Статті в журналах: "Therapeutic ERCP"

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Enns, R., MA Eloubeidi, K. Mergener, PS Jowell, MS Branch, and J. Baillie. "Predictors of Successful Clinical and Laboratory Outcomes in Patients with Primary Sclerosing Cholangitis Undergoing Endoscopic Retrograde Cholangiopancreatography." Canadian Journal of Gastroenterology 17, no. 4 (2003): 243–48. http://dx.doi.org/10.1155/2003/475603.

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Endoscopic retrograde cholangiopancreatography (ERCP) in patients with primary sclerosing cholangitis (PSC) can be a challenging and sometimes gratifying opportunity for therapeutic intervention. Although there often appears to be initial radiological improvement after ERCP, the benefit as measured by serial estimations of subsequent liver enzymes is questionable. The fluctuating course of the inflammatory process makes the interpretation of serology even more difficult.OBJECTIVES: To document and compare the liver profile and clinical status of patients before and after diagnostic and therapeutic ERCP; to determine predictors of clinical and laboratory success in patients with PSC; and to assess the complication rate of diagnostic and therapeutic ERCP in these patients.METHODS: All patients with PSC who underwent ERCP at the authors’ medical centres between January 6, 1987 and January 12, 1998 were identified using a computerized database. Presenting symptoms, liver enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase) and bilirubin were recorded before ERCP. Clinical success was defined as resolution of the presenting symptoms. Laboratory success was defined as improvement in two of three liver enzymes by at least 50%, or resolution of jaundice.RESULTS: One hundred four patients underwent 204 ERCPs of which 56 ERCPs were diagnostic. Clinical improvement was seen in 35% of the patients after diagnostic ERCP and in 70% after therapeutic procedures (Χ2=18.4, P=0.001). Laboratory improvement was seen in 35% of patients undergoing diagnostic ERCP and in 52% of the patients undergoing therapeutic ERCP (P=0.04). The reductions in liver enzymes were significant in both the diagnostic and therapeutic groups. Serum bilirubin level decreased significantly in the therapeutic ERCP group only. In a univariate analysis, patients with common bile duct strictures, any dominant stricture and those who underwent a therapeutic procedure were most likely to have clinical and laboratory improvement. In multivariable logistic regression, the presence of a dominant stricture, endoscopic therapy and high serum bilirubin were all independent predictors of a successful clinical outcome. There was no difference in total complication rates (18% versus 14%) when comparing the diagnostic and therapeutic ERCP groups. However, all seven severe complications occurred in the therapeutic ERCP group.CONCLUSIONS: First, in PSC, clinical and laboratory improvement is more common in patients undergoing therapeutic ERCP than diagnostic ERCP. Second, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase improve following both diagnostic and therapeutic ERCP, and should therefore not be relied upon to determine the success of the procedure. Third, bilirubin levels decreased in the therapeutic group but remained unchanged in the diagnostic group, suggesting that the serum bilirubin level may be a more sensitive indicator of successful therapeutic intervention than transaminases. Fourth, common bile duct strictures, dominant strictures and bilirubin levels are important variables in determining the success of an ERCP in PSC. Finally, complication rates after therapeutic ERCP are similar to those after diagnostic ERCP in PSC patients. However, severe complications occur more commonly in the therapeutic group.

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Jones, Wesley B., Joseph Blackwell, Brian McKinley, and Steven Trocha. "What is the Risk of Diagnostic Endoscopic Retrograde Cholangiopancreatography before Cholecystectomy?" American Surgeon 80, no. 8 (August 2014): 746–51. http://dx.doi.org/10.1177/000313481408000821.

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Many surgeons prefer to perform endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy, specifically in patients at significant risk of having biliary pathology. However, a preoperative diagnostic ERCP, without the use of an endoscopic ultrasound or magnetic retrograde cholangiopancreatoscopy, remains controversial. This is the result of the risk of either performing an unnecessary procedure and/or the development of post-ERCP pancreatitis (PEP). We performed a retrospective review of all surgeon-performed ERCPs at our institution between July 2011 and May 2013. This was done to examine patients who had pericholecystectomy ERCP. We had 550 ERCPs performed at our institution during this time period, 169 of which were pericholecystectomy procedures. We divided the 169 patients who had a diagnostic procedure (Diagnostic group) from those who had known biliary pathology before intervention (Therapeutic group). As a result, 34 patients (20.1%) were placed in the Diagnostic group and 135 patients (79.9%) in the Therapeutic group. Of the 34 Diagnostic patients, four (11.8%) developed PEP. Fifteen (44.1%) had unnecessary procedures, two of which had PEP (2.9%). Of the 135 ERCPs in the Therapeutic group, 18 patients (13.4%) developed PEP. Five of the 11 who had unnecessary procedures developed PEP. Based on the low incidence of complications, diagnostic ERCP has an acceptable rate of pancreatitis and/or unnecessary procedures when performed in highly selected patients and before cholecystectomy when compared with patients undergoing therapeutic ERCP. However, more aggressive use of diagnostic imaging before ERCP should be adopted given the number of unnecessary procedures performed.

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Choudhury, Bikash Narayan, Utpal Jyoti Deka, Bhaskar Jyoti Baruah, Mallika Bhattachayya, Preeti Sarma, and Porag Debroy. "Indications, outcomes and complications of therapeutic endoscopic retrograde cholangiopancreatography procedures in a tertiary care centre in North East India." International Journal of Research in Medical Sciences 8, no. 7 (June 26, 2020): 2606. http://dx.doi.org/10.18203/2320-6012.ijrms20202903.

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Background: Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is one of the most complex endoscopic procedures in the management of several pancreatobiliary diseases. There is no comprehensive data available till date about ERCP procedures from North East India. The aim of this study was to review the indications, outcomes and complications of endoscopic retrograde cholangiopancreatography (ERCP) procedures in a tertiary care centre of North East India.Methods: We retrospectively analysed the clinical records of all patients undergoing ERCP between July 2011 and November 2019. ERCP was performed under sedation (Midazolam + Pentazocine). Patient’s demographic characters, ERCP indications, outcome and post-ERCP complications were reviewed. Potential important patient and procedure related risk factors for overall post-ERCP complications were investigated.Results: A total 1038 patients were included in the study. Cannulation of the desired duct was successful in 89.2% of ERCPs. Among them male patients were 392 and females were 646. Mean age was 45 years and the age range were 7 to 92 years. Commonest indication was choledocholithiasis followed by malignancy. Overall Success rate was 82.66% with 84.64% in CBD stone and 75.65% in stenting of malignancy. Post ERCP complications developed in 96 patients (9.2%) and pancreatitis was the most common post-ERCP complication. Sedation related complications occurred only in few cases.Conclusions: Despite its associated morbidity and risk of mortality, ERCP is an important method for managing the pancreatic-biliary diseases. Indications, outcomes, and complications of therapeutic ERCPs in our centre are comparable to those reported from other centres.

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Yoon, Seung Bae, Jungmee Kim, Chang Nyol Paik, Jun Kyu Lee, Dong Kee Jang, Won Jae Yoon, Jung-Wook Kim, Byoung Kwan Son, Tae Hee Lee, and Jae-Young Jang. "Trends and Characteristics of Endoscopic Retrograde Cholangiopancreatography: A Nationwide Database Study in Korea." Korean Journal of Pancreas and Biliary Tract 26, no. 3 (July 31, 2021): 186–94. http://dx.doi.org/10.15279/kpba.2021.26.3.186.

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Background/Aim: Endoscopic retrograde choangiopancreatography (ERCP) has been established as an effective tool for the diagnosis and treatment of pancreatobiliary diseases. However, after the evolution for more than 4 decades, nationwide data on current trends and characteristic is not well known. Therefore, we conducted an analysis of nationwide database to determine the number and status of ERCP performed in Korea. Methods: We used the nationwide claims database, Korean Health Insurance Review and Assessment between 2012 and 2015. We investigated the frequencies and characteristics of ERCP procedure performed as well as demographics of the patients. Results: A total of 158,038 ERCP procedures were performed in 114,757 patients during study period. The number of total ERCPs increased every year, and especially the rate of therapeutic ERCPs is on the increased trend. About two-thirds of ERCPs (63.3%) were performed in high-scaled hospitals. In 2015, the proportion of elderly patients over 80 years old increased compared to that in 2011, from 14.3% to 17.2%. Conclusions: The annual number of ERCPs performed is increasing in Korea. With increasing ERCP for therapeutic purposes or for older patients, more attention should be paid to safety for patients.

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Jones, Wesley B., Richard H. Roettger, William S. Cobb, and Alfredo M. Carbonell. "Endoscopic Retrograde Cholangiopancreatography in General Surgery: How Much are We Outsourcing?" American Surgeon 75, no. 11 (November 2009): 1050–53. http://dx.doi.org/10.1177/000313480907501104.

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Although surgeons can safely perform endoscopic retrograde cholangiopancreatography (ERCP), it has fallen within the domain of gastroenterologists. We sought to quantify the role of ERCP in a tertiary-care surgery department. The hospital discharge database was queried for all ERCPs performed from January 2007 to December 2007. Gastroenterologists performed all ERCPs in our query. Surgical patients were admitted and/or under the care of a surgeon; whereas nonsurgical patients had no surgeon involvement. Patient characteristics and diagnoses were compared between groups. ERCP procedural details were recorded. Surgical patients comprised 48 per cent (n = 151) of the total 311 ERCPs performed. The mean time interval from a surgeon's request for ERCP to actual procedure was 2.43 days (standard deviation [SD] 2.55; range, 0-13 days). The surgical group had significantly different diagnoses and underwent less diagnostic (22% vs 56%) and more therapeutic ERCPs (72% vs 38%). Surgical patients were more likely inpatients (82.1% vs 16.8%) with a longer length of stay (6.7 vs 3.9 days; P = 0.0029) compared with nonsurgical patients. We found surgical patients requiring ERCP differ significantly from nonsurgical patients, with a significant number of technical interventions being outsourced. Given the benefits of a surgical ERCP program and the potential volume of these unique patients, this procedure should be performed by appropriately trained surgeons.

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Navaneethan, Udayakumar, Basile Njei, Xiang Zhu, Kiran Kommaraju, Mansour Parsi, and Shyam Varadarajulu. "Safety of ERCP in patients with liver cirrhosis: a national database study." Endoscopy International Open 05, no. 04 (April 2017): E303—E314. http://dx.doi.org/10.1055/s-0043-102492.

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Abstract Background and aims Given the limited data on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with liver cirrhosis, we attempted to evaluate this question using a large national database. Methods We conducted a matched case – control study using the 2010 National Inpatient Sample database in which four non-cirrhotic controls were matched randomly for every cirrhotic patient from the same 10-year age group. We compared adverse events and safety of inpatient ERCP between patients with (n = 3228) and without liver cirrhosis (controls, n = 12 912). Results Of the 3228 cirrhotic patients, 2603 (80.6 %) had decompensated and 625 (19.4 %) had compensated disease. Post-procedure bleeding (2.1 % vs. 1.2 %, P < 0.01) was higher in patients compared to controls. On multivariable analysis, decompensated cirrhosis (adjusted odds ratio [aOR], 2.7; 95 % confidence interval [CI], 2.2 – 3.2), compensated cirrhosis (aOR 2.2; 95 %CI 1.2 – 3.9), therapeutic ERCPs (aOR 1.4; 95 % CI 1.2 – 2.1), and biliary sphincterotomy (aOR 1.6; 95 %CI 1.1 – 2.1) were independently associated with increased risk of post-procedure bleeding. Performing ERCPs in large (aOR 0.5; 95 %CI 0.4 – 0.6) and medium (aOR 0.7; 95 %CI 0.6 – 0.9) sized hospitals was associated with a decreased risk of post-procedure bleeding. Biliary sphincterotomy (aOR 1.7; 95 %CI 1.2 – 2.3) and therapeutic ERCPs (aOR 1.1; 95 %CI 1.1 – 1.3) increased the risk of post-ERCP pancreatitis, and pancreatic stent placement was associated with a decreased risk of post-ERCP pancreatitis (aOR 0.8; 95 %CI 0.7 – 0.9). Conclusions Cirrhosis (both compensated and decompensated), performing therapeutic ERCPs and biliary sphincterotomy increase the risk of post-procedure bleeding. Performing ERCPs in large and medium sized hospitals may improve outcomes.

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Mesenas, Steven J. "Does the Advent of Endoscopic Ultrasound (EUS) Sound the Death Knell for Endoscopic Retrograde Cholangiopancreatography (ERCP)?" Annals of the Academy of Medicine, Singapore 35, no. 2 (February 15, 2006): 89–95. http://dx.doi.org/10.47102/annals-acadmedsg.v35n2p89.

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Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has been the premier diagnostic and therapeutic endoscopic procedure in the management of pancreatic and biliary diseases (PBD). The use of endoscopic ultrasound (EUS), including EUS-guided fine needle aspiration (FNA), of pancreatic and biliary tumours has become more widely available in the last decade and has gradually replaced diagnostic ERCP. Together with EUS, other imaging modalities like magnetic resonance cholangiopancreatography (MRCP) have resulted in a decrease in the number of ERCPs. With the advent of interventional EUS, ERCP is at risk of being completely eclipsed. Methods: A search of all relevant articles on EUS and ERCP from Medline and peer-reviewed journals. Results: This review article examines the exact place of ERCP and EUS and their relative contributions in the management algorithm of PBD. Conclusion: Although diagnostic EUS, including EUS-guided FNA, is well established in the evaluation of PBD, interventional EUS is still in its infancy and its true potential is unknown. Therefore, therapeutic ERCP still has a vital, albeit smaller role to play in the treatment of pancreatic and biliary diseases. Key words: Biliary diseases, Endoscopic retrograde cholangiopancreatography, Endosonography, Pancreatic

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Tham, Tony C. K., Jo Vandervoort, Richard C. K. Wong, David R. Lichtenstein, Jacques Van Dam, Fred Ruymann, Frank Farraye, and David L. Carr-Locke. "Therapeutic ERCP in outpatients." Gastrointestinal Endoscopy 45, no. 3 (March 1997): 225–30. http://dx.doi.org/10.1016/s0016-5107(97)70263-3.

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Kröner, Paul T., Mohammad Bilal, Ronald Samuel, Shifa Umar, Marwan S. Abougergi, Frank J. Lukens, Massimo Raimondo, and David L. Carr-Locke. "Use of ERCP in the United States over the past decade." Endoscopy International Open 08, no. 06 (May 25, 2020): E761—E769. http://dx.doi.org/10.1055/a-1134-4873.

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Abstract Background and study aims With newer imaging modalities, indications for use of endoscopic retrograde cholangiopancreatography (ERCP) have changed in the last decade. Despite advances in ERCP, paucity in recent literature regarding utilization and outcomes of ERCP exists. Thus, the aim of this study was to assess the inpatient use of ERCP, outcomes, and most common indications. Patients and methods Retrospective-cohort study using the Nationwide Inpatient Sample 2007–2016. All patients with ICD9–10CM procedural codes for ERCP were included. The primary outcome was the use of ERCP. Secondary outcomes included determining procedural specifics (stenting, sphincterotomy and dilation), complications (post-ERCP pancreatitis [PEP], bile duct perforation), hospital length of stay, total hospital costs and charges. Multivariate regression analysis was used to adjust for confounders. Results A total of 1,606,850 patients underwent inpatient ERCP. The mean age was 59 years (60 % female). The total number of ERCPs increased over the last decade. Patients undergoing ERCP in 2016 had greater odds of undergoing bile duct stent placement, pancreatic duct (PD) stenting, biliary dilation, pancreatic sphincterotomy, PEP and biliary perforation. Inpatient mortality decreased. Hospital charges increased, while length of stay (LOS) decreased. Conclusions The number of ERCPs increased in the past decade. Odds of therapeutic interventions and complications increased. The most common principal diagnoses were choledocholithiasis and gallstone-related AP. Hence, physicians must be aware to promptly diagnose and treat complications. These findings may reflect the increased case complexity and fact that ERCP continues to evolve into an increasingly interventional tool, contrasting from its former role as a predominantly diagnostic and gallstone extraction tool.

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Das, Chittaranjan, Ashis Saha, Faruk Hossain, Md Mokhlesur Rahman, Rakibul Hasan, and AHM Towhidul Alam. "Efficacy of endoscopic retrograde cholangiopancreato-graphy in elderly patients." Bangladesh Medical Journal 45, no. 1 (July 30, 2016): 44–46. http://dx.doi.org/10.3329/bmj.v45i1.28967.

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The incidence of biliary tract pathologies increases as the population ages leading to an increase in the demand of therapeutic use of endoscopic retrograde cholangiopancreatography (ERCP). This study was carried out to assess the effectiveness of therapeutic ERCP in elderly patients. It was a prospective observational study. Patients aged 65 years or more referred for therapeutic ERCP from July 2007 to June 2008 were reviewed by a preformed data sheet which included all the relevant details of the procedure. It was collected at the time of ERCP & before discharge. Of 67 patients audited, successful therapeutic ERCP was performed in 91.04% cases. Our study showed that ERCP was effective in the elderly patients.Bangladesh Med J. 2016 Jan; 45 (1): 44-46

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Chen, Chia-Chang, Wan-Tzu Lin, Chun-Fang Tung, Shou-Wu Lee, Chi-Sen Chang, and Yen-Chun Peng. "Safety of Nonagenarians Receiving Therapeutic ERCP, Single Center Experience." Journal of Clinical Medicine 11, no. 17 (September 2, 2022): 5197. http://dx.doi.org/10.3390/jcm11175197.

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(1) Background: The complication rates for nonagenarians receiving therapeutic endoscopic retrograde cholangiopancreatography (ERCP) remain poorly understood. We aimed to determine whether nonagenarians were at an increased risk of ERCP-related complications. (2) Methods: We performed a retrospective study on therapeutic ERCP in nonagenarians from 2011 to 2016 at Taichung Veterans General Hospital. A control group comprising patients aged 65 to 89 years was used to compare demographic data and the outcomes of therapeutic ERCP with the nonagenarians. The risk factors for complications were determined by logistic regression model. (3) Results: There were 35 nonagenarians and 111 patients in the control group. Overall, complication rates were not statistically different between the two groups. However, advanced age was an independent predictor of complications in the multivariate analysis (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.01–1.12; p = 0.049). End stage renal disease (ESRD) was another independent predictor of complications (OR = 4.87; 95% CI = 1.11–21.36; p = 0.036). Post-ERCP pancreatitis and bleeding were more common in ESRD patients than patients without ESRD. (4) Conclusions: Although nonagenarians receiving ERCP did not have more complications compared to elderly patients younger than 90 years, advanced age and comorbidity still affect the outcome of therapeutic ERCP in the elderly patients.

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Ahmed, Moiz, Ritesh Kanotra, Ghanshyambhai Savani, Fenilkumar Kotadiya, Nileshkumar Patel, Sarah Tareen, Matthew Fasullo, et al. "Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience." Endoscopy International Open 05, no. 04 (April 2017): E261—E271. http://dx.doi.org/10.1055/s-0043-102402.

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Abstract Study aims The goal of our study was to determine the current trends for inpatient utilization for endoscopic retrograde cholangiopancreatography (ERCP) and its economic impact in the United States between 2002 and 2013. Patients and methods A Nationwide Inpatient Sample from 2002 through 2013 was examined. We identified ERCPs using International Classification of Diseases (ICD-9) codes; Procedure codes 51.10, 51.11, 52.13, 51.14, 51.15, 52.14 and 52.92 for diagnostic and 51.84, 51.86, 52.97 were studied. Rate of inpatient ERCP was calculated. The trends for therapeutic ERCPs were compared to the diagnostic ones. We analyzed patient and hospital characteristics, length of hospital stay, and cost of care after adjusting for weighted samples. We used the Cochran-Armitage test for categorical variables and linear regression for continuous variables. Results A total of 411,409 ERCPs were performed from 2002 to 2013. The mean age was 59 ± 19 years; 61 % were female and 57 % were white. The total numbers of ERCPS increased by 12 % from 2002 to 2011, which was followed by a 10 % decrease in the number of ERCPs between 2011 and 2013.There was a significant increase in therapeutic ERCPs by 37 %, and a decrease in diagnostic ERCPs by 57 % from 2002 to 2013. Mean length of stay was 7 days (SE = 0.01) and the mean cost of hospitalization was $20,022 (SE = 41). Conclusions Our large cross-sectional study shows a significant shift in ERCPs towards therapeutic indications and a decline in its conventional diagnostic utility. Overall there has been a reduction in inpatient ERCPs.

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Naik, Arun C., Franklin E. Kasmin, Seth A. Cohen, and Jerome H. Siegel. "Is outpatient therapeutic ERCP practical?" American Journal of Gastroenterology 95, no. 9 (September 2000): 2482. http://dx.doi.org/10.1111/j.1572-0241.2000.02602.x.

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Werlin, S. L., A. Bohorfoush, M. Schmalz, and J. Geenen. "102 THERAPEUTIC ERCP IN CHILDREN." Journal of Pediatric Gastroenterology and Nutrition 19, no. 3 (October 1994): 354. http://dx.doi.org/10.1097/00005176-199410000-00114.

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ROCCA, R., F. CASTELLINO, M. DAPERNO, G. MASOERO, R. SOSTEGNI, E. ERCOLE, A. LAVAGNA, C. BARBERA, F. CANAVESE, and A. PERA. "Therapeutic ERCP in paediatric patients." Digestive and Liver Disease 37, no. 5 (May 2005): 357–62. http://dx.doi.org/10.1016/j.dld.2004.09.030.

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Agha, Farooq P. "ERCP—Diagnostic and therapeutic applications." Clinical Imaging 14, no. 2 (May 1990): 166–67. http://dx.doi.org/10.1016/0899-7071(90)90017-6.

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Ramesh, Jayapal, Nipun Reddy, Hwasoon Kim, Klaus Mönkemüller, Shyam Varadarajulu, Brendan McGuire, Derek DuBay, Devin Eckhoff, and C. Mel Wilcox. "Safety and Yield of Diagnostic ERCP in Liver Transplant Patients with Abnormal Liver Function Tests." Diagnostic and Therapeutic Endoscopy 2014 (July 9, 2014): 1–5. http://dx.doi.org/10.1155/2014/314927.

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Background. Abnormal liver enzymes postorthotopic liver transplant (OLT) may indicate significant biliary pathology or organ rejection. There is very little known in the literature regarding the current role of diagnostic ERCP in this scenario. Aim. To review the utility of diagnostic ERCP in patients presenting with abnormal liver function tests in the setting of OLT. Methods. A retrospective review of diagnostic ERCPs in patients with OLT from 2002 to 2013 from a prospectively maintained, IRB approved database. Results. Of the 474 ERCPs performed in OLT patients, 210 (44.3%; 95% CI 39.8–48.8) were performed for abnormal liver function tests during the study period. Majority of patients were Caucasian (83.8%), male (62.4%) with median age of 55 years (IQR 48–62 years). Biliary cannulation was successful in 99.6% of cases and findings included stricture in 45 (21.4 %); biliary stones/sludge in 23 (11%); biliary dilation alone in 31 (14.8%); and normal in 91 (43.3%). Three (1.4%) patients developed mild, self-limiting pancreatitis; one patient (0.5%) developed cholangitis and two (1%) had postsphincterotomy bleeding. Multivariate analyses showed significant association between dilated ducts on imaging with a therapeutic outcome. Conclusion. Diagnostic ERCP in OLT patients presenting with liver function test abnormalities is safe and frequently therapeutic.

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Ayoub, Fares, Tony S. Brar, Debdeep Banerjee, Ali M. Abbas, Yu Wang, Dennis Yang, and Peter V. Draganov. "Laparoscopy-assisted versus enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass: a meta-analysis." Endoscopy International Open 08, no. 03 (February 21, 2020): E423—E436. http://dx.doi.org/10.1055/a-1070-9132.

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Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy, which is increasing in frequency given the rise of obesity. Laparoscopy-assisted ERCP (LA-ERCP) and enteroscopy-assisted ERCP (EA-ERCP) are distinct approaches with their respective strengths and weaknesses. We conducted a meta-analysis comparing the procedural time, rates of success and adverse events of each method. Patients and methods A search of PubMed, EMBASE and the Cochrane library was performed from inception to October 2018 for studies reporting outcomes of LA or EA-ERCP in patients with RYGB anatomy. Studies using single, double, ‘short’ double-balloon or spiral enteroscopy were included in the EA-ERCP arm. Outcomes of interest included procedural time, papilla identification, papilla cannulation, therapeutic success and adverse events. Therapeutic success was defined as successful completion of the originally intended diagnostic or therapeutic indication for ERCP. Results A total of 3859 studies were initially identified using our search strategy, of which 26 studies met the inclusion criteria. The pooled rate of therapeutic success was significantly higher in LA-ERCP (97.9 %; 95 % CI: 96.7–98.7 %) with little heterogeneity (I2 = 0.0 %) when compared to EA-ERCP (73.2 %; 95 % CI: 62.5–82.6 %) with significant heterogeneity (I2: 80.2 %). Conversely, the pooled rate of adverse events was significantly higher in LA-ERCP (19.0 %; 95 % CI: 12.6–26.4 %) when compared to EA-ERCP (6.5 %; 95% CI: 3.9–9.6 %). The pooled mean procedure time for LA-ERCP was 158.4 minutes (SD ± 20) which was also higher than the mean pooled procedure time for EA-ERCP at 100.5 minutes (SD ± 19.2). Conclusions LA-ERCP is significantly more effective than EA-ERCP in patients with RYGB but is associated with a higher rate of adverse events and longer procedural time.

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Hilsden, Robert J., Joseph Romagnuolo, and Gary R. May. "Patterns of Use of Endoscopic Retrograde Cholangiopancreatography in a Canadian Province." Canadian Journal of Gastroenterology 18, no. 10 (2004): 619–24. http://dx.doi.org/10.1155/2004/741912.

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BACKGROUND:Data on current endoscopic retrograde cholangiopancreatography (ERCP) practice patterns drawn from large population-based samples are limited.METHODS:Patterns of ERCP use were determined using billing records for ERCP, sphincterotomy, stone extraction or stent placement performed between April 1, 1994 and March 31, 2002 in Alberta from a population-based administrative database. Age-sex adjusted rates (per 1000 population) were calculated using the 1991 Canadian population as the standard.RESULTS:The eight-year average ERCP rate was 0.98 without evidence of an increasing or decreasing trend over time. The ERCP rate was 0.85 in men and 1.12 in women. Significant regional variation in ERCP rates was seen, ranging from a low of 0.64 to a high of 1.27. The proportion of procedures that were therapeutic increased from 33% in 1994 to 70% in 2001. The likelihood of a procedure being considered therapeutic varied with the age and sex of the patient as well as the health region in which the procedure was performed.CONCLUSIONS:The ERCP rate remained relatively stable over an eight-year time period, but the proportion of procedures that were therapeutic increased dramatically. Important regional variation in ERCP rates and therapeutic procedures exists.

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Nayab, Dure, Sana Ara Akhtar, Sher Rehman, and Hafsa Habib. "FREQUENCY OF EARLY POST-ERCP ADVERSE EVENTS IN BOTH DIAGNOSTIC AND THERAPEUTIC PROCEDURES." Gomal Journal of Medical Sciences 16, no. 2 (June 30, 2018): 43–45. http://dx.doi.org/10.46903/gjms/16.02.1935.

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used for diagnosis and treatment of hepatobiliary disorders. However, there are many adverse events associated with this procedure. The objective of this study was to determine the frequency of early post-ERCP adverse events in both diagnostic and therapeutic procedures in our set-up. Material & Methods: This cross-sectional study was conducted at Department of Gastroenterology, Hayatabad Medical Complex, Peshawar, Pakistan, from 20th December, 2016 to 20th January, 2017. Consecutive sampling technique was used. Patients undergoing ERCP whether diagnostic or therapeutic, irrespective of age and gender, were included. Those having evidence of pancreatitis, cholangitis, or previous ERCP, or abdominal surgery were excluded. The outcome was early post-ERCP complications including pancreatitis, cholangitis, bleeding and perforation. The patients were assessed for these complications immediately and 72 hours after the procedure. Demographic data like age and gender were recorded. The data regarding early post-ERCP complications were recorded and presented as frequencies. Results: Total 102 patients were included in the study. Among these, 38(37.3%) were males and 64 (62.7%) females. Mean age of patients included was 50.89±15.67 years (range 8 to 90 years). Overall post-ERCP complications were noted in 6(5.88%) patients. The most common complication was cholangitis in 5(4.9%) patients, followed by pancreatitis in only one (0.98%). Bleeding and perforation occurred in none of our patients. Conclusion: The most common Post-ERCP complication is cholangitis. Based on our findings, we suggest closer monitoring of patients undergoing ERCP for development of infection. Proper disinfection protocols should be followed to prevent infection.

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Pereira, Pedro, Pedro Costa-Moreira, and Guilherme Macedo. "Cholangiopancreatoscopy: Expanding the Diagnostic Indications of Endoscopic Retrograde Cholangiopancreatography." Journal of Gastrointestinal and Liver Diseases 29, no. 3 (September 9, 2020): 445–54. http://dx.doi.org/10.15403/jgld-1268.

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Besides the adverse effects associated with endoscopic retrograde cholangiopancreatography (ERCP), indirect visualization of the biliopancreatic system through fluoroscopy has limited its diagnostic and therapeutic efficacy. Direct visualization through cholangiopancreatoscopy may overcome this limitation and allow the resolution of many dilemmas related to the diagnostic and therapeutic drawbacks of ERCP. Herein, we discuss the current indications of single-operator cholangioscopy (SOC) concerning the diagnostic interventions within the biliopancreatic system. The current role of SOC in the diagnosis of pancreatobiliary stenosis, primary sclerosing cholangitis, intraductal papillary mucinous neoplasm, and pre-surgical mapping of neoplastic lesions were reviewed. There is growing data in the literature supporting the early implementation of SOC in the diagnostic algorithm of pancreatobiliary diseases. In selected cases, this could prevent diagnostic delay and reduce the risks and costs related to repeated ERCPs. This potential characterizes SOC as safety and cost-effective.

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Vandervoort, J., T. C. K. Tham, R. C. K. Wong, A. D. Roston, A. Slivka, A. P. Ferrari, A. Musa, et al. "Prospective study of post-ERCP complications following diagnostic and therapeutic ERCP." Gastrointestinal Endoscopy 43, no. 4 (April 1996): 401. http://dx.doi.org/10.1016/s0016-5107(96)80438-x.

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Oren, Anath, Ronald Breumelhof, Robin Timmer, Douwe H. Biesma, and Joost B. L. Hoekstra. "Abnormal clotting parameters before therapeutic ERCP." European Journal of Gastroenterology & Hepatology 11, no. 10 (October 1999): 1093–98. http://dx.doi.org/10.1097/00042737-199910000-00004.

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Oren, A., R. Breumelhof, R. Timmer, D. H. Biesma, and J. B. L. Hoekstra. "Abnormal clotting parameters before therapeutic ERCP." European Journal of Gastroenterology & Hepatology 11, no. 12 (December 1999): A28. http://dx.doi.org/10.1097/00042737-199912000-00086.

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Byrne, M. F., and J. Baillie. "Predicting the likelihood of therapeutic ERCP." Digestive and Liver Disease 35, no. 7 (July 2003): 458–60. http://dx.doi.org/10.1016/s1590-8658(03)00216-0.

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Chuttani, Ram, and Douglas K. Pleskow. "Therapeutic ERCP: state of the art." Gastrointestinal Endoscopy Clinics of North America 13, no. 4 (October 2003): xv—xvi. http://dx.doi.org/10.1016/s1052-5157(03)00104-1.

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Kullman, Eric, Kurt Borch, Eva Lindström, Steffan Ånséhn, Ingemar Ihse, and Bo Anderberg. "Bacteremia following diagnostic and therapeutic ERCP." Gastrointestinal Endoscopy 38, no. 4 (July 1992): 444–49. http://dx.doi.org/10.1016/s0016-5107(92)70474-x.

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Walker, Robert S., Arvydas D. Vanagunas, Precious Williams, and Howard B. Chodash. "Therapeutic ERCP: a cost-prohibitive procedure?" Gastrointestinal Endoscopy 46, no. 2 (August 1997): 143–46. http://dx.doi.org/10.1016/s0016-5107(97)70062-2.

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Cohen, S. A., J. H. Siegel, and F. E. Kasmin. "Complications of diagnostic and therapeutic ERCP." Abdominal Imaging 21, no. 5 (September 1996): 385–94. http://dx.doi.org/10.1007/s002619900089.

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&NA;. "Therapeutic ERCP: A cost-prohibitive procedure?" Gastroenterology Nursing 21, no. 1 (January 1998): 28–29. http://dx.doi.org/10.1097/00001610-199801000-00009.

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Thornberg, Rob, Ashok N. Shah, and Parvez S. Mantry. "THERAPEUTIC ERCP IN THE PEDIATRIC POPULATION." American Journal of Gastroenterology 99 (October 2004): S295. http://dx.doi.org/10.14309/00000434-200410001-00896.

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Lee, Tae Yoon. "Recent Update of Accessories for ERCP." Korean Journal of Pancreas and Biliary Tract 26, no. 2 (April 30, 2021): 77–84. http://dx.doi.org/10.15279/kpba.2021.26.2.77.

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Endoscopic retrograde cholangiopancreatography (ERCP) became the standard method of choice for the management of patients with a variety of benign and malignant pancreaticobiliary disorders. A growing range of ERCP accessories has been developed to support the increasing demands and complexity of therapeutic ERCP. Various accessories are needed from selective cannulation to the removal of bile duct stones which involves endoscopic sphincterotomy or endoscopic papillary (large) balloon dilation with a balloon or basket-assisted stone extraction. Detailed knowledge and correct usage of accessories are essential to ensure optimal patient care and safety. This review describes current accessories that are available to use during diagnostic and therapeutic ERCP.

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Gkolfakis, Paraskevas, Apostolis Papaefthymiou, Antonio Facciorusso, Georgios Tziatzios, Daryl Ramai, Spyridon Dritsas, Theodosia Florou, et al. "Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis." Life 12, no. 10 (October 20, 2022): 1646. http://dx.doi.org/10.3390/life12101646.

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Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP), in surgically altered anatomy (SAA), can be challenging and the optimal technique selection remains debatable. Most common foregut interventions resulting to this burden consist of Billroth II gastrectomy, Whipple surgery and Roux-en-Y anastomoses, including gastric by-pass. This systematic review, with meta-analysis, aimed to compare the rates of successful enteroscope-assisted (EA)-, endosonography-directed transgastric- (EDGE), and laparoscopy-assisted (LA)-ERCP. Methods: A systematic research (Medline) was performed for relative studies, through January 2022. The primary outcome was technical success, defined as approaching the ampulla site. Secondary outcomes included the desired duct cannulation, successful therapeutic manipulations, and complication rates. We performed meta-analyses of pooled data, and subgroup analysis considering the EA-ERCP subtypes (spiral-, double and single balloon-enteroscope). Pooled rates are reported as percentages with 95% Confidence Intervals (95%CIs). Results: Seventy-six studies were included (3569 procedures). Regarding primary outcome, EA-ERCP was the least effective [87.3% (95%CI: 85.3–89.4); I2: 91.0%], whereas EDGE and LA-ERCP succeeded in 97.9% (95%CI: 96.4–99.4; I2: 0%) and 99.1% (95%CI: 98.6–99.7; I2: 0%), respectively. Similarly, duct cannulation and therapeutic success rates were 74.7% (95%CI: 71.3–78.0; I2: 86.9%) and 69.1% (95%CI: 65.3–72.9; I2: 91.8%) after EA-ERCP, 98% (95%CI: 96.5–99.6; I2: 0%) and 97.9% (95%CI: 96.3–99.4) after EDGE, and 98.6% (95%CI: 97.9–99.2; I2: 0%) and 98.5% (95%CI: 97.8–99.2; I2: 0%) after LA-ERCP, respectively. The noticed high heterogeneity in EA-ERCP results probably reflects the larger number of included studies, the different enteroscopy modalities and the variety of surgical interventions. Comparisons revealed the superiority of LA-ERCP and EDGE over EA-ERCP (p ≤ 0.001) for all success-related outcomes, though LA-ERCP and EDGE were comparable (p ≥ 0.43). ERCP with spiral-enteroscope was inferior to balloon-enteroscope, while the type of the balloon-enteroscope did not affect the results. Most adverse events were recorded after LA-ERCP [15.1% (95%CI: 9.40–20.8); I2: 87.1%], and EDGE [13.1% (95%CI: 7.50–18.8); I2: 48.2%], significantly differing from EA-ERCP [5.7% (95%CI: 4.50–6.80); p ≤ 0.04; I2: 64.2%]. Conclusions: LA-ERCP and EDGE were associated with higher technical, cannulation, and therapeutic success compared to EA-ERCP, though accompanied with more adverse events.

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Raza, Ali, and Kumar Krishnan. "Endoscopic Pancreato-Biliary Interventions." Digestive Disease Interventions 02, no. 04 (November 30, 2018): 336–45. http://dx.doi.org/10.1055/s-0038-1675756.

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AbstractEndoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) play a critical role in the diagnosis and management of benign and malignant pancreatobiliary diseases. In the last several years, role of ERCP has evolved from just a diagnostic procedure to mostly a therapeutic procedure. It plays a key role in the diagnosis of indeterminate biliary strictures and evaluation of bile leaks. Therapeutic ERCP utilizes various techniques for the extraction of biliary and pancreatic stones, management of bile leaks, and the treatment of malignant and benign strictures. EUS plays a central role in tissue acquisition for diagnostic purposes. Therapeutic applications of EUS have significantly increased in the recent years and include management of pancreatic fluid collections, pancreatic necrosis, drainage of the biliary obstruction, gall bladder drainage, and EUS-assisted ERCP. These procedures have good efficacy and acceptable side effect profile when performed by expert endoscopists at tertiary care medical centers.

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Hasan, Mohammad Quamrul, Nelson Taposh Mondal, Mahbub Hossain, and Irin Perveen. "Endoscopic Retrograde Cholangiopancreatography (ERCP) Experience in a Tertiary Level Hospital in Bangladesh." Journal of Enam Medical College 9, no. 1 (January 25, 2019): 9–15. http://dx.doi.org/10.3329/jemc.v9i1.39898.

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Background: Although endoscopic retrograde cholangiopancreatography (ERCP) was first described as a diagnostic technique, now-a-days we mainly do ERCP with a therapeutic intent for management of various biliary and pancreatic diseases. Objectives: This study intends to find out the diagnosis obtained by ERCP procedure and the therapeutic interventions done for appropriate cases in a tertiary level hospital in Bangladesh. Materials and Methods: This prospective observational study was performed in the Department of Gastroenterology in Enam Medical College & Hospital over a period from June 2014 to October 2016. Eighty patients, aged 15–70 years, were selected only for therapeutic ERCP. They were diagnosed and selected after taking history, physical examination and appropriate investigations. ERCP was done under short-term general anesthesia or deep sedation by using propofol or fentanyl. Results are shown in tables. Results: Majority of the cases were choledocholithiasis (53.75%) followed by cholangiocarcinoma (11.25%), ampullary carcinoma (8.75%), carcinoma of the gall bladder (6.25%), biliary ascariasis (6.25%), biliary stricture (5%), papillary stenosis (5%), chronic pancreatitis (2.5%) and sludge in the CBD (1.25%). Types of therapeutic intervention depended on diagnosis. Papillotomy with stone removal was done in patients with choledocholithiasis. Papillotomy with stenting was done in the patients with cholangiocarcinoma, ampullary carcinoma, gall bladder carcinoma, biliary stricture and paillary stenosis. Papillotomy with worm extraction was done in cases of biliary ascariasis. Papillotomy with clearing of sludge was done for sludge in the CBD and only papillotomy was done in two patients of chronic pancreatitis. Conclusion: In this study we found that choledocholithiasis and biliary tract malignancy were the two major ERCP findings. Therapeutic interventions were done according to diagnosis. The most common therapeutic intervention was papillotomy with stone removal. Next common intervention was papillotomy with stenting. J Enam Med Col 2019; 9(1): 9-15

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Ters, Jalila, Oleko Eddy, and Wadii Moaquit. "Duodenal Perforation Due to Biliary Stent Migration: Case Report." Scholars Journal of Medical Case Reports 10, no. 1 (January 28, 2022): 31–33. http://dx.doi.org/10.36347/sjmcr.2022.v10i01.008.

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ERCP is the most commonly used technique to treat biliary stenosis of benign or malignant origin. Duodenal perforations secondary to biliary prostheses are very rare but can be life threatening. Endoscopic retrograde cholangiopancreatography (ERCP) plays an important diagnostic and therapeutic role in the management of biliary and pancreatic disorders. However, it is an invasive procedure with an associated complication rate in the vicinity and mortality. Therapeutic strategies are multiple. We present an unusual case of a patient who sustained a stent-related duodenal perforation after undergoing ERCP whose prognosis was poor.

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Wagay, Mohmed Imran, Gh Mohammad Wani, Naseer Ahmad Choh, and Owvass Hamied Dar. "ERCP complicated by pseudoanerysm of right hepatic artery: A rare case report." Asian Journal of Medical Sciences 6, no. 2 (September 15, 2014): 115–17. http://dx.doi.org/10.3126/ajms.v6i2.10546.

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Endoscopic Retrograde Cholangio-Pancreatography (ERCP) has advantage of having bothdiagnostic and therapeutic utility and most common indication for endoscopic sphinterotomyis choledocholithiasis. Therapeutic ERCP is quite often associated with complications, mostcommon being acute pancreatitis followed by bleeding. Most common source of bleedingis small branches of pancreaticoduodenal artery (PDA) which lie close to papilla. We reporta rare case of leaking right hepatic artery pseudoanerysm following clearance of commonbile duct (CBD) stones by ERCP presenting with shock and upper GI bleed.DOI: http://dx.doi.org/10.3126/ajms.v6i2.10546Asian Journal of Medical Sciences Vol.6(2) 2015 115-117

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Reuterwall, Marcus, Alexander Waldthaler, Jeanne Lubbe, Nils Kadesjö, Raffaella Pozzi Mucelli, Marco Del Chiaro, Matthias Lohr, and Urban Arnelo. "Bimodal ERCP, a new way of seeing things." Endoscopy International Open 08, no. 03 (February 21, 2020): E368—E376. http://dx.doi.org/10.1055/a-1070-8749.

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Abstract Background and study aims Conventional endoscopic retrograde cholangiopancreatography (ERCP) is hampered by two-dimensional visualization, post-procedural adverse events (AEs), and exposure to ionizing radiation. Bimodal ERCP might mitigate these challenges, but no reports of its use are available to date. The aim of this study was to explore the feasibility of bimodal ERCP, while investigating its potential clinical yield. Patients and methods This was a retrospective observational study of patients that underwent bimodal ERCP in a single tertiary academic referral center. Thirteen patients undergoing conventional ERCP had a previously T2-weighted isotropic 3 D TSE MRCP sequence aligned and fused with the two-dimensional image generated from the fluoroscopy c-arm unit in real time. Results Over a 2-month period, 13 patients with a mean age of 54 underwent bimodal ERCP for bile duct stricture (61.5 %), complex cholelithiasis (7.7 %) and ductal leakage (30.1 %). Bimodal ERCP was feasible in all 13 cases, and image quality was assessed as “good” in 11 patients (84.6 %). Bimodal ERCP aided in visualizing the lesion of interest (76.9 %), assisted in understanding the 3 D anatomy of the biliopancreatic ductal system (61.5 %), and aided in finding a favorable position for the c-arm (38.4 %) for subsequent therapeutic intervention. Conclusions This first report on bimodal ERCP proves its feasibility and suggests that it may assist in increasing both the diagnostic and therapeutic yield of ERCP, while at the same time decreasing AEs during and after ERCP. Its main application might lie in treatment of complex intrahepatic disease.

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Hassan, Razeeb, J. M. H. Qausar Alam, Md Abbas Uddin, and Mousumi Akhter. "“Diagnostic-Therapeutic Management in Patients with Extrahepatic Bile Duct Cancer”." International Journal of Medical Science and Clinical Invention 8, no. 10 (October 14, 2021): 5716–20. http://dx.doi.org/10.18535/ijmsci/v8i10.07.

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Introduction: Biliary tract tumors, or cholangiocarcinomas (CCAs), comprise a heterogeneous group of malignant tumors that can affect any part of the biliary tree, from the interlobular canals of Hering to the primary biliary duct. In the last 20-30 years, the incidence of these tumours has increased especially after the introduction of the new imaging techniques endoscopic retrograde cholangiopancreatography (ERCP, percutaneous transhepatic cholangiography) and the increased interest for this pathology. Objective: To evaluate the diagnostic methods and therapeutical results in patients with extrahepatic bile duct cancer. Material and Method: This cross-sectional study was conducted in the Department of Surgery, Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from Jun-2018 to July-2021. We included 124 consecutive patients with suspected bile duct cancer who underwent endoscopic retrograde cholangiopancreatography (ERCP). Every patient underwent an ultrasound (US) examination before ERCP. ERCP was considered as the “gold standard” for diagnosis. The therapy applied consisted of endoscopic stenting, US guided biliary drainage or surgery. The sensitivity, specificity and accuracy were calculated for every tumour localisation and also globally for all tumours. Results. The sensitivity, specificity and accuracy of US were 85.9%, 76.9% and 84.4% for hilar localization, 59.1%, 50% and 57.1% for the mid common bile duct (CBD) and 33.3%, 42.8% and 36.8% for the distal CBD tumours. The global performances for US in diagnosing extrahepatic chlonagiocarcinoma were 73.5%, 61.5% and 70.9%. In 73 cases (74.5%) an endoscopic stent was placed. In 11 cases (11.2%) we performed an US guided biliary drainage and in 14 cases (14.2%) surgery was recommended. Conclusion: Ultrasonography proved to be a reliable method for the diagnosis of bile duct cancer in spite of its low accuracy for distal localization. The combination of the two investigations (US and ERCP) was very efficient in the management of these patients. Endoscopic stenting for hilar localization is a good therapeutical option.

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Tarik, Addajou, Rokhsi Soukaina, Mrabti Samir, Benhamdane Ahlame, Sair Asmae, Berraida Rida, Elkoti Ilham, Rouibaa Fedoua, Benkirane Ahmed, and Seddik Hassan. "Predictive Factors for Therapeutic Endoscopic Retrograde Cholangiopancreatography-Related Complications in the Treatment of Choledocholithiasis." SAS Journal of Medicine 8, no. 6 (June 15, 2022): 409–12. http://dx.doi.org/10.36347/sasjm.2022.v08i06.007.

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Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is now the exclusive endoscopic therapeutic modality for biliary as well as pancreatic diseases. The aim of our study is to evaluate the complication rate of ERCP in the treatment of choledocholithiasis and to assess the factors related to their occurrence. Methods: This is a retrospective descriptive and analytical study including 1048 patients who underwent ERCP for choledocholithiasis between January 2007 and August 2021. The factors associated with the occurrence of post-ERCP complications were studied by logistic regression analysis. Results: Among the patients studied, 60.5% had a simple lithiasis, 27.6% had multiple choledochal stones and 11.9% had large stones (> 15mm). Clinically, 18.7% of the patients presented with cholangitis and 9.4% with acute pancreatitis. A periampullary diverticulum was found in 9.4% of cases. A common bile duct stenosis was present in 6.5% of cases. The primary vacuity rate was 77.3%. However, additional manoeuvres were used in 20.5% of cases. Complications were reported in 5.8% of cases, including hemorrhage in 4.5%, pancreatitis in 0.8%, cholangitis in 0.2%, perforation in 0.1% and dormia impaction in 0.2%. No death was reported due to our procedures. In a multivariate analysis following adjustment of confounding factors, only the presence of a large stone (OR= 5.9, CI (1.460- 23.875), p=0.013) and female gender (OR= 1.867, CI (1.012-3.444), p=0.046) increased the risk of complications during ERCP. Conclusion: Our study suggests that female gender and the presence of à large gallstone are associated with a high risk of post-ERCP complications.

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Kaw, Madhukar, and Praveena Kaw. "3357 Complications of diagnostic and therapeutic ercp." Gastrointestinal Endoscopy 51, no. 4 (April 2000): AB70. http://dx.doi.org/10.1016/s0016-5107(00)14057-x.

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Sherman, Stuart. "Outpatient therapeutic ERCP: has the time come?" Gastrointestinal Endoscopy 45, no. 3 (March 1997): 326–28. http://dx.doi.org/10.1016/s0016-5107(97)70285-2.

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Bourgeois, N., F. Bourgeois, M. Adler, J. Van de Stadt, J. Devière, and M. Cremer. "Diagnostic and therapeutic ERCP after liver transplananion." Journal of Hepatology 13 (January 1991): S101. http://dx.doi.org/10.1016/0168-8278(91)91376-r.

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Lightdale, Charles J. "Therapeutic and Advanced ERCP Is Rapidly Progressing." Gastrointestinal Endoscopy Clinics of North America 22, no. 3 (July 2012): xiii—xiv. http://dx.doi.org/10.1016/j.giec.2012.05.011.

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Yan, Tao, Lingfeng Zhang, Feng Shao, Cheng Wang, Xiaolin Xie, and Jinwei Ying. "The Effect of Endoscopic Retrograde Cholangiopancreatography on Patients with Common Bile Duct Stones." Journal of Medical Imaging and Health Informatics 10, no. 9 (August 1, 2020): 2186–91. http://dx.doi.org/10.1166/jmihi.2020.3165.

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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.

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Tønnesen, Christer Julseth, Juliet Young, Tom Glomsaker, Tom Mala, Magnus Løberg, Michael Bretthauer, Erle Refsum, and Lars Aabakken. "Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass." Endoscopy 52, no. 08 (April 21, 2020): 654–61. http://dx.doi.org/10.1055/a-1139-9313.

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Background Patients who have undergone Roux-en-Y gastric bypass (RYGB) are at increased risk of biliary disease necessitating endoscopic retrograde cholangiopancreatography (ERCP). The most widely used approaches to perform ERCP after RYGB are laparoscopy-assisted ERCP (LA-ERCP) and balloon enteroscopy-assisted ERCP (BEA-ERCP). There are few studies comparing these procedures. We aimed to compare the performance, benefits, and harms of LA-ERCP and BEA-ERCP in RYGB patients. Methods We identified all RYGB patients who underwent ERCP at two tertiary care endoscopy centers in Oslo, Norway between May 2013 and December 2017. One center performed BEA-ERCP, the other LA-ERCP. Procedure success was defined as fulfillment of the therapeutic or diagnostic aim, according to the procedure description. Adverse events were classified according to the Clavien–Dindo grading system. Results During the study period, 40 BEA-ERCP and 39 LA-ERCP procedures were performed in 68 patients. Procedure success rate was 72.5 % for BEA-ERCP and 87.2 % for LA-ERCP (P = 0.14). Adverse events occurred in 18 % of BEA-ERCP and 28 % of LA-ERCP (P = 0.23). Serious adverse events (Clavien–Dindo grade ≥ 3b) occurred in 2.5 % of BEA-ERCP and 7.7 % of LA-ERCP procedures (P = 0.36). Concomitant cholecystectomy was performed in 25 of the 39 LA-ERCP procedures. The median procedure times for LA-ERCP performed with and without concomitant cholecystectomy were 201 minutes and 140 minutes, respectively, and for BEA-ERCP was 125 minutes. Conclusions In experienced hands, both LA-ERCP and BEA-ERCP have high success rates after RYGB. The choice of approach should be individualized according to patient characteristics and available physician competence.

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Cho, S., P. Kamalaporn, G. Kandel, P. Kortan, N. Marcon, and G. May. "‘Short’ Double-Balloon Enteroscope for Endoscopic Retrograde Cholangiopancreatography in Patients with a Surgically Altered Upper Gastrointestinal Tract." Canadian Journal of Gastroenterology 25, no. 11 (2011): 615–19. http://dx.doi.org/10.1155/2011/354546.

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BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) remains a challenge for endoscopists in patients with surgically altered anatomy of the upper gastrointestinal tract. Double-balloon enteroscopes (DBEs) have revolutionized the ability to access the small bowel. The indication for its therapeutic use is expanding to include ERCP for patients who have undergone small bowel reconstruction. Most of the published experiences in DBE-assisted ERCP have used conventional double-balloon enteroscopes that are 200 cm in length, which do not permit use of the standard ERCP accessories. The authors report their experience with DBE-assisted ERCP using a ‘short’ DBE in patients with surgically altered anatomy.METHODS: A retrospective review of patients with previous small bowel reconstruction who underwent ERCP with a ‘short’ DBE at the Centre for Therapeutic Endoscopy and Endoscopic Oncology (Toronto, Ontario) between February 2007 and November 2008 was performed.RESULTS: A total of 20 patients (10 men) with a mean age of 57.9 years (range 26 to 85 years) underwent 29 sessions of ERCP with a DBE. Six patients underwent Billroth II gastroenterostomy, seven patients Roux-en-Y hepaticojejunostomy, five patients Roux-en-Y gastrojejunostomy, one patient Roux-en-Y esophagojejunostomy and one patient a Whipple’s operation with choledochojejunostomy. Some patients (n=12 [60%]) underwent previous attempts at ERCP in which the papilla of Vater or bilioenteric anastomosis could not be reached with either a duodenoscope or pediatric colonoscope. All procedures were performed with a commercially available DBE (working length 152 cm, distal end diameter 9.4 mm, channel diameter 2.8 mm). The procedures were performed under conscious sedation with intravenous midazolam, fentanyl and diazepam, except in one patient in whom general anesthesia was administered. Either the papilla of Vater or bilioenteric anastomosis was reached in 25 of 29 cases (86.2%) in a mean duration of 20.8 min (range 5 min to 82 min). Bile duct cannulation was successful in 24 of 25 cases in which the papilla or bilioenteric anastomosis was reached. Therapeutic interventions were successful in 15 patients (24 procedures) including sphincterotomy (n=7), stone extraction (n=9), biliary dilation (n=8), stent placement (n=9) and stent removal (n=8). The mean total duration of the procedures was 70.7 min (range 30 min to 117 min). There were no procedure-related complications.CONCLUSION: DBEs enable successful diagnostic and therapeutic ERCP in patients with a surgically altered anatomy of the upper gastrointestinal tract. It is a safe, feasible and less invasive therapeutic option in this group of patients. Standard ‘long’ DBEs have limitations of long working length and the need for modified ERCP accessories. ‘Short’ DBEs are equally as effective in reaching the target limb as standard ‘long’ DBEs, and overcomes some limitations of long DBEs to result in high success rates for endoscopic therapy.

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Panda, Chitta Ranjan, Haribhakti Seba Das, Sambit Kumar Behera, and Preetam Nath. "Retrospective analysis of endoscopic retrograde cholangio pancreatography (ERCP) procedures in a tertiary care centre in coastal Odisha." International Journal of Research in Medical Sciences 5, no. 10 (September 28, 2017): 4281. http://dx.doi.org/10.18203/2320-6012.ijrms20174113.

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Background: ERCP is commonly performed for radiologic visualisation and therapeutic procedure for treating various pancreatico-biliary disorders. There is no comprehensive data available till date about ERCP procedures from Odisha. The aim of this study was to review the indications and complications of endoscopic retrograde cholangiopancreatography (ERCP) procedures in a tertiary care centre in Odisha.Methods: From July 2013 to December 2016, consecutive patients undergoing ERCP procedure were included in the study. Patients with any previous papillary intervention like papillotomy, sphincterotomy or stent placement were excluded from the study. Patients’ demographic characters, ERCP indications and post-ERCP complications were reviewed.Results: Three hundred and fourteen patients were included in the study. Among them male patients were 161 and females were 153. Mean age was 50.75 years and the age range was 18 to 82 years. Most common indications for ERCP was malignant obstructive jaundice (N = 171, 54%) and choledocholithiasis (N = 137, 43.6%). Post ERCP complications developed in 25 patients (8%). Pancreatitis was the most common post-ERCP complication.Conclusions: ERCP is a safe procedure. ERCP complications in our centre are similar to those reported from other centres.

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Patil, Mallikarjun, Keyur A. Sheth, C. K. Adarsh, and B. Girisha. "An unusual experience with endoscopic retrograde cholangiopancreatography." Journal of Digestive Endoscopy 04, no. 04 (October 2013): 114–16. http://dx.doi.org/10.4103/0976-5042.132408.

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AbstractThe endoscopic retrograde cholangiopancreatography (ERCP) is known for its varied diagnostic and therapeutic utility for a variety of disorders. However it has greater likelihood of procedure related complications among the endoscopic procedures of gastrointestinal tract. The extraluminal hemorrhagic complications following ERCP are potentially life threatening though relatively rare. We present a 50 year patient with choledocholithiasis and cholelithiasis developing rare complication of subcapsular hepatic hematoma, following ERCP due to guide wire injury.

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Srivastava, S., B. Sharma, A. Puri, S. Sachdeva, L. Jain, and A. Jindal. "Impact of completion of primary biliary procedure on outcome of endoscopic retrograde cholangiopancreatographic related perforation." Endoscopy International Open 05, no. 08 (August 2017): E706—E709. http://dx.doi.org/10.1055/s-0043-105494.

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Abstract Background and aims Perforation is one of the worst complications of therapeutic endoscopic retrograde cholangiopancreatography (ERCP). We aimed to study the epidemiology of ERCP related perforation and the impact of completion of intended procedure on the outcome of this complication. Methods ERCP records from January 2007 to April 2012 were independently evaluated by two investigators for the occurrence of procedure related perforations. A total of 11 500 patients underwent therapeutic ERCP during the study period. The case records of 171 (1.5 %) patients with ERCP related perforations were reviewed to analyze the epidemiology and risk factors associated with poor outcome. Results Of the 171 patients included in this study, the majority of perforations (n = 129, 75.4 %) were related to use of the needle-knife precut technique. Female gender (1.9 % vs 0.7 %, P < 0.001), age > 40 years (1.7 % vs 1.1 %, P < 0.01), and benign disease (1.7 % vs. 1.1 %, P < 0.01) were risk factors for ERCP related perforation. Most of the perforations (n = 135, 79 %) were detected during the procedure. The majority of patients were managed conservatively (n = 164, 96 %). Although 159 patients recovered, 12 patients (7 %) did not survive. Completion of intended biliary procedure for primary disease was associated with low risk of mortality (2 % vs 15.4 %, P < 0.001). Conclusions ERCP related perforation is uncommon. The majority of patients can be managed conservatively. The risk of mortality is low and completion of the intended biliary procedure decreases the risk of mortality.

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