BACKGROUND Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation,which is often challenging and associated with complications.In difficult cannulation cases,early precutting is freque...BACKGROUND Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation,which is often challenging and associated with complications.In difficult cannulation cases,early precutting is frequently used.However,its efficacy and optimal indications require further evaluation.AIM To evaluate the efficacy and safety of early precut(EP)in difficult bile duct cannulation.METHODS This retrospective analysis of endoscopic retrograde cholangiopancreatography procedures was performed for bile duct cannulation in patients with naive papillae who required advanced cannulation techniques(ACTs).These patients were admitted between April 2020 and March 2024 and were analyzed for risk factors,success rates,and complications.Outcomes were compared between the EP group and the conventional other ACTs group,with a focus on cases with oral protrusion large(oral protrusion-L).RESULTS The need for ACTs was identified as an independent risk factor for complications[odds ratio(OR)=5.4;95%confidence interval:1.887-15.53].Malignant biliary strictures(OR=2.58)and oral protrusion-L(OR=2.77)were also identified as independent risk factors for requiring ACTs.The EP group had a significantly higher second-line cannulation success rate(97.9%vs 73.2%,P=0.001)and lower complication rate(8.3%vs 39.0%,P=0.001)than the other ACTs group.Additionally,similar benefits were observed in the oral protrusion-L cases.CONCLUSION This study provides compelling evidence that EP is a viable alternative and a superior strategy in cases requiring ACTs,particularly oral protrusion-L.展开更多
Acute post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a feared and potentially fatal complication that can be as high as up to 30%in high-risk patients.Pre-examination measures,during the exami...Acute post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a feared and potentially fatal complication that can be as high as up to 30%in high-risk patients.Pre-examination measures,during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events.Several studies have debated on the subject,however,numerous topics remain controversial,such as the effectiveness of prophylactic medications and the amylase dosage time.This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.展开更多
BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have...BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have evaluated the efficacy of various agents, e.g. nonsteroidal anti-inflammatory drugs, octreotide,antioxidants, administered via various dosages, routes(oral, intrarectal or parenteral), and schedules(before or after the procedure), the results have been conflicting.AIM To evaluate efficacy of three pharmacologic prophylactic methods for prevention of PEP.METHODS In this prospective, single-center randomized trial, patients who underwent firsttime ERCP for choledocholithiasis were randomly assigned to three groups. The first group received 600 mg N-acetylcysteine 15 min prior to ERCP, and perrectum administration of 50 mg indomethacin both prior to and after completion of the ERCP. The second group was administered only the 50 mg indomethacin per-rectum both prior to and after the ERCP. The third group was administeredper-rectum 100 mg indomethacin only after the ERCP, representing the control group given the guideline-recommended regimen. The primary end-point was PEP prevention.RESULTS Among the total 211 patients evaluated during the study, 186 fulfilled the inclusion criteria and completed the protocol. The percentages of patients who developed PEP in each of the three groups were not significantly different(χ2 =2.793, P = 0.247). Among the acute PEP cases, for all groups, 14 patients developed mild pancreatitis(77.77%) and 4 moderate. No severe cases of PEP occurred, and in all PEP cases the resolution was favorable. No adverse events related to the medications(digestive hemorrhage, rectal irritation, or allergies)occurred.CONCLUSION The efficacies of split-dose indomethacin and combined administration(Nacetylcysteine with indomethacin) for preventing PEP were similar to that of the standard regimen.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)plays a major role in the investigation and treatment of pancreaticobiliary diseases.However,post-ERCP pancreatitis(PEP)is a severe adverse effect.Prior m...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)plays a major role in the investigation and treatment of pancreaticobiliary diseases.However,post-ERCP pancreatitis(PEP)is a severe adverse effect.Prior meta-analyses have shown that prophylactic PS was useful for preventing PEP.However,abstract reports and patients who underwent endoscopic ampullectomy were included in the previous analyses.In addition,two meta-analyses involved non-randomized controlled trials(RCTs).The efficacy of PS for preventing severe PEP was different in each meta-analysis.Therefore,we performed the current metaanalysis,which included only full-text articles,and added new findings.AIM To reveal the efficacy of prophylactic pancreatic stent(PS)placement for preventing PEP.METHODS We searched the MEDLINE,Cochrane Library and PubMed databases for related RCTs.Among the reports retrieved,11 studies were included in this metaanalysis.All full-text articles were published between 1993 and 2016.A total of 1475 patients were enrolled in the included studies;of these patients,734 had a PS inserted,and 741 did not have a PS inserted.PEP and severe PEP occurrence were evaluated in this meta-analysis.RESULTS PEP was observed in all studies and occurred in 39(5.3%)patients who received a PS.On the other hand,PEP occurred in 141(19%)patients who did not receive a PS.The occurrence of PEP was significantly lower in the patients who underwent PS placement than in the patients who did not receive a PS(OR=0.32;95%CI:0.23-0.45;P<0.001).In addition,the occurrence of severe PEP was evaluated.Notably,the occurrence of severe PEP was not observed in the stent group;however,the occurrence of severe PEP was observed in 8(1.3%)patients who did not have a PS inserted.Severe PEP occurred significantly less often in the stent group than in the no stent group(OR=0.24;95%CI:0.06-0.94;P=0.04).CONCLUSION In conclusion,prophylactic PS placement is useful for preventing PEP and severe PEP.展开更多
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation,which is often challenging and associated with complications.In difficult cannulation cases,early precutting is frequently used.However,its efficacy and optimal indications require further evaluation.AIM To evaluate the efficacy and safety of early precut(EP)in difficult bile duct cannulation.METHODS This retrospective analysis of endoscopic retrograde cholangiopancreatography procedures was performed for bile duct cannulation in patients with naive papillae who required advanced cannulation techniques(ACTs).These patients were admitted between April 2020 and March 2024 and were analyzed for risk factors,success rates,and complications.Outcomes were compared between the EP group and the conventional other ACTs group,with a focus on cases with oral protrusion large(oral protrusion-L).RESULTS The need for ACTs was identified as an independent risk factor for complications[odds ratio(OR)=5.4;95%confidence interval:1.887-15.53].Malignant biliary strictures(OR=2.58)and oral protrusion-L(OR=2.77)were also identified as independent risk factors for requiring ACTs.The EP group had a significantly higher second-line cannulation success rate(97.9%vs 73.2%,P=0.001)and lower complication rate(8.3%vs 39.0%,P=0.001)than the other ACTs group.Additionally,similar benefits were observed in the oral protrusion-L cases.CONCLUSION This study provides compelling evidence that EP is a viable alternative and a superior strategy in cases requiring ACTs,particularly oral protrusion-L.
文摘Acute post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a feared and potentially fatal complication that can be as high as up to 30%in high-risk patients.Pre-examination measures,during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events.Several studies have debated on the subject,however,numerous topics remain controversial,such as the effectiveness of prophylactic medications and the amylase dosage time.This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.
文摘BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have evaluated the efficacy of various agents, e.g. nonsteroidal anti-inflammatory drugs, octreotide,antioxidants, administered via various dosages, routes(oral, intrarectal or parenteral), and schedules(before or after the procedure), the results have been conflicting.AIM To evaluate efficacy of three pharmacologic prophylactic methods for prevention of PEP.METHODS In this prospective, single-center randomized trial, patients who underwent firsttime ERCP for choledocholithiasis were randomly assigned to three groups. The first group received 600 mg N-acetylcysteine 15 min prior to ERCP, and perrectum administration of 50 mg indomethacin both prior to and after completion of the ERCP. The second group was administered only the 50 mg indomethacin per-rectum both prior to and after the ERCP. The third group was administeredper-rectum 100 mg indomethacin only after the ERCP, representing the control group given the guideline-recommended regimen. The primary end-point was PEP prevention.RESULTS Among the total 211 patients evaluated during the study, 186 fulfilled the inclusion criteria and completed the protocol. The percentages of patients who developed PEP in each of the three groups were not significantly different(χ2 =2.793, P = 0.247). Among the acute PEP cases, for all groups, 14 patients developed mild pancreatitis(77.77%) and 4 moderate. No severe cases of PEP occurred, and in all PEP cases the resolution was favorable. No adverse events related to the medications(digestive hemorrhage, rectal irritation, or allergies)occurred.CONCLUSION The efficacies of split-dose indomethacin and combined administration(Nacetylcysteine with indomethacin) for preventing PEP were similar to that of the standard regimen.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)plays a major role in the investigation and treatment of pancreaticobiliary diseases.However,post-ERCP pancreatitis(PEP)is a severe adverse effect.Prior meta-analyses have shown that prophylactic PS was useful for preventing PEP.However,abstract reports and patients who underwent endoscopic ampullectomy were included in the previous analyses.In addition,two meta-analyses involved non-randomized controlled trials(RCTs).The efficacy of PS for preventing severe PEP was different in each meta-analysis.Therefore,we performed the current metaanalysis,which included only full-text articles,and added new findings.AIM To reveal the efficacy of prophylactic pancreatic stent(PS)placement for preventing PEP.METHODS We searched the MEDLINE,Cochrane Library and PubMed databases for related RCTs.Among the reports retrieved,11 studies were included in this metaanalysis.All full-text articles were published between 1993 and 2016.A total of 1475 patients were enrolled in the included studies;of these patients,734 had a PS inserted,and 741 did not have a PS inserted.PEP and severe PEP occurrence were evaluated in this meta-analysis.RESULTS PEP was observed in all studies and occurred in 39(5.3%)patients who received a PS.On the other hand,PEP occurred in 141(19%)patients who did not receive a PS.The occurrence of PEP was significantly lower in the patients who underwent PS placement than in the patients who did not receive a PS(OR=0.32;95%CI:0.23-0.45;P<0.001).In addition,the occurrence of severe PEP was evaluated.Notably,the occurrence of severe PEP was not observed in the stent group;however,the occurrence of severe PEP was observed in 8(1.3%)patients who did not have a PS inserted.Severe PEP occurred significantly less often in the stent group than in the no stent group(OR=0.24;95%CI:0.06-0.94;P=0.04).CONCLUSION In conclusion,prophylactic PS placement is useful for preventing PEP and severe PEP.
