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Surgeon-Performed Endoscopic Retrograde Cholangiopancreatography in a Rural Trinidad Hospital: A 10-Year Review of Practice and Outcomes.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a key therapeutic modality for biliary and pancreatic diseases. While o … ). Therapeutic intervention was performed in 84.8% of procedures, with stone extraction (64.6%) and sphincterotomy (58.2%) being the most common interventions. Thirteen procedures (16.5%) were unsuccessful, primarily due to failed cannulation, inadequate sedation, or intra-operative desaturation. Thirty-day complications occurred in 21.5% of procedures, the most …

Development and validation of a novel risk score for predicting post-ERCP pancreatitis in patients with choledocholithiasis: a retrospective study.

INTRODUCTION: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains the most common serious complication of … R 2.50, 95% CI 1.43–4.39), pancreatic duct instrumentation (aOR 1.93, 95% CI 1.12–3.33), and precut sphincterotomy (aOR 3.43, 95% CI 1.66–7.08). The model demonstrated acceptable discrimination with an optimism-corrected C-statistic of 0.760 (95% CI 0.708–0.817) after bootstrap internal validation. Calibration was satisfactory (Hosmer-Lemeshow p = 0.967; calibra …

[Application of JSGPM classification in pancreaticobiliary maljunction].

Objective: To evaluate the clinical value of the Japanese Study Group on Pancreaticobiliary Maljunction(JSGPM) classification in the diagnos … t dilation, none underwent extrahepatic bile duct resection; instead, they received only endoscopic sphincterotomy plus cholecystectomy. All patients were followed up for (36±26) months (range: 6 to 96 months), with no recurrence of biliary tract infections, obstructive jaundice, or pancreatitis. Conclusions: The JSGPM classification is concise, practical, and h …

Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the endoscopic modality of choice for the treatment of biliary and panc … 5.4%). Among them, 23 patients (12.6%) underwent balloon dilation and 79 patients (43.4%) underwent sphincterotomy. Of the patients with cirrhosis, delayed bleeding occurred in ten patients (5.5%), postoperative pancreatitis occurred in 80 patients (44.0%), and postoperative cholangitis occurred in 25 patients (13.7%). An additional multivariate analysis showed …

Efficacy and safety of therapeutic ERCP in patients with cirrhosis: a large multicenter study.

BACKGROUND AND AIMS: Patients with cirrhosis may be less than optimal candidates for ERCP because of underlying ascites, coagulopathy, encep … significant hemorrhage and the presence of coagulopathy or CP class, even in those who underwent a sphincterotomy. The presence of poorly controlled encephalopathy correlated with a higher overall adverse event rate (P = .003). Sub-analysis revealed that patients without primary sclerosing cholangitis had a significantly higher overall rate of adverse events, p …

Efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) performed in patients with Periampullary duodenal diverticula (PAD).

BACKGROUND AND AIM: Periampullary diverticula (PAD) are found in 9-32% of patients who undergo endoscopic retrograde cholangiopancreatograph … difficult cannulation, precut was performed in 12 pts (15.6%). Deep CBD cannulation and endoscopic sphincterotomy (ES) was achieved in 70 cases (90.9%). The other 7 case of failure were all in patients with CBD stones. Complete clearance of CBD stones was achieved in 57 patients (87.7%) (57/65 ERCP/ES). Stent placement was necessary in 8 cases (12.3%) (8/65 ERC …

ERCP with the overtube-assisted enteroscopy technique: a systematic review.

BACKGROUND AND STUDY AIM: Overtube-assisted enteroscopy (OAE) techniques have increased the ability to perform endoscopic retrograde cholang … n anastomosis. Overall ERCP success for all attempts was approximately 74 %. Interventions included sphincterotomy, pre-cut papillotomy, anastomotic stricturoplasty, stone removal, stent insertion, stent replacement, and balloon dilation of stenotic anastomosis. There were 32 major complications among the 945 procedures (3.4 %). CONCLUSION: Both endoscopic and …

Non surgical therapy for anal fissure.

BACKGROUND: Because of the disability associated with surgery for anal fissure and the risk of incontinence, medical alternatives for surger … rtisone, lignocaine, bran, minoxidil, indoramin, and placebo) as well as anal dilators and surgical sphincterotomy.GTN was found to be marginally but significantly better than placebo in healing anal fissure (48.6% vs. 37%, p < 0.004), but late recurrence of fissure was common, in the range of 50% of those initially cured. Botox and CCBs were equivalent to GTN i …

Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors.

BACKGROUND AND STUDY AIMS: Previous studies on the development of post-endoscopic retrograde cholangiopancreatography (post-ERCP) hyperamyla … r the development of either hyperamylasemia or pancreatitis. In contrast, additional procedures and sphincterotomy seemed to reduce the likelihood of both complications. CONCLUSIONS: Serum amylase levels higher than 4 - 5 times the normal upper limit together with the existence of pancreatic-type pain, at 24 h after ERCP, strongly suggest the occurrence of panc …

[Endoscopic cholangiography in mild acute biliary pancreatitis: when and for whom?].

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP), with or without sphincterotomy, has been widely used in patients with severe biliary acute pancreatitis (BAP) or those with cholangitis and/or obstruction of the biliary tree. Its use in subjects with mild BAP is more controversial. AIM: To optimize use of ERCP in patients with mild pancreatitis due to gallstones by identifying clinical and biochemical predictors of choledocholithiasis. MATERIAL AND METHOD: The clinical and biochemical data, images, and outcomes of 83 patients with mild BAP hospitalized at the Instituto Nacio…

Clean intermittent catheterization in spinal cord injury patients: a followup study.

A followup study on nonhospitalized spinal cord injury patients using clean intermittent catheterization was conducted to evaluate long-term … d rehospitalization for urological problems. One patient died of questionable sepsis. Transurethral sphincterotomy was performed in 15 of the 50 patients (30%) and transurethral prostatectomy was done in 1 for multiple reasons, for example high intravesical voiding pressures, difficult catheterization, repeated symptomatic urinary tract infections or per patient …

[Analysis of related factors for intestinal contents refluxing into the bile duct after endoscopic retrograde biliary drainage].

Objective: To analyze the related factors for intestinal contents refluxing into the biliary tract following endoscopic retrograde biliary d … n that in the control group [10.8% (24/223) vs 4.8% (19/397), P=0.005]. The incidence of endoscopic sphincterotomy (EST) [82.5% (184/223) vs 75.3% (299/397)] and endoscopic papillary balloon dilatation (EPBD) [94.5% (207/223) vs 87.1% (343/397)] was higher in the case group than in the control group (both P<0.05); the total number of biliary stents placed was hi …

Simultaneous endoscopic and laparoscopic management of acute biliary pancreatitis in the second trimester of pregnancy: A case report.

INTRODUCTION AND IMPORTANCE: Acute biliary pancreatitis during pregnancy is a rare but significant clinical challenge that requires a delica … ones, choledocholithiasis, and a dilated common bile duct (CBD). She underwent successful ERCP with sphincterotomy and stone extraction followed by laparoscopic cholecystectomy in the same session. The patient had an uneventful recovery and was discharged on postoperative day three without complications. CLINICAL DISCUSSION: The second trimester is considered t …

Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention.

AIM: To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a w … 5 for 24 h after PC; 38+/-0.35 centigrade vs 36.9+/-0.15 centigrade, P < 0.0001 for 72 h after PC). Sphincterotomy and stone extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients. After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications. Three out of 22 patie …

Percutaneous evacuation (PEVAC) of multivesicular echinococcal cysts with or without cystobiliary fistulas which contain non-drainable material: first results of a modified PAIR method.

BACKGROUND: Surgery is the treatment of choice in echinococcal cysts with cystobiliary fistulas. PAIR (puncture, aspiration, injection, and … ary fistula was present; external drainage of cystobiliary fistulas combined with endoprosthesis or sphincterotomy; catheter removal after complete cyst collapse and closure of the cystobiliary fistula. RESULTS: In all 12 patients initial cyst size was 13.1 (6-20) cm (mean (range)). At follow up 17.9 (4-30) months after PEVAC, seven cysts had disappeared and fi …

Waldenstrom Macroglobulinemia Leading to Cholestatic Liver Injury and Rapid Progression to Liver Failure.

Waldenstrom macroglobulinemia (WM) is an indolent B-cell neoplasm with generally good prognosis, and while hepatic involvement in WM has been documented in the literature, it is rarely clinically significant. We present a case of a 77-year-old man with WM who presented with a cholestatic liver injury and rapid progression to decompensated liver disease. The patient ultimately transitioned to comfort care and died from liver failure. This case not only highlights the rarity of this poor outcome from WM, but also underscores the importance of early recognition of infiltrative malignancy as a pot

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… Zanubrutinib held indefinitely | 43 | 25 | 153 | 8.9 | | 4.4 | 2.8 | 0.85 | 118 | 1.3 10/15/2024 | Admission #2: s/p ERCP w/sphincterotomy & cholecystectomy; 3 d prior to liver biopsy | 38 | 29 | 144 | 9.9 | | 4.6 | 2.5 | 1.02 | 132 | 1.5 10/30/2024 | Admission #2: day of discharge; s/p 5 d of dexamethasone … He underwent an endoscopic ultrasound and endoscopic retrograde cholangiopancreatography with biliary sphincterotomy, which demonstrated biliary sludge and small nonobstructing gallstones, followed by a cholecystectomy a few days later. …

Management of biliary stricture in patients with IgG4-related sclerosing cholangitis.

BACKGROUND: We aimed to determine the optimal approach with endoscopic biliary drainage (EBD) and corticosteroid (CS) for the treatment of IgG4-related sclerosing cholangitis (ISC). METHODS: To evaluate the safety of EBD for treatment of biliary stricture caused by ISC, we assessed the risk of stent dislodgement and sought to determine the most appropriate time for stent removal. We also assessed the safety of treatment with CS alone for patients with obstructive jaundice, and the rate of and risk factors for biliary tract complications. RESULTS: Sixty-nine patients with ISC treated with CS

Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study.

BACKGROUND: Endoscopic papillectomy is performed in selected patients with ampullary neoplasm, and, thus, accurate preoperative tumor staging is indispensable for its application. DESIGN: Prospective and histopathologically controlled study. SETTING: Single center. PATIENTS AND INTERVENTIONS: EUS and transpapillary intraductal US (IDUS) were performed in 40 patients with ampullary neoplasm before surgery (n = 30) or endoscopic papillectomy (n = 10). Ductal infiltration by a tumor into the bile duct (BD) or the pancreatic duct (PD) was also evaluated. The indication for endoscopic papillecto

[Features of diagnosis and treatment of ampullary adenomas of the duodenum with intraductal spread type III and IV].

OBJECTIVE: To evaluate diagnostic features of large ampullary adenomas of the duodenum using endosonography, as well as to assess advantages of precise approach to resection of complex adenomas with intraductal component. MATERIAL AND METHODS: Over the past 15 years, 86 patients with type III and IV adenomas underwent endoscopic intraluminal treatment. Among them, 19 patients had type III adenomas, and 67 patients had type IV adenomas. Involvement of common bile duct was observed in 49 patients, pancreatic duct - in 17 patients, 20 patients had simultaneous involvement of both ducts. Mean len

New developments in endoscopic treatment of chronic pancreatitis.

The aim of endoscopic therapy of chronic pancreatitis (CP) is to treat pain by draining the pancreatic duct or managing loco-regional complications. Recent decennia were characterized by continuous improvement of endoscopic techniques and devices, resulting in a better clinical outcome. Novel developments now also provide the opportunity to endoscopically treat refractory CP-related complications. Especially suboptimal surgical candidates could potentially benefit from these new developments, consequently avoiding invasive surgery. The use of fully covered self-expandable metal stents (SEMS) h