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
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 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 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 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
Endoscopic retrograde cholangiopancreatography(ERCP)is a vital diagnostic and therapeutic technique in evaluating and treating biliary and pancreatic disorders.Since its inception in the late 20th century,ERCP has tra...Endoscopic retrograde cholangiopancreatography(ERCP)is a vital diagnostic and therapeutic technique in evaluating and treating biliary and pancreatic disorders.Since its inception in the late 20th century,ERCP has transitioned from a mostly diagnostic instrument to a chiefly interventional procedure,owing to the emergence of less invasive imaging techniques like magnetic resonance cholangiopancreatography and endoscopic ultrasonography.Successful biliary cannulation is the most important and difficult step of the procedure.However,there are many challenges associated with cannulation,such as the anatomy of the major duodenal papilla,the direction of the common bile duct and pancreatic duct in the ampulla of Vater,the presence of periampullary diverticula,and scope position.Advanced techniques for cannulation are necessary when basic techniques fail.Double guidewire,precut methods,and transpancreatic sphincterotomy are examples of these advanced techniques.This review aims to summarize the challenges of biliary cannulation and tips for performing cannulation techniques.展开更多
BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary dra...BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses ...Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses on the surgical management of key ERCP-related complications:Post-sphincterotomy bleeding,perforations,stent migration-induced perforations,and Dormia basket impaction.Although many complications can be managed endoscopically,surgery remains essential in refractory cases or when less invasive methods fail.Post-sphincterotomy bleeding,although often controlled endoscopically,may necessitate surgical ligation when hemorrhage persists.Perforations,classified by anatomical type,require tailored surgical approaches-primary repair for type I and biliary diversion with defect closure for types II and III.Stent migration-induced perforations,which may lead to peritonitis or abscess formation,often require surgery due to their variable clinical presentation and the lack of standardized management guidelines.Dormia basket impaction,although rare,may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective.Early recognition,multidisciplinary collaboration,and individualized treatment strategies are pivotal in reducing morbidity and mortality.This review underscores evolving surgical approaches,emphasizing the importance of timely,patient-specific decisions to improve outcomes in severe ERCP-related complications.展开更多
BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)ha...BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.展开更多
BACKGROUND Atrial fibrillation(AF)remains the most common cardiac arrhythmia.The safety of endoscopic retrograde cholangiopancreatography(ERCP)in patients with AF remains largely unknown.AIM To analyze the effect of A...BACKGROUND Atrial fibrillation(AF)remains the most common cardiac arrhythmia.The safety of endoscopic retrograde cholangiopancreatography(ERCP)in patients with AF remains largely unknown.AIM To analyze the effect of AF on hospital outcomes in patients undergoing ERCP.METHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample database.Adult patients with AF who underwent an inpatient ERCP were identified,then stratified by timing of ERCP,via international classification of diseases-10 codes.The primary outcome was all-cause in-hospital mortality.Secondary outcomes,including resource utilization,were assessed.Statistical analysis was performed using STATA software.RESULTS Of the 433245 patients that underwent an ERCP,49615 had a diagnosis of AF.Patients with AF had a significantly higher in-hospital mortality compared to those without AF[3.82%vs 1.13%,odds ratio(OR)=1.93,P<0.01].AF was significantly associated with increased hospital stay(+1.71 days),hospital charges($21210),shock(OR=2.17),sepsis(OR=1.34),intensive care unit admission(OR=2.41),acute kidney injury(OR=1.51),as well as a decreased likelihood of discharge to home(OR=0.59),(all with P<0.01).These results were consistent after propensity score matching.Upon subgroup analysis,patients with AF,whom underwent ERCP>72 hours,had worse outcomes including higher inhospital mortality(adjusted OR=1.47,P<0.01).CONCLUSION By way of this large,national analysis it appears AF is associated with significantly worse hospitalization outcomes,inducing increased mortality,in those undergoing ERCP.Further prospective investigation is warranted to potentially guide clinical recommendations for patients with AF undergoing ERCP in this setting.展开更多
Post-endoscopic retrograde cholangiopancreatography(ERCP)cholecystitis(PEC)is a recognized adverse event associated with ERCP.The incidence of PEC is low in patients undergoing ERCP,but is high in specific subgroups,s...Post-endoscopic retrograde cholangiopancreatography(ERCP)cholecystitis(PEC)is a recognized adverse event associated with ERCP.The incidence of PEC is low in patients undergoing ERCP,but is high in specific subgroups,such as those receiving fully-covered self-expandable metallic stents(SEMS).Several risk factors contribute to PEC,including gallbladder(GB)-related factors like tumor involvement of the orifice of the cystic duct(OCD)or feeding artery,and associated gallstones.Stent-related factors,such as covered stent placement and high axial force stents,and procedure-related factors,including stent placement across the OCD and contrast injection into the GB,further elevate the risk.Prevention strategies focus on modifying techniques,such as careful contrast administration and stent selection(uncovered or low axial force SEMS),and considering prophylactic GB drainage through endoscopic transpapillary GB drainage(ETGBD)or endoscopic ultrasound-guided GB drainage(EUS-GBD),especially in high-risk patients.Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage,endoscopic techniques(ETGBD,EUS-GBD),and cholecystectomy.The choice of treatment depends on the severity of cholecystitis,the patient's condition,and other factors.The present review summarizes the currently available literature on the incidence,predictors,prevention,and management of PEC.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 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 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.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Endoscopic retrograde cholangiopancreatography(ERCP)is a vital diagnostic and therapeutic technique in evaluating and treating biliary and pancreatic disorders.Since its inception in the late 20th century,ERCP has transitioned from a mostly diagnostic instrument to a chiefly interventional procedure,owing to the emergence of less invasive imaging techniques like magnetic resonance cholangiopancreatography and endoscopic ultrasonography.Successful biliary cannulation is the most important and difficult step of the procedure.However,there are many challenges associated with cannulation,such as the anatomy of the major duodenal papilla,the direction of the common bile duct and pancreatic duct in the ampulla of Vater,the presence of periampullary diverticula,and scope position.Advanced techniques for cannulation are necessary when basic techniques fail.Double guidewire,precut methods,and transpancreatic sphincterotomy are examples of these advanced techniques.This review aims to summarize the challenges of biliary cannulation and tips for performing cannulation techniques.
文摘BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention.This review focuses on the surgical management of key ERCP-related complications:Post-sphincterotomy bleeding,perforations,stent migration-induced perforations,and Dormia basket impaction.Although many complications can be managed endoscopically,surgery remains essential in refractory cases or when less invasive methods fail.Post-sphincterotomy bleeding,although often controlled endoscopically,may necessitate surgical ligation when hemorrhage persists.Perforations,classified by anatomical type,require tailored surgical approaches-primary repair for type I and biliary diversion with defect closure for types II and III.Stent migration-induced perforations,which may lead to peritonitis or abscess formation,often require surgery due to their variable clinical presentation and the lack of standardized management guidelines.Dormia basket impaction,although rare,may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective.Early recognition,multidisciplinary collaboration,and individualized treatment strategies are pivotal in reducing morbidity and mortality.This review underscores evolving surgical approaches,emphasizing the importance of timely,patient-specific decisions to improve outcomes in severe ERCP-related complications.
基金Supported by Department of Science and Technology of Liaoning Province,No.2024JH2/102600288 and No.2022JH2/101500013。
文摘BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.
文摘BACKGROUND Atrial fibrillation(AF)remains the most common cardiac arrhythmia.The safety of endoscopic retrograde cholangiopancreatography(ERCP)in patients with AF remains largely unknown.AIM To analyze the effect of AF on hospital outcomes in patients undergoing ERCP.METHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample database.Adult patients with AF who underwent an inpatient ERCP were identified,then stratified by timing of ERCP,via international classification of diseases-10 codes.The primary outcome was all-cause in-hospital mortality.Secondary outcomes,including resource utilization,were assessed.Statistical analysis was performed using STATA software.RESULTS Of the 433245 patients that underwent an ERCP,49615 had a diagnosis of AF.Patients with AF had a significantly higher in-hospital mortality compared to those without AF[3.82%vs 1.13%,odds ratio(OR)=1.93,P<0.01].AF was significantly associated with increased hospital stay(+1.71 days),hospital charges($21210),shock(OR=2.17),sepsis(OR=1.34),intensive care unit admission(OR=2.41),acute kidney injury(OR=1.51),as well as a decreased likelihood of discharge to home(OR=0.59),(all with P<0.01).These results were consistent after propensity score matching.Upon subgroup analysis,patients with AF,whom underwent ERCP>72 hours,had worse outcomes including higher inhospital mortality(adjusted OR=1.47,P<0.01).CONCLUSION By way of this large,national analysis it appears AF is associated with significantly worse hospitalization outcomes,inducing increased mortality,in those undergoing ERCP.Further prospective investigation is warranted to potentially guide clinical recommendations for patients with AF undergoing ERCP in this setting.
文摘Post-endoscopic retrograde cholangiopancreatography(ERCP)cholecystitis(PEC)is a recognized adverse event associated with ERCP.The incidence of PEC is low in patients undergoing ERCP,but is high in specific subgroups,such as those receiving fully-covered self-expandable metallic stents(SEMS).Several risk factors contribute to PEC,including gallbladder(GB)-related factors like tumor involvement of the orifice of the cystic duct(OCD)or feeding artery,and associated gallstones.Stent-related factors,such as covered stent placement and high axial force stents,and procedure-related factors,including stent placement across the OCD and contrast injection into the GB,further elevate the risk.Prevention strategies focus on modifying techniques,such as careful contrast administration and stent selection(uncovered or low axial force SEMS),and considering prophylactic GB drainage through endoscopic transpapillary GB drainage(ETGBD)or endoscopic ultrasound-guided GB drainage(EUS-GBD),especially in high-risk patients.Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage,endoscopic techniques(ETGBD,EUS-GBD),and cholecystectomy.The choice of treatment depends on the severity of cholecystitis,the patient's condition,and other factors.The present review summarizes the currently available literature on the incidence,predictors,prevention,and management of PEC.
