scholarly journals Ūminis pankreatitas – dažniausia endoskopinės retrogradinės cholangiopankreatografijos komplikacija

2008 ◽  
Vol 6 (1) ◽  
pp. 0-0
Author(s):  
Laura Mašalaitė ◽  
Tomas Poškus ◽  
Gintautas Radžiūnas ◽  
Jonas Valantinas
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
University Hospital ◽  
Common Complication ◽  
Contrast Injection ◽  
Endoscopic Retrograde ◽  
Therapeutic Ercp ◽  
Vilnius University

Laura Mašalaitė1,  Tomas Poškus2, Gintautas Radžiūnas2, Jonas Valantinas11 Vilniaus universiteto ligoninės Santariškių klinikų Hepatologijos,gastroenterologijos ir dietologijos centras, Santariškių g. 2, LT-08661, VilniusEl paštas: [email protected] Vilniaus universiteto ligoninės Santariškių klinikų Centro filialo 3-iasis pilvo chirurgijos skyrius,Žygimantų g. 3, LT-01102 Vilnius Tikslas Ūminis pankreatitas yra dažniausia endoskopinės retrogradinės cholangiopankreatografijos (ERCP) komplikacija. Rizikos veiksniai, padidinantys pankreatito po ERCP išsivystymą, yra skirstomi į susijusius su pacientu ir susijusius su pačia procedūra. Visiškai išvengti ūminio pankreatito išsivystymo po ERCP neįmanoma, todėl ieškoma įvairių būdų sumažinti šios komplikacijos riziką. Mūsų darbo tikslas – išnagrinėti ūminio pankreatito, išsivysčiusio po diagnostinės ir gydomosios ERCP, dažnį, išsivystymo laiką, diagnostikos ir gydymo metodus, taip pat įvertinti rizikos veiksnius, galėjusius lemti pankreatito išsivystymą. Ligoniai ir metodai 1999–2004 metais 619-ai pacientų buvo atlikta 690 ERCP procedūrų. Retrospektyviai buvo išanalizuotos šių pacientų ligos istorijos. Rezultatai Iš viso per 5 metus buvo padaryta 690 diagnostinių ir gydomųjų ERCP procedūrų 619 pacientų: 41,5% vyrų ir 58,5% moterų; amžiaus vidurkis 62 metai. Po ERCP komplikacijų buvo 55 ligoniams (7,9%). Ūminis pankreatitas išsivystė 17 pacientų (2,46%) ir sudarė 31% visų komplikacijų po ERCP. Dažniausiai (70,6%) pankreatitas pasireiškė per pirmas 24 valandas po procedūros. Dauguma ligonių (88,2%) buvo gydyti konservatyviai, du ligoniai buvo operuoti. Vienas ligonis (5,9%), kuriam po ERCP išsivystė ūminis pankreatitas, mirė no dauginio organų nepakankamumo, visi kiti ligoniai (94,1%) pasveiko. Reikšmingi pankreatito rizikos veiksniai buvo jaunesnis kaip 40 metų amžius, kraujavimas po papilosfinkterotomijos ir dėl to atlikta hemostazė bei kontrasto injekcija į kasos lataką. Išvados Ūminis pankreatitas – dažniausia ERCP komplikacija, kuri išsivystė 2,46% ligonių. Statistiškai reikšmingi pankreatito rizikos veiksniai buvo jaunesnis negu 40 metų amžius, kraujavimas procedūros metu bei kontrasto injekcija į kasos lataką. Ūminis pankreatitas padidina sergamumą ir mirtingumą po ERCP, todėl labai svarbu atrinkti pacientus procedūrai remiantis griežtomis indikacijomis, o išsivysčius komplikacijoms svarbi ankstyva jų diagnostika ir tinkamas gydymas. Pagrindiniai žodžiai: endoskopinė retrogradinė cholangiopankreatografija (ERCP), komplikacijos, ūminis pankreatitas, rizikos veiksniai, profilaktika Acute pancreatitis – the most common complication after endoscopic retrograde cholangiopancreatography Laura Mašalaitė1,  Tomas Poškus2, Gintautas Radžiūnas2, Jonas Valantinas11 Vilnius University Hospital "Santariškių Clinics", Center of Hepatology,Gastroenterology and Dietology, Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Vilnius University Hospital "Santariškių Clinics", Central Branch,III Department of Abdominal Surgery, Žygimantų str. 3, LT-01102 Vilnius, Lithuania Background / objective Acute pancreatitis is the most common complication after endoscopic retrograde cholangiopancreatography (ERCP). Risk factors for pancreatitis are both patient-related and procedure-related. Because post-ERCP pancreatitis can not be prevented completely, the prophylaxis of pancreatitis remains very important. The aim of our study was to investigate the incidence, diagnosis, treatment results and risk factors for pancreatitis after diagnostic and therapeutic ERCP procedures. Patients and methods Between January 1999 and January 2004, 619 patients underwent 690 diagnostic or therapeutic ERCP procedures, and a retrospective analysis of their case histories was performed. Results In the study period 619 patients underwent 690 diagnostic or therapeutic ERCP procedures and 55 patients (7.9%) developed complications after this procedure. Acute pancreatitis, the most common complication after ERCP (31% all complications) developed in 17 patients (2.46%). The most frequent (70.6%) symptoms of pancreatitis developed on the day of the procedure. Of these patients, 88.2% were treated conservatively, two patients were operated on. One patient died because of multiorgan failure, all other patients (94.1%) recovered. Risk factors for pancreatitis were age < 40 years, bleeding after papillosphincterotomy, and pancreatic duct contrast injection. Conclusions Acute pancreatitis, the most common complication after ERCP, developed in 17 patients (2.46%). Risk factors for pancreatitis were age < 40 years, bleeding after papillosphincterotomy, and pancreatic duct contrast injection. ERCP should be considered only for strong indications, and the risk factor analysis, early diagnosis and adequate treatment of post-ERCP pancreatitis are important. Key words: endoscopic retrograde cholangiopancreatography (ERCP), complications, acute pancreatitis, risk factors, prophylaxis

scholarly journals Impact of completion of primary biliary procedure on outcome of endoscopic retrograde cholangiopancreatographic related perforation

2017 ◽  
Vol 05 (08) ◽  
pp. E706-E709 ◽  
Author(s):  
S. Srivastava ◽  
B. Sharma ◽  
A. Puri ◽  
S. Sachdeva ◽  
L. Jain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Female Gender ◽  
Benign Disease ◽  
Endoscopic Retrograde ◽  
Factors Associated ◽  
Risk Of Mortality ◽  
Therapeutic Ercp ◽  
Needle Knife ◽  
The Impact

Abstract Background and aims Perforation is one of the worst complications of therapeutic endoscopic retrograde cholangiopancreatography (ERCP). We aimed to study the epidemiology of ERCP related perforation and the impact of completion of intended procedure on the outcome of this complication. Methods ERCP records from January 2007 to April 2012 were independently evaluated by two investigators for the occurrence of procedure related perforations. A total of 11 500 patients underwent therapeutic ERCP during the study period. The case records of 171 (1.5 %) patients with ERCP related perforations were reviewed to analyze the epidemiology and risk factors associated with poor outcome. Results Of the 171 patients included in this study, the majority of perforations (n = 129, 75.4 %) were related to use of the needle-knife precut technique. Female gender (1.9 % vs 0.7 %, P < 0.001), age > 40 years (1.7 % vs 1.1 %, P < 0.01), and benign disease (1.7 % vs. 1.1 %, P < 0.01) were risk factors for ERCP related perforation. Most of the perforations (n = 135, 79 %) were detected during the procedure. The majority of patients were managed conservatively (n = 164, 96 %). Although 159 patients recovered, 12 patients (7 %) did not survive. Completion of intended biliary procedure for primary disease was associated with low risk of mortality (2 % vs 15.4 %, P < 0.001). Conclusions ERCP related perforation is uncommon. The majority of patients can be managed conservatively. The risk of mortality is low and completion of the intended biliary procedure decreases the risk of mortality.

scholarly journals Prevention of post endoscopic retrograde cholangiopancreatography pancreatitis

2012 ◽  
Vol 03 (S 05) ◽  
pp. 068-070 ◽  
Author(s):  
Nalini M. Guda
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pancreatic Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Invasive Procedures ◽  
Endoscopic Retrograde ◽  
Non Invasive ◽  
Related Risk ◽  
Pancreatic Duct Stenting ◽  
Risk Patients

AbstractPost ERCP pancreatitis (PEP) is a common problem. Knowledge of patient and procedure related risk factors along with appropriate measures aimed at reduction of risk have been successful in reducing both the incidence and the severity. Prophylactic pancreatic duct stenting has definitely reduced the incidence and the severity of PEP in high risk patients. There are some emerging data on the use of non steroidal anti inflammatory agents though this is not widely adapted in practice. Key is to avoid procedures with marginal indications and use of non invasive/less invasive procedures.

scholarly journals Acute pancreatitis in the older patient: Is a new risk score required?

2020 ◽  
pp. 175114372093787
Author(s):  
Michael F Bath ◽  
Robin Som ◽  
Daniel Curley ◽  
Rajab Kerwat
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Elderly Patients ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
The Elderly ◽  
Surgical Patient ◽  
Endoscopic Retrograde ◽  
Co Morbidity ◽  
Severity Scores ◽  
One Year

Introduction The average age of the surgical patient in the UK is increasing. Frailty and cognitive impairment have been shown to be important risk factors in elderly patients with surgical pathology. Limited work has previously assessed the outcomes of acute pancreatitis in the elderly population and the usefulness of current severity scoring methods. We aimed to assess the mortality rates in this cohort and identify any factors that may influence patient outcome. Methods All patients ≥ 80 years admitted with acute pancreatitis between 1 January 2014 and 31 May 2018 were retrospectively identified. Disease severity scores were measured by a modified Ranson score, and patients' co-morbidities were quantified with the Charlson Comorbidity Index. Primary endpoint was whether the patient was alive at discharge; multilevel logistic regression was used to identify any independent risk factors for patient outcomes. Results Eighty-seven patients were included, with an average age of 86 years. The most common aetiology was gallstones. Nine patients died during admission, and ITU admission was the only predictor of mortality (p = 0.027). Twenty-three patients had died by one year. Endoscopic retrograde cholangiopancreatography was more common in patients with gallstone disease who were alive at one year (p = 0.029). Discussion Risk severity and co-morbidity scores are not predictive of outcomes in elderly patients with acute pancreatitis. The use of endoscopic retrograde cholangiopancreatography should be considered in elderly patients with acute gallstone pancreatitis where suitable. Further work is needed to identify improved mortality prediction tools in the elderly with acute pancreatitis and optimal management strategies.

scholarly journals Endoscopic retrograde cholangiopancreatography in infants and children

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.

ID: 3522056 PROGNOSTIC SCORES IN POST-ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY ACUTE PANCREATITIS: IS THERE A BETTER OPTION?

2021 ◽  
Vol 93 (6) ◽  
pp. AB151
Author(s):  
Vítor Macedo Silva ◽  
Marta Freitas ◽  
Rui S. Magalhães ◽  
Tiago Cúrdia Gonçalves ◽  
Pedro Boal Carvalho ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Prognostic Scores ◽  
Endoscopic Retrograde
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