Subcapsular hepatic haematoma is a rare complication of endoscopic retrograde cholangiopancrea-tography (ERCP), and there are few reports about this unusual complication worldwide. The primary symptom of most cases re...Subcapsular hepatic haematoma is a rare complication of endoscopic retrograde cholangiopancrea-tography (ERCP), and there are few reports about this unusual complication worldwide. The primary symptom of most cases reported in the literature is abdominal pain. We report an unusual case with the primary symptom of fever. A 56-year-old man who had a six-month history of recurrent episodes of upper abdominal pain was diagnosed with a common bile duct stone by magnetic resonance cholangiopancrea-tography. Endoscopic biliary sphincterotomy was performed, and stones from the common bile duct were successfully extracted with a basket. The patient had a persistent fever after ERCP, and treatment with intravenous antibiotics was unsuccessful. Computed tomography showed a 13 cm × 6 cm subcapsular hepatic haematoma filled with air and liquid on the surface of the right hepatic lobe. The patient was successfully treated with peritoneal drainage under B-ultra guidance. Subcapsular liver haematoma should be considered when hard-toexplain symptoms persist in the early period after ERCP. Percutaneous drainage is an effective treatment.展开更多
AIM: To assess the efficacy and safety of a patientpositioning device(EZ-FIX) for endoscopic retrograde cholangiopancreatography(ERCP).METHODS: A total of 105 patients were randomized to the EZ-FIX(n = 53) or non-EZ-F...AIM: To assess the efficacy and safety of a patientpositioning device(EZ-FIX) for endoscopic retrograde cholangiopancreatography(ERCP).METHODS: A total of 105 patients were randomized to the EZ-FIX(n = 53) or non-EZ-FIX(n = 52) group in this prospective study. Midazolam and propofol,titrated to provide an adequate level of sedation during therapeutic ERCP, were administered by trained registered nurses under endoscopist supervision.Primary outcome measures were the total dose of propofol and sedative-related complications, including hypoxia and hypotension. Secondary outcome measures were recovery time and sedation satisfaction of the endoscopist, nurses, and patients.RESULTS: There was no significant difference in the rate of hypoxia, but there was a statistical trend(EX-FIX group; n = 4, 7.55%, control group; n = 6, 11.53%,P = 0.06). The mean total dose of propofol was lower in the EZ-FIX group than in the non-EZ-FIX group(89.43 ± 49.8 mg vs 112.4 ± 53.8 mg, P = 0.025).In addition, the EZ-FIX group had a shorter mean recovery time(11.23 ± 4.61 mg vs 14.96 ± 5.12 mg, P< 0.001). Sedation satisfaction of the endoscopist and nurses was higher in the EX.FIX group than in the nonEZ-FIX group. Technical success rates of the procedure were 96.23% and 96.15%, respectively(P = 0.856).Procedure-related complications did not differ by group(11.32% vs 13.46%, respectively, P = 0.735).CONCLUSION: Using EZ-FIX reduced the total dose of propofol and the recovery time, and increased the satisfaction of the endoscopist and nurses.展开更多
AIM:To investigate the efficacy and safety of propofol sedation for endoscopic retrograde cholangiopancreatography(ERCP).METHODS:Databases including PubMed,Embase,and the Cochrane Central Register of Controlled Trials...AIM:To investigate the efficacy and safety of propofol sedation for endoscopic retrograde cholangiopancreatography(ERCP).METHODS:Databases including PubMed,Embase,and the Cochrane Central Register of Controlled Trials updated as of October 2010 were searched.Main outcome measures were ERCP procedure duration,recovery time,incidence of hypotension and hypoxia.RESULTS:Six trials with a total of 663 patients were included.The pooled mean difference in ERCP procedure duration between the propofol and traditional sedative agents was-8.05(95%CI:-16.74 to 0.63),with no significant difference between the groups.Thepooled mean difference in the recovery time was-18.69(95%CI:-25.44 to-11.93),which showed a significant reduction with use of propofol sedation.Compared with traditional sedative agents,the pooled OR with propofol sedation for ERCP causing hypotension or hypoxia was 1.69(95%CI:0.82-3.50)and 0.90(95%CI:0.55-1.49),respectively,which indicated no significant difference between the groups.CONCLUSION:Propofol sedation during ERCP leads to shorter recovery time without an increase of cardiopulmonary side effects.Propofol sedation can provide adequate sedation during ERCP.展开更多
Portal vein cannulation is a rare complication of endo-scopic retrograde cholangiopancreatography(ERCP).It has been reported that it usually occurs after endo-scopic sphincterotomy,whereas in cases without prior sphin...Portal vein cannulation is a rare complication of endo-scopic retrograde cholangiopancreatography(ERCP).It has been reported that it usually occurs after endo-scopic sphincterotomy,whereas in cases without prior sphincterotomy,the presence of portobiliary fistulas has been shown.Here,we present a case in which cannulation of the portal vein occurred despite careful wire-guided cannulation and the absence of sphinc-terotomy.Although fatal cases of cerebral and pulmo-nary air and/or bile embolism have been reported in patients with combined portal and hepatic vein trauma after ERCP and sphincterotomy,isolated portal vein cannulation,as in the current case,does not usu-ally result in mortality or serious morbidity.However,awareness of this rare complication is important so that no further intervention is performed.展开更多
Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangio-pancre-atography (ERCP) and its incidence may exceed 25% in some high-risk patient subsets. In some patients, pancreatitis ...Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangio-pancre-atography (ERCP) and its incidence may exceed 25% in some high-risk patient subsets. In some patients, pancreatitis may follow a severe course with pancreatic necrosis, multiorgan failure, permanent disability and even death. Hence, approaches which minimize both the incidence and severity of post-ERCP pancreatitis are worth pursuing. Pancreatic stents have been used with some success in the prevention of post-ERCP, while so far pharmacological trials have yielded disappointing results. A recent multicenter, randomized, placebo-controlled, double-blind trial has shown that rectally administered indomethacin is effective in reducing the incidence of post-ERCP pancreatitis, the occurrence of episodes of moderate-to-severe pancreatitis and the length of hospital stay in high-risk patients. These results together with the demonstration that rectal administration of indomethacin is not associated with en-hanced risk of bleeding strongly support the use of this drug in the prophylaxis of post-ERCP pancreatitis.展开更多
目的:探讨早期内镜治疗急性胆源性胰腺炎(acute biliary pancreatitis,ABP)患者的疗效.方法:将确诊为ABP的86例患者,随机分为内镜组(n=42)、传统治疗组(n=46),对比分析两组患者白细胞、肝功能及血淀粉酶恢复时间,腹痛缓解时间,住院天数...目的:探讨早期内镜治疗急性胆源性胰腺炎(acute biliary pancreatitis,ABP)患者的疗效.方法:将确诊为ABP的86例患者,随机分为内镜组(n=42)、传统治疗组(n=46),对比分析两组患者白细胞、肝功能及血淀粉酶恢复时间,腹痛缓解时间,住院天数,并发症发生率及死亡率.结果:内镜组与传统组相比,白细胞恢复时间(9.7±2.6d vs 13.3±3.9d,P<0.05)、肝功能恢复正常时间(12.5±5.1d vs 21.3±6.5d,P<0.05)、血淀粉酶恢复时间(8.2±2.1 vs 12.5±3.3,P<0.05)、腹痛腹胀缓解时间(7.7±2.7d vs 11.4±3.7d,P<0.05)、住院天数均明显缩短(16.1±5.1d vs 23.3±7.6d,P<0.05);总并发症均降低(12.5% vs 23.8%,P<0.05),总死亡率与传统组相比差异无统计学意义.结论:早期内镜治疗ABP,微创、安全、疗效确切,应大力推广.展开更多
The effect of fetal radiation during endoscopic retro-grade cholangiopancreatography (ERCP) on pregnant women is a very interesting topic. Smith et al recently estimated the fetal radiation exposure in pregnant women ...The effect of fetal radiation during endoscopic retro-grade cholangiopancreatography (ERCP) on pregnant women is a very interesting topic. Smith et al recently estimated the fetal radiation exposure in pregnant women undergoing ERCPs using thermoluminescent dosimeters (TLDs). The authors concluded that TLDs are unnecessary during ERCP with modified techniques. We believe that an extreme caution is needed in clinical practice before drawing such conclusions when they are not strongly supported by enough experimental evidence. Therefore, we recommend that fetal radiation exposure be monitored in clinical practice by using dosimeters, bearing in mind that all relevant techniques to control and minimize the exposure must be applied.展开更多
Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum.In this study,we report successful biliary cannulation in three patients follow...Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum.In this study,we report successful biliary cannulation in three patients following intubation of the distal tip of the duodenoscope into the duodenal diverticulum and locating the major papilla.No complications occurred during the operation or during the postoperative period.This method didn't need second incubation an endoscope and might lower the burden of patients.So this skill is useful to deal with the papilla hidden inside the large diverticulum because of its safety and convenience.展开更多
Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminat...Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome. Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.展开更多
文摘Subcapsular hepatic haematoma is a rare complication of endoscopic retrograde cholangiopancrea-tography (ERCP), and there are few reports about this unusual complication worldwide. The primary symptom of most cases reported in the literature is abdominal pain. We report an unusual case with the primary symptom of fever. A 56-year-old man who had a six-month history of recurrent episodes of upper abdominal pain was diagnosed with a common bile duct stone by magnetic resonance cholangiopancrea-tography. Endoscopic biliary sphincterotomy was performed, and stones from the common bile duct were successfully extracted with a basket. The patient had a persistent fever after ERCP, and treatment with intravenous antibiotics was unsuccessful. Computed tomography showed a 13 cm × 6 cm subcapsular hepatic haematoma filled with air and liquid on the surface of the right hepatic lobe. The patient was successfully treated with peritoneal drainage under B-ultra guidance. Subcapsular liver haematoma should be considered when hard-toexplain symptoms persist in the early period after ERCP. Percutaneous drainage is an effective treatment.
基金Supported by Korea Healthcare Technology R and D Project,Ministry of Health and Welfare,South Korea(A100054)
文摘AIM: To assess the efficacy and safety of a patientpositioning device(EZ-FIX) for endoscopic retrograde cholangiopancreatography(ERCP).METHODS: A total of 105 patients were randomized to the EZ-FIX(n = 53) or non-EZ-FIX(n = 52) group in this prospective study. Midazolam and propofol,titrated to provide an adequate level of sedation during therapeutic ERCP, were administered by trained registered nurses under endoscopist supervision.Primary outcome measures were the total dose of propofol and sedative-related complications, including hypoxia and hypotension. Secondary outcome measures were recovery time and sedation satisfaction of the endoscopist, nurses, and patients.RESULTS: There was no significant difference in the rate of hypoxia, but there was a statistical trend(EX-FIX group; n = 4, 7.55%, control group; n = 6, 11.53%,P = 0.06). The mean total dose of propofol was lower in the EZ-FIX group than in the non-EZ-FIX group(89.43 ± 49.8 mg vs 112.4 ± 53.8 mg, P = 0.025).In addition, the EZ-FIX group had a shorter mean recovery time(11.23 ± 4.61 mg vs 14.96 ± 5.12 mg, P< 0.001). Sedation satisfaction of the endoscopist and nurses was higher in the EX.FIX group than in the nonEZ-FIX group. Technical success rates of the procedure were 96.23% and 96.15%, respectively(P = 0.856).Procedure-related complications did not differ by group(11.32% vs 13.46%, respectively, P = 0.735).CONCLUSION: Using EZ-FIX reduced the total dose of propofol and the recovery time, and increased the satisfaction of the endoscopist and nurses.
基金Supported by The grants from the Department of Anesthesiology and Intensive Care of Changhai Hospital,Shanghai,China
文摘AIM:To investigate the efficacy and safety of propofol sedation for endoscopic retrograde cholangiopancreatography(ERCP).METHODS:Databases including PubMed,Embase,and the Cochrane Central Register of Controlled Trials updated as of October 2010 were searched.Main outcome measures were ERCP procedure duration,recovery time,incidence of hypotension and hypoxia.RESULTS:Six trials with a total of 663 patients were included.The pooled mean difference in ERCP procedure duration between the propofol and traditional sedative agents was-8.05(95%CI:-16.74 to 0.63),with no significant difference between the groups.Thepooled mean difference in the recovery time was-18.69(95%CI:-25.44 to-11.93),which showed a significant reduction with use of propofol sedation.Compared with traditional sedative agents,the pooled OR with propofol sedation for ERCP causing hypotension or hypoxia was 1.69(95%CI:0.82-3.50)and 0.90(95%CI:0.55-1.49),respectively,which indicated no significant difference between the groups.CONCLUSION:Propofol sedation during ERCP leads to shorter recovery time without an increase of cardiopulmonary side effects.Propofol sedation can provide adequate sedation during ERCP.
文摘Portal vein cannulation is a rare complication of endo-scopic retrograde cholangiopancreatography(ERCP).It has been reported that it usually occurs after endo-scopic sphincterotomy,whereas in cases without prior sphincterotomy,the presence of portobiliary fistulas has been shown.Here,we present a case in which cannulation of the portal vein occurred despite careful wire-guided cannulation and the absence of sphinc-terotomy.Although fatal cases of cerebral and pulmo-nary air and/or bile embolism have been reported in patients with combined portal and hepatic vein trauma after ERCP and sphincterotomy,isolated portal vein cannulation,as in the current case,does not usu-ally result in mortality or serious morbidity.However,awareness of this rare complication is important so that no further intervention is performed.
基金Supported by The Fondazione "Umberto Di Mario" Onlus,Rome
文摘Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangio-pancre-atography (ERCP) and its incidence may exceed 25% in some high-risk patient subsets. In some patients, pancreatitis may follow a severe course with pancreatic necrosis, multiorgan failure, permanent disability and even death. Hence, approaches which minimize both the incidence and severity of post-ERCP pancreatitis are worth pursuing. Pancreatic stents have been used with some success in the prevention of post-ERCP, while so far pharmacological trials have yielded disappointing results. A recent multicenter, randomized, placebo-controlled, double-blind trial has shown that rectally administered indomethacin is effective in reducing the incidence of post-ERCP pancreatitis, the occurrence of episodes of moderate-to-severe pancreatitis and the length of hospital stay in high-risk patients. These results together with the demonstration that rectal administration of indomethacin is not associated with en-hanced risk of bleeding strongly support the use of this drug in the prophylaxis of post-ERCP pancreatitis.
文摘目的:探讨早期内镜治疗急性胆源性胰腺炎(acute biliary pancreatitis,ABP)患者的疗效.方法:将确诊为ABP的86例患者,随机分为内镜组(n=42)、传统治疗组(n=46),对比分析两组患者白细胞、肝功能及血淀粉酶恢复时间,腹痛缓解时间,住院天数,并发症发生率及死亡率.结果:内镜组与传统组相比,白细胞恢复时间(9.7±2.6d vs 13.3±3.9d,P<0.05)、肝功能恢复正常时间(12.5±5.1d vs 21.3±6.5d,P<0.05)、血淀粉酶恢复时间(8.2±2.1 vs 12.5±3.3,P<0.05)、腹痛腹胀缓解时间(7.7±2.7d vs 11.4±3.7d,P<0.05)、住院天数均明显缩短(16.1±5.1d vs 23.3±7.6d,P<0.05);总并发症均降低(12.5% vs 23.8%,P<0.05),总死亡率与传统组相比差异无统计学意义.结论:早期内镜治疗ABP,微创、安全、疗效确切,应大力推广.
文摘The effect of fetal radiation during endoscopic retro-grade cholangiopancreatography (ERCP) on pregnant women is a very interesting topic. Smith et al recently estimated the fetal radiation exposure in pregnant women undergoing ERCPs using thermoluminescent dosimeters (TLDs). The authors concluded that TLDs are unnecessary during ERCP with modified techniques. We believe that an extreme caution is needed in clinical practice before drawing such conclusions when they are not strongly supported by enough experimental evidence. Therefore, we recommend that fetal radiation exposure be monitored in clinical practice by using dosimeters, bearing in mind that all relevant techniques to control and minimize the exposure must be applied.
基金Supported by National Natural Science Foundation of China,No. 30900671Shanghai Natural Science Foundation,No. 09ZR1419700
文摘Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum.In this study,we report successful biliary cannulation in three patients following intubation of the distal tip of the duodenoscope into the duodenal diverticulum and locating the major papilla.No complications occurred during the operation or during the postoperative period.This method didn't need second incubation an endoscope and might lower the burden of patients.So this skill is useful to deal with the papilla hidden inside the large diverticulum because of its safety and convenience.
文摘Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome. Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.
