scholarly journals Role of Endoscopic Retrograde Cholangiopancreatography Guided Brush Cytology in Evaluation of Malignant Biliary Tract Strictures: Experience of a Tertiary Care Teaching Centre in Northern India

2018 ◽  
Author(s):  
Preeti Agarwal ◽  
Shivanjali Raghuvanshi ◽  
Sucheta Yadav ◽  
Shalini Bhalla ◽  
Raj Mehrotra ◽  
...  
Keyword(s):  
Biliary Tract ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
Brush Cytology ◽  
Endoscopic Retrograde ◽  
Care Teaching ◽  
Northern India

Endoscopic Retrograde Cholangiopancreatography in General Surgery: How Much are We Outsourcing?

2009 ◽  
Vol 75 (11) ◽  
pp. 1050-1053
Author(s):  
Wesley B. Jones ◽  
Richard H. Roettger ◽  
William S. Cobb ◽  
Alfredo M. Carbonell
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Surgical Patients ◽  
Time Interval ◽  
Endoscopic Retrograde ◽  
Care Surgery ◽  
Surgery Department ◽  
Nonsurgical Patients

Although surgeons can safely perform endoscopic retrograde cholangiopancreatography (ERCP), it has fallen within the domain of gastroenterologists. We sought to quantify the role of ERCP in a tertiary-care surgery department. The hospital discharge database was queried for all ERCPs performed from January 2007 to December 2007. Gastroenterologists performed all ERCPs in our query. Surgical patients were admitted and/or under the care of a surgeon; whereas nonsurgical patients had no surgeon involvement. Patient characteristics and diagnoses were compared between groups. ERCP procedural details were recorded. Surgical patients comprised 48 per cent (n = 151) of the total 311 ERCPs performed. The mean time interval from a surgeon's request for ERCP to actual procedure was 2.43 days (standard deviation [SD] 2.55; range, 0-13 days). The surgical group had significantly different diagnoses and underwent less diagnostic (22% vs 56%) and more therapeutic ERCPs (72% vs 38%). Surgical patients were more likely inpatients (82.1% vs 16.8%) with a longer length of stay (6.7 vs 3.9 days; P = 0.0029) compared with nonsurgical patients. We found surgical patients requiring ERCP differ significantly from nonsurgical patients, with a significant number of technical interventions being outsourced. Given the benefits of a surgical ERCP program and the potential volume of these unique patients, this procedure should be performed by appropriately trained surgeons.

Analysis of False-Negative Diagnoses on Endoscopic Brush Cytology of Biliary and Pancreatic Duct Strictures

2000 ◽  
Vol 124 (3) ◽  
pp. 387-392 ◽  
Author(s):  
Roberto Logrono ◽  
Daniel F. Kurtycz ◽  
Claudia P. Molina ◽  
Vipul A. Trivedi ◽  
Jick Y. Wong ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
False Negative ◽  
Pancreatic Ducts ◽  
Brush Cytology ◽  
Endoscopic Retrograde ◽  
Predictive Values ◽  
Negative Results ◽  
Sensitivity Specificity

Abstract Context.—Endoscopic brush cytology is a valuable technique for the diagnosis of pancreatobiliary malignancy. Despite its widespread use, the sensitivity of this method has been reported as approximately 50%. The specificity is usually higher than 95%. Few reports have systematically analyzed the reasons for this relatively low sensitivity. Objectives.—To determine the rate and reasons for false-negative diagnoses in endoscopic brushing cytology of biliary and pancreatic ducts based on the results of sensitivity, specificity, accuracy, and positive and negative predictive values. Design.—Retrospective analysis of laboratory data and slide review of false-negative cases. Setting.—Two tertiary care state university hospitals. Patients.—A total of 183 pancreatobiliary brushing specimens obtained from patients undergoing endoscopic retrograde cholangiopancreatography for biliary or pancreatic duct disease for a 4- to 5-year period. Intervention.—Endoscopic retrograde cholangiopancreatography brushings. Main Outcome Measures.—Determination of sensitivity, specificity, accuracy, and positive and negative predictive values. Analysis of false-negative results. Results.—The sensitivity, specificity, accuracy, and positive and negative predictive values, overall, were 48%, 98%, 79%, 92%, and 76%, respectively. Sampling error was a major cause of false-negative diagnoses (67%), followed by interpretive (17%) and technical errors (17%). Conclusions.—Improvements in sensitivity and diagnostic accuracy for cancer of the pancreatobiliary tract can be achieved by optimizing slide preparatory techniques. Also, enhancement of the cytologist's diagnostic skills enables the identification of the morphologic features of premalignant lesions. Repeat brushings are indicated for suspicious or negative results not consistent with the clinical or radiologic findings.

scholarly journals Percutaneous Transhepatic Biliary Interventions

2018 ◽  
Vol 02 (01) ◽  
pp. 027-037
Author(s):  
Ankusha Yadav ◽  
Naveen Condati ◽  
Amar Mukund
Keyword(s):  
Biliary Tract ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
Biliary Tract Diseases ◽  
Biliary Interventions ◽  
Technical Considerations

AbstractBiliary tract interventions remain indispensable procedures for treatment of a wide arena of biliary tract pathologies. The increased use of endoscopic retrograde cholangiopancreatography (ERCP) for biliary tract evaluation and intervention has resulted in fewer patients requiring percutaneous transhepatic biliary interventions. However, there remains a subset of patients in whom ERCP is not feasible. Interventional radiologists play an important role in the management of biliary pathologies in such patients who cannot be benefited by endoscopic means. These interventions may at times be challenging; hence, awareness of normal and variant biliary tract anatomy and the variety of biliary tract interventions make the job easy. This article reviews the role of percutaneous transhepatic interventions in the management of a variety of biliary tract diseases, both benign and malignant, general indications and contraindications, preprocedural evaluation, and technical considerations specific to indications.

Role of SCO-792, A Novel Enteropeptidase Inhibitor, In the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

2021 ◽  
Author(s):  
Mohammed Yousif Rashid ◽  
Anupa Gnawali
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Preventive Measures ◽  
Vital Role ◽  
Duodenal Juice ◽  
Significant Morbidity ◽  
Endoscopic Retrograde ◽  
Pancreatic Parenchyma ◽  
New Novel ◽  
Rate Limiting

AbstractAcute pancreatitis is the most common iatrogenic dilemma of endoscopic retrograde cholangiopancreatography, and it is associated with significant morbidity and mortality. Several factors have been implicated in the pathogenesis of post-endoscopic retrograde cholangiopancreatography pancreatitis, and preventive measures were practiced accordingly. This study aims to refine the potential mechanisms that trigger post-endoscopic retrograde cholangiopancreatography pancreatitis and define the role of enteropeptidase in the pathogenesis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Furthermore, address the role of a new novel medication known as SCO-792, a potent enteropeptidase inhibitor, in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.Post-endoscopic retrograde cholangiopancreatography pancreatitis is caused by premature activation of the pancreatic enzymes within the pancreatic parenchyma. This activation is either an autoactivation due to direct provocation of intra-acinar enzymes as a result of the procedure or due to activation by enterpeptidase, a rate-limiting enzyme. Endoscopic retrograde cholangiopancreatography interjects duodenal juice that is rich in enterokinase into the pancreatic-biliary tract, which in turn leads to intra-ductal activation of trypsinogen and subsequent enzymes. Given the vital role of enterokinase in initiating the pathogenesis of pancreatitis, enteropeptidase inhibition may prevent and reduce the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis.SCO-792, a novel enteropeptidase inhibitor, is developed by SCOHIA Pharma, and pre-clinical trials confirmed its efficacy in inhibiting enteropeptidase. Studies are needed to confirm the efficacy of enteropeptidase inhibitors in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis.

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