• Clinical Endoscopy
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• 제56권6호
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• pp.790-794
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• 2023

Background/Aims: Situs inversus viscerum (SIV) is a congenital condition defined by left-to-right transposition of all visceral organs. This anatomical variant has caused technical challenges in endoscopic retrograde cholangiopancreatography (ERCP). Data on ERCP in patients with SIV are limited to case reports of unknown clinical and technical success rates. This study aimed to evaluate the clinical and technical success rates of ERCP in patients with SIV. Methods: Data from patients with SIV who underwent ERCP were retrospectively reviewed. The data were collected by querying the nationwide Veterans Affairs Health System database for patients diagnosed with SIV who underwent ERCP. Patient demographics and procedural characteristics were collected. Results: Eight patients with SIV who underwent ERCP were included. Choledocholithiasis was the most common indication for ERCP (62.5%). The technical success rate was 63%. Subsequent ERCP with interventional radiology-assisted rendezvous has increased the technical success rate to 100%. Clinical success was achieved in 63% of cases. Among cases of subsequent rendezvous ERCP after conventional ERCP failure, clinical success was achieved in 100%. Conclusions: The clinical and technical success rates of ERCP in patients with SIV were both 63%. In patients with SIV in whom ERCP fails, interventional radiology-assisted rendezvous ERCP can be considered.

• Investigative Magnetic Resonance Imaging
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• 제1권1호
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• pp.148-153
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• 1997

목적: 다양한 간외담도질환에서 3차원적 자기공명췌담도조영술(MR cholangiopancreatography, MRCP)의 진단적 가치를 내시경적 역생성 췌담도조영술(ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY, ERCP)와 비교하여 알아보고자 하였다. 대상 및 방법: 간외담도질환이 의심되는 46명의 환자에 대하여 MRCP와 ERCP를 각각 시행하였다. MRCP는 reverse fast imaging with a steady-state free precession(reverse FISP:PSIF) 기법을 이용하여 얻어낸 후 MIP algorithm을 이용하여 재구성하였다. 담도확장여부와 폐쇄부위 진단에 대한 MRCP의 정확성을 ERCP를 최적기준으로 하여 평가하였다. 또한 악성 및 양성병변의 감별과 종합적인 진단정확도를 MRCP와 ERCP간에 비교하였다. 결과: MRCP의 담도확장여부 예측은 민감도 94.6%, 특이도 75.0%, 정확도 91.1%였다. 폐쇄부위 예측의 정확도는 87.0%였다. 악성과 양성병변의 감별에 있어 MRCP와 ERCP의 민감도, 특이도, 정확도는 각각 76.2%, 87.5%, 82.2%와 71.4%, 83.3%, 77.8%였다. 각각의 지롼에 대한 전체적 진단의 정확도는 MRCP가 60.0%, ERCP가 55.6%였다. 결론: 3D MRCP는 간외담도질환에 있어 ERCP와 비교하여 손색없는 진단적 가치를 가지며, 앞으로 ERCP를 대체할 수 있는 좋은 검사방법이라고 생각된다.

• Clinical Endoscopy
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• 제56권4호
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• pp.433-445
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• 2023

Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient's clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

• Clinical Endoscopy
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• 제56권5호
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• pp.578-589
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• 2023

Background/Aims: The safety of endoscopic retrograde cholangiopancreatography (ERCP) in hepatic cirrhosis and the impact of Child-Pugh class on post-ERCP complications need to be better studied. We investigated the post-ERCP complication rates in patients with cirrhosis compared with those without cirrhosis. Methods: We conducted a literature search of relevant databases to identify studies that reported post-ERCP complications in patients with hepatic cirrhosis. Results: Twenty-four studies comprising 28,201 patients were included. The pooled incidence of post-ERCP complications in cirrhosis was 15.5% (95% confidence interval [CI], 11.8%-19.2%; I²=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI, 3.1%-7.2%; I²=91.5%), bleeding 3.6% (95% CI, 2.8%-4.5%; I²=67.5%), cholangitis 2.9% (95% CI, 1.9%-3.8%; I²=83.4%), and perforation 0.3% (95% CI, 0.1%-0.5%; I²=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41; 95% CI, 1.16-1.71; I²=56.3%). The risk of individual odds of adverse events between cirrhosis and non-cirrhosis was as follows: pancreatitis (RR, 1.25; 95% CI, 1.06-1.48; I²=24.8%), bleeding (RR, 1.94; 95% CI, 1.59-2.37; I²=0%), cholangitis (RR, 1.15; 95% CI, 0.77-1.70; I²=12%), and perforation (RR, 1.20; 95% CI, 0.59-2.43; I²=0%). Conclusions: Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권5호
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• pp.406-412
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• 2022

Purpose: The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary and pancreatic diseases in the pediatric population was not well defined until recently. Our aim was to determine the feasibility, outcomes, and safety of ERCP in a local pediatric population, particularly using standard adult endoscopes and accessories. Methods: This retrospective study was conducted at the National Hospital of Sri Lanka. Pediatric patients (aged <16 years) who underwent ERCP from January 2015 to December 2020 were included in the study. Data, including patient demographics, indications for the procedure, technical details, and associated complications, were collected from the internal database and patient records maintained at the hospital. Results: The study included 62 patients who underwent a total of 98 ERCP procedures. All the procedures were performed by adult gastroenterologists using standard adult endoscopes and accessories. The mean age was 11.01±3.47 years. Pancreatic diseases were the major indications for most of the procedures (n=81, 82.7%), with chronic pancreatitis being the most common. Seventeen procedures (17.3%) were carried out for biliary diseases. Overall cannulation and technical success rates were 87.8% and 85.7%, respectively. Stent placement was the most common therapeutic intervention (n=66; 67.4%). Post-ERCP pancreatitis was the most common complication, occurring in eight patients (8.2%). Conclusion: ERCP can be successfully and safely performed in pediatric populations using standard adult endoscopes and accessories with complications similar to those of adults. Adult ERCP services can be offered to most pediatric patients without additional costs of pediatric endoscopes and accessories.

• 한국방사선학회논문지
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• 제13권1호
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• pp.1-8
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• 2019

본 연구의 목적은 ERCP 검사 시 테이블 보조 기구 사용의 유용성을 평가함에 있다. 이 연구를 위해 ERCP 검사를 시행한 15명의 환자(평균연령: $76.0{\pm}11.4$ 세)와 검사에 참여했던 6명의 의료진을 대상으로 하여 테이블 보조 기구 사용의 유용성 평가를 위해 설문조사를 실시하였고 안락한 정도, 심리적 안정성 및 만족도 항목에 대하여 최저 1점에서 최대 5점 범위로 집계하여 평가하였다. 안락한 정도에 관한 결과에 있어서는 테이블 보조 기구 없이 진행한 ERCP 검사에서 환자들이 $1.7{\pm}0.5$점으로 불편하다고 느꼈으며, 이와 반대로 테이블 보조 기구를 사용한 경우에는 $4.4{\pm}0.5$점(p-value${\leq}0.000$)으로 편안함을 느꼈다고 조사되었다. 심리적 안정성에 관한 결과에 있어서는 환자들이 테이블 보조기구 사용에 $4.8{\pm}0.4$점으로 안정감을 보였다. 추가적으로 테이블 보조 기구 사용에 대한 환자들의 만족도는 $4.9{\pm}0.3$점이었다. 본 결과를 고려할 때에 ERCP 검사에 있어 테이블 보조 기구의 사용은 그 유용성이 매우 높음을 알 수 있었다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권16호
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• pp.6823-6827
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• 2014

Objective: This study was conducted to investigate the efficacy of pancreatic drainage for pain relief in advanced pancreatic cancer. Method: Seventy-one patients with pancreatic carcinoma were divided into two groups: dilated and non-dilated pancreatic ducts. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP), endoscopic biliary stenting and pancreatic stenting. Visual Analog Scale (VAS) scores, pain remission rates and survival time were evaluated during follow-up. Results: The post-ERCP VAS score of the dilated group was lower than that of the non-dilated group at 1 and 3 months post-ERCP. There was no difference at 6 months. The pain remission rate in the dilated duct group was significantly higher than that in non-dilated duct group in 1 and 3 months post-ERCP. The median survival times were 8.17 and 8.22 months respectively. Conclusion: Endoscopic pancreatic drainage can relieve pain of advanced pancreatic cancer accompanied by safe dilation of the pancreatic duct.

• Clinical Endoscopy
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• 제56권3호
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• pp.290-297
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• 2023

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive endoscopic technique that has many diagnostic and therapeutic implications. It is a procedure with small but significant life-threatening complications. To ensure the best possible care, minimize complications, and improve the quality of health care, a constant review of the performance of the operator using ideal benchmark standards is needed. Hence, quality indicators are necessary. The American and European Societies of Gastrointestinal Endoscopy have provided guidelines on quality measures for ERCP, which describe the skills to be developed and training to be implemented in performing quality ERCP. These guidelines have divided the indicators into pre-procedure, intraprocedural, and post-procedure measures. The focus of this article was to review the quality indicators of ERCP.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.136-142
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• 2011

Purpose: Blunt pancreatic injury has a high mortality rate, especially if adequate management is delayed. Although many guidelines exist for diagnosis and treatment, there is no consensus to date. Therefore, we analyzed the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool for the treatment of traumatic pancreatic injury. Methods: We retrospectively reviewed the electronic medical records (EMR) database at Asan Medical Center (Seoul, South Korea) to identify all patients diagnosed with trauma to the pancreas between June 2003 and December 2010. Clinical and operative findings, CT (computed tomography) images, and ERCP findings were assessed. Results: A total of 40 patients were evaluated in this study. Of these, 14 patients underwent diagnostic ERCP, and 26 did not. Of the 14 patients who underwent diagnostic ERCP, 5 were found to have normal pancreatic ducts, thereby preventing a needless laparotomy in these patients. Of the patients diagnosed with ductal injury, four were treated with endoscopic intervention, and four underwent an exploratory laparotomy. The remaining patient was treated with radiologic intervention (percutaneous drainage) to manage pancreatic pseudocyst formation. Conclusion: Our findings suggest that ERCP is a beneficial diagnostic and therapeutic modality for the treatment of traumatic pancreatic injury.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1539-1541
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• 2012

Cholangitis is relatively uncommon but associated mortality is high due to the predisposition in people with underlying disease. For this recognition of contributing risk factors is necessary. Therefore, the present descriptive-analytical cross-sectional survey was designed to determine contributing risk factors for post-ERCP cholangitis in patients with pancreatic cancer. From 2005 to 2010, 110 consecutive cases of pancreatic cancer attending to a tertiary referral centre (Taleghani Hospital), Tehran, Iran were recruited. The patients all underwent stenting via endoscopic retrograde cholangiopancreatography (ERCP). On univariate analysis, a metallic stent type (95% confidence interval (CI) 1.025-11.34, P=0.037), having no jaundice (1.44-2.22, P=0.009), having no pain (1.32-1.91, P=0.026), a history of prior ERCP (1.16-10.37, P=0.020), and having a proximal biliary stone (1.002-5.93, P=0.046) were related to cholangitis. However on multivariate analysis, none of these factors were found to be contributing risk factors. Cholangitis is avoidable with adequate biliary drainage. Because success rates are higher and complication rates lower for endoscopists performing large volumes of ERCP, performance of the procedure should be concentrated as much as possible in institutions with endoscopists having adequate experience. Patients with a high risk for complications may be best served by referral to an advanced center.