scholarly journals Endoscopic retrograde cholangiopancreatography in giant lithiasis of the bile tract: case report and literature review

2021 ◽  
Author(s):  
Alexandro Corona ◽  
José M. Zepeda ◽  
Fabiola Bustos ◽  
Javier Contreras ◽  
Felix Osuna
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biliary Disease ◽  
Multidisciplinary Management ◽  
Distal Bile Duct ◽  
Optimal Conditions ◽  
Endoscopic Retrograde ◽  
Selection Of Patients ◽  
Selection Of

In Mexico, the prevalence of biliary disease is 8.5% in men and 20.5% in women. Choledocholithiasis is a frequent clinical entity, predominantly in females and with well-defined risk factors. Obstruction of the bile duct due to stones is called giant choledocholithiasis when the largest diameter of the stone is greater than 15 mm. Endoscopic treatment fails in up to 88% of cases of giant choledocholithiasis. The authors presented the case of a patient suffering from giant choledocholithiasis, of 9 years of evolution, with an endoprosthesis, successfully treated by ERCP (endoscopic retrograde cholangiopancreatography). The selection of patients who will undergo this type of procedure must be careful, multidisciplinary management is essential to maintain the optimal conditions possible for each case, since the risks are usually high, it is a fact that the diameter of the distal bile duct it is the most important predictive factor when selecting the diameter of the balloon to use, since excessive dilation increases the risk of perforation.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojia Chen ◽  
Fan Wang ◽  
Jing Liu ◽  
Wenhui Tao ◽  
Zhang Zhang ◽  
...  
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.

scholarly journals A Novel Two-Step Approach for Retrieval of an Impacted Biliary Extraction Basket

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Calvin H. Y. Chan ◽  
Fergal Donnellan ◽  
Godfrey C. K. Chan ◽  
Michael F. Byrne
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Balloon Dilatation ◽  
Bile Duct Stone ◽  
Surgical Removal ◽  
Distal Bile Duct ◽  
Endoscopic Retrograde ◽  
Safe Technique

Biliary extraction baskets are a commonly used instrument for the removal of choledocholithiasis in endoscopic retrograde cholangiopancreatography (ERCP). Impaction of the extraction basket is a recognized complication of ERCP, and is usually the result of discrepancy between the size of bile duct stone and the diameter of the distal bile duct. Whilst mechanical lithotriptors can be used to crush the stone or break the wires of the basket to allow its release, failure of the lithotriptor device can occur. We describe the case of a 59-year-old gentleman who had an ERCP performed for choledocholithiasis. Basket impaction was encountered, and the mechanical lithotriptor failed to dislodge the stone/basket complex. A two-step technique involving balloon dilatation and forceps manipulation of the basket was applied to successfully dislodge the impacted basket. We believe this simple and safe technique should be adopted to rescue impacted biliary extraction baskets to avoid the need for potential surgical removal.

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

2020 ◽  
Vol 38 (6) ◽  
pp. 534-541 ◽  
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

<b><i>Background:</i></b> 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. <b><i>Methods:</i></b> A multivariate analysis was carried out in a dataset of ERCPs performed during 17 years. <b><i>Results:</i></b> 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 &#x3e;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%). <b><i>Conclusions:</i></b> 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.

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

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.

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

Endoscopy ◽  
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.

scholarly journals Incidence and risk factors of residual bile duct stones after extraction by endoscopic retrograde cholangiopancreatography

2020 ◽  
Author(s):  
Akashi Fujita ◽  
Kazunari Nakahara ◽  
Yosuke Michikawa ◽  
Ryo Morita ◽  
Keigo Suetani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bile Duct Stone ◽  
Multiple Logistic Regression Analysis ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
And Performance ◽  
Univariate Analyses ◽  
Residual Stones

Abstract Background: Residual bile duct stones may be found eventually after confirmation of complete stone removal. Aims: we retrospectively investigated the incidence and risk factors of residual bile duct stones after extraction by endoscopic retrograde cholangiopancreatography (ERCP). Methods: We conducted a retrospective review of all ERCP sessions that underwent endoscopic bile duct stone extraction between April 2014 and March 2019. A total of 505 patients were enrolled to evaluate the incidence and risk factors of residual bile duct stones after ERCP. Results: The rate of residual stones was 4.8% (24/505). Residual stones were detected by CT (12/24) or MRCP (12/24). In univariate analyses, a large number of stones (P = 0.01), long procedure time (P = 0.005), and performance of the pancreatic duct guidewire placement method (P-GW) for selective bile duct cannulation (P = 0.01) were the factors involved in residual stones. In multiple logistic regression analysis, performing P-GW was retained as the only independent factor of residual stones (odds ratio [OR], 3.4; 95% CI, 1.1–9.5; P = 0.02). Conclusions: When removing bile duct stones with a pancreatic guidewire in place, paying attention to residual stones is necessary.

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