Endoscopic retrograde cholangiopancreatography-related adverse events in Korea: A nationwide assessment.

BACKGROUND: Although endoscopic retrograde cholangiopancreatography (ERCP) is a pivotal procedure for the diagnosis and treatment of a variety of pancreatobiliary diseases, it has been known that the risk of procedure-related adverse events (AEs) is significant. OBJECTIVE: We conducted this nationwide cohort study since there have been few reports on the real-world data regarding ERCP-related AEs. METHODS: Patients who underwent ERCP were identified between 2012 and 2015 using Health Insurance Review and Assessment database generated by the Korea government. Incidence, annual trends, demographics, characteristics according to the types of procedures, and the risk factors of AEs were assessed. RESULTS: A total of 114,757 patients with male gender of 54.2% and the mean age of 65.0 ± 15.2 years were included. The most common indication was choledocholithiasis (49.4%) and the second malignant biliary obstruction (22.8%). Biliary drainage (33.9%) was the most commonly performed procedure, followed by endoscopic sphincterotomy (27.4%), and stone removal (22.0%). The overall incidence of ERCP-related AEs was 4.7% consisting of post-ERCP pancreatitis (PEP; 4.6%), perforation (0.06%), and hemorrhage (0.02%), which gradually increased from 2012 to 2015. According to the type of procedures, ERCP-related AEs developed the most commonly after pancreatic stent insertion (11.4%), followed by diagnostic ERCP (5.9%) and endoscopic sphincterotomy (5.7%). Younger age and diagnostic ERCP turned out to be independent risk factors of PEP. CONCLUSIONS: ERCP-related AEs developed the most commonly after pancreatic stent insertion, diagnostic ERCP and endoscopic sphincterotomy. Special caution should be used for young patients receiving diagnostic ERCP due to increased risk of PEP.

Palliative endoscopic retrograde biliary drainage for malignant biliary obstruction in Korea: A nationwide assessment.

BACKGROUND: Malignant biliary obstruction (MBO) is usually caused by biliary tract cancer or pancreatic cancer. This study was performed to summarize the current situation regarding palliative endoscopic retrograde biliary drainage (ERBD) for MBO in Korea and to determine its clinical significance by analyzing representative nationwide data. METHODS: Patients that underwent palliative ERBD for MBO between 2012 and 2015 were identified using the Health Insurance Review and Assessment database, which covers the entire Korean population. We assessed clinical characteristics and complications and compared the clinical impacts of initial metal and plastic stenting in these patients. RESULTS: A total of 9,728 subjects (mean age, 65 ± 11.4 years; male, 61.4%) were identified and analyzed. The most common diagnosis was malignant neoplasm of liver and intrahepatic bile ducts (32.1%) and this was followed by extrahepatic or Ampulla of Vater cancer and pancreatic cancer. Initial plastic stent(s) placement was performed in 52.9% of the study subjects, and metal stent(s) placement was performed in 23.3%. The number of sessions of endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) was significantly higher in patients that underwent initial plastic stenting than in patients that underwent metal stenting (2.2 ± 1.7 vs 1.8 ± 1.4, P < 0.0001), but rates of post-ERCP pancreatitis, hospital days, and time to second ERCP or PTBD were not significantly different. CONCLUSION: This nationwide assessment study suggests that initial metal stenting is associated with fewer sessions of total ERCP or PTBD following the initial procedure, despite the preference for initial plastic stenting in Korea.

[The usefulness of Doppler sonography in the assessment of disease activity of ulcerative colitis].

BACKGROUND/AIMS: disease activity in ulcerative colitis (UC) is generally assessed using symptoms, laboratory data, endoscopic findings, and histology of the biopsy specimens. In this study, we compared disease activity of UC as determined by clinical features and endoscopic findings, and aimed to assess the clinical usefulness of Doppler sonography. METHODS: the duplex Doppler sonography of superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) of 10 patients with clinically inactive UC and 20 patients with active UC were evaluated by one radiologist who was blinded to clinical information. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) of the SMA and IMA were evaluated. All patients underwent biochemical and endoscopic evaluations thereafter. Correlation between disease activity by the Truelove-Witts classification and the Mayo scoring system was measured, and we compared hemodynamic parameters between active and inactive UC. RESULTS: correlation rate of disease activity between these two scoring systems was 93.3%. Flow velocities (PSV, p<0.001 and EDV, p=0.03) and PI (p=0.03) were significantly higher in patients with active UC than inactive UC. PSVs of the SMA and IMA were also significantly correlated with disease severity. The active UC could be accurately diagnosed using Doppler sonography (AUC=0.83; 95% confidence interval 0.68-0.99). CONCLUSIONS: in patients with UC, clinical stage was well matched with endoscopic disease activity. Doppler sonography was a readily available method, and PSV of SMA would be clinically useful in predicting of disease activity and severity.