USES OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE MANAGEMENT OF BILE DUCT STONES IN KURDISTAN CENTER FOR GASTROENTEROLOGY AND HEPATOLOGY
DOI:
https://doi.org/10.17656/jsmc.10099Keywords:
ERCP, KCGH, Sulaimani, endoscopic sphincterotomy, choledocholithiasisAbstract
Objectives
The purpose of this study is to document the extent of pre and post-cholecystectomy retained bile duct stones in our region with evaluation of the endoscopic retrograde cholangio pancreatography role in their management.
Design
Retrospective study.
Patients and Methods
This retrospective case series was carried out in Kurdistan center for gastroenterology and Hepatology in Sulaimani city–Iraq from January 2014 to January 2015. The records of 486 patients were retrospectively evaluated to collect demographic, clinical and procedure related data.
Results
The mean age was 51 years (range14-88 years).The female : male ratio was 2.01:1 with females constituted 325 (66.87%) while males constituted 161 (33.12%).Less than quarter of the patients were referrals from Iraqi governorates other than Sulaimani governorate. The mean duration of the ERCP procedure was 27.5 min. Deep cannulation was successful in 452 (93.o1%) patients. There was 34 (6.99%) failure of cannulation. In cases that had successful cannulation a cholangiogram was obtained which showed bile duct dilatation. Endoscopic sphincterotomy is almost done in all cases before stone extraction, and it is an adjunct for stone removal which is done by basket or balloon. It was performed in 285 (84.2%) patients, followed by stone extraction in 341 (96.05%) patients, stenting in 208 (45.51%). The most common complications reported in this study were pancreatitis, bleeding and cholangitis. Elevated liver function tests and dilated CBD by ultrasound are the most accurate predictors of stones.
Conclusion
Despite its associated morbidity and risk of mortality, ERCP (Endoscopic Retrograde Cholangio Pancreatography) is an important method in managing pre and post cholecystectomy choledocholithiasis. Our indications, interventions and complications rates are comparable to those reported in other countries.
References
Puig I, Calvet X, Baylina M, Isava Á, Sort P, Llaó J, et al. How and when should NSAIDs be used for preventing post-ERCP pancreatitis? A systematic review and meta-analysis. PLoS One. 2014. 9(3):e92922. DOI: https://doi.org/10.1371/journal.pone.0092922
Adler DG, Baron TH, Davila RE. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 2005;62 (1):1-8. DOI: https://doi.org/10.1016/j.gie.2005.04.015
Penaloza-Ramirez A, Leal-Buitrago C, Rodriguez-Hernandez A. Adverse events of ERCP at San JoseHospital of Bogota (Colombia). Rev Esp Enferm Dig 2009; 101: 837-849. DOI: https://doi.org/10.4321/S1130-01082009001200003
Cotton PB. Analysis of 59 ERCP lawsuits; mainly about indications. Gastrointest Endosc. 2006 Mar. 63(3):378-82; quiz 464. DOI: https://doi.org/10.1016/j.gie.2005.06.046
Hunter JG, Soper NJ. Laparoscopic management of bile duct stones Surg Clin North Am 1992;72:1077-97. Endosc 1992;38:27-34. DOI: https://doi.org/10.1016/S0039-6109(16)45833-0
Cranley B, Logan H. Exploration of the common bile duct—the relevance of the clinical picture and the importance of peroperative cholangiography Br.J Surg 1980;67:869-72. DOI: https://doi.org/10.1002/bjs.1800671210
Cohen S, Bacon BR, Berlin JA, Fleischer D, Hecht GA, Loehrer PJ Sr. National Institutes of Health State-of-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14-16, 2002. Gastrointest Endosc. 2002 Dec. 56(6):803-9. [Medline] DOI: https://doi.org/10.1067/mge.2002.129875
Lopes TL, Wilcox CM. Endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anatomy. Gastroenterol Clin North Am. 2010 Mar. 39(1):99-107. [Medline] DOI: https://doi.org/10.1016/j.gtc.2009.12.008
Baron TH, Kozarek RA, Carr-Locke DL. ERCP. Philadelphia: Elsevier Saunders; 2013. 2nd ed:
Kelly JC. AGA issues new endoscope safety recommendations. Medscape Medical News. April 2, 2015. [Full Text].
Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol. 2007 Aug. 102(8):1781-8. [Medline]. DOI: https://doi.org/10.1111/j.1572-0241.2007.01279.x
Guitron-Cantu A, Adalid-Martinez R, Gutierrez-Bermudez J, et al. [Does fentanyl hinder the cannulation of Vater’s papilla? A prospective and comparative study.]. Rev Gastroenterol Mex. 2010 Apr-Jun. 75(2):142-8. [Medline].
Schilling D, Rosenbaum A, Schweizer S, Richter H, Rumstadt B. Sedation with propofol for interventional endoscopy by trained nurses in high-risk octogenarians: a prospective, randomized, controlled study. Endoscopy. 2009 Apr. 41(4):295-8. [Medline].. DOI: https://doi.org/10.1055/s-0028-1119671
Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T, et al. Complications of ERCP. Gastrointest Endosc. 2012 Mar. 75(3):467-73. [Medline].. DOI: https://doi.org/10.1016/j.gie.2011.07.010
Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc. 2003 Mar. 57(3):291-4. [Medline]. DOI: https://doi.org/10.1067/mge.2003.124
Chavalitdhamrong D, Donepudi S, Pu L.Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography.Digestive Endoscopy 2014; 26: 15–22 DOI: https://doi.org/10.1111/den.12178
Huang LY, Liu YX, Wu CR. Application of endoscopic retrogradecholangiopancreatography in biliarypancreatic diseases. Chinese Med J 2009; 122: 2967-2972.
Scarlett PY, Falk GL. The management of perforation of the duodenum following endoscopic sphincterotomy: a proposal for selective therapy. Aust N Z J Surg 1994; 64:843-846. CrossRef, Medline DOI: https://doi.org/10.1111/j.1445-2197.1994.tb04561.x
Alizadeh AM, Afzali ES, Mousavi M et al. Endoscopicretrograde cholangiopancreatography outcome from a single referral center in Iran. Hepatobiliary Pancreat Dis Int 2010; 9: 428-432.
Tsou YK, Lin CH, Liu NJ et al. Treating delayed endoscopic sphincterotomy-induced bleeding:epinephrine injection with or without thermotherapy.World J Gastroenterol 2009; 15: 4823-4828. DOI: https://doi.org/10.3748/wjg.15.4823
Baron TH, Petersen BT, Mergener K et al.Quality indicators for endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 2006;63 (4): S29-34. DOI: https://doi.org/10.1016/j.gie.2006.02.019
Rogers SJ, Cello JP, Horn JK et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC forcommon bile duct stone disease. Arch Surg 2010; 145:28-33. DOI: https://doi.org/10.1001/archsurg.2009.226
Salman B, Yýlmaz U, Kerem M et al. The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cholelithiasis coexisting with choledocholithiasis. J Hepatobiliary Pancreat Surg 2009; 16: 832-836. DOI: https://doi.org/10.1007/s00534-009-0169-4
Zerem E, Omerovic S. Minimally invasive management of biliary complications after laparoscopic cholecystectomy. Eur J Intern Med 2009; 20: 686-689. DOI: https://doi.org/10.1016/j.ejim.2009.07.010
Aksoz K, Unsal B, Yoruk G et al. Endoscopic sphincterotomy alone in the management of low-grade biliary leaks due to cholecystectomy. Dig Endosc 2009; 21: 158-161. DOI: https://doi.org/10.1111/j.1443-1661.2009.00878.x
Tanaka K, Kida M. Role of endoscopy in screening of early pancreatic cancer and bile duct cancer. Dig Endosc 2009; 21: S97-S100. DOI: https://doi.org/10.1111/j.1443-1661.2009.00856.x
Rabago L, Guerra I, Moran M et al. Is outpatient ERCP suitable, feasible, and safe? The experience of a Spanish community hospital. Surg Endosc 2010; 24:1701-1706. DOI: https://doi.org/10.1007/s00464-009-0832-5
Cotton PB, Garrow DA, Gallagher J et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009; 70:80-88. DOI: https://doi.org/10.1016/j.gie.2008.10.039
Mitra V, Mitchison H, Nylander D. Endoscopicretrograde cholangiopancreatography services can be accessible and of a high standard in a district generalhospital. Frontline Gastroenterology 2012;3:152–156. DOI: https://doi.org/10.1136/flgastro-2011-100084
Toros AB, Kesici B, Argun F et al. Evaluation of Repeat ERCP: Analysis of a Four-Year Experience. J Gastroint Dig Syst 2013: 2;116. doi:10.4172/2161-069X.1000116. DOI: https://doi.org/10.4172/2161-069X.1000116
S Chatterje e, C Rees, AD Dwarakanath et al. Endoscopic retrograde cholangiopancreatography practice in district general hospitals in NorthEast England: a NorthernRegional Endoscopy Group (NREG) studyJ R Coll Physicians Edinb 2011; 41:109–13 doi:10.4997/JRCPE. 2011.221 DOI: https://doi.org/10.4997/JRCPE.2011.221
Downloads
Published
Issue
Section
License
Copyright (c) 2016 Ali Fadhil Al-Najjar, Taha Karboly
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This work is licensed under 