Quality assessment of endoscopic retrograde cholangiopancreatography

Kapral, C; Mühlberger, Andrea; Wewalka, F; Duller, Christine; Knoflach, P; Schreiber, F.

doi:10.1097/meg.0b013e3283583c6f

Cited by 58 publications

(24 citation statements)

References 28 publications

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“…8 9 In this study, where 79.4% of patients were Afro-Caribbean and African Americans of low socioeconomic status, the prevalence of overall complications was 9.8%, which falls within the range of previously reported rates between 4% and 12% in the overall population. [5][6][7][8] However, our reported rate may be lower than the actual number of delayed complications. Though we were able to capture 99.1% of our procedures, we did not have a standard method for collecting data on delayed complications that occurred in patients who presented to other medical institutions or outside providers.…”

Section: Discussioncontrasting

confidence: 53%

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Outcomes and risk factors for ERCP-related complications in a predominantly black urban population

Kwak

Yeoun

Arroyo-Mercado

et al. 2020

BMJ Open Gastroenterol

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ObjectiveThere is a lack of literature on postendoscopic retrograde cholangiopancreatography (ERCP) complications in predominantly black urban populations of low socioeconomic status. The aim of this study was to determine the incidence and predictors of post-ERCP complications in this patient population.DesignRetrospective review of ERCP cases performed at two hospitals from 2007 to 2017 was performed. The categories of complications evaluated were overall complications, severe or fatal complications, pancreatitis, bleeding, infection, perforation and cardiopulmonary events. Predictors of complications were determined by univariate analysis.ResultsA total of 1079 ERCP procedures were reviewed. There were 106 complications (9.8%). Twenty-one were severe (1.9%) and 20 were fatal (1.9%). Both post-ERCP pancreatitis (PEP) and post-ERCP bleeding occurred in 18 patients (1.7%) each. Risk factors for overall complications were male sex (OR 1.54), ASA grade IV or V (OR 2.19), prior history of PEP (OR 6.98) and pancreatic duct stent placement (OR 2.75). Those who were ASA grade III or lower (OR 0.4) or who underwent biliary stone extraction (OR 0.62) had fewer complications. PEP was more likely in those with a prior history of PEP (OR 37.6). Those with a suspected or known biliary duct stone had less frequent pancreatitis (OR 0.32). Post-ERCP bleeding was more likely in the presence of cholangitis (OR 8.72).ConclusionOutcomes of ERCP in a predominantly black urban population demonstrate a lower incidence of PEP and all-cause mortality compared with historical data reported in the general population. Potential risk factors for post-ERCP complications were identified but require larger studies for validation.

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Section: Discussioncontrasting

confidence: 53%

“…4 Other large studies reported complication rates between 4% and 12%. [5][6][7][8] The most common complication is post-ERCP pancreatitis (PEP). Other complications include post-ERCP bleeding, infection, perforation and cardiopulmonary events.…”

Section: Endoscopicmentioning

confidence: 99%

Outcomes and risk factors for ERCP-related complications in a predominantly black urban population

Kwak

Yeoun

Arroyo-Mercado

et al. 2020

BMJ Open Gastroenterol

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“…The most common complication is post-ERCP pancreatitis (PEP). Among unselected ERCP patients, the PEP rate was 1.8-4.2% [8][9][10]. In a native papilla cannulation, the PEP rate was 5.3% [2] and is rather high 10.8-14.9% in difficult cannulation [1][2][3]11].…”

Section: Ercp (Endoscopic Retrograde Cholangiopancreatography)mentioning

confidence: 95%

“…ERCP is an invasive procedure with an overall complication rate of approximately 4-11% [8][9][10][11]. The most common complication is post-ERCP pancreatitis (PEP).…”

Section: Ercp (Endoscopic Retrograde Cholangiopancreatography)mentioning

confidence: 99%

Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale

et al. 2020

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Background Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP). If CBD cannulation is difficult, an endoscopist can open the septum between the pancreatic and biliary duct with a sphincterotome to gain access. Long-term results of this procedure are unclear. We wanted to evaluate the short-and long-term complications of TPBS on patients with native papilla and benign indication for ERCP. Patients and Methods ERCPs performed in Helsinki University Hospital between 2007 and 2013 were reviewed. The study group comprised 143 consecutive patients with TPBS and 140 controls (CG). Data were collected from patient records and a phone survey was performed as a follow-up ≥ 4 years after the index ERCP. Results Post-ERCP pancreatitis (PEP) developed in seven patients (4.9%) in TPBS and one patient (0.7%) in CG (p = 0.067). The rates of other acute complications were similar between the groups. ERCP ended with no access to CBD in four cases (2.8%) in TPBS. The median length of follow-up was 6 years in TPBS and 7 years in CG. During this period, three patients (2.1%) in TPBS and six patients (4.3%) in CG suffered from acute pancreatitis (AP) (p = 0.238). One (0.7%) patient in CG and none in TPBS developed chronic pancreatitis (CP). Abdominal pain was suffered by ten patients (6.9%) in TPBS and twelve patients (8.6%) in CG daily, whereas by six patients (4.2%) in TPBS and twelve patients (8.6%) in CG weekly. Conclusion TPBS is a useful procedure, with acceptable complication rates. No significant difference occurred between the groups when evaluating the short-term or long-term complications with a follow-up period of four to 10 years. Additionally, no significant differences occurred in upper abdominal pain, episodes of AP, or development of CP.

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“…Previous surveys conducted elsewhere [16, 17] have shown that despite robust clinical evidence and published guidelines, most ERCP practitioners do not follow the proposed guidelines. Little is known about the situation in Portugal.…”

Section: Introductionmentioning

confidence: 99%

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Lopes

Canena

2018

GE Port J Gastroenterol

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Background/Aims: Recently the European Society of Gastrointestinal Endoscopy delivered guidelines on the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and on the papillary cannulation and sphincterotomy techniques at endoscopic retrograde cholangiopancreatography (ERCP). There are no data concerning current practices in Portugal. The aim of this study was to capture practice patterns of Portuguese pancreaticobiliary endoscopists with special interest in the prevention of PEP and cannulation techniques. Methods: A written survey was distributed to all pancreaticobiliary endoscopists attending the first Portuguese meeting dedicated to ERCP in November 2016. The main outcome measures were: technique used for standard biliary cannulation, use of nonsteroidal anti-inflammatory drugs (NSAIDs) in PEP, attempting prophylactic pancreatic stenting after using pancreatic guidewire (PGW)-assisted biliary cannulation in patients where biliary cannulation was difficult, and use of precut as the first rescue technique when biliary cannulation was difficult. Results: Completed surveys were collected from 28 of the 32 pancreatobiliary endoscopists attending the meeting (answer rate 87.5%). Biliary cannulation was performed using a guidewire access technique by the majority (77%), usually with a sphincterotome. When cannulation was unsuccessful, precut was the first choice for 70%. NSAIDs were administered routinely for PEP by only 54%; PGW-assisted biliary cannulation was the first choice after failed standard cannulation for a minority of them, and only 27% reported to routinely attempt insertion of a pancreatic stent. High-volume endoscopists (> 150/year) tended to use NSAIDs and to insert a stent in PGW-assisted cannulation less often than low-volume-endoscopists (50 vs. 83.3%, p < 0.01, and 40 vs. 100%, p < 0.01, respectively). Precut was started without prior formal training by more than half of the endoscopists. Conclusions: There is a pronounced discrepancy between evidence-based guidelines and current clinical practice. This discrepancy is more pronounced in PEP prophylaxis, especially among high-volume endoscopists. Some advanced techniques in ERCP are initiated unsupervised, without any previous formal training. Key Message: There is a significant gap between guidelines and routine clinical practice.

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Quality assessment of endoscopic retrograde cholangiopancreatography

Cited by 58 publications

References 28 publications

Outcomes and risk factors for ERCP-related complications in a predominantly black urban population

Outcomes and risk factors for ERCP-related complications in a predominantly black urban population

Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

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