Post-endoscopic Retrograde Cholangiopancreatography Complications Research Articles

Management of Common Bile Duct Stones: Evaluation of the Effect of Size of Stones as the Determinant for the Procedure for Treatment in Era of Laparoscopic and Endoscopic Surgery

Abstract Background Common bile duct stones (CBDS) are estimated to be present in 10–20% of individuals with symptomatic gallstones. A variety of imaging modalities can be employed to identify the condition while management of confirmed cases of CBDS may involve endoscopic retrograde cholangiopancreatography (ERCP), surgery and radiological methods of stone extraction. Clinicians are therefore confronted with a number of potentially valid options to treat individuals with suspected CBDS. Objective To determine if ERCP sphincterotomy and extraction is effective in management of CBDS ranging from 10 to 20 mm or if surgical intervention is preferred in a sample of patients with common bile duct stones. Patients and Methods In this study, the data of (30) patients with CBDS who presented for the first time to the department of General surgery at Ain Shams University hospitals, Cairo, Egypt. Were collected during the period of August 2021 to February 2022. Results In the current study, all patients received proper pre-operative assessment and were operated on using same endoscope set and by experienced operators. Also, all patients were observed for post ERCP complications. The current study found that ERCP stone extraction in stones ranging from 10-20 mm success rate shows no significant difference in comparison with results that were published in different recent researches studying ERCP success rate in different stone sizes. Conclusion The current study found that success rate of ERCP in CBD stones extraction in stones ranging from 10-20 mm in size is similar to success rate in stone extraction compared to other studies not specifying stone size range. Also, complication rate was comparable to other recent published studies’ complication rate.

Safety and efficacy of endoscopic retrograde cholangiopancreatography in previously treated liver cancer patients: a survival analysis.

The prognosis and medication response for liver malignancies are both dismal and highly heterogeneous. For this diverse malignancy, multimodality therapies such as drugs, surgical management, and/or l+iver transplantation are available. Biliary complications remain a major problem after liver cancer treatment especially in those patients who undergo liver transplantation for their end stage liver disease. Although, most biliary complications can be successfully managed with endoscopic retrograde cholangiopancreatography. However, biliary complications still considered an important factor influencing long-term results in liver cancer treatment patients. The aim of this study was to evaluate the effect of biliary complications on the overall patient's survival rate after the endoscopic retrograde cholangiopancreatography. We retrospectively analyzed data of consecutive patients who were treated for liver cancer at our tertiary care hospital from January 2015 to July 2020. We focused on the biliary complications and procedural data, including post-endoscopic retrograde cholangiopancreatography complications, survival rate, and complementary or alternative treatments to endoscopic retrograde cholangiopancreatography. We identified 967 cases (mean age 49; range 11-75), 84% men. During the mean follow up of 25 months (range 1 to 66 months), 102 patients developed biliary complications; 68/102 underwent 141 therapeutics endoscopic retrograde cholangiopancreatography procedures. The rest 34/102 patients were managed with percutaneous transhepatic cholangiography, conservative management, and/or surgery. Post- endoscopic retrograde cholangiopancreatography complications occurred in 79.4%, including anastomotic strictures in 25, non-anastomotic strictures in 5, stones in 5, cholangitis in 4, post-sphinctretomy bleeding in 3, pancreatitis in 2, and bile leakage in 1 patient. Seven (13.0%) patients died after ERCP due to multiple organ dysfunction syndrome. Although the survival rate of patients who underwent ERCP and those without ERCP was similar, patients with biliary complications fared significant worse. Although endoscopic retrograde cholangiopancreatography is useful for the management of post liver cancer treatment biliary complications; the need for multiple rounds of endoscopic retrograde cholangiopancreatography and even post endoscopic retrograde cholangiopancreatography complications is relatively high, and often results in increased mortality. However, the survival following endoscopic or surgical therapy in liver cancer treatment patients is similar.

Patterns of Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Complications

In the treatment of common bile duct stones and palliative decompression of malignant strictures, endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard. However, there are still concerns about procedure-related complications and patient discomfort. The aim of the study is to evaluate the pattern of post ERCP complications. This prospective observational study was conducted at the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from February to October 2017. A total of one hundred patients who were eligible for ERCP were included in this study but five patients were excluded due to cannulation failure. Clinical examination , biochemical, and radiological investigation were performed before and after ERCP to assess the complication that occurred. The majority of patients in this study were at and below the age of 50 years, with a mean age of 49.74 ± 14.07 years and the age range was between 18 to 80 years. Majority of the subjects were male (54.7%), and male to female ratio was 1.21:1. The highest number of patients were diagnosed as choledocholithiasis (58.9%) followed by proximal cholangiocarcinoma (13.7%), Ca-gallbladder with biliary infiltration (8.4%), Distal cholangiocarcinoma (6.3%), Chronic calcific pancreatitis and Periampullary carcinoma each (3.2%), Suspected SOD & Chronic pancreatitis each (2.1%) and Worm in CBD and benign biliary stricture each (1.1%). In this study, the overall post-ERCP complication was 12.6%, with pancreatitis accounting for 9.4%, bleeding accounting for 2.1%, and cholangitis accounting for 2.1%. From the study, it can be concluded that pancreatitis is the most frequent Post-ERCP complication. Bangladesh Med J. 2021 May; 50(2) : 35-39

Patterns of post endoscopic retrograde cholangiopancreatography (ERCP) complications- experience from an university hospital

In the treatment of common bile duct stones and palliative decompression of malignant strictures, endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard. However, there are still concerns about procedure-related complications and patient discom- fort. To evaluate the pattern of the post ERCP complications. This prospective observational study was conducted at the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from February 2017 to October 2017. A total of one hundred patients who were eligible for ERCP were included in this study but five patients were excluded due to cannulation failure. Clinical examination , biochemical, and radiological investigation were performed before and after ERCP to assess the complication that occurred. The majority of patients in this study were under the age of 50, with a mean age of 49.74 }14.07 years between the ages of 18 and 80 years. Males (54.7%) were predominant than female (45.3%) and male to female ratio was 1.21:1. The most common diagnosis was choledocholithiasis (58.9%) followed by proximal cholangiocarcinoma (13.7%), Carcinoma-gallbladder with biliary infiltration (8.4%), Distal cholangiocarcinoma (6.3%), Chronic calcific pancreatitis and Periampullary carcinoma each (3.2%), Suspected SOD & Chronic pancreatitis each (2.1%) and Worm in CBD and benign biliary stricture each (1.1%). In this study, the overall post-ERCP complication rate was 12.6% with pancreatitis accounting for 9.4%, bleeding accounting for 2.1%, and cholangitis accounting for 2.1%. From the study data it can be concluded that pancreatitis is the most frequent Post-ERCP complication. BSMMU J 2022; 15(1): 50-53

Rare post-endoscopic retrograde cholangiopancreatography complications: Can we avoid them?

Rare post-endoscopic retrograde cholangiopancreatography complications: Can we avoid them?

Transient venous air embolism after ERCP: worrisome or not?

The paper describes the occurrence of a rare complication – portal and systemic venous air embolism – after endoscopic retrograde cholangiopancreatography, related to the endoscopic procedure. It can be associated with the more frequently encountered post-endoscopic retrograde cholangiopancreatography complications pancreatitis or cholangitis. However, it can also be noted with perforation. The presented case suggests that in the clinical context an early abdominal ultrasound examination confirming hepatic portal venous gas and/or systemic venous air embolism could be useful for the diagnosis of post-endoscopic retrograde cholangiopancreatography retroduodenal perforation, and thus highlights the need for a high index of suspicion should this occurrence be noted post-procedurally, in order to ensure the best care of patients.

Multiprofessional in situ simulation is an effective method of identifying latent patient safety threats on the gastroenterology ward

ObjectiveIn situ simulation (ISS) is an effective training method for multiprofessional teams dealing with emergencies in high pressured environments. A regular ISS programme was organised for the multiprofessional gastroenterology team...

869 A Comparison of ERCP Outcomes Between High Volume and Low Volume Centers

INTRODUCTION: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a commonly performed procedure for simultaneous diagnosis and treatment of biliary disease, which has several potential post-procedural complications. Few studies have addressed the association between hospital ERCP volume and post procedural complications. This study aims to examine the difference in the rate of post ERCP complications between high and low volume centers. METHODS: The study population was extracted from the 2016 Nationwide Readmissions Database using International Classification of Diseases, Tenth Revision, and Clinical Modification/Procedure Coding System for ERCP and in-hospital outcomes. Centers that performed > 200 ERCPs during the year of 2016 were considered high-volume, whereas centers that performed < 200 ERCPs were considered low-volume. Study endpoints included in-hospital all-cause mortality, length of hospital stay (LOS), post ERCP pancreatitis, and infection rates. RESULTS: A total of 137,825 ERCPs were identified, of which 39.8% were diagnostic ERCPs while 60.2% were therapeutic ERCPs. The mean age of patients was 59.7 years. 56.9% of the study population were female. High-volume centers performed 54,640 procedures while low-volume centers performed 83,185 procedures. In regards to complications, high-volume centers compared to low-volume centers, had a significantly higher rate of all-cause mortality (1.9% vs 1.4%, P < 0.01), post-op pancreatitis (7.0% vs 6.2%, P < 0.01), post-procedural infection (0.7% vs 0.5%, P < 0.01), and LOS (6.7 days vs 5.9 days, P < 0.01). This pattern was consistent for ERCP procedures performed for both diagnostic and therapeutic purposes, with the exception of similar rates of post-procedural pancreatitis associated with ERCP performed for diagnostic purposes in both high and low volume centers. CONCLUSION: In this preliminary analysis of a large database, hospitals with high ERCP volume were associated with a higher rate of complications including post procedural in-hospital mortality, morbidity, and length of stay. While procedural technique and operators vary amongst centers, we hypothesize that the higher rate of complications seen in patients being treated at high volume centers may, in part be due to a higher complexity in patients been seen at high volume centers.

Comparative Study between Use of Endoscopic Ultrasound before Endoscopic Retrograde Cholangio Pancreatography Versus Endoscopic Retrograde Cholangio Pancreatography Alone

AbstractBackground: Endoscopic Ultrasound (EUS) could be used as non-invasive procedure instead of Endoscopic Retrograde Cholangiopancreatography (ERCP) in pancreatico-biliary disorders diagnosis. The impact of EUS use before ERCP need to be evaluated.Aim of Study: The aim of this study was to determine the impact of EUS use before ERCP in patients of pancreatico-biliary disorders as regard, the procedure accessibility, duration, success rate and rate of complications.Methods: This study was conducted on fifty patients with pancreatico-biliary disorders prepared to ERCP procedure. Randomly, 25 patients were subjected to ERCP directly (group-I) and for the remaining 25 patients EUS was done before ERCP (group-II).Results: There was no significant difference between patients of both groups regarding age and sex, clinical features, laboratory parameters, sonographic and diagnostic findings and post ERCP complications. Use of EUS before ERCP showed significant higher rates of successful stone extraction without lithotriptor and reduced the procedure duration.Conclusion: Our study supports the idea that use of EUS before ERCP showed significant reduction of procedure time and higher rates of successful stone extraction by balloon or basket without use of lithotripter and did not alter the rate of procedure complications.

Comparative Study between Use of Endoscopic Ultrasound before Endoscopic Retrograde Cholangio Pancreatography vs. Endoscopic Retrograde Cholangio Pancreatography Alone

Endoscopic ultrasound (EUS) could be used as non-invasive procedure instead of Endoscopic Retrograde Cholangiopancreatography (ERCP) in pancreatico-biliary disorders diagnosis. The impact of EUS use before ERCP needs to be evaluated. This study was conducted on fifty patients with pancreatico-biliary disorders prepared to ERCP procedure. Randomly, 25 patients were subjected to ERCP directly (group-I) and for the remaining 25 patients EUS was done before ERCP (group-II). For all patients’ clear written consent, full clinical and routine laboratory assessment and abdominal sonography were done. There was no significant difference between patients of both groups regarding age and sex, clinical features, laboratory parameters, sonographic and diagnostic findings and post ERCP complications. Use of EUS before ERCP showed significant higher rates of successful stone extraction without lithotriptor and reduced the procedure duration. Further study with larger number of patients is highly recommended.

Obesity and Post ERCP Complications Among Hospitalized Patients with Cholangitis

Introduction: Complications of Endoscopic Retrograde Cholangiopancreatography (ERCP) are an important concern, especially in cholangitis patients. Relationship between obesity and complications of ERCP remain unknown. We sought to evaluate the relationship between obesity and post ERCP complications in hospitalized cholangitis patients. Methods: We analyzed National Inpatient Sample (NIS) database from 2001 to 2010 and identified adult inpatients (> 18 years) with a principal diagnosis of cholangitis using International Classification of Disease 9th Revision, Clinical Modification (ICD9-CM) codes 576.1. Obese patients were identified using ICD9-CM code 278.0. The primary outcomes included rates of post ERCP complications (pancreatitis, cholecystitis, perforation, pulmonary complications) and secondary outcome was mortality. We compared the complication rates among patients with and without obesity, using chi square and student t test. Multivariable logistic regression adjusting for patient demographics such as age, sex, income, hospital diagnosis, co morbidities, hospital characteristics (bed size, hospital location, rural/urban, teaching vs non teaching) and case mix was used to investigate the odds of various ERCP related complication for obese patients compared to non obese patients. Results: Our final sample comprised 38,557 patients. Of these, 1281 (3.3%) were obese and 37,276 (96.7%) were non obese. When compared with non-obese patients, obese individuals had similar rates of post ERCP pancreatitis (1.3% vs 0.9%, p = 0.18), perforation (0.08% vs 0.1%, p = 0.71), cholecystitis (0.6% vs 0.5%, p = 0.68) and pulmonary complications (1.8% vs 2.2%, p = 0.29). However, mortality was reduced among obese (1% vs 3%, p < 0.01) when compared to non-obese patients. Conclusion: Among the inpatients undergoing ERCP for cholangitis, there were no differences in post ERCP complications by obesity. However, obese patients had less in-patient mortality for reasons that are unclear. Further studies are needed to elucidate effect of obesity on ERCP outcomes.

Endoscopic inside stent placement is suitable as a bridging treatment for preoperative biliary tract cancer.

BackgroundEndoscopic biliary stenting (EBS) is one of the most important palliative treatments for biliary tract cancer. However, reflux cholangitis arising from bacterial adherence to the inner wall of the stent must be avoided. We evaluated the use of EBS above the sphincter of Oddi to determine whether reflux cholangitis could be prevented in preoperative cases.MethodsFifty-seven patients with primary biliary tract cancer were retrospectively recruited for the evaluation of stent placement either above (n = 25; inside stent group) or across (n = 32; conventional stent group) the sphincter of Oddi. We compared the stent patency periods prior to the time of surgical resection.ResultsThe preoperative periods were 96.3 days in the conventional stent group and 96.8 days in the inside stent group (P = 0.979). Obstructive jaundice and/or acute cholangitis occurred in 7 patients (28.0%) in the inside stent group and in 15 patients (46.9%) in the conventional stent group during the preoperative period (P = 0.150). The average patency periods of the stents were 85.2 days (range, 13–387 days) for the inside stent group and 49.1 days (range, 9–136 days) for the conventional stent group (log-rank test: P = 0.009). The mean numbers of re-interventions because of stent occlusion were 0.32 for the inside stent group and 1.03 for the conventional stent group (P = 0.026). Post-endoscopic retrograde cholangiopancreatography complications occurred in 2 patients in the inside stent group and 4 patients in the conventional stent group (P = 0.516). Postoperative liver abscess occurred in 1 patient in the inside stent group and 5 patients in the conventional stent group (P = 0.968). Inside stent placement was the only significant preventative factor associated with stent obstruction based on univariate (hazard ratio [HR], 0.286; 95% confidence interval [CI], 0.114-0.719; P = 0.008) and multivariate (HR, 0.292; 95% CI, 0.114-0.750; P = 0.011) analyses.ConclusionTemporary plastic stent placement above the sphincter of Oddi is a better bridging treatment than conventional stent placement in preoperative primary biliary tract cancer.

Comparison between ulinastatin and nafamostat for prevention of post-endoscopic retrograde cholangiopancreatography complications: A prospective, randomized trial

ObjectivesPancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this prospective trial was to compare the effect of ulinastatin and nafamostat on the prophylaxis of post-ERCP complications. MethodsA total of 159 patients who underwent ERCP were divided into ulinastatin (n = 53), nafamostat (n = 53) and control (n = 53) groups. Each patient received ulinastatin (150,000 units), nafamostat (20 mg), or placebo from 2-4 h before ERCP to 6–8 h after ERCP. The primary endpoint was the incidence of PEP, and the secondary endpoints were the incidence of post-ERCP hyperamylasemia, hyperlipasemia and abdominal pain. ResultsThe overall incidence of PEP was 6.3% (10/159) and no significant differences were observed between ulinastatin and nafamostat groups in terms of the incidences of PEP (1.9% and 3.8%, P = 0.560), hyperamylasemia, hyperlipasemia, and abdominal pain, although these were significantly lower than those of the control group (P < 0.001). ConclusionsThere was no significant difference for preventing PEP between ulinastatin and nafamostat and both drugs were efficacious for preventing post-ERCP complications.

Endoscopic papillary large balloon dilation vs endoscopic sphincterotomy for retrieval of common bile duct stones: a meta-analysis.

To compare the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) in retrieval of common bile duct stones (≥ 10 mm). PubMed, Web of Knowledge, EBSCO, the Cochrane Library, and EMBASE were searched for eligible studies. Randomized controlled trials (RCTs) that compared EPLBD with EST were identified. Data extraction and quality assessment were performed by two independent reviewers using the same criteria. Any disagreement was discussed with a third reviewer until a final consensus was reached. Pooled outcomes of complete bile duct stone clearance, stone clearance in one session, requirement for mechanical lithotripsy, and overall complication rate were determined using relative risk and 95%CI. The separate post-endoscopic retrograde cholangiopancreatography complications were pooled and determined with the Peto odds ratio and 95%CI because of the small number of events. Heterogeneity was evaluated with the chi-squared test with P ≤ 0.1 and I(2) with a cutoff of ≥ 50%. A fixed effects model was used primarily. A random effects model was applied when significant heterogeneity was detected. Sensitivity analysis was applied to explore the potential bias. Five randomized controlled trials with 621 participants were included. EPLBD compared with EST had similar outcomes with regard to complete stone removal rate (93.7% vs 92.5%, P = 0.54) and complete duct clearance in one session (82.2% vs 77.7%, P = 0.17). Mechanical lithotripsy was performed less in EPLBD in the retrieval of whole stones (15.5% vs 25.2%, P = 0.003), as well as in the stratified subgroup of stones larger than 15 mm (24.2% vs 40%, P = 0.001). There was no statistically significant difference in the incidence of overall adverse events (7.9% vs 10.7%, P = 0.25), post-ERCP pancreatitis (4.0% vs 5.0%, P = 0.54), hemorrhage (1.7% vs 2.8%, P = 0.32), perforation (0.3% vs 0.9%, P = 0.35) or acute cholangitis (1.3% vs 1.3%, P = 0.92). EPLBD could be advocated as an alternative to EST in the retrieval of large common bile duct stones.

Post-endoscopic retrograde cholangiopancreatography complications: How can they be avoided?

Endoscopic retrograde cholangiopancreatography (ERCP) has a significant complication rate which can be lowered by adopting technical variations of proven beneficial effect and prophylactic maneuvers such as pancreatic stenting during ERCP or periprocedural non-steroidal anti-inflammatory drug administration. However, adoption of these prophylactic maneuvers by endoscopists is not uniform. In this editorial we discuss the beneficial effects of the aforementioned maneuvers.

Prevention and Management of Post-Endoscopic Retrograde Cholangiopancreatography Complications

Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a spectrum of complications such as pancreatitis, hemorrhage, perforation, and cardiopulmonary events. These complications can range from mild to severe resulting in extended hospitalization, requiring surgical intervention, and leading to permanent disability or even death. Complications of ERCP have been better understood in the past decade, with adoption of standardized consensus-based definitions of complications and introduction of new recommendations to minimize risks of ERCP. Adequate selection of patients undergoing ERCP, skilled operators using novel techniques and prompt identification and treatment are key to successful prevention and management.

Predictors of Difficult or Failed Endoscopic Retrograde Cholangiopancreatography Cannulation in Clinical Practice

Purpose: Difficult/failed endoscopic retrograde cholangiopancreatography (ERCP) cannulation rates range from 5%-20% and is an independent risk factor for post ERCP complications. The aim of our study was to determine clinical, biochemical and patient demographic factors that predict difficult or failed ERCP cannulation. Methods: Retrospective chart review of all patients who underwent ERCP procedure between January 2006 and October 2008 at two community medical centers was performed and appropriate demographic, clinical and biochemical factors were extracted for analysis. All patients who underwent ERCP for the first time were included in the study and all patients with a previous history of ERCP procedure were excluded. Difficult ERCP cannulation was defined when there was difficulty/failure to cannulate the ampulla or if the total duration of the procedure exceeded 45 minutes. Univariate and multivariate logistic regression analysis was performed to identify the predictors of difficult/failed cannulation. Results: 220 patients underwent ERCP of which 146 patients (Table 1) who met the inclusion criteria were included in the study. 25% (n=36) of patients had difficult/failed ERCP cannulation. Multivariate analysis revealed previous gastrointestinal (GI) surgery (OR 2.59; 95% CI 1.21-5.57; p=0.01), age (OR 1.03 95% CI 1.01-1.06 P value 0.0017) and history of smoking (OR 3.16; 95% CI 1.43 - 6.97; p=0.004) to be significantly associated with difficult or unsuccessful cannulation.Table 1: Baseline characteristics of the patientsConclusion: Elderly patients, smokers and patients with prior GI surgery are at a higher risk for difficult or failed ERCP cannulation. These factors needed to be considered when individualizing the choice of technique prior to ERCP.

Post-Endoscopic Retrograde Cholangiopancreatography Complications at Dr. Cipto Mangunkusumo General Hospital

Background: This study retrospectively evaluated post-endoscopic retrograde cholangiopancreatography (ERCP) complications at Cipto Mangunkusumo hospital in order to improve management of a subsequent prospective study of post-ERCP complications. Method : The indications, findings, diagnostic or therapeutic procedure, cannulation, devices used during the procedure, and complications of patients treated consecutively with ERCP between January 2004 and November 2008 were evaluated retrospectively. Results : Of 176 ERCP patients who were initially evaluated, 38% had undergone diagnostic ERCP and 62% therapeutic ERCP. The median age of the patients was 49 years (range 18–80 years); 95 (53.9%) were male. Only 54 of these 176 procedures could be evaluated for post-ERCP complications. A computed tomographic abdominal scan or magnetic resonance cholangio-pancreatography was performed in 23 (42.6%) patients and a biliary sphincterotomy in 14 (25.9%) patients. The overall complication rate was 33.3%: 14.8% after diagnostic ERCP and 18.5% after therapeutic ERCP. The complications after diagnostic ERCP were pancreatitis in 3 (15%) patients, cholangitis in 3 (15%) patients, hemorrhage in 1 (5%) patient, pancreatitis and hemorrhage in 1 (5%) patient; the complications after therapeutic ERCP were pancreatitis in 6 (17.6%) patients, cholangitis in 3 (8.8%) patients, hemorrhage in none, and concomitant pancreatitis with hemorrhage in 1 (2.9%) patient. No significant difference was observed between the complication rates and the type of ERCP performed. Conclusion : There were no differences in the complications after diagnostic and therapeutic ERCP. As our study shows the post-ERCP complication rate to be higher than those of other large retrospective and prospective studies, we must evaluate it in a prospective study. Keywords : post-ERCP, complications, therapeutic ERCP, diagnostic ERCP

Acute Pancreatitis in Patients With Crohnʼs Disease: Clinical Features and Outcomes

Acute pancreatitis has occasionally been associated with Crohn's disease (CD), but whether a causal association exists remains unclear. We sought to determine the frequency of etiologies in a consecutive series of patients with CD with acute pancreatitis. A centralized diagnostic index was used to identify all patients with CD with acute pancreatitis that were evaluated at Mayo Clinic Rochester between 1976 and 2001. Both diagnoses were made or confirmed at our institution. Records were abstracted for demographics, presenting symptoms, diagnostic tests, risk factors of pancreatitis, treatment, and follow-up. Forty-eight patients with CD with pancreatitis were identified. The median age at diagnosis of acute pancreatitis was 47 years (range, 31-91 yr). Forty-six (96%) met biochemical criteria for acute pancreatitis. The most sensitive radiographic tests were abdominal computed tomography (70%) and abdominal ultrasound (46%). The etiology of pancreatitis was considered to be gallstones (21%), significant alcohol intake (15%), use of purine analogs (13%), duodenal Crohn's involvement (12%), postendoscopic retrograde cholangiopancreatography complications (10%), postoperative complications (12%), use of other medications (4%) and idiopathic (8%). The median length of hospitalization was 7 days (range, 0-40 d). Ten patients (21%) had recurrence of acute pancreatitis. Three patients (6%) were subsequently diagnosed with pancreatic cancer. A definite etiology could be identified in most patients with CD with acute pancreatitis. Gallstones and alcohol accounted for more than one third of cases, whereas CD, either because of duodenal involvement or medications used for its treatment, accounted for more than one quarter of the cases. A small proportion of patients remained idiopathic.

Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older.

An increasing proportion of the general population across the Western World now survives to an advanced age. However, there is limited data on the outcome of therapeutic endoscopic retrograde cholangiopancreatography in patients above 90 years of age with severe acute cholangitis. To determine the relative frequency of postendoscopic retrograde cholangiopancreatography complication in this group of patients. The postendoscopic retrograde cholangiopancreatography complications related outcome of 64 patients aged 90 years and above (Group 1) with severe acute cholangitis were retrospectively compared with 165 patients under the age of 90 years (Group 2). The postendoscopic retrograde cholangiopancreatography complication rate was 4.7% (three patients) in Group 1 and 7.3% (12 patients) in Group 2. There was no significant difference in the postendoscopic retrograde cholangiopancreatography complication rate between the two groups (P = 0.567). The relative frequency of 30-day mortality was 7.8% (five patients) in Group 1 and 4.2% (seven patients) in Group 2 (P = 0.227). Urgent biliary decompression with endoscopic retrograde cholangiopancreatography in patients 90 years of age and older with severe acute cholangitis is a safe and effective procedure in the hands of highly skilled endoscopists and is not associated with increased morbidity or mortality even in this group of high risk patients.