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
Post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) is not an uncommon adverse event but may be an avoidable complication. Although pancreatitis of severe grade is reported in 0.1%-0.5% of ERCP...Post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) is not an uncommon adverse event but may be an avoidable complication. Although pancreatitis of severe grade is reported in 0.1%-0.5% of ERCP patients, a serious clinical course may be lethal. For prevention of severe PEP, patient risk stratification, appropriate selection of patients using noninvasive diagnostic imaging methods such as magnetic resonance cholangiopancreatography or endoscopic ultrasonography(EUS), and avoidance of unnecessary invasive procedures, are important measures to be taken before any procedure. Pharmacological prevention is also commonly attempted but is usually ineffective. No ideal agent has not yet been found and the available data conflict. Currently, rectal non-steroidal anti-inflammatory drugs are used to prevent PEP in high-risk patients, but additional studies using larger numbers of subjects are necessary to confirm any prophylactic effect. In this review, we focus on endoscopic procedures seeking to prevent or decrease the severity of PEP. Among various cannulation methods, wire-guided cannulation,precut fistulotomy,and transpancreatic septostomy are reviewed.Prophylactic pancreatic stent placement,which is the best-known prophylactic method,is reviewed with reference to the ideal stent type,adequate duration of stent placement,and stentrelated complications.Finally,we comment on other treatment alternatives,and make the point that further advances in EUS-guided techniques may afford useful PEP prophylaxis.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
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
AIM: To investigate the efficacy and outcomes of endoscopic papillary large balloon dilation (EPLBD) for bile duct stones in a multicenter prospective study.
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
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.
文摘Post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) is not an uncommon adverse event but may be an avoidable complication. Although pancreatitis of severe grade is reported in 0.1%-0.5% of ERCP patients, a serious clinical course may be lethal. For prevention of severe PEP, patient risk stratification, appropriate selection of patients using noninvasive diagnostic imaging methods such as magnetic resonance cholangiopancreatography or endoscopic ultrasonography(EUS), and avoidance of unnecessary invasive procedures, are important measures to be taken before any procedure. Pharmacological prevention is also commonly attempted but is usually ineffective. No ideal agent has not yet been found and the available data conflict. Currently, rectal non-steroidal anti-inflammatory drugs are used to prevent PEP in high-risk patients, but additional studies using larger numbers of subjects are necessary to confirm any prophylactic effect. In this review, we focus on endoscopic procedures seeking to prevent or decrease the severity of PEP. Among various cannulation methods, wire-guided cannulation,precut fistulotomy,and transpancreatic septostomy are reviewed.Prophylactic pancreatic stent placement,which is the best-known prophylactic method,is reviewed with reference to the ideal stent type,adequate duration of stent placement,and stentrelated complications.Finally,we comment on other treatment alternatives,and make the point that further advances in EUS-guided techniques may afford useful PEP prophylaxis.
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.
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AIM: To investigate the efficacy and outcomes of endoscopic papillary large balloon dilation (EPLBD) for bile duct stones in a multicenter prospective study.
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.
