Endoscopic retrograde cholangiopancreatography, lights, and shadows: Handle with care

Salerno, Raffaele; Mezzina, Nicolò; Ardizzone, Sandro

doi:10.4253/wjge.v11.i3.219

Cited by 12 publications

(9 citation statements)

References 68 publications

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“…The duodenoscope in endoscopic retrograde cholangiopancreatography (ERCP) and enteroscopy still play a major role in the evaluation of lesions over the papillary and infrapapillary regions. However, ERCP and enteroscopy are time-consuming, require patient cooperation, and have additional risks [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Exploring Deeper Sections of the Infrapapillary Area of the Duodenum by Using Sedative Esophagogastroduodenoscopy

Hsu

Chen

Liao

et al. 2022

Gastroenterology Research and Practice

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Background. Using conventional esophagogastroduodenoscopy (EGD) to evaluate the infrapapillary area is not feasible. The use of sedative EGD may enable endoscopists to investigate the infrapapillary condition of the duodenum. In this study, we aimed to evaluate lesions in the infrapapillary regions by using sedative EGD. Methods. In this retrospective observational study, we used the data of patients who underwent sedative EGD examinations at a tertiary hospital in southern Taiwan. The endoscopists evaluated the esophagus, stomach, and proximal duodenum and then attempted to explore the infrapapillary portion of the duodenum as deeply as possible. We assessed the success rate for the exploration of infrapapillary areas. Furthermore, we analyzed specific clinical findings of sedative EGD examination. Results. In total, 2973 patients underwent sedative EGD between November 1, 2010, and December 31, 2011. For 2632 of these patients, it was their first sedative EGD examination. In 2511 patients (95.4%), the exploration of the infrapapillary areas was successful. In approximately 10% of the patients, specific findings were detected over the infrapapillary region, and 7 of these patients exhibited clinically significant findings (i.e., gallbladder cancer with metastasis, periampullary Vater adenoma, natural killer cell enteropathy, villous adenoma with moderate dysplasia, infrapapillary duodenal adenoma with dysplasia, duodenal perforation with tumor-like formation, and follicular lymphoma). No patient experienced minor or major adverse reactions during the sedative EGD procedure. Conclusions. The current study provided evidence that sedative EGD examination enables a safe, comfortable, and effective endoscopic examination of deeper sections of the duodenum to evaluate the papillary and infrapapillary regions.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Exploring Deeper Sections of the Infrapapillary Area of the Duodenum by Using Sedative Esophagogastroduodenoscopy

Hsu

Chen

Liao

et al. 2022

Gastroenterology Research and Practice

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“…Compared to surgical alternatives, ERCP has the advantage of being a less-invasive and cost-effective procedure. However, because ERCP is a high-risk endoscopic procedure associated with various complications, its primary role has switched from diagnostic to therapeutic [ 1 ]. According to a recent multicentric database registry for ERCP in Japan, the overall complication rate of ERCP was 10.6%, with a 30-day mortality rate of 1.1% [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Large Hepatic Subcapsular Hematoma Following Endoscopic Retrograde Cholangiopancreatography: A Case Report

Arya¹,

Priyadarshi²,

Maji³

et al. 2022

Cureus

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For decades, endoscopic retrograde cholangiopancreatography (ERCP) has been the cornerstone in the treatment of several biliopancreatic diseases. Although it is a relatively safe procedure, there are certain hazards involved. Hepatic subcapsular hematoma (HSH) is an uncommon complication of ERCP, with only a few cases reported in the literature to date. We present here a case of large HSH that developed 48 hours after an otherwise uneventful ERCP for choledocholithiasis. After being apparently well for the first two days post-ERCP, the patient began to develop abdominal pain and restlessness associated with hemodynamic instability and a decline in hemoglobin levels. Computed tomography (CT) confirmed the presence of a large HSH. The patient was managed nonsurgically with vascular angioembolization followed by ultrasoundguided percutaneous catheter drainage of hematoma. This case highlights the necessity of increasing awareness about this complication in order to aid in early diagnosis and management.

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“…In addition to the advances made in these hybrid procedures, our focus should remain on clinical success and mitigating risk independent of technical success during a single procedure. This article will review the progress made since the last review in this journal[ 2 ] and clarify future research directions in the field.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography: Current practice and future research

Sanders¹,

Bomman²,

Krishnamoorthi³

et al. 2021

WJGE

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Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a primarily diagnostic to therapeutic procedure in hepatobiliary and pancreatic disease. Most commonly, ERCPs are performed for choledocholithiasis with or without cholangitis, but improvements in technology and technique have allowed for management of pancreatic duct stones, benign and malignant strictures, and bile and pancreatic leaks. As an example of necessity driving innovation, the new disposable duodenoscopes have been introduced into practice. With the advantage of eliminating transmissible infections, they represent a paradigm shift in quality improvement within ERCP. With procedures becoming more complicated, the necessity for anesthesia involvement and safety of propofol use and general anesthesia has become better defined. The improvements in endoscopic ultrasound (EUS) have allowed for direct bile duct access and EUS facilitated bile duct access for ERCP. In patients with surgically altered anatomy, selective cannulation can be performed with overtube-assisted enteroscopy, laparoscopic surgery assistance, or the EUS-directed transgastric ERCP. Cholangioscopy and pancreatoscopy use has become ubiquitous with defined indications for large bile duct stones, indeterminate strictures, and hepatobiliary and pancreatic neoplasia. This review summarizes the recent advances in infection prevention, quality improvement, pancreaticobiliary access, and management of hepatobiliary and pancreatic diseases. Where appropriate, future research directions are included in each section.

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Endoscopic retrograde cholangiopancreatography, lights, and shadows: Handle with care

Cited by 12 publications

References 68 publications

Efficacy and Safety of Exploring Deeper Sections of the Infrapapillary Area of the Duodenum by Using Sedative Esophagogastroduodenoscopy

Efficacy and Safety of Exploring Deeper Sections of the Infrapapillary Area of the Duodenum by Using Sedative Esophagogastroduodenoscopy

Large Hepatic Subcapsular Hematoma Following Endoscopic Retrograde Cholangiopancreatography: A Case Report

Endoscopic retrograde cholangiopancreatography: Current practice and future research

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