scholarly journals Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic Hepatic Ductal Injuries due to Blunt Trauma: Diagnostic and Treatment Algorithms

HPB Surgery ◽  
2008 ◽  
Vol 2008 ◽  
pp. 1-9 ◽  
Author(s):  
Nikhil P. Jaik ◽  
Brian A. Hoey ◽  
S. Peter Stawicki
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
English Language ◽  
Hepatic Duct ◽  
Traumatic Injury ◽  
Illustrative Case ◽  
Endoscopic Retrograde ◽  
Left Hepatic Duct ◽  
Abdominal Ultrasonography ◽  
Treatment Algorithms

Extrahepatic hepatic ductal injuries (EHDIs) due to blunt abdominal trauma are rare. Given the rarity of these injuries and the insidious onset of symptoms, EHDI are commonly missed during the initial trauma evaluation, making their diagnosis difficult and frequently delayed. Diagnostic modalities useful in the setting of EHDI include computed tomography (CT), abdominal ultrasonography (AUS), nuclear imaging (HIDA scan), and cholangiography. Traditional options in management of EHDI include primary ductal repair with or without a T-tube, biliary-enteric anastomosis, ductal ligation, stenting, and drainage. Simple drainage and biliary decompression is often the most appropriate treatment in unstable patients. More recently, endoscopic retrograde cholangiopancreatography (ERCP) allowed for diagnosis and potential treatment of these injuries via stenting and/or papillotomy. Our review of 53 cases of EHDI reported in the English-language literature has focused on the evolving role of ERCP in diagnosis and treatment of these injuries. Diagnostic and treatment algorithms incorporating ERCP have been designed to help systematize and simplify the management of EHDI. An illustrative case is reported of blunt traumatic injury involving both the extrahepatic portion of the left hepatic duct and its confluence with the right hepatic duct. This injury was successfully diagnosed and treated using ERCP.

Role of SCO-792, A Novel Enteropeptidase Inhibitor, In the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

2021 ◽  
Author(s):  
Mohammed Yousif Rashid ◽  
Anupa Gnawali
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Preventive Measures ◽  
Vital Role ◽  
Duodenal Juice ◽  
Significant Morbidity ◽  
Endoscopic Retrograde ◽  
Pancreatic Parenchyma ◽  
New Novel ◽  
Rate Limiting

AbstractAcute pancreatitis is the most common iatrogenic dilemma of endoscopic retrograde cholangiopancreatography, and it is associated with significant morbidity and mortality. Several factors have been implicated in the pathogenesis of post-endoscopic retrograde cholangiopancreatography pancreatitis, and preventive measures were practiced accordingly. This study aims to refine the potential mechanisms that trigger post-endoscopic retrograde cholangiopancreatography pancreatitis and define the role of enteropeptidase in the pathogenesis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Furthermore, address the role of a new novel medication known as SCO-792, a potent enteropeptidase inhibitor, in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.Post-endoscopic retrograde cholangiopancreatography pancreatitis is caused by premature activation of the pancreatic enzymes within the pancreatic parenchyma. This activation is either an autoactivation due to direct provocation of intra-acinar enzymes as a result of the procedure or due to activation by enterpeptidase, a rate-limiting enzyme. Endoscopic retrograde cholangiopancreatography interjects duodenal juice that is rich in enterokinase into the pancreatic-biliary tract, which in turn leads to intra-ductal activation of trypsinogen and subsequent enzymes. Given the vital role of enterokinase in initiating the pathogenesis of pancreatitis, enteropeptidase inhibition may prevent and reduce the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis.SCO-792, a novel enteropeptidase inhibitor, is developed by SCOHIA Pharma, and pre-clinical trials confirmed its efficacy in inhibiting enteropeptidase. Studies are needed to confirm the efficacy of enteropeptidase inhibitors in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis.

Spectrum of periampullary lesions and the role of endoscopic retrograde cholangiopancreatography in their diagnosis

2021 ◽  
Vol 6 (1) ◽  
pp. 25
Author(s):  
EmadM Abd-Elkhalik ◽  
MorsyM Morsy ◽  
SalahI Mohammed ◽  
MahmoudR Shehata ◽  
AdnanA Mohammed
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Retrograde

Endoscopic Retrograde Cholangiopancreatography in General Surgery: How Much are We Outsourcing?

2009 ◽  
Vol 75 (11) ◽  
pp. 1050-1053
Author(s):  
Wesley B. Jones ◽  
Richard H. Roettger ◽  
William S. Cobb ◽  
Alfredo M. Carbonell
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Surgical Patients ◽  
Time Interval ◽  
Endoscopic Retrograde ◽  
Care Surgery ◽  
Surgery Department ◽  
Nonsurgical Patients

Although surgeons can safely perform endoscopic retrograde cholangiopancreatography (ERCP), it has fallen within the domain of gastroenterologists. We sought to quantify the role of ERCP in a tertiary-care surgery department. The hospital discharge database was queried for all ERCPs performed from January 2007 to December 2007. Gastroenterologists performed all ERCPs in our query. Surgical patients were admitted and/or under the care of a surgeon; whereas nonsurgical patients had no surgeon involvement. Patient characteristics and diagnoses were compared between groups. ERCP procedural details were recorded. Surgical patients comprised 48 per cent (n = 151) of the total 311 ERCPs performed. The mean time interval from a surgeon's request for ERCP to actual procedure was 2.43 days (standard deviation [SD] 2.55; range, 0-13 days). The surgical group had significantly different diagnoses and underwent less diagnostic (22% vs 56%) and more therapeutic ERCPs (72% vs 38%). Surgical patients were more likely inpatients (82.1% vs 16.8%) with a longer length of stay (6.7 vs 3.9 days; P = 0.0029) compared with nonsurgical patients. We found surgical patients requiring ERCP differ significantly from nonsurgical patients, with a significant number of technical interventions being outsourced. Given the benefits of a surgical ERCP program and the potential volume of these unique patients, this procedure should be performed by appropriately trained surgeons.

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