Death after endoscopic retrograde cholangiopancreatography: findings at autopsy. Hum Pathol. 2010;41:1138-1144. [PMID: 20381117 DOI: 10.1016/j.humpath.2010.01.009]

A Prospective Comparative Study of Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography for Managing Common Bile Duct Calculi

INTRODUCTION

Common bile duct (CBD) calculi are typically managed by either laparoscopic CBD exploration (LCBDE) or endoscopic retrograde cholangiopancreatography (ERCP). The superiority of one method over the other remains a matter of debate. This study was designed to compare the efficacy and morbidity profile of LCBDE and ERCP in the management of CBD calculi.

MATERIALS AND METHODS

This analytical cross-sectional study was conducted from January 2021 to July 2024. A total of 72 patients with CBD calculi were included, with 36 undergoing LCBDE and 36 undergoing preoperative ERCP followed by laparoscopic cholecystectomy. The primary endpoint was the complete stone clearance rate from the CBD via LCBDE (using either a trans-cystic or supra-duodenal approach) or at the first ERCP procedure. Morbidity and mortality outcomes were also assessed.

RESULTS

The stone clearance rate was significantly higher in the LCBDE group (88.89%) compared to the ERCP group (72.22%), with an OR of 3.077 and a 95% CI of 0.864-10.954. Retained CBD calculi were noted in 10 patients in the ERCP group, compared to four in the LCBDE group. Two patients in the ERCP group developed acute pancreatitis with elevated amylase and lipase levels. Biliary leaks were observed in two patients in the LCBDE group and one in the ERCP group who succumbed to multidrug-resistant sepsis.

CONCLUSION

LCBDE demonstrates higher efficacy in clearing CBD calculi compared to ERCP, especially in patients with multiple and large CBD calculi, with a lower morbidity profile.

Potentially avoidable mortality after endoscopic retrograde cholangiopancreatography in Australia: an 8-year qualitative analysis

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed procedure worldwide. The aim of this study was to examine cases of mortality after ERCP to identify clinical incidents that are potentially preventable, to improve patient safety.

METHODS

The Australian and New Zealand Audit of Surgical Mortality provides an independent and externally peer-reviewed audit of surgical mortality pertaining to potentially avoidable issues. A retrospective review of prospectively collected data within this database was performed for the 8-year audit period from 1 January 2009 to 31 December 2016. Clinical incidents were identified by assessors through first- or second-line review, and thematically coded into periprocedural stages. These themes were then qualitatively analysed.

RESULTS

There were 58 potentially avoidable deaths following ERCP, with 85 clinical incidents. Preprocedural incidents were most common (n = 37), followed by postprocedural (n = 32) and then intraprocedural (n = 8). Communication issues occurred across the periprocedural period (n = 8). Preprocedural incidents included delay to procedure, inadequate resuscitative management, decision to perform procedure and inadequate assessment. Intraprocedural incidents comprised technical factors and inadequate support. Postprocedural incidents involved inappropriate treatment, delay in definitive surgical treatment or in recognizing complications, inappropriate second-line intervention and inadequate assessment. Communication incidents comprised inadequate documentation, failure to escalate care and poor inter-clinician communication.

CONCLUSION

Causes of mortality following ERCP are wide-ranging, and reviewing clinical incidents associated with potentially avoidable mortality can serve to inform and educate practitioners. In collating a subset of cases in which procedure-related mortality was deemed avoidable, a series of cautionary tales about ERCP is presented that may provide cues to practitioners on improving patient safety and inform future surgical practice.

Fatal outcomes of endoscopy: an analysis from the coroner's point of view

Background and study aims  This study was designed to provide a profound analysis of fatalities associated with endoscopic procedures. Methods  Protocols of all autopsies performed within 20 years in a large Department of Forensic Medicine were retrospectively analyzed to identify all fatalities directly related to an endoscopic procedure. Data were further specified focusing on the type of endoscopy and the final cause of death. Results  Of 22,615 autopsies performed between January 2000 and September 2019, 86 deaths were identified as complications of an endoscopic procedure. The average age of these 86 patients was 70.9 years (66.4 (range, 26-89) in males (n = 35) and 74.1 years (range, 22-94) in females (n = 51)). Endoscopic procedures included 29 endoscopic retrograde cholangeopancreatographies (ERCPs), 27 colonoscopies, 18 percutaneous endoscopic gastrostomy (PEG) tube placements, six gastroscopies, two upper endosopic ultrasonographies, and four transesophageal echocardiographies. ERCPs, colonoscopy and PEG procedures together accounted for 74 of 86 (86 %) endoscopy-related deaths. Focusing on the single procedures, post-ERCP pancreatitis (14/29, 48 %), colonoscopy-associated perforation (24/27, 89 %), and peritonitis after PEG placement (16/18, 88 %) were the most common causes of death. Conclusions  Even in the thought-to-be-safe and screening endoscopic procedures fatalities do occur. This study gives an overview of endoscopy-related fatalities, stressing the role of ERCP, colonoscopy, and PEG.

Video education can improve awareness of risks for patients undergoing endoscopic retrograde cholangiopancreatography: A randomized trial

OBJECTIVE

We conducted a randomized trial aiming at improving patients' informed consent for undergoing endoscopic retrograde cholangiopancreatography (ERCP) in clinical care by comparing the efficacy of an additional educational video to written informed consent with that of written informed consent alone.

METHODS

This was a single-center, randomized controlled trial. Consecutive patients undergoing ERCP were randomized to a video education or a control group. An educational video detailing ERCP procedure plus standard written informed consent was administered to the video education group, while the control group reviewed standard written informed consent only. The primary outcome was the patients' perception of the risk or possibility of ERCP complications. Their perception of the benefits of ERCP, alternative treatments and overall satisfaction with the process of informed consent were also compared.

RESULTS

In total 205 patients were included in the study (104 in the control group and 101 in the video education group). Patients' comprehension of ERCP-related complications in the video education group was significantly increased (P < 0.001), and these patients were more likely to correctly identify the incidence of such complications. Significantly more patients in the video education group were very satisfied with informed consent process (87.1% vs 76.0%, P = 0.040) and fewer patients needed additional explanations (31.7% vs 47.1%, P = 0.024).

CONCLUSIONS

A supplementary educational video could greatly improve patient's understanding of ERCP procedure, in particular, its potential risks and complications, as well as their overall satisfaction with the process of informed consent (ClinicalTrials.gov no. NCT02810379).

CT-guided percutaneous catheter drainage for treatment of pancreatic abscess after post-ERCP pancreatitis

AIM: To evaluate the feasibility and effectiveness of CT-guided percutaneous catheter drainage for treatment of pancreatic abscess after post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.

METHODS: Sixteen patients underwent CT-guided percutaneous catheter drainage for pancreatic abscess after post-ERCP pancreatitis at our hospital from January 2006 to May 2013. All of them received 24 h continuous irrigation through the catheter.

RESULTS: CT-guided percutaneous catheter drainage was successful in all patients, and they all recovered. No death occurred, and no surgery was required. The average number of punctures was 1.88, and the mean time of catheter placement was 24.12 d.

CONCLUSION: CT-guided percutaneous catheter drainage is minimally invasive, safe and highly effective in the treatment of pancreatic abscess after post-ERCP pancreatitis. However, it is just a complementary therapy and cannot replace the surgical treatment completely.

Post-endoscopic retrograde cholangio-pancreatography pancreatitis: Is time for a new preventive approach?

Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangio-pancreatography (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 enhanced risk of bleeding strongly support the use of this drug in the prophylaxis of post-ERCP pancreatitis.