Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs

Halttunen, Jorma; Meisner, Søren; Aabakken, Lars; Arnelo, Urban; Grönroos, Juha; Hauge, Truls; Kleveland, P. M.; Schmidt, Palle Nordblad; Saarela, Arto; Swahn, Fredrik; Tóth, Ervin; Mustonen, Harri; Löhr, J.‐Matthias

doi:10.3109/00365521.2014.894120

Cited by 133 publications

(117 citation statements)

References 28 publications

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“…Notably, absent as an independent risk was contrast injection, which was overshadowed by deep wire passage. Subsequent studies have corroborated the risk of pancreatic wire passage, especially during guidewire cannulation [12,13]. Most studies of Bdouble-wire^technique to cannulate bile duct also suggest increased risk [14].…”

Section: Procedure-related Factorsmentioning

confidence: 96%

Preventing Post-ERCP Pancreatitis: Update 2016

Freeman

2016

Curr Treat Options Gastro

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Post-ERCP remains a major challenge, although significant progress has been made in predicting risk and methods of prevention. Facets of post-ERCP pancreatitis can be divided into the four "P's": they are patient-related factors, procedure-related factors, pancreatic stents, and pharmacoprophylaxis. New information about risk factors includes a description of IPMN as a patient-related risk, with smoking and chronic liver disease as protective factors. Procedure-related factors include one or more deep passages of a guidewire into the pancreatic duct as a salient risk, perhaps outweighing difficult cannulation or contrast injection, but one that can be mitigated by placement of a pancreatic stent. In addition, placement of transpapillary metallic stents has emerged as an independent risk for post-ERCP pancreatitis (PEP). Although there has been a rising wave of enthusiasm for rectal NSAIDs as a kind of panacea for prevention of post-ERCP pancreatitis, the newest data question their efficacy in unselected cohorts. Pancreatic stent placement remains the most proven and reliable method of preventing post-ERCP pancreatitis in both mixed- and high-risk ERCP. Success at placement of protective pancreatic stents is a paramount for safety and efficacy, and technical expertise at placing pancreatic stents widely among centers. The use of specialized techniques including very small caliber guidewires and stents is necessary to approach 100 % success.

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Section: Procedure-related Factorsmentioning

confidence: 96%

Preventing Post-ERCP Pancreatitis: Update 2016

Freeman

2016

Curr Treat Options Gastro

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“…10 There is wide disparity but the most accurate overall risk of PEP from prospective studies ranges from 3%-10%. 1,4,5,[11][12][13][14][15][16] A survey of prospective studies in 2007 reported that about 10% of PEP cases were graded as severe and the overall mortality of PEP was 3%. 1 …”

Section: Post-ercp Pancreatitismentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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“…ERCP may not be feasible in patients with malignant gastric outlet or duodenal obstruction, and rarely if there is an inability to cannulate the papilla or transverse a common bile duct (CBD) stricture. 23 When ERCP fails, percutaneous drainage, surgical bypass, and EUS-guided biliary drainage (EUS-BD) are alternative options. [24][25][26] The rates of technical and clinical success have been high with EUS-BD (86%-98% and 88%-94%, respectively), although complication rates have been high as well (9%-26%).…”

Section: Bile Duct Drainagementioning

confidence: 99%

Lumen apposing metal stents: A review of current uses and outcomes

Bank

Adler

2017

Int J Gastrointest Interv

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A B S T R A C TLumen-apposing metal stents (LAMS) represent a new innovation in gastrointestinal endoscopy. These devices have a saddle-shaped design and larger inner lumen diameter than either plastic or metal biliary stents, which should decrease the risk of migration and allows for an endoscope to pass into pancreatic fluid collections as well as the ability to perform direct endoscopic necrosectomy. LAMS were originally conceived and designed for transmural pancreatic fluid collection drainage but are currently also being used for many off label indications. There are three different LAMS available at this time around the globe. This manuscript will review the current state of the art with regards to LAMS and their indications, usage, and outcomes.

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Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs

Abstract: If the increasing rate of PEP is taken as defining factor, the wire-guided cannulation of a native papilla can be considered difficult after 5 min, five attempts, and two pancreatic guide-wire passages when any of those limits is exceeded.

Cited by 133 publications

References 28 publications

Preventing Post-ERCP Pancreatitis: Update 2016

Preventing Post-ERCP Pancreatitis: Update 2016

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Lumen apposing metal stents: A review of current uses and outcomes

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