scholarly journals Clinical efficacy, timing, and outcomes of ERCP for management of bile duct leaks: a nationwide cohort study

2021 ◽  
Vol 09 (02) ◽  
pp. E247-E252
Author(s):  
Aakash Desai ◽  
Patrick Twohig ◽  
Sophie Trujillo ◽  
Shaman Dalal ◽  
Gursimran S. Kochhar ◽  
...  
Keyword(s):  
Bile Duct ◽  
Combination Therapy ◽  
The United States ◽  
Biliary Stent ◽  
Duodenal Perforation ◽  
Effective Management ◽  
Clinical Database ◽  
Endoscopic Retrograde ◽  
Significant Difference ◽  
Ascending Cholangitis

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) can safely and effectively manage postsurgical or traumatic bile duct leaks (BDLs). Standardized guidelines are lacking regarding effective management of BDLs. Our aim was to evaluate the efficacy, clinical outcomes, and complications of different ERCP techniques and intervention timing using a nationwide database. Patients and methods We performed a retrospective analysis of the IBM Explorys database (1999–2019), a pooled, national, de-identified clinical database of over 64 million unique patients across the United States. ERCP timing after BDL was classified as emergent (< 1 day), urgent (1–3 days) or expectant (> 3 days). ERCP technique was classified into sphincterotomy, stent or combination therapy. ERCP complications were defined as pancreatitis, duodenal perforation, duodenal hemorrhage, and ascending cholangitis within 7 days of the procedure. Results Expectant ERCP had a decreased risk of adverse events (AEs) compared to emergent and urgent ERCP (P = 0.004). Rehospitalization rates also were lower in expectant ERCP (P < 0.001). Patients with COPD were more likely to have an AE if the ERCP was performed emergently compared to expectantly (P = 0.002). Combination therapy had a lower rate of ERCP failure compared to placement of a biliary stent (P = 0.02). There was no statistically significant difference in rates of ERCP failure between biliary stent and sphincterotomy (P = 0.06) or sphincterotomy and combination therapy (P = 0.74). Conclusion Our study suggests that ERCP does not need to be performed emergently or urgently for management of BDLs. Combination therapy is superior to stenting but not sphincterotomy; however, future prospective studies are needed to validate these findings.

scholarly journals Duodenal Perforation Secondary to Migrated Biliary Stent: A Rare and Serious Complication of Endoscopic Retrograde Cholangiopancreatography

2018 ◽  
Vol 09 (04) ◽  
pp. 193-195
Author(s):  
Vipul D. Yagnik ◽  
Vismit P. Joshipura
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bile Duct Stone ◽  
Intestinal Wall ◽  
Biliary Stent ◽  
Duodenal Perforation ◽  
Biliary Stents ◽  
Endoscopic Retrograde

AbstractAlthough migration of biliary stents is not uncommon, stent‑induced perforation of the intestinal wall is a rare and serious complication. We report a case of duodenal perforation secondary to migrated biliary stent kept for obstructive jaundice for common bile duct stone in a 64‑year‑old male. Intestinal perforation secondary to migrated stent should be considered in patients reported with abdominal pain and sepsis after an endoscopic retrograde cholangiopancreatography with biliary stent placement.

scholarly journals Short-Term Biliary Stent Placement Contributing Common Bile Duct Stone Disappearance with Preservation of Duodenal Papilla Function

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Tatsuki Ueda ◽  
Masataka Kikuyama ◽  
Yuzo Kodama ◽  
Takafumi Kurokami
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Stent Placement ◽  
Bile Ducts ◽  
Common Bile Duct Stones ◽  
Biliary Stent ◽  
Duodenal Papilla ◽  
Short Term ◽  
Endoscopic Retrograde ◽  
Obstructive Cholangitis

Aims. To investigate the effect of biliary stent placement without endoscopic sphincterotomy (EST) on common bile duct stones (CBDS) disappearance and the contribution of preserving the duodenal papilla function to reduce recurrence of CBDS.Methods. Sixty-six patients admitted for acute obstructive cholangitis due to CBDS who underwent biliary stent placement without EST for 2 years from March 2011 were evaluated retrospectively. The second endoscopic retrograde cholangiopancreatography (ERCP) was performed for treatment of CBDS 3 to 4 months after the first ERCP. We estimated the rate of stone disappearance at the time of second ERCP.Results. CBDS disappearance was observed in 32 (48.5%) of 66 patients. The diameter of the bile ducts and the diameter of CBDS in patients with CBDS disappearance were significantly smaller than in those with CBDS requiring extraction (p=0.007andp<0.001, resp.). Stone disappearance was evident when the diameter of bile ducts and that of CBDS were <10 and 7 mm, respectively (p=0.002).Conclusions. Short-term stent placement without EST eliminates CBDS while preserving duodenal papilla function and may be suitable for treating CBDS in patients with nondilated bile ducts and small CBDS.

scholarly journals Successful Endoscopic Removal of a Biliary Stent with Stent-Stone Complex after Long-Term Migration

2019 ◽  
Vol 13 (1) ◽  
pp. 113-117 ◽  
Author(s):  
Masashi Morimachi ◽  
Masami Ogawa ◽  
Masashi Yokota ◽  
Aya Kawanishi ◽  
Yohei Kawashima ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Sclerosing Cholangitis ◽  
Biliary Stent ◽  
Endoscopic Removal ◽  
Endoscopic Retrograde ◽  
Plastic Stent ◽  
Staged Approach ◽  
Outpatient Appointments

A 49-year-old man was referred to our hospital for an abnormality of the hepatobiliary enzyme. The patient was diagnosed with primary sclerosing cholangitis 9 years ago, and he had a biliary stent with a string placed as an inside stent. We attempted to remove the stent 6 months later, but the string was cut off, so the stent could not be removed. Removal was attempted again, but the patient cancelled the outpatient appointments. During the examination performed at the present visit, we discovered that the biliary stent had migrated into the bile duct, and a stone had formed around the stent. We attempted to remove the stent-stone complex by endoscopic retrograde cholangiopancreatography, but it was difficult; thus, we decided to implant a new biliary stent and remove the other stent later. When we performed endoscopic retrograde cholangiopancreatography again 2 days later, the bile duct axis was linearized thanks to the additional stent, enabling us to grab the migrated stent with stent-stone complex using grasping forceps and to successfully pull it out. By implanting an additional plastic stent temporarily, we were able to straighten the biliary axis and endoscopically remove the biliary stent that migrated and caused the development of stent-stone complex in a 2-staged approach.

scholarly journals A Novel Cause of Biliary Peritonitis after Endoscopic Retrograde Cholangiopancreatography: Case Report and Literature Review

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Andrija Karačić ◽  
Paula Batur ◽  
Domagoj Štritof ◽  
Taro Fukui ◽  
Branko Bakula ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Intrahepatic Bile Duct ◽  
Liver Parenchyma ◽  
Duodenal Perforation ◽  
Emergency Laparotomy ◽  
Endoscopic Retrograde ◽  
Biliary Peritonitis ◽  
First Case ◽  
Therapeutic Ercp

Background. Endoscopic retrograde cholangiopancreatography (ERCP) can lead to several complications such as duodenal or bile duct perforation. The incidence of pneumoperitoneum post-ERCP is rarely seen (<1%) and is associated with perforations of the duodenum or common bile duct in therapeutic ERCP after sphincterotomy. In this case, we disclose a novel cause of biliary peritonitis after ERCP. Case Presentation. A 65-year-old man presented with abdominal pain and distended abdomen after uneventful ERCP with sphincterotomy. An abdominal computed tomography (CT) was performed whose finding indicated duodenal perforation. The patient was rushed to an emergency laparotomy where only a rupture of an otherwise normal subcapsular intrahepatic bile duct was found. The surrounding liver parenchyma was healthy. The cause of this condition was probably post-ERCP pneumobilia and the increase of pressure in the biliary tract. Conclusions. This is the first case in literature describing the rupture of a subcapsular healthy bile duct as cause of biliary peritonitis after ERCP. This case also suggests that in the management of post-ERCP complications, the cooperation of radiologists and surgeons is vital for the patient’s wellbeing.

scholarly journals Broken stent of endoscopic retrograde cholangiopancreatography mimicking a common bile duct stone: a case report

2019 ◽  
Vol 7 (5) ◽  
pp. 1960
Author(s):  
Thirugnanasambandam Nelson ◽  
AmudaRavichandar Pranavi ◽  
Sathasivam Sureshkumar ◽  
GubbiShamanna Sreenath ◽  
Ananthakrishnan Ramesh ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Common Bile Duct Stone ◽  
Bile Duct Stone ◽  
Biliary Stent ◽  
Stent Fracture ◽  
Endoscopic Stenting ◽  
Endoscopic Retrograde ◽  
Distal Common Bile Duct

Long standing biliary stent for biliary stricture may have complications like cholangitis, cholecystitis, stent fracture and stent migration. Treatment includes re-do endoscopic retrograde cholangiopancreatography, removal of fractured stent and restenting. Authors report a case of fractured biliary stent mimicking as distal common bile duct stone. Patient presented with features of cholangitis with history of endoscopic stenting 6 years back but lost follow up thereafter. Ultrasound showed 2cm calculus in distal common bile duct and the stent was seen on endoscopy through the papilla in the duodenum. Contrast enhanced computed tomography of abdomen showed radio opaque dense shadow in the distal common bile duct suggesting possibility of broken biliary stent. Redo endoscopic retrograde cholangiopancreatography failed to remove the fractured stent. A new stent was placed without complications. Patient underwent open common bile duct exploration and the fractured stent was removed. Patient recovered completely after the procedure.

scholarly journals Is Cholecystectomy a cause of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography?

2021 ◽  
Vol 84 (4) ◽  
Author(s):  
R.E. Cankurtaran ◽  
R Atalay ◽  
Y.H. Polat ◽  
F Kivrakoglu ◽  
M Tahtacı ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Common Bile Duct Stones ◽  
Study Patient ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Significant Difference ◽  
Difficult Biliary Cannulation

Background and study aim: In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of naive papillae is defined as difficult in the presence of more than 5 papilla contacts, more than 5min cannulation time or more than one unintended pancreatic duct cannulation or opacification. It is not known whether cholecystectomy is a cause of difficult biliary cannulation. This study aimed to investigate whether cholecystectomy (CCY) is a cause of difficult biliary cannulation in patients who have undergone Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis. Patients and methods: Adult patients with naive papillae and those who underwent ERCP for common bile duct stones and/or sludge were included in this retrospective study. Patient demographics, clinical presentation (acute cholangitis, biliary pancreatitis or biliary colic), periprocedural data including laboratory and radiological findings and ERCP results were compared between no-CCY and post-CCY groups. Results: 438 patients were included in the present study and 347 of these patients were in the no-CCY group and 91 patients were in post-CCY group. A statistically significant difference was found in the number of patients with difficult cannulation in the post-CCY group (n=30, 33.0%) patients compared to the no- CCY group (n=67, 19.3%) (p=0.011). According the multivariate analyses results, presence of history of cholecystectomy was found an independent risk factor of difficult cannulation (Odds ratio: 2.014; 95 % Cl 1.205-3.366; p=0.008). Conclusions: The results showed that biliary cannulation was significantly more difficult in patients with cholecystectomy who underwent ERCP for common bile duct stones.

scholarly journals Comparative study between laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis

2019 ◽  
Vol 6 (7) ◽  
pp. 2250
Author(s):  
Mohamed Mohsen Salem ◽  
Mohamed Emad Esmat ◽  
Ahmed Mohamed Abdelaziz Hassan ◽  
Yaser Amer ◽  
Hisham Abdelaziz ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Clearance Rate ◽  
Common Bile Duct Exploration ◽  
Prospective Clinical Study ◽  
Endoscopic Retrograde ◽  
One Stage ◽  
Significant Difference

Background: Endoscopic retrograde cholangiopancreatography (ERCP) with consequent laparoscopic cholecystectomy (LC) has been the favored approach for the treatment of choledocholithiasis for a long time; however recently, laparoscopic common bile duct exploration (LCBDE) has been offered to patients with suspected choledocholithiasis. Objective and aim of this work was to compare the efficacy, safety, and the surgical outcomes of LCBDE with ERCP followed by LC and determine the most appropriate approach for patients with choledocholithiasis.Methods: A prospective clinical study was carried out from March 2017 to September 2018. It included 50 patients with cholecysto-choledocholithiasis who were divided into two groups: group A (25 patients) included patients who underwent transcystic LCBDE and stone extraction with LC in one stage, and group B (25 patients) included patients who underwent ERCP followed by LC in two stages. The common bile duct (CBD) stone clearance rate, postoperative bile leakage, postoperative morbidity, mortality, overall hospital stay, and patient satisfaction were analyzed.Results: LCBDE and ERCP+LC were similar in terms of clearance rate, operative time, postoperative complications, retained CBD stones, and postoperative length of stay, but there was a significant difference in number of procedures and patient satisfaction.Conclusions: Although both approaches have equivalent success rates, LCBDE is better in terms of fewer procedures, and better satisfaction compared with ERCP + LC. Our study suggests that one-stage management is the treatment of choice for patients with cholecysto-choledocholithiasis.

Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis

2018 ◽  
Vol 37 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Subhash Chandra ◽  
Jagpal Singh Klair ◽  
Kaartik Soota ◽  
Daniel J. Livorsi ◽  
Frederick C. Johlin
Keyword(s):  
Tertiary Care ◽  
Acute Cholangitis ◽  
Multivariable Analysis ◽  
Intestinal Flora ◽  
Biliary Tree ◽  
Blood Cultures ◽  
Biliary Stent ◽  
Endoscopic Retrograde ◽  
Bile Culture ◽  
Ascending Cholangitis

Background: Only a small proportion of patients with biliary tree infection grow microorganisms in blood cultures. Antibiotics chosen or tailored based on organisms identified on blood cultures have a potential for under-treatment and unfavorable outcomes, including recurrent infection and early stent occlusion. In our current practice, we collect bile for culture if an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is performed in patients with suspected cholangitis. In this study, we compare the microbial yield of blood cultures and ERCP-obtained bile cultures in patients with ascending cholangitis. Methods: We reviewed medical records of all the patients treated for ascending cholangitis who had blood cultures and ERCP-obtained bile cultures at a tertiary care center between 2010 and 2016. Bile was collected for culture before injecting contrast, via a catheter after discarding the initial 3 mL. Results: Ninety-three patients were included with mean age of 71 (±15) years. Out of 93 patients, 11 (12%) had prior sphincterotomy, 29 (31%) had an indwelling biliary stent, and malignant obstruction was the most common etiology (34%). ERCP-obtained bile cultures were positive in 90 out of 93 (97%) patients with monomicrobial growth in 34 out of 93 (39%) patients. Mixed intestinal flora was noted in 3 patients. Blood cultures were positive in only 30 out of 93 patients (32%) and 24 out of 93 (26%) patients had monomicrobial growth. Totally 26 out of 30 patients (87%) grew the same organism as the bile culture, 3 grew an organism different from bile cultures, and one had no growth in the bile culture. On multivariable analysis, the presence of an indwelling biliary stent was the lone factor associated with polymicrobial growth, 83 vs. 52%, p = 0.007. Conclusion: ERCP-obtained bile cultures are a reliable and feasible mechanism to evaluate patients with suspected biliary tree infection. This technique has a significantly higher yield when compared to blood culture. Selection and tailoring of antibiotics based on bile culture in the management of ascending cholangitis are advised.

The clinical analysis of endoscopic pancreaticobiliary separation in the treatment of occult pancreaticobiliary reflux

2020 ◽  
Author(s):  
Zhao Gang ◽  
Zhang Cheng ◽  
Cai Hao ◽  
Xu An An ◽  
Li Hai Dong ◽  
...  
Keyword(s):  
Bile Duct ◽  
Recurrence Rate ◽  
Endoscopic Sphincterotomy ◽  
Clinical Analysis ◽  
Endoscopic Retrograde ◽  
Curative Effect ◽  
Papillary Tumour ◽  
Significant Difference ◽  
The Difference ◽  
Pancreatic Reflux

Abstract Objective To investigate the aetiology of occult pancreaticobiliary reflux (OPBR) and the curative effect of EST in patients with cholecystolithiasis. Methods The clinical data of 47 OPBR patients with cholecystolithiasis from October 2013 to October 2016 were analyzed retrospectively.Results The average gallbladder bile amylase (GBA) of 47 patients was 864 ± 575 U/L. Forty patients underwent endoscopic retrograde cholangiopancreatography (ERCP), among which 26 patients were diagnosed with papillitis, 16 patients with peripapillary diverticulum, 14 patients with nipple overlength, five patients with nipple atrophy, three patients with ampullary calculi and two patients with papillary tumour. Thirty-three patients underwent endoscopic sphincterotomy (EST), after the operation, 16 patients reexamined GBA, in which 15 patients had normal GBA, and the difference of GBA was statistically significant (1161 ± 764 U/L vs 47 ± 17 U/L, t=5.641, P<0.05). After following up of 1 to 4 years, 27 patients without cholecystectomy who underwent EST had no recurrence of calculus, and in 9 patients who did not undergo EST, two patients had a recurrence of calculus. There was a significant difference in the recurrence rate of calculus (χ2=21.340, P<0.05). Conclusion Pancreaticobiliary junction disease is an essential cause of OPBR and cholecystolithiasis formation. EST can reduce the retention of pancreatic reflux juice both in gallbladder and bile duct and can reduce the recurrence rate of cholecystolithiasis after choledochoscopic lithotomy.

scholarly journals Montelukast Use and Patterns of Ambulatory Care among Asian versus Non-Asian Adult Patients with Asthma and/or Allergic Rhinitis in the United States

10.36469/9835 ◽  
2015 ◽  
Vol 3 (2) ◽  
pp. 194-213
Author(s):  
Joseph Vasey ◽  
Shalini Bagga ◽  
Huan Huang ◽  
Tongsheng Wang ◽  
David Thompson
Keyword(s):  
United States ◽  
Allergic Rhinitis ◽  
Combination Therapy ◽  
Ambulatory Care ◽  
Persistent Asthma ◽  
The United States ◽  
Future Research ◽  
Therapy Regimen ◽  
Asian Patients ◽  
Significant Difference

Background: Asthma and allergic rhinitis (AR) are inflammatory conditions that are similar in pathophysiology. Mild-to-moderate persistent asthma has been widely treated with inhaled corticosteroids, while allergic rhinitis is commonly treated with antihistamines, nasal corticosteroids, anticholinergics, and other allergy specific medications. The introduction of montelukast, a leukotriene receptor antagonist, has opened a treatment pathway that is common to both conditions. Previous real world studies of montelukast (Singulair®) relative to other medications have not investigated the role of race in the management of asthma and AR, specifically as relates to differences among Asian versus non-Asian patients. Objective: To contrast montelukast use and patterns of ambulatory care for adult Asian versus non-Asian patients in the United States with asthma and/or AR. Methods: Data for adult asthma and AR patients were extracted from a national electronic medical records database for the years 2006-2014. Patients were classified into condition cohort (Asthma-Only, AR-Only, Asthma &amp; AR), and treatment condition (monotherapy or combination therapy, with or without montelukast for Asthma and Asthma &amp; AR cohorts, usual care with or without montelukast for AR-Only) and stratified by race (Asian vs. non-Asian). Results: Overall patterns of use of montelukast were similar for Asian and non-Asian patients, but Asians were more likely to receive it as part of a combination therapy regimen. Changes in treatment regimen followed similar patterns for both groups. Asian patients with both asthma and AR were found to have lower service utilization rates if their therapy included montelukast, whereas for non-Asians there was no significant difference between regimens with or without montelukast. Conclusion: Differences in montelukast use and outcomes of care exist between Asian and non-Asian patients in the United States. Future research should explore the reasons for these differences and whether they can be replicated in non-US settings.

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