scholarly journals Therapeutic Endoscopy Can Be Performed Safely in an Ambulatory Surgical Center: A Multicenter, Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-10
Author(s):  
Shaffer R. S. Mok ◽  
Henry C. Ho ◽  
John P. Gaughan ◽  
Adam B. Elfant
Keyword(s):  
Total Population ◽  
Sphincter Of Oddi ◽  
Needle Aspiration ◽  
Therapeutic Endoscopy ◽  
Sphincter Of Oddi Dysfunction ◽  
Class Iii ◽  
Endoscopic Retrograde ◽  
Multicenter Prospective Study ◽  
American Society ◽  
Oddi Dysfunction

Background. Even amongst experienced endoscopists, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound with fine needle aspiration (EUS-FNA) carry a potential risk for complications. These procedures are typically performed in a hospital-based endoscopy unit with general anesthesia. Aims. The goal of our study was to evaluate the feasibility of ERCP and EUS-FNA in an ambulatory surgical center (ASC). Methods. From June to November of 2014, we prospectively enrolled consecutive subjects undergoing ERCP and/or EUS-FNA in an ASC. An anesthesiologist, who was not involved in our study group, screened all subjects prior to their scheduled procedure. In order to monitor for adverse events (AE), all subjects received a telephone call at day 1 and 30 days after procedure. Results. 375 subjects (98 inpatients and 277 from an ASC) were enrolled. In the total population, a high proportion of subjects underwent procedures for neoplasms (21 (23.3%) inpatients versus 44 (17.1%) from an ASC) and for sphincter of Oddi dysfunction (SOD) (27 (27.5%) versus 48 (17.3%)) and had the American Society for Anesthesiologists (ASA) class ≥III (75 (76.5%) versus 140 (50.5%)) and high-risk features (17 (17.3%) versus 75 (27.1%)). Overall ERCP-related AE (10 (13.2%) versus 12 (7.5%), p=0.2), pancreatitis (7 (9.2%) versus 11 (6.9%), p=0.6), and hemorrhage (3.9% versus 0.6%, p=0.25) were not different between inpatients and ASC subjects. There was also no difference between inpatients and ASC subjects’ EUS-related AE (1 (4.5%) versus 4 (3.4%), p=0.6), pancreatitis (1 (4.5%) versus 3 (2.6%), p=0.2), and hemorrhage (0% versus 1 (0.9%), p=0.9). Conclusions. ERCP and EUS can be performed in a higher risk population under the supervision of anesthesia in ASCs. Overall, the AE are equivalent between inpatients and ASC subjects.

Risk factors of pancreatitis after endoscopic sphincterotomy. Review of literature and practical remarks based on approximately 10,000 ERCPs

2017 ◽  
Vol 89 (5) ◽  
pp. 29-33 ◽  
Author(s):  
Andrzej Jamry
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Endoscopy ◽  
Cumulative Risk ◽  
Sphincter Of Oddi ◽  
Female Gender ◽  
Current Evidence ◽  
Sphincter Of Oddi Dysfunction ◽  
Endoscopic Retrograde ◽  
Oddi Dysfunction ◽  
Associated Risk Factors

Post-endoscopic pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Depending on the presence of risk factors, PEP can occur in 4,1% to about 43% of patients. According to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines, only three to patient-associated risk factors have been identified: suspected sphincter of Oddi dysfunction (SOD) (OR 4.09), female gender (OR 2.23), and previous pancreatitis (OR 2.46). Another three procedure-associated factors include cannulation attempt duration > 10 minutes (OR 1.76), more than one pancreatic guidewire passage (OR 2.77, CI: 1.79 – 4.30), and pancreatic injection (OR 2.2, CI: 1.60 – 3.01). Importantly, analyses of cumulative risk due to coexistence of several factors emphasize the importance of female sex, difficult cannulation, CBD diameter <5 mm, young age, and many other factors. Unfortunately, studies performed to date have included only small numbers of patients with several co-existing risk factors. Therefore, further analysis of other risk factors and the cumulative risk related to their co-occurrence is necessary. Based on current evidence, special care must be given to patients with several risk factors. Also, care should be given to proper qualification of patients, use of guidewires, early pre-cut incision, protective Wirsung’s duct stenting, and rectal NSAID administration.

scholarly journals Clinical course of biliary-type sphincter of Oddi dysfunction: endoscopic sphincterotomy and functional dyspepsia as affecting factors

2019 ◽  
Vol 12 ◽  
pp. 263177451986718 ◽  
Author(s):  
Hiroyuki Miyatani ◽  
Hirosato Mashima ◽  
Masanari Sekine ◽  
Satohiro Matsumoto
Keyword(s):  
Functional Dyspepsia ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Sphincterotomy ◽  
Severe Pain ◽  
Sphincter Of Oddi ◽  
Sphincter Of Oddi Dysfunction ◽  
Endoscopic Retrograde ◽  
History Of ◽  
Oddi Dysfunction ◽  
New Onset

Background and study aims: The objective of this study was to clarify the effectiveness of treatment selection for biliary-type sphincter of Oddi dysfunction by severe pain frequency and the risk factors for recurrence including the history of functional gastrointestinal disorder. Patients and methods: Thirty-six sphincter of Oddi dysfunction patients who were confirmed endoscopic retrograde cholangiopancreatography enrolled in this study. Endoscopic sphincterotomy was performed for type I and manometry-confirmed type II sphincter of Oddi dysfunction patients with severe pain (⩾2 times/year; endoscopic sphincterotomy group). Others were treated medically (non-endoscopic sphincterotomy group). Results: The short-term effectiveness rate of endoscopic sphincterotomy was 91%. The final remission rates of the endoscopic sphincterotomy and non-endoscopic sphincterotomy groups were 86% and 100%, respectively. Symptoms relapsed after endoscopic sphincterotomy in 32% of patients. Patients in the endoscopic sphincterotomy and non-endoscopic sphincterotomy groups had or developed functional dyspepsia in 41% and 14%, irritable bowel syndrome in 5% and 14%, and gastroesophageal reflux disorder in 14% and 0%, respectively. History or new onset of functional dyspepsia was related to recurrence on multivariate analysis. The frequency of occurrence of post-endoscopic retrograde cholangiopancreatography pancreatitis and post-endoscopic retrograde cholangiopancreatography cholangitis was high in both groups. Two new occurrences of bile duct stone cases were observed in each group. Conclusion: According to the treatment criteria, endoscopic and medical treatment for biliary-type sphincter of Oddi dysfunction has high effectiveness, but recurrences are common. Recurrences may be related to new onset or a history of functional dyspepsia.

scholarly journals Defining a Therapeutic Program for Recurrent Acute Pancreatitis Patients with Unknown Etiology

2014 ◽  
Vol 7 ◽  
pp. CGast.S13531 ◽  
Author(s):  
Vincenzo Neri ◽  
Francesco Lapolla ◽  
Alessandra Di Lascia ◽  
Libero Luca Giambavicchio
Keyword(s):  
Acute Pancreatitis ◽  
Sphincter Of Oddi ◽  
Diagnostic Process ◽  
Unknown Etiology ◽  
Sphincter Of Oddi Dysfunction ◽  
Endoscopic Retrograde ◽  
Recurrent Acute Pancreatitis ◽  
Therapeutic Program ◽  
Oddi Dysfunction

Aim To define a therapeutic program for mild-moderate acute pancreatitis (AP), often recurrent, which at the end of the diagnostic process remains of undefined etiology. Material and Methods In the period 2011-2012, we observed 64 cases of AP: 52 mild-moderate, 12 severe; biliary 39, biliary in alcoholic chronic pancreatitis 5, unexplained recurrent 20. The clinical and instrumental evaluation of the 20 cases of unexplained AP showed 6 patients with biliary sludge, 4 microlithiasis, 4 sphincter of Oddi dysfunction, and 6 cases that remained undefined. Results Among 20 patients with recurrent, unexplained AP at initial etiological assessment, we performed 10 video laparo cholecystectomies (VLCs), 2 open cholecystectomies and 4 endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomies (ERCP/ES) in patients who had undergone previous cholecystectomy; 4 patients refused surgery. Among these 20 patients, 6 had AP that remained unexplained after second-level imaging investigations. For these patients, 4 VLCs and 2 ERCP/ES were performed. Follow-up after six months was negative for further recurrence. Conclusion The recurrence of unexplained acute pancreatitis could be treated with empirical cholecystectomy and/or ERCP/ES in cases of previous cholecystectomy.

scholarly journals Prevalence of sphincter of Oddi dysfunction in patients referred to endoscopic retrograde cholangiopancreatography

2007 ◽  
Vol 44 (1) ◽  
pp. 18-21 ◽  
Author(s):  
Ermelindo Della Libera ◽  
Rodrigo Azevedo Rodrigues ◽  
Ana Paula Rodrigues Guimarães ◽  
Gustavo Andrade de Paulo ◽  
Stephan Geocze ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Sphincter Of Oddi ◽  
Sphincter Of Oddi Dysfunction ◽  
Safe Procedure ◽  
Biliary Strictures ◽  
Biliary Stones ◽  
Endoscopic Retrograde ◽  
Gold Standard Method ◽  
Benign Biliary Strictures ◽  
Oddi Dysfunction

BACKGROUND: Sphincter of Oddi manometry is the gold-standard method for sphincter of Oddi dysfunction. The prevalence of sphincter of Oddi dysfunction among patients referred to endoscopic retrograde cholangiopancreatography is largely unknown. AIM: To evaluate prospectively the prevalence of biliary sphincter of Oddi dysfunction (B-SOD) among Brazilian patients referred to endoscopic retrograde cholangiopancreatography and to study the safety of sphincter of Oddi manometry in this setting. METHODS: Biliary sphincter of Oddi manometry was intended in 110 patients referred to endoscopic retrograde cholangiopancreatography. The number of attempts to obtain deep cannulation with the manometry catheter was recorded and patients were divided into two groups: up to 5 (easy cannulation) and >5 attempts (difficult cannulation). RESULTS: Sphincter of Oddi manometry was successful in 71/110 patients (64.5%). Sphincter of Oddi dysfunction was found in 18/71 patients (25%). Endoscopic retrograde cholangiopancreatography findings were: normal in 16, biliary stones in 39, malignant biliary strictures in 9 and benign biliary strictures in 7. There was no statistical difference in sphincter of Oddi dysfunction prevalence regarding disease, gender or difficulty of cannulation. Only 2/71 patients developed post-procedure mild pancreatitis. CONCLUSIONS: We have found a high prevalence of sphincter of Oddi dysfunction in patients referred to endoscopic retrograde cholangiopancreatography. Gender, nature of disease or difficulty of cannulation did not influence the prevalence of sphincter of Oddi dysfunction among these patients. Sphincter of Oddi manometry is a safe procedure for the evaluation of sphincter of Oddi dysfunction in patients referred to endoscopic retrograde cholangiopancreatography.

scholarly journals Hypertensive Pancreatic Sphincter

1998 ◽  
Vol 12 (5) ◽  
pp. 333-337 ◽  
Author(s):  
Glen A Lehman ◽  
Stuart Sherman
Keyword(s):  
Sphincter Of Oddi ◽  
Treatment Session ◽  
Noninvasive Testing ◽  
Sphincter Of Oddi Dysfunction ◽  
Sphincter Pressure ◽  
Endoscopic Retrograde ◽  
Biliary Sphincterotomy ◽  
Oddi Dysfunction ◽  
Low Sensitivity ◽  
Pancreatic Sphincterotomy

Major papilla pancreatic sphincter dysfunction, a variant of sphincter of Oddi dysfunction, causes pancreatitis or pancreatic-type pain. Endoscopic manometry as performed at endoscopic retrograde cholangiography is the most commonly used method to identify sphincter dysfunction. Noninvasive testing, such as secretin-stimulated ultrasound analysis of duct diameter, is less reliable and of relatively low sensitivity. Two-thirds of patients with sphincter of Oddi dysfunction have elevated pancreatic basal sphincter pressure. Patients with suspected or documented sphincter of Oddi dysfunction may respond to biliary sphincterotomy alone, but warrant evaluation of their pancreatic sphincter if symptoms persist after therapy. Whether such pancreatic and biliary sphincters should be treated at the first treatment session is controversial. Pancreatic sphincterotomy is associated with a complication rate very similar to that of biliary sphincterotomy except that the pancreatitis rate is two- to fourfold higher. Prophylactic pancreatic stenting diminishes such pancreatitis by approximately 50%.

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