Endoscopic Retrograde Cholangiopancreatography Under General Anesthesia Compared to Conscious Sedation Study

Greaves, Grant; Harding, Kaitlyn G; Parker, Brent; Nguyen, Vu C; Ahmed, Azim; Yee, Belinda; Perren, Joël; Norman, Mathew; Grey, Morgan; Perini, Rafael; Jowhari, Fahd; Bak, Adrian

doi:10.1093/jcag/gwad037

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…Currently, there are various methods available for stone removal, with ERCP combined with EST being a representative approach [ 9 , 10 ]. This method is advantageous in that most bile duct stones can be cleared by incising the sphincter of the ampulla of Vater without the need for T-tube placement [ 11 , 12 ]. However, the disadvantages of this approach may include postoperative complications such as pancreatitis, bleeding, and perforation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the therapeutic effects of three minimally invasive approaches for laparoscopic cholecystectomy combined with common bile duct exploration—— a 5-year retrospective analysis

Li,

Zeng,

et al. 2024

BMC Surg

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Objective The aim of this retrospective study was to explore the indications for three minimally invasive approaches—T-tube external drainage, double J-tube internal drainage, and primary closure—in laparoscopic cholecystectomy combined with common bile duct exploration. Methods Three hundred eighty-nine patients with common bile duct stones who were treated at the Second People's Hospital of Hefei between February 2018 and January 2023 were retrospectively included. Patients were divided into three groups based on the surgical approach used: the T-tube drainage group, the double J-tube internal drainage group, and the primary closure group. General data, including sex, age, and BMI, were compared among the three groups preoperatively. Surgical time, length of hospital stay, pain scores, and other aspects were compared among the three groups. Differences in liver function, inflammatory factors, and postoperative complications were also compared among the three groups. Results There were no significant differences among the three groups in terms of sex, age, BMI, or other general data preoperatively (P > 0.05). There were significant differences between the primary closure group and the T-tube drainage group in terms of surgical time and pain scores (P < 0.05). The primary closure group and double J-tube drainage group differed from the T-tube drainage group in terms of length of hospital stay, hospitalization expenses, and time to passage of gas (P <0.05). Among the three groups, there were no statistically significant differences in inflammatory factors or liver function, TBIL, AST, ALP, ALT, GGT, CRP, or IL-6, before surgery or on the third day after surgery (P > 0.05). However, on the third day after surgery, liver function in all three groups was significantly lower than that before surgery (P<0.05). In all three groups, the levels of CRP and IL-6 were significantly lower than their preoperative levels. The primary closure group had significantly lower CRP and IL-6 levels than did the T-tube drainage group (P < 0.05). The primary closure group differed from the T-tube drainage group in terms of the incidences of bile leakage and electrolyte imbalance (P < 0.05). The double J-tube drainage group differed from the T-tube drainage group in terms of the tube dislodgement rate (P < 0.05). Conclusion Although primary closure of the bile ducts has clear advantages in terms of length of hospital stay and hospitalization expenses, it is associated with a higher incidence of postoperative complications, particularly bile leakage. T-tube drainage and double J-tube internal drainage also have their own advantages. The specific surgical approach should be selected based on the preoperative assessment, indications, and other factors to reduce the occurrence of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Comparison of the therapeutic effects of three minimally invasive approaches for laparoscopic cholecystectomy combined with common bile duct exploration—— a 5-year retrospective analysis

Li,

Zeng,

et al. 2024

BMC Surg

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Capturing the incidence of patient agitation amongst conscious sedation ERCPs and the impact on therapeutic outcomes

Keating,

Bennett,

Martir

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Background: Completing advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) under conscious sedation is challenging. International recommendations favor enhanced sedation (e.g. propofol) for ERCP. Conscious sedation can result in sedation-related failure (SRF) and agitation for some patients, limiting therapeutic efficacy. Aim: The aim of this study is to establish the risk of SRF and the impact on therapeutic success under conscious sedation practice in a single tertiary referral center. Methods: A retrospective review of a prospectively maintained ERCP database, analyzing sedation, procedural success, and complications. Results: Over 19 months, 807 conscious sedation ERCPs were recorded. Median midazolam dose was 5 mg (range 1–14 mg) and median fentanyl dose was 75 µg (0–200 µg). Sedation reversal was required in 0.1% of cases (1/807). Overall ductal cannulation rate was 92%. Severe agitation was recorded in 11% (86/807) of conscious sedation ERCP reports with SRF present in 3% (22/807). Patient agitation resulted in significantly lower cannulation (81% vs 92%, P = 0.002) and successful clearance rates (49% vs 85%, P = 0.002) versus non-agitated cases. Complication and pancreatitis rates were unaffected. Highest rates of SRF and agitation were identified in female patients, patients aged <50 years old, and post-operative biliary leak indications. Conclusion: Over 10% of conscious sedation ERCPs are compromised by sedation issues, resulting in procedure abandonment or significantly diminished therapeutic success. General anesthetic ERCP is beneficial in facilitating biliary access, removing the risk of agitation and providing stability to aid cannulation. Female patients, patients aged <50 years, and post-operative biliary leak ERCPs appear as the priority cases for enhanced sedation support.

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Comparative Efficacy and Safety of Anesthetic and Sedative Regimens for Endoscopic Retrograde Cholangiopancreatography: A Network Meta-Analysis

Liu,

Xiao,

Chen

et al. 2024

Dig Dis

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Introduction: This study evaluates the efficacy and safety of various anesthetic and sedative regimens for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. Methods: A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios. Results: 42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR<0.01), dexmedetomidine plus fentanyl (RR<0.01), propofol plus nalbuphine (RR=0.01), Mg sulfate plus propofol (RR=0.01), and propofol plus fentanyl (RR=0.02), showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazolam plus pethidine plus dexmedetomidine (RR=0.01), propofol plus oxycodone (RR=0.09), and dexmedetomidine plus fentanyl (RR=0.2) exhibited lower rates of adverse events compared to propofol. Conclusion: This study provides comprehensive evidence to guide clinical decision-making and optimize anesthetic management for ERCP procedures.

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Endoscopic Retrograde Cholangiopancreatography Under General Anesthesia Compared to Conscious Sedation Study

Cited by 3 publications

References 23 publications

Comparison of the therapeutic effects of three minimally invasive approaches for laparoscopic cholecystectomy combined with common bile duct exploration—— a 5-year retrospective analysis

Comparison of the therapeutic effects of three minimally invasive approaches for laparoscopic cholecystectomy combined with common bile duct exploration—— a 5-year retrospective analysis

Capturing the incidence of patient agitation amongst conscious sedation ERCPs and the impact on therapeutic outcomes

Comparative Efficacy and Safety of Anesthetic and Sedative Regimens for Endoscopic Retrograde Cholangiopancreatography: A Network Meta-Analysis

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