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2.
Folia Med (Plovdiv) ; 66(1): 46-58, 2024 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-38426465

RESUMO

INTRODUCTION: Obstructive jaundice is a clinical syndrome that is commonly seen in gastroenterology. Endoscopic retrograde cholangiopancreatography (ERCP) has been recognized as a first-choice therapeutic approach, with percutaneous biliary interventions (PBIs) being a viable alternative. Recent data questions the performance and safety profile of PBIs.


Assuntos
Sistema Biliar , Endossonografia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Drenagem
4.
South Med J ; 117(3): 159-164, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38428938

RESUMO

OBJECTIVES: Pancreatic divisum (PD) is the second most common congenital abnormality of the pancreatic duct, which affects 2% to 3% of the population. Most of the population remains asymptomatic, but in people who present with symptoms, it can be a cause of anguish and should be recognized. The main goal of this article was to provide a comprehensive picture of clinical and epidemiological methods of diagnosis and treatment of PD. METHODS: A total of 57 PD case reports were considered in this descriptive analysis with 51 case reports and case series published within the last 25 years. The search strategies include systemic searches using scholarly search engines such as Medscape, Scopus, Cochrane, and PubMed. RESULTS: The 57 cases we studied have an average age of presentation of 42 years, with female sex (58%) predominance. Common presenting symptoms were abdominal pain (87.72%) and radiation to the back (21.6%). Eighty-one percent of the case studies reported pancreatitis, and 63.2% had recurrent pancreatitis. At presentation, laboratory values demonstrated increased amylase, lipase, and liver enzymes. PD was diagnosed using magnetic resonance cholangiopancreatography (28.1%), endoscopic retrograde cholangiopancreatography (57.9%), endoscopic ultrasound (7%), or computed tomography (5.3%) scan of the abdomen. Of significance, biliary duct dilation was found in 70.6% of patients diagnosed as having PD. Incidental masses were found in 66.7% of the patients. The most successful treatment was sphincterotomy with or without stents (47.6%), followed by pancreatoduodenectomy (19%) and pancreaticojejunostomy (10%). CONCLUSIONS: Physicians managing pancreatitis should add PD to their differential diagnoses because it will help improve patient outcomes and avoid unfavorable consequences.


Assuntos
Pâncreas Divisum , Pancreatite , Humanos , Feminino , Adulto , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Pancreatite/diagnóstico , Pancreatite/epidemiologia , Pancreatite/terapia , Ductos Pancreáticos/anormalidades , Dor Abdominal/etiologia
5.
PLoS One ; 19(3): e0300029, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38470865

RESUMO

BACKGROUND: Perforation is one of the most serious complications of endoscopic retrograde cholangiopancreatography (ERCP). Conventional nonsurgical endoscopic treatments including intravenous antibiotic administration and plastic endoscopic biliary drainage are generally approved for the treatment of ERCP-related Stapfer type II perforation (perivaterian type). Biliary covered metal stent placement has recently been reported to have favorable outcomes in ERCP-related Stapfer type II perforations. We aimed to compare the outcomes of conventional endoscopic bile drainage and biliary covered self-expandable metal stent (SEMS) insertion in patients with Stapfer type II perforation. METHODS: Medical records of patients who underwent ERCP at Kyungpook National University Hospital in Daegu from 2011 to 2022 were retrospectively reviewed. RESULTS: A total of 8,402 ERCP procedures were performed in our hospital. Sixty-six ERCP-related perforations (0.78%) were identified. Among them, 37 patients (56.1%) who had Stapfer type II perforations were enrolled. Thirteen and twenty-four patients received biliary covered SEMS insertion and conventional endoscopic bile drainage treatments, respectively. No significant differences were observed in the clinical success rate (92.3% vs. 91.7%, p = 1.000), hospital stay (9.46 ± 5.97 vs. 13.9 ± 13.2 days, p = 0.258), and post-ERCP-related fasting time (5.4 ± 3.4 vs 4.3 ± 3.0 days, p = 0.305). Complications including bleeding, post-ERCP pancreatitis, fever, and death were not significantly different between the two groups. The conventional endoscopic bile drainage group took less time for ERCP than the SEMS group (11.5 ± 5.2 vs. 18.5 ± 11.2 min, p = 0.013). CONCLUSIONS: Compared with the conventional endoscopic bile drainage treatment method, biliary covered SEMS did not improve patient outcomes in ERCP-related Stapfer type II perforations.


Assuntos
Bile , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Estudos Retrospectivos , Stents , Drenagem/métodos , Resultado do Tratamento
7.
Pancreas ; 53(4): e357-e367, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38518062

RESUMO

OBJECTIVES: Secondary infections due to transmission via the duodenoscope have been reported in up to 3% of endoscopic retrograde cholangiopancreatographies. The use of single-use duodenoscopes has been suggested. We investigate the cost-effectiveness of these duodenoscopes use in cholangiopancreatography. MATERIALS AND METHODS: A cost-effectiveness analysis was implemented to compare the performance of cholangiopancreatographies with reusable duodenoscopes versus single-use duodenoscopes. Effectiveness was analyzed by calculating quality-adjusted life years (QALY) from the perspective of the National Health System. Possibility of crossover from single-use to reusable duodenoscopes was considered. A willingness-to-pay of €25,000/QALY was set, the incremental cost-effectiveness ratio (ICER) was calculated, and deterministic and probabilistic sensitivity analyses were performed. RESULTS: Considering cholangiopancreatographies with single-use and reusable duodenoscopes at a cost of €2900 and €1333, respectively, and a 10% rate of single-use duodenoscopes, ICER was greater than €3,000,000/QALY. A lower single-use duodenoscope cost of €1211 resulted in an ICER of €23,583/QALY. When the unit cost of the single-use duodenoscope was €1211, a crossover rate of more than 9.5% made the use of the single-use duodenoscope inefficient. CONCLUSIONS: Single-use duodenoscopes are cost-effective in a proportion of cholangiopancreatographies if its cost is reduced. Increased crossover rate makes single-use duodenoscope use not cost-effective.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Duodenoscópios , Humanos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Análise de Custo-Efetividade , Desenho de Equipamento
9.
J Int Med Res ; 52(3): 3000605241239215, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38513144

RESUMO

To investigate the outcomes following percutaneous placement of a retrievable fully covered self-expanding metal stent (fcSEMS) with anchoring flaps at proximal and distal ends for the treatment of biliary anastomotic strictures following living-donor liver transplantation (LDLT). We retrospectively reviewed the medical records of nine patients who underwent this procedure at our centre between April 2020 and March 2021. Percutaneous stent placement was technically successful in 100% patients, and all stents were successfully retrieved. No proximal or distal stent migration or occlusion was observed during the mean (±SD) stent indwelling period of 191(± 77) days. Clinical success was 89%. There was one major bleeding complication related to the biliary approach and one minor stent-related complication of calculus/sludge. During the mean (±SD) follow-up period of 595 ± 207 days after stent retrieval, only one patient developed recurrent clinical biliary stricture and symptoms. Percutaneous placement of a retrievable fcSEMS with anchoring flaps is safe and feasible for the treatment of biliary anastomotic strictures following LDLT.


Assuntos
Colestase , Transplante de Fígado , Humanos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Resultado do Tratamento , Transplante de Fígado/efeitos adversos , Estudos Retrospectivos , Doadores Vivos , Colestase/etiologia , Colestase/cirurgia , Stents/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos
10.
World J Gastroenterol ; 30(7): 614-623, 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38515949

RESUMO

Severe gallstone pancreatitis (GSP) refractory to maximum conservative therapy has wide clinical variations, and its pathophysiology remains controversial. This Editorial aimed to investigate the pathophysiology of severe disease based on Opie's theories of obstruction, the common channel, and duodenal reflux and describe its types. Severe GSP might be a hybrid disease with pathology polarized between acute cholangitis with mild pancreatitis (biliary type) and necrotizing pancreatitis uncomplicated with biliary tract disease (pancreatic type), in which hepatobiliary and pancreatic lesion severity is inversely related to the presence or absence of impacted ampullary stones. Severe GSP is caused by stones that are persistently impacted at the ampulla with biliopancreatic obstruction (biliary type), and probably, stones that are either temporarily lodged at the duodenal orifice or passed into the duodenum, thereby permitting reflux of bile or possible duodenal contents into the pancreas (pancreas type). When the status of the stones and the presence or absence of impacted ampullary stones with biliopancreatic obstruction are determined, the clinical course and outcome can be predicted. Gallstones represent the main cause of acute pancreatitis globally, and clinicians are expected to encounter GSP more often. Awareness of the etiology and pathogenesis of severe disease is mandatory.


Assuntos
Doenças Biliares , Colangite , Cálculos Biliares , Pancreatite , Humanos , Cálculos Biliares/complicações , Cálculos Biliares/terapia , Pancreatite/complicações , Doença Aguda , Doenças Biliares/complicações , Colangite/complicações , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos
11.
World J Gastroenterol ; 30(8): 811-816, 2024 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-38516233

RESUMO

Endoscopic ultrasound (EUS) with fine needle aspiration or fine needle biopsy is the gold standard for sampling tissue to diagnose pancreatic cancer and autoimmune pancreatitis or to analyze cyst fluid. The most common reported adverse event of fine needle aspiration and/or fine needle biopsy is acute pancreatitis, which is likely induced by the same pathophysiological mechanisms as after endoscopic retrograde cholangiopancreatography (ERCP). According to the current European Society of Gastrointestinal Endoscopy guideline, nonsteroidal anti-inflammatory drugs are administered prior to ERCP as a scientifically proven treatment to reduce post-ERCP pancreatitis incidence rate. A single suppository of diclofenac or indomethacin prior to EUS guided tissue acquisition (TA) is harmless in healthy adults. Since it is associated with low costs and, most important, may prevent a dreadsome complication, we strongly recommend the administration of 100 mg diclofenac rectally prior to EUS-TA. We will explain this recommendation in more detail in this review as well as the risk and pathophysiology of post-EUS TA pancreatitis.


Assuntos
Pancreatite , Adulto , Humanos , Pancreatite/epidemiologia , Pancreatite/etiologia , Pancreatite/prevenção & controle , Incidência , Diclofenaco/uso terapêutico , Doença Aguda , Anti-Inflamatórios não Esteroides/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos
12.
Arq Gastroenterol ; 61: e23112, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38451665

RESUMO

BACKGROUND: Common bile duct (CBD) stones are known to complicate 10-15% of gallstone diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is the therapeutic modality of choice for bile duct clearance in CBD stones but may fail to achieve stone clearance. This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. OBJECTIVE: This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. METHODS: All consecutive patients with bile duct stones undergoing ERCP at a tertiary care center were prospectively included from October 2020 to October 2021. The study's primary outcome was to identify and analyze factors that could predict the failure of complete CBD clearance. RESULTS: A total of 120 patients (50.8% males, median age: 53.5 years) were included in the final analysis. Successful clearance of CBD stones during the index procedure was achieved in 70% of patients. At a cut-off stone diameter of >10.5 mm and CBD diameter of >12.5 mm, the AUC was 0.890 and 0.884, respectively, to predict failed clearance of CBD. On multivariate analysis, stone diameter ≥15 mm [odds ratio (OR) 16.97, 95% confidence interval (CI): 1.629-176.785], location of stones in hepatic ducts (OR 7.74, 95%CI: 2.041-29.332), presence of stricture distal to stone (OR 6.99, 95%CI: 1.402-34.726) and impacted stone (OR 21.61, 95%CI: 1.84-253.058) were independent predictors of failed bile duct clearance. CONCLUSION: Stone size and location are independent predictors of failed bile duct clearance. The endoscopist should consider these factors while subjecting a patient to biliary ductal clearance to plan additional intervention. BACKGROUND: • Failure to clear bile duct stones in the index ERCP can be seen in 15-20% of cases, and identifying the factors associated with failure is important. BACKGROUND: • A prospective analysis was conducted to identify and analyze the factors that could predict the failure of complete CBD clearance. BACKGROUND: • The present study reported a successful clearance of CBD stones during the index procedure in only 70% of patients. BACKGROUND: • A stone diameter ≥15 mm, location of stones in hepatic ducts, presence of stricture distal to stone, and impacted stone were independent predictors of failed bile duct clearance.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Cálculos Biliares , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Estudos Prospectivos , Constrição Patológica , Ductos Biliares
13.
Arq Gastroenterol ; 61: e23152, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38451671

RESUMO

BACKGROUND: • The ERCP even when done by experienced professionals, fails in 10% of cases. BACKGROUND: • Until the development of the EUS-BD, PTBD had a role as a rescue therapy, despite a high rate of adverse events. BACKGROUND: • The EUS-BD is safe and has similar efficacy, when compared to PTBD and should be performed immediately after ERCP failure. BACKGROUND: • A doctor with skills in both methods (ERCP/EUS) is needed to determine the best EUS-guided therapeutic option.


Assuntos
Adenocarcinoma , Neoplasias Pancreáticas , Médicos , Humanos , Colangiopancreatografia Retrógrada Endoscópica , Endossonografia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia
14.
Rev Assoc Med Bras (1992) ; 70(1): e20230810, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38511752

RESUMO

OBJECTIVE: Acute pancreatitis is a rare disease in pregnant patients. Although it may have serious maternal and fetal consequences, morbidity and mortality rates have decreased recently due to appropriate and rapid treatment with earlier diagnosis. The aim of this study was to evaluate pregnant patients diagnosed with acute pancreatitis. METHODS: The study included pregnant patients diagnosed with acute pancreatitis who were admitted to Adana City Training and Research Hospital in Adana, Turkey, between January 2014 and January 2022. Patients' files were screened. Patients' demographics, acute pancreatitis etiology, severity, complications, and applied treatment, as well as maternal and fetal outcomes were evaluated. RESULTS: The study included 65 pregnant patients with acute pancreatitis. The mean age was 26.6±5 (19-41) years. Acute pancreatitis was observed in the third trimester. The most common cause of acute pancreatitis was gallstones, and its severity was often mild. Only two patients required endoscopic retrograde cholangiopancreatography, and the remaining patients were treated medically. Maternal and infant death developed in a patient with necrotizing acute pancreatitis secondary to hyperlipidemia. CONCLUSION: The most common etiology of acute pancreatitis in pregnancy was gallstones. Acute pancreatitis occurred in the third trimester. Most of the patients had mild acute pancreatitis. Maternal and fetal complications were rare. We think that the reasons for the low mortality rate were mild disease severity and biliary etiology, and most patients were in the third trimester, as well as early diagnosis and no delay in the intervention.


Assuntos
Cálculos Biliares , Pancreatite Necrosante Aguda , Complicações na Gravidez , Gravidez , Feminino , Humanos , Adulto Jovem , Adulto , Estudos Retrospectivos , Cálculos Biliares/complicações , Doença Aguda , Colangiopancreatografia Retrógrada Endoscópica
17.
Niger J Clin Pract ; 27(1): 22-28, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38317031

RESUMO

BACKGROUND: ERCP is an endoscopic procedure for the diagnosis and treatment of biliopancreatic system diseases. An increase in intra-abdominal pressure due to the insufflation of air to the intestinal lumen may be transmitted to ICP through the course of ERCP. In this prospective, randomized, controlled double-blinded study, we aimed to assess the ICP change using ultrasonography measurement of ONSD in patients undergoing ERCP comparing the effects of propofol and ketofol anesthesia. MATERIAL/METHODS: One hundred and nine patients undergoing ERCP under propofol or ketofol anesthesia were enrolled in the study. Ultrasonography measurement of ONSD was performed before (T0) and immediately after induction of anesthesia (T1), during sphincterotomy (T2), at the end of procedure (T3), and after the patient is fully awake (T4). RESULTS: Comparison of ONSD values and ONSD alteration between groups showed no statistically significant difference (P > 0.05). Both groups showed significantly greater changes from T0 to T2 compared with values from T0 to T1, T3, and T4, respectively (P = 0,000). T0 to T3 alteration was also significantly greater than T0 to T1 and T4 change in both groups (P = 0,000). CONCLUSIONS: ERCP procedure increases intracranial pressure most prominently during sphincterotomy both under propofol or ketofol anesthesia. Further studies are needed to investigate the impact of this phenomenon on adverse clinical outcomes.


Assuntos
Anestesia , Propofol , Humanos , Colangiopancreatografia Retrógrada Endoscópica , Estudos Prospectivos , Nervo Óptico/diagnóstico por imagem , Ultrassonografia
18.
ACS Biomater Sci Eng ; 10(3): 1743-1752, 2024 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-38373217

RESUMO

Brush cytology is a sampling technique extensively used for mucosal surfaces, particularly to identify malignancies. A sample is obtained by rubbing the brush bristles over the stricture or lesion several times until cells are trapped. Brush cytology detection rate varies, with malignancy confirmed in 15-65% of cases of adenocarcinoma-associated biliary strictures and 44-80% of cases of cholangiocarcinoma. Despite the widespread use of brush cytology, there is no consensus to date defining the optimal biliary brushing parameters for the collection of suspicious lesions, such as the number of passes, brushing rate, and force applied. The aim of this work is to increase the brush cytology diagnostic yield by elucidating the underlying mechanical phenomena. First, the mechanical interactions between the brush bristles and sampled tissue are analyzed. During brushing, mucus and detached cells are transferred to the space between the bristles through the capillary rise and flow eddies. These mass transfer mechanisms and their dependence on mucus rheology as a function of pH, brush displacement rate, and bristle geometry and configuration are examined. Lastly, results from ex vivo brushing experiments performed on porcine stomachs are presented. Clinical practitioners from a variety of disciplines can apply the findings of this study to outline clear procedures for cytological brushing to increase the sensitivity and specificity of the brushings.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colestase , Humanos , Citologia , Citodiagnóstico/métodos , Colestase/patologia , Sensibilidade e Especificidade
19.
Sci Rep ; 14(1): 4221, 2024 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-38378736

RESUMO

Plant leaf diseases are a major cause of plant mortality, especially in crops. Timely and accurately identifying disease types and implementing proper treatment measures in the early stages of leaf diseases are crucial for healthy plant growth. Traditional plant disease identification methods rely heavily on visual inspection by experts in plant pathology, which is time-consuming and requires a high level of expertise. So, this approach fails to gain widespread adoption. To overcome these challenges, we propose a channel extension residual structure and adaptive channel attention mechanism for plant leaf disease classification network (ERCP-Net). It consists of channel extension residual block (CER-Block), adaptive channel attention block (ACA-Block), and bidirectional information fusion block (BIF-Block). Meanwhile, an application for the real-time detection of plant leaf diseases is being created to assist precision agriculture in practical situations. Finally, experiments were conducted to compare our model with other state-of-the-art deep learning methods on the PlantVillage and AI Challenger 2018 datasets. Experimental results show that our model achieved an accuracy of 99.82% and 86.21%, respectively. Also, it demonstrates excellent robustness and scalability, highlighting its potential for practical implementation.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Recuperação Demorada da Anestesia , Agricultura , Produtos Agrícolas , Folhas de Planta
20.
Cancer Med ; 13(3): e7020, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38400670

RESUMO

BACKGROUND AND AIMS: The two most common interventions used to treat painless jaundice from pancreatic cancer are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD). Our study aimed to characterize the geographic distribution of ERCP-performing hospitals among patients with pancreatic cancer in the United States and the association between geographic accessibility to ERCP-performing hospitals and biliary interventions patients receive. METHODS: This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database for pancreatic cancer from 2005 to 2013. Multilevel models were used to examine the association between accessibility to ERCP hospitals within a 30- and 45-min drive from the patient's residential ZIP Code and the receipt of ERCP treatment. A two-step floating catchment area model was used to calculate the measure of accessibility based on the distribution across SEER regions. RESULTS: 7464 and 782 patients underwent ERCP and PTBD, respectively, over the study period. There were 808 hospitals in which 8246 patients diagnosed with pancreatic cancer in SEER regions from 2005 to 2013 received a procedure. Patients with high accessibility within both 30- and 45-min drive to an ERCP-performing hospital were more likely to receive an ERCP (30-min adjusted odds ratio [aOR]: 1.53, 95% confidence interval [CI]: 1.17-2.01; 45-min aOR: 1.31, 95% CI: 1.01-1.70). Furthermore, in the adjusted model, Black patients (vs. White) and patients with stage IV disease were less likely to receive ERCP than PTBD. CONCLUSIONS: Patients with pancreatic cancer and high accessibility to an ERCP-performing hospital were more likely to receive ERCP. Disparities in the receipt of ERCP persisted for Black patients regardless of their access to ERCP-performing hospitals.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Neoplasias Pancreáticas , Humanos , Idoso , Estados Unidos/epidemiologia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Estudos Retrospectivos , Medicare , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/cirurgia
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