A Novel Cause of Biliary Peritonitis after Endoscopic Retrograde Cholangiopancreatography: Case Report and Literature Review

Background. Endoscopic retrograde cholangiopancreatography (ERCP) can lead to several complications such as duodenal or bile duct perforation. The incidence of pneumoperitoneum post-ERCP is rarely seen (<1%) and is associated with perforations of the duodenum or common bile duct in therapeutic ERCP after sphincterotomy. In this case, we disclose a novel cause of biliary peritonitis after ERCP. Case Presentation. A 65-year-old man presented with abdominal pain and distended abdomen after uneventful ERCP with sphincterotomy. An abdominal computed tomography (CT) was performed whose finding indicated duodenal perforation. The patient was rushed to an emergency laparotomy where only a rupture of an otherwise normal subcapsular intrahepatic bile duct was found. The surrounding liver parenchyma was healthy. The cause of this condition was probably post-ERCP pneumobilia and the increase of pressure in the biliary tract. Conclusions. This is the first case in literature describing the rupture of a subcapsular healthy bile duct as cause of biliary peritonitis after ERCP. This case also suggests that in the management of post-ERCP complications, the cooperation of radiologists and surgeons is vital for the patient’s wellbeing.

The radiation doses and radiation protection on the endoscopic retrograde cholangiopancreatography procedures

Although many interventions involving radiation exposure have been replaced to endoscopic procedure in the gastrointestinal and hepatobiliary fields, there remains no alternative for enteroscopy and endoscopic retrograde cholangiopancreatography (ERCP), which requires the use of radiation. In this review, we discuss the radiation doses and protective measures of endoscopic procedures, especially for ERCP. For the patient radiation dose, the average dose area product for diagnostic ERCP was 14–26 Gy.cm², while it increased to as high as 67–89 Gy.cm² for therapeutic ERCP. The corresponding entrance skin doses for diagnostic and therapeutic ERCP were 90 and 250 mGy, respectively. The mean effective doses were 3– 6 mSv for diagnostic ERCP and 12–20 mSv for therapeutic ERCP. For the occupational radiation dose, the typical doses were 94 μGy and 75 μGy for the eye and neck, respectively. However, with an over-couch-type X-ray unit, the eye and neck doses reached as high as 550 and 450 μGy, with maximal doses of up to 2.8 and 2.4 mGy/procedure, respectively. A protective lead shield was effective for an over couch X-ray tube unit. It lowered scattered radiation by up to 89.1% in a phantom study. In actual measurements, the radiation exposure of the endoscopist closest to the unit was reduced to approximately 12%. In conclusion, there is a clear need for raising awareness among medical personnel involved endoscopic procedures to minimise radiation risks to both the patients and staff.

Increased Severity of Complications After Therapeutic ERCP in Geriatric Patients With Chronic Pancreatitis: An Observational Study

Background: Studies of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in geriatric patients have mainly examined patients with biliary diseases, rather than chronic pancreatitis (CP). This study aimed to evaluate the safety and success rate of therapeutic ERCP in geriatric patients with CP. Methods: This was an observational study from prospectively collected data. The medical records of patients with CP aged over 65 years (Group A) were collected in a tertiary hospital from January 2013 to December 2018. Sex-matched CP patients under 65 years (Group B) were randomly selected into the control group (matching ratio = 1:2). Collected data included demographic data, endoscopic findings, interventions, success, and complications. The success rate and the complication rate of therapeutic ERCP in two groups were compared with chi-square test. The risk factors for post-ERCP pancreatitis were investigated by univariate and multivariate analysis.Results: A total of 268 ERCPs were performed in 179 patients of Group A and 612 ERCPs in 358 patients of Group B. The success rate of ERCP in Group A was similar to that of Group B (92.16% vs 92.32%; P=0.936). The overall incidence of post-ERCP complications was 7.09% (19/268) and 5.72% (35/612) in Group A and B, respectively (P=0.436). However, geriatric patients had a significantly increased occurrence of moderate to severe complications (2.61% vs 0.16%; P=0.002). Female gender (OR=3.40; 95% CI, 1.02-11.31; P=0.046), pancreas divisum (OR=7.15; 95% CI, 1.01-50.62; P=0.049), dorsal pancreatogram (OR=7.40; 95% CI, 1.63-33.64; P=0.010), and lithotripsy (OR=0.15; 95% CI, 0.03-0.70; P=0.016) were significantly associated with risk of post-ERCP pancreatitis in geriatric patients.Conclusions: Therapeutic ERCP is safe and feasible in elderly patients with CP. However, occurrence of moderate to severe complications after ERCP increased in geriatric patients.Trial registration: retrospectively registered.

The Effect of Endoscopic Retrograde Cholangiopancreatography on Patients with Common Bile Duct Stones

Objective: To explore the safety and effectiveness of therapeutic ERCP technology. Methods: A retrospective analysis of clinical data from March 1, 2017 to March 1, 2018 in the endoscopic center of our hospital. The frequency of ERCP procedures, the success rate of treatment, the incidence of complications, and the mortality rate of cholelithiasis in non-elderly patients. Results: In this study, 236 patients underwent 267 ERCP lithotripsy treatments. Group A was a patient older than 80 years old and performed 20 ERCP procedures; group B was a patient aged 60 to 80 years old and performed 110 ERCP procedures. Group C is a age from 18 to 60, with a total of 137 operations. Difference between ERCP treatment, the incidence of postoperative pancreatitis, cholangitis, bleeding and other complications in the three groups, and no ERCP-induced perforation occurred. There were no ERCP-related deaths. Conclusion: With good preoperative evaluation and prevention.