Risk Factors for ERCP-Related Complications: A Prospective Multicenter Study

Wang, Peng; Li, Zhao‐Shen; Liu, Feng; Ren, Xu; Lü, Nonghua; Fan, Zhining; Huang, Qiang; Zhang, Xiao; He, Liu; Sun, Wensheng; Zhao, Qiu; Shi, Ruihua; Tian, Zibin; Li, Yanqing; Wen, Li; Zhi, Fachao

doi:10.1038/ajg.2008.5

Cited by 436 publications

(410 citation statements)

References 39 publications

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“…Although ERCP is the gold-standard method of the diagnosis for biliary lesions, post-ERCP pancreatitis remains an important and sometimes fatal (2-15%) problem [Freeman et al 1996;Loperfido et al 1998;Wang et al 2009;Cheng et al 2006;Testoni et al 2010;Meister et al 2011]. On the other hand, EUS-FNA can be performed for pancreatic masses with high sensitivity and safety compared with ERCP [Yamao et al 2005;Hasan and Hawes, 2012].…”

Section: Discussionmentioning

confidence: 99%

“…These results may not be sufficient for CCA patients with poor prognosis. In addition, ERCP is associated with critical adverse events such as acute pancreatitis [Freeman et al 1996;Loperfido et al 1998;Wang et al 2009;Cheng et al 2006;Testoni et al 2010;Meister et al 2011]. Improvements in the accuracy and safety of diagnostic modality are thus still required.…”

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confidence: 99%

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EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

Onda

Ogura

Kurisu

et al. 2016

Therap Adv Gastroenterol

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Background: Few reports have described endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) for biliary lesions. In addition, adverse events were not completely examined in previous reports, due to the inclusion of cases in which biliary stents had already been placed. The present study aimed to investigate the diagnostic yield and adverse events of EUS-FNA for biliary lesions as the first-line diagnostic modality for consecutive prospectively registered patients. Methods: Inclusion criteria were as follows: (1) patients with suspected cholangiocarcinoma (CCA) based on computed tomography or other imaging modalities; (2) patients who had not previously undergone endoscopic retrograde cholangiopancreatography or EUS-FNA; (3) absence of surgically altered anatomy, such as Roux-en-Y anastomosis or duodenal obstruction caused by tumor invasion, through which an endoscope could not pass; and (4) provision of written informed consent to all procedures associated with the study. Results: A total of 47 consecutive patients with suspected CCA were registered to this study. Sensitivity and accuracy were 89% and 87%, respectively. On multivariate analysis, puncture site was the only factor associated with reduced diagnostic yield (hazard ration, 6.879; 95% confidence interval, 1.172–40.374; P = 0.033). Remarkably, no adverse events such as bleeding or bile leakage were associated with EUS-FNA in any of the 47 patients. Conclusions: Our results suggest that EUS-FNA can be safely performed for biliary disease without biliary stenting. Furthermore, this procedure may warrant use as the first-line diagnostic method, although our results need to be validated in future prospective studies.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

Onda

Ogura

Kurisu

et al. 2016

Therap Adv Gastroenterol

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“…ERCP is a demanding procedure associated with significant morbidity (6.85% of AEs) and occasional mortality (0.33%) [69][70][71]. AEs can be divided into general (in common with upper GI endoscopy) and specifically related to bilio-pancreatic handling (bleeding, perforation, infection and pancreatitis).…”

Section: Endoscopic Retrograde Cholangiopancreatography (Ercp)mentioning

confidence: 99%

Emergencies after endoscopic procedures

Rolanda

Caetano

Dinis-Ribeiro

2013

Best Practice & Research Clinical Gastroenterology

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Keywords:GI endoscopy adverse events GI emergencies Bleeding Haemorrhage Perforation Infection Embolization Diagnosis and management of severe complications a b s t r a c t Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.

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“…Th ese risk factors are additive and highlight the importance of refraining from performing ERCP in cases with marginal indication. Procedural factors have long been identifi ed as important, including pancreatic contrast injection, precut sphincterotomy, pancreatic sphincterotomy, and ampullectomy ( 6,7 ). Diffi cult cannulation with resultant papillary trauma has proven to be an independent risk factor, increasing with the number of cannulation attempts ( 5 ).…”

Section: Editorialmentioning

confidence: 99%

“…While it is widely thought that contrast injection into the pancreatic duct is a prime culprit in causing post-ERCP pancreatitis, recent studies have revealed that guidewire passage into the pancreatic duct (without subsequent pancreatic stent placement) is a major independent technique-related culprit ( 6,8,9 ). In the fi rst study ever to assess the independent role of PD wire passage, Wang and colleagues ( 6 ) performed a comprehensive evaluation of risk factors in 3,178 ERCP.…”

Section: Editorialmentioning

confidence: 99%

Editorial: Guidewire Trauma: A Key Component of Post-ERCP Pancreatitis That Is Best Controlled by the Endoscopist

Srinivasan

Freeman

2016

American Journal of Gastroenterology

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Risk Factors for ERCP-Related Complications: A Prospective Multicenter Study

Abstract: Patient-related factors are as important as procedure-related factors in determining high-risk predictors for post-ERCP overall complications and pancreatitis. However, the risk factors for asymptomatic hyperamylasemia may be mostly procedure related.

Cited by 436 publications

References 39 publications

EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

Emergencies after endoscopic procedures

Editorial: Guidewire Trauma: A Key Component of Post-ERCP Pancreatitis That Is Best Controlled by the Endoscopist

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