scholarly journals Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study

2020 ◽  
Vol 15 (3) ◽  
pp. 526-532
Author(s):  
Senem Koruk ◽  
Irfan Koruk ◽  
Ayse Arslan ◽  
Murat Bilgi ◽  
Rauf Gul ◽  
...  
Keyword(s):  
Prospective Study ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
Double Blind

scholarly journals Can topical epinephrine application to the papilla prevent pancreatitis after endoscopic retrograde cholangiopancreatography? Results from a double blind, multicentre, placebo controlled, randomised clinical trial

2021 ◽  
Vol 8 (1) ◽  
pp. e000562
Author(s):  
Adriana Fabiola Romano-Munive ◽  
J Jesus García-Correa ◽  
Luis F García-Contreras ◽  
José Ramírez-García ◽  
Luis Uscanga ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Controlled Trial ◽  
Randomised Clinical Trial ◽  
Sterile Water ◽  
Endoscopic Retrograde ◽  
Double Blind ◽  
Registration Number ◽  
Baseline Characteristics ◽  
Randomised Controlled ◽  
Rectal Indomethacin

Background and study aimsPost-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a complication associated with important morbidity, occasional mortality and high costs. Preventive strategies are suboptimal as PEP continues to affect 4% to 9% of patients. Spraying epinephrine on the papilla may decrease oedema and prevent PEP. This study aimed to compare rectal indomethacin plus epinephrine (EI) versus rectal indomethacin plus sterile water (WI) for the prevention of PEP.Patients and methodsThis multicentre randomised controlled trial included patients aged >18 years with an indication for ERCP and naive major papilla. All patients received 100 mg of rectal indomethacin and 10 mL of sterile water or a 1:10 000 epinephrine dilution. Patients were asked about PEP symptoms via telephone 24 hours and 7 days after the procedure. The trial was stopped half way through after a new publication reported an increased incidence of PEP among patients receiving epinephrine.ResultsOf the 3602 patients deemed eligible, 3054 were excluded after screening. The remaining 548 patients were randomised to EI group (n=275) or WI group (n=273). The EI and WI groups had similar baseline characteristics. Patients in the EI group had a similar incidence of PEP to those in the WI group (3.6% (10/275) vs 5.12% (14/273), p=0.41). Pancreatic duct guidewire insertion was identified as a risk factor for PEP (OR 4.38, 95% CI (1.44 to 13.29), p=0.009).ConclusionSpraying epinephrine on the papilla was no more effective than rectal indomethacin alone for the prevention of PEP.Trial registration numberThis study was registered with ClinicalTrials.gov (NCT02959112).

scholarly journals Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in the Indomethacin Era – A Prospective Study

2018 ◽  
Vol 26 (3) ◽  
pp. 176-183
Author(s):  
David N. Perdigoto ◽  
Dário Gomes ◽  
Nuno Almeida ◽  
Sofia Mendes ◽  
Ana Rita Alves ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
A Prospective Study

scholarly journals Doxapram as an additive to propofol sedation for endoscopic retrograde cholangiopancreatography: a placebo-controlled, randomized, double-blinded study

2020 ◽  
Vol 34 (12) ◽  
pp. 5477-5483 ◽  
Author(s):  
Jarno Jokelainen ◽  
Anna Belozerskikh ◽  
Harri Mustonen ◽  
Marianne Udd ◽  
Leena Kylänpää ◽  
...  
Keyword(s):  
Respiratory Depression ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Significant Rise ◽  
Repeated Measurements ◽  
Double Blind Study ◽  
Continuous Variables ◽  
Endoscopic Retrograde ◽  
Double Blind ◽  
Clinical Trial Registration ◽  
Propofol Sedation

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) requires moderate to deep sedation, usually with propofol. Adverse effects of propofol sedation are relatively common, such as respiratory and cardiovascular depression. This study was conducted to determine if doxapram, a respiratory stimulant, could be used to reduce the incidence of respiratory depression. Methods This is a single-center, prospective randomized double-blind study performed in the endoscopy unit of Helsinki University Central Hospital. 56 patients were randomized in a 1:1 ratio to either receive doxapram as an initial 1 mg/kg bolus and an infusion of 1 mg/kg/h (group DOX) or placebo (group P) during propofol sedation for ERCP. Main outcome measures were apneic episodes and hypoxemia (SpO2 < 90%). Mann–Whitney test for continuous variables and Fisher’s exact test for discrete variables were used and mixed effects modeling to take into account repeated measurements on the same subject and comparing both changes within a group as a function of time and between the groups. Results There were no statistically significant differences in apneic episodes (p = 0.18) or hypoxemia (p = 0.53) between the groups. There was a statistically significant rise in etCO2 levels in both groups, but the rise was smaller in group P. There was a statistically significant rise in Bispectral Index (p = 0.002) but not modified Observer’s Assessment of Agitation/Sedation (p = 0.21) in group P. There were no statistically significant differences in any other measured parameters. Conclusions Doxapram was not effective in reducing respiratory depression caused by deep propofol sedation during ERCP. Further studies are warranted using different sedation protocols and dosing regimens. Clinical trial registration ClinicalTrials.gov ID NCT02171910.

scholarly journals Radiation protection effect of mobile shield barrier for the medical personnel during endoscopic retrograde cholangiopancreatography: a quasi-experimental prospective study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e027729 ◽  
Author(s):  
Kwang Hyun Chung ◽  
Young Sook Park ◽  
Sang Bong Ahn ◽  
Byoung Kwan Son
Keyword(s):  
Radiation Dose ◽  
Prospective Study ◽  
Radiation Protection ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Medical Personnel ◽  
Secondary Outcome ◽  
Radiation Doses ◽  
Endoscopic Retrograde ◽  
Quasi Experimental ◽  
The Mean

ObjectiveTo investigate the effectiveness of radiation protection offered by a newly designed mobile shield barrier for medical personnel during endoscopic retrograde cholangiopancreatography (ERCP).DesignQuasi-experimental prospective study.SettingERCP procedures conducted between October 2016 and June 2017 at a single secondary referral hospital that performs approximately 250 therapeutic ERCP procedures annually.InterventionsThe mobile shield barrier was a custom-made 2 mm Pb shielding plate (width: 120 cm, height: 190 cm) with a 0.5 mm Pb window (width: 115 cm, height: 60 cm) on its upper part was used. Four wheels were attached to the bottom to allow easy moving.Primary and secondary outcome measuresThe radiation doses were measured during ERCP using personal thermoluminescence dosimetry (TLD) badges on both sides of the mobile shield barrier (patient’s side: TLD1 and medical staff’s side: TLD2). The radiation doses were also measured on the outer surface of the thyroid shield of the endoscopist (TLD3), and on the chest area inside the protective apron of the endoscopist (TLD4) and the main assistant (TLD5). The TLD was changed and reported once every 3 months. The radiation dose measured by TLD badges were compared.ResultsDuring the study period, a total of 128 ERCP procedures were performed. The mean fluoroscopy time per procedure was 244.9±257.0 s and the mean number of digital radiographs per procedure was 3.7±1.0. TLD1 (outside the barrier) had a mean radiation dose of 26.85±3.47 mSv and all the other TLDs (inside the barrier) had less than 1 mSv (p<0.001). In the post hoc analysis, the difference between TLD1 and others showed a statistical significance; however, there were no significant differences between the TLDs inside the barrier.ConclusionOur mobile shield barrier was useful to reduce the radiation exposure of medical personnel during ERCP.

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