are well recognized and reported in the literature (1-5), and they may require different surgical approaches. Based on Huang et al (1) (Fig. 1), normal bifurcation of the donor liver requires only a single biliary reconstruction (choledochocholedochostomy or choledochojejunostomy) in the recipient. Other donor livers with aberrant drainage of the right ductal system, such as trifurcation and right posterior duct draining into left main duct, require two separate biliary anastomoses in order to prevent postoperative biliary leakage and long-term segmental atrophy in recipients.Although endoscopic retrograde cholangiopancreatography (ERCP) is well accepted as a gold standard for evaluation of biliary anatomy, it poses substantial risks (5.5% risk of pancreatitis, 3-5% risk of perforation) (6) in otherwise healthy donors. Recently, MRCP has emerged as a non-invasive alternative imaging examination for evaluation of the biliary system and is performed with increasing frequency (7-10). This study is designed to assess the ut...

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mentioning

confidence: 99%

The utility of MRCP in preoperative mapping of biliary anatomy in adult‐to‐adult living related liver transplant donors

Limanond

Raman

Ghobrial

et al. 2004

Magnetic Resonance Imaging

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“…In agreement with us, several researchers 5,12,15 advocated that the clinical condition of the patient should be the key factor determining the mode of treatment. We believe that clinical and laboratory variables should be correctly interpreted in the overall clinical context.…”

Section: Commentmentioning

confidence: 70%

“…[3][4][5] Because of the rarity of this complication, management recommendations have largely been based on small series, [6][7][8][9][10][11][12][13][14] expert opinion, 1 and literature reviews. 2,15 Although nonoperative management has been recognized as a viable option for retroperitoneal DPs since the early era of ERCP and endoscopic sphincterotomy, 6,7,10 multiple studies 8,9,11,13,16 advocating primary surgical management have been published.…”

Section: Uodenal Perforationsmentioning

confidence: 99%

Validity of Clinical Criteria in the Management of Endoscopic Retrograde Cholangiopancreatography–Related Duodenal Perforations

Assalia

Suissa²,

Ilivitzki³

et al. 2007

Arch Surg

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“…If, on the one hand, obtaining reproducible results does not necessarily imply that they are accurate (considering that the examiners might systematically agree on an error), on the other hand, methods with low reproducibility are not associated with high accuracy 27 . Errors in image diagnostics may derive from four variables: inadequate technique, absence of knowledge or training, error of perception and error of judgment.…”

Section: Viewing Of the Bile Ductsmentioning

confidence: 99%

Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation

et al. 2010

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Purpose: To evaluate the accuracy and reproducibility of magnetic resonance cholangiopancreatography (MRCP) in the detection of biliary complications in liver transplanted patients. Methods: A study was conducted, with blinded review of 28 MRCP exams of 24 patients submitted to liver transplantation. The images were reviewed by two independent observers, at two different moments, regarding the degree of biliary tree visualization and the presence or absence of biliary complications. The MRCP results were compared, when negative, to at least 3 months of clinical and biochemical follow-up, and when positive, to the findings at surgery or endoscopic retrograde cholangiopancreatography (ERCP). Results: The degree of intrahepatic biliary tree visualization was considered good or excellent in 78.6% and 82.1% of the exams by the two observers and visualization of the donor duct, recipient duct and biliary anastomosis was considered good or excellent in 100% of the exams, by both observers. Six biliary complications were detected (21.4%), all of them anastomotic strictures. Intra and interobserver agreement were substantial or almost perfect (kappa k values of 0.611 to 0.804) for the visualization of the biliary tree and almost perfect (k values of 0.900 to 1.000) for the detection of biliary complications. MRCP achieved 100% sensitivity, 95.45% specificity, 85.7% positive predictive value and 100% negative predictive value for the detection of biliary complications. Conclusions: MRCP is an accurate examination for the detection of biliary complications after orthotopic liver transplantation and it is a highly reproducible method in the evaluation of the biliary tree of liver transplanted patients. Key words: Liver Transplantation. Magnetic Resonance Imaging. Bile Ducts. Cholangiography. RESUMOObjetivo: Medir a acurácia e reprodutibilidade da colangiopancreatografia por ressonância magnética (CPRM) na avaliação da visibilização de complicações biliares em pacientes submetidos a transplantes hepáticos ortotópicos. Métodos: Realizado estudo retrospectivo de 28 exames de CPRM de 24 pacientes submetidos a transplantes hepáticos. Os exames foram interpretados por dois observadores independentes, em dois momentos distintos, quanto ao grau de visibilização das estruturas estudadas e quanto à presença ou ausência de alterações nas vias biliares. Os resultados da CPRM foram comparados, nos casos de CPRM negativa, à evolução clínico-laboratorial por pelo menos 3 meses e, nos casos de CPRM alterada, aos achados de colangiopancreatografia retrógrada endoscópica (CPRE) e cirurgia, quando indicados. Resultados: A visibilização das vias biliares intra-hepáticas foi considerada boa ou excelente em 78,6% e 82,1% dos exames pelos dois observadores. A visibilização da via biliar extra-hepática do doador e do receptor, bem como da anastomose biliar, foi considerada boa ou excelente em 100% dos casos por ambos os observadores. Foram detectadas seis complicações biliares (21,4% dos casos), todas elas estenoses anastomóticas. A conco...

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Complications of diagnostic and therapeutic ERCP

Cited by 94 publications

References 37 publications

The utility of MRCP in preoperative mapping of biliary anatomy in adult‐to‐adult living related liver transplant donors

The utility of MRCP in preoperative mapping of biliary anatomy in adult‐to‐adult living related liver transplant donors

Validity of Clinical Criteria in the Management of Endoscopic Retrograde Cholangiopancreatography–Related Duodenal Perforations

Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation

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