Early successes and late failures in the prevention of post endoscopic retrograde cholangiopancreatography

Lieb, John G.; Draganov, Peter V.

doi:10.3748/wjg.v13.i26.3567

Cited by 16 publications

(7 citation statements)

References 82 publications

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“…Skepticism in this area has been attributed to reports of promising preliminary results with many drugs that were not confirmed in subsequent, larger, trials. 22 Interestingly, our survey respondents rated all mechanical interventions as more effective than drugs for PEP prophylaxis, even in cases in which this was incorrect (using pure-cut current during sphincterotomy does not decrease the incidence of PEP compared with using mixed current, contrary to NSAIDs vs placebo). [6][7][8]23 Measurement of PEP incidence was associated with the use of prophylactic pancreatic stenting, and this is recommended for quality assessment of ERCP.…”

Section: Discussionmentioning

confidence: 96%

Prophylaxis of post-ERCP pancreatitis: a practice survey

Dumonceau¹,

Rigaux²,

Kahaleh³

et al. 2010

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 96%

Prophylaxis of post-ERCP pancreatitis: a practice survey

Dumonceau¹,

Rigaux²,

Kahaleh³

et al. 2010

Gastrointestinal Endoscopy

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“…Postprocedural pancreatitis is observed in 4-40 % of patients, depending on their risk factors (Lieb and Draganov 2007 ). Therefore, invasive diagnostic/ therapeutic ERC is reserved for cases with defi nitive demonstration of a stone by MRCP.…”

Section: Clinical Managementmentioning

confidence: 99%

The Abdomen

Kühn¹,

Lühken²

2014

Whole-Body MRI Screening

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Focal liver lesions are present in more than 5 % of the population and are often detected incidentally when an imaging study is performed for another reason. In 40 % of cases, it is not possible to categorize such incidental lesions adequately by imaging ( Strobel and Bernatik 2006 ). Liver lesions are especially challenging for the radiologist interpreting whole-body screening MRI studies, which typically only include non-contrast-enhanced pulse sequences. With unenhanced MR images, only a crude characterization of focal liver lesions is possible.In the screening situation, we can roughly distinguish three categories of focal liver lesions: benign cysts and cyst-like lesions, benign solid masses, and solid malignancies (Table 8.1 ). Lesions with a cystic appearance such as dysontogenetic cysts, echinococcal cysts, and cavernous hemangiomas can be diagnosed with confi dence on the basis of an unenhanced MRI examination (including conventional T1-and T2-weighted sequences), and treatment recommendations can be made accordingly. This is not the case for solid liver lesions such as focal nodular hyperplasia, hepatocellular adenoma, metastasis, hepatocellular carcinoma, or cholangiocellular carcinoma. In most instances, a contrast-enhanced study is necessary to characterize solid liver lesions and estimate their total extent.

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“…The majority of patients suffer from mild pancreatitis, while severe pancreatitis occurs in 0.3%-0.6% [1].…”

Section: Introductionmentioning

confidence: 99%

Diclofenac vs. Placebo in a Randomized Double Blind Controlled Trial, in Post ERCP Pancreatitis

Abu-Safieh¹,

Altiti²,

Lobadeh³

2014

AJCMR

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Background and Study Aim:In several studies non-steroidal anti inflammatory drugs (NSAIDs) showed reduction of post (ERCP) pancreatitis incidence and severity. Our aim is to study the effect of NSAIDs in reducing post ERCP pancreatitis (PEP). Patients and Methods: A double blind placebo controlled study was conducted, patients who underwent ERCP in Specialized Arab Hospital (SAH), collected over one year, from June 2012 to June 2013 . Patients were randomized by an endoscopy nurse to receive IM Diclofenac 75 mg, or IM isotonic saline 3 ml as placebo. 12 hours after completing the procedure all patients were evaluated for abdominal pain and serum amylase. Results: The total number of patients was 199 patients, 17 patients were excluded, 182 patients completed the study, diclofenac group (89), placebo (93), the two groups were comparable for the following: age, sex, ERCP finding, pancreatic duct cannulation, failure of common bile duct (CBD) cannulation, number of pancreatic duct cannulation, ERCP time, sphincterotomy, and stenting. The overall incidence of pancreatitis was (18/182) 10%, (6/89) 6.9% for the diclofenac group and (12/93) 12.9% for the placebo group. There was no significant difference in the incidence of pancreatitis between the two groups; the P value was 0.164. In all the cases in which pancreatitis occurs, it was mild or moderate; there was no severe pancreatitis among the two groups. But in subgroup analysis the frequency of pancreatitis in patients with multiple pancreatic duct cannulation was significantly lower in the diclofenac group than in control group with p value = 0.021. Conclusion: Intramuscular diclofenac does not lower PEP rate or severity. But it significantly decreased PEP in patients with multiple pancreatic duct cannulations.

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Early successes and late failures in the prevention of post endoscopic retrograde cholangiopancreatography

Cited by 16 publications

References 82 publications

Prophylaxis of post-ERCP pancreatitis: a practice survey

Prophylaxis of post-ERCP pancreatitis: a practice survey

The Abdomen

Diclofenac vs. Placebo in a Randomized Double Blind Controlled Trial, in Post ERCP Pancreatitis

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