Association of procedure length on outcomes and adverse events of endoscopic retrograde cholangiopancreatography

Objective:The aims of this study were to determine the effects of length of procedure on endoscopic retrograde cholangiopancreatography(ERCP)outcomes and adverse events.Methods:All ERCP procedures,performed by experienced advanced endoscopists,in patients without prior papillary intervention from 2006 to 2008 were reviewed.Procedures were arbitrarily divided into two groups:shorter procedures(SP),with a duration shorter than the overall mean procedure length,and longer procedures(LP),with a duration longer than overall mean procedure length.Length of procedure was defined as the time from endoscope insertion to endoscope removal.Results:Two hundred and ninety-five procedures were included in the analysis.Mean procedure length was 45.630.1 min.One hundred and seventy-seven procedures(60%)were SP and 118(40%)were LP.There were no differences between the groups with regard to patients’ages,genders,race,or trainee participation.SP cases were more likely to be biliary vs pancreatic or bi-ductal evaluations(P=0.03).LP had significantly higher complexity scores(34%with>3 vs 13%;P=0.046)and were more likely to require pre-cut papillotomy(39%vs 15%;P<0.001).There was no significant difference between the groups in overall completion rates(91.5%LP vs 96%SP;P=0.10)or adverse events(10.2%LP vs 6.2%SP;P=0.21).However,LP cases were associated with higher rates of post-ERCP bleeding(4.2%vs 0.6%;P=0.029).Conclusion:There was no significant difference in outcomes or overall adverse events between shorter and longer ERCP procedures.However,longer procedures were associated with higher procedure complexity,higher utilization of pre-cut technique,and increased risk of bleeding.

A rare cause of gastro-intestinal hemorrhage in a patient with a Roux-en-Y gastric bypass

This case illustrates a rare cause of gastro-intestinal bleeding following bariatric surgery.Though it is essential to rule out common causes of variceal formation accompanied by intermittent,profuse bleeding,there should be a high degree of suspicion of this rare etiology in patients who have previously undergone alteration of their anatomy,especially Roux-en-Y gastric bypass(RYGB).The case emphasizes the need for a multidisciplinary medical-surgical team in evaluating and treating patients who present with complex intra-abdominal pathology.