A Retrospective Comparison of ERCP Complications with Conventional ERCP vs. Wire Guided ERCP
Notice bibliographique
Résumé
Purpose: Endoscopic Retrograde Cholangiopancreatography (ERCP) is an invasive endoscopic technique which affords both diagnostic studies and therapeutic interventions. This procedure is associated with potentially severe complications including post ERCP pancreatitis. A factor that may increase the risk of post ERCP pancreatitis is contrast opacification of the pancreatic duct. Recently, a wire guided technique has been developed which avoids opacification of the pancreatic duct. The purpose of this study was to determine whether there was any difference in post ERCP pancreatitis requiring hospitalization when conventional cannulation using contrast is compared with wire guided cannulation. Methods: A retrospective review of ERCP at a single institution was performed. In 2005 there was a change made from a conventional contrast injection approach to use of a wire guided approach to ERCP. This latter technique involves cannulating the common bile duct with a guide wire prior to injecting contrast. If the pancreatic duct is cannulated, no contrast is injected. A retrospective chart review of ERCPs performed in April through September 2004 and January through June 2005 was performed. Data on procedure length, indication, and complications including pancreatitis was gathered. Pancreatitis was defined as pain post procedure associated with an increased lipase and requiring a hospital stay. Results: A total of 282 ERCPs were performed within the study period by 3 endoscopists, with 14 episodes of post-ERCP pancreatitis (5.0%) documented. The mean age of the patients was 63 years with 42% being male. The major indications for ERCP were biliary colic or obstructive jaundice (75%) and therapeutic intervention was performed in 77% of cases. There were no differences in demographics between groups. In the 2005 period, 130 ERCPs were performed, with 3 cases of pancreatitis, compared with 152 ERCPs in 2004, with 11 cases of pancreatitis [Odds Ratio 0.30 (0.08 to 1.11)]. During the study period, 167 ERCPs were performed using the wire guided technique, with 4 cases of pancreatitis, compared with 115 ERCPs performed conventionally, with 10 cases of pancreatitis [Odds Ratio 0.26 (0.09 to 0.79)]. Procedure length was a mean of 32 min and 35 min for conventional and wire guided ERCP respectively. (P= 0.08). Conclusion: This retrospective study demonstrates that wire guided ERCP is associated with a lower rate of post-ERCP pancreatitis than conventional ERCP.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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