Endoscopic Retrograde Cholangiopancreatography: Deciphering the Black and White

Mahalingam, Sowmya; Langdon, Jonathan; Muniraj, Thiruvengadam; Do, Albert; Guo, Yang; Spektor, Michael; Mathur, Mahan

doi:10.1067/j.cpradiol.2020.01.001

Cited by 3 publications

(4 citation statements)

References 69 publications

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“…The pitfalls of cholangiography can be categorized into technical, interpretative, and operative factors. [ 66 67 ] In most institutions, the onus is on the endoscopist to acquire and interpret images during the procedure. It is important to optimize the position of the image intensifier to obtain an image of adequate exposure as well as utilize techniques such as oblique rotation of a C-arm or changing the patient or endoscope position to obtain complete views.…”

Section: Endoscopic Sphincterotomy and Confirmation Of Common Bile Du...mentioning

confidence: 99%

“…[ 69 70 71 ] Finally, there are steps to performing a good-quality cholangiogram that may help improve outcomes, which are described in detail elsewhere. [ 64 66 ] The rates of residual bile duct stones after intended complete duct clearance have been reported to be between 4.8%–37%. [ 72 73 74 75 76 77 78 79 80 ] The risk is increased in the setting of a dilated CBD, presence of pneumobilia, following lithotripsy (mechanical, electrohydraulic or laser) and pancreatic guidewire placement.…”

Section: Endoscopic Sphincterotomy and Confirmation Of Common Bile Du...mentioning

confidence: 99%

“…Several reviews have described techniques for achieving optimal cholangiographic imaging. [ 64 66 67 68 ] However, given the long-standing history of ERCP, it is perhaps surprising that there are no published standards stipulating the minimum set and quality of images that need to be acquired and captured. The American Society of Gastrointestinal Endoscopy task force alluded to the importance of capturing endoscopic and fluoroscopic images as an objective way of demonstrating what has been carried out during an ERCP, but the recommended dataset of image documentation was not defined.…”

Section: Endoscopic Sphincterotomy and Confirmation Of Common Bile Du...mentioning

confidence: 99%

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Controversies in ERCP

Dietrich

Bekkali

Burmeister

et al. 2022

Endoscopic Ultrasound

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The aim of the series of papers on controversies of biliopancreatic drainage procedures is to discuss pros and cons of the varying clinical practices and techniques in ERCP and EUS for drainage of biliary and pancreatic ducts. While the first part focuses on indications, clinical and imaging prerequisites prior to ERCP, sedation options, post-ERCP pancreatitis prophylaxis, and other related technical topics, the second part discusses specific procedural ERCP techniques including precut techniques and their timing as well as management algorithms. In addition, reviews on controversies in EUS-guided bile duct and pancreatic drainage procedures are under preparation.

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Section: Endoscopic Sphincterotomy and Confirmation Of Common Bile Du...mentioning

confidence: 99%

Section: Endoscopic Sphincterotomy and Confirmation Of Common Bile Du...mentioning

confidence: 99%

Section: Endoscopic Sphincterotomy and Confirmation Of Common Bile Du...mentioning

confidence: 99%

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Controversies in ERCP

Dietrich

Bekkali

Burmeister

et al. 2022

Endoscopic Ultrasound

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“…Therefore, laparoscopic cholecystectomy should not be delayed for 2 or more weeks (144,146). ERCP should be performed urgently (i.e., within 24 hours) for SAP associated with acute cholangitis, as a delay is associated with an increased risk of mortality (16,17,(147)(148)(149). However, for patients with an inflammatory response, delaying cholecystectomy for ≥6 weeks is recommended until regression of the inflammatory response is achieved (110,150).…”

Section: Acute Biliary Pancreatitismentioning

confidence: 99%

A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management

Zheng

Ding

et al. 2021

Ann Transl Med

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Acute pancreatitis (AP) is an inflammatory disease that can progress to severe acute pancreatitis (SAP), which increases the risk of death. AP is characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. Other contributing factors may include calcium (Ca 2+ ) overload, mitochondrial dysfunction, impaired autophagy, and endoplasmic reticulum (ER) stress. In addition, exosomes are also associated with pathophysiological processes of many human diseases and may play a biological role in AP. However, the pathogenic mechanism has not been fully elucidated and needs to be further explored to inform treatment. Recently, the treatment guidelines have changed; minimally invasive therapy is advocated more as the core multidisciplinary participation and "step-up" approach. The surgical procedures have gradually changed from open surgery to minimally invasive surgery that primarily includes percutaneous catheter drainage (PCD), endoscopy, small incision surgery, and video-assisted surgery. The current guidelines for the management of AP have been updated and revised in many aspects. The type of fluid to be used, the timing, volume, and speed of administration for fluid resuscitation has been controversial. In addition, the timing and role of nutritional support and prophylactic antibiotic therapy, as well as the timing of the surgical or endoscopic intervention, and the management of complications still have many uncertainties that could negatively impact the prognosis and patients' quality of life. Consequently, to inform clinicians about optimal treatment, we aimed to review recent advances in the understanding of the pathogenesis of AP and its diagnosis and management.

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Endoscopic Retrograde Cholangiopancreatography Versus Laparoscopic Transcystic Balloon Dilatation of Papilla Vateri in Patients with Choledocholithiasis

Aleksandrovs,

Ivanovs,

Plaudis

et al. 2024

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Two-step therapy, endoscopic retrograde cholangiopancreatography with papillotomy and stone evacuation from common bile duct (CBD), and laparoscopic cholecystectomy (ERCP/LC) is standard treatment of choledocholithiasis and acute cholecystitis in our hospital, Rīga East University Hospital Gaiļezers. The one-step method, LC with intraoperative transcystic balloon dilatation of the papilla Vateri and anterograde evacuation of gallstones to duodenum (BD/LC), has been introduced in our hospital. The aim of this study was to compare two-step and BD/LC methods and report the outcomes from hospital’s clinical experience. A retrospective, comparative study was done from 01.2021 to 10.2023. Patients with acute calculous cholecystitis and choledocholithiasis with gallstone diameter in CBD cm, ASA score I-III were included. Gallstone’s diameter and number, hospitalisation time, and success rate were analysed. A total of 95 patients were included in our study, of which 46 patients underwent BD/LC and in 49 patients ERCP/LC was used. Median diameter of gallstones in the CBD was 6.1 mm in BD/LC and 6.3 mm in the ERCP/LC group (p = 0.38). Median hospitalisation time for patients with single-step treatment was seven days, and two-step therapy — 14 days (p = 0.001). The complication rate in BD/LS was 4.34% but in ERCP/LC group — 10.2% after ERCP (p = 0.049). The success rate in BD/LC was 95.6% and in ERCP/LC group — 89.6% (p = 0.145). BD/LC is associated with a shorter hospitalisation time, similar success rate and lower complication rate compared with an ERCP/LC.

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Endoscopic Retrograde Cholangiopancreatography: Deciphering the Black and White

Cited by 3 publications

References 69 publications

Controversies in ERCP

Controversies in ERCP

A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management

Endoscopic Retrograde Cholangiopancreatography Versus Laparoscopic Transcystic Balloon Dilatation of Papilla Vateri in Patients with Choledocholithiasis

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