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At least 109 records · Page 6Linked to original sources
PubMed2001

Where do ERCP, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography fit in the management of acute biliary pancreatitis? A decision analysis model.

OBJECTIVES: The role of ERCP in acute biliary pancreatitis (ABP) is controversial. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) are modalities for bile duct visualization that could lower costs and prevent ERCP-related complications. We analyzed costs and examined the cost-effectiveness of these modalities to define their role in ABP. METHODS: A decision analysis model of ABP was constructed. The strategies evaluated were 1) ERCP, 2) MRCP followed by ERCP if positive for common bile duct stones (CBDS) or if biliary sepsis ensued, 3) EUS followed by ERCP if positive or if biliary sepsis ensued, and 4) observation with intraoperative cholangiography at the time of cholecystectomy with ERCP only if biliary sepsis ensued. We compared costs and performed cost-effectiveness analysis between strategies at probabilities of CBDS ranging from 0% to 100%. The outcome measures were total costs and costs per ABP death prevented. RESULTS: At probabilities of CBDS < 15%, observation with intraoperative cholangiography is the least expensive strategy, whereas EUS and ERCP are the least expensive strategies at probabilities of 15-58% and >58%, respectively. In terms of cost-effectiveness, at probabilities of CBDS of 7-45%, EUS is the most cost-effective alternative, and at a probability of >45% ERCP is the most cost-effective option. CONCLUSIONS: Total costs and cost-effectiveness ratios of these strategies in patients with ABP are highly dependent on the probability of CBDS.

Acute Disease↗
PubMed2006

Chronic pancreatitis: MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation.

PURPOSE: To retrospectively compare-in patients with chronic pancreatitis-magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) for measurement of main pancreatic duct (MPD) diameter by using area intensity measurement (AIM) at MRCP and full width at half maximum (FWHM) at ERCP and to retrospectively determine the accuracy of MRCP for depiction of pathologic changes by using ERCP as the reference standard. MATERIALS AND METHODS: The institutional review board approved this study and waived the need to obtain informed consent. Both MRCP and ERCP were performed in 24 patients with chronic pancreatitis (21 men, three women; mean age, 54 years +/- 14 [standard deviation]). The diameter of the MPD was determined by using both methods at the same sites in the head, body, and tail of the pancreas. MRCP and ERCP measurements involved AIM and FWHM techniques, respectively. For qualitative evaluation, visualization of the MPD and pathologic findings was also examined by using both methods. Paired t and Wilcoxon matched-pair signed rank tests were performed for the quantitative and qualitative evaluations, respectively. RESULTS: The mean diameter of the MPD at ERCP was 1.5 times larger, on average, than that at MRCP; differences were statistically significant for each segment, as well as for the entire duct system. For qualitative evaluation, MRCP tended to be superior to ERCP for delineation of the MPD. Overall sensitivity, specificity, and accuracy values of MRCP for delineating pathologic pancreatic changes were 88% (87 of 99), 98% (44 of 45), and 91% (131 of 144), respectively. CONCLUSION: Use of ERCP tends to result in overestimation of the caliber of the MPD. MRCP can enable accurate evaluation of the condition of the pancreatic duct and its changes in patients with chronic pancreatitis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1999

Must ERCP Be routinely performed if choledocholithiasis is suspected?

OBJECTIVE: To evaluate the results of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of those patients suspected of harboring bile duct stones before laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: A total of 1,235 consecutive LCs performed between 1991 and 1997 were studied prospectively. ERCP was performed to explore the common bile duct (CBD) preoperatively when choledocholithiasis was suspected on the basis of clinical, analytical or echographical data. RESULTS: ERCPs were performed in 268 patients: unsuccessful CBD evaluation in 3%; dilated CBD without lithiasis in 13%, and normal exploration in 37% (99 patients). CBD stones were found in 46% (124 patients), and endoscopic sphincterotomy was then performed and stone extraction attempted. Endoscopic therapy achieved 92.8% successful removal of CBD stones (115 patients). There was no ERCP-related mortality and the morbidity rate was 6%. Retained CBD stones have been observed in 7 cases after ERCP-LC; all of them have been successfully treated by ERCP. CONCLUSIONS: A combined approach to bile duct stones with selective use of ERCP followed by LC is a good therapeutical alternative. Nevertheless, the usual selection criteria for ERCP may lead to unnecessary exploration. It appears to be necessary to modify the current diagnostic and therapeutic strategy.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2002

Why the incidence of post-ERCP pancreatitis varies considerably? Factors affecting the diagnosis and the incidence of this complication.

The reported incidence of post-ERCP/sphincterotomy pancreatitis ranges between 1.3 and 24.4% in non-selected series. This varying incidence likely reflects on the one hand difference in patient populations, indications and endoscopic expertise and, on the other hand, different definitions of pancreatitis and methods of data collection. Among a number of patient-related factors recognized at risk for post-ERCP pancreatitis in four recent large prospective studies, the combination of female gender, normal serum bilirubin levels and recurrent abdominal pain suggesting sphincter of Oddi dysfunction and previous post-ERCP pancreatitis placed patients at an increasingly higher risk of pancreatitis. Among the technique-related risk factors for post-ERCP pancreatitis, biliary sphincter balloon dilation, difficult cannulation, sphincter of Oddi manometry and pancreatic sphincterotomy have also been recognized as significant risk factors. However, since the case mix in non-selected series does not significantly differ in the different studies, it is logical to assume that the different criteria adopted for defining the post-ERCP pancreatitis play a key role in the reported wide variation of incidence reported for this complication. The occurrence and duration of pain and the amplitude of serum amylase after ERCP are critical points in the definition of post-ERCP pancreatitis. Although a consensus conference identified 24-hour persisting pain associated with hyperamylasemia greater than 3 times the upper reference limit as an indicator of pancreatitis, these two parameters are however considered in a different manner in the studies available up to now. In a prospective study where we calculated the incidence of post-ERCP pancreatitis by using the most widely used criteria, for both occurrence and duration of pancreatic pain and serum amylase amplitude, the incidence of post-procedure pancreatitis ranged from 1.9 to 11.7% depending on the criteria adopted.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2003

Antisecretory agents for prevention of post-ERCP pancreatitis: rationale for use and clinical results.

Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Over the past decade, there has been notable research on the use of various prophylactic agents in preventing post-ERCP pancreatitis. The most widely investigated drug is the antisecretory agent somatostatin and its analogue octreotide. Both agents are potent inhibitors of exocrine secretion of the pancreas, which plays an important role in the pathogenesis of acute pancreatitis by causing autodigestion of pancreas. In addition, somatostatin and octreotide appear to have anti-inflammatory and cytoprotective effects, both of which may be protective against post-ERCP pancreatitis. Furthermore, somatostatin has been shown to relax the sphincter of Oddi, whereas octreotide increases the basal pressure of the sphincter. Several randomized controlled trials have evaluated the efficacy of somatostatin and octreotide in reducing post-ERCP pancreatitis. The results of these trials vary due to different patient populations and experimental designs. Overall, the available evidence suggests that somatostatin reduces the incidence of post-ERCP pancreatitis, whereas octreotide does not. Whether the difference in efficacy between the two drugs is related to their differential effects on sphincter of Oddi motility or is due to other reasons remains unclear. Although there is some evidence supporting the use of somatostatin in reducing the frequency of post-ERCP pancreatitis, it is widely agreed that generalized treatment of all patients undergoing ERCP with prophylactic somatostatin may not be cost-effective. Further studies should focus on the elucidation of the most cost-effective dosage regimen of somatostatin and it efficacy in patients at high risk for post-ERCP pancreatitis.

Animals↗
PubMedDate not supplied

ERCP and acute pancreatitis.

Acute biliary pancreatitis (ABP) is a serious complication of biliary stones disease and is associated with significant morbidity and mortality. The role of ERCP in the management of ABP has been the focus of discussion in recent years. In this report, we evaluated a protocol of emergency Endoscopic retrograde Cholangiopancreatography (ERCP) (within 24 hours) and early ERCP (within 72 hours). From July 1997 to July 2000, were observed 45 patients (19 man and 26 women) with acute biliary pancreatitis. Mean age of patients was 63.4 years (range 21-87 years). Diagnosis of ABP was based on anamnesis and clinical assessment and was confirmed by specific laboratory data (hyperamylasemia, hyperlipasemia, total and fractionated bilirubinemia, gamma-GT, transaminase, alkaline phosphatase, hypocalcemia, hyperglycemia, leukocytosis). Ultrasound scanning within 24 h of admission was performed in 45 patients (100%) and it revealed gallbladder stones and muddy bile in 39 patients (87%). Computed tomography (CT) performed in all patients, showed a severe acute pancreatitis in the second or subsequent week following admission. The severity of acute pancreatitis was established by Glasgow's criteria and by clinical details of patients. ERCP and Endoscopic Sphinterotomy (ES) was performed in all 45 patients with acute biliary pancreatitis. Twenty-six patients (57%) were classified as having a severe attack (> 4) 19 as having a mild attack by Glasgow's criteria. ERCP associated with ES was performed within 24 hours in 22 patients (49%), 11 (50%) showed a severe attack and 11 (50%) showed a mild attack. A total of 2 complications (4%) occurred and the mortality was of 2 patients (4%). In 23 patients (51%) ERCP and ES was performed within 72 hours after conservative therapy, 8 (35%) showed a mild attack and 15 (65%) showed a severe attack. A total of 5 complications (9%) occurred and the mortality was of 3 patients (6%). Our study showed that ERCP with endoscopic sphincterotomy can be performed safely by skilled endoscopist, without adverse consequences soon after the onset of acute biliary pancreatitis even within the first 24 hours and it showed that is better than ERCP within 72 hours after conservative therapy.

Adult↗
PubMed1992

Role of ERCP and therapeutic biliary endoscopy in association with laparoscopic cholecystectomy.

Laparoscopic removal is rapidly becoming the preferred method of cholecystectomy; however, choledocholithiasis cannot usually be managed with a laparoscopic approach. Combined endoscopic sphincterotomy and laparoscopic cholecystectomy is a potential solution to this problem. To determine the feasibility of this combined procedure we studied 41 patients who had both endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy. Indications for ERCP included jaundice, gallstone pancreatitis, dilated ducts on sonography, elevated liver enzymes, or stones seen on operative cholangiography. Twenty-eight patients had ERCP preoperatively. Nine patients had common duct stones; these were successfully removed from eight patients after sphincterotomy. Two patients had unexpected strictures requiring a change in surgical approach. Thirteen patients had ERCP postoperatively. Eight of those patients had common duct stones, and all were successfully removed following endoscopic sphincterotomy. Three patients had postoperative strictures, one of which was treated by endoscopic stent placement. No complications as a result of ERCP or sphincterotomy were encountered. ERCP and endoscopic sphincterotomy can be safely performed both preoperatively and as early as 1 day postoperatively. If indicators of choledocholithiasis are present, preoperative ERCP is preferred, because stone removal occasionally is unsuccessful, and cholangiographic findings may change the operative approach. Postoperative ERCP can define and, in some instances, treat biliary tract injuries resulting from laparoscopic cholecystectomy.

Adolescent↗
PubMed1991

The effect of ERCP on circulating pancreatic enzymes and pancreatic protease inhibitors.

The pathogenesis of endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis is poorly understood. To elucidate a role for pancreatic enzymes in ERCP-induced pancreatitis, we measured serum amylase, lipase, trypsin, and elastase in 25 patients undergoing ERCP. Serum alpha 1-antitrypsin and alpha 2-macroglobulin, two major pancreatic protease inhibitors, also were measured. All pancreatic enzymes measured rose significantly after ERCP. Pancreatic duct cannulation was associated with a greater elevation in serum amylase and lipase. Circulating alpha 2-macroglobulin was reduced by 7% (p = 0.04) 6 h after ERCP, whereas circulating alpha 1-antitrypsin increased over the same time period. Papillotomy, stent placement, or underlying disease did not influence changes any further. Three patients developed ERCP-induced pancreatitis. All three patients had circulating alpha 2-macroglobulin levels below 243 mg/dl (p = 0.03). The ERCP-induced alterations in circulating pancreatic enzymes and their inhibitors are similar to changes seen in clinical pancreatitis. Low circulating alpha 2-macroglobulin levels may predispose to ERCP-induced pancreatitis.

Acute Disease↗
PubMed1990

[The place of ERCP in pancreatic diagnosis. The change caused by sonography and computed tomography].

Based on 1099 endoscopic retrograde cholangiopancreatograms (ERCP), 659 examinations conducted in 1973-1980 prior to the introduction of computed tomography (CT) and 440 performed in 1988-1989, the impact of sonography and CT on ERCP is studied. The availability of CT did not cause any significant change in the frequency of and indications for ERCP. The rate of successful ERCP examinations increased from 73.6% to 92%. Complications occurred in 2.3%, and the mortality rate was 0.4% and was similar in both periods. ERCP was the third imaging procedure, being applied after sonography and CT, in most patients. The diagnostic value of ERCP in pancreatic disease is compared with that of sonography and CT in 116 patients with histologically or clinically proven diagnosis. The sensitivity is 79% for ERCP and 78% for CT. Indeterminate findings were recorded in 11% of the ERCP and 8% of the CT examinations; these rates can be decreased by complementary use of both imaging modalities.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

Is ERCP necessary for symptomatic gallbladder stone patients before laparoscopic cholecystectomy?

OBJECTIVE: Laparoscopic cholecystectomy (LC) has become the choice of treatment for symptomatic gallbladder stones. The goal of this study was to predict the necessity for ERCP before LC using the noninvasive method of liver function testing (LFT) and sonography. METHODS: Before LC, 115 symptomatic gallbladder stone patients, whose diagnoses were confirmed by sonography, were studied by both LFT and ERCP. Patients who were already found to have either tumors or intrahepatic biliary stones on sonogram were excluded. Patients were classified into normal and dilated biliary tree groups by sonographic findings and normal and abnormal LFT (including bilirubin, alkaline phosphatase, gamma glutamyl transferase and amylase) groups. RESULTS: In patients with both normal biliary sonogram and LFT, 97.6% of patients had a negative ERCP study. Biliary tree dilation on sonogram had an 87% positive predictability for ductal pathology on ERCP (40/46). A normal biliary tree on sonogram had a 17.4% incidence of positive ductal pathology on ERCP (12/69). A single abnormal LFT equated to a 68.8% positive predictability for ductal pathology on ERCP. CONCLUSION: ERCP is not necessary before LC for patients with symptomatic gallbladder stones who have both a normal biliary tree on sonogram and normal LFT. A patient with either a dilated bile duct on sonogram or an abnormal liver function test does require ERCP study.

Bile Ducts↗
PubMed1997

[100 emergency ERCPs performed at a surgery department].

Since the year 1989 the authors, surgeons, performed more then 1600 ERCP. In the period of 1992 to 1995 urgent ERCP was indicated in one hundred cases when block of papila Vateri, cholangitis or acute pancreatitis were suspected. Our results in ERCP were: cholangitis with common bile duct stones 14, pancreatitis acuta biliaris 53, pancreatitis acuta nonbiliiaris 28, other diagnosis 1. In 4 cases, ERCP was unsuccessful. Endoscopic papillosphincterotomy (EPS) was indicated in all patients after the successful ERCP with pancreatitis or cholagitis. We achieved success in urgent EPS in 92%. No patient died owing to ERCP or EPS. From our point of view urgent ERCP and EPS are important diagnostical and therapeutical methods in patients with cholangitis and pancreatitis biliaris which may be performed as soon as possible. (in our cases all patients undergo ERCP and EPS no later than six hours after their admission to the hospital). In case of nonbiliaris pancreatitis we prefer and have good results with EPS too, but our number of these patients is too small to be generalized. (Tab. 5, Ref. 13.).

Adult↗
PubMed1998

[ERCP and laparoscopic cholecystectomy].

The use of perioperative endoscopic retrograde cholangiopancreatography (ERCP) for suspected common bile duct stones (CBDS) was investigated retrospectively in 153 of 477 patients undergoing laparoscopic cholecystectomy (LC). Pre- and postoperative ERCP was performed in 141 patients (29.6%) and 12 patients (2.5%), respectively. Successful cannulation of the CBD was achieved in 95%. Preoperative CBDS were found in 40/141 patients (28%), of whom 65% were successfully retracted during one session and 35% during two sessions. Twelve patients underwent postoperative ERCP of whom eight patients had CBDS. The complication rate of preoperative ERCP was 9.9%. There was no mortality. Prediction of CBDS diagnosed by preoperative ERCP, using history, liver biochemistry, ultrasonography and combination of biochemistry and ultrasonography showed values of 2.2%, 37.5%, 33.3% and 55.6%, respectively. The diagnostic and therapeutic success rate of ERCP is acceptable. However, the low rate of CBDS in patients undergoing ERCP preoperatively calls for a more selective use of ERCP in patients undergoing LC. History, liver biochemistry and ultrasonography are inefficient methods of patient selection.

Adolescent↗
PubMedDate not supplied

The use of ERCP in the management of common bile duct stones in patients undergoing laparoscopic cholecystectomy.

The purpose of this study was to evaluate the indications and results of endoscopic retrograde cholangiopancreatography (ERCP) for gallstone disease since the advent of laparoscopic cholecystectomy. In our personal series of 410 consecutive cases of laparoscopic cholecystectomy, we found 17 common bile duct (CBD) stones; seven were identified by preop ERCP, nine at laparoscopy by intraoperative cholangiography, and one postop by ERCP. We have performed preop ERCP in 21 patients (5.1%); CBD stones were found in seven. Our indications for preop ERCP were elevated liver function tests, dilatation of the common duct by ultrasound, or a history of jaundice/pancreatitis, and all stones were successfully removed by endoscopic sphincterotomy. At laparoscopic cholecystectomy nine patients were found to have stones; one was treated with laparoscopic methods, four with open CBD exploration, and four by postop endoscopic sphinecterotomy. Post-laparoscopic cholecystectomy, five patients underwent ERCP for pain or increased liver function tests suggestive of common duct stones. One of the five was found to have stones and these were successfully removed by endoscopic sphincterotomy. ERCP is very useful as a diagnostic and therapeutic modality in laparoscopic cholecystectomy patients with suspected CBD stones. Elevated liver function tests and dilated CBD by ultrasound are the most accurate predictors of stones. Endoscopic sphincterotomy is a more effective route, at present, for stone removal than a laparoscopic approach.

Adolescent↗
PubMed1992

Bile duct disease: prospective comparison of ERCP, CT, and fat suppression MRI.

The authors compared computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP), techniques commonly used to study the biliary tree, with pre- and post-Gd-DTPA breath-hold fast low angle shot (FLASH) and fat suppressed spin-echo in 28 consecutive patients with bile duct abnormalities detected on ERCP, including 11 patients with malignant disease and 17 patients with benign disease. ERCP, CT, and magnetic resonance (MR) images were prospectively interpreted in a blinded fashion and reviewed by consensus. ERCP characterized all cases of malignant disease by the presence of a narrowed bile duct lumen with irregular margins. CT and MRI detected all cases of malignant disease and characterized nine of 11 as malignant. In seven of these cases, CT and MRI showed thickening of extrahepatic bile duct walls greater than 5 mm. MRI images showed intrahepatic-enhancing periportal tissue in four cases, which was not seen on CT images, and which was biopsy-proven tumor extension. Benign disease was characterized on ERCP images by the demonstration of smooth tapered narrowings in 16 cases, whereas on CT and MR images it was characterized by mild to moderate dilatation of the intrahepatic bile ducts and wall thickness less than 5 mm in 13 cases. Overall ERCP correctly characterized 27 cases as benign or malignant and CT and MRI both characterized 25. The results of this study show a trend that ERCP is superior to CT and MRI for characterizing bile duct disease.

Adult↗
PubMed1999

[Effect of preventive selenium administration on development of ERCP-induced acute pancreatitis].

BACKGROUND: Sodium selenite may play a role in reduction of enhanced oxygen free radicals in the early phase of experimental acute pancreatitis. The aim of the study was to determine whether ERCP induced pancreatitis can be used as a human model for early acute pancreatitis and if a prophylactic antioxidant therapy with sodium selenite or a prophylactic antibiotic therapy has a beneficial effect on the clinical outcome in patients with ERCP. PATIENTS AND METHODS: Sixty patients were randomly allocated in 3 groups: A (n = 20, sodium selenite i.v. 1 day before ERCP 1 mg bolus/2 x 1 mg infusion); B (n = 20, metronidazole 0.5 g/ofloxacin 0.2 g before and 6 hours after ERCP); C (n = 20, controls, no prophylaxis). Various labor parameters and physical complaints after ERCP were determined. RESULTS: Patients with an antibiotic prophylaxis or with a sodium selenite substitution had no less physical complaints or pancreatitis than the controls. Seven patients (= 11.7%) developed a pancreatitis after ERCP. Concentration of zinc, copper, manganese, vitamin A and E did not differ significantly between the various groups. CONCLUSION: A prophylactic substitution with sodium selenite or prophylactic antibiotic therapy with metronidazole/ofloxacin has no beneficial effect on the clinical outcome in patients with ERCP.

Acute Disease↗
PubMed1999

MR cholangiopancreatography: prospective comparison of a breath-hold 2D projection technique with diagnostic ERCP.

The aim of this study was to compare prospectively a breath-hold projection magnetic resonance cholangiopancreatography (MRCP) technique with diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Seventy-six patients with suspected strictures or choledocholithiasis were referred for MRCP and subsequent ERCP examination, which were performed within 4 h of each other. The MRCP technique was performed using fat-suppressed rapid acquisition with relaxation enhancement (RARE) projection images obtained in standardised planes with additional targeted projections as required by the supervising radiologist. Two radiologists (in consensus) assessed the MRCP results prospectively and independently for the presence of bile duct calculi, strictures, non-specific biliary dilatation and pancreatic duct dilatation, and recorded a single primary diagnosis. The ERCP was assessed prospectively and independently by a single endoscopist and used as a gold standard for comparison with MRCP. Diagnostic agreement was assessed by the Kappa statistic. The MRCP technique failed in two patients and ERCP in five. In the remaining 69 referrals ERCP demonstrated normal findings in 23 cases, strictures in 19 cases, choledocholithiasis in 9 cases, non-specific biliary dilatation in 14 cases and chronic pancreatitis in 4 cases. The MRCP technique correctly demonstrated 22 of 23 normal cases, 19 strictures with one false positive (sensitivity 100 %, specificity 98 %), all 9 cases of choledocholithiasis with two false positives (sensitivity 100 %, specificity 97 %), 12 of 14 cases of non-specific biliary dilatation and only 1 of 4 cases of chronic pancreatitis. There was overall good agreement for diagnosis based on a kappa value of 0.88. Breath-hold projection MRCP can provide non-invasively comparable diagnostic information to diagnostic ERCP for suspected choledocholithiasis and biliary strictures and may allow more selective use of therapeutic ERCP.

Adult↗
PubMed2004

Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) to remove common bile duct stones during routine laparoscopic cholecystectomy does not prolong hospitalization: a 2-year experience.

BACKGROUND: There is still some controversy regarding the optimal timing and best method for the removal of common bile duct stones (CBDS). Intraoperative endoscopic retrograde cholangiopancreaticography (IO-ERCP) is an alternative method that should be considered for this procedure. The aim of our study was to investigate the clinical outcome of a single-step procedure (IO-ERCP) to remove CBDS, thereby combining two existing high-volume clinical modalities-i.e., laparoscopic cholecystectomy (LC) and ERCP. METHODS: Between January 2000 and December 2001, 674 patients, 192 male and 482 female, underwent cholecystectomy at our hospital. There were 612 LC (90.8%), 37 converted procedures (5.5%), and 25 open operations (3.7%). In 592 of the patients, (87.8%) intraoperative cholangiography (IOC) was performed. In 34 (5.7%) of those who had and IOC, an IO-ERCP was performed. While the surgeon waited for the endoscopist, care was taken to introduce a thin guidewire through the lOC catheter and pass it through the sphincter of Oddi, out into the duodenum. This complementary procedure greatly facilitated the subsequent cannulation of the bile ducts. RESULTS: The cannulation frequency of the CBD was 100%. Common bile duct stones were successfully extracted in 93.5%. Endoscopic sphincterotomy (EST), followed by the insertion of a plastic endoprosthesis, was performed in two patients with remaining stones. The CBD of these two patients was cleared by postoperative ERCP. None of the patients developed postoperative pancreatitis. The operating time was prolonged as compared with the time for LC (192 vs 110 mins; p < 0.05). The length of hospitalization for IO-ERCP patients did not differ from that for patients undergoing cholecystectomy alone (2.6 vs 2.1. days; NS). CONCLUSIONS: The study suggests that elective IO-ERCP is a safe and efficient method for removing CBDS that has a low risk of inducing postoperative pancreatitis and does not prolong postoperative hospitalization. This technique enables perioperative extraction of CBDS without open or laparoscopic surgical exploration of the CBD and can be used safely in a routine clinical setting.

Adolescent↗
PubMed1995

The efficacy of early ERCP in pediatric pancreatic trauma.

Recognition of pancreatic injuries is frequently delayed, and optimal treatment is often controversial. The use of endoscopic retrograde cholangiopancreatography (ERCP) has allowed accurate delineation of pancreatic ductal injuries; however, the small size of children and the concern with inducing pancreatitis and/or lesser sac contamination have limited its use in children. In 1988, the authors began using ERCP for selected pancreatic injuries. This report describes their experience with this technique and examines the role of ERCP in pediatric pancreatic injuries. Six children with pancreatic transections resulting from blunt trauma were treated between 1988 and 1993. The age range was 2 1/2 to 8 years, and the weight range was 13.6 to 27.9 kg. The average period from injury to referral to the hospital was 14 days (range, 2 to 30 days). All six children presented with chemical evidence of pancreatitis and had an initial computed tomography (CT) scan; five scans were interpreted as being normal. Five of the six patients had subsequent CT scans, which showed lesser-sac fluid collection. Three patients were treated with drainage (2 percutaneous, 1 open [outside hospital]), and when this failed, ERCP was performed, at 13.6 days (average) after presentation. These three patients underwent ERCP relatively early in the course (an average of 3 days after presentation). All six children had major ductal transections documented through ERCP. After ERCP, the serum amylase level remained elevated in three, increased in one, and normal in one. (It was not measured in one of the recent cases taken for immediate operation.)(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Pain↗