Effects of medications on post-endoscopic retrograde cholangiopancreatography pancreatitis.

BACKGROUND AND AIMS: Drug-induced pancreatitis accounts for about 2% of acute pancreatitis. The aim of this study is to determine whether propofol and other medications are associated with increased risk for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. METHODS: A retrospective study was conducted at a single tertiary care hospital. All patients who underwent ERCP from 2001 to 2004 were included. Diagnosis of acute post-ERCP pancreatitis was based on a consensus definition. RESULTS: A total of 506 patients underwent ERCP. The total incidence of post-ERCP pancreatitis was 7.1%. There was no significant difference in post-ERCP pancreatitis between patients who received propofol compared to patients who received midazolam and fentanyl (9.0 vs. 5.9%, p = 0.18). Patients receiving an angiotensin receptor blocker were approximately 4 times more likely to develop post-ERCP pancreatitis (OR = 4.1, 95% CI 1.6-10.9). Patients younger than 65 years and smokers also had higher risk of developing acute post-ERCP pancreatitis than those who were older than 65 years (OR = 3.9, 95% CI 1.7-9.1) and non-smokers (OR = 2.8, 95% CI 1.3-6.2). CONCLUSIONS: Propofol is a safe sedative drug for ERCP without additional risk of developing acute post-ERCP pancreatitis. Use of angiotensin receptor blockers, smoking and younger age are independent risk factors for post-ERCP pancreatitis.

Primary small-bowel malignancy in the UK and its association with coeliac disease.

BACKGROUND: Malignancies of the small intestine are rare, accounting for <2% of all cancers of the gastrointestinal tract. There is little information about the presentation and prognosis of these tumours, and the frequency of established risk factors. AIM: To estimate the frequency of small-bowel malignancy in the UK, and its relationship to the presence of coeliac disease. DESIGN: Survey of clinicians registered with the British Society of Gastroenterology. METHODS: Data were collected monthly from June 1998 to May 2000. Clinicians (n=1327) were asked by post to report newly diagnosed cases of primary small-bowel malignancy. A form was sent to reporting clinicians, requesting an anonymous identifier, type of malignancy, and whether coeliac disease was present. A detailed questionnaire followed, requesting further clinical and pathological details. RESULTS: Clinico-pathological data were ascertained for 395 cases, including 175 adenocarcinomas, 107 lymphomas and 79 carcinoid tumours. In 13% of adenocarcinoma cases and in 39% of lymphomas, there was a diagnosis of coeliac disease. Survival rates at 30 months for adenocarcinomas, lymphomas and carcinoid tumours were 58%, 45% and 78%, respectively. Prognosis of all tumours was inversely related to stage at presentation, and lymphomas associated with coeliac disease were associated with a poorer prognosis. DISCUSSION: This study provides additional evidence that coeliac disease confers susceptibility to adenocarcinoma of the small bowel, as well as lymphoma. The long time from the onset of symptoms to diagnosis of small bowel tumours is of concern, as this delay is reflected in the high proportion that presented with metastatic disease. Although the absolute risk of malignancy is small, coeliac disease complicated by malignancy appears to be poorly controlled.

Medical treatment of gastro-oesophageal reflux disease.

Gastro-oesophageal reflux disease is common and is a chronic recurring condition. In view of our improved knowledge about the pathogenesis and complications of gastro-oesophageal reflux, the therapy should be individualized and a cost-effective approach should be attempted in its management.

Magnetic endoscope imaging: a new technique for localizing colonic lesions.

BACKGROUND AND STUDY AIMS: The precise localization of advanced colorectal lesions preoperatively directs the appropriate surgical management. The use of internal landmarks at colonoscopy can be inaccurate, and other methods are therefore necessary to localize lesions precisely. Magnetic endoscope imaging (MEI), a real-time, nonradiographic technique for imaging of the colonoscope, may assist in determining the location of lesions found at colonoscopy. PATIENTS AND METHODS: A prospective study was carried out to determine the accuracy of MEI for localizing the colonoscope tip anatomically. The MEI system was used to identify one of four predetermined locations within the colon. Once identified, two endoscopic marking clips were attached to the colonic mucosa, and 400 - 500 ml of Urografin radiographic contrast medium was injected to produce an air-contrast "enema." The clips were subsequently localized using plain abdominal radiography, assessed by a single experienced radiologist who was blinded to the colonoscopic findings. RESULTS: Twenty-nine consecutive patients were enrolled in the study. The overall accuracy of MEI in comparison with the air-contrast "enema" was 90 % (26 of 29 cases). There were three slight errors of localization - clips localized to the descending rather than the sigmoid-descending colon junction (n = 1), or to either side of the mid-transverse (n = 1) and hepatic flexure (n = 1) - but these were not considered to be of surgical or clinical importance. CONCLUSIONS: MEI is a reliable and accurate method for determining the anatomical position of the endoscope tip during colonoscopy. When it becomes commercially available, we believe the use of MEI will avoid the need for unnecessary barium enemas for localization of lesions prior to definitive surgery.