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PubMed1995

Use of corticosteroids in the prevention of post-ERCP pancreatitis.

BACKGROUND: Pancreatitis frequently complicates diagnostic and therapeutic ERCP. A variety of causes have been implicated. A number of different agents have been used, without success, in an attempt to prevent pancreatitis. METHODS: In the current study, 824 patients with a history of iodine sensitivity were given preprocedure corticosteroid therapy (651 oral steroids and 173 intravenous steroids) in an attempt to prevent allergic reactions. These patients were retrospectively studied in an attempt to determine if corticosteroid administration prevents ERCP-related pancreatitis. Two control groups were used for comparison, including 1000 patients during the same study period (Control Group I) and 1954 patients from the Midwest Pancreaticobiliary Group (Control Group II). RESULTS: There was a significant difference in the overall incidence of post-ERCP pancreatitis in the corticosteroid treated group (4.6%) compared with either control group (Control Group I = 7.4% and Control Group II = 9.1%). Of those patients undergoing therapeutic ERCP, results were even more significant in favor of the steroid-treated group (5.2%) compared with Control Group I (9.7%) and Control Group II (11.2%). CONCLUSIONS: These results demonstrate that the administration of corticosteroids prior to ERCP results in a decreased incidence of post-ERCP pancreatitis. A prospective, randomized, controlled trial is warranted.

Acute Disease↗
PubMed1999

Iodine absorption in patients undergoing ERCP compared with coronary angiography.

BACKGROUND: Systemic absorption of iodinated contrast material occurs during endoscopic retrograde cholangiopancreatography (ERCP), the clinical significance of which has not yet been determined. METHODS: Urinary iodine excretion was measured before and after coronary angiography (n = 20) and ERCP (n = 12). Thyroid hormone levels were determined before iodine load and after 6 and 24 weeks. RESULTS: Before coronary angiography, iodine excretion was 101 +/- 38.3 micromol/mol creatinine and increased to 865. 10(5) +/- 721. 10(5) micromol/mol on the next day (p </= 0.001). After 6 weeks, it was still elevated (167 +/- 88.8 micromol/mol, p < 0.01). Before ERCP, iodine excretion was 115 +/- 60.3 micromol/mol and reached a peak of 5.3. 10(5) +/- 4.9. 10(5) micromol/mol (p < 0.001). Six weeks later, it had returned to baseline. Two patients in the coronary angiography group but none in the ERCP group had suppressed thyrotropin after 6 weeks. CONCLUSIONS: The systemic iodine load during ERCP is approximately 0.6% of the iodine load during coronary angiography. Therefore routine measurement of thyroid hormones before ERCP is not recommended.

Absorption↗
PubMed2001

Acute cholangitis--predictive factors for emergency ERCP.

BACKGROUND: Acute cholangitis varies in severity from a mild form to severe cases which require urgent biliary decompression. AIM: This study was undertaken in order to develop a prognostic scoring system that can be used to predict which patients are likely to require emergency endoscopic retrograde cholangiopancreatogram (ERCP) upon admission. METHODS: This is a prospective study of 142 consecutive patients with acute cholangitis. Emergency ERCP was performed in patients who did not respond to medical therapy. RESULTS: Thirty-one patients (21.8%) required emergency ERCP. A maximum heart rate of more than 100/min, albumin of less than 30 g/L, bilirubin of more than 50 micromol/L and prothrombin time of more than 14 s on admission were associated with failure of medical treatment and the need for emergency ERCP (P=0.001, < 0.001, 0.006 and 0.004, respectively). By using these four factors in a scoring system, 50.7% of those with a score of one or more required emergency ERCP compared with 1.5% of those with none of the four risk factors (P < 0.001). This scoring system has a sensitivity of 96.8% and a specificity of 59.6%. CONCLUSIONS: As patients with severe acute cholangitis show a higher mortality, we recommend that emergency ERCP be performed in patients with one or more of the four prognostic factors.

Acute Disease↗
PubMed1999

Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP).

BACKGROUND AND STUDY AIMS: Considerable controversy exists regarding the role of antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography (ERCP), in that various studies of antibiotic prophylaxis have reached conflicting conclusions. The aim of this meta-analysis is to synthesize the data in order to determine whether antibiotic prophylaxis reduces the rate of occurrence of bacteremia and/or the rate of sepsis/cholangitis among patients undergoing ERCP. PATIENTS AND METHODS: Clinical trials were selected via Medline and Pubmed using subject words and textwords "ERCP", "antibiotic" and "antibiotic prophylaxis". Summary estimates of the risk ratios for the outcomes of bacteremia and sepsis/cholangitis were calculated. RESULTS: After 49 abstracts had been reviewed, seven randomized placebo-controlled trials of antibiotic prophylaxis prior to ERCP were identified. Upon further review, two studies were excluded because patients received antibiotics before and after the ERCP. Four studies reported on the clinical outcome of bacteremia. Five studies reported on the clinical outcome of sepsis/cholangitis. The summary relative risk of the association between antibiotic prophylaxis and bacteremia was 0.39 (95% CI, 0.12-1.29). For sepsis/cholangitis the summary relative risk was 0.91 (95 % CI, 0.39-2.15). CONCLUSIONS: Antibiotic prophylaxis prior to ERCP may reduce the incidence of bacteremia but this has little clinical relevance. Prophylaxis does not substantially reduce the incidence of sepsis/cholangitis and thus the routine use of antibiotic prophylaxis cannot be recommended.

Antibiotic Prophylaxis↗
PubMed2001

A prospective, randomized, placebo-controlled trial of prednisone and allopurinol in the prevention of ERCP-induced pancreatitis.

BACKGROUND AND STUDY AIMS: Acute pancreatitis is the most frequent and difficult-to-avoid complication of endoscopic retrograde cholangiopancreatography (ERCP). Corticosteroids, potent anti-inflammatory drugs, and allopurinol--a xanthine oxidase inhibitor that blocks the generation of oxygen-derived free radicals--may be potentially effective in preventing post-ERCP pancreatitis. The aim of this prospective study was to determine the effect of prophylactic oral corticosteroids and allopurinol on the incidence and severity of procedure-induced pancreatitis. PATIENTS AND METHODS: 300 patients were randomly assigned to receive oral prednisone (40 mg), allopurinol (200 mg), or placebo 15 h and 3 h prior to ERCP. The diagnosis and grading of ERCP complications were based on commonly accepted criteria. Patients receiving prednisone or allopurinol were compared with the placebo group in a search for differences in pancreatitis rates associated with endoscopic techniques. RESULTS: The overall incidence of pancreatitis was 10.7 %, with 12 % in the prednisone group, 12.1 % in the allopurinol group, and 7.9 % in the placebo group. There were no statistical differences in the incidence or distribution of severity grades between the groups, although severe pancreatitis occurred only in the prednisone and allopurinol groups. Multiple cannulations and prolonged manipulations of the papilla of Vater were identified as risk factors for ERCP-induced pancreatitis. CONCLUSIONS: Neither prednisone nor allopurinol showed a beneficial influence on the incidence and severity of post-ERCP pancreatitis.

Acute Disease↗
PubMed2002

Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors.

BACKGROUND AND STUDY AIMS: Previous studies on the development of post-endoscopic retrograde cholangiopancreatography (post-ERCP) hyperamylasemia and pancreatitis have focused on different risk factors, either procedure- or patient-related, and also prognostic factors, such as amylase levels together with the occurrence of pancreatic-type pain, which might be implicated. The aim of this study is to identify possible predictive risk factors and also prognostic factors in order to better organize the treatment strategy. PATIENTS AND METHODS: During a 5-year period, 556 ERCP procedures were performed by the same operator. Of these, 43 procedures were excluded from the study. Data recorded from the procedures included both patient characteristics and procedure details. Patients were evaluated for pancreatic-type pain at 4 and 24 h after the procedure, and serum amylase levels were determined at 2 and 24 h after the procedure. Pancreatitis was diagnosed on the basis of both clinical and laboratory examination, while patients with hyperamylasemia were in a normal clinical condition but had high serum amylase levels. RESULTS: Post-ERCP pancreatitis occurred after 17 procedures (3.3%) and hyperamylasemia after 85 procedures (16.5%). Patients who developed pancreatitis all had pancreatic-type pain together with amylase levels higher than 4-5 times the upper normal limit at 24 h after ERCP. There was a significant association between serum amylase levels and post-procedure pancreatic-type pain both at 4 h and 24 h after ERCP (P = 0.006). Age less than 50 years, history of relapsing pancreatitis, pancreatic duct opacification, and difficulty in obtaining bile duct cannulation all proved to be significant predictive risk factors for the development of either hyperamylasemia or pancreatitis. In contrast, additional procedures and sphincterotomy seemed to reduce the likelihood of both complications. CONCLUSIONS: Serum amylase levels higher than 4 - 5 times the normal upper limit together with the existence of pancreatic-type pain, at 24 h after ERCP, strongly suggest the occurrence of pancreatitis. When any of the predictive risk factors coexist during a procedure it would be better either to abandon the procedure and try again later or, if the situation is urgent, to have earlier recourse to an alternative, such as precut or needle-knife papillotomy.

Adolescent↗
PubMed2002

Bedside scoring system to predict the risk of developing pancreatitis following ERCP.

BACKGROUND AND STUDY AIMS: Pancreatitis is the most common significant complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of the present study was to develop a simple scoring system that clinicians can use to predict the risk of post-ERCP pancreatitis. PATIENTS AND METHODS: We analyzed a prospectively assembled database of 1835 ERCP procedures at a single referral hospital. Multivariate logistic regression analysis was performed to identify risk factors for pancreatitis and determine their relative contributions. From these results, a scoring system was constructed. The performance of the scoring system was assessed on the entire procedure database and in selected subgroups. RESULTS: Multivariate analysis yielded four risk factors: pain during the procedure, cannulation of the pancreatic duct (PD), previous post-ERCP pancreatitis, and number of cannulation attempts. Based on the regression model, the scoring system was: 4 points for pain, 3 points for PD cannulation, 2 points for a history of post-ERCP pancreatitis, and 1 - 4 points depending on the number of cannulation attempts. A total score of 1 - 4 points was associated with a low risk of pancreatitis (< 2 %), while a score of 5 - 8 points had an intermediate risk (7 %), and a score of 9 or above had a high risk (28 %). CONCLUSIONS: This simple scoring system may enable clinicians to stratify patients into low-risk, medium-risk, and high-risk groups for the development of post-ERCP pancreatitis. In addition, when patients with suspected sphincter of Oddi dysfunction and patients who underwent minor papilla cannulation were analyzed separately, the scoring system was able to predict accurately the pancreatitis risk of these patients as well.

Adult↗
PubMed2003

[Clinical value of intraductal ultrasonography for clarification of confusing ERCP results].

OBJECTIVE: This study assesses the value of intraductal ultrasound (IDUS) when the findings of endoscopic retrograde cholangio-pancreatography (ERCP) are unclear. PATIENTS AND METHODS: IDUS was performed over a two-year period in cases of bile duct or pancreatic duct stenosis of unknown origin found during ERCP or if cholelithiasis was suspected but ERC was seemingly normal. Duct stenoses were classified,before and after IDUS, as benign or malignant ductal or malignant extraductal, the findings then being checked by clinical follow-up,histology or, if bile duct stones had been suspected, by instrumental bile duct exploration. RESULTS: Among 1303 ERCP investigations IDUS was attempted in 125 patients (9.6%; average age 60+/-14 years; 62 females). IDUS failed in seven patients for technical reasons (failure rate 6%). IDUS took an average time of 9+/-3 min. ERCP plus IDUS provided correct classification in 52 of 60 patients with bile duct stenosis (87%), and in 14 of 16 (88%) patients with pancreatic duct stenosis.ERCP alone correctly classified duct stenosis in 54 of 76 patients(87%), but in 66 of 76 (87%) with additional IDUS. The correct demonstration or exclusion of choledocholithiasis was obtained by IDUS in 40 of 42 patients (95%). Thus IDUS changed the diagnosis made by ERCP in 28 of 118 patients (24%). CONCLUSION: With minor expenditure of time and an acceptable failure rate, additional IDUS after ERCP increases the diagnostic accuracy in cases where ductal stenosis or bile duct stones have not been clearly demonstrated.

Adenocarcinoma↗
PubMed1997

Pancreatic sphincter hypertension increases the risk of post-ERCP pancreatitis.

BACKGROUND AND STUDY AIMS: The reason for the increased risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with sphincter of Oddi dysfunction is not known. This study sought to determine whether pancreatic sphincter hypertension might explain some of the increased risk. PATIENTS AND METHODS: The incidence of pancreatitis was determined from a cohort of patients who underwent pancreatic sphincter manometry. Additional data collected included: pancreatic and biliary sphincter manometry results, distal bile duct diameter, chronic pancreatitis grade by pancreatography, and endoscopic treatments. RESULTS: Ten of 32 patients (31%) with pancreatic sphincter hypertension developed post-ERCP pancreatitis, compared to one of 33 (3%) with normal pancreatic manometry (P = 0.002). Patients with pancreatic sphincter hypertension were more likely to undergo endoscopic treatments (88%) compared to those with normal manometry (27%) (P = 0.001). The distal bile duct diameter was significantly smaller (4.5 +/- 0.5 mm) in patients who developed post-ERCP pancreatitis than in those who did not (6.2 +/- 0.3) (P = 0.025). Patients with small distal bile duct diameters (< 5 mm) were three times more likely to develop post-ERCP pancreatitis than those with larger ducts (relative risk [RR] 3.1, 95% confidence interval [CI] 0.9, 10.7). Patients with pancreatic sphincter hypertension were ten times more likely to develop post-ERCP pancreatitis than those with normal pancreatic manometry (RR 10.3, 95% CI 1.5, 76.0). In patients with a small bile duct size, pancreatic sphincter hypertension substantially increased the risk compared to those with normal manometry (RR 18.1, 95% CI 1.1, 287.6). CONCLUSIONS: Pancreatic sphincter hypertension greatly increases the risk of post-ERCP pancreatitis in patients undergoing treatment or evaluation, or both, for sphincter of Oddi dysfunction.

Acute Disease↗
PubMed1997

Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. The German Study Group on Acute Biliary Pancreatitis.

BACKGROUND: The role of early endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy in the treatment of patients who have acute biliary pancreatitis without obstructive jaundice is uncertain. METHODS: We conducted a prospective, multicenter study in which 126 patients were randomly assigned to early ERCP (within 72 hours after the onset of symptoms) and endoscopic papillotomy for the removal of stones in the common bile duct, when appropriate, and 112 patients were assigned to conservative treatment. In the conservative-treatment group, ERCP was performed within three weeks if signs of biliary obstruction or sepsis developed. Overall mortality, mortality due to pancreatitis, and complications were compared in the two groups. RESULTS: Early ERCP was successful in 121 of the 126 patients in the invasive-treatment group. Endoscopic papillotomy was performed to remove bile-duct stones in 58 patients; stones were successfully extracted in 57. ERCP was performed in 22 of the 112 patients in the conservative-treatment group; papillotomy for stone removal was successful in 13 patients. Fourteen patients in the invasive-treatment group and 7 in the conservative-treatment group died within three months (P=0.10); 10 patients in the invasive-treatment group and 4 in the conservative-treatment group died from acute biliary pancreatis (P=0.16). The overall rate of complications was similar in the two groups, but patients in the invasive-treatment group had more severe complications. Respiratory failure was more frequent in the invasive-treatment group, and jaundice was more frequent in the conservative-treatment group. CONCLUSIONS: In patients with acute biliary pancreatis but without obstructive jaundice, early ERCP and sphincterotomy were not beneficial.

Acute Disease↗
PubMed2000

Routine droperidol pre-medication improves sedation for ERCP.

BACKGROUND: Pre-medication with droperidol has been used to improve sedation during endoscopy, especially in patients with a history of alcohol or narcotic abuse. We studied whether routine use of droperidol pre-endoscopic retrograde cholangiopancreatography (ERCP) could improve patient and physician satisfaction with sedation. METHODS: Sixty-seven patients undergoing routine ERCP were enrolled in this double-blind placebo-controlled study. Patients were given either parenteral normal saline solution or 5 mg of droperidol 15 minutes before the procedure. After the ERCP, several parameters of procedural sedation were scored on an ordinal scale by the endoscopist, the endoscopy nurse, and the recovered patient. In addition, a follow-up telephone call was made to the patient after 24 hours. RESULTS: The mean procedural room time was similar in the two groups. Nearly 25% less meperidine and diazepam was used in the droperidol-treated patients, making the overall medication cost similar in both groups. The mean recovery room time was 113 minutes for the placebo group and 106 minutes for the droperidol group. Droperidol premedication significantly decreased post-procedure nausea and vomiting, reduced gagging at intubation, and decreased retching during the procedure. Droperidol also improved physician (p = 0.001), nurse (p = 0.001), and patient (p = 0.0001) impressions of overall sedation and decreased the need for physical restraint during the procedure. Droperidol significantly increased the number of patients with no memory of the procedure. CONCLUSION: Droperidol improved overall patient, physician, and nurse satisfaction with sedation during ERCP. It also reduced post-ERCP nausea and vomiting without increasing recovery time or medication cost. Droperidol is recommended for routine pre-ERCP sedation. (Gastrointest Endosc 2000;52:362-6).

Adolescent↗
PubMed2001

Cost analysis of ERCP in a university hospital.

BACKGROUND: A detailed analysis of the costs of ERCP is needed to provide medical staff, hospital administrators, and health care insurers with a solid basis for decision making. METHODS: An incremental cost analysis was performed from the hospital perspective. Cost calculations were based on a prospective registration of materials, labor time, and equipment needed to perform 204 ERCPs in a tertiary care center. RESULTS: Annual fixed cost related to the organization of the ERCP-unit amounted to $136,213. Variable costs per procedure, including labor and material costs, amounted to $344 and $961 for diagnostic and therapeutic procedures, respectively. Average reimbursement was $221. For the actual situation in our unit, with about 900 procedures yearly and a ratio diagnostic versus therapeutic procedures of 35 to 65, a net yearly loss because of the performance of ERCP activities amounts to $608,038. Theoretical measures to decrease costs could reduce this loss to $394,798, with an average loss of $439 per procedure. CONCLUSIONS: This analysis of costs related to performance of ERCPs clearly shows that ERCP is not sufficiently reimbursed. From our model, it appears that increasing the reimbursement rate for therapeutic procedures to $600 per procedure would generate a net positive balance.

Adolescent↗
PubMed2002

Management of gallstone pancreatitis: cholecystectomy or ERCP and endoscopic sphincterotomy.

BACKGROUND: Currently, cholecystectomy is recommended for patients with gallstone-induced pancreatitis. ERCP with endoscopic sphincterotomy (ES) within 24 to 48 hours is also suggested for the treatment of acute gallstone pancreatitis. The aim of this study was to determine outcome after cholecystectomy versus ES alone in patients with gallstone pancreatitis. METHODS: One hundred seventeen patients with gallstone pancreatitis were included in this prospective observational study. Inclusion criteria were typical abdominal pain; serum amylase level 3 times or greater than normal; and gallbladder stones and a dilated bile duct, with or without stones, by US, CT, or ERCP. RESULTS: Eighty-three patients (Group A) underwent cholecystectomy after initial evaluation including ERCP in 43 (53%) and ERCP with ES in 38 (47%). The remaining 34 (Group B) underwent successful ERCP with ES alone. Mean follow-up was 33 months for Group A and 34 months for Group B. Recurrent gallstone pancreatitis was noted in 2 patients (2.4%) in Group A (bile duct stone in 2, sludge and papillary stenosis in 1), and in 1 patient (2.9%) in Group B. Ten patients in Group B had follow-up US of the gallbladder that showed disappearance of stones in 3. During follow-up, there was no significant difference in the rates of biliary complications (Group A, 3.6% vs. Group B, 11.6%; p = 0.19) or serious complications (pancreatitis, cholecystitis, cholangitis) (Group A, 3.6% vs. Group B, 5.8%). Also, there was no significant difference in procedure-related complications. CONCLUSIONS: Recurrence of pancreatitis after ERCP with ES alone for gallstone pancreatitis is rare. In patients who have undergone ES alone, cholecystectomy should be considered only if there are overt manifestations of gallbladder disease (e.g., biliary pain, cholecystitis, cystic duct obstruction) and not for prevention of recurrent gallstone pancreatitis. Because treatment by ES alone may be associated with a higher risk of biliary complications during follow-up compared with cholecystectomy, these patients may require close surveillance.

Acute Disease↗
PubMed2002

Laryngeal mask airway--a novel method of airway protection during ERCP: comparison with endotracheal intubation.

BACKGROUND: ERCP sometimes requires deep sedation and rarely general anesthesia with airway protection. The laryngeal mask airway device is placed perorally to create a seal over the larynx. Unlike endotracheal intubation, no tube traverses the vocal cords, thus reducing airway stimulation and obviating the need to administer muscle relaxants. The feasibility of using the laryngeal mask airway during ERCP was evaluated and recovery times compared for patients undergoing ERCP with the laryngeal mask airway versus endotracheal intubation. METHODS: In this retrospective cohort study, anesthesia records were reviewed for anesthesiologist-assisted ERCP procedures performed during a 30-month period. Demographics, procedure duration, and time from endoscope removal to extubation were abstracted. Either propofol or inhalation agents were used for anesthesia in all patients. OBSERVATIONS: Anesthesiologists administered sedation for 41 ERCPs. The airway was managed in 12 patients with endotracheal intubation and the laryngeal mask airway in 20 patients. Six patients underwent laryngeal mask airway insertion and removal while prone. A therapeutic duodenoscope was passed beyond the laryngeal mask airway with little or no resistance in all cases. Repositioning the laryngeal mask airway during the procedure was required in 1 case. Laryngeal mask airway use was associated with shorter extubation time compared with endotracheal intubation (7.2 vs. 12 min.; p = 0.004). There were no airway complications. CONCLUSION: ERCP can be performed while using the laryngeal mask airway for airway protection. The laryngeal mask airway can be placed with the patient prone, obviating the need to change position. Laryngeal mask airway shortens extubation time compared with endotracheal intubation.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2003

Transdermal glyceryl trinitrate for prevention of post-ERCP pancreatitis: A randomized double-blind trial.

BACKGROUND: Pancreatic sphincter hypertension increases the risk of pancreatitis in patients undergoing ERCP. Glyceryl trinitrate reduces sphincter of Oddi pressure. This study tested the hypothesis that transdermal glyceryl trinitrate could be effective in the prevention of post-ERCP pancreatitis. METHODS: One hundred forty-four patients undergoing ERCP were randomized: 71 received a 15-mg glyceryl trinitrate patch (glyceryl trinitrate group) and 73 a placebo patch (control group). RESULTS: In the control group, post-ERCP pancreatitis developed in 11 patients versus 3 in the glyceryl trinitrate group (p < 0.05). Twenty-four hour to baseline serum amylase and lipase ratios were lower in the glyceryl trinitrate group (respectively, 3.6 vs. 7.5, p < 0.05; and 5.3 vs. 27.7, p < 0.05). In a multivariate analysis, glyceryl trinitrate patch and the number of pancreatic injections, but not endoscopic sphincterotomy, were independent risk factors for post-ERCP pancreatitis. CONCLUSIONS: The results of this study suggest that use of a transdermal glyceryl trinitrate patch protects against post-ERCP pancreatitis.

Administration, Cutaneous↗
PubMed2003

Diagnostic and therapeutic ERCP in hepatic hydatid disease.

BACKGROUND: This retrospective study evaluated the use of diagnostic and therapeutic ERCP in pre- and postoperative patients with hepatic hydatid disease. METHODS: For 8 years, ERCP was performed in 39 patients with hepatic echinococcal disease. Indications in the preoperative group of patients (n = 19) included a cholestatic enzyme profile in all cases; jaundice or acute cholangitis also was present in, respectively, 14 and 7 cases. In the postoperative group (n = 20), indications for ERCP included persistent external biliary fistula after surgery in 10 patients, jaundice in 8, acute cholangitis in 7, and right upper quadrant pain in 2 patients. RESULTS: ERCP findings in the preoperative group included cystobiliary fistula (9 patients), external compression of the hepatic biliary system (5), hydatid vesicles and/or membranes within the biliary tract (3), intrahepatic duct stricture (1), and a normal cholangiogram (4). The most common ERCP finding in the postoperative group was external biliary fistula (10 patients); other findings consisted of hydatid cyst material within the bile duct (4), bile duct stenosis (2), cystobiliary fistula and hydatid cyst material in the bile duct (1), cystobiliary fistula (1), hydatid membranes in the gallbladder (1), extrinsic compression to bile ducts (1), and a normal cholangiogram (1). In the preoperative group, endoscopic sphincterotomy was performed in 11 patients, with balloon catheter extraction in 2; complete resolution of findings was achieved in 10 cases. In the postoperative group, sphincterotomy (with balloon or basket extraction as needed) was performed in 19 patients, stents were placed in 2 patients, 1 patient underwent balloon dilatation, and 1 had nasobiliary drainage; there was complete resolution of the findings in 14 of the 20 patients. CONCLUSIONS: ERCP and related therapeutic maneuvers are safe and valuable in the pre- and postoperative management of patients with hepatic hydatid disease.

Adult↗
PubMed1989

Selective ERCP and preoperative stone removal in bile duct surgery.

This project was undertaken to evaluate in a prospective fashion the effects of selective preoperative endoscopic-retrograde cholangiography and stone extraction (ERCP-ST EXTR) on the results of biliary tract surgery. Over a 6-year period, 728 patients with primary or secondary biliary tract disease were admitted to the First Surgical Department, landeskrankenanstalten, Salzburg, Austria. If, based on preoperative screening, the possibility of common bile duct stones (CBDS) existed, the patients were subjected to ERCP-ST EXTR. Two to 4 days later, these patients underwent a simple cholecystectomy with intraoperative cholangiogram and functional manometry. Evaluation criteria for this study were morbidity, mortality, and retained stone (RST) rates. The overall complication rate for the entire series was 6%. In patients who underwent operative common duct stone removal (n = 78), the complication rate amounted to 21.8%. The rate was reduced to 2.1% by ERCP-ST EXTR. The RST rate was likewise reduced from 2.2% to 0.5% by ERCP-ST EXTR. Mortality in patients with CBDS fell from 3.8% to 1% through the use of this method. In those patients with secondary stones who were treated by ERCP-ST EXTR only, morbidity was 2%, the RST rate was 0%, and mortality was 0%. It is concluded that selective ERCP-ST EXTR, followed by simple cholecystectomy, is a suitable treatment protocol and that this approach may reduce complication and mortality rates.

Adult↗
PubMed1983

Prospective evaluation of the risk of bacteremia and the role of antibiotics in ERCP.

To determine the frequency of bacteremia associated with endoscopic retrograde cholangiopancreatography (ERCP), we obtained blood cultures before, during, and after ERCP in 51 consecutive patients. Patients with radiographically demonstrated abnormalities in pancreatic and/or biliary ducts were routinely given antibiotic therapy after ERCP. Bacteremia after successful cannulation of the papilla of Vater was observed in only one patient with multiple strictures of the main pancreatic duct. No episodes of acute febrile illness was observed in any patient during the 48-hour follow-up period after ERCP. Our observations suggest that the risk of bacteremia from ERCP is minimal, and that any possibility of sepsis after ERCP in patients with abnormal pancreatic or biliary ducts may be prevented by administering appropriate antibiotics after the procedure.

Adolescent↗