Risk Factors for Post-ERCP Pancreatitis: A Prospective Multicenter Study

Cheng, Ching‐Yi; Sherman, Stuart; Watkins, James L.; Barnett, Jeffrey L.; Freeman, Martin L.; Geenen, Joseph E.; Ryan, Michael E.; Parker, Harrison W.; Frakes, James T.; Fogel, Evan L.; Silverman, William B.; Dua, Kulwinder S.; Aliperti, Giuseppe; Yakshe, Paul N.; Uzer, Michael; Jones, Warren T.; Goff, John S.; Lazzell–Pannell, Laura; Rashdan, Abdullah; Temkit, MʼHamed; Lehman, Glen A.

doi:10.1111/j.1572-0241.2006.00380.x

Cited by 576 publications

(486 citation statements)

References 41 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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“…Knowledge and judgment, theoretically, is more likely to be acquired with increased experience. The risk of PEP increases when ERCP is performed by physicians with less experience 27,28 while the risk is decreased when ERCP is performed at referral centers. 22 Some of the procedure factors (see below) are considered attributable to techniques associated with less operator expertise.…”

Section: Physician Factorsmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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“…Early complications after ERCP include acute pancreatitis, bleeding, perforation, and infection (cholangitis and cholecystitis) Of these ERCP related complications, pancreatitis remain the most common with a reported incidence of 2 to 15% in multicenter prospective studies. [1][2][3][4][5] Most cases of post ERCP pancreatitis are mild, showing complete recovery in a few days. After severe ERCP related Pancreatitis however., secondary consequences (e.g.…”

Section: Introductionmentioning

confidence: 99%

A study on ulinastatin in preventing post ERCP pancreatitis

2017

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INTRODUCTIONERCP is widely performed for the diagnosis and management of various pancreaticobiliary diseases. Early complications after ERCP include acute pancreatitis, bleeding, perforation, and infection (cholangitis and cholecystitis) Of these ERCP related complications, pancreatitis remain the most common with a reported incidence of 2 to 15% in multicenter prospective studies.1-5 Most cases of post ERCP pancreatitis are mild, showing complete recovery in a few days. After severe ERCP related Pancreatitis however., secondary consequences (e.g. pancreatic pseudocyst and abscess) and multiorgan failure frequently develop: surgical intervention and prolonged hospital stay are usually required, and eventually the patient dies. In a reported series of 7,869 patients undergoing diagnostic or therapeutic ERCP, 3 patients (0.04%) died from severe post-ERCP Pancreatitis. The prevention of post ERCP pancreatitis has been a never-ending challenge ever since ERCP was introduced in clinical settings in the 1970s. The exact pathogenesis of post-ERCP pancreatitis has remained unclear but diverse factors, which include mechanical injury, hydrostatic injury, chemical and allergic injury. enzymatic Injury, infection and thermal injury have been postulated as causes of post ERCP pancreatitis.6-8 Many pharmacologic agents of different types he been used to prevent post ERCP pancreatitis on the assumption that they Pharmacologically inhibit one or more of the aforementioned factors associated with pancreatic damage. Irrespective of the etiology of acute pancreatitis, the activation of proteases enzymes starting with trypsinogen activation to trypsin in pancreatic acinar cells, has been considered to play an Initial role in the ABSTRACT Background: Pancreatitis remains the major complication of endoscopic retrograde cholangiopancreatography (ERCP), and hyperenzymemia after ERCP is common. Ulinastatin, a protease inhibitor, has proved effective in the treatment of acute pancreatitis. The aim of this study was to assess the efficacy of ulinastatin, compare to placebo study to assess the incidence of complication due to ERCPP procedure. Methods: In this study a randomized placebo controlled trial, patients undergoing the first ERCP was randomizing to receive ulinastatin one lakh units (or) placebo by intravenous infusion one hour before ERCP for ten minutes duration. Clinical evaluation, serum amylase, ware analysed before the procedure 4 hours and 24 hours after the procedure. Results: Total of 46 patients were enrolled (23 in ulinastatin and 23 in placebo group). The incidence of Hyper enzymemia is lower in ulinastatin group (13 %) than in placebo group (30.4%). Conclusions: Prophylactic short-term administration of ulinastatin one lakh units intravenously, one hour before ERCP procedure is effective when compared to placebo infusion.

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Risk Factors for Post-ERCP Pancreatitis: A Prospective Multicenter Study

Abstract: This study emphasizes the role of patient factors (age, SOD, prior history of post-ERCP pancreatitis) and technical factors (number of PD injections, minor papilla sphincterotomy, and operator experience) as the determining high-risk predictors for post-ERCP pancreatitis.

Cited by 576 publications

References 41 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

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

A study on ulinastatin in preventing post ERCP pancreatitis

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