Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ERCP”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 181 records · Page 10Linked to original sources
PubMed1996

Urinary trypsinogen activation peptides (TAP) are not increased in mild ERCP-induced pancreatitis.

Acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) occurs in 3-18% of patients undergoing either diagnostic or therapeutic ERCP. We prospectively measured urinary trypsinogen activation peptides (TAP) by an automated anti-TAP enzyme-linked immunoassay among 107 patients 4 h after ERCP to determine whether this measurement helps in the early diagnosis of ERCP-induced pancreatitis. Pancreatitis was documented in 10 of 107 patients (9.3%). All episodes were graded as mild. Urinary TAP was not significantly increased. We conclude that measurement of urinary TAP 4 h after ERCP is not helpful in documenting mild ERCP-induced acute pancreatitis.

Acute Disease↗
PubMed1998

Pretreatment with methylprednisolone to prevent ERCP-induced pancreatitis: a randomized, multicenter, placebo-controlled clinical trial.

OBJECTIVE: Pancreatitis remains the major complication of endoscopic retrograde cholangiopancreatography (ERCP). Uncontrolled data suggest a lower incidence of pancreatitis in patients with a history of iodine sensitivity when given pretreatment with corticosteroids. We conducted a clinical trial to assess the efficacy of a commonly prescribed corticosteroid, methylprednisolone, to prevent ERCP-induced pancreatitis. METHODS: Patients were entered into a randomized, multicenter, double-blind, placebo-controlled study of intravenous methylprednisolone (125 mg) versus a saline placebo immediately before the ERCP. All patients were evaluated for early and late complications. RESULTS: Two hundred eighty-six patients were randomized. Thirty-one randomized patients were excluded for technical reasons at the time of ERCP. Overall, the incidence of pancreatitis was 16 of 129 (12.4%, 95% CI: 6.7-18.1%) in the methylprednisolone group and 11 of 126 (8.7%, 95% CI: 4.4-15.1%) in the placebo group, which was not significantly different (p = 0.34). Although there was a higher rate of sphincterotomy performed in the methylprednisolone group compared to the control group (31.8% vs 16.8%, p = 0.005), the incidence of pancreatitis was not different when patients undergoing sphincterotomy were analyzed separately (13.6% in the methylprednisolone group and 9.6% in the placebo group,p = 0.50). There was no significant difference between the two groups for those with ERCP-induced pancreatitis in hospital length of stay (p = 0.22), days of parenteral analgesia (p = 0.09), or days of parenteral nutrition (p = 0.15). CONCLUSION: Intravenous methylprednisolone is not beneficial in preventing ERCP-induced pancreatitis.

Analgesia↗
PubMed2000

Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment.

OBJECTIVE: In about 30% of cases, the etiology of acute recurrent pancreatitis remains unexplained, and the term "idiopathic" is currently used to define such disease. We aimed to evaluate the long-term outcome of patients with idiopathic recurrent pancreatitis who underwent endoscopic cholangiopancreatography (ERCP) followed by either endoscopic biliary (and seldom pancreatic) sphincterotomy or ursodeoxycholic acid (UDCA) treatment, in a prospective follow-up study. METHODS: A total of 40 consecutive patients with intact gallbladder entered the study protocol after a 24-month observation period during which at least two episodes of pancreatitis occurred. All patients underwent diagnostic ERCP, followed by biliary or minor papilla sphincterotomy in cases of documented or suspected bile duct microlithiasis and sludge, type 2 sphincter of Oddi dysfunction, or pancreas divisum with dilated dorsal duct. Patients with no definite anatomical or functional abnormalities received long-term treatment with UDCA. After biliary sphincterotomy, patients with further episodes of pancreatitis underwent main pancreatic duct stenting followed by pancreatic sphincterotomy if the stent had proved to be effective. RESULTS: ERCP found an underlying cause of pancreatitis in 70% of cases. Patients were followed-up for a period ranging from 27 to 73 months. Effective therapeutic ERCP or UDCA oral treatment proved that occult bile stone disease and type 2 or 3 sphincter of Oddi dysfunction (biliary or pancreatic segment) had been etiological factors in 35 of the 40 cases (87.5%) After therapeutic ERCP or UDCA, only three patients still continued to have episodes of pancreatitis. CONCLUSIONS: Diagnostic and therapeutic ERCP and UDCA were effective in 92.5% of our cases, over a long follow-up, indicating that the term "idiopathic" was justified only in a few patients with acute recurrent pancreatitis.

Acute Disease↗
PubMed1992

Does the somatostatin analogue octreotide protect against ERCP induced pancreatitis?

This study evaluates the effect of the long acting somatostatin analogue octreotide on biochemical and clinical parameters of endoscopic retrograde cholangiopancreatography (ERCP) induced pancreatitis. Altogether 245 patients were randomised to receive either octreotide or isotonic saline. Octreotide (100 micrograms) was administered intravenously five minutes before ERCP and subcutaneously 45 minutes after ERCP. There were no significant differences in the median serum amylase and lipase activities at baseline, eight, and 24 hours after ERCP. Five patients (2%) developed clinical pancreatitis--three in the octreotide and two in the placebo groups. Excluding patients who developed pancreatitis, 43 (18%) developed abdominal pain after ERCP--21 in the octreotide and 23 in the placebo groups. There were no significant differences in the median serum amylase and lipase values between the treatment groups. None of the 52 patients who had therapeutic interventions developed pancreatitis. This study suggests that octreotide may not protect against ERCP induced pancreatitis.

Amylases↗
PubMed1999

Role of MR cholangiopancreatography in patients with failed or inadequate ERCP.

OBJECTIVE: The purpose of our study was to evaluate the usefulness of MR cholangiopancreatography in the diagnosis and further treatment of patients with failed or inadequate ERCP. SUBJECTS AND METHODS: Fifty-eight patients with failed or inadequate ERCP underwent MR cholangiopancreatography using a two-dimensional heavily T2-weighted multislice fast spin-echo technique. The final diagnosis was made on the basis of a second ERCP (n = 4), percutaneous transhepatic cholangiopancreatography (n = 19), intraoperative cholangiography (n = 6), percutaneous biopsy (n = 3), surgical findings (n = 5), or clinical follow-up (n = 21) for a mean period of 22 months (range, 7-31 months). RESULTS: MR cholangiopancreatography was technically successful in 57 patients and resulted in a sensitivity, specificity, and diagnostic accuracy of 97.1%, 100%, and 98.2%, respectively. Overall, MR cholangiopancreatography gave clinically useful information that contributed to patient management in 56 (96.6%) of the 58 patients. On the basis of the MR cholangiopancreatography findings, patients were managed using a second ERCP (n = 4), combined percutaneous and endoscopic procedure (n = 2), percutaneous biliary stent insertion (n = 13), surgery (n = 12), chemotherapy (n = 1), or conservative treatment (n = 24). CONCLUSION: MR cholangiopancreatography was found to have a unique and valuable role in the investigation of patients in whom ERCP failed or was inadequate. MR cholangiopancreatography helped us avoid using invasive procedures such as percutaneous transhepatic cholangiography in the diagnosis of bile duct disease after failed ERCP.

Adolescent↗
PubMed1996

Applied virtual reality for simulation of endoscopic retrograde cholangio-pancreatography (ERCP).

Researchers from the Georgia Institute of Technology and the Medical College of Georgia (GIT/MCG) have developed an interactive computer simulation of Endoscopic Retrograde Cholangio-Pancreatography (ERCP). ERCP is a minimally invasive technique for evaluating and treating pathologic conditions of the biliary and pancreatic ducts. While ERCP provides the patient with substantial advantages over traditional methods, ERCP requires advanced skills and extensive experience to minimize the risk of complications. Computer simulation offers many advantages for efficiently and safely training physicians in ERCP. The GIT/MCG proof of concept simulation provides realistic training with both visual and force feedback while an endoscopist practices the ERCP procedure.

Biliary Tract Diseases↗
PubMed2002

Unresolved issues about post-ERCP pancreatitis: an overview.

Pancreatitis represents the most common and feared complication after endoscopic retrograde cholangio-pancreatography. Since the introduction of ERCP into clinical practice, many attempts have been made to identify the mechanisms and conditions that can place patients at risk of developing post-procedure pancreatitis, with conflicting and in most cases unsatisfactory results. The following questions about post-ERCP pancreatitis still remain unanswered: the knowledge of the mechanisms involved in the onset of pancreatitis, procedural factors that can induce pancreatic damage, patient conditions that can increase the risk of developing pancreatitis in the post-procedure period, criteria for predicting the occurrence of pancreatitis, and possible methods of preventing the complication. Moreover, the criteria used to define post-ERCP pancreatitis differ in various studies and, consequently, there is a wide variation in the literature of the incidence of this complication and it is still not clear what its real incidence is. In the last six years, a significant advance in knowledge has been achieved in most of the above-mentioned fields. Four large prospective multicentre trials seemed to definitely identify patient- and technique-related risk factors that can place patients at risk of developing post-ERCP pancreatitis; clinical conditions, procedure- and patient-related factors, and laboratory tests able to predict the occurrence of post-ERCP pancreatitis in the early phase have been identified. An attempt to identify criteria for defining post-ERCP pancreatitis has also been carried out, although these proposed criteria have not been widely adopted by all Authors.

Biomarkers↗
PubMed2003

The impact of post-procedure interpretation of ERCP X-ray films by radiologists on patient care: should it be routine or selective?

BACKGROUND: Review of ERCP x-ray films by radiologists is routine, but the utility of this practice is unproven. The aim of this study was to assess whether the routine post-procedural interpretation of ERCP films by radiologists alters patient management. METHODS: A retrospective analysis of 212 ERCPs followed by a prospective analysis of 112 ERCPs was performed. Comparative ductogram interpretations were categorized as: I, complete agreement; II, minor findings reported only by the radiologist; III, findings reported only by the endoscopist; and IV, major findings reported only by the radiologist that altered or should have altered management. RESULTS: In the retrospective analysis, 289 ductograms were identified, and interpretations were classified as: category I, 73%; category II, 16%; category III, 10.7%; and category IV, 0.3%. In the prospective study, interpretations of 167 ductograms were analyzed and classified as follows: category I, 84%; category II, 11%; category III, 5%; category IV, none. CONCLUSIONS: Post-procedure interpretation of ERCP spot x-ray films by radiologists adds little to patient management. Selective consultation with radiologists would appear to be more appropriate than review by radiologists of ERCP spot x-ray films on a routine basis.

Adolescent↗
PubMed2004

[Comparison of ERCP and MRCP: invasiveness and cost].

The purpose of this study was to compare ERCP and MRCP in terms of invasiveness and cost. A questionnaire regarding patient satisfaction was distributed to 23 ERCP patients and 63 MRCP patients. The practical cost of each examination and total yearly cost for 2002, including medication costs for post-ERCP pancreatitis, were calculated. On a trial basis, the total yearly cost for 2002 was also calculated as a percentage of the cost in 1996. Results of the questionnaire showed that patients tended to favor MRCP over ERCP. In our hospital, the practical costs of MRCP and ERCP were 2063 points and 3964 points, respectively. Medication costs for pancreatitis corresponded to about 3% of the total yearly cost for ERCP. The total yearly costs for both examinations and the medication costs for pancreatitis were about 1,360,000 points. The result of trial calculation with the examination percentage of 1996 was about 1,950,000 points. The results of our study demonstrated that MRCP is a noninvasive examination for patients and that its popularization contributed to a reduction in medical costs. For further popularization of equipment and advanced imaging methods, careful assessment of examination costs is important.

Adult↗
PubMedDate not supplied

Safety of therapeutic ERCP in pregnancy - an Indian experience.

INTRODUCTION: Only limited data are available regarding the safety of therapeutic ERCP in pregnancy. We report our experience with therapeutic ERCP in pregnant women. METHODS: Medical records of 18 pregnant women (first trimester 4, second 6, third 8) who underwent ERCP between July 1994 and December 2004 were reviewed. Patients and their families were contacted to assess the well being of mother and baby. RESULTS: All the women underwent therapeutic ERCP and biliary sphincterotomy for common bile duct (CBD) stones. In 4 patients, 10-Fr CBD stents were inserted; three of these four cases required mechanical lithotripsy after delivery. Median procedure time was 17 min and median fluoroscopy time was 8 seconds. One patient each developed mild post ERCP pancreatitis and post sphincterotomy bleed. One woman had a preterm delivery. At follow up after a median of 6 years, all the babies were healthy. CONCLUSION: Therapeutic ERCP can be performed safely in all the trimesters of pregnancy provided appropriate precautions are taken.

Adult↗
PubMed1998

[Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy].

BACKGROUND: Diagnostic and therapeutic endoscopic cholangiopancreatography (ERCP) is more difficult in patients with Billroth II gastrectomy. METHODS: Personal experience in the last 28 months with 38 ERCP regarding 33 Billroth II patients representing the 5.4% of total number of ERCP performed in the same period is reported. RESULTS: Choledochal lithiasis could be treated in all cases observed also if two observed patients necessitated of two ERCP procedure. Only one patient with biliary stenosis could not be treated because of failed sphincterotomy and deep incannulation. The most difficult step in the procedure was duodenal intubation. A final ERCP success rate was 79%. EST could be performed in most cases (16 out of 17 patients=94%). No complications are reported. The use of the lateral viewing duodenoscope is emphasized. CONCLUSIONS: Today, ERCP and endoscopic sphincterotomy (EST) give similar results and no higher risk in patients with regular anatomy or in patients with Billroth II gastrectomy.

English Abstract↗
PubMed1992

Ultrasonography, CT, and ERCP in the diagnosis of choledochal stones.

A prospective study of jaundiced (n = 187) and nonjaundiced (n = 33) cholestatic patients was carried out to evaluate the sensitivity of ultrasonography (US), CT, and endoscopic retrograde cholangiopancreatography (ERCP) in the detection of choledochal stone disease. Altogether 83 patients had the final diagnosis of choledocholithiasis. In the jaundiced patients, the sensitivity of US, CT, and ERCP was 22.5%, 23.2%, and 80.6%, respectively. In cases of cholestasis without jaundice, the values were 20%, 37.5%, and 66.7%. In patients in whom all 3 imaging studies were done (n = 64), the differences between US and ERCP and between CT and ERCP were statistically significant (p less than 0.0001). In most false-negative ERCP studies (10/15), the clinical course of the disease strongly suggested a passed choledochal stone. On the basis of this study, we recommend prompt ERCP to be performed if choledochal stone disease is suspected on clinical grounds.

Adult↗
PubMed1986

ERCP and serum alkaline phosphatase in pancreatic carcinoma.

In 323 patients with suspected pancreatic or bile duct disease, the investigations included measurement of serum alkaline phosphatase (S-ALP) and endoscopic retrograde cholangiopancreatography (ERCP). The targeted duct system was satisfactorily cannulated in 283 patients, including 171 referred for ERCP because of suspected chronic pancreatitis and 75 with suspected pancreatic carcinoma. The follow-up time in all 283 cases was 3 years or, in the fatal cases, until death. ERCP was false-positive for pancreatic carcinoma in one case. S-ALP was elevated in 20 of the 24 patients with pancreatic malignancy shown at ERCP and histologically verified, but in only 35 of the 108 with chronic pancreatitis and 5 of 123 with normal ERCP. S-ALP should always be checked when pancreatic affection is suspected. If the level is raised, ERCP should also be done early in the clinical investigation, as it has high sensitivity in detection of pancreatic carcinoma.

Alkaline Phosphatase↗
PubMed1996

Preoperative ERCP in the management of common bile duct stones before laparoscopic cholecystectomy.

OBJECTIVE: To evaluate the effectiveness of a policy of preoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) before laparoscopic cholecystectomy. DESIGN: Retrospective review. SETTING: University hospital, Singapore. SUBJECTS. From January 1991 to December 1992, 303 patients underwent elective laparoscopic cholecystectomy, of which 46 (15%) were selected to have ERCP preoperatively because they had clinical, biochemical, and ultrasound signs of the presence of stones in the common bile duct (CBD). MAIN OUTCOME MEASURES: Effectiveness and efficiency of ERCP. RESULTS: Successful cannulation of the CBD was achieved in 45/46 cases (98%). In 19 patients (42%) stones were found, of which 18 (95%) were removed endoscopically. There were no major complications from the ERCP or the sphincterotomy. One patient developed symptoms from an unsuspected common duct stone two weeks after cholecystectomy and it was removed endoscopically. CONCLUSION: Selective preoperative ERCP is an effective and safe way of clearing the CBD before laparoscopic cholecystectomy, but its efficiency can be improved further by widening the criteria for preoperative ERCP and by doing operative cholangiography for patients with a low risk of stones in the CBD.

Adult↗
PubMed1997

Recurrent pyogenic cholangitis in Asian immigrants to the United States: natural history and role of therapeutic ERCP.

We reviewed the clinical presentation, cholangiographic features, and long-term outcomes in 41 patients with recurrent pyogenic cholangitis (RPC, "Oriental" cholangiohepatitis) who underwent ERCP at our institution, comparing patients who were initially managed with therapeutic ERCP, immediate hepatobiliary surgery, and no intervention. Patients undergoing only diagnostic ERCP had recurrent symptoms in 62% of cases, twice as often as patients managed initially by therapeutic ERCP or immediate surgery. These former patients required subsequent surgery more often than patients in the latter two groups. Outcomes for patients with diffuse biliary calculi were no different between patients managed by therapeutic ERCP or by immediate hepatobiliary surgery. In the 15 patients with only extrahepatic stones, 7/9 (71%) managed by therapeutic endoscopy and 7/8 (87.5%) managed by immediate hepatobiliary surgery were asymptomatic at almost two years mean follow-up (P > 0.05). Patients having undergone at least one definitive hepatobiliary surgery had fewer recurrences when managed by repeat surgery, although the difference was not statistically significant. Four of six (67%) patients with dominant strictures managed endoscopically are asymptomatic at mean follow-up of 15 months. Our study emphasizes the recurrent nature of symptoms in RPC and supports the primary role of therapeutic ERCP in managing these patients, especially those with extrahepatic stone disease alone.

Asia, Southeastern↗
PubMed1997

ERCP and sphincterotomy in the context of laparoscopic cholecystectomy: academic and community practice patterns and results.

OBJECTIVE: To study the effect of practice setting and practitioner experience on the use and results of ERCP and sphincterotomy in the context of laparoscopic cholecystectomy. METHODS: Data were collected on 780 ERCPs performed before or after laparoscopic cholecystectomy. Biliary endoscopists at four academic centers and 33 community-based gastroenterologists of varying experience participated. RESULTS: Indications for perioperative ERCP were similar in academic centers and community practice, but academic experts performed a significantly higher proportion of postoperative procedures. Success rates were high for all participants, although the least experienced group of community-based gastroenterologists had a significantly lower rate of success with sphincterotomy. Complication rates did not vary significantly among participants. CONCLUSIONS: Experienced community-based gastroenterologists can perform ERCP and sphincterotomy in the context of laparoscopic cholecystectomy with results comparable to those of academic experts. Gastroenterologists with a life-time experience of fewer than 200 ERCPs have lower success rates for sphincterotomy than more experienced practitioners in either practice setting. ERCP performed in community or academic settings can provide safe and effective management of common bile duct stones and biliary leaks or strictures that occur after laparoscopic cholecystectomy.

Academic Medical Centers↗
PubMed1998

[Evaluation of MRCP compared to ERCP in the diagnosis of biliary and pancreatic duct].

Recently, Magnetic Resonance Cholangiopancreatography (MRCP) is developed as a noninvasive diagnostic modality in the diagnosis of biliary and pancreatic tract. Using Endoscopic Retrograde Cholangiopancreatography (ERCP) as the gold standard, we evaluated the diagnostic quality of MRCP and direct cholangiography. Fifty-six patients (9 cases of cholangiocarcinoma, 5 of gallbladder carcinoma, 1 of gallbladder carcinoma and anomalous arrangement of pancreaticobiliary ductal system, 4 of cholecystlithiasis, 3 of papillary carcinoma, 1 of adenomyomatosis of the gallbladder, 1 of primary sclerosing cholangitis, 1 of hepatolithiasis and postoperative bile duct stricture, 4 of mucin producing pancreatic tumor, 13 of pancreatic carcinoma, 1 of chronic pancreatitis and pancreas divisum, 9 of chronic pancreatitis, and 1 of chronic pancreatitis and biliary stricture) are studied prospectively with MRCP and direct cholangiography (included ERCP and percutaneous transhepatic cholangiography). The image of MRCP accorded with direct cholangiography in twenty-two of 27 patients with biliary tract disease, and in sixteen of 29 patients with pancreatic disease. The different diagnosis is observed in ten of 56 patients. In cases of not visualized gallbladder, pancreatic cyst without communicated to the pancreatic duct, and pre-stenotic dilatation of biliary and pancreatic duct, the image of MRCP was better than that of ERCP. However, the image of MRCP for the diagnosis of either benign or malignant strictures, mucin producing pancreatic tumor, and a branch of pancreatic duct in patients with pancreatic carcinoma were not suitable for evaluation than that of ERCP. In our study, ERCP is superior to MRCP due to the important information for diagnosis such as mentioned above. Therefore we advocate using ERCP as the first diagnostic tool in the diagnosis of biliary and pancreatic duct.

Aged↗
PubMed1981

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) in the evaluation of suspected pancreatic carcinoma: diagnostic limitations and contemporary roles.

The accuracy of ERCP and PTC in the diagnosis of pancreatic carcinoma was evaluated in a series of 376 and 112 patients, respectively. ERCP had a sensitivity of 94% and a specificity of 97%; PTC had a sensitivity of 100% and a specificity of 96%. Prior to the introduction of CT, these highly accurate examinations were the first major diagnostic procedures performed in patients with suspected pancreatic carcinoma. CT has had a significant impact on the role of ERCP and PTC and has replaced them as the initial procedure of choice. The current indications for ERCP and PTC were evaluated in a series of 211 patients with suspected pancreatic disease who were studied initially by CT. ERCP is now used to evaluate patients in whom CT is normal, equivocal, or technically unsatisfactory. PTC is used as a preoperative procedure for precise definition of biliary anatomy or for percutaneous placement of a palliative biliary drainage catheter.

Biopsy↗