Role Of ERCP Research Articles

Diagnostic and Therapeutic Value of ERCP : Experience from a Tertiary Care Center

IntroductionEndoscopic Retrograde Cholangiopancreatography (ERCP) is an advanced endoscopic technique to diagnose and manage biliopancreatic diseases. The role of ERCP is increasing since its inception with refinement of operator skill, technical advancement and better patient selection. The aim of the study is to highlight common clinical and endoscopic characteristics, outcome, adverse events and safety profile of patients undergoing the procedure in a tertiary care center. MethodA retrospective observational study was conducted on patients undergoing ERCP in department of Gastroenterology, Tribhuvan University Teaching Hospital, for management of biliopancreatic diseases from April 2023 to March 2024 after taking approval from IRC committee. Patient demographics, clinical characteristics, ERCP findings and post procedure outcome data were collected and analyzed using SPSS version 26. ResultA total of 200 patients were included with mean age 52.36 + 17.04 years and female: male ratio of 1.43. Elective procedure was done in 91% patients and 9% as urgent procedure (within 48 hours). The most common indications were choledocholithiasis (78.5%) followed by benign biliary stricture (6%). Endoscopic observation revealed that the most frequent papilla was type 1 papilla (normal variant) in 48% followed by type 3 papilla (protruding) in 30% and type 4 papilla ( creased) in 10%. Difficult cannulation was encountered in 51.5 % cases. Post ERCP pancreatitis (4.5%) and hypoxia (4.5%) were the most common procedure and anesthesia related adverse events respectively. Therapeutic interventions included sphincterotomy (88%), CBD stenting (78.5%) and precut sphincterotomy (22.5%). ConclusionERCP is a relatively safe and effective therapeutic and diagnostic procedure for management of biliopancreatic disorders with acceptable risk.

The Role of ERCP in the diagnosis of Postcholecystectomy Cholangitis

The Role of ERCP in the diagnosis of Postcholecystectomy Cholangitis

Effect of Programmed Nursing Plan Based on Thinking Map Guidance Mode on Hemodynamics and Intestinal Function Recovery of Patients Undergoing Endoscopic Retrograde Cholangiopancreatography.

ERCP is an effective method for the diagnosis and treatment of pancreatic and biliary diseases. With the improvement of endoscopes by researchers and the intubation and angiography technologies of medical workers, the role of ERCP in the diagnosis and treatment of pancreatic and biliary diseases has become increasingly important. Although ERCP is a minimally invasive diagnostic technique, it still falls into the category of surgery, and thus the physical and psychological dysfunction of patients undergoing ERCP caused by various factors such as surgery cannot be ignored. This study explored the effects of the procedural nursing plan based on the thinking map guidance mode on hemodynamics and intestinal function recovery of ERCP patients. The results showed that this plan could reduce the effects of ERCP on hemodynamics of patients, promote intestinal function recovery, relieve their bad psychology, reduce postoperative complications, and help to improve patients' satisfaction with the nursing work, and it was worthy of promotion.

Role of ERCP in acute biliary pancreatitis: yet unanswered.

Role of ERCP in acute biliary pancreatitis: yet unanswered.

S3364 The Role of ERCP in Managing Bile Leaks From Penetrating Liver Injury

S3364 The Role of ERCP in Managing Bile Leaks From Penetrating Liver Injury

Pancreatic Adenocarcinoma: Epidemiology, Role of EUS in Diagnosis, Role of ERCP, Endoscopic Palliation.

Pancreatic cancer is the seventh leading cause of cancer deaths worldwide and is associated with a poor survival rate. The vast majority of pancreatic cancers are inoperable at the time of diagnosis. In the absence of metastatic disease, operability depends on the extent of local disease; in particular, the presence or absence of vascular and lymph node involvement. Adequate staging is vital in deciding an appropriate treatment plan. Cross sectional imaging including CT, MRI and PET-CT are commonly used for staging. However, EUS is a useful adjunct for accurate loco-regional staging in addition to allowing diagnostic tissue samples to be obtained. Emerging EUS-guided therapeutic techniques have opened up new horizons in the management of pancreatic malignancy. EUS guidance can be used for coeliac plexus neurolysis in patients with intractable pain and fiducial placement in directing stereotactic radiotherapy. The majority of patients with cancer of the pancreatic head present with biliary obstruction. ERCP can be used to drain the obstructed biliary system with plastic or metal stents and offers an opportunity to confirm the diagnosis by obtaining brush cytology and forceps biopsy specimens. EUS-guided choledocho-duodenostomy or hepatico-gastrostomy is increasingly being employed for draining the biliary system if ERCP is unsuccessful.

Paediatric pancreaticobiliary endoscopy: a 21-year experience from a tertiary hepatobiliary centre and systematic literature review

BackgroundIn adults ERCP and endoscopic ultrasound (EUS) are standard methods of evaluating and treating many hepatopancreaticobiliary (HPB) conditions. HPB disease is being diagnosed with increasing frequency in children but information about role of ERCP and EUS and their outcomes in this population remain limited. Therefore the aims of this study were to describe the paediatric ERCP and EUS experience from a large tertiary referral HPB centre, and to systematically compare outcomes with those of other published series.MethodsAll patients <18 years undergoing an ERCP or EUS between January 1992–December 2014 were included. Indications for the procedure, rates of technical success, procedural adverse events and reinterventions were recorded in all cases.ResultsNinety children underwent 111 procedures (87 ERCPs and 24 EUS). 53% (48) were female with a median age of 14 years (range: 3 months - 17 years). Procedures were performed under general anaesthesia (n = 48) or conscious sedation (n = 63). Common indications for ERCP included chronic or recurrent pancreatitis and biliary obstruction. Patients frequently had multiple comorbidities, with a median ASA grade of 2 (range 1–4). Therapeutic procedures performed included biliary or pancreatic sphincterotomy, common bile duct or pancreatic duct stone removal, biliary or pancreatic stent insertion, EUS-guided fine needle aspiration and endoscopic transmural drainage of pancreatic fluid collections. No adverse events were reported following ERCP but there was one complication requiring surgery following EUS guided cystenterostomy.ConclusionERCP and EUS in children and adolescents have high technical success rates and low rates of adverse events when performed in high volume HPB centres.

Role of ERCP and MRI/MRCP in the diagnosis of early chronic pancreatitis: Not quite there yet

Role of ERCP and MRI/MRCP in the diagnosis of early chronic pancreatitis: Not quite there yet

The role of ERCP in the era of EUS-FNA for preoperative cytological confirmation of resectable pancreatic ductal adenocarcinoma

In patients with pancreatic ductal carcinoma (PDAC), EUS-FNA carries a risk of cancer seeding. To avoid this risk, we attempted to obtain preoperative cytological confirmation of adenocarcinoma by ERCP. The aim of this study was to assess the validity of our diagnostic strategy. The medical records of 124 consecutive patients who were investigated for potentially resectable PDAC were retrospectively reviewed, and the ability to detect adenocarcinoma by ERCP was evaluated. ERCP was performed in 115 patients, 69 of whom had positive cytology results. Thirty-four patients underwent EUS-FNA, 29 of whom had positive cytology results. A total of 98 patients (79 %), therefore, had preoperative cytological confirmation of adenocarcinoma, which was more frequent in patients with lesions of the head of the pancreas than in those with lesions of the body or tail of the pancreas. The postoperative pathological diagnosis demonstrated malignant pancreatic neoplasms in 122 patients (98 %), including 111 with PDAC. EUS-FNA did not affect the rate of postoperative peritoneal dissemination. Our strategy using ERCP as the initial diagnostic modality for obtaining cytological confirmation of potentially resectable PDAC seems to be adequate, yielding a high rate of positive cytology, especially in cases with tumors of the head of the pancreas.

The Etiological Spectrum of Obstructive Jaundice &amp; Role of Ercp In Thi-Qar Governorate

The Etiological Spectrum of Obstructive Jaundice &amp; Role of Ercp In Thi-Qar Governorate

Role of ERCP in cytological confirmation for possibly resectable pancreatic ductal adenocancinoma (PDAC) in the era of EUS-FNA

Role of ERCP in cytological confirmation for possibly resectable pancreatic ductal adenocancinoma (PDAC) in the era of EUS-FNA

Management of chronic pancreatitis: Role of endoscopic therapy

AbstractChronic pancreatitis (CP), a disease of varied etiology can, from the endoscopists perspective present as ductal strictures, stones, ductal leaks and fluid collections, biliary strictures or duodenal narrowing. This article deals with role of ERCP in the management of CP associated strictures and calculi. ERCP has a limited role in the diagnosis CP, though we feel that it is better at identifying small ductal calculi or leaks as compared to MRCP. Major and minor papilla sphincterotomy gives relief from pain in patients with mild or moderate ductal changes. Pancreatic ductal strictures are best managed by stenting. Use of multiple plastic stents (8.5-11Fr diameter) gives relief from pain in 84% and strictures resolution in 95% on follow up of over 3 years. CP associated CBD strictures are also managed by placement of multiple stents. Covered SEMS are increasingly being used in these strictures. Surgery is often the best option for CP associated CBD strictures which recur after adequate endotherapy. ESWL is the standard of therapy for pancreatic ductal calculi which are large, as seen in the tropics and the non alcoholic form of CP. Our experience has shown complete or partial clearance with ESWL in over 90% of patients with large PD calculi. Good pain relief was seen in both on short and long term follow up. In selected patients of CP, ERCP and endotherapy should be offered as first line of treatment, as the results are comparable to surgery. Prior endotherapy also does not interfere with subsequent surgical procedures.

Continuing Medical Education Exam: October 2011

Instructions: The GIE: Gastroinintestinal Endoscopy CME Activity can now be completed entirely on-line. To complete do the following: 1. Read the CME article in this issue carefully and complete the activity: Lewis J, Rubenstein JH, Singal AG, et al. Factors associated with esophageal stricture formation after endoscopic mucosal resection for neoplastic Barrett’s esophagus. Gastrointest Endosc 2011;74:753-60. Kim HN, Alousi AM, Lee JH, et al. Role of ERCP in patients after hematopoietic stem cell transplantation. Gastrointest Endosc 2011;74:817-24. Yadav A, Heigh R, Hara AK, et al. Performance of the patency capsule compared with nonenteroclysis radiologic examinations in patients with known or suspected intestinal strictures. Gastrointest Endosc 2011;74:834-9. Park S-Y, Kim H-S, Yoon K-W, et al. Usefulness of cap-assisted colonoscopy during colonoscopic EMR: a randomized, controlled trial. Gastrointest Endosc 2011;74:869-75. 2. To date, ACC Sections and their Councils have been a valuable resource for the decision-making bodies of the College and have provided a welcome opportunity for the ACC to cultivate leadership and engage members. Visit the journals Web site at www.asge.org (members) or www.giejournal.org (nonmembers). 3. To date, ACC Sections and their Councils have been a valuable resource for the decision-making bodies of the College. Exams can be saved to be accessed at a later date. ou may create a free personal account to save and return to your work in progress, as well as save and track your completed activities o that you may print a certificate at any time. The complete articles, detailed instructions for completion, as well as past Journal CME ctivities can also be found at this site.

Role of ERCP in patients after hematopoietic stem cell transplantation

The role of ERCP in evaluating patients with hepatobiliary dysfunction after hematopoietic stem cell transplantation (HSCT) has not been well-defined. The aim of this study was to better define the role of ERCP after HSCT by reviewing our institutional experience, including indications, findings, and outcomes. Retrospective review of ERCP findings and outcomes in patients after HSCT. MD Anderson Cancer Center from 1997 to 2009. A total of 40 patients had ERCP after HSCT during the study period. ERCP. Overall survival. A total of 40 patients had ERCP after HSCT during the study period. Seventeen patients had biliary strictures (group 1), and 13 proved to be malignant. Ten patients had common duct stones (group 2). Thirteen patients (group 3) had neither stones nor stricture. Findings in group 3 included bile duct leak (1), dilation without stricture (2), resolution of pretransplant strictures (3), biliary sludge (1), or normal ducts (6). The normal subset proved to have hepatic graft-versus-host disease (GVHD) (3), hepatic drug toxicity (1), hepatic recurrence of myeloma (1), or pancreatitis with biliary sludge (1). Patients with GI GVHD were equally distributed among the 3 groups. Group 1 had 100% mortality with median time to death being 85 days after ERCP. Group 2 had 30% mortality with median time to death of 584 days after ERCP. Ten of 13 patients in Group 3 died at a median of 148 days after ERCP. The only procedural complication was a mild case of pancreatitis. Retrospective study at a single center. One in every 130 post-HSCT patients required ERCP evaluation. Biliary stricture is frequently caused by recurrent or new malignancy, particularly after autologous HSCT. GI GVHD is not associated with biliary stricture. ERCP procedural risks in HSCT patients are acceptable.

Role of ERCP in the management of non-iatrogenic traumatic bile duct injuries in the pediatric population

Role of ERCP in the management of non-iatrogenic traumatic bile duct injuries in the pediatric population

Role of ERCP in Evaluation of Post-stem Cell Transplantation Patients with Hepatobiliary Disease

Purpose: Patients with hematopoietic stem cell transplantation (HSCT) may develop hepatobiliary disease. The role of ERCP in evaluating this group of patients is being defined. The aim was to review our experience with ERCP in HSCT patients. Methods: All patients who had ERCP following HSCT from 2002-2009 were identified. Clinical data were extracted from the electronic medical record. Results: During the study period 8,010 HSCTs were performed (53% allogeneic). Thirty patients (13 male) who had 37 ERCPs were identified. Average age was 50 years and 24 patients were white. There were 19 allogeneic HSCT. Indications for HSCT were: lymphoma (9), acute leukemia (9), breast cancer (3), MDS (2), CLL (2), ovarian cancer (2) and other malignancies (3). Nine patients had biopsy proven graft-versus-host disease (GVHD), 7 with GI tract involvement. Mean and time to ERCP was 640 (S.D. 808) days post transplant with a range of 20 to 3805 days. Indications for initial ERCP were: obstructive jaundice (12), suspected choledocholithiasis (CBD stones) (11), dilated bile ducts (3), stent removal/revision (3), and bile leak (1). Findings on ERCP were: stricture (14), CBD stones (10), resolved stricture/normal (3), leak (1), sludge (1), and dilated duct without stricture or stone (1). The stricture group had 10 females and the mean age was 50.6 (SD 13.2) years. Eight patients had autologous and 6 had allogeneic HSCT with two having GI GHVD. ERCP occurred at a mean of 1088 days after HSCT (SD 980). Etiologies of the strictures were: recurrent malignancy (11), pancreatic cancer (1), gallbladder compressing bile duct (1) and unclear etiology (1). This latter patient had mild duodenal GVHD, negative biliary brushings and sludge on EUS. The stent was removed after 2 wks and 4 wks later CT scan showed resolution of ductal dilation. None of the stricture patients with recurrent disease had GI GVHD. The CBD stone group had a mean age of 45.9 (SD 9.0) years and 6 were female. All patients had allogeneic HSCT and two had GI GVHD. ERCP occurred at a mean of 362 days after HSCT (SD 310). Overall there were 20 deaths, 16 from recurrent disease. Other deaths were from pneumonia (2), pancreatic cancer (1), and GVHD induced liver failure (1). All 14 patients with strictures died in a mean time of 139 days after ERCP. Three of 10 with CBD stones died at a mean of 164 days post ERCP. The seven survivors in the stone group have been followed a mean of 951 days without recurrence of biliary disease. Conclusion: ERCP is uncommonly performed in the post HSCT patient. The most common indication is obstructive jaundice from either recurrent disease or CBD stones. Inflammatory strictures possibly related to GHVD are rare in our experience.

T1570: The Role of ERCP in the Management of Biliary Anastomotic Strictures in Non-Liver Transplant Patients

Recent reports have documented the importance of ERCP in the management of anastomotic strictures after orthotropic liver transplant. In contrast, the role of ERCP in non-liver transplant biliary anastomotic strictures following elective and emergency biliary-enteric anastomoses has been less studied.

Complications after ERCP in patients with primary sclerosing cholangitis

There are conflicting data regarding the role of ERCP in patients with primary sclerosing cholangitis (PSC) and the risk of procedure-related complications. We compared the complication rate after ERCP in a consecutive series of patients with PSC compared with control patients with biliary strictures who did not have PSC. Retrospective cross-sectional study. A tertiary referral academic hospital. Incidence of complications after ERCP. A total of 85 ERCPs among 30 patients with PSC and 70 ERCPs among 45 control patients were reviewed. There was no significant difference in the overall complication rates between patients with and without PSC (11/85 [12.9%] vs 6/70 [8.6%], P = .45). Complications in PSC were more likely to occur after ERCP done to evaluate an acute sign or symptom than in elective cases (7/24 [29.2%] vs 4/61 [6.6%], P = .01). Patients with PSC who had complications had more total and acute ERCPs than did those without complications. There was no significant difference in the rate of complications in diagnostic versus therapeutic ERCPs nor between stent placement and dilation-only therapeutic ERCPs in the PSC population. Retrospective study design and limited power related to the small sample sizes. Elective ERCP is safe and carries a modest risk in patients with PSC; however, ERCP for acute indications greatly increases the probability of postprocedure complications. The overall complication rate after therapeutic ERCP in patients with PSC is similar to that in patients without PSC.

Role of ERCP in Acute Calculus Cholecystitis

Role of ERCP in Acute Calculus Cholecystitis

ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas

ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas