scholarly journals Endoscopic retrograde cholangiopancreatography‐related adverse events in Korea: A nationwide assessment

2021 ◽  
Author(s):  
Dong Kee Jang ◽  
Jungmee Kim ◽  
Chang Nyol Paik ◽  
Jung‐Wook Kim ◽  
Tae Hee Lee ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Retrograde

Efficacy of an Oxycodone-Propofol Combination versus a Fentanyl-Propofol Combination in Conscious Sedation during Therapeutic Endoscopic Retrograde Cholangiopancreatography in Elderly Patients

Gerontology ◽  
2020 ◽  
pp. 1-8
Author(s):  
Peipei Guo ◽  
Huisheng Wu ◽  
Lan Liu ◽  
Qiu Zhao ◽  
Zhao Jin
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Adverse Reactions ◽  
Conscious Sedation ◽  
Endoscopic Retrograde ◽  
Patients Satisfaction ◽  
Low Incidence

<b><i>Background:</i></b> With a rapidly aging population, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. The commonly used sedation anesthesia in ERCP is a combination of propofol and fentanyl, even though fentanyl may cause some adverse reactions such as respiratory depression. <b><i>Objectives:</i></b> This study aimed to evaluate the efficacy of oxycodone combined with propofol versus fentanyl combined with propofol for sedation anesthesia during ERCP. <b><i>Methods:</i></b> A total of 193 patients aged from 65 to 80 years undergoing ERCP were enrolled and randomized into two groups: an “oxycodone combined with propofol” group (group OP, <i>n</i> = 97) and a “fentanyl combined with propofol” group (group FP, <i>n</i> = 96). The rate of perioperative adverse events as well as the recovery time, patients’ satisfaction, and endoscopists’ satisfaction were noted. <b><i>Results:</i></b> There was no difference in the frequency of hypotension or bradycardia between the two groups, but there were more episodes of desaturation (SpO<sub>2</sub> &#x3c;90% for &#x3e;10 s in 8.3%), postoperative nausea (7.3%), and vomiting (5.2%) in group FP than in group OP. Patients’ satisfaction in group FP was lower than that in group OP. The recovery time was longer in group FP than in group OP. <b><i>Conclusions:</i></b> Oxycodone combined with propofol was effective in ERCP, with a low incidence of perioperative adverse events.

scholarly journals Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojia Chen ◽  
Fan Wang ◽  
Jing Liu ◽  
Wenhui Tao ◽  
Zhang Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Univariate Analysis ◽  
Balloon Dilation ◽  
Endoscopic Papillary Balloon Dilation ◽  
Endoscopic Retrograde ◽  
Therapeutic Success ◽  
Surgically Altered Anatomy

Abstract Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI 2.693–466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

scholarly journals Laparoscopy-assisted versus enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass: a meta-analysis

2020 ◽  
Vol 08 (03) ◽  
pp. E423-E436 ◽  
Author(s):  
Fares Ayoub ◽  
Tony S. Brar ◽  
Debdeep Banerjee ◽  
Ali M. Abbas ◽  
Yu Wang ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Procedure Time ◽  
Endoscopic Retrograde ◽  
Therapeutic Success ◽  
Procedural Time

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with Roux-en-Y gastric bypass (RYGB) anatomy, which is increasing in frequency given the rise of obesity. Laparoscopy-assisted ERCP (LA-ERCP) and enteroscopy-assisted ERCP (EA-ERCP) are distinct approaches with their respective strengths and weaknesses. We conducted a meta-analysis comparing the procedural time, rates of success and adverse events of each method. Patients and methods A search of PubMed, EMBASE and the Cochrane library was performed from inception to October 2018 for studies reporting outcomes of LA or EA-ERCP in patients with RYGB anatomy. Studies using single, double, ‘short’ double-balloon or spiral enteroscopy were included in the EA-ERCP arm. Outcomes of interest included procedural time, papilla identification, papilla cannulation, therapeutic success and adverse events. Therapeutic success was defined as successful completion of the originally intended diagnostic or therapeutic indication for ERCP. Results A total of 3859 studies were initially identified using our search strategy, of which 26 studies met the inclusion criteria. The pooled rate of therapeutic success was significantly higher in LA-ERCP (97.9 %; 95 % CI: 96.7–98.7 %) with little heterogeneity (I2 = 0.0 %) when compared to EA-ERCP (73.2 %; 95 % CI: 62.5–82.6 %) with significant heterogeneity (I2: 80.2 %). Conversely, the pooled rate of adverse events was significantly higher in LA-ERCP (19.0 %; 95 % CI: 12.6–26.4 %) when compared to EA-ERCP (6.5 %; 95% CI: 3.9–9.6 %). The pooled mean procedure time for LA-ERCP was 158.4 minutes (SD ± 20) which was also higher than the mean pooled procedure time for EA-ERCP at 100.5 minutes (SD ± 19.2). Conclusions LA-ERCP is significantly more effective than EA-ERCP in patients with RYGB but is associated with a higher rate of adverse events and longer procedural time.

scholarly journals Feasibility of Non-Anesthesiologist-Administered Propofol Sedation for Emergency Endoscopic Retrograde Cholangiopancreatography

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Nobuhito Ikeuchi ◽  
Takao Itoi ◽  
Takuji Gotoda ◽  
Chika Kusano ◽  
Shin Kono ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Acute Cholangitis ◽  
Careful Monitoring ◽  
Endoscopic Retrograde ◽  
Serious Adverse Events ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Technical Safety

Background. The safety of non-anesthesiologist-administered propofol (NAAP) sedation in emergent endoscopic retrograde cholangiopancreatography (ERCP) has not been fully clarified. Thus, the aim of this study was to assess the safety of NAAP sedation in emergent ERCP.Materials and Methods. We retrospectively analyzed 182 consecutive patients who had obstructive jaundice and who underwent ERCP under NAAP sedation. The patients were divided into Group A (with mild acute cholangitis or without acute cholangitis) and Group B (moderate or severe acute cholangitis). And technical safety and adverse events were assessed.Results. The adverse events were hypoxia (31 cases), hypotension (26 cases), and bradycardia (2 cases). There was no significant difference in the rate of each adverse event of hypoxia and bradycardia in either group. Although the rate of transient hypotension associated in Group B was higher than that in Group A, it was immediately improved with conservative treatment. Moreover, there were no patients who showed delayed awakening, or who developed other complications.Conclusions. In conclusion, NAAP sedation is feasible even in emergent ERCP. Although some transient adverse events (e.g., hypotension) were observed, no serious adverse events occurred. Thus, propofol can be used in emergent ERCP but careful monitoring is mandatory.

scholarly journals Technical and clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in patients with COVID-19

2020 ◽  
Vol 13 ◽  
pp. 175628482098067
Author(s):  
Theodor Voiosu ◽  
Andrei Voiosu ◽  
Ivo Boškoski ◽  
Marianna Arvanitakis ◽  
Michiel Bronswijk ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Multivariable Analysis ◽  
Secondary Outcome ◽  
Control Group ◽  
Minimal Risk ◽  
Technical Failure ◽  
Success Rates ◽  
Technical Success ◽  
Endoscopic Retrograde

Background: The unprecedented situation caused by the coronavirus disease 2019 (COVID-19) pandemic has profoundly affected endoscopic practice in regard to access, volume, and workflow. We aimed to assess the potential changes in the technical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures carried out in patients with confirmed SARS-CoV-2 infection. Methods: We conducted an international, multicenter, retrospective, matched case-control study of ERCP procedures carried out in patients with confirmed COVID-19. The main outcome was technical success of the procedure as assessed by the endoscopist, and the secondary outcome was the development of procedure-related adverse events. Each case was matched in a 1:4 ratio with controls extracted from each center’s database in order to identify relevant changes in outcome measures compared with the pre-pandemic era. Results: Eighteen procedures performed in 16 COVID-19 patients [14 men, 65 years (9–82)] and 67 controls were included in the final analysis. Technical success was achieved in 14/18 COVID-19 cases, which was significantly lower as compared with the control group (14/18 versus 64/67, p = 0.034), with an endoscopic reintervention required in 9/18 cases. However, the rate of procedure-related adverse events was low in both groups (1/18 versus 10/67, p = 0.44). On multivariable analysis, COVID-19 status remained the only risk factor for technical failure of the procedure [odds ratio of 19.9 (95% confidence interval 1.4–269.0)]. Conclusions: The COVID-19 pandemic has affected the volume and practice of ERCP, resulting in lower technical success rates without significantly impacting patient safety. Prioritizing cases and following recommendations on safety measures can ensure good outcome with minimal risk in dedicated centers.

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