Endoscopic Retrograde Cholangiopancreatography Decreases All-Cause and Pancreatitis Readmissions in Patients With Acute Gallstone Pancreatitis Who Do Not Undergo Cholecystectomy
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Cholecystectomy is the definitive management of gallstone pancreatitis (GSP). The benefit of endoscopic retrograde cholangiopancreatography (ERCP) in patients who do not undergo cholecystectomy remains unclear. This study aims to evaluate the effect of ERCP on all-cause and pancreatitis readmissions in GSP.Adult hospitalizations for GSP in the 2010-2014 National Readmissions Database were divided into the following 3 groups: (1) no cholecystectomy nor ERCP, (2) no cholecystectomy with ERCP, and (3) cholecystectomy group. A multivariable Cox model was used to compare the 60-day readmission rates controlling for significant confounders.There were 153,480 GSP admissions, 29.2% did not undergo cholecystectomy or ERCP, 12.0 % underwent ERCP only, and 58.8% had cholecystectomy. In the no cholecystectomy group, ERCP was associated with lower all-cause readmissions (adjusted hazard ratio, 0.80; 95% confidence interval, 0.76-0.83; P < 0.0001) and pancreatitis readmissions rate (adjusted hazard ratio, 0.51; 95% confidence interval, 0.47-0.55; P < 0.0001) compared with no ERCP. The protective effect of ERCP remained significant in severe pancreatitis. Cholecystectomy had the strongest protective effect against readmissions.In this large, nationally representative sample, ERCP was associated with reduced readmissions in patients with GSP who did not undergo cholecystectomy. Although cholecystectomy remains the most important intervention to prevent readmissions, these results support performing ERCP in patients unfit for surgery.Previous pancreatitis is a definite patient-related risk factor for pancreatitis after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis: PEP). However, the effects of differences in the history of PEP and acute pancreatitis on the occurrence of PEP have not been fully investigated. We examined the relationship between previous PEP or previous acute pancreatitis and procedural factors associated with PEP.Clinical data on 1,334 consecutive patients undergoing ERCP between April 2006 and June 2010 were collected. A multivariate logistic regression analysis was conducted to assess the relationship between PEP and the cannulation time (<15 min vs. ≥15 min) or total procedure time (<30 min vs. ≥30 min) according to previous pancreatitis (previous PEP: pPEP or previous acute pancreatitis: pAP), with adjustments for clinical characteristics.Longer cannulation times (≥15 min) correlated with the occurrence of PEP in the pPEP group (OR=2.97; 95% CI=1.10 to 8.43, P=0.03) and in patients without previous pancreatitis (non-preP group) (OR=2.43; 95% CI=1.41 to 4.14, P= 0.002), but not in the pAP group (OR=2.78; 95% CI=0.50 to 22.42, P= 0.25). In contrast, longer procedure times correlated with the occurrence of PEP in the pAP group (OR=3.93; 95% CI=1.11 to 16.5, P= 0.03), but not in the pPEP group (OR=2.79; 95% CI=0.92 to 9.18, P= 0.068) or non-preP group (OR=0.71; 95% CI=0.39 to 1.24, P= 0.23).A higher risk of PEP with previous PEP was associated with longer cannulation times, whereas a higher risk of PEP with previous acute pancreatitis was associated with longer procedure times.
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Introduction: Pancreatitis is the common complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Diagnosing the risk factors for post-ERCP pancreatitis is important in the management of patients. In this study, we evaluated possible risk factors of post-ERCP pancreatitis among Iranian patients. Materials and methods: In this retrospective study, 708 diagnostic and therapeutic ERCPs performed in Imam Reza hospital, Tabriz, Iran between April 2011 and September 2012 were studied. The rate of post-ERCP pancreatitis and possible risk factors were evaluated using a multivariate regression analysis. Results: Post-ERCP pancreatitis occurred in 4.58% of cases. Unsuccessful ERCP (27% vs. 12.4%, p=0.02) and Body mass index (23.48±3.02 vs. 26.11±4.70 kg/m2, p=0.002) were significantly higher in patients with pancreatitis compared to those without pancreatitis. Regression analysis showed that only lower body mass index was the independent risk factor for post-ERCP pancreatitis occurrence (OR=1.341, CI95%[1.003-1.793], p=0.04). Conclusion: Among identifiable risk factors, only lower body mass index was the independent predictor of post-ERCP pancreatitis. Keywords: Endoscopic retrograde cholangiopancreatography; Pancreatitis; Risk factor
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To determine the period during which we should avoid cholecystectomy after endoscopic retrograde cholangiopancreatography.A retrospective analysis of electronic medical charts of 532 patients undergoing endoscopic retrograde cholangiopancreatography, between March 2013 and December 2017.Approximately one-third of patients underwent the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography. The conversion rate was 3.8%. The need for abdominal drainage and the finding of biliary tract injury after surgery were observed in 15.1% and 1.9% of patients, respectively. The length of stay was significantly shorter among patients undergoing surgery more than 30 days after endoscopic retrograde cholangiopancreatography. These patients had a median length of stay of one day, whereas the median length of stay in the group undergoing the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography was 2 days.The period during which we should avoid cholecystectomy is between 4 and 30 days after endoscopic retrograde cholangiopancreatography.
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Post Endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a well-known complication of endoscopic retrograde cholangiopancreatography (ERCP) (Bilbao et al., 1976; Freeman, 2012), ranging from biochemical rise of amylase to severe fatal necrotising pancreatitis (Talukdar, 2016). Since pancreatitis is a preventable complication, technical optimisation at pre, intra and post procedural levels should be carried out to reduce the risk (Kahaleh et al., 2012). Trying to implement the best approach to lower the risk of pancreatitis, combination of wire assisted cannulation and pure-cut sphincterotomy technique were adopted, since each of these techniques is individually proven to be associated with lower risk of pancreatitis.
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Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography.The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis varies substantially and is reported around 1%-10%, although there are some reports with an incidence of around 30%.Usually, PEP is a mild or moderate pancreatitis, but in some instances it can be severe and fatal.Generally, it is defined as the onset of new pancreatictype abdominal pain severe enough to require hospital admission or prolonged hospital stay with levels of serum amylase two to three times greater than normal, occurring 24 h after ERCP.Several methods have been adopted for preventing pancreatitis, such as pharmacological or endoscopic approaches.Regarding medical prevention, only non-steroidal anti-inflammatory drugs, namely diclofenac sodium and indomethacin, are recommended, but there are some other drugs which have some potential benefits in reducing the incidence of post-ERCP pancreatitis.Endoscopic preventive measures include cannulation (wire guided) and pancreatic stenting, while the adoption of the early pre-cut technique is still arguable.This review will attempt to present and discuss different ways of preventing post-ERCP pancreatitis.
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Background/Aim. Chronic pancreatitis is defined as an amount of chronic inflammatory lesions that lead to the destruction of pancreatic tissue and fibrosis development, whereas the later stages of the illness are characterized by the destruction of the endocrine portion of the organ. Although the results of different studies are abundant, chronic pancreatitis still remains enigmatic, both in its diagnostic and therapeutic aspect. To test the correlation between the findings of echosonography and endoscopic retrograde cholangiopancreatography (ERCP) examination in chronic pancreatitis patients. The observed degree of correlation may serve for the validation of echosonography as a diagnostic tool in chronic pancreatitis patients. Methods. We collected and analyzed data on morphological features in chronic pancreatitis patients revealed by echosonography as well as endoscopic retrograde cholangiopancreatography. Results. 35 patients 34?73 years of age were included in this study. In 60% (21 subject) history was subjective for alcohol abuse. significant correlation has been found between alcohol abuse and chronic pancreatitis (?2 = 6.896; p < 0.05). Correlation between groups of chronic pancreatitis patients diagnosed by echosonography and endoscopic retrograde cholangiopancreatography was highly significant (p = 0.799; p < 0.01). Conclusion. Echosonography was proved to be a suitable first choice imaging method for the examination of patients when chronic pancreatitis was suspected. Echosonography might provide conclusive information on the morphology of pancreatic canalicular system, as well as on the state of pancreatic parenchyma.
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The presence, course and shape of the accessory pancreatic duct have not been previously studied in patients with chronic pancreatitis.The accessory pancreatic duct exhibits several appearances on pancreatography. It was examined using dye-injection endoscopic retrograde cholangiopancreatography, and the duct course and shape were studied in patients having chronic pancreatitis and were compared to patients with normal pancreatogram.A prospective comparative study was carried out.One hundred and 57 consecutive patients (79 males and 78 females) who underwent endoscopic retrograde cholangiopancreatography for suspicion of pancreatobiliary disease.Forty-eight patients were diagnosed as having chronic pancreatitis using endoscopic retrograde cholangiopancreatography (28 alcoholic, 4 metabolic, and 16 idiopathic) and 109 patients had a normal pancreatogram.The insertion type of the accessory pancreatic duct to the main pancreatic duct was determined and the terminal portion of the accessory pancreatic duct was described in both groups.In patients with chronic pancreatitis, the insertion of the accessory pancreatic duct of short type prevailed; 31 patients (64.6%), independently of the degree of intensity of chronic pancreatitis. However, in patients with a normal pancreatogram, the intermediate and long type prevailed, 46 (42.2%) and 41 (37.6%) patients, respectively. In patients with a normal pancreatogram Stick type termination occurred in 66 patients (60.0%), and in patients having chronic pancreatitis, the Cudgel type was present in 34 patients (70.8%) which was statistically significant.The accessory pancreatic duct should be analyzed when we carry out the cholangiopancreatography because the patients with short type insertion have a higher risk of developing chronic pancreatitis.
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