Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 311
Filtrar
1.
Mymensingh Med J ; 28(2): 317-321, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086145

RESUMO

Endoscopic retrograde cholangiopancreatography (ERCP) is a modern & universally established modality in the evaluation and treatment of suspected biliary and pancreatic disease. In Bangladesh, ERCP services are limited to few tertiary care centers mostly in the capital & large city. ERCP was 1st introduced in Mymensingh on 3rd April 2016 in a private hospital. Since then, Mymensingh Medical College Hospital (MMCH) provides ERCP services to a large volume of patients in collaboration with private center for diagnostic accuracy & therapeutic purpose. The aim of this study was to evaluate our experience in ERCP, to characterize & evaluate the aetiology, findings of ERCP & frequency of complications. This prospective type of study was carried out by the department of hepatology, MMCH from 3rd April 2016 to 10th July 2018 in collaboration with that private center where ERCP has been established. All patients undergoing ERCP during this period were included. Aetiology & findings were assessed at the time of ERCP & complications were assessed during procedure, index hospitalization & within 30 days after the procedure by telephone contact. A total of 301 consecutive ERCP were performed during the study period. Among them, 182(60.5%) were male & 119(39.5%) were female with an age range of 18-78 years. The most common indications for ERCP were: cholangiocarcinoma in 98(32.56%) & choledocholithiasis in 95(31.56%) followed by periampullary growth in 93(30.89%), suspected CBD stricture in 12(4%) & chronic pancreatitis in 2(0.66%). The most common findings were choledocholithiasis (32.56%), cholangiocarcinoma (32.56%), biliary obstruction due to periampullary growth (30.56%). Biliary fistula with distal bile duct stricture was found in (1.66%), bile duct stricture in (1.33%), chronic pancreatitis in (0.66%), and organic papillary stenosis with deformed bulb were discovered in (0.34%) case. All ERCPs were done for therapeutic purpose. Endoscopic sphincterotomy was the most common therapeutic procedure (87.04%) of which biliary stenting was done in (67.44%) & stone extraction in (33.71%). Stone extraction from biliary tree was successfully done in 94 cases (98.67%) but it was unsuccessful from biliary tree in 4 cases (1.33%) & also from pancreatic duct in a separate case. The most frequent complication was Post-ERCP pancreatitis in 9 patients (2.99%) followed by acute confusional state (1.33%). Post-ERCP cholangitis occurred in (0.99%) & death was reported in 2 cases (0.66%) due to anaesthetic hazard.


Assuntos
Doenças Biliares , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Coledocolitíase , Esfinterotomia Endoscópica , Adolescente , Adulto , Idoso , Bangladesh , Doenças Biliares/diagnóstico , Doenças Biliares/cirurgia , Coledocolitíase/diagnóstico , Coledocolitíase/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
2.
Pancreatology ; 19(4): 524-530, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31036491

RESUMO

BACKGROUND/OBJECTIVES: Gallstones are the leading cause of acute pancreatitis in developed countries. National and international guidelines recommend that a cholecystectomy should be performed during the index hospitalization for acute gallstone pancreatitis. We aimed to delineate the national trends for same-admission cholecystectomy and ERCP for acute gallstone pancreatitis over the last ten years. METHODS: We used the 2004, 2009 and 2014 National Inpatient Sample database including patients with a principal diagnosis of acute pancreatitis and a secondary diagnosis of choledocholithiasis or cholelithiasis. Exclusion criteria were age <18 years and elective admission. Primary outcome was the trend in incidence rate of same admission cholecystectomy from 2004 to 2014. The secondary outcomes were: 10-year trend in 1) Incidence of gallstone pancreatitis, 2) proportion of gallstone pancreatitis compared to all other etiologies of acute pancreatitis, 3) incidence rate of same-admission ERCP, 4) length of hospital stay, and 5) total hospitalization costs and charges. RESULTS: The proportion of admissions during which a same-admission cholecystectomy was performed decreased from 48.7% in 2004 to 46.9% in 2009 to 45% in 2014 (trend p < 0.01). During the same time interval, the percentage of admissions during which an ERCP was performed decreased from 25.1% to 18.7% (Trend p < 0.01). CONCLUSIONS: Adherence to the guidelines for same-admission cholecystectomy for patients admitted with acute gallstone pancreatitis have been declining over the past decade. On the other hand, decline in rate of ERCP in patients with acute gallstone pancreatitis and no signs of cholangitis demonstrates adherence to guidelines in this regard.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/tendências , Colecistectomia/tendências , Cálculos Biliares/terapia , Pancreatite/terapia , Admissão do Paciente/estatística & dados numéricos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colecistectomia/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Cálculos Biliares/epidemiologia , Cálculos Biliares/etiologia , Fidelidade a Diretrizes , Custos Hospitalares , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia
3.
Indian Pediatr ; 56(3): 196-198, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30954989

RESUMO

OBJECTIVE: To evaluate spectrum, efficacy and safety of Endoscopic retrograde cholangiopancreatography (ERCP) in pediatric population. METHODS: Retrospective case record review of pediatric patients (age ≤15 y) undergoing ERCP between January 2011 to June 2015 at a tertiary care referral hospital in New Delhi, India. The Indications for ERCP, cannulation success rate, procedure success rate and complications were recorded. RESULTS: The mean (SD) age of the participants were 11.5 (3) years. 164 ERCP procedures were done in 126 patients (67 males). All procedures were done under conscious sedation. The common indications for ERCP were choledocholithiasis (50, 30.5%), chronic calcific pancreatitis (38,23.2%), main pancreatic duct injury with leak (21,12.8%), and bile leak (12,7.3%). The cannulation success rate was 90.4% (114 out of 126), while procedural success rate was 86% (141 out of 164). Overall 8 complications were encountered; all were successfully managed conservatively. CONCLUSIONS: ERCP in children can be successfully performed at centers with such expertise.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Adolescente , Criança , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/cirurgia , Estudos Retrospectivos
4.
Eur J Gastroenterol Hepatol ; 31(4): 463-470, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30830881

RESUMO

BACKGROUND: The increasing complexity involved in procedures requiring fluoroscopy such as endoscopic retrograde cholangiopancreatography (ERCP) results in heightened screening times with attendant radiation exposure during these procedures. There is increasing awareness of tissue-reactions to the lens of the eye due to radiation exposure, with evidence suggesting that threshold doses may be lower than previously considered. MATERIALS AND METHODS: A literature search was performed to identify studies involving ERCP in which radiation exposure was reported. Demographic data and data on fluoroscopy time and ocular exposure were extracted. Fixed and random-effects meta-analyses were conducted. RESULTS: Twenty-six studies (8016 procedures) were identified, of which 10 studies (818 procedures) contained data on ocular exposure. The mean screening time per procedure was 3.9 min with a mean of three images captured per procedure. On fixed effects meta-analysis, the point estimate for the effective ocular exposure dose per procedure was 0.018 (95% confidence interval: 0.017-0.019) mSv. On random-effects meta-analysis, the effective ocular exposure dose was 0.139 (0.118-0.160) mSv (Q=2590.78, I=99.5, P<0.001). On comparing these point estimates to the ocular dose limit of 20 mSv/year, 1111 ERCPs (using fixed effects data) and 144 ERCPs (using random-effects data), with a mean of 627 ERCPs/individual/year, could deliver an ocular radiation dose equivalent to this dose limit. CONCLUSION: Ocular radiation exposures in high-volume ERCP operators (>200 procedures/year) and operators performing complex ERCPs involving prolonged fluoroscopy, need to exercise caution in relation to ocular exposure. Shielding using lead-lined glasses may be reasonable in this group.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Olho/efeitos da radiação , Fluoroscopia/efeitos adversos , Exposição Ocupacional/análise , Exposição à Radiação/análise , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Humanos , Exposição Ocupacional/estatística & dados numéricos , Doses de Radiação , Exposição à Radiação/estatística & dados numéricos , Radiologistas/estatística & dados numéricos
5.
World J Gastroenterol ; 25(8): 1002-1011, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30833805

RESUMO

BACKGROUND: A clinical pathway (CP) is a standardized approach for disease management. However, big data-based evidence is rarely involved in CP for related common bile duct (CBD) stones, let alone outcome comparisons before and after CP implementation. AIM: To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS: This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017. The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care (non-pathway group, n = 467) and CP care (pathway group, n = 2196). RESULTS: At baseline, the main differences observed between the two groups were the percentage of patients with multiple stones (P < 0.001) and incidence of cholangitis complication (P < 0.05). The percentage of antibiotic use and complications in the CP group were significantly less than those in the non-pathway group [adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI): 0.55-0.93, P = 0.012, adjusted OR = 0.44, 95%CI: 0.33-0.59, P < 0.001, respectively]. Patients spent lower costs on hospitalization, operation, nursing, medication, and medical consumable materials (P < 0.001 for all), and even experienced shorter length of hospital stay (LOHS) (P < 0.001) after the CP implementation. No significant differences in clinical outcomes, readmission rate, or secondary surgery rate were presented between the patients in the non-pathway and CP groups. CONCLUSION: Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS, hospital costs, antibiotic use, and complication rate.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Coledocolitíase/cirurgia , Procedimentos Clínicos/estatística & dados numéricos , Análise de Dados , Complicações Pós-Operatórias/epidemiologia , Idoso , Big Data , Colangiopancreatografia Retrógrada Endoscópica/economia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocolitíase/economia , Ducto Colédoco/cirurgia , Procedimentos Clínicos/economia , Feminino , Gastos em Saúde/estatística & dados numéricos , Preços Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Resultado do Tratamento
6.
Dig Liver Dis ; 51(7): 978-984, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30718203

RESUMO

BACKGROUND: Prospective studies about endoscopic retrograde cholangio-pancreatography (ERCP) in a community setting are rare. AIM: To assess success and complication rates of routinely-performed ERCP in a regional setting, and the priority quality indicators for ERCP practice. METHODS: Prospective region wide observational study on consecutive patients undergoing ERCP during a 6-month period. A centralized online ERCP questionnaire was built and used for data storage. Primary quality indicators provided by the American Society of Gastrointestinal Endoscopy (ASGE) were considered. RESULTS: 38 endoscopists from 18 centers performed a total of 2388 ERCP. The most common indication for ERCP was choledocholitiasis (54.8%) followed by malignant jaundice (22.6%). Cannulation of the desired duct was obtained in 2293 cases (96%) and ERCP was successful in 2176 cases (91.1%). Success and ERCP difficulty were significantly related to the experience of the operator (p = 0.001 and p < 0.001, respectively). ERCP difficulty was also significantly related to volume centers (p < 0.01). The overall complication rate was 8.4%: post-ERCP pancreatitis (PEP) occurred in 4.1% of procedures, bleeding in 2.9%, infection in 0.8%, perforation in 0.4%. Mortality rate was 0.4%. All the ASGE priority quality indicators for ERCP were confirmed. CONCLUSIONS: The procedural questionnaire proved to be an important tool to assess and verify the quality of routinely-performed ERCP performance in a community setting.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Hemorragia/epidemiologia , Pancreatite/epidemiologia , Indicadores de Qualidade em Assistência à Saúde , Cateterismo/estatística & dados numéricos , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Bases de Dados Factuais , Hemorragia/etiologia , Humanos , Itália/epidemiologia , Icterícia/diagnóstico por imagem , Modelos Logísticos , Pancreatite/etiologia , Estudos Prospectivos , Inquéritos e Questionários
7.
Cir Cir ; 87(2): 146-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768067

RESUMO

Background: Cholecystectomy is one of the most performed procedures worldwide. Many surgeons defend the use of routine intraoperative cholangiography (IOC), but this action is getting less practiced because other preoperative tools that can omit IOC. Objective: Evaluate the utility of performing intraoperative cholangiography in patients whom got a preoperative imaging or endoscopy study. We analized the association between the diagnostic-therapeutic approach and hospital readmissions because of bile duct obstruction. Method: Retrospective and comparative study of 117 patients admitted with choledocholithiasis and submitted to cholecystectomy between January 2014 and December 2016. The statistical analysis was performed comparing groups using chi squared test with a statistical significance of p < 0.05. Results: Patients whom got a preoperative study and had performed an intraoperative cholangiography didn't readmitted. The study reported nine readmissions, being residual gallbladder stone the diagnostic. Patients whom didn't get an intraoperative cholangiography reported the most readmissions. The studied group who registered the most readmissions was the one who didn't get performed an intraoperative cholangiography nor a preoperative study. No mortality was reported. Conclusion: Patients who had IOC performed reported less readmissions for residual stone.


Assuntos
Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiografia/métodos , Colangiografia/estatística & dados numéricos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colestase/epidemiologia , Feminino , Humanos , Cuidados Intraoperatórios , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
8.
Am J Surg ; 217(6): 1006-1009, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30654919

RESUMO

BACKGROUND: Choledocholithiasis is present in up to 15% of cholecystectomy patients. Treatment can be surgical, endoscopic, or via interventional radiology. We hypothesized significant heterogeneity between hospitals exists in the approach to suspected common duct stones. METHODS: A retrospective review of patients that had a preoperative MRCP, endoscopic ultrasound, endoscopic retrograde cholangiopancreatogram (ERCP), or intra-operative cholangiogram was performed. Comparisons were by Wilcoxon-Mann-Whitney tests with significance of p < 0.05 for paired variables and p < 0.017 for multiple comparisons. RESULTS: Twelve participating institutions identified 1263 patients (409 men and 854 women) with a median age of 49 years (IQR: 31-94). Liver function tests (LFT's) were elevated in 939 patients (75%), median bilirubin level 1.75 mg/dl (IQ: 0.8-3.7 mg/dl) and median common duct size 7 mm (IQR 5-10 mm). The most common initial procedure was cholecystectomy with IOC at seven institutions, endoscopy at four and MRCP at one. CONCLUSION: Significant variation exists within the surgical community regarding suspected common duct stones. These results underscore the need for a protocol for common duct stones to minimize multiple, redundant interventions.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colangiopancreatografia por Ressonância Magnética/estatística & dados numéricos , Colecistectomia/estatística & dados numéricos , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Endossonografia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sudoeste dos Estados Unidos
10.
Gastrointest Endosc ; 89(6): 1169-1177.e10, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30503844

RESUMO

BACKGROUND AND AIMS: Acute biliary pancreatitis (ABP) is associated with increased rates of morbidity in pregnancy. Because there is a paucity of population-based studies evaluating ABP in pregnancy, we sought to investigate clinical outcomes in hospitalized pregnant women on a national level. METHODS: By using the Nationwide Readmission Database (2011-2014), we identified all women (age ≥18 years) with an index admission for ABP in the United States. Multivariate and propensity-score matched analyses were performed to evaluate the impact of pregnancy on the clinical outcomes of early readmission and severe acute pancreatitis (SAP) in ABP. RESULTS: There were 7787 hospitalizations for ABP in pregnant women during the study period. The rate of 30-day readmission was 16.26%; 57% of these early readmissions were due to adverse events of ABP. Compared with nonpregnant women with ABP, ERCP (21.1% vs 25.2%; P < .001) and cholecystectomy (52.8% vs 55.2%; P = .02) were performed less frequently during pregnancy. Propensity-score matched analysis revealed an increased risk of 30-day readmissions in pregnancy (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.67-2.30), whereas there was no difference in the risk of SAP (OR, 1.09; 95% CI, 0.76-1.57). Multivariate analysis demonstrated that weekend admission (OR, 1.40; 95% CI, 1.10-1.79) and >1 week of hospitalization (OR, 1.75; 95% CI, 1.24-2.48) increased the risk of 30-day readmission, whereas ERCP (OR, 0.40; 95% CI, 0.27-0.57) and cholecystectomy (OR, 0.13; 95% CI, 0.10-0.18) reduced the odds of early readmission in pregnancy. CONCLUSIONS: Pregnant women with ABP less frequently undergo timely endoscopic biliary decompression and cholecystectomy. These modifiable factors can potentially lower early readmissions in pregnant women.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colecistectomia/estatística & dados numéricos , Cálculos Biliares/cirurgia , Pancreatite/cirurgia , Complicações na Gravidez/cirurgia , Adulto , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Cálculos Biliares/complicações , Humanos , Mortalidade Materna , Pessoa de Meia-Idade , Mortalidade , Pancreatite/etiologia , Readmissão do Paciente , Gravidez , Complicações na Gravidez/etiologia , Resultado da Gravidez/epidemiologia , Índice de Gravidade de Doença
11.
Rom J Intern Med ; 57(2): 151-158, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30517080

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography has evolved significantly in recent years. The increase in complexity and range of applications has not been adequately reflected in an improvement of training methods for ERCP, with many endoscopists failing to meet required performance standards during their training period and limited available data on their performance immediately after completing training. We aimed to analyze the performance of an independent operator from a developing country after the completion of formal training with regard to procedure and patient-related outcomes. METHODS: We conducted an observational study of ERCPs performed by a young endoscopist from a referral center. Data about the procedure, cannulation technique (including use of precut), trainee involvement and procedure-related outcomes was retrieved and analyzed from a prospectively maintained database on quality in ERCP (the QUASIE initiative). RESULTS: Data from 679 consecutive ERCPs conducted or supervised by one endoscopist with < 200 independent procedures prior to the study period were included in the final analysis. Cannulation rates significantly improved over time, from 90% to 96% (p = 0.016). Use of precut techniques changed significantly over time, with an initial increase followed by a subsequent decrease as overall cannulation rates improved. Trainee involvement was significantly associated with prolonged cannulation times (p = 0.003) and use of precut (p = 0.001), but did not impact on technical success or patient safety. CONCLUSIONS: Independent practice of ERCP after the training period is characterized by ongoing changes in technique, especially with regard to cannulation and use of precut, showing significant improvements in performance over time.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Idoso , Doenças dos Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/normas , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Educação , Feminino , Humanos , Curva de Aprendizado , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento
12.
Saudi J Gastroenterol ; 25(2): 132-138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30381495

RESUMO

Background/Aims: The aim of this study is to predict cases where the clearance of the biliary system from stones at the initial endoscopic retrograde cholangiopancreatography (ERCP) might be of value for better risk-stratifying patients. We attempted to identify factors that are associated with a higher failure rate of clearing the biliary system on the index ERCP. Patients and Methods: This is a retrospective study from January 2008 to January 2015. All patients with bile duct stones confirmed on ERCP were included in this study. Patients who had prior attempts of bile duct stone extraction were excluded. Results: A total of 554 ERCPs were performed to extract biliary duct stones from 426 patients. The mean age was 46.3 years and 41.7% were males. The group where the index ERCP did not clear the biliary system tended to be older (50.4 vs. 45.2 years, P = 0.03). On multivariate analysis, the presence of fever (OR 4.64; 95% CI, 1.66-12.79), a larger number of filling defects (OR 1.34; 95% CI, 1.13-1.93), presence of a stricture distal to a stone (OR 4.63; 95% CI, 1.36-15.78), the use of an extraction basket (OR 3.23; 95% CI, 1.56-6.74), and/or mechanical lithotripsy (OR 3.05; 95% CI, 1.10-8.49) were all associated with a lower odds of clearing the biliary system. The use of an extraction balloon was associated with the success of clearing the biliary system (99.7% vs. 77.4%, P < 0.01) and a lower odds of failing (OR 0.01; 95% CI, 0.00-0.08) on multivariate analysis. Conclusion: A few of the characteristics that are found on cholangiography at the index ERCP could be used to identify patients that might require more than one ERCP to clear the biliary system from stones.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/normas , Ducto Colédoco/diagnóstico por imagem , Cálculos Biliares/diagnóstico por imagem , Adulto , Idoso , Procedimentos Cirúrgicos do Sistema Biliar/estatística & dados numéricos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Ducto Colédoco/patologia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/patologia , Feminino , Cálculos Biliares/terapia , Humanos , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Falha de Tratamento , Resultado do Tratamento
13.
Surg Laparosc Endosc Percutan Tech ; 29(2): 113-116, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30520814

RESUMO

BACKGROUND: The incidence of common bile duct (CBD) stones is between 10% to 18% in people undergoing cholecystectomy for gallstones. Laparoscopic exploration of the CBD is now becoming routine practice in the elective setting, however its safety and efficacy in emergencies is poorly understood. METHODS: We analyzed our results for index emergency admission laparoscopic cholecystectomy within a specialist center in the United Kingdom. Data from all emergency cholecystectomies in our unit, between 2011 to 2016 were collected and analyzed retrospectively. RESULTS: In total, 494 patients underwent emergency laparoscopic cholecystectomy; 53 (10.7%) patients underwent common bile duct exploration (CBDE), with 1 conversion and 1 bile leak. Indications for CBDE were based on preoperative imaging (41 cases, 81%) or intra-operative cholangiogram (44 cases, 83%) findings. CONCLUSIONS: Index admission laparoscopic cholecystectomy and concomitant CBDE is safe and should be the gold standard treatment for patients presenting with acute biliary complications, reducing readmissions and the need for a 2-stage procedure.


Assuntos
Colecistectomia Laparoscópica/métodos , Ducto Colédoco/cirurgia , Cálculos Biliares/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colecistite Aguda/etiologia , Cólica/etiologia , Tratamento de Emergência , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Centros Cirúrgicos/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
14.
Obes Surg ; 29(2): 451-456, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30302653

RESUMO

BACKGROUND: Endoscopic ultrasound-directed transgastric ERCP (EDGE) by creating an anastomosis from the gastric pouch or jejunum to the excluded stomach allows performance of ERCP in Roux-en-Y gastric bypass (RYGB) anatomy. Concern for persistent fistula following stent removal and sparse data limit adoption. METHODS: Retrospective review of consecutive patients undergoing EDGE over a 2-year period. RESULTS: Nineteen RYGB patients underwent EDGE; three had previously failed ERCP by the device-assisted method. Indications for ERCP were choledocholithiasis (8), recurrent acute pancreatitis (6), benign post-surgical stricture (3), elevated bilirubin, and papillary stenosis (1 each). EDGE was technically successful in all 19 patients with jejunogastric anastomosis in 11 patients and gastrogastric in 8 using a 15-mm lumen-apposing metal stent. Stent malposition occurred in six and was managed by rescue maneuvers. ERCP was performed in the same session in four patients; the remainder were delayed after a mean of 48 days. Diagnostic endoscopic ultrasound (EUS) was performed in four patients. No severe adverse events occurred; clinical success was 100%. Stents were removed after a mean dwell time of 182 days. Argon plasma coagulation (APC) was used to promote fistula closure in 12 patients. Upper GI series to assess fistula closure was obtained in 11 patients after a mean of 182 days following stent removal. One persistent fistula was identified and closed endoscopically. CONCLUSIONS: EDGE is an effective modality for performing ERCP in patients with RYGB anatomy and can be performed via gastrogastric or jejunogastric approaches. Persistent fistula is uncommon and can be managed endoscopically. APC may promote fistula closure.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Derivação Gástrica , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Coledocolitíase/cirurgia , Humanos , Obesidade/cirurgia , Pancreatite/cirurgia , Reoperação , Estudos Retrospectivos , Ultrassonografia de Intervenção
15.
Dig Liver Dis ; 51(1): 75-78, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30366810

RESUMO

BACKGROUND AND AIMS: The guidelines by the American Society for Gastrointestinal Endoscopy (ASGE) suggest that in patients with gallbladder in situ, endoscopic retrograde cholangiopancreatography (ERCP) should be performed in the presence of high-risk criteria for choledocholithiasis, after biochemical tests and abdominal ultrasound. There are no specific recommendations for cholecystectomized patients. The aim of this study was to evaluate the applicability of ASGE criteria for ERCP in cholecystectomized patients with suspected choledocholithiasis. METHODS: We conducted a retrospective study that included patients with high-risk ASGE criteria for choledocholithiasis who underwent ERCP from 2013-2016. RESULTS: We included 327 patients in our analysis - 258 with gallbladder in situ (79%) and 69 with cholecystectomy (21%). We showed that the ASGE criteria true positive rate was similar between patients with and without cholecystectomy - the prevalence of choledocholithiasis on ERCP was 71% in cholecystectomized and 70% in non-cholecystectomized. In addition, both the presence and the diameter of the CBD stone were predictors of positive ERCP in both groups. In contrast, the diameter of the CBD was predictor of positive ERCP only in non-cholecystectomized patients. CONCLUSIONS: Although dilatation of the CBD was not a predictive factor for choledocholithiasis in cholecystectomized patients, the ASGE criteria true positive rate was similar to that of non-cholecystectomized patients.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colecistectomia/estatística & dados numéricos , Coledocolitíase/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colangiopancreatografia Retrógrada Endoscópica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco
16.
Turk J Gastroenterol ; 30(2): 192-197, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30459128

RESUMO

BACKGROUND/AIMS: To investigate the safety and long-term results of endoscopic retrograde cholangiopancreatography (ERCP) in children with a literature review. MATERIALS AND METHODS: All patients within the age range of 6-17 years who underwent ERCP between 1994 and 2014 at our institution were retrospectively evaluated. RESULT: Twenty-four patients with a median age of 15 years underwent ERCP. Cannulation of the papilla was achieved in all patients (100%) without the use of needle-knife papillotomy. Before 1999, ERCP was used as a diagnostic method only in 7 patients (29%). In 17 (71%) patients, the procedure was used for therapeutic purposes. The indications were choledocholithiasis (10 cases, 42%), postoperative complications (5 patients, 21%), and recurrent pancreatitis (2 cases, 8%). In 2 patients (8%), the therapeutic effect was not achieved, thus requiring subsequent operations. There were no major complications. Mild pancreatitis occurred in only 1 patient (4%). Long-term follow-up information was obtained in 16 (67%) patients (median, 18 years; range, 3.5-22.5 years), and no long-term complications were detected. CONCLUSION: Endoscopic retrograde cholangiopancreatography is a valuable tool in the diagnosis and treatment of pancreatobiliary disorders in the pediatric population. Large-scale studies are required to create evidence-based guidelines specific to children.


Assuntos
Doenças Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Pancreatopatias/cirurgia , Adolescente , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
17.
Sao Paulo Med J ; 137(6): 491-497, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32159634

RESUMO

BACKGROUND: Obstructive jaundice may lead to ominous complications and requires complex diagnostic evaluations and therapies that are not widely available. OBJECTIVE: To analyze the epidemiological profile, referral routes and diagnostic accuracy at admittance of cases of acute cholangitis among patients with obstructive jaundice treated at a referral unit. DESIGN AND SETTING: Cross-sectional study at a tertiary-level university hospital. METHODS: Patients with obstructive jaundice who were treated by means of endoscopic retrograde cholangiopancreatography, resection and/or surgical biliary drainage were evaluated. The main variables analyzed were epidemiological data, referral route, bilirubin levels and time elapsed between symptom onset and admittance and diagnosing of acute cholangitis at the referral unit. The accuracy of the clinical diagnosis of acute cholangitis was compared with a retrospective analysis on the medical records in accordance with the Tokyo criteria. RESULTS: Female patients predominated (58%), with an average age of 56 years. Acute cholangitis was detected in 9.9% of the individuals; application of the Tokyo criteria showed that the real prevalence was approximately 43%. The main referral route was direct contact (31.8%) and emergency care (29.7%); routing via official referral through the public healthcare system accounted for 17.6%, and internal referral from other specialties, 20%. The direct route with unofficial referral was the most important route for cases of neoplastic etiology (P < 0.01) and was the fastest route (P < 0.01). CONCLUSIONS: There is a deficiency in the official referral routes for patients with obstructive jaundice. The accuracy of the clinical diagnosis of acute cholangitis was poor. Wider dissemination of the Tokyo criteria is essential.


Assuntos
Colangite/diagnóstico , Hospitais Universitários , Icterícia Obstrutiva/diagnóstico , Centros de Atenção Terciária , Doença Aguda , Adulto , Idoso , Bilirrubina/análise , Brasil/epidemiologia , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colangite/epidemiologia , Colangite/cirurgia , Estudos Transversais , Confiabilidade dos Dados , Drenagem , Feminino , Humanos , Icterícia Obstrutiva/epidemiologia , Icterícia Obstrutiva/cirurgia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Admissão do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Sensibilidade e Especificidade , Tempo para o Tratamento
18.
Orv Hetil ; 159(37): 1506-1515, 2018 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-30196719

RESUMO

INTRODUCTION: The continuous monitoring of quality indicators in gastrointestinal endoscopy has become an essential requirement nowadays. Most of these data cannot be extracted from the currently used free text reports, therefore a structured web-based data-collecting system was developed to record the indicators of pancreatobiliary endoscopy. AIM: A structured data-collecting system, the ERCP Registry, was initiated to monitor endoscopic retrograde cholangiopancreatography (ERCP) examinations prospectively, and to verify its usability. METHOD: From January 2017, all ERCPs performed at the First Department of Medicine, University of Pécs, have been registered in the database. In the first year, the detailed data of 595 examinations were entered into the registry. After processing these data, the testing period of the registry is now finished. RESULTS: On 447 patients, 595 ERCPs were performed. The success rate of cannulation is 93.8% if all cases are considered. Difficult biliary access was noted in 32.1% of patients with native papilla, and successful cannulation was achieved in 81.0% of these cases during the first procedure. Post-ERCP pancreatitis was observed in 13 cases (2.2%), clinically significant post-papillotomy bleeding was registered in 2 cases (0.3%), while 27 patients (4.5%) developed temporary hypoxia during the procedure. 30-day follow-up was successful in 75.5% of the cases to detect late complications. All of the quality indicators determined by the American Society of Gastrointestinal Endoscopy (ASGE) were possible to monitor with the help of the registry. Our center already complies with most of these criteria. CONCLUSIONS: Continuous monitoring of the quality indicators of endoscopic interventions are not supported by the current hospital information system but it became possible with our registry. The ERCP Registry is a suitable tool to detect the quality of patient care and also useful for clinical research. Several endoscopy units have joined already this initiative and it is open for further centres through our web page ( https://tm-centre.org/hu/regiszterek/ercp-regiszter/ ). Orv Hetil. 2018; 159(37): 1506-1515.


Assuntos
Doenças Biliares/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Sistema de Registros , Esfinterotomia Endoscópica/estatística & dados numéricos , Feminino , Humanos , Hungria , Masculino , Qualidade da Assistência à Saúde
19.
J Surg Res ; 230: 40-46, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30100038

RESUMO

BACKGROUND: The purpose of this study is to describe a cohort of pediatric patients undergoing cholecystectomy for biliary dyskinesia (BD) and characterize postoperative resource utilization. METHODS: Single-institution, retrospective chart review of pediatric patients after cholecystectomy for BD was done. Patient demographics and clinical characteristics as well as operative details and postoperative interventions were abstracted. Telephone follow-up was performed to identify persistent symptoms, characterize the patient experience, and quantify postoperative resource utilization. RESULTS: Forty-nine patients were included. Twenty-two patients (45%) were seen postoperatively by a gastroenterologist, of which, only 32% were known to the gastroenterologist before surgery. Postoperative studies included 13 abdominal ultrasounds for persistent pain, 13 esophagogastroduodenoscopies, five endoscopic retrograde cholangiopancreatographies (ERCPs), one endoscopic ultrasound, one magnetic resonance cholangiopancreaticogram, and five colonoscopies. Of the patients with additional diagnostic testing postoperatively, one had mild esophagitis, three had sphincter of Oddi dysfunction, and one was suspected to have inflammatory bowel disease. Telephone survey response rate was 47%. Among respondents, 65.2% reported ongoing abdominal pain, nausea, or vomiting at an average of 26 mo after operation. Of note, all patients who underwent postoperative ERCP with sphincterotomy reported symptom relief following this procedure. CONCLUSIONS: Relief of symptoms postoperatively in pediatric patients with BD is inconsistent. Postoperative studies, though numerous, are of low diagnostic yield and generate high costs. These findings suggest that the initial diagnostic criteria and treatment algorithm may require revision to better predict symptom improvement after surgery. Improvement seen after ERCP/sphincterotomy is anecdotal but appears to merit further investigation.


Assuntos
Discinesia Biliar/cirurgia , Colecistectomia/efeitos adversos , Dor Pós-Operatória/diagnóstico por imagem , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Adolescente , Discinesia Biliar/diagnóstico por imagem , Discinesia Biliar/economia , Colangiopancreatografia Retrógrada Endoscópica/economia , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colecistectomia/economia , Colecistectomia/métodos , Colecistectomia/normas , Procedimentos Clínicos/normas , Endoscopia do Sistema Digestório/estatística & dados numéricos , Endossonografia/estatística & dados numéricos , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Masculino , Dor Pós-Operatória/economia , Dor Pós-Operatória/cirurgia , Utilização de Procedimentos e Técnicas/economia , Estudos Retrospectivos , Esfincterotomia/estatística & dados numéricos , Resultado do Tratamento
20.
Z Gastroenterol ; 56(10): 1227-1236, 2018 10.
Artigo em Alemão | MEDLINE | ID: mdl-30107618

RESUMO

The quality assurance program "Benchmarking ERCP", that his been under the patronage of the ÖGGH for ten years (with a one-year break in 2008), in collaboration with the Institute for Applied Statistics University Linz, has followed patient safety measures and successes while undergoing ERCP in Austria. A total of 28 319 examinations were registered. The participating centers all had different ERCP frequency and variable expertise, thereby enabling them to recognise individual problems in terms of success, cannulation and complication rates (3.9 % post-ERCP pancreatitis, 3.8 % bleeding, 0.6 % perforation, 1.2 % cholangitis, 1.0 % cardiopulmonary complications). The aim of quality assurance measures in medicine is to ensure the best possible patient care.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colangite , Pancreatite , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Áustria , Benchmarking , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colangite/etiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA