Follow-up to determine unplanned hospitalization and complications after endoscopic retrograde cholangiopancreatography.

BACKGROUND: Studies of endoscopic retrograde cholangiopancreatography (ERCP)-related complications are inconsistent and sometimes have insufficient patient follow-up. The aim of this study was to investigate risk factors for ERCP-related events, leading to hospitalization in the case of outpatients and prolonged hospital stay in the case of inpatients, using assiduous follow-up and contemporaneous recording of data. METHODS: Prospectively collected data of 1000 consecutive ERCP procedures performed by a single endoscopist at a tertiary referral centre in Canberra, Australia, were studied and the complications evaluated. Intense short-term follow-up with same evening and next day phone calls/consultations was undertaken with contemporaneous recording of indications, results and complications. RESULTS: Of 1000 procedures, 87 patients required unplanned hospitalization or prolongation of hospital stay. Risk factors for prolonged hospital stay included unusual indication (odds ratio (OR): 3.26, confidence interval (CI): 1.36-7.79, P = 0.008), age <50 (OR: 2.05, CI: 1.30-3.23, P = 0.002), procedure time >30 min (OR: 1.85, CI: 1.17-2.94, P = 0.009), being an outpatient (OR: 1.78, CI: 1.13-2.81, P = 0.012), inability to access the bile duct (OR: 1.98, CI: 1.03-3.82, P = 0.038) and placement of a pancreatic stent (OR: 1.93, CI: 1.08-3.45, P = 0.025). Of these, all but procedure time and placement of a pancreatic stent were risk factors if multivariate analysis was used. A total of 26 patients (30% of those with unplanned hospitalization) developed self-limiting pain without apparent complications. CONCLUSIONS: Both patient-related and procedure-related factors are important risk factors for determining the likelihood of unplanned post-ERCP hospitalization. There are a significant number of patients who experience self-limiting pain following ERCP, without evidence of recognized complications.

Microparticles released from Mycobacterium tuberculosis-infected human macrophages contain increased levels of the type I interferon inducible proteins including ISG15.

Microparticles (MPs) are small membranous particles (100-1000 nm) released under normal steady-state conditions and are thought to provide a communication network between host cells. Previous studies demonstrated that Mycobacterium tuberculosis (M. tb) infection of macrophages increased the release of MPs, and these MPs induced a proinflammatory response from uninfected macrophages in vitro and in vivo following their transfer into uninfected mice. To determine how M. tb infection modulates the protein composition of the MPs, and if this contributes to their proinflammatory properties, we compared the proteomes of MPs derived from M. tb-infected (TBinf-MP) and uninfected human THP-1 monocytic cells. MP proteins were analyzed by GeLC-MS/MS with spectral counting revealing 68 proteins with statistically significant differential abundances. The 42 proteins increased in abundance in TBinf-MPs included proteins associated with immune function (7), lysosomal/endosomal maturation (4), vesicular formation (12), nucleosome proteins (4), and antigen processing (9). Prominent among these were the type I interferon inducible proteins, ISG15, IFIT1, IFIT2, and IFIT3. Exposure of uninfected THP-1 cells to TBinf-MPs induced increased gene expression of isg15, ifit1, ifit2, and ifit3 and the release of proinflammatory cytokines. These proteins may regulate the proinflammatory potential of the MPs and provide candidate biomarkers for M. tb infection.