scholarly journals Outcome of ERCP related to case-volume

2022 ◽  
Author(s):  
Eva-Lena Syrén ◽  
Gabriel Sandblom ◽  
Lars Enochsson ◽  
Arne Eklund ◽  
Bengt Isaksson ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Stone ◽  
Successful Outcome ◽  
Complication Rates ◽  
Procedure Time ◽  
Case Volume ◽  
Endoscopic Retrograde ◽  
Successful Cannulation ◽  
Lower Complication ◽  
Multivariable Analyses

Abstract Background and aims In some studies, high endoscopic retrograde cholangiopancreatography (ERCP) case-volume has been shown to correlate to high success rate in terms of successful cannulation and fewer adverse events. The aim of this study was to analyze the association between ERCP success and complications, and endoscopist and centre case-volumes. Methods Data were obtained from the Swedish National Register for Gallstone Surgery and ERCP (GallRiks) on all ERCPs performed for Common Bile Duct Stone (CBDS) (n = 17,873) and suspected or confirmed malignancy (n = 6152) between 2009 and 2018. Successful cannulation rate, procedure time, intra- and postoperative complication rates and post-ERCP pancreatitis (PEP) rate, were compared with endoscopist and centre ERCP case-volumes during the year preceding the procedure as predictor. Results In multivariable analyses of the CBDS group adjusting for age, gender and year, a high endoscopist case-volume was associated with higher successful cannulation rate, lower complication and PEP rates, and shorter procedure time (p < 0.05). Centres with a high annual case-volume were associated with high successful cannulation rate and shorter procedure time (p < 0.05), but not lower complication and PEP rates. When indication for ERCP was malignancy, a high endoscopist case-volume was associated with high successful cannulation rate and low PEP rates (p < 0.05), but not shorter procedure time or low complication rate. Centres with high case-volume were associated with high successful cannulation rate and low complication and PEP rates (p < 0.05), but not shorter procedure time. Conclusions The results suggest that higher endoscopist and centre case-volumes are associated with safer ERCP and successful outcome.

scholarly journals Optimal Timing of Single-Stage Retrograde Endoscopic Common Bile Duct Stone Removal in Mild and Moderate Acute Cholangitis: A Prospective Trial

2020 ◽  
Author(s):  
Chih-Ming Liang ◽  
Yi-Chun Chiu ◽  
Lung-Sheng Lu ◽  
Cheng-Kun Wu ◽  
Fai-Meng Sou ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stone ◽  
Bile Duct Stone ◽  
Acute Cholangitis ◽  
Single Stage ◽  
Complication Rates ◽  
Stone Extraction ◽  
Endoscopic Retrograde ◽  
Stone Removal

Abstract Background: In this study, we aimed to compare the efficacy and safety of removing a single-stage, retrograde, endoscopic common bile duct stone in patients with mild and moderate acute cholangitis associated with choledocholithiasis.Methods: We enrolled 196 endoscopic retrograde cholangiopancreatography (ERCP)-naïve patients diagnosed with acute cholangitis and choledocholithiasis between September 2018 and February 2020 at a single hospital. For eligible patients, single-stage treatment involved stone removal at initial ERCP. Early ERCP was defined as ERCP performed ≤ 72 hours following diagnosis in the emergency room.Results: The final analysis included 138 patients. The success rate of complete stone extraction was similar in patients with mild and moderate cholangitis (88.5% vs. 91.7%; p = 0. 536). Complication rates were also comparable between the two groups. In the moderate cholangitis group, the length of hospitalization declined significantly among patients who underwent early single-stage ERCP (10.6 ± 6.1 vs. 18.7 ± 12.5 days; p = 0.001) compared with patients treated with delayed ERCP. In the multivariate analysis, early ERCP indicated shorter hospitalization times (≤ 10 days) (odds ratio (OR), 7.689; p = 0.030), while endoscopic retrograde biliary drainage, for acute cholangitis only, indicated longer hospitalization times (OR, 0.358; p = 0.030). A stone size larger than 1.5 cm was an independent risk factor for stone extraction failure (OR, 24.507; p = 0.009).Conclusions: Single-stage, retrograde, endoscopic common bile duct stone removal may be safe and effective for patients with mild and moderate cholangitis. The benefit of early single-stage ERCP (≤ 72 hours) was reflected mainly by reduced hospitalization time and costs.Trial registration: ClinicalTrials.gov: NCT03754491.

scholarly journals Three Cases of Difficult Bile Duct Stone Removal by EUS-guided Choledochoduodenostomy

2020 ◽  
Vol 25 (2) ◽  
pp. 128-134
Author(s):  
Yeong Joo Jeong ◽  
Man Ki Choi ◽  
Seung Goun Hong
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Bile Duct Stone ◽  
Intrahepatic Bile Duct ◽  
Safe Procedure ◽  
Bile Duct Stones ◽  
Metal Stent ◽  
Endoscopic Retrograde ◽  
Duration Of Hospital Stay

After failed removal of common bile duct or intrahepatic bile duct (IHD) stones by endoscopic retrograde cholangiopancreatography (ERCP), percutaneous lithotripsy is well-known as an effective procedure. However, it is time-consuming because multiple sessions of transhepatic tract dilatation are required. Endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) has been recently used to approach IHD to remove difficult bile duct stones. We recently experienced EUS-guided CDS performed with metal stent. Common bile duct or IHD stones were removed by retrieval accessories after initial failed or inadequate ERCP in three patients. Serious complications including bleeding, infection, and perforation were not noted. The duration of hospital stay from EUS-guided procedure to discharge ranged from 10 to 14 days. Although this result is interim and ongoing, it suggests that EUS-guided CDS might be an effective and safe procedure after failed ERCP to remove difficult bile duct stones through the tract.

Analysis of Endoscopic Retrograde Cholangiopancreatography after Positive Intraoperative Cholangiogram: Is it Necessary?

2016 ◽  
Vol 82 (10) ◽  
pp. 985-988
Author(s):  
John V. Gahagan ◽  
Steven Maximus ◽  
Matthew D. Whealon ◽  
Michael J. Phelan ◽  
Aram Demirjian ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Acute Cholecystitis ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Nationwide Inpatient Sample ◽  
Bile Duct Stone ◽  
Stone Extraction ◽  
Endoscopic Retrograde ◽  
Intraoperative Cholangiogram ◽  
Nationwide Inpatient Sample Database

The necessity of routine endoscopic retrograde cholangiopancreatography (ERCP) after positive intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy is not well defined. We aimed to examine the incidence of positive IOC among patients who undergo IOC during cholecystectomy and the rate of subsequent ERCP stone extraction. The Nationwide Inpatient Sample database was reviewed for all patients undergoing cholecystectomy with IOC from 2002 to 2012. Patients were then analyzed for ERCP and stone extraction. A total of 73,508 patients who underwent cholecystectomy with IOC for a diagnosis of acute cholecystitis and found to have a bile duct stone were identified. Of these patients, 5915 underwent subsequent ERCP. In the patients that underwent subsequent ERCP, 1478 had a documented stone extraction during ERCP. The rate of stone extraction in the ERCP subset is 25 per cent, which is 2 per cent of all patients who had a positive IOC. The rate of stone extraction after positive IOC is low. Positive IOC may not warrant a routine postoperative ERCP. Our results suggest that clinical monitoring of patients with positive IOC is reasonable, as the majority of patients with a positive IOC ultimately have no stone extraction.

scholarly journals A Novel Two-Step Approach for Retrieval of an Impacted Biliary Extraction Basket

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Calvin H. Y. Chan ◽  
Fergal Donnellan ◽  
Godfrey C. K. Chan ◽  
Michael F. Byrne
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Balloon Dilatation ◽  
Bile Duct Stone ◽  
Surgical Removal ◽  
Distal Bile Duct ◽  
Endoscopic Retrograde ◽  
Safe Technique

Biliary extraction baskets are a commonly used instrument for the removal of choledocholithiasis in endoscopic retrograde cholangiopancreatography (ERCP). Impaction of the extraction basket is a recognized complication of ERCP, and is usually the result of discrepancy between the size of bile duct stone and the diameter of the distal bile duct. Whilst mechanical lithotriptors can be used to crush the stone or break the wires of the basket to allow its release, failure of the lithotriptor device can occur. We describe the case of a 59-year-old gentleman who had an ERCP performed for choledocholithiasis. Basket impaction was encountered, and the mechanical lithotriptor failed to dislodge the stone/basket complex. A two-step technique involving balloon dilatation and forceps manipulation of the basket was applied to successfully dislodge the impacted basket. We believe this simple and safe technique should be adopted to rescue impacted biliary extraction baskets to avoid the need for potential surgical removal.

Total Bilirubin is a Useful Predictor of Persisting Common Bile Duct Stone in Gallstone Pancreatitis

2008 ◽  
Vol 74 (10) ◽  
pp. 977-980 ◽  
Author(s):  
Tony Chan ◽  
Arezou Yaghoubian ◽  
David Rosing ◽  
Edward Lee ◽  
Roger J. Lewis ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Total Bilirubin ◽  
Bile Duct Stone ◽  
Total Bilirubin Level ◽  
Serum Total Bilirubin ◽  
Gallstone Pancreatitis ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Unnecessary Procedures

Accepted guidelines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are lacking. Our previous investigations suggested that serum total bilirubin on hospital Day 2 best predicts persisting common bile duct (CBD) stones. We aim to identify an optimal total bilirubin threshold on hospital Day 2 that would predict persisting CBD stones and guide obtaining preoperative ERCP. Prospective and retrospective data were available from 200 consecutive patients with gallstone pancreatitis at a public teaching hospital from 2003 through 2007. Charts were examined for persisting CBD stones on ERCP and/or intraoperative cholangiography during laparoscopic cholecystectomy. Patients with cholangitis (n = 18) were excluded. Nineteen of the remaining 182 (10%) patients had CBD stones. Mean hospital Day 2 bilirubin was 3.7 mg/dL for patients with CBD stones versus 1.4 mg/dL for those without (P < 0.0001). Seventeen patients (9%) had total bilirubin 4 or greater on hospital Day 2. Of these, eight (4%) had CBD stones (specificity 94%). Of the 165 patients with total bilirubin less than 4, 11 (7%) had CBD stones (P < 0.0001). In gallstone pancreatitis, a serum total bilirubin level 4 mg/dL or greater on hospital Day 2 predicts persisting CBD stones with enough specificity to serve as a practical guideline for ERCP while minimizing unnecessary procedures.

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