ABSTRACT
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) within 72 h is suggested for patients presenting with acute biliary pancreatitis (ABP) and biliary obstruction without cholangitis. This study aimed to identify if urgent ERCP (within 24 h) improved outcomes compared to early ERCP (24-72 h) in patients admitted with predicted mild ABP. METHODS: Patients admitted for predicted mild ABP defined as a bedside index of severity in acute pancreatitis score < 3 and underwent ERCP for biliary obstruction within 72 h of presentation during the study period were included. Patients with prior biliary sphincterotomy or surgically altered anatomy preventing conventional ERCP were excluded. The primary outcome was the development of moderately severe or severe pancreatitis based on the revised Atlanta classification. Secondary outcomes were the length of hospital stay, the need for ICU admission, and ERCP-related adverse events (AEs). RESULTS: Of the identified 166 patients, baseline characteristics were similar between both the groups except for the WBC count (9.4 vs. 8.3/µL; p < 0.044) and serum bilirubin level (3.0 vs. 1.6 mg/dL; p < 0.0039). Biliary cannulation rate and technical success were both high in the overall cohort (98.8%). Urgent ERCP was not associated with increased development of moderately severe pancreatitis (10.4% vs. 15.7%; p = 0.3115). The urgent ERCP group had a significantly shorter length of hospital stay [median 3 (IQR 2-3) vs. 3 days (IQR 3-4), p < 0.01]. CONCLUSION: Urgent ERCP did not impact the rate of developing more severe pancreatitis in patients with predicted mild ABP but was associated with a shorter length of hospital stay and a lower rate of hospital readmission.
Subject(s)
Carcinoma, Pancreatic Ductal/diagnosis , Endoscopy, Digestive System , Lymphoma/diagnosis , Neuroendocrine Tumors/diagnosis , Pancreatic Neoplasms/diagnosis , Carcinoma, Pancreatic Ductal/surgery , Cholangiopancreatography, Endoscopic Retrograde , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Endosonography , Humans , Lymphoma/surgery , Magnetic Resonance Imaging , Neuroendocrine Tumors/surgery , Pancreatic Neoplasms/surgery , Positron-Emission Tomography , Tomography, X-Ray ComputedSubject(s)
Adenocarcinoma , Gastrointestinal Stromal Tumors , Gastroscopy , Lymphoma, B-Cell, Marginal Zone , Precancerous Conditions , Stomach Neoplasms , Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Gastrointestinal Stromal Tumors/diagnosis , Gastrointestinal Stromal Tumors/therapy , Humans , Lymphoma, B-Cell, Marginal Zone/diagnosis , Lymphoma, B-Cell, Marginal Zone/therapy , Metaplasia/diagnosis , Metaplasia/therapy , Polyps/diagnosis , Polyps/therapy , Precancerous Conditions/diagnosis , Precancerous Conditions/therapy , Stomach/pathology , Stomach Neoplasms/diagnosis , Stomach Neoplasms/therapySubject(s)
Bile Ducts/pathology , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/therapy , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic/therapy , Choledocholithiasis/therapy , Constriction, Pathologic/etiology , Humans , Sphincter of Oddi Dysfunction/therapy , StentsSubject(s)
Endoscopy, Gastrointestinal , Esophageal and Gastric Varices/etiology , Gastrointestinal Hemorrhage/therapy , Hemostasis, Endoscopic , Adrenergic beta-Antagonists/therapeutic use , Balloon Occlusion , Esophageal and Gastric Varices/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/prevention & control , Humans , Hypertension, Portal/complications , Ligation , Liver Cirrhosis/complications , SclerotherapySubject(s)
Biopsy/methods , Endoscopy, Gastrointestinal/methods , Gastrointestinal Diseases/pathology , Gastrointestinal Tract/pathology , Mucous Membrane/pathology , Specimen Handling/methods , Barrett Esophagus/pathology , Colitis, Microscopic/pathology , Eosinophilic Esophagitis/pathology , Esophagitis/pathology , Esophagitis/virology , Gastric Mucosa/pathology , Gastritis, Atrophic/pathology , Gastroesophageal Reflux/pathology , Helicobacter Infections/pathology , Humans , Inflammatory Bowel Diseases/pathology , Intestinal Mucosa/pathology , Peptic Ulcer/pathology , Polyps/pathologySubject(s)
Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects , Endosonography/adverse effects , Gastrointestinal Neoplasms/diagnosis , Bacteremia/etiology , Esophageal Perforation/etiology , Humans , Intestinal Perforation/etiology , Pancreatitis/etiology , Peritonitis/etiology , Postoperative Hemorrhage/etiologySubject(s)
Endoscopy, Gastrointestinal/standards , Geriatric Assessment , Practice Guidelines as Topic/standards , Aged , Aged, 80 and over , Analgesia/standards , Conscious Sedation/standards , Female , Humans , Male , Practice Patterns, Physicians'/standards , Societies, Medical/standards , Therapeutic Irrigation/standards , Total Quality Management , United StatesSubject(s)
Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Endoscopy/standards , Neoplasm Staging/standards , Practice Guidelines as Topic/standards , Biopsy, Fine-Needle/methods , Biopsy, Fine-Needle/standards , Colonoscopy/methods , Colonoscopy/standards , Colorectal Neoplasms/therapy , Endoscopy/methods , Endosonography/methods , Evidence-Based Medicine/standards , Female , Humans , Image-Guided Biopsy/standards , Immunohistochemistry , Magnetic Resonance Imaging/methods , Male , Neoplasm Invasiveness/pathology , Proctoscopy/methods , Proctoscopy/standards , Role , Sensitivity and Specificity , Societies, Medical/standards , Tomography, X-Ray ComputedSubject(s)
Adenocarcinoma , Biliary Tract Neoplasms , Endoscopy, Digestive System/methods , Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Bile Duct Neoplasms/diagnosis , Bile Duct Neoplasms/therapy , Bile Ducts, Intrahepatic , Biliary Tract Neoplasms/diagnosis , Biliary Tract Neoplasms/therapy , Cholangiocarcinoma/diagnosis , Cholangiocarcinoma/therapy , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy/methods , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Endosonography , Humans , Lymphoma/diagnosis , Lymphoma/therapy , Polyps/diagnosis , Polyps/therapyABSTRACT
Boerhaave syndrome, or spontaneous rupture of the esophagus, is a complication of violent vomiting. Although the syndrome is rare, awareness of it is important because delayed or missed diagnosis can be fatal. Radiographic imaging, particularly computed tomography, is the mainstay of diagnosis, and endoscopy generally does not play a role. We present a case of Boerhaave syndrome diagnosed by computed tomography that was complemented by endoscopic direct visualization to optimize surgical management. True Boerhaave syndrome is extremely rare, and rarer still is an endoscopic view of a known full-thickness tear of the esophagus.
Subject(s)
Adenocarcinoma , Barrett Esophagus , Carcinoma, Squamous Cell , Esophageal Neoplasms , Esophagoscopy , Precancerous Conditions , Ablation Techniques , Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Barrett Esophagus/diagnosis , Barrett Esophagus/surgery , Burns, Chemical/pathology , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/surgery , Early Detection of Cancer , Esophageal Achalasia/pathology , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/surgery , Esophagectomy/methods , Esophagus/injuries , Humans , Keratoderma, Palmoplantar, Diffuse/pathology , Precancerous Conditions/diagnosis , Precancerous Conditions/surgerySubject(s)
Endoscopy, Gastrointestinal/adverse effects , Intraoperative Complications/therapy , Ablation Techniques/adverse effects , Dilatation/adverse effects , Endoscopy, Gastrointestinal/methods , Esophageal Perforation/etiology , Esophageal Perforation/prevention & control , Esophageal Perforation/surgery , Foreign Bodies/surgery , Hemostatic Techniques/adverse effects , Humans , Intestinal Perforation/etiology , Intestinal Perforation/prevention & control , Intestinal Perforation/surgery , Intraoperative Complications/etiology , Risk Factors , Sclerotherapy/adverse effects , Stents/adverse effects , Stomach/injuries , Stomach/surgerySubject(s)
Endoscopy, Gastrointestinal , Lactation , Anti-Bacterial Agents/therapeutic use , Antidotes/therapeutic use , Benzodiazepines/therapeutic use , Cathartics/therapeutic use , Digestive System Diseases/diagnosis , Digestive System Diseases/therapy , Endoscopy, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/methods , Female , Humans , Hypnotics and Sedatives/therapeutic use , Naloxone/therapeutic use , Narcotic Antagonists/therapeutic use , Narcotics/therapeutic use , Parasympatholytics/therapeutic use , PregnancyABSTRACT
BACKGROUND: Colonoscopy fails to achieve cecal intubation in 5-10 % of cases. Many of these cases can be completed using balloon-assisted colonoscopy, either with the single-balloon colonoscopy (SBC) or the double-balloon colonoscopy (DBC) techniques. AIM: To compare the completion rates of SBC and DBC in patients with previous incomplete conventional colonoscopy. METHODS: Between August 2009 and July 2011 either SBC or DBC was performed in 53 patients in whom previous conventional colonoscopy did not achieve cecal intubation. The medical records of these 53 patients were reviewed retrospectively for details regarding (1) indication for the initial colonoscopy, (2) patient characteristics, (3) data from the initial colonoscopy, and (4) details on both SBC and DBC. RESULTS: SBC was successful in intubating the cecum in 100 % (26/26) of patients and DBC was successful in 93 % (25/27) of patients. The median (range) time to reach the cecum was 17 (9-43) min in the SBC group and 20 (7-58) min in the DBC group (P = 0.37). The presence of polyps was an entirely new finding in 35 % (9/26) of patients in the SBC group and 30 % (8/27) of patients in DBC group. Therapeutics were performed in 73 % (19/26) of patients in SBC group and 67 % (18/27) of patients in DBC group. CONCLUSION: For patients with incomplete conventional colonoscopy, SBC and DBC offer high cecal intubation rates as well as detection of additional polyps and therapeutic capability. Either SBC or DBC can be considered after incomplete conventional colonoscopy.
