Endoscopic retrograde pancreatography-guided versus endoscopic ultrasound-guided technique for pancreatic duct cannulation in patients with pancreaticojejunostomy stenosis: a systematic literature review

Endoscopy ◽  
2020 ◽  
Author(s):  
Kirill Basiliya ◽  
Govert Veldhuijzen ◽  
Christian Gerges ◽  
Johannes Maubach ◽  
Uwe Will ◽  
...  
Keyword(s):  
Adverse Event ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasound ◽  
Event Rate ◽  
Outcome Data ◽  
Treatment Modalities ◽  
Adverse Event Rate ◽  
Endoscopic Retrograde Pancreatography ◽  
Endoscopic Retrograde ◽  
Cannulation Success

Background Stenosis of the pancreaticojejunostomy is a well-known long-term complication of pancreaticoduodenectomy. Traditionally, the endoscopic approach consisted of endoscopic retrograde pancreatography (ERP). Endoscopic ultrasound (EUS)-guided intervention has emerged as an alternative, but the success rate and adverse event rate of both treatment modalities are poorly known. We aimed to compare the outcome data of both interventions. Methods We performed a systematic literature search using the Pubmed/Medline and Embase databases in order to summarize the available data regarding efficacy and complications of ERP- and EUS-guided pancreatic duct (PD) drainage and compare these outcome data using uniform outcome measures in a multilevel logistic model. Results 13 studies were included, involving 77 patients who underwent ERP-guided drainage, 145 who underwent EUS-guided drainage, and 12 patients who underwent both modalities. An EUS-guided approach was significantly superior to an ERP-guided approach with regard to pancreatic duct opacification (87 % vs. 30 %; P < 0.001), cannulation success (79 % vs. 26 %; P < 0.001), and stent placement (72 % vs. 20 %; P < 0.001). An EUS-guided approach also appeared superior with regard to clinical outcomes such a pain resolution. The adverse event rate between the two treatment modalities could not be compared due to insufficient data. All included studies were found to be of low quality. Conclusion Based on limited available data, EUS-guided PD intervention appears superior to ERP-guided PD intervention.

A novel “hitch-and-ride” deep biliary cannulation method during rendezvous endoscopic ultrasound-guided ERCP technique

Endoscopy ◽  
2017 ◽  
Vol 49 (10) ◽  
pp. 983-988 ◽  
Author(s):  
Yousuke Nakai ◽  
Hiroyuki Isayama ◽  
Saburo Matsubara ◽  
Hirofumi Kogure ◽  
Suguru Mizuno ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Event Rate ◽  
The Other ◽  
Adverse Event Rate ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Technical Success Rate ◽  
The Wire

Abstract Background and study aim Endoscopic ultrasound-guided rendezvous (EUS-RV) is increasingly reported as a treatment option after failed endoscopic retrograde cholangiopancreatography. We developed a novel “hitch-and-ride” catheter for biliary cannulation to reduce the risk of guidewire loss during EUS-RV. Patients and methods We retrospectively evaluated safety and technical success of EUS-RV between June 2011 and May 2016. Biliary cannulation during EUS-RV using three methods – over-the-wire, along-the-wire, and hitch-and-ride – were compared. Results A total of 30 EUS-RVs were attempted and the technical success rate was 93.3 %, with two failures (one bile duct puncture and one guidewire insertion). After 28 cases of successful guidewire passage, cannulation was attempted by the over-the-wire (n = 13), along-the-wire (n = 4) or hitch-and-ride (n = 11) method. Only the hitch-and-ride method achieved biliary cannulation without guidewire loss or conversion to the other methods. Time to cannulation was shorter with the hitch-and-ride method (4 minutes) than with over-the-wire and along-the-wire methods (9 and 13 minutes, respectively). The adverse event rate of EUS-RV was 23.3 %. Conclusion A novel hitch-and-ride catheter was feasible for biliary cannulation after EUS-RV.

Clinical impact of endoscopic ultrasound-guided through-the-needle microbiopsy in patients with pancreatic cysts

Endoscopy ◽  
2020 ◽  
Vol 53 (01) ◽  
pp. 44-52 ◽  
Author(s):  
Bojan Kovacevic ◽  
Pia Klausen ◽  
Charlotte Vestrup Rift ◽  
Anders Toxværd ◽  
Hanne Grossjohann ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Clinical Management ◽  
Event Rate ◽  
Clinical Impact ◽  
Adverse Event Rate ◽  
Controlled Study ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts

Abstract Background The limited data on the utility of endoscopic ultrasound (EUS)-guided through-the-needle biopsies (TTNBs) in patients with pancreatic cystic lesions (PCLs) originate mainly from retrospective studies. Our aim was to determine the clinical impact of TTNBs, their added diagnostic value, and the adverse event rate in a prospective setting. Methods This was a prospective, single-center, open-label controlled study. Between February 2018 and August 2019, consecutive patients presenting with a PCL of 15 mm or more and referred for EUS were included. Primary outcome was a change in clinical management of PCLs following TTNB compared with cross-sectional imaging and cytology. Adverse events were defined according to the ASGE lexicon. Results 101 patients were included. TTNBs led to a change in clinical management in 11.9 % of cases (n = 12). Of these, 10 had serous cysts and surveillance was discontinued, while one of the remaining two cases underwent surgery following diagnosis of a mucinous cystic neoplasm. The diagnostic yield of TTNBs for a specific cyst diagnosis was higher compared with FNA cytology (69.3 % vs. 20.8 %, respectively; P < 0.001). The adverse event rate was 9.9 % (n = 10; 95 % confidence interval 5.4 % – 17.3 %), with the most common event being acute pancreatitis (n = 9). Four of the observed adverse events were severe, including one fatal outcome. Conclusions TTNBs resulted in a change of clinical management in about one in every 10 patients; however, the associated adverse event risk was substantial. Further studies are warranted to elucidate in which subgroups of patients the clinical benefit outweighs the risks.

The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury

2001 ◽  
Vol 54 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Hyun Soo Kim ◽  
Dong Ki Lee ◽  
Il Whoi Kim ◽  
Soon Koo Baik ◽  
Sang Ok Kwon ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Endoscopic Retrograde Pancreatography ◽  
Endoscopic Retrograde

scholarly journals Microalbuminuria is associated with high adverse event rate following cardiac surgery

2011 ◽  
Vol 39 (6) ◽  
pp. 932-938 ◽  
Author(s):  
Martin Majlund Mikkelsen ◽  
Niels Holmark Andersen ◽  
Thomas Decker Christensen ◽  
Troels Krarup Hansen ◽  
Hans Eiskjaer ◽  
...  
Keyword(s):  
Adverse Event ◽  
Cardiac Surgery ◽  
Event Rate ◽  
Adverse Event Rate ◽  
High Adverse Event

Missed acute myocardial infarction in the emergency department–standardizing measurement of misdiagnosis-related harms using the SPADE method

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Adam L. Sharp ◽  
Aileen Baecker ◽  
Najlla Nassery ◽  
Stacy Park ◽  
Ahmed Hassoon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Event ◽  
Chest Pain ◽  
Administrative Data ◽  
Diagnostic Performance ◽  
Event Rate ◽  
Public Health Problem ◽  
Diagnostic Error ◽  
Adverse Event Rate ◽  
Disease Pair

AbstractObjectivesDiagnostic error is a serious public health problem. Measuring diagnostic performance remains elusive. We sought to measure misdiagnosis-related harms following missed acute myocardial infarctions (AMI) in the emergency department (ED) using the symptom-disease pair analysis of diagnostic error (SPADE) method.MethodsRetrospective administrative data analysis (2009–2017) from a single, integrated health system using International Classification of Diseases (ICD) coded discharge diagnoses. We looked back 30 days from AMI hospitalizations for antecedent ED treat-and-release visits to identify symptoms linked to probable missed AMI (observed > expected). We then looked forward from these ED discharge diagnoses to identify symptom-disease pair misdiagnosis-related harms (AMI hospitalizations within 30-days, representing diagnostic adverse events).ResultsA total of 44,473 AMI hospitalizations were associated with 2,874 treat-and-release ED visits in the prior 30 days. The top plausibly-related ED discharge diagnoses were “chest pain” and “dyspnea” with excess treat-and-release visit rates of 9.8% (95% CI 8.5–11.2%) and 3.4% (95% CI 2.7–4.2%), respectively. These represented 574 probable missed AMIs resulting in hospitalization (adverse event rate per AMI 1.3%, 95% CI 1.2–1.4%). Looking forward, 325,088 chest pain or dyspnea ED discharges were followed by 508 AMI hospitalizations (adverse event rate per symptom discharge 0.2%, 95% CI 0.1–0.2%).ConclusionsThe SPADE method precisely quantifies misdiagnosis-related harms from missed AMIs using administrative data. This approach could facilitate future assessment of diagnostic performance across health systems. These results correspond to ∼10,000 potentially-preventable harms annually in the US. However, relatively low error and adverse event rates may pose challenges to reducing harms for this ED symptom-disease pair.

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