scholarly journals Does the presence of a trainee compromise success of biliary cannulation at ERCP?

2017 ◽  
Vol 05 (07) ◽  
pp. E559-E562 ◽  
Author(s):  
John Frost ◽  
Arun Kurup ◽  
Sharan Shetty ◽  
Neil Fisher
Keyword(s):  
Primary Outcome Measure ◽  
Success Rates ◽  
Serious Adverse Events ◽  
Biliary Cannulation ◽  
Exact Test ◽  
Cannulation Technique ◽  
Cannulation Success ◽  
A Prospective Study ◽  
Mean Time ◽  
Training Protocol

Abstract Background and study aims Findings in the literature are conflicting on whether trainee involvement in endoscopic retrograde cholangiopancreatography (ERCP) procedures is detrimental to cannulation success rates. We addressed this in a prospective study, where cannulation success with or without trainee presence was the primary outcome measure. Patients and methods We prospectively recorded data on 2 senior endoscopists and their trainees over an 18-month period for ERCPs in patients with a virgin ampulla. Presence or absence of a trainee at ERCP procedures was pragmatic, reflecting their other service or training commitments or annual leave. For trainee presence, the training protocol allowed them 6 minutes of supervised time in which to achieve biliary cannulation after reaching the ampulla. Study outcome measures included cannulation success, time to cannulation, technique, whether this was achieved independently by the trainee, and complications. Results There were 219 procedures recorded and analyzed (134 with a trainee, 85 without). Three trainees were involved. Selective biliary cannulation was achieved in 201 (92 %) of cases. When a trainee was present, cannulation was successful in 122/134 procedures (91 %), compared to 79/85 (93 %) with a senior endoscopist alone (P = 0.8, Fisher’s exact test). Mean time to biliary cannulation with a trainee present was 7 minutes, compared with 5 minutes with no trainee. Mean time for successful independent cannulation by the trainee was 4 minutes, and 9 minutes for a consultant following a trainee’s attempt. There were no serious adverse events. Conclusion Our study shows that with this training protocol, involvement of a trainee on a routine secondary care ERCP list does not impair biliary cannulation success, and does not prolong a subsequent attempt by the senior endoscopist if initially unsuccessful. These findings support the involvement of trainees in routine ERCP lists with this training protocol.

Comparison between a rotatable sphincterotome and a conventional sphincterotome for selective bile duct cannulation

Endoscopy ◽  
2019 ◽  
Vol 51 (09) ◽  
pp. 852-857
Author(s):  
Akira Kurita ◽  
Yasushi Kudo ◽  
Kenichi Yoshimura ◽  
Tadamasa Takemura ◽  
Yoshiharu Mori ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Conventional Group ◽  
Success Rates ◽  
Single Center ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Cannulation Technique ◽  
Group 3 ◽  
Cannulation Success

Abstract Background Selective biliary cannulation (SBC) is the first challenge of endoscopic retrograde cholangiopancreatography (ERCP), especially for trainees, and a rotatable sphincterotome may be useful to guide the directional axis of the scope and SBC. Methods We performed a prospective randomized single-center trial, enrolling 200 patients with a native papilla who required therapeutic biliary ERCP. Patients were randomly assigned to the rotatable sphincterotome group (n = 100) or the conventional sphincterotome group (n = 100). The primary endpoint was successful SBC by the trainees within 10 minutes. Results The early and late cannulation success rates did not differ significantly between the groups (P = 0.46 and P > 0.99, respectively). For the patients in whom trainees failed to achieve SBC, the rotatable sphincterotome was used as a rescue cannulation technique in four patients from the conventional group; in no patients in the rotatable group was the conventional sphincterotome used for SBC. Post-ERCP pancreatitis (PEP) occurred in 11 patients (5.5 %; 6 mild, 5 moderate); the incidence did not differ significantly between the two groups (rotatable group 3 %, conventional group 8 %; P = 0.21). The two groups were thus combined for evaluation of the factors relating to cannulation difficulty for trainees, which revealed that orientation of the papilla was a significant factor (P < 0.001). Conclusions The type of sphincterotome used did not affect the success of SBC by trainees. However, orientation of the papilla was revealed to be a significant factor relating to cannulation difficulty for trainees overall.

Vein cannulation success rates by German paramedics: a single-centre study

2021 ◽  
Vol 11 (2) ◽  
pp. 35-39
Author(s):  
Paulina Naklicka ◽  
Luis Möckel ◽  
Thomas Hofmann
Keyword(s):  
Vascular Access ◽  
Night Shift ◽  
Federal State ◽  
Success Rates ◽  
Single Centre ◽  
Exact Test ◽  
Factors Associated ◽  
Risk Of Failure ◽  
Single Centre Study ◽  
Cannulation Success

Introduction: Gaining intravenous (IV) access is vulnerable to errors and failure, and this study analysed IV procedures by paramedics in the federal state of Hesse in Germany to examine these. Methods: This was a single-centre, observational, pilot study survey on gaining vascular access. As well as identifying the success and failure rate of IV attempts, factors associated with a higher risk of failure were analysed using logistic regression, Χ2 or Fisher's exact test. Results: A total of 207 vascular access attempts were included in the analysis, of which 90.34% were successful. Significantly associated with higher risk of failure were patients' age (OR 1.05; 95% (CI 1.02–1.10); p=0.041), or when two (OR 3.94; 95% CI (2.39–6.20); p≤0.001) or more than three attempts (OR: 3.26 [95% CI: 1.35; 5.17]; p=0.003) were needed rather than one. In contrast, risk of failure was significantly lower when patients indicate a good (OR 0.02; 95% CI (0.00–0.15); p≤0.001) or moderate (OR 0.04 (95% CI 0.01–0.17); p≤0.001) vein status compared to a bad vein status. Failure rates were higher when paramedics were working a night shift (OR 0.06; 95% CI (0.00–0.98); p=0.005) rather then during the day. Conclusion: A proportion of IV access attempts by paramedics are unsuccessful and, if paramedics are to provide invasive interventions, non-IV options for drug administration should be available.

scholarly journals Impact of a Novel Oblique-Tip Papillotome for Biliary Cannulation during ERCP: A Nonrandomized Coarsened Exact Matching Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Hiroo Imazu ◽  
Shiaw-Hooi Ho ◽  
Shoryoku Hino ◽  
Khean-Lee Goh ◽  
Mitsuhiko Moriyama ◽  
...  
Keyword(s):  
University Hospital ◽  
Exact Matching ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Coarsened Exact Matching ◽  
Patient Allocation ◽  
Cannulation Technique ◽  
The Mean ◽  
A Prospective Study ◽  
The University

Background. We developed a novel oblique-tip papillotome (OT-papillotome) to facilitate biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate the utility of the OT-papillotome for contrast-guided cannulation (CGC) and wire-guided cannulation (WGC) during ERCP, compared with standard cannulation by WGC using a standard-tip papillotome (ST-papillotome). Methods. A prospective study was performed at two centers. CGC with the OT-papillotome (OT-CGC group) was performed at Jikei University Hospital, while WGC was done with the OT-papillotome and ST-papillotome (OT-WGC and ST-WGC groups, respectively) at the University of Malaya Medical Centre. The results of the OT-CGC and OT-WGC groups were compared with those of the ST-WGC group after performing coarsened exact matching (CEM) to reduce bias due to nonrandomized and center-based patient allocation. Results. Eighty patients were enrolled in each of the OT-CGC, OT-WGC, and ST-WGC groups. After CEM, the successful biliary cannulation rate was significantly higher in the OT-CGC and OT-WGC groups than in the ST-WGC group, while rescue cannulation was reduced. The mean number of unintended pancreatic access events in the OT-WGC and OT-CGC groups was similar to the ST-WGC group. However, it was significantly lower in the OT-WGC group than in the OT-CGC group. Multivariate analysis revealed that the OT-papillotome was independently associated with less frequent rescue cannulation and a higher successful biliary cannulation rate. Conclusions. Although use of the OT-papillotome in biliary cannulation did not reduce unintended pancreatic access events or PEP compared to the ST-papillotome, the OT-papillotome increased the successful biliary cannulation rate, while reducing the frequency of rescue cannulation procedures. Combining the OT-papillotome with WGC might be the best cannulation technique for minimizing unintended pancreatic access.

scholarly journals Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: An Overview of Advanced Techniques

2021 ◽  
pp. 73-82
Author(s):  
Brian M. Fung ◽  
Teodor C. Pitea ◽  
James H. Tabibian
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Clinical Success ◽  
Success Rates ◽  
Significant Progress ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Vast Array ◽  
The Past ◽  
Difficult Biliary Cannulation ◽  
Cannulation Success

Endoscopic retrograde cholangiopancreatography (ERCP) plays a significant role in the treatment of a vast array of pancreatobiliary diseases. However, despite significant progress in the optimisation of ERCP methods and accessories, the technical and clinical success of ERCP can vary significantly due to a variety of patient and operator factors. Over the past several decades, a number of advanced techniques have been developed to improve cannulation success rates, including the use of double-guidewire, pancreatic duct accessory-assisted, precut, and rendezvous techniques. Here, the authors provide an update and overview of the existing advanced techniques used in cases of difficult biliary cannulation, as well as the approach to their selection.

Early double-guidewire versus repeated single-guidewire technique to facilitate selective bile duct cannulation: a randomized controlled trial

Endoscopy ◽  
2021 ◽  
Author(s):  
Arthur Laquière ◽  
Jocelyn Privat ◽  
Jeremie Jacques ◽  
Romain Legros ◽  
Romina Urena-Campos ◽  
...  
Keyword(s):  
Bile Duct ◽  
Pancreatic Duct ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Randomized Study ◽  
Biliary Duct ◽  
Success Rates ◽  
Biliary Cannulation ◽  
The Common ◽  
Cannulation Success

Abstract Background During endoscopic retrograde cholangiopancreatography (ERCP), access to the common bile duct (CBD) can be problematic after unintentional insertion of the guidewire into the pancreatic duct. We conducted a prospective, randomized study in order to compare biliary cannulation success rates of early double-guidewire (EDG) and repeated single-guidewire (RSG) techniques in patients with inadvertent passage of the guidewire into the pancreatic duct. Methods Patients with a native papilla were randomly assigned to either the EDG or RSG groups after unintentional insertion of the guidewire into the pancreatic duct. The primary outcome was successful selective CBD cannulation within 10 minutes. The secondary outcomes were successful final selective bile duct cannulation, time to bile duct cannulation, and frequency of post-ERCP pancreatitis (PEP). Results 142 patients were randomized and selective bile duct cannulation was achieved in 57/68 patients (84 %) in the EDG group and in 37/74 patients (50 %) in the RSG group within 10 minutes (relative risk 1.34; 95 % confidence interval 1.08–6.18; P < 0.001). The overall final selective bile duct cannulation rate was 99.3 %. The time to access the CBD was shorter using the EDG technique (6.0 vs. 10.4 minutes; P = 0.002). Mild PEP was not observed more frequently in the EDG group than in the RSG group. Conclusion The EDG technique significantly increased the success rate of biliary duct cannulation within 10 minutes compared with an RSG approach.

scholarly journals The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽  
2021 ◽  
pp. 146040862094972
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory ◽  
Gavin Gordon ◽  
Fiona Smith ◽  
Andrew Jennings
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Hospital Admissions ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Time To Death ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

scholarly journals 109 Game Changing Magnetic Experience in Rural and Urban Wirral Peninsula - Our Experience with Magseed Localisation of Impalpable Breast Tumours and Axillary Nodes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Arif ◽  
R Vinayagam ◽  
J M Lund ◽  
S Poonawala
Keyword(s):  
Incidental Finding ◽  
Breast Tumour ◽  
Axillary Node ◽  
Reliable Technique ◽  
Breast Tumours ◽  
Rural And Urban ◽  
Mean Size ◽  
The Right ◽  
A Prospective Study ◽  
Mean Time

Abstract Introduction Magseed is a novel localization technology in which a tiny seed is inserted to accurately mark the site of breast tumour. These can be detected intra-operatively by sentimag localization system. It aids localization of impalpable breast lesions improving margin clearance rates. Method A prospective study of first fifty Magseed localised breast tumour and axillary node excisions in Clatterbridge General Hospital. Results A total of 50 patients had 52 Magseed inserted. n = 14 was symptomatic, n = 35 was screen detected and n = 1 was an incidental finding on surveillance mammogram for a B3 lesion. 30 seeds were inserted on the right and 22 were inserted on the left (two were bilateral). 44 seeds were inserted under ultrasound guidance and the rest were targeted under stereo guidance (n = 8). Deployment of two resulted in malposition requiring wire localization. Mean age of subjects was 59.76 (range 31-81) years. Mean time to surgery after magseed insertion was 8.04 (range 1-27) days. Mean weight of the specimen was 48.57(range 10-264) gm. Mean size of the lesions was 20.32 (range 8-65) mm. Redo surgery for margin clearance was performed bringing the re-excision rate to 15.38% (n = 8). Conclusions We conclude that Magseed localization of breast tumours is a safe and reliable technique

scholarly journals The Trend in Distribution of Q223R Mutation of Leptin Receptor Gene in Amoebic Liver Abscess Patients from North India: A Prospective Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Anil Kumar Verma ◽  
Vineet Ahuja ◽  
Jaishree Paul
Keyword(s):  
Liver Abscess ◽  
Leptin Receptor ◽  
Receptor Gene ◽  
Rflp Analysis ◽  
North India ◽  
Amoebic Liver Abscess ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Pcr Rflp ◽  
A Prospective Study

Host genetic susceptibility is an important risk factor in infectious diseases. We explored the distribution of Q223R mutation in leptin receptor gene of amoebic liver abscess (ALA) patients of North India. A total of 55 ALA samples along with 102 controls were subjected to PCR-RFLP analysis. The frequency of allele “G” (coding for arginine) was in general high in Indian population irrespective of the disease. Our results of Fisher exact test shows that heterozygous mutant (QQ versus QR,P=0.049) and homozygous mutant (QQ versus RR,P=0.004) were significantly associated with amoebic liver abscess when compared with homozygous wild (QQ).

High Success Rate of Prehospital and En Route Cricothyroidotomy Performed in the Israel Defense Forces: 20 Years of Experience

2021 ◽  
pp. 1-6
Author(s):  
Eran Beit Ner ◽  
Avishai M. Tsur ◽  
Roy Nadler ◽  
Elon Glassberg ◽  
Avi Benov ◽  
...  
Keyword(s):  
Success Rate ◽  
Body Part ◽  
Salvage Procedure ◽  
Care Providers ◽  
Success Rates ◽  
Exact Test ◽  
Medical Teams ◽  
Israel Defense Forces ◽  
Different Levels ◽  
Overall Mortality

Abstract Introduction: Securing the airway is a crucial stage of trauma care. Cricothyroidotomy (CRIC) is often addressed as a salvage procedure in complicated cases or following a failed endotracheal intubation (ETI). Nevertheless, it is a very important skill in prehospital settings, such as on the battlefield. Hypothesis/Problem: This study aimed to review the Israel Defense Forces (IDF) experience with CRIC over the past two decades. Methods: The IDF Trauma Registry (IDF-TR) holds data on all trauma casualties (civilian and military) cared for by military medical teams since 1997. Data of all casualties treated by IDF from 1998 through 2018 were extracted and analyzed to identify all patients who underwent CRIC procedures. Variables describing the incident scenario, patient’s characteristics, injury pattern, treatment, and outcome were extracted. The success rate of the procedure was described, and selected variables were further analyzed and compared using the Fisher’s-exact test to identify their effect on the success and failure rates. Odds Ratio (OR) was further calculated for the effect of different body part involvement on success and for the mortality after failed ETI. Results: One hundred fifty-three casualties on which a CRIC attempt was made were identified from the IDF-TR records. The overall success rate of CRIC was reported at 88%. In patients who underwent one or two attempts, the success rate was 86%. No difference was found across providers (physician versus paramedic). The CRIC success rates for casualties with and without head trauma were 80% and 92%, respectively (P = .06). Overall mortality was 33%. Conclusions: This study shows that CRIC is of merit in airway management as it has shown to have consistently high success rates throughout different levels of training, injuries, and previous attempts with ETI. Care providers should be encouraged to retain and develop this skill as part of their tool box.

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