Endoscopic biliopancreatic investigations and therapy

Costamagna, Guido; Familiari, Pietro; Marchese, Michele; Tringali, Andrea

doi:10.1016/j.bpg.2008.05.004

Cited by 13 publications

(13 citation statements)

References 79 publications

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“…If we make a small advance in the requirements contemplated for biliary endoscopists with a greater number of procedures in their experience, we find that the recommended cannulation rate for experienced biliary endoscopists is estimated to be ≥ 90 % (4) and to be considered a bile duct expert over 95 % (17). Gastroenterology specialty programs in most hospitals in Europe (10) and the U.S. (28) usually fail to reach a sufficient number of biliopancreatic procedures as those proposed previously (except Great Britain where they perform approximately 150 ERCPs), and it was found that the European average was 113 procedures (32). In our country performing ERCP is not mandatory during the period of specialization in gastroenterology and the number of ERCPs we had performed during our training period was clearly lower than the recommended to be competent in this technique, which is why we decided to go to a referral center (where they perform more than 250 procedures/year) (16) to complete our training and that of our nursing staff, since their participation after a training period also improve the results of ERCP (33,34).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of ERCP in a low-volume hospital

Riesco-López¹,

Vázquez-Romero

Rizo-Pascual

et al. 2013

Rev. esp. enferm. dig.

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Section: Discussionmentioning

confidence: 99%

“…Collection of the results obtained by our group and their subsequent analysis is one of the basic criteria recommended by the ASGE to perform adequate intra-and post-procedure quality control in any ERCP unit (32).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of ERCP in a low-volume hospital

Riesco-López¹,

Vázquez-Romero

Rizo-Pascual

et al. 2013

Rev. esp. enferm. dig.

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“…It is used for both therapeutic (eg, bile duct stone removal) and diagnostic interventions in the bile and pancreatic ducts [1]. The latter include: tissue sampling from biliary or pancreatic lesions, sphincter of Oddi manometry, and diagnostic pancreatoscopy or cholangiography [2]. However, as less-invasive diagnostic tools, such as magnetic resonance cholangiopancreatography and endoscopic ultrasound have become widespread, the proportion of ERCP for therapeutic purposes increased from 66% in the early 1990s [3] to 89% in the late 2000s [4].…”

Section: Introductionmentioning

confidence: 99%

A unusual case of multifocal pyogenic abscess formation following ERCP procedure

et al. 2020

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is essential for managing biliary and pancreatic disorders. Infection is the most morbid complication of ERCP and among the most common causes of ERCP-related death. Case presentation: A 69-year-old man presented with right upper quadrant abdominal pain, obstructive jaundice and abnormal liver function tests. Ultrasound revealed cholelithiasis without bile duct dilation. After receiving intravenous antibiotics for acute cholecystitis, the patient was discharged. Two weeks later, an endoscopic ultrasound demonstrated gallstones and CBD dilation of up to 6.4 mm with 2 filling defects. An ERCP was performed with a papillotomy and stone extraction. Twenty-four hours post-ERCP the patient developed a fever, chills, bilirubinemia and elevated liver function tests. Ascending cholangitis was empirically treated using Ceftriaxone and Metronidazole. However, the patient remained febrile, with a diffusely tender abdomen and elevated inflammatory markers. A CT revealed a very small hypodense lesion in the seventh liver segment. Extended-spectrum beta-lactamase positive Klebsiella Pneumonia and Enterococcus Hirae were identified, and the antibiotics were switched to Imipenem and Cilastatin. The hypodense lesion in the liver increased to 1.85 cm and a new hypodense lesion was seen in the right psoas. At day 10 post-ERCP, the patient started having low back pain and difficulty walking. MRI revealed L4-L5 discitis with a large epidural abscess, spanning L1-S1 and compressing the spinal cord. Decompressive laminectomy of L5 was done and Klebsiella pneumonia was identified. Due to continued drainage from the wound, high fever, we performed a total body CT which revealed increased liver and iliopsoas abscess. Decompressive laminectomy was expanded to include L2-L4 and multiple irrigations were done. Gentamycin and Vancomycin containing polymethylmethacrylate beads were implanted locally and drainage catheters were placed before wound closure. Multidisciplinary panel discussion was performed, and it was decided to continue with a non invasive approach .

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“…Quality assurance becomes an increasingly very important part of modern clinical medicine and of the field of interventional endoscopy, like ERCP [5,6]. In 2006, a list of quality end-points for ERCP was proposed by the ASGE/ACG taskforce on the quality in endoscopy [7].…”

Section: Introductionmentioning

confidence: 99%

Quality assurance of sphincterotomy: A prospective single-centre survey

et al. 2011

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AbstractQuality assurance becomes an increasingly important part of clinical medicine and of the field of endoscopy. Endoscopic sphincterotomy is associated with a fairly high complication rate. We aimed to assess our quality of sphincterotomy for benchmarking by using a prospective electronic database registry, and to identify potential risk factors for post-interventional complications. Over 2 years, 471 sphincterotomies were performed in a single tertiary referral centre. Patient- and procedure-related variables were prospectively recorded with the support of a multi-centre international sphincterotomy registry. Multivariate analysis was performed. The overall post-interventional complication rate was 9.3%. Pancreatitis happened in 5.5%, bleeding in 2.1%, perforation in 1.3%, and cholangitis in 0.4%. In the multivariate analysis following variables remained highly significant and predictive for complications: ‘papilla only in lateral view’ (p=0.001), antiplatelet therapy (p=0.024), and opacification with contrast up to the pancreatic tail (p=0.001). The primary success rate of sphincterotomy was 95.1%. The rate of post-interventional pancreatitis did not differ significantly regardless of the presence of prophylactic pancreatic stent (p=0.56). The outcome of sphincterotomy in our centre matches with literature data. The extent of pancreatic duct opacification has an influence on the pancreatitis rate. Prevention of pancreatitis by inserting pancreatic stents is not confirmed.

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Endoscopic biliopancreatic investigations and therapy

Cited by 13 publications

References 79 publications

Efficacy and safety of ERCP in a low-volume hospital

Efficacy and safety of ERCP in a low-volume hospital

A unusual case of multifocal pyogenic abscess formation following ERCP procedure

Quality assurance of sphincterotomy: A prospective single-centre survey

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