Informado Herramientas. Servicio Central de Endoscopia. Abordaremos por separado cada una de ellas. Guidelines for the Management of Acute Pancreatitis. Boston, MA.
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Se observaron complications en 10 pacientes 4. Introduction: There have been numerous studies describing different risk factors for complications after ERCP. A prospective study to determine the frequency and associated risk factors for complications after ERCP was performed in our center.. Material and methods: The following data were recorded prospectively: indication and duration of the procedure, number of cannulation attempts, use of precut or sphincterotomy, pancreatic duct cannulation and pancreatography; patient demographics, including age, gender, height, weight and body mass index we also noted.
ERCP complications were evaluated during and after the procedure. Mortality at 30 days was evaluated by clinical follow-up or records. Descriptive statistics as well as univariate and multivariate analysis were performed.. Sphincterotomy was performed in Precut was performed in 18 8. On multivariate analysis, obesity and duration of the procedure were significant factors associated to development of complications..
Conclusion: Obesity and lenghty procedures are factors associated with development of post-ERCP complications in our studied population.. The risk of serious complications associated to endoscopic retrograde cholangiopancreatography ERCP is well known.
These facts should reduce the complication rate of ERCP to a minimal level, by ensuring that procedures are performed only when really indicated. Efforts to do identify and understand the factors that make complications more or less likely, have contributed greatly towards this aim. Several studies document the complications of ERCP and analyze various risk factors as well as predictors. The aim of this study was to determine the frequency of complications after ERCP in our center and evaluate the associate factors.
We included all procedures performed in our institution for any indication and excluded patients in whom the procedure could not performed or declined to participate. In every case, before the first procedure, complete blood count, INR, and prothrombin time were obtained to minimize the risk of bleeding. An experienced ERCP endoscopist performed all cases. Written informed consent was obtained for each patient and all procedures were performed under deep sedation with Midazolam, Propofol and Phentanyl by an anesthesiologist.
Demographic, clinical and endoscopic data were collected; weight and height were extracted from the medical records before the study. An investigator recorded prospectively the following variables during endoscopy; indication and duration of procedure, number of attempts, use of precut, sphincterotomy, cannulation of pancreatic duct and pancreatography. Mortality at 30 days was evaluated by clinical follow-up and records. All patients were hospitalized for at least two hours after the procedure for surveillance of possible complications.
ERCP complications were defined as described in previous papers as follows:. Severe: medical treatment for more than 10 days or intervention percutaneous or surgical. Severe: Pancreatitis requiring hospitalization for more than 10 days, or hemorrhagic pancreatitis, phlegmon or pseudocyst, or intervention percutaneous drainage or surgery.
Descriptive statistics were used for demographic variables. Comparison of quantitative data was performed using the Mann-Whitney U test. The difference in proportions of categorical data was analyzed with the Fisher exact test when the expected number of subjects was less than five, and by the Chi-square test when the number of subjects in each cell was five or more.
Seventy-five patients had more than one indication for the procedure. Seventeen cases were sphincterotomy extension. The differences between patients whom developed complications and patients whom did not are shown in Table 1.
Pancreatitis presented in five patients 1. The multivariate analysis is shown in Table 2. No mortality was observed at 30 days.
There are numerous previous studies in which the risk-factors associated with development of post-ERCP complications have been studied, mainly post-ERCP pancreatitis. Some of the factors commonly reported include: needle-knife sphincterotomy or precut, the number of attempts at cannulating the papilla, the number of cannulations of the main pancreatic duct MPD , the injection of contrast medium into the MPD and the extent of MPD opacification, among others.
Subsequent papers however, have casted doubts on this assertion. In our work, as well as other prospective studies, we found no evidence that performing precut had any implication related to complications. According to our data, the length of the procedure is a more important factor for the development of complications.
As it is well known, most procedures in whom sphincterotomy is performed, are tend to be of longer duration, but this is not always synonymous. We believe that the association with the duration of the procedure relates to the number of attempts at cannulation of the papilla and subsequent trauma. Our data as well as previous one support this opinion. Regarding the association with obesity found by us, this disease has been associated with multiple deleterious consequences in humans, however, there are scarce previous studies that report this association.
Some limitations of our study are the sample number and the observational design. Studies with larger samples and a randomized design early vs late precut in patients with and without obesity could help confirm our initial data. Finally, in this study all complications were considered. In conclusion, obesity and lengthy procedures are factors associated with development of post-ERCP complications, including pancreatitis. Vasco de Quiroga Mexico City, Mexico.
E-mail: felixtelleza gmail. Obesity as a risk factor for the development of complications after ERCP. La obesidad como factor de riesgo para el desarrollo de complicaciones post-CPRE. Descargar PDF. Instituto Nacional de Ciencias M?? Mexico City, M?? Palabras clave:. A prospective study to determine the frequency and associated risk factors for complications after ERCP was performed in our center.
Descriptive statistics as well as univariate and multivariate analysis were performed. On multivariate analysis, obesity and duration of the procedure were significant factors associated to development of complications. Conclusion: Obesity and lenghty procedures are factors associated with development of post-ERCP complications in our studied population.
ERCP, complications, pancreatitis, obesity, Mexico. Texto completo. Introduction The risk of serious complications associated to endoscopic retrograde cholangiopancreatography ERCP is well known. ERCP complications were defined as described in previous papers as follows: - Perforation: Mild: If there was the possibility or only a very leak of fluid or contrast dye; treatable with I.
Moderate: any perforation treated medically for four to 10 days. Moderate: Pancreatitis requiring hospitalization of four to 10 days. Statistical analyses Descriptive statistics were used for demographic variables. Risk factors for complications after ERCP: a multivariate analysis of 11, procedures over 12 years.. Gastrointest Endosc. Complications of ERCP: a prospective study..
Outcome and early complications of ERCP: a prospective single center study.. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study.. Risk factors for post-ERCP pancreatitis: a prospective multicenter study.. Am J Gastroenterol. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification..
Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial.. Needle-knife sphincterotomy: factors predicting its use and the relationship with post-ERCP pancreatitis with video.. Timing of precut procedure does not influence success rate and complications of ERCP procedure: a prospective randomized comparative study..
Obesity: a risk factor for severe acute biliary and alcoholic pancreatitis.. Obesity: a prognostic factor of severity in acute pancreatitis.. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis..
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Cómo comprender la CPRE
Complications of endoscopic retrograde cholangiopancreatography. A study in a small ERCP unit. Backgrounds and aim : endoscopic retrograde cholangiopancreatography ERCP is an established procedure to drain the biliary and pancreatic ducts. Nevertheless, there are complications which seem to be more common in centers performing less than ERCPs per year. Sometimes, however, due to the distribution of health resources, it is necessary to perform this technique in centers with a smaller number of procedures. We present the experience of ERCP-related complications in a small unit. Material and methods : this is a retrospective study on prospective data recorded during six years