Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

Abstract Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI 2.693–466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

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Risk Factors for Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography in Patients With Surgically Altered Anatomy: A Retrospective Study

10.21203/rs.3.rs-835539/v1 ◽

2021 ◽

Author(s):

Xiaojia Chen ◽

Fan Wang ◽

Jing Liu ◽

Zhang Zhang ◽

Tingting Cao ◽

...

Keyword(s):

Risk Factors ◽

Bile Duct ◽

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Univariate Analysis ◽

Balloon Dilation ◽

Endoscopic Papillary Balloon Dilation ◽

Endoscopic Retrograde ◽

Therapeutic Success ◽

Surgically Altered Anatomy

Abstract Introduction : Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI, 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI, 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI, 2.693-466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

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Underwater cap-assisted Endoscopic Retrograde Cholangiopancreatography in patients with surgically altered anatomy: a pilot study

Endoscopy ◽

10.1055/a-1311-9779 ◽

2020 ◽

Author(s):

Alessandro Fugazza ◽

Andrea Anderloni ◽

Danilo Paduano ◽

Matteo Badalamenti ◽

Roberta Maselli ◽

...

Keyword(s):

Bile Duct ◽

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Management ◽

Biliary Disease ◽

Bile Duct Stones ◽

Endoscopic Retrograde ◽

Promising Alternative ◽

Surgically Altered Anatomy ◽

Transparent Cap

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy (SAA) pa-tients is technically challenging and associated with a significant number of failures. We examined the feasibility and efficacy of a novel technique for management of jaundice orcholangitis second-ary to bile duct stones (BDS), called underwater cap-assisted ERCP (u-ERCP). Methods Between June 2019 and February 2020 all patients with jaundice or cholangitis secondary to bile duct stones (BDS) with SAA who underwent u-ERCP were enrolled. The u-ERCP tecnnique combines the underwater advancement of a pediatric colonoscope with a transparent cap fitted on the tip of the endoscope. We evaluated the technical success, clinical suc-cess and adverse events associated with u-ERCP. Results We describe the technique itself and our first experience in 6 patients. A complete and successful procedure was carried out in all patients with no adverse events occurrence. None of the patients needed additional treatments for recurrence of symptoms during the follow-up period. Conclusions The u-ERCP can be considered as a promising alternative for successful endoscopic management of biliary disease in patients with SAA.

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Adverse events of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy

Progress of Digestive Endoscopy ◽

10.11641/pde.92.1_64 ◽

2018 ◽

Vol 92 (1) ◽

pp. 64-68

Author(s):

Kunihiro Hosono ◽

Kensuke Kubota ◽

Akito Iwasaki ◽

Takamitsu Sato ◽

Emiko Tanida ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Retrograde ◽

Balloon Enteroscopy ◽

Surgically Altered Anatomy

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Laparoscopy-assisted versus enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass: a meta-analysis

Endoscopy International Open ◽

10.1055/a-1070-9132 ◽

2020 ◽

Vol 08 (03) ◽

pp. E423-E436 ◽

Cited By ~ 4

Author(s):

Fares Ayoub ◽

Tony S. Brar ◽

Debdeep Banerjee ◽

Ali M. Abbas ◽

Yu Wang ◽

...

Keyword(s):

Gastric Bypass ◽

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Procedure Time ◽

Endoscopic Retrograde ◽

Therapeutic Success ◽

Procedural Time

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy, which is increasing in frequency given the rise of obesity. Laparoscopy-assisted ERCP (LA-ERCP) and enteroscopy-assisted ERCP (EA-ERCP) are distinct approaches with their respective strengths and weaknesses. We conducted a meta-analysis comparing the procedural time, rates of success and adverse events of each method. Patients and methods A search of PubMed, EMBASE and the Cochrane library was performed from inception to October 2018 for studies reporting outcomes of LA or EA-ERCP in patients with RYGB anatomy. Studies using single, double, ‘short’ double-balloon or spiral enteroscopy were included in the EA-ERCP arm. Outcomes of interest included procedural time, papilla identification, papilla cannulation, therapeutic success and adverse events. Therapeutic success was defined as successful completion of the originally intended diagnostic or therapeutic indication for ERCP. Results A total of 3859 studies were initially identified using our search strategy, of which 26 studies met the inclusion criteria. The pooled rate of therapeutic success was significantly higher in LA-ERCP (97.9 %; 95 % CI: 96.7–98.7 %) with little heterogeneity (I2 = 0.0 %) when compared to EA-ERCP (73.2 %; 95 % CI: 62.5–82.6 %) with significant heterogeneity (I2: 80.2 %). Conversely, the pooled rate of adverse events was significantly higher in LA-ERCP (19.0 %; 95 % CI: 12.6–26.4 %) when compared to EA-ERCP (6.5 %; 95% CI: 3.9–9.6 %). The pooled mean procedure time for LA-ERCP was 158.4 minutes (SD ± 20) which was also higher than the mean pooled procedure time for EA-ERCP at 100.5 minutes (SD ± 19.2). Conclusions LA-ERCP is significantly more effective than EA-ERCP in patients with RYGB but is associated with a higher rate of adverse events and longer procedural time.

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Risk Factors for Success, Complications, and Death after Endoscopic Sphincterotomy for Bile Duct Stones: A 17-Year Experience with 2,137 Cases

Digestive Diseases ◽

10.1159/000507321 ◽

2020 ◽

Vol 38 (6) ◽

pp. 534-541 ◽

Cited By ~ 2

Author(s):

Júlio Carlos Pereira Lima ◽

Ivan David Arciniegas Sanmartin ◽

Bruna Latrônico Palma ◽

Carlos Eduardo Oliveira dos Santos

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Sphincterotomy ◽

Older Patients ◽

Bile Duct Stones ◽

Related Complication ◽

Endoscopic Retrograde ◽

Stone Removal

Background: Risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) complications are well-studied. However, risk factors for complications and success after endoscopic sphincterotomy (EST) for duct stones are poorly determined. This study aimed to verify risk factors for mortality, complications, and success after EST. Methods: A multivariate analysis was carried out in a dataset of ERCPs performed during 17 years. Results: A total of5,226 ERCPs were performed, of which 2,137 were in patients with bile duct stones (1,458 women and 679 men; mean age = 57 years) who underwent EST with attempted stone removal. There were 171 (8%) complications, with pancreatitis in 87 (4.1%), bleeding in 48 (2.2%), other complications in 36 (1.8%), and mortality of 0.6%. Successful stone(s) removal was obtained in 2,028 cases (94.9%). On multivariate analysis, mortality was associated with age >60 years (1 vs. 0.2%), cholangitis (4.3 vs. 0.3%), and EST-related complications (5.8 vs. 0.2%). Complications were associated with unsuccessful stone removal (13.4 vs. 7.5%) and difficult cannulation (13.9 vs. 5.4%). An unsuccessful EST was independently related to difficult cannulation (86.2 vs. 98.7%), precutting (79.4 vs. 96.4%), and complications (86.5 vs. 95.6%). Conclusions: Risk factors for complications after EST for stones are delayed bile duct cannulation and failed stone retrieval. Mortality is higher in older patients, those who presented with an EST-related complication, or those who presented initially with cholangitis. Difficult cannulation, EST-related complications, and precutting were associated with an unsuccessful procedure. In this series, outpatient EST with attempted stone retrieval was found to be as safe as performing the procedure in hospitalized patients.

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Risk Factors for Adverse Events Following Endoscopic Retrograde Cholangiopancreatography (ERCP): Is the Invasiveness of the Procedure Related with Major Complications and Pancreatitis?

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2009.03.226 ◽

2009 ◽

Vol 69 (5) ◽

pp. AB146-AB147

Author(s):

Carlos Huertas-Nadal ◽

Montserrat Figa ◽

Ferrán González-Huix ◽

Marcela Perez

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Retrograde ◽

Major Complications

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Analysis of the Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Children With Symptomatic Pancreas Divisum

Frontiers in Pediatrics ◽

10.3389/fped.2021.761331 ◽

2021 ◽

Vol 9 ◽

Author(s):

Guixian Pan ◽

Kaihua Yang ◽

Biao Gong ◽

Zhaohui Deng

Keyword(s):

Risk Factors ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Pancreas Divisum ◽

Medical Center ◽

Statistical Significance ◽

Univariate Analysis ◽

Median Number ◽

Therapeutic Effects ◽

Endoscopic Retrograde ◽

Pancréas Divisum

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in children with symptomatic pancreas divisum (PD).Aim: To investigate the safety and efficacy of ERCP in the treatment of children with symptomatic PD.Methods: We performed a retrospective analysis on children with PD who were treated with ERCP at Shanghai Children's Medical Center between June 2015 and May 2020. Pertinent patient, clinical and procedural data were collected to assess the therapeutic effects and identify the risk factors for post-ERCP pancreatitis (PEP).Results: Overall, 114 ERCPs were performed in 46 children with PD. With a median follow-up of 28.5 months (12–71 months), 40 (87.0%) children achieved clinical remission, the median number of acute pancreatitis episodes decreased from four times per year pre-operatively to once per year post-operatively (P < 0.001), and the nutritional score improved post-operatively (P = 0.004). The incidence of PEP was 7.9%, and female sex, stone extraction, and gene mutations were identified as possible risk factors for PEP on univariate analysis. However, there was no statistical significance on multivariate analysis (P > 0.05).Conclusion: Therapeutic ERCP is an effective and safe intervention for children with symptomatic PD.

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Risk factors for the development of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones

World Journal of Gastrointestinal Endoscopy ◽

10.4253/wjge.v11.i10.515 ◽

2019 ◽

Vol 11 (10) ◽

pp. 515-522

Author(s):

Hirokazu Saito ◽

Tatsuyuki Kakuma ◽

Ikuo Matsushita

Keyword(s):

Risk Factors ◽

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Endoscopic Retrograde

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Epinephrine in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Preliminary Study

Case Reports in Gastroenterology ◽

10.1159/000479494 ◽

2018 ◽

Vol 12 (1) ◽

pp. 125-136 ◽

Cited By ~ 6

Author(s):

Behzad Hatami ◽

Seyed Mohammad Hossein Kashfi ◽

Mohammad Abbasinazari ◽

Ehsan Nazemalhosseini Mojarad ◽

Mohammad Amin Pourhoseingholi ◽

...

Keyword(s):

Risk Factors ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Univariate Analysis ◽

Combination Group ◽

Endoscopic Retrograde ◽

Significant Difference ◽

Blinded Manner ◽

Group A ◽

Group B ◽

Double Blinded

Background: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The incidence of post-ERCP pancreatitis (PEP) ranges between 15 and 20% among patients at high risk of developing PEP. The efficacy of indomethacin administration in the prevention of PEP is rather debatable. In the present randomized trial study, we evaluated whether or not the combination of indomethacin and epinephrine in comparison to the single administration of indomethacin differs in the pathogenesis and prevention of post-ERCP pancreatitis. Patients and Methods: One hundred and ninety-two patients were randomized in a double-blinded manner into 3 groups: the epinephrine group (group A), the indomethacin group (group B), and the combined epinephrine and indomethacin group (group C). After the procedure, patients were evaluated for the PEP development. Results: During the procedure, 66 patients were randomized to the epinephrine group (group A), 68 cases to the indomethacin group (group B), and 58 individuals to the indomethacin-epinephrine group (group C). The mean age of patients in the epinephrine group was 59.59 ± 15.680 years, in the indomethacin group it was 58.06 ± 17.125 years, and in the combination group it was 59.62 ± 15.369 years. In the present study, we did not observe a significant difference between the 3 groups in sex, age, pre-ERCP amylase, lipase, and patient and procedure risk factors including pancreatic duct (PD) dilation (p = 0.404), PD cannulation (p = 0.329), and difficult cannulation (p = 0.076) among others. PEP developed in 7 of the 192 individuals (3.6%), 6 PEP cases occurred in the indomethacin group and 1 in the epinephrine group (p = 0.016). Univariate analysis of risk factors for PEP in patients with and without pancreatitis revealed no significant difference between the pancreatitis group and the non-pancreatitis group. Conclusion: In comparison to the administration of indomethacin alone, a single application of epinephrine and the combination of epinephrine and indomethacin seem to be effective in reducing the cases of PEP. A further randomized clinical trial with a larger sample size is required to confirm the efficacy of our medication in the prevention of pancreatitis after ERCP.

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