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
Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or complicated.Within the last decade,endoscopic management of these col...Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or complicated.Within the last decade,endoscopic management of these collections via endoscopic ultrasound-guided transmural drainage has become the gold standard treatment for encapsulated pancreatic collections with high clinical success and lower morbidity compared to traditional surgery and percutaneous drainage.Proper understanding of anatomic landmarks,including assessment of the main pancreatic duct and any associated lesions–such as disruptions and strictures-are key to achieving clinical success,reducing the need for reintervention or recurrence,especially in cases with suspected disconnected pancreatic duct syndrome.Additionally,proper review of imaging and anatomic landmarks,including collection location,are pivotal to determine type and size of pancreatic stenting as well as approach using long-term transmural indwelling plastic stents.Pancreatography to adequately assess the main pancreatic duct may be performed by two methods:Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically via retrograde cholangiopancreatography.Despite the critical need to understand anatomy via pancrea tography and assess the main pancreatic duct,a standardized approach or uniform assessment strategy has not been described in the literature.Therefore,the aim of this review was to clarify the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and to propose a new classification system to aid in proper assessment and endoscopic treatment.展开更多
BACKGROUND The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography(ERCP)is still controversial.AIM To assess whether antibiotic prophylaxis reduces the rates of complications in patients ...BACKGROUND The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography(ERCP)is still controversial.AIM To assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective ERCP.METHODS This systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.A comprehensive search of multiple electronic databases was performed.Only randomized controlled trials were included.The outcomes analyzed included bacteremia,cholangitis,sepsis,pancreatitis,and mortality.The risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled trials.The quality of evidence was assessed by the Grading of Recommendation Assessment,Development,and Evaluation.Meta-analysis was performed using the Review Manager 5.4 software.RESULTS Ten randomized controlled trials with a total of 1757 patients that compared the use of antibiotic and non-antibiotic prophylaxis in patients undergoing elective ERCP were included.There was no significant difference between groups regarding incidence of cholangitis after ERCP[risk difference(RD)=-0.02,95%confidence interval(CI):-0.05,0.02,P=0.32,cholangitis in patients with suspected biliary obstruction(RD=0.02,95%CI:-0.08 to 0.13,P=0.66),cholangitis on intravenous antibiotic prophylaxis(RD=-0.02,95%CI:-0.05 to 0.01,P=0.25),septicemia(RD=-0.02,95%CI:-0.06 to 0.01,P=0.25),pancreatitis(RD=-0.02,95%CI:-0.06 to 0.01,P=0.19),and allcause mortality(RD=0.00,95%CI:-0.01 to 0.01,P=0.71).However,the antibiotic prophylaxis group presented a 7%risk reduction in the incidence of bacteremia(RD=-0.07,95%CI:-0.14 to-0.01,P=0.03).CONCLUSION The prophylactic use of antibiotics in patients undergoing elective ERCP reduces the risk of bacteremia but does not appear to have an impact on the rates of cholangitis,septicemia,pancreatitis,and mortality.展开更多
BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent an...BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas.In a recent case series,EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia.There have been no previous reports on preemptive EVT after pancreaticoduodenectomy.CASE SUMMARY We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice,choluria,fecal acholia,abdominal pain,and fever.Admission examinations revealed leukocytosis and hyperbilirubinemia(total:13 mg/dL;conjugated:12.1 mg/dL).Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct.Magnetic resonance imaging demonstrated a stenotic area,and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreaticoduodenectomy,preemptive endoluminal vacuum therapy was performed.The system comprised a nasogastric tube,gauze,and an antimicrobial incise drape.The negative pressure was 125 mmHg,and no adverse events occurred.The patient was discharged on postoperative day 5 without any symptoms.CONCLUSION Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.展开更多
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Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or complicated.Within the last decade,endoscopic management of these collections via endoscopic ultrasound-guided transmural drainage has become the gold standard treatment for encapsulated pancreatic collections with high clinical success and lower morbidity compared to traditional surgery and percutaneous drainage.Proper understanding of anatomic landmarks,including assessment of the main pancreatic duct and any associated lesions–such as disruptions and strictures-are key to achieving clinical success,reducing the need for reintervention or recurrence,especially in cases with suspected disconnected pancreatic duct syndrome.Additionally,proper review of imaging and anatomic landmarks,including collection location,are pivotal to determine type and size of pancreatic stenting as well as approach using long-term transmural indwelling plastic stents.Pancreatography to adequately assess the main pancreatic duct may be performed by two methods:Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically via retrograde cholangiopancreatography.Despite the critical need to understand anatomy via pancrea tography and assess the main pancreatic duct,a standardized approach or uniform assessment strategy has not been described in the literature.Therefore,the aim of this review was to clarify the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and to propose a new classification system to aid in proper assessment and endoscopic treatment.
文摘BACKGROUND The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography(ERCP)is still controversial.AIM To assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective ERCP.METHODS This systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.A comprehensive search of multiple electronic databases was performed.Only randomized controlled trials were included.The outcomes analyzed included bacteremia,cholangitis,sepsis,pancreatitis,and mortality.The risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled trials.The quality of evidence was assessed by the Grading of Recommendation Assessment,Development,and Evaluation.Meta-analysis was performed using the Review Manager 5.4 software.RESULTS Ten randomized controlled trials with a total of 1757 patients that compared the use of antibiotic and non-antibiotic prophylaxis in patients undergoing elective ERCP were included.There was no significant difference between groups regarding incidence of cholangitis after ERCP[risk difference(RD)=-0.02,95%confidence interval(CI):-0.05,0.02,P=0.32,cholangitis in patients with suspected biliary obstruction(RD=0.02,95%CI:-0.08 to 0.13,P=0.66),cholangitis on intravenous antibiotic prophylaxis(RD=-0.02,95%CI:-0.05 to 0.01,P=0.25),septicemia(RD=-0.02,95%CI:-0.06 to 0.01,P=0.25),pancreatitis(RD=-0.02,95%CI:-0.06 to 0.01,P=0.19),and allcause mortality(RD=0.00,95%CI:-0.01 to 0.01,P=0.71).However,the antibiotic prophylaxis group presented a 7%risk reduction in the incidence of bacteremia(RD=-0.07,95%CI:-0.14 to-0.01,P=0.03).CONCLUSION The prophylactic use of antibiotics in patients undergoing elective ERCP reduces the risk of bacteremia but does not appear to have an impact on the rates of cholangitis,septicemia,pancreatitis,and mortality.
文摘BACKGROUND Pancreaticoduodenectomy is a technically demanding operation,with reported morbidity rates of approximately 40%-50%.A novel idea is to use endoscopic vacuum therapy(EVT)in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas.In a recent case series,EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia.There have been no previous reports on preemptive EVT after pancreaticoduodenectomy.CASE SUMMARY We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice,choluria,fecal acholia,abdominal pain,and fever.Admission examinations revealed leukocytosis and hyperbilirubinemia(total:13 mg/dL;conjugated:12.1 mg/dL).Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct.Magnetic resonance imaging demonstrated a stenotic area,and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreaticoduodenectomy,preemptive endoluminal vacuum therapy was performed.The system comprised a nasogastric tube,gauze,and an antimicrobial incise drape.The negative pressure was 125 mmHg,and no adverse events occurred.The patient was discharged on postoperative day 5 without any symptoms.CONCLUSION Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.
