Prognosis and risk factors of ERCP pancreatitis in elderly

Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and < 65 years old (494 patients, 274 F, 220 M). PEP was diagnosed in 4.3% of patients aged 65 years and older. The female gender was risk factors in elderly for PEP. The Sphincter Oddi Dysfunction (SOD) and Juxta papillary diverticula (JPD) were higher in elderly patients with PEP. Age did not increase the risk of PEP development. The most important post ERCP pancreatitis risk factor in the elderly is the female gender, while the risk is enhanced slightly by SOD and JPD.

JUST BECAUSE IT IS RARE DOESN’T MEAN IT IS IMPLAUSIBLE: LEMMEL’S SYNDROME A CASE SERIES

Lemmel’s syndrome is a rare pancreaticobiliary complication of duodenal diverticula. It occurs when a duodenal diverticulum causes obstructive jaundice due to a mechanical obstruction of the common bile duct. Other mechanisms like sphincter of Oddi dysfunction can also play a role in pathophysiology. We report three cases of Lemmel’s syndrome where liver biochemistry showed obstructive jaundice; but subsequent MRCP showed a massive periampullary diverticulum causing biliary obstruction. Early detection and intervention can prevent needless additional investigations and complications due to obstruction.