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1.
Medicine (Baltimore) ; 100(12): e25268, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761729

RESUMO

INTRODUCTION: In patients with malignant distal bile duct obstruction and normal gastrointestinal anatomy, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is indicated when endoscopic retrograde cholangiopancreatography (ERCP) fails. The ERCP drainage route passes through the tumor, whereas the EUS-CDS route does not. Therefore, EUS-CDS is expected to have a longer stent patency than ERCP. However, for first-line biliary drainage, it remains unclear whether EUS-CDS or ERCP is superior in terms of stent patency. To reduce the frequency of highly adverse events (AEs) such as bile peritonitis or stent migration following EUS-CDS, we developed an antimigration metal stent with a thin delivery system for tract dilatation. This study is designed to assess whether EUS-CDS with this novel stent is superior to ERCP with a traditional metal stent in terms of stent patency when the two techniques are used for first-line drainage of malignant distal biliary obstruction. METHODS/DESIGN: This study is a multicenter single-blinded randomized controlled trial (RCT) involving 95 patients in four tertiary centers. Patients with malignant distal biliary obstruction that is unresectable or presents a very high surgical risk and who pass the inclusion and exclusion criteria will be randomized to EUS-CDS or ERCP in a 1:1 proportion. The primary endpoint is the stent patency rate 180 days after stent insertion. Secondary outcomes include the rates of technical success, clinical success, technical success in cases not requiring fistulous-tract dilation (only EUS-CDS group), procedure-related AEs, re-intervention success, patients receiving post-drainage chemotherapy, procedure time, and overall survival time. DISCUSSION: If EUS-CDS is superior to ERCP in terms of stent patency and safety for the first-line drainage of malignant distal biliary obstruction, it is expected that the first-line drainage method will be changed from ERCP to EUS-CDS, and that interruption of chemotherapy due to stent dysfunction can be avoided. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000041343. Registered on August 6, 2020. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047201Version number: 1.2, December 7, 2020.


Assuntos
Neoplasias dos Ductos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Coledocostomia , Colestase , Endossonografia/métodos , Peritonite , Complicações Pós-Operatórias , Stents , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/patologia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocostomia/efeitos adversos , Coledocostomia/instrumentação , Coledocostomia/métodos , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/cirurgia , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Peritonite/etiologia , Peritonite/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Falha de Prótese , Cirurgia Assistida por Computador/métodos
2.
Acta Gastroenterol Belg ; 84(1): 73-77, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33639696

RESUMO

Background and study aims: Data on procedural outcome and quality of endoscopic retrograde cholangiopancreatography (ERCP) in Belgian practice are scarce. The aim of this study is to assess current status of ERCP-performance in Belgium. Methods: National multi-institutional survey (online questionnaire) among members of the Belgian Society of Gastrointestinal Endoscopy (BSGIE), conducted in the period June-August 2018. The RIZIV/INAMI provided real-life data on the total number of ERCPs performed in Belgium. Results: Forty-five responders completed the survey (for 43 centers performing ERCP), providing information for 8368 ERCPs performed in 45% (43/95) of institutions performing ERCP in Belgium. Fifty-eight percent of centers performed > 100 ERCPs/year and 7% of centers (n=3) performed < 50 ERCPs/year. According to the RIZIV/INAMI data, low case-volume centers are underrepresented in this survey. The most common ERCPindication was stone extraction (52%). 74% of endoscopists had more than 10 years of experience in performing ERCP. The majority of centers had their own written protocol (84%) for microbiological duodenoscope surveillance. Monitoring of cannulation rate and post-ERCP pancreatitis (PEP) was only performed in a minority of centers (30%). The majority of centers (76%) provided verbal informed consent relating to the ERCP-procedure ; a minority also requested a written informed consent (23%). 65% of centers systematically use NSAIDs for PEP prophylaxis. Conclusion: This is the first survey of ERCP performance in Belgium. There were wide variations in practice. Adherence to key performance measures and measurement and evaluation of ERCP performance in daily practice at center and endoscopist level are not uniformly widespread.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Pancreatite , Bélgica/epidemiologia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Endoscopia Gastrointestinal , Humanos , Inquéritos e Questionários
3.
Orv Hetil ; 162(1): 31-38, 2021 01 03.
Artigo em Húngaro | MEDLINE | ID: mdl-33388737

RESUMO

Összefoglaló. Bevezetés: Az endoszkópos retrográd cholangiopancreatographiát (ERCP) követo pancreatitis (PEP) incidenciája a magas kockázatú betegcsoportban 14,7%. Célkituzés: A munkacsoportunk által szerzett tapasztalatok elemzése. Módszerek: A profilaktikus pancreassztentes (PPS), magas kockázatú betegek adatait tartalmazó prospektív adatbázisunkat elemeztük retrospektív módon. Az adatokat a PEP-incidencia és a súlyosság tekintetében összehasonlítottuk a korábbi, hasonlóan magas kockázatú, sztent nélküli beteganyagunkkal, illetve a sztenteléssel kapcsolatos szövodményeket és a különbözo sztenttípusokat is elemeztük. A Cotton-kritériumok szerint értékeltük a PEP-t. Eredmények: A 317, magas kockázatú betegbol 288 esetben (90,9%) volt sikeres a PPS-implantáció. A sztent nélküli kontrollcsoportba 121, magas kockázatú beteget választottunk be. A sikeresen sztentelt betegekben a PEP incidenciája 10,0% volt. Ez és a PEP súlyossága (enyhe: 8,3%, középsúlyos: 1,4%, súlyos: 0,3%) is szignifikánsan alacsonyabb volt a PPS nélküli beteganyaghoz (PEP: 31,4%, enyhe: 15,7%, középsúlyos: 10,7%, súlyos: 5,0%) és a sikertelenül sztentelt betegekhez (PEP: 41,3%, enyhe: 24,1%, középsúlyos: 13,8%, súlyos: 3,4%) képest. Az utóbbi két csoport közötti különbség nem volt szignifikáns. A sztenttel kapcsolatos szövodmények közül a leggyakrabban a korai sztentkicsúszást (5/288 beteg, 1,74%) és a proximalis sztentmigrációt (3/288 beteg, 1,04%) észleltük. A sztenttípusok közül a legkedvezobb mellékhatás-profilúnak a Freeman-típusú, belso füllel és külso "pigtail" véggel ellátott sztenteket találtuk. Következtetés: A profilaktikus pancreassztentelés hatékonyan csökkenti a PEP incidenciáját, és a súlyosságát az enyhébb esetek felé tolja el. Alkalmazása viszonylag egyszeru, azonban ismerni kell használatának megfelelo technikáját, idoben történo eltávolításának és a szövodmények felismerésének fontosságát. Eredményeink és a nemzetközi ajánlások alapján magas PEP-rizikójú betegekben a PPS rutinszeru alkalmazása minden ERCP-laborban ajánlott. Orv Hetil. 2021; 162(1): 31-38. INTRODUCTION: The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP). Its incidence in the high-risk patient population is 14.7%. OBJECTIVE: To analyze 10 years experiences of our working group. METHODS: We retrospectively analyzed our prospective database of high-risk patients treated with prophylactic pancreatic stents (PPS) including the period between 2009 and 2014. We compared PEP incidence and severity findings with our historical data of pre-PPS period of similarly high-risk patients (no-stent group), furthermore analyzed the complications of PPS insertion and different stent types. PEP was defined and categorized according to the Cotton criteria. RESULTS: In 317 high-risk patients, PPS implantation was successful in 288 cases (90.9%). The no-stent group comprised of 121 patients. Incidence and the severity of PEP in the successfully stented group (all: 10.0%; mild: 8.3%, moderate: 1.4%, severe: 0.3%) were significantly lower compared to the no-stent group (all: 31.4%; mild: 15.7%, moderate: 10.7%, severe: 5.0%) and the unsuccessfully stented group (all: 41.3%; mild: 24.1%, moderate: 13.8%, severe: 3.4%). The difference between the latter two groups was not significant. Only early dislodgment (5/288 patients, 1.74%) and proximal migration (3/288 patients, 1.04%) were observed as stent-related complications. Freeman type (single inner flange, outer pigtail end) stent was the best based on the complication profile. CONCLUSION: Prophylactic pancreatic stenting effectively lowers the incidence and severity of PEP. We should recognize the proper technic of its application and the importance of proper timing of its extraction and identification of complications. Utilization of PPSs in high-risk patients is strongly recommended in every ERCP center. Orv Hetil. 2021; 162(1): 31-38.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Pancreatite/prevenção & controle , Stents , Humanos , Pancreatite/etiologia , Complicações Cognitivas Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
4.
Zhonghua Yi Xue Za Zhi ; 101(4): 276-279, 2021 Jan 26.
Artigo em Chinês | MEDLINE | ID: mdl-33486937

RESUMO

Objective: To explore whether the use of pancreatic stent combined with somatostatin can produce the synergistic effect of preventing acute pancreatitis (AP) and hyperamylasemia (HP) after endoscopic retrograde cholangiopancreatography (ERCP). Methods: From January 2019 to December 2019, the clinical data of 325 patients with ERCP were analyzed retrospectively in cholelithic center of Shanghai East Hospital Affiliated to Tongji University. According to the different methods of AP prevention, the patients were divided into the observation group (pancreatic stent and somatostatin) and the control group (pancreatic stent) and the incidence of AP and HP were compared. Results: In the observation group, there were 5 cases of AP (3.65%) and 10 cases of HP (7.30%). In the control group, there were 7 cases of AP (3.72%) and 19 cases of HP (10.11%). The incidence of AP and HP in the observation group was lower than that in the control group, but the differences were not statistically significant (χ²=0.001, P=0.972; χ²=0.768, P=0.381). Conclusion: The use of pancreatic stent combined with somatostatin will not produce the synergistic effect of preventing AP and HP after ERCP.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Pancreatite , Doença Aguda , China , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Humanos , Pancreatite/etiologia , Pancreatite/prevenção & controle , Estudos Retrospectivos , Somatostatina/uso terapêutico , Stents
5.
Acta Gastroenterol Belg ; 83(4): 598-602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33321017

RESUMO

Background and aims: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive modality, and has a high risk of causing post-ERCP pancreatitis (PEP). Risk factors of PEP have been investigated and conflicting results are present for most risk factors. The aim of this study was to evaluate the risk factors for PEP and to determine whether the risk factors differ due to the ERCP indication. Patients and methods: A retrospective study was conducted which included 666 patients with 968 ERCP procedures. Some risk factors were evaluated for PEP, and they were also evaluated separately for patients with bile duct stones and patients who underwent ERCP for other reasons than bile duct stones. Results: In patients with bile duct stones detected on ERCP ; female gender, lower diameter of the common bile duct, placing a biliary plastic stent and not having a cholecystectomy history were risk factors for PEP, whereas in patients without bile duct stones the only risk factor for PEP was not having a prior endoscopic sphincterotomy. Conclusions: Our study revealed that PEP risk factors depend on the indication of ERCP. To the best of our knowledge our study is the first study defining cholecystectomy as a protective factor for PEP in patients with bile duct stones and endoscopic sphincterotomy history as a protective factor for PEP in patients without bile duct stones. Our study also showed that female gender, lower diameter of the common bile duct and placing a plastic biliary stent were risk factors for PEP in patients with bile duct stones.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Pancreatite , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Feminino , Humanos , Pancreatite/epidemiologia , Pancreatite/etiologia , Estudos Retrospectivos , Fatores de Risco , Esfinterotomia Endoscópica/efeitos adversos
8.
Einstein (Sao Paulo) ; 18: eAO5393, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33111809

RESUMO

OBJECTIVE: To determine the period during which we should avoid cholecystectomy after endoscopic retrograde cholangiopancreatography. METHODS: A retrospective analysis of electronic medical charts of 532 patients undergoing endoscopic retrograde cholangiopancreatography, between March 2013 and December 2017. RESULTS: Approximately one-third of patients underwent the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography. The conversion rate was 3.8%. The need for abdominal drainage and the finding of biliary tract injury after surgery were observed in 15.1% and 1.9% of patients, respectively. The length of stay was significantly shorter among patients undergoing surgery more than 30 days after endoscopic retrograde cholangiopancreatography. These patients had a median length of stay of one day, whereas the median length of stay in the group undergoing the procedure between 4 and 30 days after endoscopic retrograde cholangiopancreatography was 2 days. CONCLUSION: The period during which we should avoid cholecystectomy is between 4 and 30 days after endoscopic retrograde cholangiopancreatography.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia/efeitos adversos , Contraindicações de Procedimentos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Humanos , Tempo de Internação , Estudos Retrospectivos , Resultado do Tratamento
9.
Anesth Analg ; 131(5): 1566-1572, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079880

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) patients typically receive either tubeless anesthesia or general endotracheal anesthesia (GETA). Patients receiving propofol-based total intravenous anesthesia (TIVA) are at higher risk of sedation-related adverse events (SRAEs) than patients receiving GETA, primarily due to the need for additional airway maneuvers. The increasing use of non-operating room (OR) anesthesia and the perception of a higher incidence of adverse outcomes in non-OR areas has led to the development of devices to improve safety while maintaining efficiency. The purpose of this study was to evaluate if the LMA Gastro™ could be used as a safe alternative to tubeless anesthesia for successfully completing ERCPs. METHODS: Eligible subjects were identified within the patient population at MD Anderson Cancer Center. Inclusion criteria consisted of adult patients (≥18 years old) scheduled for elective ERCP with TIVA. This was a prospective observational study in which the following data were collected: number of attempts and time to successful supraglottic airway (SGA) placement, vital signs, peripheral oxygen saturation (SpO2), median end-tidal CO2, practitioner satisfaction, and any complications. RESULTS: A total of 30 patients were included in this study. The overall rate of successful SGA placement within 3 attempts was 96.7% (95% confidence interval [CI], 82.8-99.9) or 29/30. The rate of successful ERCP with SGA placement within 3 attempts was 93.3% (95% CI, 77.9-99.2) or 28/30. Both the gastroenterologist and anesthesiologist reported satisfaction with the device in 90% of the cases (in 66.7% of the cases both anesthesiologist and gastroenterologist scored the device a 7/7 for satisfaction). Patients maintained an SpO2 of 95%-100% from induction to discharge, with the exception of 1 patient who had an SpO2 of 93%. The median end-tidal CO2 during the procedure for all patients was 35 mm Hg. Observed aspiration did not occur in any patient. Symptoms of hoarseness (13.3%), mouth soreness (6.7%), sore throat (6.6%), and minor bleeding/cuts/redness/change in taste to the tongue (3.3%) were determined through patient questioning before postanesthesia care unit (PACU) discharge. CONCLUSIONS: Our study suggests that the LMA Gastro might be a safe alternative for ERCP procedures. There was a high level of practitioner satisfaction. Only minor complications, such as hoarseness, mouth or throat soreness, or minor trauma to the tongue were experienced by patients. Similar incidences of complications may occur with GETA and tubeless anesthesia. The procedure was well tolerated by all patients; all patients maintained adequate oxygenation and required only minimal blood pressure support.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Máscaras Laríngeas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas , Anestesiologistas , Dióxido de Carbono/sangue , Colangiopancreatografia Retrógrada Endoscópica/métodos , Feminino , Gastroenterologistas , Rouquidão/epidemiologia , Rouquidão/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Segurança do Paciente , Faringite/epidemiologia , Faringite/etiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Língua/lesões
10.
Medicine (Baltimore) ; 99(37): e22051, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925738

RESUMO

Addressing pancreaticobiliary disorders concomitant with gastroesophageal varices remains challenging. The goal of this study was to evaluate and compare the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotic and noncirrhotic patients with gastroesophageal varices.We retrospectively analyzed the data of consecutive patients with gastroesophageal varices who underwent ERCP.Two hundred seventy ERCP procedures were performed on 208 patients. The overall technical success rate was 98.5%, and no difference was found between cirrhotic and noncirrhotic patients (98.7% vs 97.7%, P = .511); of these, endoscopic retrograde biliary drainage, endoscopic metal biliary endoprosthesis placement, endoscopic retrograde pancreatic drainage, and stone extraction were conducted in 173/270 (64.1%), 27/270 (10.0%), 26/270 (9.6%), and 116/270 (43.0%) cases, respectively. Endoscopic retrograde biliary drainage and stone extraction were more frequently performed in cirrhotic cases (67.7% versus 45.5%, P = .005; 46.5% versus 25.0%, P = .009, respectively), while the noncirrhotic group had significantly higher rates of endoscopic metal biliary endoprosthesis placement (31.8% versus 5.8%, P = .000) and endoscopic retrograde pancreatic drainage (18.2% versus 8.0%, P = .036) than the cirrhotic group. The overall rate of adverse events was 21.1%, including fever (6.7%), post-ERCP pancreatitis ( 3.0%), hyperamylasemia (6.3%), duodenal papilla bleeding (3.3%), cardiac mucosal laceration (1.1%), and perforation (0.4%). No differences in any of the adverse events were found between the 2 groups. Additionally, gastroesophageal variceal bleeding occurred in 1 patient with grade III varices 7 days after ERCP.ERCP may be effective and safe for patients with gastroesophageal varices, irrespective of the etiologies caused by liver cirrhosis.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Varizes Esofágicas e Gástricas/cirurgia , Cirrose Hepática/complicações , Adulto , Idoso , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Hipertensão Portal/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 99(34): e21831, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846829

RESUMO

Adoption of interventional endoscopic procedures is increasing with increasing prevalence of diseases. However, medical radiation exposure is concerning; therefore, radiation protection for medical staff is important. However, there is limited information on the usefulness of an additional lead shielding device during interventional endoscopic procedures. Therefore, we aimed to determine whether an additional lead shielding device protects medical staff from radiation.An X-ray unit (CUREVISTA; Hitachi Medical Systems, Tokyo, Japan) with an over-couch X-ray system was used. Fluoroscopy-associated scattered radiation was measured using a water phantom placed at the locations of the endoscopist, assistant, nurse, and clinical engineer. For each location, measurements were performed at the gonad and thyroid gland/eye levels. Comparisons were performed between with and without the additional lead shielding device and with and without a gap in the shielding device. Additionally, a clinical study was performed with 27 endoscopic retrograde cholangiopancreatography procedures.The scattered radiation dose was lower with than without additional lead shielding at all medical staff locations and decreased by 84.7%, 82.8%, 78.2%, and 83.7%, respectively, at the gonad level and by 89.2%, 86.4%, 91.2%, and 87.0%, respectively, at the thyroid gland/eye level. Additionally, the scattered radiation dose was lower without than with a gap in the shielding device at all locations.An additional lead shielding device could protect medical staff from radiation during interventional endoscopic procedures. However, gaps in protective equipment reduce effectiveness and should be eliminated.


Assuntos
Exposição Ocupacional/prevenção & controle , Exposição à Radiação/prevenção & controle , Proteção Radiológica/instrumentação , Radiografia Intervencionista/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Fluoroscopia/efeitos adversos , Gônadas/efeitos da radiação , Humanos , Traumatismos Ocupacionais/prevenção & controle , Imagens de Fantasmas/estatística & dados numéricos , Equipamentos de Proteção/normas , Doses de Radiação , Lesões por Radiação/prevenção & controle , Proteção Radiológica/métodos , Glândula Tireoide/efeitos da radiação
12.
Medicine (Baltimore) ; 99(27): e21111, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629744

RESUMO

RATIONALE: Intermittent combined pancreaticobiliary obstruction may lead to multiple episodes of ascending cholangitis and pancreatitis, usually due to choledocholithiasis or periampullary mass. However, one of the rare causes is periampullary or juxtapapillary duodenal diverticulum. Although duodenal diverticula are relatively common in the general population, the overwhelming majority are asymptomatic. Duodenal diverticula can cause combined pancreaticobiliary obstruction through multiple mechanisms such as stasis-induced primary choledocholithiasis, stasis-induced intradiverticular enterolith, or longstanding diverticulitis, causing stenosing fibrosing papillitis or a combination of more than one of these mechanisms. Herein, I report a case of Lemmel syndrome due to a combination of multiple mechanisms and review the available literature on the epidemiology, pathogenesis, clinical presentation, diagnostic work-up, and management of juxtapapillary duodenal diverticulum. PATIENT CONCERNS: Multiple episodes of abdominal pain, jaundice, anorexia, fever, and significant unintentional weight loss. DIAGNOSES AND INTERVENTIONS: Primary choledocholithiasis, recurrent ascending cholangitis, recurrent acute pancreatitis, and pancreatic atrophy due to giant juxtapapillary duodenal diverticulum, with unsuccessful endoscopic retrograde cholangiopancreatography that was completely resolved after open transduodenal sphincteroplasty and septoplasty, transampullary and transcystic common bile duct exploration and stone extraction, and duodenal diverticular inversion. OUTCOME: Complete resolution of combined pancreaticobiliary obstruction without recurrence for 2 years after surgery. LESSONS: Surgeons should be aware of such rare syndromes to avoid misdiagnosis and delayed or inappropriate management. Furthermore, they should understand the different available operative options for cases that are refractory to endoscopic approach.


Assuntos
Colangite/complicações , Divertículo/complicações , Icterícia/etiologia , Pancreatite/complicações , Dor Abdominal/etiologia , Atrofia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Coledocolitíase/complicações , Colestase/etiologia , Colestase/patologia , Diverticulite/complicações , Divertículo/patologia , Divertículo/cirurgia , Neoplasias Duodenais/patologia , Feminino , Humanos , Indonésia/etnologia , Pancreatopatias/patologia , Recidiva , Esfincterotomia Transduodenal/métodos , Resultado do Tratamento , Adulto Jovem
14.
PLoS One ; 15(5): e0233388, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32453738

RESUMO

OBJECTIVES: The adequate duration for EPBD was unclear. Therefore, we aimed to investigate the effect of balloon dilatation duration of EPBD on the occurrence of PEP. METHODS: One hundred and ninety-eight patients with common bile duct (CBD) stone treated by EPBD were retrospectively recruited. The dilatation duration was determined according to adequate opening of the biliary orifice without bleeding. The clinical outcomes and complications of EPBD were recorded. RESULTS: We stratified the patients according to dilatation duration (Group A, <3 minutes; Group B, 3-5 minutes; Group C, ≥5 minutes). The group C patients had a higher proportion of large CBD stones (stones ≥10 mm) (33.3% vs. 26.8% vs. 53.5%, p = 0.01). Patients in group A had a significantly higher PEP rate than patients in group B (13.3 vs. 3.1, p = 0.032). There were no significant differences in perforation and bleeding rate among the three groups. Univariate and multivariate analyses showed that a dilatation duration of <3 minutes, CBD diameter < 10 mm and age ≤ 75 years were independent risk factors of PEP in post-EPBD patients. CONCLUSIONS: In patients receiving EPBD, dilatation duration <3 minutes, lower CBD diameter, and younger age were independent risk factors of PEP.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Dilatação/efeitos adversos , Cálculos Biliares/cirurgia , Pancreatite/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Estudos Retrospectivos , Fatores de Tempo
16.
Intern Med ; 59(14): 1687-1693, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32296000

RESUMO

Objective We investigated the results of biliary cannulation using a short-type single-balloon enteroscope in patients with a native papilla who had previously undergone Roux-en-Y gastrectomy and analyzed the factors associated with successful cannulation. Methods The study subjects consisted of patients with a native papilla who had previously undergone Roux-en-Y gastrectomy and endoscopic retrograde cholangiopancreatography using a short-type single-balloon enteroscope at our institution between September 2011 and July 2019. We carried out a retrospective investigation of the outcomes, including assessing the success rate of biliary cannulation, and analyzed the factors associated with successful cannulation. Results In total, 78 patients underwent biliary cannulation of a native papilla. The success rate of biliary cannulation was 80.8% (88.5% when including success on repeated attempts). The success rate of the standard cannulation technique was 60.3%, with the use of advanced cannulation techniques to secure the pancreatic duct providing the same additional effect as a normal anatomy. Adverse events occurred in 9.0% of cases. A multivariate analysis of the Roux-en-Y gastrectomy patients found that cannulation was more likely to be successful in patients in whom the scope could be placed in the retroflex position (odds ratio: 7.88, 95% confidence interval: 2.19-37.77, p<0.001). Conclusion Selective biliary cannulation using a short-type single-balloon enteroscope in patients with a native papilla who had undergone Roux-en-Y gastrectomy was effective and safe. The retroflex position provided a good papilla field of view and improved the success rate of biliary cannulation.


Assuntos
Anastomose em-Y de Roux/efeitos adversos , Enteroscopia de Balão/normas , Sistema Biliar , Cateterismo/normas , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Gastrectomia/normas , Ductos Pancreáticos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
17.
Dig Dis ; 38(6): 534-541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187605

RESUMO

BACKGROUND: Risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) complications are well-studied. However, risk factors for complications and success after endoscopic sphincterotomy (EST) for duct stones are poorly determined. This study aimed to verify risk factors for mortality, complications, and success after EST. METHODS: A multivariate analysis was carried out in a dataset of ERCPs performed during 17 years. RESULTS: A total of5,226 ERCPs were performed, of which 2,137 were in patients with bile duct stones (1,458 women and 679 men; mean age = 57 years) who underwent EST with attempted stone removal. There were 171 (8%) complications, with pancreatitis in 87 (4.1%), bleeding in 48 (2.2%), other complications in 36 (1.8%), and mortality of 0.6%. Successful stone(s) removal was obtained in 2,028 cases (94.9%). On multivariate analysis, mortality was associated with age >60 years (1 vs. 0.2%), cholangitis (4.3 vs. 0.3%), and EST-related complications (5.8 vs. 0.2%). Complications were associated with unsuccessful stone removal (13.4 vs. 7.5%) and difficult cannulation (13.9 vs. 5.4%). An unsuccessful EST was independently related to difficult cannulation (86.2 vs. 98.7%), precutting (79.4 vs. 96.4%), and complications (86.5 vs. 95.6%). CONCLUSIONS: Risk factors for complications after EST for stones are delayed bile duct cannulation and failed stone retrieval. Mortality is higher in older patients, those who presented with an EST-related complication, or those who presented initially with cholangitis. Difficult cannulation, EST-related complications, and precutting were associated with an unsuccessful procedure. In this series, outpatient EST with attempted stone retrieval was found to be as safe as performing the procedure in hospitalized patients.


Assuntos
Cálculos Biliares/epidemiologia , Cálculos Biliares/cirurgia , Complicações Pós-Operatórias/etiologia , Esfinterotomia Endoscópica/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Feminino , Cálculos Biliares/mortalidade , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
18.
Pediatr Surg Int ; 36(5): 611-620, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32206892

RESUMO

AIM: We aimed to determine predictive factors for predicting cystobiliary fistulas (CBF) in children after treatment of liver hydatid cyst (LHD). METHODS: The records of patients who were treated for LHD between 01.06.2009 and 1.06.2019 were retrospectively reviewed. Age, sex, laboratory test results, size and number of cysts, method of first intervention (percutaneous or surgery), whether or not CBF developed and how it was treated were investigated. Among findings, those could be predictive were investigated. Data were evaluated with SPSS 21.0 program, p < 0.05 was considered significant. RESULTS: Of the 97 patients, 48 (49.5%) were male, 49 (50.5%) female, the mean age was 11.2 years, Eighty patients had right (82.5%), 13 had left, and 4 had bilobar involvement. As first intervention, surgery was performed in 39 (40.2%); percutaneous treatment was performed in 58 (59.8%) patients. In 8 patients (20.5%) in surgery group and in 6 patients (10.3%) in percutaneous group, totally in 14 patients (14.4%), CBF developed. The mean cyst diameter of CBF-developed group was 114.36 mm, and of CBF-undeveloped group was 74.30 mm. There was no statistically significant differences between groups in terms of age, sex, involved lobe, other organ involvement, and preoperative results (p > 0.5). There was a significant relationship between the cyst diameter and the rate of CBF development in both surgical and percutaneous groups (p < 0.05). ROC analysis was performed, and the cut-off value for the development of CBF detected as 69 mm for children. Since obstructive jaundice seen in adults is not common in children, an increase in liver function tests and bilirubin levels were not seen in our patients. CONCLUSION: A significant correlation was found only between the size of the cyst and developing CBF. Cysts greater than 69 mm have a higher risk of developing CBF after both percutaneous and surgical treatment and should be closely monitored.


Assuntos
Fístula Biliar/etiologia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Drenagem/efeitos adversos , Equinococose Hepática/complicações , Complicações Pós-Operatórias/etiologia , Adolescente , Fístula Biliar/diagnóstico , Fístula Biliar/cirurgia , Criança , Pré-Escolar , Equinococose Hepática/diagnóstico , Equinococose Hepática/cirurgia , Feminino , Humanos , Testes de Função Hepática , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia
19.
Medicine (Baltimore) ; 99(13): e19498, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32221072

RESUMO

This study aimed to analyze the dose of radiation to which the physician is exposed during endoscopic retrograde cholangiopancreatography (ERCP) and to identify predictive factors of radiation exposure during the procedure. Furthermore, we evaluated the patient characteristics and procedural factors associated with prolonged fluoroscopy time (FT).A cross-sectional retrospective analysis of 780 ERCPs performed at a tertiary academic hospital over a 2-year period was conducted. The primary outcome was radiation exposure during ERCP as determined by FT; additionally, the association between variables and radiation exposure was determined. Moreover, we evaluated their correlations with age, sex, body mass index (BMI), diagnosis, duration of procedure, procedure name, and procedure complexity.According to the analysis of the 780 ERCPs performed in 2 years, the mean FT was 5.07 minutes (95% confidence interval [CI], 4.87-5.26). The mean radiation durations were as follows: cholelithiasis, 5.76 minutes (95% CI, 4.75-6.80); malignant biliary obstruction, 6.13 minutes (95% CI, 5.91-6.35); pancreatic disease, 5.28 minutes (95% CI, 4.45-6.28); and benign biliary stricture, 5.32 minutes (95% CI, 5.02-5.94). Significant differences affecting fluoroscopy duration between the 2 endoscopists were not observed in the present study. Multivariate analysis revealed that prolonged fluoroscopy duration was related to specific characteristics, including higher BMI (BMI >27.5 kg/m) (+4.1 minutes; 95% CI, 2.56-5.63), mechanical lithotripsy (+4.85 minutes; 95% CI, 0.45-9.25), needle-knife use (+4.5 minutes; 95% CI, 2.15-6.86), and malignant biliary obstruction (+2.34 minutes; 95% CI, 0.15-4.53).ERCPs are associated with significantly higher radiation exposure of patients on the specific procedure. Endoscopists should be aware of the determining factors, including patients with obesity, who underwent mechanical lithotripsy, who had malignant biliary obstruction, and who underwent a procedure using a needle knife, that affect FT during ERCP.


Assuntos
Doenças dos Ductos Biliares/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatopatias/diagnóstico por imagem , Exposição à Radiação/análise , Centros Médicos Acadêmicos , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores Sexuais
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