Gastroenterology
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
Usual onset is around 10 years of age, but can begin as early as 1 year. Episodes of abdominal pain lasting from 2 days to 2 weeks occur from monthly to yearly. Attacks can be precipitated by large, fatty meals, alcohol and stress. Frequency of attacks usually decreases with age. There is severe epigastric pain that may radiate to the back and is lessened by adopting the fetal position. Epigastric tenderness and, in some cases, reduced bowel sounds and abdominal distension occur (Figs 9.57, 9.58). Helpful investigations include blood pancreatic enzyme levels, abdominal ultrasound and MRI. Endoscopic retrograde cholangiopancreatography (ERCP) should be performed when an anatomical cause is suspected.
Acute Cholecystitis
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
The accuracy of an abdominal ultrasound is limited by the patient’s body habitus and the expertise of the sonographer. In case of doubt, contrast-enhanced CT scan of the abdomen can be performed. CT helps in the identification of acute cholecystitis-related complicationa such as emphysema of the gallbladder, abscess formation, and perforation; however, its diagnostic accuracy has not been proven to supersede abdominal ultrasound. Magnetic resonance cholangiopancreatography (MRCP) is preferred for the assessment of patients with gallstones and suspected common bile duct stones (derangement of liver function tests including an elevated serum bilirubin). Hepatobiliary iminodiacetic acid scintigraphy is reported to yield higher diagnostic accuracy compared with ultrasound, but it is not recommended due to limited availability and its time-consuming nature. Endoscopic retrograde cholangiopancreatography is a useful modality as both diagnostic and therapeutic tool for common bile duct stones with cholangitis. It is fraught with the inherent risk of inducing an attack of acute pancreatitis (<5%).
Complications of Biliary Tract Surgery and Trauma
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Endoscopic retrograde cholangiopancreatography (ERCP) can be either a diagnostic or a therapeutic procedure in cases of bile duct injury. Cholangiography can easily pinpoint the exact location of injury to the biliary tree. Therapeutic maneuvers such as sphincterotomy, stone extraction, and biliary stent placement may be performed when appropriate. ERCP can easily detect cystic duct leaks and lacerations to the common duct. In cases of transections of the biliary tree, however, ERCP may not allow visualization of proximal anatomy, and complete delineation of the injury may not be possible. In 5% of cases, ERCP is associated with serious complications such as pancreatitis, hemorrhage, cholangitis, and intestinal perforation.1
Meta-analysis comparing the efficiency of high-flow nasal cannula versus low-flow nasal cannula in patients undergoing endoscopic retrograde cholangiopancreatography
Published in Baylor University Medical Center Proceedings, 2022
Mohamed Gamal, Manar Ahmed Kamal, Mohamed Abuelazm, Amman Yousaf, Basel Abdelazeem
Endoscopic retrograde cholangiopancreatography (ERCP) is a common intervention to diagnose and treat pancreatic and biliary pathologies.1 The procedure is primarily performed in the lateral or prone position under moderate to deep sedation or general anesthesia. However, performing ERCP under sedation in the prone position increases the risk of hypoxemia, leading to procedural interruptions or even termination.2–4 Conventionally, a low-flow nasal cannula (LFNC) is used to reduce hypoxemia events during anesthesia from 77% to 16%.5,6 However, the maximum oxygen flow through the nasal cannula is 5 L/min, with a fraction of inspired oxygen of not greater than 0.5. A high-flow nasal cannula (HFNC) can deliver heated and humidified gas under physiological temperature in a high flow rate up to 70 L/min fraction of inspired oxygen of 100%.7 This can generate positive pressure in the upper airways, increasing end-expiratory lung capacity and improving oxygenation.8,9 Therefore, we conducted a systematic review and meta-analysis to assess the effectiveness of HFNC compared to LFNC in preventing hypoxemic events in patients undergoing ERCP.
Value of the revised Atlanta classification (RAC) and determinant-based classification (DBC) systems in the evaluation of acute pancreatitis
Published in Current Medical Research and Opinion, 2018
Xiaolei Wang, Li Qin, Jingli Cao
Acute pancreatitis (AP), a common acute abdominal disease, is characterized by acute upper abdominal pain and elevated serum amylase or lipase levels. AP has a worldwide prevalence of 49,734 cases/100,000 people and imposes a significant mental, physical and economic burdens on the patient1,2. Biliary AP is the most common type of AP in China, while in Western countries AP is most commonly caused by alcoholism3. Definitive diagnosis of AP in patients with atypical symptoms is achieved by abdominal imaging4. It is estimated that micro-stones are an important cause of AP in some patients, and cholecystectomy is recommended for hospitalized patients with mild biliary AP, and after the first recurrence of AP5,6. Endoscopic retrograde cholangiopancreatography (ERCP) is used to confirm pancreatic duct rupture in patients with severe AP (SAP), following which the endoscopic sphincterotomy (EST) procedure is performed to remove stones and relieve the obstruction. Early ERCP (within 24 h of admission) has been shown to reduce morbidity and mortality in AP patients with concomitant biliary sepsis7,8, while magnetic resonance cholangiopancreatography (MRCP) and other non-invasive procedures are used for mild AP (MAP)9.
Safety and efficacy of different techniques in difficult biliary cannulation at endoscopic retrograde cholangiopancreatography
Published in Hospital Practice, 2022
Ankit Dalal, Chaiti Gandhi, Gaurav Patil, Nagesh Kamat, Sehajad Vora, Amit Maydeo
The usefulness of endoscopic retrograde cholangiopancreatography (ERCP) in managing various disorders of pancreas and biliary system is well documented [1]. Modern day endoscopy has advanced and proven incredibly useful with minimal risks and optimal benefits. The success of ERCP relies on patient selection, appropriate indication for procedure, experience of the endoscopist, technique of biliary cannulation, anesthesia management, and vigilance during the procedure [2]. It is almost impossible to predict upfront difficult biliary cannulation (DBC) in majority of the cases. Failed biliary cannulation during ERCP is common and occurs in 5–20% of the cases [3,4]. In 5% of cases, deep cannulation can fail in experienced hands and 15–35% chances of failure with selective biliary cannulation (SBC) [5]. Incidence of complications while trying to achieve biliary access in DBC ranges from 4–30% [6]. Prolonged procedures and repeated attempts at biliary cannulation leads to post-procedural complications [7]. A biliary cannulation rate of >85% is ideal for endoscopists routinely involved in ERCP. Use of advanced cannulation techniques contributes to higher success rates of biliary access (up to 98%) in specialized tertiary centers [8]. Numerous studies have shown the utility of various techniques for DBC after a failed ERCP. Nonetheless, the safety and efficacy of each technique and sequential algorithm to be followed during failure of each technique is explored to a lesser extent. This study aimed to study the outcomes of utilizing various techniques for DBC.
Related Knowledge Centers
- Endoscopy
- Fluoroscopy
- Pancreas
- Gallstone
- Bile Duct
- Stomach
- Pancreatic Duct
- Radiography
- Duodenum
- Contrast Agent