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Cozma MA, Angelescu C, Haidar A, Mateescu RB, Diaconu CC. Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital. Biomedicines 2025; 13:727. [PMID: 40149703 PMCID: PMC11940217 DOI: 10.3390/biomedicines13030727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 03/02/2025] [Accepted: 03/11/2025] [Indexed: 03/29/2025] Open
Abstract
Background/Objectives: Pancreatitis is the most frequent and serious complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence between 2 and 10% and a mortality rate of 1 in 500 patients. Etiopathogenesis remains poorly understood. The aim of this study was to analyze the incidence of post-ERCP pancreatitis (PEP) and to identify potential patient- and procedure-related risk factors (RF) in a cohort of patients from a tertiary referral center in Romania. Methods: We conducted a retrospective, observational, single-center study in which we analyzed ERCP procedures performed in the Gastroenterology Department of Colentina Clinical Hospital, Bucharest, Romania, between January 2019 and September 2024. All patients received intrarectal diclofenac before the ERCP and were hydrated with at least 1500 mL of Ringer's solution after the procedure in the absence of contraindications, according to the latest international recommendations. Results: In total, 2743 ERCPs were performed in the given time period, while 2350 procedures were analyzed in the study. PEP occurred in 350 cases (14.9%). Of these, 191 (54.6%) occurred in males with a mean age of 66.5 years. Procedural RF with adjusted odds ratios (OR) were as follows: difficult cannulation of the common bile duct, OR = 3.734, p < 0.001, main pancreatic duct catheterization, OR = 1.454, p = 0.022, and endoscopic papillary balloon dilatation, with an OR of 3.258, p < 0.001. Pancreatic duct stent placement was shown to prevent PEP in this study group (p < 0.001). Conclusions: PEP remains a serious complication of ERCP, associated with significant morbidity and occasional mortality. While some proven risk factors, such as age, gender, or comorbidities, are unmodifiable, avoiding Wirsung duct cannulation and pancreatography, or prophylactic pancreatic duct stent placement, could play a significant role in PEP prevention.
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Affiliation(s)
- Matei-Alexandru Cozma
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Cristina Angelescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Andrei Haidar
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Radu Bogdan Mateescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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Ma JM, Wang PF, Yang LQ, Wang JK, Song JP, Li YM, Wen Y, Tang BJ, Wang XD. Machine learning model-based prediction of postpancreatectomy acute pancreatitis following pancreaticoduodenectomy: A retrospective cohort study. World J Gastroenterol 2025; 31:102071. [DOI: 10.3748/wjg.v31.i8.102071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/07/2024] [Accepted: 01/03/2025] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND The International Study Group of Pancreatic Surgery has established the definition and grading system for postpancreatectomy acute pancreatitis (PPAP). There are no established machine learning models for predicting PPAP following pancreaticoduodenectomy (PD).
AIM To explore the predictive model of PPAP, and test its predictive efficacy to guide the clinical work.
METHODS Clinical data from consecutive patients who underwent PD between 2016 and 2024 were retrospectively collected. An analysis of PPAP risk factors was performed, various machine learning algorithms [logistic regression, random forest, gradient boosting decision tree, extreme gradient boosting, light gradient boosting machine, and category boosting (CatBoost)] were utilized to develop predictive models. Recursive feature elimination was employed to select several variables to achieve the optimal machine algorithm.
RESULTS The study included 381 patients, of whom 88 (23.09%) developed PPAP. PPAP patients exhibited a significantly higher incidence of postoperative pancreatic fistula (55.68% vs 14.68%, P < 0.001), grade C postoperative pancreatic fistula (9.09% vs 1.37%, P = 0.001). The CatBoost algorithm outperformed other algorithms with a mean area under the receiver operating characteristic curve of 0.859 [95% confidence interval (CI): 0.814-0.905] in the training cohort and 0.822 (95%CI: 0.717-0.927) in the testing cohort. According to shapley additive explanations analysis, pancreatic texture, main pancreatic duct diameter, body mass index, estimated blood loss, and surgery time were the most important variables based on recursive feature elimination. The CatBoost algorithm based on selected variables demonstrated superior performance, with an area under the receiver operating characteristic curve of 0.837 (95%CI: 0.788-0.886) in the training cohort and 0.812 (95%CI: 0.697-0.927) in the testing cohort.
CONCLUSION We developed the first machine learning-based predictive model for PPAP following PD. This predictive model can assist surgeons in anticipating and managing this complication proactively.
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Affiliation(s)
- Ji-Ming Ma
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Peng-Fei Wang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Liu-Qing Yang
- Department of Information Administration, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Jun-Kai Wang
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Jian-Ping Song
- Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yu-Mei Li
- Department of Otorhinolaryngology, Xiangyang No. 1 People’s Hospital, Xiangyang 441000, Hubei Province, China
| | - Yan Wen
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Bing-Jun Tang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Xue-Dong Wang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
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Li W, Ma Y, Yang L. Systematic review and meta-analysis: no evidence that low-dose non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). BMC Gastroenterol 2025; 25:83. [PMID: 39962414 PMCID: PMC11834321 DOI: 10.1186/s12876-025-03690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Accepted: 02/13/2025] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND Currently, many studies focus on the use of high-dose NSAIDs, showing significant effectiveness in preventing post-ERCP pancreatitis after surgery. However, some studies suggest that low-dose NSAIDs can also have certain effects. Nevertheless, after using propensity score matching to balance potential biases, the results do not seem ideal and fail to demonstrate clear effectiveness. AIM This study investigates the effectiveness of NSAIDs in preventing post-ERCP pancreatitis through a systematic review and meta-analysis of relevant literature. METHODS We conducted a systematic search of PubMed, Embase, and Web of Science, covering literature up to September 2024. The search utilized keywords such as "ERCP," "NSAIDs," and "propensity score matching." A total of three studies employing propensity score matching were included, encompassing 857 patients-417 receiving NSAIDs before ERCP and 440 in the control group. Statistical analysis was performed using RevMan 5.3, applying a random-effects model for meta-analysis. RESULTS The meta-analysis revealed no significant difference in treatment outcomes between the NSAID and control groups, with an odds ratio (OR) of 0.82 (95% CI: 0.45-1.49, P = 0.74) and no observed heterogeneity (I²=0%). Sensitivity analysis confirmed the stability of results, indicating minimal impact from the removal of any single study. DISCUSSION These findings challenge previous assertions that NSAIDs effectively reduce post-ERCP pancreatitis incidence. The lack of consistent evidence raises concerns about the reliability of existing research. Additionally, the lower NSAID doses used in studies may contribute to the observed ineffectiveness. Future large-scale, well-designed clinical trials are essential to establish clear treatment guidelines and enhance patient outcomes.
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Affiliation(s)
- Weizheng Li
- YunFu People's Hospital, Yunfu, Guangdong, 527300, China.
| | - Yihan Ma
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Li Yang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihua East Road, Zhuhai, 519000, China
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Fukuma T, Ishii S, Fujisawa T, Takahashi K, Nakamura T, Shibata F, Tomishima K, Takasaki Y, Suzuki A, Takahashi S, Ito K, Ushio M, Ikemura M, Kabemura D, Ota H, Nakai Y, Kogure H, Takahara N, Isayama H. Development of a Dedicated X-Ray Fluoroscopic Apparatus for Therapeutic Pancreatobiliary Endoscopy: A Review. J Clin Med 2025; 14:1214. [PMID: 40004745 PMCID: PMC11856850 DOI: 10.3390/jcm14041214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/30/2025] [Accepted: 02/07/2025] [Indexed: 02/27/2025] Open
Abstract
In recent years, pancreaticobiliary endoscopy (PBE) has evolved to include a wide range of endoscopic procedures used to treat various diseases. Several interventional endoscopic ultrasonography procedures have been developed for conditions that cannot be treated with conventional endoscopic methods. As PBE continues to advance, it is crucial to improve fluoroscopic systems to enhance image quality, ensure patient safety, reduce radiation exposure, and ensure the operation of video-recording systems. The difficult procedures require the precise imaging of thin pancreatic/biliary branch devices, including guidewires, catheters, and stents. It is crucial to reduce noise caused by patient breathing and movement, while retaining the necessary movement in the image on the screen. A stable table is effective for ensuring the safety of patients during the procedure. A reduction in radiation exposure is important, and the flame rate conversion technique is effective. Ensuring high-quality recording is useful for the video presentation of PBE procedures. In collaboration with Fujifilm (Tokyo, Japan), we researched and developed various functions in fluoroscopic systems for PBE. In this review, we outline the requirements for fluoroscopic procedures in PBE, the evolution of technology to date, and its prospects, while also presenting the commercial equipment currently available.
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Affiliation(s)
- Taito Fukuma
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Shigeto Ishii
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Toshio Fujisawa
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Keiko Takahashi
- Medical System Research & Development Center, MS R&D Department, FUJIFILM Corporation, Chiba 277-0804, Japan; (K.T.); (T.N.)
| | - Tadashi Nakamura
- Medical System Research & Development Center, MS R&D Department, FUJIFILM Corporation, Chiba 277-0804, Japan; (K.T.); (T.N.)
| | - Futoshi Shibata
- Modality Solution Division, Medical System Business Division, XR Product Marketing Group, FUJIFILM Corporation, Tokyo 107-0052, Japan;
| | - Ko Tomishima
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Yusuke Takasaki
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Akinori Suzuki
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Sho Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Koichi Ito
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Mako Ushio
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Muneo Ikemura
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Daishi Kabemura
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Hiroto Ota
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (Y.N.); (N.T.)
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Hirofumi Kogure
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 101-8309, Japan;
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (Y.N.); (N.T.)
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (T.F.); (S.I.); (T.F.); (K.T.); (Y.T.); (A.S.); (S.T.); (K.I.); (M.U.); (M.I.); (D.K.); (H.O.)
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Akshintala VS, Boparai IS, Barakat MT, Husain SZ. Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Novel Mechanisms and Prevention by Drugs. United European Gastroenterol J 2025; 13:78-85. [PMID: 39711464 PMCID: PMC11866316 DOI: 10.1002/ueg2.12732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 10/21/2024] [Accepted: 10/23/2024] [Indexed: 12/24/2024] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is becoming more common than first-line therapy for pancreaticobiliary duct disorders. However, post-ERCP pancreatitis is the most common complication of ERCPs, and affects about 10% of cases. In this review, we provide an overview of the mechanisms purported to cause post-ERCP pancreatitis as well as associated risk factors. We discuss measures that are in practice for post-ERCP pancreatitis pharmaco-prophylaxis, along with advances in the pipeline. We emphasize that there is still a pressing need to narrow the incidence of post-ERCP pancreatitis and that a mechanistic approach may reveal the greatest benefit from utilizing a combination of targets.
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Affiliation(s)
- Venkata S. Akshintala
- Division of GastroenterologyDepartment of Internal MedicineJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
| | - Ibadat S. Boparai
- Division of GastroenterologyDepartment of Internal MedicineJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
| | - Monique T. Barakat
- Division of GastroenterologyDepartment of PediatricsSchool of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Sohail Z. Husain
- Division of GastroenterologyDepartment of PediatricsSchool of MedicineStanford UniversityStanfordCaliforniaUSA
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Jia F, Lv F, Zhang S. Comparison of the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with and without diabetes: a meta-analysis. Surg Endosc 2025; 39:807-819. [PMID: 39586879 DOI: 10.1007/s00464-024-11401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 11/03/2024] [Indexed: 11/27/2024]
Abstract
BACKGROUND Pancreatitis is a common complication for patients receiving endoscopic retrograde cholangiopancreatography (ERCP). The objective of the meta-analysis was to compare the incidence of post-ERCP pancreatitis (PEP) in individuals with and without pre-existing diabetes. METHODS A comprehensive review of the existing literature was carried out in PubMed, Embase, and Web of Science to identify applicable observational studies. The data were combined using a random-effects model while accounting for potential heterogeneity. RESULTS A total of 16 datasets from 14 observational studies involving 158,847 patients who received ERCP were included. Among them, 26,823 (16.9%) had pre-existing diabetes, and 24,654 (15.5%) had developed PEP. The pooled results showed that, compared to patients without diabetes, those with pre-existing diabetes had a lower incidence of PEP (odds ratio: 0.77, 95% confidence interval: 0.63 to 0.94, p = 0.01; I2 = 52%). A sensitivity analysis conducted by excluding one dataset at a time showed similar results (OR 0.74 to 0.81, p all < 0.05). Further subgroup and meta-regression analyses indicated that the link between diabetes and a decreased likelihood of PEP was not notably influenced by study factors such as country, average age, male representation, diabetes prevalence, incidence of PEP among the patients studied, diagnostic methods for PEP, or study quality scores. CONCLUSIONS Integrated evidence from observational studies currently indicate that diabetes could potentially act as a protective element against PEP. However, it is important to confirm these findings through extensive prospective studies that account for various influencing factors.
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Affiliation(s)
- Fang Jia
- Department of Gastroenterology, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China
| | - Fujing Lv
- Department of Gastroenterology, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, China.
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Sadeghi A, Samar H, Abbasinazari M, Mohammadi P, Abazarikia A, Ziaie S. Efficacy of 2-Mercaptoethane Sulfonate Sodium (MESNA) in the Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Randomized Open Label Trial. JGH Open 2025; 9:e70083. [PMID: 39834905 PMCID: PMC11743974 DOI: 10.1002/jgh3.70083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 12/01/2024] [Accepted: 12/09/2024] [Indexed: 01/22/2025]
Abstract
Background and Aim Oxidative stress has been considered a factor in the development of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The present clinical trial evaluated whether adding intravenous mesna to rectal indomethacin could prevent or alleviate PEP. Methods An open-labeled clinical trial was done on 698 participants undergoing endoscopic retrograde cholangiopancreatography (ERCP). Eligible patients received 100 mg indomethacin suppository 30 min before undergoing ERCP. Randomly, the participants received 400 mg intravenous mesna or nothing 30 min before doing the procedure. The PEP incidence and degree were measured in the patients as the main outcome. Results The total rate of PEP was equal to 13.7%. No significant difference was seen in the rate and severity of PEP between the mesna plus indomethacin and indomethacin alone arms (14% vs. 13.4%, respectively, p = 0.671). In high-risk patients, PEP rate and severity were lower in the mesna plus indomethacin group compared with indomethacin alone group and the statistical analysis showed that the difference was significant (41.7% vs. 51.8%, respectively, p = 0.033). Conclusion In high-risk patients undergoing ERCP, a combination of intravenous mesna plus rectal indomethacin may decrease the PEP rate and severity.
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Affiliation(s)
- Amir Sadeghi
- Gastroenterology and Liver Diseases Research CenterResearch Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical SciencesTehranIran
| | - Hesamoddin Samar
- Department of Clinical PharmacySchool of Pharmacy, Shahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Abbasinazari
- Anesthesiology Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Parvaneh Mohammadi
- Gastroenterology and Liver Diseases Research CenterResearch Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical SciencesTehranIran
| | - Ali Abazarikia
- Department of Clinical PharmacySchool of Pharmacy, Shahid Beheshti University of Medical SciencesTehranIran
| | - Shadi Ziaie
- Department of Clinical PharmacySchool of Pharmacy, Shahid Beheshti University of Medical SciencesTehranIran
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Alatise OI, Akinyemi PA, Owojuyigbe AO, Ojumu TA, Omisore AD, Aderounmu A, Ekinadese A, Asombang AW. Endoscopic management of postcholecystectomy complications at a Nigerian tertiary health facility. BMC Gastroenterol 2024; 24:375. [PMID: 39438793 PMCID: PMC11515645 DOI: 10.1186/s12876-024-03468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 10/16/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Cholecystectomy and common bile duct exploration for biliary stone disease are common hepatobiliary surgeries performed by general surgeons in Nigeria. These procedures can be complicated by injury to the biliary tree or retained stones, requiring repeat surgical intervention. This study presents the experience of using endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary surgery complications at the academic referral center of Obafemi Awolowo University Teaching Hospital (OAUTHC) Ile-Ife, Nigeria. METHODS All patients with postcholecystectomy complications referred to the endoscopy unit at OAUTHC from March 2018 to April 2023 were enrolled. Preoperative imaging included a combination of abdominal ultrasound, CT, MRI, magnetic resonance cholangiopancreatography (MRCP), and T-tube cholangiogram. All ERCP procedures were performed under general anesthesia. RESULTS Seventy-two ERCP procedures were performed on 45 patients referred for postcholecystectomy complications. The most common mode of presentation was ascending cholangitis [16 (35.6%)], followed by persistent biliary fistula [12 (26.7%)]. The overall median duration of symptoms after cholecystectomy was 20 weeks, with a range of 1-162 weeks. The most common postcholecystectomy complication observed was retained stone [16 (35.6%)]. Other postcholecystectomy complications included bile leakage, bile stricture, bile leakage with stricture, and persistent bile leakage from the T-tube in 12 (26.7%), 11 (24.4%), 4 (8.9%), and 2 (4.4%) patients, respectively. Ampullary cannulation during ERCP was successful in all patients (45, 100%). Patients with complete biliary stricture (10/12) required hepaticojejunostomy. CONCLUSION Endoscopic management of postcholecystectomy complications was found to be safe and reduce the number of needless surgeries to which such patients are exposed. We recommended prompt referral of such patients for ERCP.
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Affiliation(s)
- Olusegun Isaac Alatise
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria.
- African Research Group for Oncology, Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria.
- Department of Surgery, Division of Gastrointestinal/Surgical Oncology, Obafemi Awolowo University/Teaching Hospitals Complex, PMB 5538, Ile-Ife, Osun, Nigeria.
| | - Patrick Ayodeji Akinyemi
- African Research Group for Oncology, Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
| | | | - Titilayo Adenike Ojumu
- Department of Anaesthesia, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Adeleye Dorcas Omisore
- Department of Radiology, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Adewale Aderounmu
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Aburime Ekinadese
- Department of Advanced, Therapeutic Endoscopy Piedmont Rockdale Hospital at Piedmont Healthcare, Statesville, USA
| | - Akwi Wasi Asombang
- Department of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Aronen A, Guilabert L, Hadi A, Kiudelis V, Panaitescu A, Wlodarczyk B, Laukkarinen J, Regner S, de-Madaria E. Idiopathic acute pancreatitis (IAP)-a review of the literature and algorithm proposed for the diagnostic work-up of IAP. Transl Gastroenterol Hepatol 2024; 9:71. [PMID: 39503029 PMCID: PMC11535791 DOI: 10.21037/tgh-23-125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/23/2024] [Indexed: 11/08/2024] Open
Abstract
Background and Objective This narrative review addresses idiopathic acute pancreatitis (IAP) and its epidemiology, diagnosis, clinical course and treatment during the last decade. As there is no previously validated protocol for finding the aetiology of acute pancreatitis (AP), the primary aim of this study is to find, describe and unify evidence about the diagnostic work-up of AP to diagnose the true IAP. By finding the aetiology with the highest possible yield it may be possible to reduce recurrent AP (RAP) episodes and related morbidity and thereby decrease health care costs and possibly improve patients' quality of life. Methods This narrative review includes articles retrieved from PubMed search with publications from 2013-2023. Cross references were used when found relevant. Key Content and Findings The rates of aetiologies of AP and the diagnostics performed behind these numbers vary widely between different studies, time periods and different geographical regions, as there is no unified algorithm in diagnostic work-up of IAP. In this study, we describe an up-to-date summary of epidemiology, diagnostic course and treatment of IAP, and propose an algorithm of IAP diagnostics in light of recent scientific studies and their outcomes and address possible treatments of IAP. Conclusions Although aetiology is key for AP management, there is still no validated protocol for aetiological diagnosis. IAP is relevant due to its recurrence rate and possible evolution to chronic pancreatitis. We still need more studies addressing this topic and evaluating new diagnostic protocols with advanced tests and treatment strategies in true IAP.
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Affiliation(s)
- Anu Aronen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lucía Guilabert
- Gastroenterology Department, Dr. Balmis General University Hospital, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Amer Hadi
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Copenhagen, Denmark
| | - Vytautas Kiudelis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Afrodita Panaitescu
- Gastroenterology and Interventional Endoscopy Department, Bucharest Clinical Emergency Hospital, Bucharest, Romania
| | - Barbara Wlodarczyk
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sara Regner
- Surgery Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
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Kolodecik TR, Guo X, Shugrue CA, Guo X, Desir GV, Wen L, Gorelick F. Renalase peptides reduce pancreatitis severity in mice. Am J Physiol Gastrointest Liver Physiol 2024; 327:G466-G480. [PMID: 39010833 PMCID: PMC11427088 DOI: 10.1152/ajpgi.00143.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024]
Abstract
Acute pancreatitis, an acute inflammatory injury of the pancreas, lacks a specific treatment. The circulatory protein renalase is produced by the kidney and other tissues and has potent anti-inflammatory and prosurvival properties. Recombinant renalase can reduce the severity of mild cerulein pancreatitis; the activity is contained in a conserved 20 aa renalase site (RP220). Here, we investigated the therapeutic effects of renalase on pancreatitis using two clinically relevant models of acute pancreatitis. The ability of peptides containing the RP220 site to reduce injury in a 1-day post-endoscopic retrograde cholangiopancreatography (ERCP) and a 2-day severe cerulein induced in mice was examined. The initial dose of renalase peptides was given either prophylactically (before) or therapeutically (after) the initiation of the disease. Samples were collected to determine early pancreatitis responses (tissue edema, plasma amylase, active zymogens) and later histologic tissue injury and inflammatory changes. In both preclinical models, renalase peptides significantly reduced histologic damage associated with pancreatitis, especially inflammation, necrosis, and overall injury. Quantifying inflammation using specific immunohistochemical markers demonstrated that renalase peptides significantly reduced overall bone marrow-derived inflammation and neutrophils and macrophage populations in both models. In the severe cerulein model, administering a renalase peptide with or without pretreatment significantly reduced injury. Pancreatitis and renalase peptide effects appeared to be the same in female and male mice. These studies suggest renalase peptides that retain the anti-inflammatory and prosurvival properties of recombinant renalase can reduce the severity of acute pancreatitis and might be attractive candidates for therapeutic development.NEW & NOTEWORTHY Renalase is a secretory protein. The prosurvival and anti-inflammatory effects of the whole molecule are contained in a 20 aa renalase site (RP220). Systemic treatment with peptides containing this renalase site reduced the severity of post-endoscopic retrograde cholangiopancreatography (ERCP) and severe cerulein pancreatitis in mouse models.
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Affiliation(s)
- Thomas R Kolodecik
- Veterans Affairs Health Care System, Yale University, New Haven, Connecticut, United States
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Xiaoyu Guo
- State Key Laboratory of Complex, Severe, and Rare Diseases, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
- Center for Biomarker Discovery and Validation, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Christine A Shugrue
- Veterans Affairs Health Care System, Yale University, New Haven, Connecticut, United States
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Xiaojia Guo
- Veterans Affairs Health Care System, Yale University, New Haven, Connecticut, United States
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Gary V Desir
- Veterans Affairs Health Care System, Yale University, New Haven, Connecticut, United States
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Li Wen
- State Key Laboratory of Complex, Severe, and Rare Diseases, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
- Center for Biomarker Discovery and Validation, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Fred Gorelick
- Veterans Affairs Health Care System, Yale University, New Haven, Connecticut, United States
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States
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Bai B, Wang S, Du Y, Li M, Huang Q, Liu S, Zhang C, Fang Y, Chen X, Hong J, Li Y, Xu Z, Liu X, Hong R, Bao J, Mei Q. Indomethacin Does Not Reduce Post-ERCP Pancreatitis in High-Risk Patients Receiving Pancreatic Stenting. Dig Dis Sci 2024; 69:3442-3449. [PMID: 39009916 DOI: 10.1007/s10620-024-08542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/20/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Rectal indomethacin reduces pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). However, there is insufficient evidence regarding its added benefits in patients already receiving prophylactic pancreatic stenting. Our goal was to evaluate the impact of indomethacin in high-risk patients undergoing pancreatic stenting. METHODS A cohort study was conducted on all patients who underwent the rescue cannulation technique for challenging bile duct cannulation (selected high-risk patients). Patients were split into two groups based on the prophylaxis method for post-ERCP pancreatitis (PEP): one receiving a combination of indomethacin and pancreatic stenting, while the other received pancreatic stenting alone. Comparative analyses were carried out on PEP, hyperamylasemia, gastrointestinal bleeding, and postoperative hospital stay among post-ERCP pancreatitis patients. RESULTS Between November 2017 and May 2023, a total of 607 patients with native papillae were enrolled, with 140 grouped into the indomethacin plus stent group and 467 into the stent alone group. The overall PEP rate was 4.4% in the entire cohort, with no statistical differences observed between the groups in terms of PEP rates (P = 0.407), mild PEP (P = 0.340), moderate to severe PEP (P = 1.000), hyperamylasemia (P = 0.543), gastrointestinal bleeding (P = 0.392), and postoperative hospital stay (P = 0.521). Furthermore, sensitivity analysis using multivariable analysis also validated these findings. CONCLUSIONS Indomethacin did not reduce the incidence or severity of PEP in high-risk patients who routinely received prophylactic pancreatic stent placement. Therefore, the additional administration of rectal indomethacin to further mitigate PEP appears to be not necessary.
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Affiliation(s)
- Bingqing Bai
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Shaofei Wang
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
- Department of Gastroenterology, Suzhou First People's Hospital, Suzhou, 234000, Anhui, China
| | - Yemei Du
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
- Department of Gastroenterology, Xuancheng People's Hospital, Xuancheng, 242000, Anhui, China
| | - Mengwen Li
- Department of Gastroenterology, Fuyang People's Hospital, Fuyang, 236012, Anhui, China
| | - Qiming Huang
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Sisi Liu
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Chenyu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Yuanyuan Fang
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Xinwen Chen
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Jianglong Hong
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Yang Li
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Zhangwei Xu
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Xiaochang Liu
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Rutao Hong
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Junjun Bao
- Department of Endoscopy, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China
| | - Qiao Mei
- Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China.
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Jia Y, Wu HJ, Li T, Liu JB, Fang L, Liu ZM. Establishment of predictive models and determinants of preoperative gastric retention in endoscopic retrograde cholangiopancreatography. World J Gastrointest Surg 2024; 16:2574-2582. [PMID: 39220084 PMCID: PMC11362919 DOI: 10.4240/wjgs.v16.i8.2574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Study on influencing factors of gastric retention before endoscopic retrograde cholangiopancreatography (ERCP) background: With the wide application of ERCP, the risk of preoperative gastric retention affects the smooth progress of the operation. The study found that female, biliary and pancreatic malignant tumor, digestive tract obstruction and other factors are closely related to gastric retention, so the establishment of predictive model is very important to reduce the risk of operation. AIM To analyze the factors influencing preoperative gastric retention in ERCP and establish a predictive model. METHODS A retrospective analysis was conducted on 190 patients admitted to our hospital for ERCP preparation between January 2020 and February 2024. Patient baseline clinical data were collected using an electronic medical record system. Patients were randomly matched in a 1:4 ratio with data from 190 patients during the same period to establish a validation group (n = 38) and a modeling group (n = 152). Patients in the modeling group were divided into the gastric retention group (n = 52) and non-gastric retention group (n = 100) based on whether gastric retention occurred preoperatively. General data of patients in the validation group and modeling group were compared. Univariate and multivariate logistic regression analyses were performed to identify factors influencing preoperative gastric retention in ERCP patients. A predictive model for preoperative gastric retention in ERCP patients was constructed, and calibration curves were used for validation. The receiver operating characteristic (ROC) curve was analyzed to evaluate the predictive value of the model. RESULTS We found no statistically significant difference in general data between the validation group and modeling group (P > 0.05). The comparison of age, body mass index, hypertension, and diabetes between the two groups showed no statistically significant difference (P > 0.05). However, we noted statistically significant differences in gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction between the two groups (P < 0.05). Multivariate logistic regression analysis showed that gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction were independent factors influencing preoperative gastric retention in ERCP patients (P < 0.05). The results of logistic regression analysis revealed that gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction were included in the predictive model for preoperative gastric retention in ERCP patients. The calibration curves in the training set and validation set showed a slope close to 1, indicating good consistency between the predicted risk and actual risk. The ROC analysis results showed that the area under the curve (AUC) of the predictive model for preoperative gastric retention in ERCP patients in the training set was 0.901 with a standard error of 0.023 (95%CI: 0.8264-0.9567), and the optimal cutoff value was 0.71, with a sensitivity of 87.5 and specificity of 84.2. In the validation set, the AUC of the predictive model was 0.842 with a standard error of 0.013 (95%CI: 0.8061-0.9216), and the optimal cutoff value was 0.56, with a sensitivity of 56.2 and specificity of 100.0. CONCLUSION Gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction are factors influencing preoperative gastric retention in ERCP patients. A predictive model established based on these factors has high predictive value.
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Affiliation(s)
- Ying Jia
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hao-Jun Wu
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tang Li
- Division of General Surgery, West China Hospital-Chengdu Shangjin Nanfu, West China Hospital, Chengdu 611730, Sichuan Province, China
| | - Jia-Bin Liu
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ling Fang
- Division of General Surgery, West China Hospital-Chengdu Shangjin Nanfu, West China Hospital, Chengdu 611730, Sichuan Province, China
| | - Zi-Ming Liu
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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13
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Lin W, Zheng Q, Wang X, Lin X, Ni X, Pan J, Zippi M, Fiorino S, Hong W. The causality between use of glucocorticoids and risk of pancreatitis: a Mendelian randomization study. Front Immunol 2024; 15:1420840. [PMID: 39221257 PMCID: PMC11363070 DOI: 10.3389/fimmu.2024.1420840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background and aim To date, the association between glucocorticoid use and the risk of pancreatitis remains controversial. The aim of this study was the investigation of this possible relationship. Methods We carried out a two-sample Mendelian randomization (MR) analysis using GWAS data from European ancestry, East Asian descendants and the FinnGen Biobank Consortium to evaluate this potential causal relationship. Genetic variants associated with glucocorticoid use were selected based on genome-wide significance (p < 5×10-8). Results Our MR analysis of European ancestry data revealed no significant causal relationship between glucocorticoid use and AP (IVW: OR=1.084, 95% CI= 0.945-1.242, P=0.249; MR-Egger: OR=1.049, 95% CI= 0.686-1.603, P=0.828; weighted median: OR=1.026, 95% CI= 0.863-1.219, P=0.775) or CP (IVW: OR=1.027, 95% CI= 0.850-1.240, P=0.785; MR-Egger: OR= 1.625, 95% CI= 0.913-2.890, P= 0.111; weighted median: OR= 1.176, 95% CI= 0.909-1.523, P= 0.218). Sensitivity analyses, including MR-Egger and MR-PRESSO, indicated no evidence of pleiotropy or heterogeneity, confirming the robustness of our findings. Multivariable MR analysis adjusted for alcohol consumption, BMI, cholelithiasis and C-reactive protein levels supported these findings. Replicated analysis was performed on datasets from the FinnGen Biobank Consortium and East Asian descendants, and similar results were obtained. Conclusions This MR analysis suggests that there is no causal association between glucocorticoid use and the risk of pancreatitis.
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Affiliation(s)
- Wenfeng Lin
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiqi Zheng
- Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaorong Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaolu Lin
- Department of Digestive Endoscopy Center, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xixi Ni
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingye Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Sirio Fiorino
- Unit of Internal Medicine, Budrio Hospital, Local Health Unit of Bologna, Bologna, Italy
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Rogowska J, Semeradt J, Durko Ł, Małecka-Wojciesko E. Diagnostics and Management of Pancreatic Cystic Lesions-New Techniques and Guidelines. J Clin Med 2024; 13:4644. [PMID: 39200786 PMCID: PMC11355509 DOI: 10.3390/jcm13164644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Pancreatic cystic lesions (PCLs) are increasingly diagnosed owing to the wide use of cross-sectional imaging techniques. Accurate identification of PCL categories is critical for determining the indications for surgical intervention or surveillance. The classification and management of PCLs rely on a comprehensive and interdisciplinary evaluation, integrating clinical data, imaging findings, and cyst fluid markers. EUS (endoscopic ultrasound) has become the widely used diagnostic tool for the differentiation of pancreatic cystic lesions, offering detailed evaluation of even small pancreatic lesions with high sensitivity and specificity. Additionally, endoscopic ultrasound-fine-needle aspiration enhances diagnostic capabilities through cytological analysis and the assessment of fluid viscosity, tumor glycoprotein concentration, amylase levels, and molecular scrutiny. These detailed insights play a pivotal role in improving the clinical prognosis and management of pancreatic neoplasms. This review will focus mainly on the latest recommendations for the differentiation, management, and treatment of pancreatic cystic lesions, highlighting their clinical significance.
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Affiliation(s)
- Jagoda Rogowska
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-647 Lodz, Poland; (J.S.); (Ł.D.); (E.M.-W.)
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杨 璐, 傅 燕, 孙 正, 周 佳, 唐 娟, 倪 静. [Risk factors for pancreatitis after endoscopic retrograde cholangiopancreatography in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:690-694. [PMID: 39014944 PMCID: PMC11562034 DOI: 10.7499/j.issn.1008-8830.2402047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/03/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES To investigate the application of endoscopic retrograde cholangiopancreatography (ERCP) in children and the risk factors for post-ERCP pancreatitis (PEP). METHODS A retrospective analysis was conducted on the clinical data of 66 children, aged ≤16 years, who underwent ERCP for pancreaticobiliary diseases at the Gastrointestinal Endoscopy Center of the Second Affiliated Hospital of Kunming Medical University from September 2013 to September 2023. The incidence rate of PEP and the risk factors for the development of PEP were analyzed. RESULTS A total of 78 ERCP procedures were performed on 66 children, with 5 diagnostic ERCPs, 69 therapeutic ERCPs, and 4 failed procedures. The success rate of ERCP operations was 95% (74/78). There were 17 cases of PEP in total, with an incidence rate of 22%. In the PEP group, the proportion of children with normal preoperative bilirubin and the proportion of guidewire insertion into the pancreatic duct during surgery were higher than in the non-PEP group (P<0.05). The multivariate logistic regression analysis showed that guidewire insertion into the pancreatic duct was an independent risk factor for PEP (P<0.05). CONCLUSIONS With the increasing application of ERCP in children with pancreaticobiliary diseases, it is important to select an appropriate intubation technique during surgery to avoid blindly entering the guidewire into the pancreatic duct and reduce the occurrence of PEP.
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Chen Z, Fu H. Efficacy of Topical Epinephrine in Preventing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Meta-analysis. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2024; 35:709-717. [PMID: 39344664 PMCID: PMC11391239 DOI: 10.5152/tjg.2024.23386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/25/2024] [Indexed: 10/01/2024]
Abstract
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP. As the clinical effectiveness of topical epinephrine in preventing PEP is elusive, this work attempts to assess its impact on PEP prevention. The databases Embase, Web of Science, PubMed, and Cochrane Library were searched for randomized controlled trials (RCTs) and retrospective cohort studies (RCSs) on topical epinephrine in PEP prevention (data cutoff, November 2022). This study included a total of 10 research articles, involving 5683 patients, comprising 7 RCTs and 3 RCSs. The results of the meta-analysis indicated that epinephrine had no significant effect on preventing PEP or improving its severity. The meta-analysis results of RCTs subgroup revealed no significant difference in the incidence of PEP between patients receiving epinephrine treatment [alone/in combination with nonsteroidal anti-inflammatory drugs (NSAIDs)] vs. without epinephrine treatment (control group) (P = .23). However, patients treated with epinephrine alone experience a lower incidence of PEP compared to the control group (risk ratio [RR] = 0.28, 95% CI = 0.14-0.56, P = .0004). The treatment with epinephrine+NSAIDs vs. NSAIDs showed no significant difference (P = .95). The meta-analysis results of RCSs subgroup demonstrated a significant reduction in the incidence of PEP with the epinephrine+NSAIDs vs. NSAIDs (P < .05). Regarding the severity of PEP [mild, and moderate to severe (M-S)] in the RCT subgroup, the incidence of PEP was not reduced with epinephrine treatment (alone/in combination with NSAIDs) vs. control group. In the RCS subgroup, receiving epinephrine (alone/in combination with NSAIDs) reduced the incidence of mild PEP, while it had no effect on the incidence of M-S PEP. Epinephrine was not significantly effective in preventing PEP and improving its severity. The combined use of NSAIDs and epinephrine as a possible preventive measure requires further investigation into its efficacy.
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Affiliation(s)
- Zhiliang Chen
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital, Shaoxing, China
- Shaoxing Key Laboratory of Minimally Invasive Abdominal Surgery and Precise Treatment of Tumor, Shaoxing, China
| | - Hong Fu
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital, Shaoxing, China
- Shaoxing Key Laboratory of Minimally Invasive Abdominal Surgery and Precise Treatment of Tumor, Shaoxing, China
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Ghambari K, de Jong DM, Bruno MJ, Polak WG, van Driel LMJW, den Hoed CM. Risks of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis After Liver Transplantation. Clin Transplant 2024; 38:e15399. [PMID: 39023321 DOI: 10.1111/ctr.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/14/2024] [Accepted: 06/22/2024] [Indexed: 07/20/2024]
Abstract
Biliary complications are common after liver transplantation (LT). Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred method to treat biliary complications. Nevertheless, ERCP is not without complications and may have a greater complication rate in the LT population. Knowledge of the prevalence, severity, and possible risk factors for post-ERCP pancreatitis (PEP) in LT recipients is limited. Therefore, this study aims to determine the incidence and severity of PEP and identify potential risk factors in LT recipients. This retrospective cohort included patients ≥18 years who underwent ≥1 ERCP procedures after LT between January 2010 and October 2021. Two hundred thirty-two patients were included, who underwent 260 LTs and 1125 ERCPs. PEP occurred after 23 ERCP procedures (2%) with subsequent mortality in three (13%). Multivariate logistic regression identified wire cannulation of the pancreatic duct as a significant risk factor for PEP (OR, 3.21). The complication rate of PEP after LT in this study was shown to be low and is lower compared to patients without a history of LT. Nevertheless, the mortality rate of this group of patients was notably higher.
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Affiliation(s)
- Kimia Ghambari
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - David M de Jong
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wojciech G Polak
- Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lydi M J W van Driel
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Caroline M den Hoed
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Jaber F, Alsakarneh S, Alsharaeh T, Salahat AJ, Jaber M, Abboud Y, Aldiabat M, Ahmed K, Abdallah M, Abdel-Jalil A, Bilal M, Barakat M, Adler DG. Adverse Events and Device Failures Associated with Pancreatic Stents: A Comprehensive Analysis Using the FDA's MAUDE Database. Dig Dis Sci 2024; 69:2018-2025. [PMID: 38580887 DOI: 10.1007/s10620-024-08396-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/17/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Pancreatic duct stents (PDS) are widely used for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. However, there is a paucity of data regarding the adverse events associated with PDS placement. This study aims to investigate the reported adverse events and device failures related to PDS, utilizing the Manufacturer and User Facility Device Experience (MAUDE) database maintained by the U.S. Food and Drug Administration (FDA). METHODS Post-marketing surveillance data from January 2013 to December 8, 2023, were extracted from the FDA's MAUDE database to analyze the reports pertaining to the use of commonly used PDS. The primary outcomes of interest were device issues and patient-related adverse events. Statistical analysis was performed using Microsoft Excel 2010, with the calculation of pooled numbers and percentages for each device and patient adverse event. RESULTS A total of 579 device issues and 194 patient-related adverse events were identified. Device issues were primarily attributed to stent deformation (n = 72; 12.4%), followed by migration of the device into the pancreatic duct or expulsion out of the duct (n = 60; 10.4%), and stent fracture/breakage (n = 55; 9.4%). Among the patient-reported adverse events, inflammation was the most common (n = 26; 13.4%), followed by reports of stents becoming embedded in tissue (n = 21; 10.8%) and stent occlusion/obstruction (n = 16; 8.2%). The most prevalent device failures associated with Advanix stents were material deformation, with perforation (n = 3, 30%) being the most frequently reported adverse event. Concerning Geenen stents, migration or expulsion of the device (n = 34, 16.9%) constituted the most common device-related adverse events, while inflammation (n = 20, 16.7%) was the most frequently reported patient-related issue. For Zimmon stents, migration or expulsion of the device (n = 22, 8.8%) were the most frequently reported device-related problems, whereas perforation (n = 7, 10.9%) and bleeding (n = 7, 10.9%) were the most frequent patient-related adverse events. CONCLUSION Our findings highlight important device and patient adverse events that endoscopists and referring providers should be aware of before considering pancreatic stent placement.
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Affiliation(s)
- Fouad Jaber
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Saqr Alsakarneh
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Tala Alsharaeh
- Department of Medical Education, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmed-Jordan Salahat
- Department of Medical Education, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Jaber
- Department of Medical Education, Faculty of Medicine, Al-Azhar University, Gaza, Palestine
| | - Yazan Abboud
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mohammad Aldiabat
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Khalid Ahmed
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamed Abdallah
- Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Ala Abdel-Jalil
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Monique Barakat
- Division of Gastroenterology, Stanford University, Stanford, CA, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Centura Health, Denver, CO, USA.
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Shen JB, Chen PC, Su JG, Feng QC, Shi PD. Clinical application of ERCP concurrent laparoscopic cholecystectomy in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones. Heliyon 2024; 10:e31022. [PMID: 38803867 PMCID: PMC11128888 DOI: 10.1016/j.heliyon.2024.e31022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration and lithotomy (LCBDE) in the treatment of cholecystolithiasis combined with bile duct stones. Methods From September 2018 to January 2022, 195 patients with cholecystolithiasis complicated with extrahepatic bile duct stones from Department of Department of General Surgery, Shanghai Jiading Central Hospital met the inclusion criteria, including 60 cases in the LC group and 86 cases in the LCBDE group. The general condition, operation success rate, complications and residual stone rate of the two groups were retrospectively analyzed. Results In the simultaneous operation group, 58 patients successfully performed ERCP, and the indwelling rate of the abdominal drainage tube (41.7 % vs. 95.3 %) was significantly better than that in the LCBDE group. There was no significant difference in the conversion rate to open surgery, operation time, and intraoperative blood loss between the two groups. In the simultaneous surgery group, 4 patients (6.7 %) developed pancreatitis after ERCP, which was cured by conservative treatment. The pain score at 6 h after operation was significantly lower than that in the LCBDE group (3.9 ± 1.6 vs 6.5 ± 2.4). There were no significant differences in biliary leakage (1.7 % vs. 4.7 %), postoperative cholangitis (5.0 % vs. 5.8 %), incision infection (3.3 % vs. 3.5 %), and bile duct stone residue rate (5.0 % vs 3.5 %) between the two groups. There was no severe pancreatitis, second operation or death. The duration of hospital stay was shortened in the concurrent operation group (5.1 ± 2.3d vs 7.9 ± 3.7d), and the operation cost was significantly higher than that in the LCBDE group (48839.9 ± 8549.5 vs 34635.9 ± 5893.7 yuan). Conclusion ERCP combined with LC and LCBDE are both safe and effective methods for the treatment of cholecystolithiasis combined with extrahepatic bile duct stones. The simultaneous operation group has certain advantages in patient comfort and rapid rehabilitation, which can be popularized in qualified units.
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Affiliation(s)
| | | | - Jin-Gen Su
- Department of General Surgery, The Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Qing-Chun Feng
- Department of General Surgery, The Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Pei-Dong Shi
- Department of General Surgery, The Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
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Yan C, Zheng J, Tang H, Fang C, Zhu J, Feng H, Huang H, Su Y, Wang G, Wang C. Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015-2023). BMC Med Inform Decis Mak 2024; 24:143. [PMID: 38807169 PMCID: PMC11134846 DOI: 10.1186/s12911-024-02541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Post-ERCP pancreatitis is one of the most common adverse events in ERCP-related procedures. The purpose of this study is to construct an online model to predict the risk of post-ERCP pancreatitis in non-elderly patients with common bile duct stones through screening of relevant clinical parameters. METHODS A total of 919 cases were selected from 7154 cases from a major Chinese tertiary hospital. Multivariable logistic regression model was fitted using the variables selected by the LASSO regression from 28 potential predictor variables. The internal and external validation was assessed by evaluating the receiver operating characteristic curve and the area under curve. Restricted cubic spline modelling was used to explore non-linear associations. The interactive Web application developed for risk prediction was built using the R "shiny" package. RESULTS The incidence of post-ERCP pancreatitis was 5.22% (48/919) and significantly higher in non-elderly patients with female, high blood pressure, the history of pancreatitis, difficult intubation, endoscopic sphincterotomy, lower alkaline phosphatase and smaller diameter of common bile duct. The predictive performance in the test and external validation set was 0.915 (95% CI, 0.858-0.972) and 0.838 (95% CI, 0.689-0.986), respectively. The multivariate restricted cubic spline results showed that the incidence of pancreatitis was increased at 33-50 years old, neutrophil percentage > 58.90%, hemoglobin > 131 g/L, platelet < 203.04 or > 241.40 × 109/L, total bilirubin > 18.39 umol / L, aspartate amino transferase < 36.56 IU / L, alkaline phosphatase < 124.92 IU / L, Albumin < 42.21 g / L and common bile duct diameter between 7.25 and 10.02 mm. In addition, a web server was developed that supports query for immediate PEP risk. CONCLUSION The visualized networked version of the above model is able to most accurately predict the risk of PEP in non-elderly patients with choledocholithiasis and allows clinicians to assess the risk of PEP in real time and provide preventive treatment measures as early as possible.
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Affiliation(s)
- Chaoqun Yan
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Jinxin Zheng
- School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Haizheng Tang
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Changjian Fang
- Department of Pediatric Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Jiang Zhu
- Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hu Feng
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Hao Huang
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China
| | - Yilin Su
- Department of Pediatric Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China.
| | - Gang Wang
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China.
| | - Cheng Wang
- Department of Biliary and Pancreatic Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui Province, China.
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Balaban M, Balaban DV, Enache I, Nedelcu IC, Jinga M, Gheorghe C. Impact of Serum Glucose Levels on Outcomes in Acute Pancreatitis: A Retrospective Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:856. [PMID: 38929473 PMCID: PMC11205522 DOI: 10.3390/medicina60060856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: The risk of developing glycemic dysregulation up to overt diabetes mellitus (DM) after an episode of acute pancreatitis (AP) is increasingly being analyzed. We aimed to assess the changes in serum glucose levels associated with the first episode of AP, as well as the impact of dysglycemia on outcomes such as the severity of inflammation, the length of hospitalization, mortality, and the persistence of hyperglycemia at follow-up. Materials and Methods: All patients experiencing their first episode of AP, who presented to the Emergency Room (ER) between 1 January 2020 and 31 December 2023, were retrospectively included. On-admission serum glucose and peak serum glucose during hospitalization were the biological markers used to assess glucose metabolism impairment, and they were correlated with outcomes of AP. Results: Our study included 240 patients, 46.67% (112 patients) having a biliary etiology for an AP flare. Patients with COVID-19-associated AP exhibited the highest on-admission and peak serum glucose levels (244.25 mg/dL and 305.5 mg/dL, respectively). A longer hospital stay was noted in patients with peak serum glucose levels of ≥100 mg/dL (9.49 days) compared to normoglycemic patients (6.53 days). Both on-admission and peak glucose levels were associated with elevated CRP levels during hospitalization. A total of 83.78% of patients who received antibiotics exhibited on-admission hyperglycemia, and 72.07% had peak serum glucose levels of ≥100 mg/dL. The presence of hyperglycemia at follow-up was associated with both on-admission and peak serum glucose levels of ≥100 mg/dL, as well as with a longer stay, higher CRP levels, and antibiotic use during index admission. Conclusions: On-admission hyperglycemia predicts a higher inflammatory response in patients at the first episode of AP, while the presence of hyperglycemia during hospitalization is associated with imaging and biological severity and longer hospitalizations, indicating a more severe disease course. Both on-admission and peak in-hospital hyperglycemia were identified as risk factors for sustained hyperglycemia at follow-up.
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Affiliation(s)
- Marina Balaban
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.E.); (I.C.N.)
| | - Daniel Vasile Balaban
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.V.B.); (M.J.); (C.G.)
- Gastroenterology Department, Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Iulia Enache
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.E.); (I.C.N.)
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.V.B.); (M.J.); (C.G.)
- Gastroenterology Department, Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Ioan Cristian Nedelcu
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.E.); (I.C.N.)
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.V.B.); (M.J.); (C.G.)
- Gastroenterology Department, Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Mariana Jinga
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.V.B.); (M.J.); (C.G.)
- Gastroenterology Department, Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Cristian Gheorghe
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.V.B.); (M.J.); (C.G.)
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
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22
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Feng Y, Liang Y, Liu Y, Zhang Y, Huang S, Ren L, Ma X, Zhou A, Shi R. Digital cholangioscopy-assisted, direct visualization-guided, radiation-free, endoscopic retrograde intervention for cholelithiasis: technical feasibility, efficacy, and safety. Surg Endosc 2024; 38:1637-1646. [PMID: 38286835 DOI: 10.1007/s00464-024-10684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Nonradiation, digital cholangioscope (DCS)-assisted endoscopic intervention for cholelithiasis has not been widely performed. For this study, we aimed to report the feasibility, efficacy, and safety of an established DCS-guided lithotomy procedure. METHODS Data relating to biliary exploration, stone clearance, adverse events, and follow-up were obtained from 289 patients. The choledocholithiasis-related outcomes via the DCS-guided procedure were subsequently compared to those via conventional endoscopic retrograde cholangiopancreatography (ERCP). RESULTS Biliary access was achieved in 285 patients. The technical success rate for the exploration of the common bile duct, the cystic stump, the hilar ducts, and secondary radicals was 100%. Moreover, the success rates were 98.4%, 61.7%, and 20.7%, for the exploration of the cystic duct, complete cystic duct, and gallbladder, respectively. Suspicious or confirmed suppurative cholecystitis, cholesterol polyps, and hyperplastic polyps were detected in 42, 23, and 5 patients, respectively. Stone clearance was achieved in one session in 285 (100%), 11 (100%), 13 (100%), 7 (100%), 6 (100%), and 3 (14.3%) patients with choledocholithiasis and hepatolithiasis, cystic duct stump stones, nondiffuse located intrahepatic lithiasis, a single cystic duct stone, a single gallbladder stone, and diffuse located intrahepatic lithiasis, respectively. Complete stone clearance for diffuse intrahepatic lithiasis was achieved in 19 (90.5%) patients, and fractioned re-lithotomy was performed in 16 (76.2%) patients. One patient developed mild acute cholangitis, and 12 developed mild pancreatitis. Stones recurred in one patient. Compared with conventional ERCP, DCS-guided lithotomy has the advantages of clearing difficult-to-treat choledocholithiasis and revealing concomitant biliary lesions, and this technique has fewer complications and a decreased risk of stone recurrence. CONCLUSIONS The technical profile, efficacy, and safety of nonradiation-guided and DCS-guided lithotomy are shown in this study. We provide a feasible modality for the endoscopic removal of cholelithiasis.
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Affiliation(s)
- Yadong Feng
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of Gastroenterology, Lianshui People's Hospital, 6 Hongri Road, Lianshui, 223400, China.
| | - Yan Liang
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Yang Liu
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Yinqiu Zhang
- Department of Gastroenterology, Previously School of Medicine, Humanity Hospital, Southeast University, 3777 Yuexian Road, Xiamen, 361006, China
| | - Shuaijing Huang
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Lihua Ren
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Xiaojun Ma
- Department of Translational Research, Nanjing Microtech Medical Technology Co. Ltd., 10 Gaoke 3rd Road, Nanjing, 210018, China
| | - Aijun Zhou
- Department of Gastroenterology, Lianshui People's Hospital, 6 Hongri Road, Lianshui, 223400, China.
| | - Ruihua Shi
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
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Monino L, Moreels TG. Patient Radiation Exposure during Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy (with Video). Diagnostics (Basel) 2024; 14:142. [PMID: 38248019 PMCID: PMC10814473 DOI: 10.3390/diagnostics14020142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Fluoroscopy must be used cautiously during endoscopic retrograde cholangiopancreatography (ERCP). Radiation exposure data in patients with surgically altered anatomy undergoing enteroscopy-assisted ERCP (EA-ERCP) are scarce. METHODS 34 consecutive EA-ERCP procedures were compared with 68 conventional ERCP (C-ERCP) procedures. Patient and procedure characteristics and radiation data were collected. RESULTS Surgical reconstructions were gastrojejunostomy, Roux-en-Y hepaticojejunostomy, Roux-en-Y total gastrectomy, Roux-en-Y gastric bypass and Whipple's duodenopancreatectomy. Procedures were restricted to biliary indications. Mean fluoroscopy time was comparable in both groups (370 ± 30 s EA-ERCP vs. 393 ± 40 s C-ERCP, p = 0.7074), whereas total mean radiation dose was lower in EA-ERCP (83 ± 6 mGy) compared to C-ERCP (110 ± 11 mGy, p = 0.0491) and dose area product (DAP) was higher in EA-ERCP (2216 ± 173 µGy*m2) compared to C-ERCP (1600 ± 117 µGy*m2, p = 0.0038), as was total procedure time (77 ± 5 min vs. 39 ± 3 min, p < 0.0001). Enteroscope insertion to reach the bile duct during EA-ERCP took 28 ± 4 min, ranging from 4 to 90 min. These results indicate that C-ERCP procedures are generally more complex, needing magnified fluoroscopy, whereas EA-ERCP procedures take more time for enteroscope insertion under wide field fluoroscopic guidance (increased DAP) with less complex ERCP manipulation (lower total radiation dose). CONCLUSIONS Radiation exposure during EA-ERCP in surgically altered anatomy is different as compared to C-ERCP. EA-ERCP takes longer with a higher DAP because of the enteroscope insertion, but with lower total radiation dose because these ERCP procedures are usually less complex.
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Affiliation(s)
| | - Tom G. Moreels
- Department of Gastroenterology & Hepatology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
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24
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Zhu P. Analysis of risk factors and construction of predictive model for post-endoscopic retrograde cholangiopancreatography pancreatitis. Pak J Med Sci 2023; 39:1642-1646. [PMID: 37936748 PMCID: PMC10626097 DOI: 10.12669/pjms.39.6.7972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/06/2023] [Accepted: 08/19/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To explore the risk factors of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and to establish a predictive model. Methods This was a retrospective observational study. Patients diagnosed with calculous cholangitis and treated with ERCP (n=998) in The First People's Hospital of Linping District from January 2014 to September 2022 were included. Risk factors of PEP were identified using univariate and multivariate logistic regression, and a nomograph prediction model was established based on the identified independent risk factors. Results PEP occurred in 52 patients (5.2%). Logistic regression analysis showed that common bile duct diameter, history of PEP, operation time, intubation frequency, pancreatic ducts visualization, and Sphincter of Oddi dysfunction (SOD) were independent risk factors for inducing PEP (P<0.05). The calibration curve showed that the predicted probability of occurrence of the nomograph model was consistent with the actual probability of occurrence. The C-index value calculated by the Bootstrap method was 0.966, suggesting the nomograph prediction model has a good discrimination ability. The AUC of the nomograph prediction model ROC curve was 0.966 (95% CI: 0.857-0.941), suggesting good prediction efficiency, and the decision analysis curve shows a high value. Conclusions Independent risk factors for PEP are large diameter of common bile duct, history of pancreatitis, long operation time, high intubation frequency, pancreatic ducts visualization, and SOD. The nomogram prediction model based on the above independent risk factors has good prediction ability.
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Affiliation(s)
- Ping Zhu
- Ping Zhu Department of Gastroenterology, The first people’s Hospital of Linping District, Hangzhou 311100, Zhejiang Province, P.R. China
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25
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Qin XM, Yu FH, Lv CK, Liu ZM, Wu J. Endoscopic retrograde cholangiopancreatography for diagnosing and treating pediatric biliary and pancreatic diseases. World J Gastrointest Surg 2023; 15:2272-2279. [PMID: 37969723 PMCID: PMC10642467 DOI: 10.4240/wjgs.v15.i10.2272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND This study evaluated the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients with biliary and pancreatic diseases. A retrospective analysis was conducted on 57 ERCP procedures performed in 41 children, primarily for treating pancreatic diseases. The overall success rate was 91.2%, with no major complications observed. Post-ERCP pancreatitis (PEP) occurred in 8.8% of cases. Follow-up examinations over one year showed no recurrence of biliary or pancreatic diseases. Notably, endoscopic treatment led to a significant increase in body mass index (BMI). These findings demonstrate the valuable role of ERCP in managing such conditions. AIM To evaluate the safety and efficacy of ERCP for the management of biliary and pancreatic diseases in pediatric patients. METHODS We conducted a retrospective analysis of data from children aged 1-18 years who underwent ERCP for biliary and pancreatic diseases at Beijing Children's Hospital between January 2021 and December 2022. The collected data included procedure time, endoscopic treatment, success rate, and postoperative complications. RESULTS Forty-one children underwent 57 ERCP procedures, including 14 with biliary duct disease and 27 with pancreatic disease. The mean age of the patients was 7.48 ± 3.48 years. Biliary duct-related treatments were performed 18 times, and pancreatic disease treatments were performed 39 times. ERCP was primarily used to treat pediatric pancreatic diseases [68.4% (39/57) of the procedures]. The overall success rate was 91.2% (52/57 patients). PEP was noted in five patients (8.8%, 5/57), and no instances of bleeding, perforation, or cholangitis were observed. The patients were followed up for over one year, and no recurrence of biliary or pancreatic diseases was detected. Importantly, BMI significantly increased after endoscopic treatment compared to that before treatment (P = 0.001). CONCLUSION The high success rate and lack of major complications support the valuable role of ERCP in the management of pediatric biliary and pancreatic diseases in the pediatric population.
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Affiliation(s)
- Xiu-Min Qin
- Department of Gastroenterology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Fei-Hong Yu
- Department of Gastroenterology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Chuan-Kai Lv
- Department of Ultrasound, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Zhi-Min Liu
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
| | - Jie Wu
- Department of Gastroenterology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
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Boicean A, Birlutiu V, Ichim C, Todor SB, Hasegan A, Bacila C, Solomon A, Cristian A, Dura H. Predictors of Post-ERCP Pancreatitis (P.E.P.) in Choledochal Lithiasis Extraction. J Pers Med 2023; 13:1356. [PMID: 37763124 PMCID: PMC10532909 DOI: 10.3390/jpm13091356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
In the present era, post-ERCP pancreatitis (PEP) stands out as one of the most commonly occurring complications associated with endoscopic choledochal lithiasis extraction. The ability to predict the occurrence of such an event, particularly by utilizing absolute values and ratio dynamics of the emergency blood tests, constitutes the primary step in effectively managing a patient with a complex pathology. The study involved 134 patients who performed ERCP to extract choledochal lithiasis (n = 48 with PEP and n = 86 without PEP). The results revealed increased risks of post-ERCP pancreatitis in women and lower risks in those who benefited from manipulation of the main bile duct with the Dormia probe and dilatation balloon (OR: 2.893 CI 95%: 1.371-6.105, p = 0.005 and respectively OR: 0.346 CI 95%: 0.156-0.765, p = 0.009), without biliary stent placement. Moreover, the results brought novel elements to the literature, showing that higher values of CRPR (OR: 4.337 CI 95%: 1.945-9.668; p < 0.001), TBIR (4.004 CI 95%: 1.664-9.634; p = 0.002) and NLR post-ERCP (3.281 CI 95%: 1.490-7.221; p = 0.003) are predictive for PEP. Nevertheless, lower total bilirubin levels upon admission are predictive of PEP with an OR of 5.262 (95% confidence interval: 2.111-13.113, p < 0.001).
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Affiliation(s)
- Adrian Boicean
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania (V.B.); (A.H.); (C.B.); (A.S.); (A.C.); (H.D.)
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Victoria Birlutiu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania (V.B.); (A.H.); (C.B.); (A.S.); (A.C.); (H.D.)
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Cristian Ichim
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania (V.B.); (A.H.); (C.B.); (A.S.); (A.C.); (H.D.)
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Samuel B. Todor
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania (V.B.); (A.H.); (C.B.); (A.S.); (A.C.); (H.D.)
| | - Adrian Hasegan
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania (V.B.); (A.H.); (C.B.); (A.S.); (A.C.); (H.D.)
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Ciprian Bacila
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania (V.B.); (A.H.); (C.B.); (A.S.); (A.C.); (H.D.)
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Adelaida Solomon
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania (V.B.); (A.H.); (C.B.); (A.S.); (A.C.); (H.D.)
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Adrian Cristian
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania (V.B.); (A.H.); (C.B.); (A.S.); (A.C.); (H.D.)
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Horatiu Dura
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania (V.B.); (A.H.); (C.B.); (A.S.); (A.C.); (H.D.)
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
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Chiriac S, Sfarti CV, Stanciu C, Cojocariu C, Zenovia S, Nastasa R, Trifan A. The Relation between Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis and Different Cannulation Techniques: The Experience of a High-Volume Center from North-Eastern Romania. Life (Basel) 2023; 13:1410. [PMID: 37374192 DOI: 10.3390/life13061410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/03/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Despite numerous advances that have aimed to increase the safety of endoscopic retrograde cholangiopancreatography (ERCP), post-ERCP pancreatitis (PEP) still remains a major issue. We aimed to assess the rate of PEP as well as the relation to the cannulation techniques in our unit, a high-volume center in north-eastern Romania. METHODS ERCPs performed in our unit from March to August 2022 were retrospectively included. Data concerning demographic information, presence of difficult cannulation, the technique used for cannulation, as well as immediate complications, were gathered from the electronic database. RESULTS 233 ERCPs were included. PEP was diagnosed in 23 (9.9%) of cases. Precut sphincterotomy (PS), transpancreatic sphincterotomy (TPBS), and a combination of TPBS and PS were performed in 6.4%, 10.3%, and 1.7% of cases, respectively, while an Erlangen precut papillotomy was performed in one case. Both in patients with PS and TPBS the rate of PEP was 20%. When the two techniques were associated, the rate of PEP was 25%. TPBS and PS represented risk factors for PEP (OR 1.211 for a CI of 0.946-1.551, p = 0.041, and OR 1.124 for a CI of 0.928-1.361, p = 0.088, respectively). No PEP-associated deaths were found. CONCLUSIONS Both PS and TPBS presented a similar risk of PEP.
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Affiliation(s)
- Stefan Chiriac
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Catalin Victor Sfarti
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Camelia Cojocariu
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Sebastian Zenovia
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Robert Nastasa
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
| | - Anca Trifan
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, "St. Spiridon" Emergency Hospital, 700259 Iasi, Romania
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Arabi TZ, Almuhaidb A. Periampullary diverticulum in endoscopic retrograde cholangiopancreatography: A paper tiger? Saudi J Gastroenterol 2023; 29:1-2. [PMID: 36647939 PMCID: PMC10117007 DOI: 10.4103/sjg.sjg_9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Tarek Z Arabi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Aymen Almuhaidb
- Section of Gastroenterology, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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