BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of H...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)is a cornerstone procedure for the diagnosis and management of pancreatic and hepatobiliary diseases.Although its diagnostic role has been increasingly supplanted by...Endoscopic retrograde cholangiopancreatography(ERCP)is a cornerstone procedure for the diagnosis and management of pancreatic and hepatobiliary diseases.Although its diagnostic role has been increasingly supplanted by nonin-vasive imaging modalities such as magnetic resonance imaging(MRI)and mag-netic resonance cholangiopancreatography,the therapeutic applications of ERCP have continued to expand.ERCP is widely used and has a generally favorable safety profile.However,it is important to recognize expected post-procedural imaging findings and serious complications that can arise.The increasing comple-xity of therapeutic interventions and the growing volume of procedures have led to a higher incidence of complications that often present with overlapping clinical and laboratory features,underscoring the critical role of imaging in differential diagnosis.This review focused on the typical normal ERCP findings and the imaging characteristics of common complications,including pancreatitis,bleeding,ERCP-related infections,perforations,and stent-related complications.Computed tomography(CT)is particularly valuable in timely recognition,management,and surgical decision-making for these complications.Furthermore,MRI offers a radiation-free alternative for managing complications in selected patients.Therefore,radiological modalities,particularly CT and MRI,are critical tools for the rapid diagnosis,management,and surgical decision-making processes for post-ERCP complications.展开更多
BACKGROUND Periampullary diverticulum(PAD)is a common anatomical variant,but its association with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)remains controversial.While PAD may alter amp...BACKGROUND Periampullary diverticulum(PAD)is a common anatomical variant,but its association with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)remains controversial.While PAD may alter ampullary anatomy,increasing technical difficulty during ERCP,existing studies report inconsistent findings on its role in PEP pathogenesis.We hypothesize that PAD presence,particularly type B,shows a significant association with PEP development and may interact with procedural factors like pancreatic duct guidewire insertion.AIM To examine the association between PAD(including subtypes A/B)and PEP incidence after ERCP for choledocholithiasis.METHODS We conducted a retrospective cohort study of 615 patients undergoing ERCP at two tertiary hospitals from 2023 to 2025.Participants were stratified into PAD(n=183;subtype A=125,subtype B=58)and non-PAD(n=432)groups.The primary outcome was PEP incidence.Multivariable logistic regression adjusted for age,sex,hypertension,diabetes,gallbladder surgery,and guidewire insertion.Statistical significance was set at P<0.05(two-tailed).RESULTS PAD prevalence was 29.8%(183/615).PEP occurrence was more frequent in PAD patients[15.3%(28/183)]than in non-PAD patients[4.2%(18/432)],odds ratio(OR)=3.86,95%confidence interval:2.03-7.35,P<0.001.Type B PAD showed a stronger association with PEP than type A(OR=14.16,95%confidence interval:5.84-34.34,P<0.001).Guidewire pancreatic duct entry was linked to higher PEP odds in PAD patients(adjusted OR=5.02,P<0.05).Hypertension also demonstrated an association with PEP in the PAD subgroup(P=0.012).CONCLUSION PAD,particularly type B,is independently associated with PEP after ERCP.Patients with these features,especially those with hypertension or pancreatic duct instrumentation,may benefit from enhanced monitoring and prophylaxis.展开更多
BACKGROUND Despite advancements,endoscopic retrograde cholangiopancreatography(ERCP)poses challenges,including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.AIM To compare dome and tapered t...BACKGROUND Despite advancements,endoscopic retrograde cholangiopancreatography(ERCP)poses challenges,including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.AIM To compare dome and tapered tip sphincterotomes,focusing on their efficacy in achieving successful biliary cannulation and reducing the incidence of post-ERCP pancreatitis.METHODS In this prospective,single-blind,randomized pilot study conducted at Inha Uni-versity Hospital,85 patients undergoing ERCP were equally divided into dome and tapered tip sphincterotome groups.The co-primary outcomes were the success rate of selective biliary cannulation and incidence of post-ERCP pancre-atitis.The secondary outcomes included biliary cannulation time,number of unintended pancreatic duct access events,and total procedure time.RESULTS The success rates of selective biliary cannulation were 74.4%and 85.7%in the dome and tapered tip groups,respectively,with no significant difference(P=0.20).Similarly,the incidence of post-ERCP pancreatitis did not differ significantly between the groups(5 cases in the tapered tip group vs 6 in the dome tip group,P=0.72).However,difficult cannulation was significantly more common in the dome tip group than in the tapered tip group(P=0.05).Selective biliary cannula-tion time emerged as a significant predictor of post-ERCP pancreatitis(multivariate odds ratio=9.33,95%confi-dence interval:1.31-66.44,P=0.03).CONCLUSION This study indicated that the sphincterotome tip type does not markedly affect biliary cannulation success or post-ERCP pancreatitis rates.However,cannulation duration is a key risk factor for post-ERCP pancreatitis.These findings provide preliminary insights that highlight the importance of refining ERCP practices,including sphinc-terotome selection,while underscoring the need for larger multicenter studies to improve procedure time and patient safety.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-ter...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-term ERCP outcomes,particularly using established quality benchmarks.AIM To evaluate ERCP indications,success rates,complications,and quality performance at a high-volume tertiary care center in Pakistan over a 17-year period.METHODS This retrospective study analyzed 13215 ERCP procedures performed between 2006 and 2023.Data included demographics,indications,cannulation rates,complications,and pediatric cases.Findings were assessed against American Society of Gastroenterology/European Society of Gastrointestinal Endoscopy quality indicators.RESULTS Biliary ERCP accounted for 93.1%of procedures;choledocholithiasis was the most common indication(40%).Cannulation success was 93.9%for biliary and 94.2%for pancreatic ERCP.Pediatric ERCP comprised 4%of cases,mostly for stones and chronic pancreatitis.Bleeding(1.7%)and post-ERCP pancreatitis(2.3%)were the most frequent complications.Performance met or exceeded most American Society of Benchmarks.CONCLUSION This study offers insight into nearly two decades of ERCP practice within a public sector hospital.Our experience echoes the quality and efficiency of ERCP not previously available in Pakistan.As healthcare systems in resourcelimited sectors expand,our findings serve as a reference point.Continued training and quality improvement studies can further enhance ERCP effectiveness in the region and beyond.展开更多
This letter aims to discuss the article,published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2025.Endoscopic retrograde cholangiopan-creatography(ERCP)is widely acknowledged as an effective...This letter aims to discuss the article,published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2025.Endoscopic retrograde cholangiopan-creatography(ERCP)is widely acknowledged as an effective procedure for managing biliary obstruction.However,its use in very elderly patients,partic-ularly centenarians,presents unique challenges related to both safety and efficacy.In this report,we share our experience with three centenarian patients who underwent ERCP for biliary obstruction in our unit.Remarkably,all patients had favorable outcomes,and no significant adverse events were observed.展开更多
BACKGROUND Data suggest that elderly patients may have a lower risk of complications after endoscopic retrograde cholangiopancreatography(ERCP),especially post-ERCP pancreatitis(PEP).AIM To validate these findings in ...BACKGROUND Data suggest that elderly patients may have a lower risk of complications after endoscopic retrograde cholangiopancreatography(ERCP),especially post-ERCP pancreatitis(PEP).AIM To validate these findings in a large,real-world clinical setting.METHODS Clinical,epidemiological,and procedural data collected from a prospectively maintained database were gathered over a 20-year period(2001-2021)from consecutive patients undergoing their first ERCP.Patients were grouped based on age:<80 years and≥80 years.RESULTS A total of 3147 patients were included in the study,with 70.3%<80 years old and 28.7%≥80 years.The most common indication for ERCP was biliary colic with or without elevated liver enzymes(39.6%).Periampullary diverticula were more frequently observed in elderly patients(P<0.001).Successful cannulation of the common bile duct was achieved in 96.1%of cases and did not differ significantly between age groups(P=0.148).Complete common bile duct clearance during the first ERCP was accomplished in 90.1%,and stone size was the only independent predictor of success.Use of antiplatelet or anticoagulant therapy was independently associated with intraprocedural bleeding(odds ratio[OR]=1.333;P=0.03 and OR=1.275;P=0.041,respectively).Overall,post-ERCP complications occurred in 6%of cases,with similar rates between elderly and younger patients.The most common complication was PEP.The incidences of clinical bleeding and PEP did not differ significantly between groups(P=0.290 and P=0.128,respectively).Clinical bleeding was independently associated with anticoagulant use and intraprocedural bleeding.CONCLUSION Our findings highlight that elderly patients do not experience higher complication rates or lower success rates with ERCP,supporting the procedure’s safety and efficacy in this population.展开更多
BACKGROUND The optimal duration of antimicrobial treatment for acute cholangitis complicated by gram-positive coccus(GPC)bacteremia remains unclear.The Tokyo Guidelines 2018 recommended 14 days of antimicrobial treatm...BACKGROUND The optimal duration of antimicrobial treatment for acute cholangitis complicated by gram-positive coccus(GPC)bacteremia remains unclear.The Tokyo Guidelines 2018 recommended 14 days of antimicrobial treatment following adequate source control measures;however,evidence supporting this recommendation is limited,and deviations from real-world practice are often observed.AIM To evaluate the efficacy and safety of shorter antimicrobial treatments for acute cholangitis complicated by GPC bacteremia.METHODS Adult patients with acute cholangitis complicated by GPC bacteremia who underwent endoscopic retrograde cholangiopancreatography between July 2003 and December 2023 were included.Patients were categorized into two groups based on the duration of effective antimicrobial treatment:(1)Short-course treatment(SCT)(<14 days);and(2)Long-course treatment(LCT)(≥14 days).The outcomes assessed included mortality,recurrence,reinfection with the same organism related to the cholangitis,and length of hospital stay.RESULTS A total of 44 patients were included in the study:(1)19 patients in the SCT group;and(2)25 patients in the LCT group.The median duration of antimicrobial treatment was 9 days[interquartile range(IQR):2.5-11.0 days]and 16 days(IQR:15.0-19.0 days)in the SCT and LCT groups,respectively,with a statistically significant difference(P<0.05).No significant differences were observed in 30-day mortality,cholangitis recurrence,or reinfection with the same organisms within 3 months.However,the length of hospital stay was shorter in the SCT group(median:12.0 days vs 14.0 days,P=0.092).CONCLUSION For acute cholangitis complicated by GPC bacteremia,shorter antimicrobial treatment may be a viable option following appropriate biliary drainage.Further studies with larger sample sizes are warranted.展开更多
BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides dire...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.展开更多
BACKGROUNDGastric food retention during endoscopic retrograde cholangiopancreatography(ERCP) can lead to complications such as aspiration and failed procedure. Livertransplant (LT) recipients are exposed to an increas...BACKGROUNDGastric food retention during endoscopic retrograde cholangiopancreatography(ERCP) can lead to complications such as aspiration and failed procedure. Livertransplant (LT) recipients are exposed to an increased risk of impaired gastrointestinalmotility due to surgical alterations, immunosuppressive therapy, andpost-transplant complications. Given the high frequency of ERCP in this population,our anecdotal experience suggests an increased incidence of gastric foodretention at the time of the procedure.AIMTo evaluate the association between LT and gastric food retention observed atERCP over a two-year period.METHODSThis retrospective study included all patients who underwent standard ERCP atour institution between 2022 and 2024. Data were collected on demographics,medical history including LT and procedural details.RESULTSA total of 1100 patients underwent ERCP, including 238 LT recipients (22%).Gastric food retention was observed 17 patients (1.5%). The incidence was significantly higher in LT recipientscompared to non-transplant patients (3.8% vs 0.9%, P = 0.004). Multivariate analysis confirmed that LT recipientswere independently associated with an increased risk of food retention.CONCLUSIONLT recipients demonstrated over three-fold increased incidence of gastric food retention during ERCP. This shouldbe considered in pre-procedural assessment and preparation in this patient population.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)serves an essential role in treating biliary diseases,especially in choledocholithiasis.However,due to the limited human lifespan,there remains a paucity ...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)serves an essential role in treating biliary diseases,especially in choledocholithiasis.However,due to the limited human lifespan,there remains a paucity of clinical investigations on ERCP treatment in patients over 90 years old.AIM To explore the effectiveness and safety of ERCP in super-older patients aged≥90 years with choledochal stones.METHODS This study retrospectively analyzed data from patients(aged≥65 years)with choledocholithiasis who received ERCP treatment in our hospital from 2011 to 2023.Among them,patients≥90 years old were in the super-older group,and patients aged 65-89 years were in the older group.Baseline data,including gender,number of stones,stone size,gallbladder stones,periampullary diverti-culum,and common bile duct intubation of patients in the two groups,were mat-ched by adopting the 1:1 propensity score matching method.RESULTS After matching,44 patients were included in both the super-older group and the older group.The incidence of stroke in the super-older group was markedly higher than that in the older group[34.1%(15/44)vs 6.8%(3/44),P=0.008].The success rate of the ERCP procedure in the super-older group was 90.9%(40/44),compared to that in the older group[93.2%(41/44),P=1.000].Although endo-scopic papillary balloon dilation was more frequently used in the super-older group than in the older group[61.4%(27/44)vs 18.2%(8/44),P<0.001],there was no significant difference in terms of stone removal rate,the incidence of complications,mortality,recurrence,and length of hospitalization between the two groups(P>0.05).CONCLUSION ERCP is safe and effective in super-older patients≥90 years old with choledocholithiasis.展开更多
BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP ins...BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP instruments can be used.Therefore,MSE-ERCP appears to be the optimal solution for postsurgical patients,especially with Roux-en-Y anatomy.AIM To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.METHODS We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.RESULTS We identified 26 MSE-ERCPs:(1)18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation(n=11)or gastrectomy(n=2);and(2)Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass.Overall success of reaching the biliary entry was 88%and further interventions were successful in 83%of patients.In very long alimentary limb situations,success of reaching the biliary entry was not-significantly lower compared to“standard”Roux-en-Y(75%vs 94%,P=0.215).ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy(63%vs 93%,P=0.103).Mean intervention time was 105 minutes.Intervention times were longer in very long limb situations(133 minutes vs 91 minutes;P=0.032).Overall,we observed three adverse events(n=1 caused by enteroscopy,n=1 caused by the biliary intervention,n=1 unrelated to the procedure).In 15/26 cases(58%)MSE-ERCP was carried out on an outpatient basis.CONCLUSION MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions.However,MSE was recently withdrawn from the market due to severe safety concerns,which were not observed in this study.展开更多
BACKGROUND Current diagnostic standards for post-endoscopic retrograde cholangiopancreato-graphy(ERCP)pancreatitis(PEP)rely on 24-hour post-ERCP amylase and lipase levels,delaying timely intervention and highlighting ...BACKGROUND Current diagnostic standards for post-endoscopic retrograde cholangiopancreato-graphy(ERCP)pancreatitis(PEP)rely on 24-hour post-ERCP amylase and lipase levels,delaying timely intervention and highlighting the need for earlier predic-tive biomarkers.AIM To evaluate the utility of 4-hour post-ERCP serum amylase and lipase levels in a large cohort to establish optimal cut-off values and improve early PEP prediction.METHODS This prospective study involved patients with naïve major papillae who under-went diagnostic or therapeutic ERCP between June 2021 and December 2024.Serum amylase and lipase levels were measured before ERCP and 4 hours and 24 hours after ERCP.The primary endpoint was to determine optimal cut-off values for 4-hour serum amylase and lipase levels for the early prediction of PEP.RESULTS PEP occurred in 117 patients(6.1%).Diagnostic performance assessment of 4-hour serum amylase and lipase for predicting PEP yielded area under the curves of 0.877 and 0.893,respectively.Optimal cut-off values were 1.2 times the upper nor-mal limit(119.5 IU/L)for amylase and 8 times the upper normal limit(488.5 IU/L)for lipase.At these thresholds,4-hour amylase demonstrated a sensitivity of 0.846,a specificity of 0.806,and a negative predictive value of 0.988.Similarly,4-hour lipase showed a sensitivity of 0.863,a specificity of 0.862,and a negative predictive value of 0.990.These biomarkers effectively predicted moderately severe to severe PEP in high-risk groups.CONCLUSION Early measurement of 4-hour serum amylase and lipase shows strong predictive capabilities for PEP,with clinically meaningful cut-off values.These biomarkers enable timely interventions,potentially reducing PEP-related adverse events and the overall healthcare burden.展开更多
This commentary addresses the recent article by Yılmaz et al,featured in the May 2025 issue of this journal.Even though endoscopic procedures are common for both gastroenterologists and surgeons,there are clear differ...This commentary addresses the recent article by Yılmaz et al,featured in the May 2025 issue of this journal.Even though endoscopic procedures are common for both gastroenterologists and surgeons,there are clear differences between the two fields regarding when to use endoscopy,how to prepare for it,and how to monitor patients afterward.A primary determinant of these discrepancies lies in the variations in the duration and pedagogical frameworks of endoscopy training inherent to each discipline.These basic differences are very important for keeping patients safe and ensuring the procedures are done correctly,especially for treatments like endoscopic retrograde cholangiopancreatography(ERCP).This article aims to outline specific criticisms related to this topic,particularly in response to information shared about ERCP procedures performed in Türkiye.展开更多
BACKGROUND Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy(SAA).However,direct compa...BACKGROUND Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy(SAA).However,direct comparative data between double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)remain limited.AIM To compare the ERCP-related outcomes between DBE and SBE in patients with SAA.METHODS We retrospectively reviewed the medical records of 1042 patients with SAA who underwent ERCP.After propensity score matching for age and sex,494 patients were included,with 247 patients in each of the SBE and DBE groups.RESULTS The success rates of intubation,cannulation,completion of intended ERCP,and adverse events were similar between the DBE and SBE groups(94.3%vs 96.4%,P=0.393;89.5%vs 93.5%,P=0.147;88.3%vs 92.7%,P=0.125;10.5%vs 14.6%,P=0.222,respectively).However,the SBE group had significantly longer intubation and procedure times than the DBE group(23.5±22.3 minutes vs 14.1±13.5 minutes,P<0.001;65.2±37.9 minutes vs 31.0±18.5 minutes,P<0.001).Preserved gastric anatomy and Roux-en-Y reconstruction were independently associated with intubation failure(odds ratio=3.18,95%confidence interval:1.30-8.31;odds ratio=8.65,95%confidence interval:1.71-157.60,respectively).CONCLUSION DBE and SBE showed comparable clinical success and safety profiles in ERCP for patients with SAA,although SBE required significantly longer procedure times.DBE could provide procedural efficiency benefits in cases where an extended procedure duration is expected.Furthermore,a preserved gastric anatomy and Roux-en-Y reconstruction were identified as independent risk factors for intubation failure.展开更多
Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly u...Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly utilized,particularly for hepatobiliary and pancreatic diseases.However,only a limited number of gastroenterologists are trained and experienced to perform endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in pediatric patients.While GI endoscopic emergencies in children are uncommon,they can be serious.Effective care demands true multidisciplinary teamwork,with close and ongoing collaboration between gastroenterologists,anesthetists,and the pe-diatric team especially in centres where pediatric endoscopy specialists are not available.This mini-review outlines current practices in pediatric digestive endoscopy and explores recent advances in interventional endoscopy compared to adult patients.展开更多
BACKGROUND Single-use duodenoscopes(SDs)were introduced to eliminate exogenous infection risks post-endoscopic retrograde cholangiopancreatography(ERCP).AIM To evaluate their efficacy and safety against reusable duode...BACKGROUND Single-use duodenoscopes(SDs)were introduced to eliminate exogenous infection risks post-endoscopic retrograde cholangiopancreatography(ERCP).AIM To evaluate their efficacy and safety against reusable duodenoscopes(RDs).METHODS This was a single-center case control study.All consecutive patients undergoing ERCP using SD between 2020 and 2023 were enrolled.A similar number of patients undergoing ERCP using RD were randomly selected and enrolled.In case of ERCP failure using SD,operators switched to a RD if judged appropriate.The primary outcome was successful ERCP completion rates.The secondary outcomes were rate of difficult biliary cannulation,incidence of crossover from SD to RD,procedure related adverse events,30-day re-admission rate,and endoscopists'assessment of SD's performance.RESULTS A total of 133 patients were enrolled(n=53 for SD,n=80 for RD).Baseline characteristics and American Society for Gastrointestinal Endoscopy ERCP complexity grades were comparable between both groups.Successful ERCP completion rates were 88.7%for SD and 95%for RD(P=0.3).In cases of unsuccessful ERCP with SD,crossover to RD occurred in 3 out of 6 instances,with 2 subsequently succeeding with RD.Rates of adverse events and 30-day readmission were comparable:(1)13.2%vs 11.2%(P=0.19);and(2)15.4%vs 8.9%(P=0.25),respectively.Median overall endoscopists’satisfaction with SD was 8 out of 10.CONCLUSION The novel SDs demonstrated no difference in efficacy and safety compared to conventional RDs when used to perform a wide range of ERCPs.Nevertheless,further development and study of SDs’financial and environmental effectiveness is warranted.展开更多
BACKGROUND Situs inversus viscerum(SIV)is a rare autosomal recessive genetic disorder characterized a complete mirror-image organ reversal in the thoracic and abdo-minal cavities.Its low incidence presents considerabl...BACKGROUND Situs inversus viscerum(SIV)is a rare autosomal recessive genetic disorder characterized a complete mirror-image organ reversal in the thoracic and abdo-minal cavities.Its low incidence presents considerable challenges in clinical dia-gnosis and treatment,especially concerning gastrointestinal endoscopic proce-dures.CASE SUMMARY Herein,we report a case of an 80-year-old male with choledocholithiasis and acute obstructive empyematous cholangitis.Imaging revealed total visceral inversion in the patient.Endoscopic retrograde cholangiopancreatography(ERCP)was successfully performed to remove the stones,resulting to substantial relief of clinical symptoms and gradual improvement of the patient’s condition,leading to successful recovery and discharge.CONCLUSION Therapeutic ERCP is a safe and effective surgical option for patients with SIV.The main focus for successful ERCP in patients with SIV includes positioning adju-stments during the surgical process and using the dual-guidewire technique for biliary cannulation.展开更多
BACKGROUND The current surgical treatments for bile duct stones(BDSs)demonstrate suboptimal efficacy,warranting further exploration of superior therapies or improvement of existing surgical protocols.AIM To assess the...BACKGROUND The current surgical treatments for bile duct stones(BDSs)demonstrate suboptimal efficacy,warranting further exploration of superior therapies or improvement of existing surgical protocols.AIM To assess the therapeutic efficacy and safety profiles of endoscopic retrograde cholangiopancreatography(ERCP)vs common bile duct exploration(CBDE)in BDS treatment.METHODS This study enrolled 103 consecutive patients with BDSs treated at the First People’s Hospital of Changde from January 2024 to January 2025,with 53 patients undergoing ERCP(ERCP group)and 50 receiving conventional CBDE(CBDE group).Comprehensive comparative analyses were conducted across multiple parameters,including clinical efficacy,surgical success rate,safety(bile leakage incidence,surgical site infection,acute pancreatitis,and acute cholangitis),postoperative biochemical markers(total bilirubin and serum amylase),surgeryrelated metrics(stone removal time,procedure duration,intraoperative blood loss,and hospitalization time),and postoperative recovery indicators(time to intestinal recovery,jaundice resolution,biliary drainage removal,and postoperative activity recovery).RESULTS The ERCP group demonstrated markedly superior overall efficacy than the CBDE group,with similar surgical success rates and comparable stone removal durations.Importantly,patients undergoing ERCP experienced fewer complications overall,required less operative time,had minimal intraoperative blood loss,and needed shorter hospitalization periods.Recovery parameters such as bowel function recovery,jaundice resolution,biliary stent removal,and normal activity resumption,were significantly improved in the ERCP group.Both groups demonstrated substantial postoperative reductions in total bilirubin and amylase,with no significant intergroup differences.CONCLUSION ERCP demonstrates effectiveness and safety in managing BDSs,thereby providing notable clinical benefits that support its broader implementation in medical practice.展开更多
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is a cornerstone procedure for the diagnosis and management of pancreatic and hepatobiliary diseases.Although its diagnostic role has been increasingly supplanted by nonin-vasive imaging modalities such as magnetic resonance imaging(MRI)and mag-netic resonance cholangiopancreatography,the therapeutic applications of ERCP have continued to expand.ERCP is widely used and has a generally favorable safety profile.However,it is important to recognize expected post-procedural imaging findings and serious complications that can arise.The increasing comple-xity of therapeutic interventions and the growing volume of procedures have led to a higher incidence of complications that often present with overlapping clinical and laboratory features,underscoring the critical role of imaging in differential diagnosis.This review focused on the typical normal ERCP findings and the imaging characteristics of common complications,including pancreatitis,bleeding,ERCP-related infections,perforations,and stent-related complications.Computed tomography(CT)is particularly valuable in timely recognition,management,and surgical decision-making for these complications.Furthermore,MRI offers a radiation-free alternative for managing complications in selected patients.Therefore,radiological modalities,particularly CT and MRI,are critical tools for the rapid diagnosis,management,and surgical decision-making processes for post-ERCP complications.
文摘BACKGROUND Periampullary diverticulum(PAD)is a common anatomical variant,but its association with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)remains controversial.While PAD may alter ampullary anatomy,increasing technical difficulty during ERCP,existing studies report inconsistent findings on its role in PEP pathogenesis.We hypothesize that PAD presence,particularly type B,shows a significant association with PEP development and may interact with procedural factors like pancreatic duct guidewire insertion.AIM To examine the association between PAD(including subtypes A/B)and PEP incidence after ERCP for choledocholithiasis.METHODS We conducted a retrospective cohort study of 615 patients undergoing ERCP at two tertiary hospitals from 2023 to 2025.Participants were stratified into PAD(n=183;subtype A=125,subtype B=58)and non-PAD(n=432)groups.The primary outcome was PEP incidence.Multivariable logistic regression adjusted for age,sex,hypertension,diabetes,gallbladder surgery,and guidewire insertion.Statistical significance was set at P<0.05(two-tailed).RESULTS PAD prevalence was 29.8%(183/615).PEP occurrence was more frequent in PAD patients[15.3%(28/183)]than in non-PAD patients[4.2%(18/432)],odds ratio(OR)=3.86,95%confidence interval:2.03-7.35,P<0.001.Type B PAD showed a stronger association with PEP than type A(OR=14.16,95%confidence interval:5.84-34.34,P<0.001).Guidewire pancreatic duct entry was linked to higher PEP odds in PAD patients(adjusted OR=5.02,P<0.05).Hypertension also demonstrated an association with PEP in the PAD subgroup(P=0.012).CONCLUSION PAD,particularly type B,is independently associated with PEP after ERCP.Patients with these features,especially those with hypertension or pancreatic duct instrumentation,may benefit from enhanced monitoring and prophylaxis.
基金Supported by the Shihwa Medical Center Research Fund.
文摘BACKGROUND Despite advancements,endoscopic retrograde cholangiopancreatography(ERCP)poses challenges,including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.AIM To compare dome and tapered tip sphincterotomes,focusing on their efficacy in achieving successful biliary cannulation and reducing the incidence of post-ERCP pancreatitis.METHODS In this prospective,single-blind,randomized pilot study conducted at Inha Uni-versity Hospital,85 patients undergoing ERCP were equally divided into dome and tapered tip sphincterotome groups.The co-primary outcomes were the success rate of selective biliary cannulation and incidence of post-ERCP pancre-atitis.The secondary outcomes included biliary cannulation time,number of unintended pancreatic duct access events,and total procedure time.RESULTS The success rates of selective biliary cannulation were 74.4%and 85.7%in the dome and tapered tip groups,respectively,with no significant difference(P=0.20).Similarly,the incidence of post-ERCP pancreatitis did not differ significantly between the groups(5 cases in the tapered tip group vs 6 in the dome tip group,P=0.72).However,difficult cannulation was significantly more common in the dome tip group than in the tapered tip group(P=0.05).Selective biliary cannula-tion time emerged as a significant predictor of post-ERCP pancreatitis(multivariate odds ratio=9.33,95%confi-dence interval:1.31-66.44,P=0.03).CONCLUSION This study indicated that the sphincterotome tip type does not markedly affect biliary cannulation success or post-ERCP pancreatitis rates.However,cannulation duration is a key risk factor for post-ERCP pancreatitis.These findings provide preliminary insights that highlight the importance of refining ERCP practices,including sphinc-terotome selection,while underscoring the need for larger multicenter studies to improve procedure time and patient safety.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-term ERCP outcomes,particularly using established quality benchmarks.AIM To evaluate ERCP indications,success rates,complications,and quality performance at a high-volume tertiary care center in Pakistan over a 17-year period.METHODS This retrospective study analyzed 13215 ERCP procedures performed between 2006 and 2023.Data included demographics,indications,cannulation rates,complications,and pediatric cases.Findings were assessed against American Society of Gastroenterology/European Society of Gastrointestinal Endoscopy quality indicators.RESULTS Biliary ERCP accounted for 93.1%of procedures;choledocholithiasis was the most common indication(40%).Cannulation success was 93.9%for biliary and 94.2%for pancreatic ERCP.Pediatric ERCP comprised 4%of cases,mostly for stones and chronic pancreatitis.Bleeding(1.7%)and post-ERCP pancreatitis(2.3%)were the most frequent complications.Performance met or exceeded most American Society of Benchmarks.CONCLUSION This study offers insight into nearly two decades of ERCP practice within a public sector hospital.Our experience echoes the quality and efficiency of ERCP not previously available in Pakistan.As healthcare systems in resourcelimited sectors expand,our findings serve as a reference point.Continued training and quality improvement studies can further enhance ERCP effectiveness in the region and beyond.
文摘This letter aims to discuss the article,published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2025.Endoscopic retrograde cholangiopan-creatography(ERCP)is widely acknowledged as an effective procedure for managing biliary obstruction.However,its use in very elderly patients,partic-ularly centenarians,presents unique challenges related to both safety and efficacy.In this report,we share our experience with three centenarian patients who underwent ERCP for biliary obstruction in our unit.Remarkably,all patients had favorable outcomes,and no significant adverse events were observed.
文摘BACKGROUND Data suggest that elderly patients may have a lower risk of complications after endoscopic retrograde cholangiopancreatography(ERCP),especially post-ERCP pancreatitis(PEP).AIM To validate these findings in a large,real-world clinical setting.METHODS Clinical,epidemiological,and procedural data collected from a prospectively maintained database were gathered over a 20-year period(2001-2021)from consecutive patients undergoing their first ERCP.Patients were grouped based on age:<80 years and≥80 years.RESULTS A total of 3147 patients were included in the study,with 70.3%<80 years old and 28.7%≥80 years.The most common indication for ERCP was biliary colic with or without elevated liver enzymes(39.6%).Periampullary diverticula were more frequently observed in elderly patients(P<0.001).Successful cannulation of the common bile duct was achieved in 96.1%of cases and did not differ significantly between age groups(P=0.148).Complete common bile duct clearance during the first ERCP was accomplished in 90.1%,and stone size was the only independent predictor of success.Use of antiplatelet or anticoagulant therapy was independently associated with intraprocedural bleeding(odds ratio[OR]=1.333;P=0.03 and OR=1.275;P=0.041,respectively).Overall,post-ERCP complications occurred in 6%of cases,with similar rates between elderly and younger patients.The most common complication was PEP.The incidences of clinical bleeding and PEP did not differ significantly between groups(P=0.290 and P=0.128,respectively).Clinical bleeding was independently associated with anticoagulant use and intraprocedural bleeding.CONCLUSION Our findings highlight that elderly patients do not experience higher complication rates or lower success rates with ERCP,supporting the procedure’s safety and efficacy in this population.
文摘BACKGROUND The optimal duration of antimicrobial treatment for acute cholangitis complicated by gram-positive coccus(GPC)bacteremia remains unclear.The Tokyo Guidelines 2018 recommended 14 days of antimicrobial treatment following adequate source control measures;however,evidence supporting this recommendation is limited,and deviations from real-world practice are often observed.AIM To evaluate the efficacy and safety of shorter antimicrobial treatments for acute cholangitis complicated by GPC bacteremia.METHODS Adult patients with acute cholangitis complicated by GPC bacteremia who underwent endoscopic retrograde cholangiopancreatography between July 2003 and December 2023 were included.Patients were categorized into two groups based on the duration of effective antimicrobial treatment:(1)Short-course treatment(SCT)(<14 days);and(2)Long-course treatment(LCT)(≥14 days).The outcomes assessed included mortality,recurrence,reinfection with the same organism related to the cholangitis,and length of hospital stay.RESULTS A total of 44 patients were included in the study:(1)19 patients in the SCT group;and(2)25 patients in the LCT group.The median duration of antimicrobial treatment was 9 days[interquartile range(IQR):2.5-11.0 days]and 16 days(IQR:15.0-19.0 days)in the SCT and LCT groups,respectively,with a statistically significant difference(P<0.05).No significant differences were observed in 30-day mortality,cholangitis recurrence,or reinfection with the same organisms within 3 months.However,the length of hospital stay was shorter in the SCT group(median:12.0 days vs 14.0 days,P=0.092).CONCLUSION For acute cholangitis complicated by GPC bacteremia,shorter antimicrobial treatment may be a viable option following appropriate biliary drainage.Further studies with larger sample sizes are warranted.
基金Supported by Guangdong Province Clinical Teaching Base Teaching Reform Research Project,No.2021JD086.
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.
文摘BACKGROUNDGastric food retention during endoscopic retrograde cholangiopancreatography(ERCP) can lead to complications such as aspiration and failed procedure. Livertransplant (LT) recipients are exposed to an increased risk of impaired gastrointestinalmotility due to surgical alterations, immunosuppressive therapy, andpost-transplant complications. Given the high frequency of ERCP in this population,our anecdotal experience suggests an increased incidence of gastric foodretention at the time of the procedure.AIMTo evaluate the association between LT and gastric food retention observed atERCP over a two-year period.METHODSThis retrospective study included all patients who underwent standard ERCP atour institution between 2022 and 2024. Data were collected on demographics,medical history including LT and procedural details.RESULTSA total of 1100 patients underwent ERCP, including 238 LT recipients (22%).Gastric food retention was observed 17 patients (1.5%). The incidence was significantly higher in LT recipientscompared to non-transplant patients (3.8% vs 0.9%, P = 0.004). Multivariate analysis confirmed that LT recipientswere independently associated with an increased risk of food retention.CONCLUSIONLT recipients demonstrated over three-fold increased incidence of gastric food retention during ERCP. This shouldbe considered in pre-procedural assessment and preparation in this patient population.
基金Supported by the Natural Science Foundation of China,No.81974442and Science and Technology Project of Guangzhou City,No.2024A03J0670.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)serves an essential role in treating biliary diseases,especially in choledocholithiasis.However,due to the limited human lifespan,there remains a paucity of clinical investigations on ERCP treatment in patients over 90 years old.AIM To explore the effectiveness and safety of ERCP in super-older patients aged≥90 years with choledochal stones.METHODS This study retrospectively analyzed data from patients(aged≥65 years)with choledocholithiasis who received ERCP treatment in our hospital from 2011 to 2023.Among them,patients≥90 years old were in the super-older group,and patients aged 65-89 years were in the older group.Baseline data,including gender,number of stones,stone size,gallbladder stones,periampullary diverti-culum,and common bile duct intubation of patients in the two groups,were mat-ched by adopting the 1:1 propensity score matching method.RESULTS After matching,44 patients were included in both the super-older group and the older group.The incidence of stroke in the super-older group was markedly higher than that in the older group[34.1%(15/44)vs 6.8%(3/44),P=0.008].The success rate of the ERCP procedure in the super-older group was 90.9%(40/44),compared to that in the older group[93.2%(41/44),P=1.000].Although endo-scopic papillary balloon dilation was more frequently used in the super-older group than in the older group[61.4%(27/44)vs 18.2%(8/44),P<0.001],there was no significant difference in terms of stone removal rate,the incidence of complications,mortality,recurrence,and length of hospitalization between the two groups(P>0.05).CONCLUSION ERCP is safe and effective in super-older patients≥90 years old with choledocholithiasis.
文摘BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP instruments can be used.Therefore,MSE-ERCP appears to be the optimal solution for postsurgical patients,especially with Roux-en-Y anatomy.AIM To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.METHODS We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.RESULTS We identified 26 MSE-ERCPs:(1)18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation(n=11)or gastrectomy(n=2);and(2)Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass.Overall success of reaching the biliary entry was 88%and further interventions were successful in 83%of patients.In very long alimentary limb situations,success of reaching the biliary entry was not-significantly lower compared to“standard”Roux-en-Y(75%vs 94%,P=0.215).ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy(63%vs 93%,P=0.103).Mean intervention time was 105 minutes.Intervention times were longer in very long limb situations(133 minutes vs 91 minutes;P=0.032).Overall,we observed three adverse events(n=1 caused by enteroscopy,n=1 caused by the biliary intervention,n=1 unrelated to the procedure).In 15/26 cases(58%)MSE-ERCP was carried out on an outpatient basis.CONCLUSION MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions.However,MSE was recently withdrawn from the market due to severe safety concerns,which were not observed in this study.
基金Supported by National Research Foundation of Korea,No.NFR-2022R1C1C1006242the Hallym University Medical Center Research Fund.
文摘BACKGROUND Current diagnostic standards for post-endoscopic retrograde cholangiopancreato-graphy(ERCP)pancreatitis(PEP)rely on 24-hour post-ERCP amylase and lipase levels,delaying timely intervention and highlighting the need for earlier predic-tive biomarkers.AIM To evaluate the utility of 4-hour post-ERCP serum amylase and lipase levels in a large cohort to establish optimal cut-off values and improve early PEP prediction.METHODS This prospective study involved patients with naïve major papillae who under-went diagnostic or therapeutic ERCP between June 2021 and December 2024.Serum amylase and lipase levels were measured before ERCP and 4 hours and 24 hours after ERCP.The primary endpoint was to determine optimal cut-off values for 4-hour serum amylase and lipase levels for the early prediction of PEP.RESULTS PEP occurred in 117 patients(6.1%).Diagnostic performance assessment of 4-hour serum amylase and lipase for predicting PEP yielded area under the curves of 0.877 and 0.893,respectively.Optimal cut-off values were 1.2 times the upper nor-mal limit(119.5 IU/L)for amylase and 8 times the upper normal limit(488.5 IU/L)for lipase.At these thresholds,4-hour amylase demonstrated a sensitivity of 0.846,a specificity of 0.806,and a negative predictive value of 0.988.Similarly,4-hour lipase showed a sensitivity of 0.863,a specificity of 0.862,and a negative predictive value of 0.990.These biomarkers effectively predicted moderately severe to severe PEP in high-risk groups.CONCLUSION Early measurement of 4-hour serum amylase and lipase shows strong predictive capabilities for PEP,with clinically meaningful cut-off values.These biomarkers enable timely interventions,potentially reducing PEP-related adverse events and the overall healthcare burden.
文摘This commentary addresses the recent article by Yılmaz et al,featured in the May 2025 issue of this journal.Even though endoscopic procedures are common for both gastroenterologists and surgeons,there are clear differences between the two fields regarding when to use endoscopy,how to prepare for it,and how to monitor patients afterward.A primary determinant of these discrepancies lies in the variations in the duration and pedagogical frameworks of endoscopy training inherent to each discipline.These basic differences are very important for keeping patients safe and ensuring the procedures are done correctly,especially for treatments like endoscopic retrograde cholangiopancreatography(ERCP).This article aims to outline specific criticisms related to this topic,particularly in response to information shared about ERCP procedures performed in Türkiye.
基金Supported by National Research Foundation of Korea,No.RS-2022-NRO71822Hallym University Medical Center Research Fund(Mighty Hallym,4.0).
文摘BACKGROUND Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy(SAA).However,direct comparative data between double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)remain limited.AIM To compare the ERCP-related outcomes between DBE and SBE in patients with SAA.METHODS We retrospectively reviewed the medical records of 1042 patients with SAA who underwent ERCP.After propensity score matching for age and sex,494 patients were included,with 247 patients in each of the SBE and DBE groups.RESULTS The success rates of intubation,cannulation,completion of intended ERCP,and adverse events were similar between the DBE and SBE groups(94.3%vs 96.4%,P=0.393;89.5%vs 93.5%,P=0.147;88.3%vs 92.7%,P=0.125;10.5%vs 14.6%,P=0.222,respectively).However,the SBE group had significantly longer intubation and procedure times than the DBE group(23.5±22.3 minutes vs 14.1±13.5 minutes,P<0.001;65.2±37.9 minutes vs 31.0±18.5 minutes,P<0.001).Preserved gastric anatomy and Roux-en-Y reconstruction were independently associated with intubation failure(odds ratio=3.18,95%confidence interval:1.30-8.31;odds ratio=8.65,95%confidence interval:1.71-157.60,respectively).CONCLUSION DBE and SBE showed comparable clinical success and safety profiles in ERCP for patients with SAA,although SBE required significantly longer procedure times.DBE could provide procedural efficiency benefits in cases where an extended procedure duration is expected.Furthermore,a preserved gastric anatomy and Roux-en-Y reconstruction were identified as independent risk factors for intubation failure.
文摘Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly utilized,particularly for hepatobiliary and pancreatic diseases.However,only a limited number of gastroenterologists are trained and experienced to perform endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in pediatric patients.While GI endoscopic emergencies in children are uncommon,they can be serious.Effective care demands true multidisciplinary teamwork,with close and ongoing collaboration between gastroenterologists,anesthetists,and the pe-diatric team especially in centres where pediatric endoscopy specialists are not available.This mini-review outlines current practices in pediatric digestive endoscopy and explores recent advances in interventional endoscopy compared to adult patients.
文摘BACKGROUND Single-use duodenoscopes(SDs)were introduced to eliminate exogenous infection risks post-endoscopic retrograde cholangiopancreatography(ERCP).AIM To evaluate their efficacy and safety against reusable duodenoscopes(RDs).METHODS This was a single-center case control study.All consecutive patients undergoing ERCP using SD between 2020 and 2023 were enrolled.A similar number of patients undergoing ERCP using RD were randomly selected and enrolled.In case of ERCP failure using SD,operators switched to a RD if judged appropriate.The primary outcome was successful ERCP completion rates.The secondary outcomes were rate of difficult biliary cannulation,incidence of crossover from SD to RD,procedure related adverse events,30-day re-admission rate,and endoscopists'assessment of SD's performance.RESULTS A total of 133 patients were enrolled(n=53 for SD,n=80 for RD).Baseline characteristics and American Society for Gastrointestinal Endoscopy ERCP complexity grades were comparable between both groups.Successful ERCP completion rates were 88.7%for SD and 95%for RD(P=0.3).In cases of unsuccessful ERCP with SD,crossover to RD occurred in 3 out of 6 instances,with 2 subsequently succeeding with RD.Rates of adverse events and 30-day readmission were comparable:(1)13.2%vs 11.2%(P=0.19);and(2)15.4%vs 8.9%(P=0.25),respectively.Median overall endoscopists’satisfaction with SD was 8 out of 10.CONCLUSION The novel SDs demonstrated no difference in efficacy and safety compared to conventional RDs when used to perform a wide range of ERCPs.Nevertheless,further development and study of SDs’financial and environmental effectiveness is warranted.
文摘BACKGROUND Situs inversus viscerum(SIV)is a rare autosomal recessive genetic disorder characterized a complete mirror-image organ reversal in the thoracic and abdo-minal cavities.Its low incidence presents considerable challenges in clinical dia-gnosis and treatment,especially concerning gastrointestinal endoscopic proce-dures.CASE SUMMARY Herein,we report a case of an 80-year-old male with choledocholithiasis and acute obstructive empyematous cholangitis.Imaging revealed total visceral inversion in the patient.Endoscopic retrograde cholangiopancreatography(ERCP)was successfully performed to remove the stones,resulting to substantial relief of clinical symptoms and gradual improvement of the patient’s condition,leading to successful recovery and discharge.CONCLUSION Therapeutic ERCP is a safe and effective surgical option for patients with SIV.The main focus for successful ERCP in patients with SIV includes positioning adju-stments during the surgical process and using the dual-guidewire technique for biliary cannulation.
文摘BACKGROUND The current surgical treatments for bile duct stones(BDSs)demonstrate suboptimal efficacy,warranting further exploration of superior therapies or improvement of existing surgical protocols.AIM To assess the therapeutic efficacy and safety profiles of endoscopic retrograde cholangiopancreatography(ERCP)vs common bile duct exploration(CBDE)in BDS treatment.METHODS This study enrolled 103 consecutive patients with BDSs treated at the First People’s Hospital of Changde from January 2024 to January 2025,with 53 patients undergoing ERCP(ERCP group)and 50 receiving conventional CBDE(CBDE group).Comprehensive comparative analyses were conducted across multiple parameters,including clinical efficacy,surgical success rate,safety(bile leakage incidence,surgical site infection,acute pancreatitis,and acute cholangitis),postoperative biochemical markers(total bilirubin and serum amylase),surgeryrelated metrics(stone removal time,procedure duration,intraoperative blood loss,and hospitalization time),and postoperative recovery indicators(time to intestinal recovery,jaundice resolution,biliary drainage removal,and postoperative activity recovery).RESULTS The ERCP group demonstrated markedly superior overall efficacy than the CBDE group,with similar surgical success rates and comparable stone removal durations.Importantly,patients undergoing ERCP experienced fewer complications overall,required less operative time,had minimal intraoperative blood loss,and needed shorter hospitalization periods.Recovery parameters such as bowel function recovery,jaundice resolution,biliary stent removal,and normal activity resumption,were significantly improved in the ERCP group.Both groups demonstrated substantial postoperative reductions in total bilirubin and amylase,with no significant intergroup differences.CONCLUSION ERCP demonstrates effectiveness and safety in managing BDSs,thereby providing notable clinical benefits that support its broader implementation in medical practice.
