Application Of Endoscopic Retrograde Cholangiopancreatography Research Articles

Risk factors for pancreatitis after endoscopic retrograde cholangiopancreatography in children

To investigate the application of endoscopic retrograde cholangiopancreatography (ERCP) in children and the risk factors for post-ERCP pancreatitis (PEP). A retrospective analysis was conducted on the clinical data of 66 children, aged ≤16 years, who underwent ERCP for pancreaticobiliary diseases at the Gastrointestinal Endoscopy Center of the Second Affiliated Hospital of Kunming Medical University from September 2013 to September 2023. The incidence rate of PEP and the risk factors for the development of PEP were analyzed. A total of 78 ERCP procedures were performed on 66 children, with 5 diagnostic ERCPs, 69 therapeutic ERCPs, and 4 failed procedures. The success rate of ERCP operations was 95% (74/78). There were 17 cases of PEP in total, with an incidence rate of 22%. In the PEP group, the proportion of children with normal preoperative bilirubin and the proportion of guidewire insertion into the pancreatic duct during surgery were higher than in the non-PEP group (P<0.05). The multivariate logistic regression analysis showed that guidewire insertion into the pancreatic duct was an independent risk factor for PEP (P<0.05). With the increasing application of ERCP in children with pancreaticobiliary diseases, it is important to select an appropriate intubation technique during surgery to avoid blindly entering the guidewire into the pancreatic duct and reduce the occurrence of PEP.

Application of endoscopic retrograde cholangiopancreatography combined with intraductal ultrasonography in differential diagnosis of enign and malignant biliary stricture and nursing management

Application of endoscopic retrograde cholangiopancreatography combined with intraductal ultrasonography in differential diagnosis of enign and malignant biliary stricture and nursing management

Current status and research progress of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of biliary and pancreatic system diseases

Endoscopic retrograde cholangiopancreatography (ERCP) has been used clinically since the 1960s, after nearly half a century of development, it has become an important method for clinical diagnosis and treatment of biliary and pancreatic system diseases. In recent years, with the continuous updating of endoscopy equipment, the advancement of endoscopists’ technology, and the progress in understanding of biliary and pancreatic diseases, the application of ERCP in the diagnosis and treatment of biliary and pancreatic diseases has become more extensive, and the diagnosis and treatment procedures have become more standardized. At the same time, the diagnostic role of ERCP has declined slightly with the advancement of noninvasive imaging technology. But, its intervention role in treatment is more prominent, reducing dependence on traditional trauma therapy. The aim of the study was to summarize the application status of ERCP technology in biliary and pancreatic system diseases and the research progress in recent years.

Application of endoscopic retrograde cholangiopancreatography to common bile duct stones with periampullary diverticulum

Objective To explore the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stones with periampullary diverticula (PAD). Methods Data of 2, 103 patients with common bile duct stones(CBD stones), who underwent therapeutic ERCP for the first time from April 2013 to March 2016, were prospectively analyzed. Patients were divided into two groups according to presence or absence of PAD (PAD group and non-PAD group). Success rate of ERCP, complete clearance rate of the CBD stones after the first attempt and difficult cannulation rate were compared between the two groups. Results The difficult CBD cannulation rate was 14.87%(117/787) in PAD group and 9.93% (123/1 239) in non-PAD group with significant difference (P=0.001). Successful CBD cannulation was achieved in 96.92% (787/812) patients in PAD group and 95.97% (1 239/1 291) in non-PAD group (P=0.156). The complete clearance rate of CBD stones after the first attempt was 85.39% (672/787) in PAD group and 87.09% (1 079/1 239)in non-PAD group (P=0.154). There was no significant difference between the two groups in the complication rate[26/812(3.20%) VS 33/1 291(2.56%), P=0.833]. Conclusion Although PAD increases the difficulty of ERCP, ERCP is an effective and safe method for patients of CBD stones with PAD. Key words: Cholangiopancreatography, endoscopic etrograde; Choledocholithiasis; Diverticulum

Application of endoscopic retrograde cholangiopancreatography in treatment of extrahepatic biliary adenoma

Application of endoscopic retrograde cholangiopancreatography in treatment of extrahepatic biliary adenoma

Recent progress in ERCP for biliary and pancreatic diseases

In recent years, with the continuous development of endoscopic and interventional techniques, many new devices and methods have been used in clinical practice, and the application of endoscopic retrograde cholangiopancreatography (ERCP) in biliary and pancreatic diseases has developed rapidly. This paper reviews and summarizes the recent progress in ERCP among patients with biliary and pancreatic diseases, including those with altered gastrointestinal anatomy, pregnant patients, patients with benign and malignant biliary strictures, and patients with pancreatic pseudocysts, as well as the application of Spy Glass, photodynamic therapy, and radiofrequency ablation, the management of ERCP-related duodenal perforation, and the prevention of post-ERCP pancreatitis. All the progress has made a great contribution to the diagnosis and treatment of biliary and pancreatic diseases.

Analysis of clinical application of endoscopic retrograde cholangiopancreatography for the pancreatic diseases in children

To study the feasibility and risk of endoscopic retrograde cholangiopancreatography (ERCP) for children in clinic, and to evaluate the effects of ERCP in diagnosis and treatment of the pancreatic diseases in children. Totally 98 patients under 14 years of age who underwent ERCP from 1994 to 2011 were enrolled in the study. The data of diagnosis, anesthesia type, treatments, and postoperative complications were collected. The 98 patients were 4 to 14 years old, of whom 32 cases suffered from acute pancreatitis (30 cases with biliary disease and 2 with hyperlipidemia); 42 cases had chronic pancreatitis, of whom 36 had calculus of pancreatic duct, pancreatic pseudocyst was seen in 6 cases. Pancreas divisum was found in 20 cases, choledochopancreatic junction anomaly in 6 cases,and annular pancreas in 1 case. The operations of dissection of pancreatic duct and biliary duct, calculus removal, insertion of endoprosthesis and draining tube in pancreatic duct or biliary duct were performed. No patients died from ERCP complications. In observation of postoperative complications, acute pancreatitis after ERCP occurred in 1 case, with the incidence rate of 1%, 1 case had bleeding (1%), and 5 cases had hyperamylasemia (5%). All the complications were cured within 1 week. The average hospital stay was 5.51 d. ERCP is useful and safe in children under suitable condition of doctors and equipments, and no high rates of complications were observed.

Endoscopic diagnosis and treatment of anomalous pancreaticobiliary ductal junction

Objective To evaluate application of endoscopic retrograde cholangiopancreatography （ERCP） in diagnosis and managements of anomalous pancreaticobiliary ductal junction （APBDJ）. Methods Data of APBDJ patients, including oecurence, sub-type characteristics, relationship with concurrent pancreaticobiliary diseases and endoscopic treatment, who underwent ERCP in the past 5 years, were retrospectively reviewed. Results APBDJ was diagnosed in 49 patients, which accounted for 0. 74% of all ERCP cases （6639） in the same period, among whom, there were 27 cases of P-B sub-type, 19 B-P type, and 3 complex type. Gallbladder carcinoma was accompanied in 16 patients, choledochal cyst in 19, chronic pan creatitis in 7, and pancreas divisum in 2, with morbidity rates significantly higher than those in non-APBDJ population （P 〈 0. 01 ）. The gallbladder carcinoma was most commonly seen in P-B patients （14/16）, and choledochal cyst most frequently occurred in B-P type （15/19）. The endoscopic managements applied in APBDJ patients included sphincterotomy in 10 cases, naso-biliary drainage in 16, plastic stenting in 15, metal stenting in 6, and pancreatic stent placement in 2. Conclusion ERCP is a direct and reliable method for the diagnosis of APBDJ, which is commonly complicated with gallbladder carcinoma, choledochal cyst, and chronic pancreatitis. Endoscopic therapy can be considered in accordance with complications. Key words: Cholangiopancreatography, endoscopic retrograde ; Diagnosis ; Therapy ; Anomalous pancreaticobiliary ductal junction

Blunt Pancreatic Head Hematoma as an Infrequent Cause of Delayed Obstructive Jaundice

BackgroundBlunt pancreatic injury is a rare type of abdominal trauma. It is a challenge to physicians due to difficulties in early diagnosis and associated complications. Most simple cases of pancreas contusion and hematoma can be safely treated conservatively. Nevertheless, the possibility of delayed mass effect and complications always exists. ObjectivesWe present a case with delayed complications after blunt pancreatic trauma. Case ReportA 70-year-old woman with simple pancreatic head hematoma was treated conservatively. A delayed obstructive jaundice occurred 4 weeks subsequent to the trauma. Endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement provided a successful treatment instead of surgical intervention. ConclusionA pancreatic hematoma after blunt abdominal trauma can be complicated by common bile duct obstruction with a delayed onset of obstructive jaundice. The application of ERCP with placement of a biliary stent was effective in this case. Conscientious follow-up and serial imaging studies should be utilized in patients with an initial presentation of an uncomplicated pancreatic head hematoma.

A Catheter Devised for Intraoperative Cholangiography during Laparoscopic Cholecystectomy

Abstract:A catheter devised to facilitate intraoperative cholangiography (IC) during laparoscopic cholecystectomy (lapcholy) is herein introduced. It is a polyethylene tube connected to a 10 mm stainless‐steel tube with an adjustable, pliable guiding sheath. The catheter allowed for accurate and easy cannulation of the cystic duct, as well as tight clipping of the cystic duct. Removal of the guiding sheath after clipping decreased the tension on the polyethylene tube, thereby giving natural biliary tract findings. We describe, herein, our experience with this instrument.The mean duration of IC during lapcholy, including developing time, was only about 10 minutes. This catheter made the intraoperative administration of IC more rapid and reliable, thus markedly reducing the duration of surgery. As a result, preoperative application of ERCP (endoscopic retrograde cholangiopancreatography), which used to be applied to all patients undergoing lapcholy, is now limited to selected cases.

Bile leak after laparoscopic cholecystectomy. Diagnostic and therapeutic application of endoscopic retrograde cholangiopancreatography.

Laparoscopic cholecystectomy, introduced less than 2 years ago, is widely accepted by patients and physicians despite the lack of controlled trials comparing this technology with conventional cholecystectomy. Recent series have described a variable incidence of biliary tract injury with laparoscopic gallbladder removal. The primary interaction of endoscopic retrograde cholangiopancreatography with this technology is usually in the preoperative or postoperative diagnosis and treatment of common bile duct stones. During a 12-month period, 597 patients underwent laparoscopic cholecystectomy by 20 general surgeons at six Puget Sound (Wash) hospitals. All patients with symptomatic postoperative biloma diagnosed by abdominal ultrasound or computed tomography with or without endoscopic retrograde cholangiopancreatography, as well as those who had acute bile duct injury diagnosed and repaired at the time of cholecystectomy, were retrospectively reviewed. Three bile duct transections were acutely recognized and treated with hepaticojejunostomy. Fourteen additional patients presented within 7 days with biloma, three of whom were treated with percutaneous drainage alone. Of the remaining 11 patients who underwent endoscopic retrograde cholangiopancreatography, six were noted to have common bile duct injuries; two, bile duct transections; and 3, cystic duct leaks that required a variety of endoscopic or surgical therapies. In all, 17 (2.9%) of 597 patients sustained a bile duct injury and, to date, seven (1.2%) of 597 patients required surgery for such injury. In a regional setting, laparoscopic cholecystectomy appears to be associated with a higher incidence of bile duct injury than previous reports of open cholecystectomy. Possible explanations include variant anatomy plus failure to obtain an operative cholangiogram, inadequate dissection, injudicious use of cautery or clip placement, inherent limitations of the procedure, or the learning curve associated with a new technology.