Endoscopic retrograde cholangio-pancreatography early Barbadian experience - abstract

ABSTRACT

Endoscopic retrograde cholangio-pancreatography (E.R.C.P.) was first introduced in Barbados in January, 1981 using an ACMI side-viewing instrument. In the intervening five months, forty-seven procedures were carried out. There were twenty-three men and twenty-four women with ages ranging from eleven to eighty-six years. The average age was fifty-five years with 68 percent of patients over fifty years. The indication for E.R.C.P. was suspected pancreatic disease in twenty-nine cases and biliary disease in eighteen. Successful cannulation of at least one duct was achieved in forty cases (87 percent). An unsuccessful cannulation occurred in six cases. No attempt at cannulation was made in one patient in whom an obvious carcinoma of the pancreas was visible. The correct duct was cannulated in thirty-eight of forty-six cases (82.6 percent). There were no complications noted. Real-time ultrasound was performed in twenty-two patients. In six of these, the ultra-sound did not suggest the diagnosis. Diagnosis was confirmed by surgery; liver biopsy or follow-up in all cases. E.R.C.P. predicted an incorrect diagnosis in one patient and an inconclusive diagnosis in another with chronic pancreatitis. E.R.C.P. was therefore specific in 96 percent of cases in which cannulation was successful. The poor specificity of ultrasound (72 percent) was likely due, at least in part, to the use of an outdated scanner designed mainly for obstetrical scanning. This illustrates that appropriate equipment must be used if satisfactory results are to be expected. The early experience with E.R.C.P. in Barbados suggests that it is a useful adjunct to ultrasound and transhepatic choliangiography in the investigation of biliary and pancreatic disease (AU)