[The role of endoscopy registries in quality health care. The first data from the Hungarian Endoscopic Retrograde Cholangiopancreatography (ERCP) Registry]. / Az endoszkópos regiszterek szerepe a minoségi betegellátásban. Az új magyar Endoszkópos Retrográd Cholangiopancreatographia (ERCP) Regiszter elso eredményei.

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.

[Cost-effectiveness trial of self-expandable metal stents and plastic biliary stents in malignant biliary obstruction]. / A fém- és muanyag stentek költséghatékonysága malignus epeúti szukületek esetében - összehasonlító vizsgálat.

INTRODUCTION: Self-expandable metal and plastic stents can be applied in the palliative endoscopic treatment of patients with unresectable malignant biliary obstruction. The use of metal stentsis recommended if the patient's life expectancy is more than four months. AIM: To compare the therapeutic efficacy and cost-effectiveness of metal and plastic stents in the treatment of malignant biliary obstruction. METHOD: The authors retrospectively enrolled patients who received metal (37 patients) or plastic stent (37 patients). The complication rate, stent patency and cumulative cost of treatment were assessed in the two groups. RESULTS: The complication rate of metal stents was lower (37.84% vs. 56.76%), but the stent patency was higher compared with plastic stents (19.11 vs. 8.29 weeks; p = 0.0041). In the plastic stent group the frequency of hospitalization of patients in context with stent complications (1.18 vs. 2.32; p = 0.05) and the necessity of reintervention for stent dysfunction (17 vs. 27; p = 0.033) were substantially higher. In this group multiple stent implantation raised the stent patency from 7.68 to 10.75 weeks. There was no difference in the total cost of treatment of malignant biliary obstruction between the two groups (p = 0.848). CONCLUSIONS: Considering the cost of treatment and the burden of patients the authors recommend self-expandable metal sten timplantation if the life expectancy of patients is more than two months. In short survival cases multiple plastic stent implantation is recommended.

[Prevention of acute pancreatitis following endoscopic retrograde cholangiopancreatography]. / Az endoszkópos retrográd cholangiopancreatographiát követo heveny hasnyálmirigy-gyulladás megelozése.

Over 14,000 endoscopic retrograde cholangiopancreatographies are performed in Hungary annually, and approximately 1400 patients are calculated to develop pancreatititis including 10 cases with fatal outcome. This article reviews the recent and relevant literature and presents a practical guide based on the authors' own experience for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. The authors emphasize the importance of careful consideration of indications, analysis of risk factors, avoiding unnecessary diagnostic intervention, a decrease of the attempts for cannulation, early precut, implantation of pancreatic stent in high risk patients, administration of rectal indomethacin or diclofenac, and adequate intravenous fluid replacement.