Impact of the protocol proposed by the American Society for Gastrointestinal Endoscopy in patients at high risk of choledocholithiasis, in Puebla Regional Hospital ISSSTE in Mexico.

BACKGROUND: Choledocholithiasis is one of the main complications of cholelithiasis with a prevalence in the Mexican population of 14%. The management through the guide proposed by the American Society for Gastrointestinal Endoscopy (ASGE) in 2010 can support the surgeon for the timely resolution of the pathology. OBJECTIVE: To determine that the guide proposed by ASGE for the management of choledocholithiasis in patients with "high risk" reduces the complications of this pathology. METHODS: A comparative, retrospective case-control study was conducted from January 1, 2015 to December 31, 2017. We included patients who were stratified at high risk of choledocholithiasis according to the ASGE guidelines. They were divided into 2 groups: the case group (diagnosis by ASGE guidelines) was submitted directly to endoscopic retrograde cholangiopancreatography (ERCP), the second group (no ASGE) followed the protocol of performing computed tomography, magnetic cholangioresonance, and finally ERCP. RESULTS: Of 61 patients with choledocholithiasis, the following groups were compared: the appearance of cholangitis, the complications after ERCP, time of ERCP, days of hospital stay and mortality. Obtaining significant difference in: "complications post ERCP" group ASGE 3/35 (9%), group no ASGE 8/26 (30.7%) with OR of 0.2 (0.05 - 0.9 IC 95%) and a p = 0.03; "Cholangitis" group ASGE 2/35 (5.7%), group no ASGE 8/26 (30-7%) with ORP 0.13 (0.03-0.71 IC 95%) and p = 0.009. CONCLUSION: In our setting, the use of the ASGE guideline reduces the presence of cholangitis and post-ERCP complications.

ANTECEDENTES: La coledocolitiasis es una de las principales complicaciones de la colelitiasis, con una prevalencia en la población mexicana del 14%. El manejo a través de la guía propuesta por la American Society for Gastrointestinal Endoscopy (ASGE) en 2010 puede apoyar al cirujano para la resolución oportuna de la patología. OBJETIVO: Determinar que el uso de la guía de la ASGE para el manejo de coledocolitiasis en pacientes con «alto riesgo¼ reduce las complicaciones de esta patología. MÉTODO: Estudio comparativo, retrospectivo, de casos y controles, del 1 de enero de 2015 al 31 de diciembre de 2017. Se incluyeron pacientes que se estratificaron en alto riesgo de coledocolitiasis de acuerdo con la guía ASGE y se dividieron en dos grupos: el grupo de casos (diagnóstico por guía ASGE) fue sometido directamente a colangiopancreatografía retrógrada endoscópica (CPRE), y el otro grupo (no ASGE) siguió el protocolo de realizar tomografía computarizada, colangiorresonancia magnética y finalmente CPRE. RESULTADOS: De 61 pacientes con coledocolitiasis, se comparó entre los grupos la aparición de colangitis, las complicaciones posteriores a la CPRE, el tiempo de realización de la CPRE, los días de estancia hospitalaria y la mortalidad. Se obtuvo diferencia significativa en complicaciones tras la CPRE (grupo ASGE 3/35 [9%], grupo no ASGE 8/26 [30.7%]; odds ratio [OR]: 0.2; intervalo de confianza del 95% [IC 95%]: 0.05-0.9; p = 0.03) y en colangitis (grupo ASGE 2/35 [5.7%], grupo no ASGE 8/26 [30-7%]; OR: 0.13; IC 95%: 0.03-0.71; p = 0.009). CONCLUSIÓN: En nuestro medio, el empleo de la guía ASGE reduce la presencia de colangitis y las complicaciones tras la CPRE.

Risk factors and outcomes of pyogenic liver abscess in adult liver recipients: a matched case-control study.

BACKGROUND: Adult liver recipients (ALR) differ from the general population with pyogenic liver abscess (PLA) as they exhibit: reconstructed biliary anatomy, recurrent hospitalizations, poor clinical condition and are subjected to immunosuppression. The aim of this study was to identify risk factors associated with PLA in ALR and to analyze the management experience of these patients. METHODS: Between 1996 and 2016, 879 adult patients underwent liver transplantation (LT), 26 of whom developed PLA. Patients and controls were matched according to the time from transplant to abscess in a 1 to 5 relation. A logistic regression model was performed to establish PLA risk factors considering clusters for matched cases and controls. Risk factors were identified and a multivariate regression analysis performed. RESULTS: Patients with post-LT PLA were more likely to have lower BMI (p = 0.006), renal failure (p = 0.031) and to have undergone retransplantation (p = 0.002). A history of hepatic artery thrombosis (p = 0.010), the presence of Roux en-Y hepatojejunostomy (p < 0.001) and longer organ ischemia time (p = 0.009) were independent predictors for the development of post-LT PLA. Five-year survival was 49% (95%CI 28-67%) and 89% (95%CI 78%-94%) for post-LT PLA and no post-LT PLA, respectively (p < 0.001). CONCLUSION: history of hepatic artery thrombosis, the presence of hepatojejunostomy and a longer ischemia time represent independent predictors for the development of post-LT PLA. There was a significantly poorer survival in patients who developed post-LT PLA compared with those who did not.

Adverse events of ERCP at San José Hospital of Bogotá (Colombia).

Endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred treatment method for hepatobiliary and pancreatic disease. Despite technological progress this technique continues to account for the greatest morbidity and mortality caused by digestive endoscopic procedures. ERCP carries a risk of pancreatitis, perforation, hemorrhage, cholangitis and cardiopulmonary events occurring in upto 10% of patients in referral centers, implying a mortality of up to 1%, not including therapeutic failures or the need for re-intervention. A greater mortality rate has been demonstrated in prospective studies rather than in retrospective studies, but overall, the number of complications described in the literature is much lower than the number of complications that actually occur.A descriptive prospective study was conducted at San José Hospital from April 1, 2006 to April 30, 2007 in patients who underwent an ERCP and had a 1-month follow-up. A total of 381 patients were included; 9 (2.3%) were excluded, and of the remaining 372 there was an overall success in 79.6% of cases, 8.3% had a second intervention, 7.6% developed complications (pancreatitis, perforation, hemorrhage, cholangitis, pain, intolerance to sedatives, and cardiopulmonary events), and 4.3% were failed ERCP studies. The mortality rate of the ERCP procedure was 0.8%.ERCP-related complications were determined at a teaching center, and this suggests the need to implement centers of excellence in order to improve the efficacy of the procedure.

Análise das complicações após realização de colangiopancreatografias retrógradas endoscópicas (CPRE) / Analysis of complications after performing of endoscopic retrograde cholangiopancreatography (ERCP)

Objetivo: Descrever a experiência dos autores na realização de CPRE, verificando a ocorrência de complicações associadas ao procedimento.Materiais e métodos: Trata-se de um estudo prospectivo. Foram incluídos no estudo todos os pacientes que realizaram CPRE entre janeiro de 1996 e setembro de 2003 em dois hospitais de Caxias do Sul. As variáveis analisadas foram sexo, idade, complicações relacionadas ao procedimento e mortalidade. Resultados: Foram realizadas 311 CPRE;55,7 por cento dos pacientes eram do sexo feminino e 44,3 por cento do masculino. Ocorreram complicações em 8,4 por cento dos exames realizados, sendo pancreatite a mais freqüente, verificada em 5,1 por cento dos casos.Ocorreu um óbito relacionado à CPRE no presente estudo. Conclusão: A freqüência e a etiologia das complicações verificadas assemelham-se às de outros estudos. Seu conhecimento é de extrema importância para aumentar a possibilidade de prevenção e de diagnóstico precoce de tais complicações