Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Management of Choledochal Cysts

Choledochal cysts are an uncommon anomaly of the biliary system manifested by cystic dilatation of the extra or intrahepatic biliary tree or both. It is most frequently found in Orientals and in females. Endoscopic retrograde cholangiopancreatography is a valuable imaging technique in the diagnosis of choledochal cysts in adults. Additionaly, in selected cases, a choledochocele may be effectively managed by endoscopic sphincterotomy. We present clinical and endoscopic findings of six adult patients with choledochal cysts. Clinical symptoms were characterized by abdominal pain, jaundice and cholangitis. Associated hepatobiliary pathologic findings included cholelithiasis, recurrent acute pancreatitis, gallbladder carcinoma, Cystolithiasis, choledocholithiasis, biliary stricture and hepatic abscess.

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Endoscopic retrograde cholangiopancreatography in infants and children

Endoscopy International Open ◽

10.1055/a-1337-2212 ◽

2021 ◽

Vol 09 (03) ◽

pp. E292-E296

Author(s):

Tone Lise Åvitsland ◽

Lars Aabakken

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Medical Records ◽

Pediatric Patients ◽

Biliary Stricture ◽

Infants And Children ◽

University Hospital ◽

Older Children ◽

Endoscopic Retrograde ◽

Procedure Codes ◽

In Infants And Children

Abstract Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients < 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic.Complications were uncommon in infants; only two episodes of infection were registered. In children (> 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children.

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Endoscopic Fistulotomy – ‘The Suprapapillary Punch’: A Method of Access to the Bile Duct during ERCP

Canadian Journal of Gastroenterology ◽

10.1155/1994/497470 ◽

1994 ◽

Vol 8 (1) ◽

pp. 33-35

Author(s):

Noel B Hershfield

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Biliary Tree ◽

Usual Method ◽

Endoscopic Retrograde ◽

The Common ◽

A Minor ◽

Endoscopic Fistulotomy

Endoscopic retrograde cholangiopancreatography (ERCP) is established as the method of choice to investigate the biliary tree when obstruction is suspected. On rare occasions, the papilla cannot be entered because of anatomical or pathological abnormalities. This report describes endoscopic fistulotomy or the suprapapillary punch that has been carried out at the Foothills Hospital in Calgary, Alberta, on 30 of 623 patients referred for ERCP for conditions causing obstruction of the common bile duct or suspected obstruction of the common bile duct. The following communication also describes the method of suprapapillary punch or endoscopic fistulotomy. Results have been excellent with only one complication, a minor attack of pancreatitis after the procedure. In summary, the suprapapillary punch or fistulotomy is a safe and useful method for entering the common bile duct when access by the usual method is impossible.

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The Clinical Relevance of Same-session Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography Guided Tissue Sampling for Biliary Stricture

Korean Journal of Gastroenterology ◽

10.4166/kjg.2019.73.4.193 ◽

2019 ◽

Vol 73 (4) ◽

pp. 193

Author(s):

Jae Hee Cho

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Ultrasonography ◽

Clinical Relevance ◽

Biliary Stricture ◽

Tissue Sampling ◽

Endoscopic Retrograde

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Number of Endoscopic Retrograde Cholangiopancreatography Procedures Required for Short Biliary Cannulation Time

Gastroenterology Research and Practice ◽

10.1155/2017/1515260 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Koichiro Mandai ◽

Koji Uno ◽

Yasutoshi Fujii ◽

Takuji Kawamura ◽

Kenjiro Yasuda

Keyword(s):

Pancreatic Cancer ◽

Bile Duct ◽

Confidence Interval ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Odds Ratio ◽

Biliary Stricture ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Malignant Biliary Stricture ◽

Cannulation Success Rate

Background. Several previous studies assessed the competence in endoscopic retrograde cholangiopancreatography (ERCP) using the bile duct cannulation success rate. However, the cannulation time is also important, because a long cannulation time was reported to be a risk factor for post-ERCP pancreatitis. Aim. To determine the number of ERCP procedures required for short cannulation time of the bile duct. Methods. We retrospectively analyzed 605 ERCP procedures performed for bile duct cannulation in patients with native papilla at our institution between March 2012 and December 2015. The successful procedures were divided into 2 groups: group L and group S (cannulation time>15 minutes and ≤15 minutes, resp.). An analysis of the relationship among the biliary cannulation time, ERCP experience, and other factors was then conducted. Results. Multivariate analysis showed that the ERCP experience of ≤300 procedures (odds ratio, 2.080; 95% confidence interval, 1.337–3.142; P=0.001) and malignant biliary stricture due to pancreatic cancer (odds ratio, 1.912; 95% confidence interval, 1.072–3.412; P=0.028) were found to be significantly associated with a cannulation time of >15 minutes. Conclusions. Our findings suggested that an ERCP experience of ≤300 procedures and malignant biliary stricture due to pancreatic cancer were associated with prolonged biliary cannulation time.

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Role of endoscopic retrograde cholangiopancreatography in diagnosis and management of congenital choledochal cysts: 28 pediatric cases

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2012.01.040 ◽

2012 ◽

Vol 47 (5) ◽

pp. 885-888 ◽

Cited By ~ 23

Author(s):

Paola De Angelis ◽

Francesca Foschia ◽

Erminia Romeo ◽

Tamara Caldaro ◽

Francesca Rea ◽

...

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Choledochal Cysts ◽

Endoscopic Retrograde ◽

Diagnosis And Management

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A novel, stiff-shaft, flexible-tip guidewire for cannulation of biliary stricture during endoscopic retrograde cholangiopancreatography: a randomized trial

Endoscopy ◽

10.1055/s-0034-1391620 ◽

2015 ◽

Vol 46 (10) ◽

pp. c1-c1

Author(s):

Jörg Albert ◽

Katja Lucas ◽

Natalie Filmann ◽

Eva Herrmann ◽

Oliver Schröder ◽

...

Keyword(s):

Randomized Trial ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Biliary Stricture ◽

Endoscopic Retrograde

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An Unusual Recurrent Bile Leak Following High Grade Liver Trauma

JOURNAL OF ACUTE CARE SURGERY ◽

10.17479/jacs.2021.11.3.137 ◽

2021 ◽

Vol 11 (3) ◽

pp. 137-140

Author(s):

Morgan E Jones ◽

Ee Jun Ban ◽

Charles H. C. Pilgrim

Keyword(s):

Liver Injury ◽

Endoscopic Retrograde Cholangiopancreatography ◽

High Speed ◽

Bile Leak ◽

Biliary Tree ◽

Operative Management ◽

Liver Trauma ◽

Post Injury ◽

Endoscopic Retrograde ◽

Non Operative Management

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.

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Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis

Endoscopy International Open ◽

10.1055/a-0862-0215 ◽

2019 ◽

Vol 07 (04) ◽

pp. E477-E486 ◽

Cited By ~ 14

Author(s):

Juan Serrano ◽

Diogo de Moura ◽

Wanderley Bernardo ◽

Igor Ribeiro ◽

Tomazo Franzini ◽

...

Keyword(s):

Acute Pancreatitis ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Meta Analysis ◽

Biliary Tree ◽

Rectal Administration ◽

Control Group ◽

Endoscopic Retrograde ◽

Therapeutic Success ◽

Inflammatory Drugs ◽

Anti Inflammatory

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic procedure for treatment of diseases that affect the biliary tree and pancreatic duct. While the therapeutic success rate of ERCP is high, the procedure can cause complications, such as acute pancreatitis (PEP), bleeding, and perforation. This meta-analysis aimed to assess the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing PEP following (ERCP). Materials and methods We searched databases, such as MEDLINE, Embase, and Cochrane Central Library. Only randomized controlled trials (RCTs) that compared the efficacy of NSAIDs and placebo for the prevention of PEP were included. Outcomes assessed included incidence of PEP, severity of pancreatitis, route of administration, and type of NSAIDs. Results Twenty-one RCTs were considered eligible with a total of 6854 patients analyzed. Overall, 3427 patients used NSAIDs before ERCP and 3427 did not use the drugs (control group). In the end, 250 cases of acute pancreatitis post-ERCP were diagnosed in the NSAIDs group and 407 cases in the placebo group. Risk for PEP was lower in the NSAID group (risk difference (RD): −0.05; 95 % confidence interval (CI): −0.07 to – 0.03; number need to treat (NNT), 20; P < 0.05). Use of NSAIDs effectively prevented mild pancreatitis compared with use of placebo (2.5 % vs. 4.1 %; 95 % CI, −0.05 to – 0.01; NNT, 33; P < 0.05), but the information on moderate and severe PEP could not be completely elucidated. Only rectal administration reduced incidence of PEP (6.8 % vs. 13 %; 95 % CI, −0.10 to – 0.04; NNT, 20; P < 0.05). Furthermore, only diclofenac or indomethacin use was effective in preventing PEP. Conclusions Rectal administration of diclofenac and indomethacin significantly reduced risk of developing mild PEP. Further RCTs are needed to compare efficacy between NSAID administration pathways in prevention of PEP after ERCP.

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Endoscopic Retrograde Cholangiopancreatography and Endoscopic Sphincterotomy: Experience in the Sudan

Tropical Doctor ◽

10.1177/004947559302300110 ◽

1993 ◽

Vol 23 (1) ◽

pp. 20-23

Author(s):

Sulieman S Fedail ◽

A Alia Gaber ◽

Ikhals Sulieman

Keyword(s):

Pancreatic Cancer ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Sphincterotomy ◽

Advanced Pancreatic Cancer ◽

Biliary Tract Disease ◽

Biliary Tree ◽

Pancreatic Disease ◽

Endoscopic Retrograde ◽

Abnormal Finding ◽

Tract Disease

Over a 5 year period 626 endoscopic retrograde cholangiopancreatography (ERCP) examinations were attempted in Khartoum, Sudan. The relevant duct was successfully cannulated and visualized in 94% of cases of biliary tract disease and in 73% of cases of pancreatic disease. This was due to the large number of cases with advanced pancreatic cancer. The commonest abnormal finding was stones in the biliary tree in 214 cases (35% of all cases). Cholangiocarcinoma was seen in 18 cases, pancreatic cancer in 64 cases, chronic pancreatitis in 48 cases and periampullary carcinoma in 20 cases. ERCP was considered normal in 100 cases. Endoscopic sphincterotomy (EST) was performed in 48 cases; 44 had common duct stones. ERCP and EST are feasible and useful procedures in a developing country. However they are expensive and should be carried out in referral centres.

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