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development of complications after. ERCP. La obesidad como factor de riesgo para el desarrollo de complicaciones post-CPRE. Gustavo López-Arce, Jesús. Eventos adversos de la CPRE en el Hospital de San José de Bogotá. Abstract clasificaron las complicaciones post-CPRE en 3 catego-. El diagnóstico de estas complicaciones puede ser inmediato, es decir, en el post-polipectomía en el primer supuesto o la pancreatitis post-CPRE en el.

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Complications of endoscopic retrograde cholangiopancreatography. Complicxciones study in a small ERCP unit. 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. In this period, two endoscopists working together performed ERCPs, which yields an approximately average of 84 procedures per year. There were 28 pancreatitis 5. There were There were 89 The procedures performed for coledocho-lithiasis originated 14 7. ERCPs performed for choledoco-lithiasis was associated with the lowest complications rate. The risk-benefit ratio in the anticipated, purely diagnostic ERCP must ppst carefully weighed due to its morbidity.

Rev Esp Complcaciones Dig ; Endoscopic retrograde cholangiopancreatography ERCP is a very effective procedure to drain both the biliary and pancreatic ducts 1.

Nowadays, available methods to image the pancreatobiliary system, specially magnetic resonance cholangiopancratography MRCPhave turned ERCP into an eminently therapeutic procedure. Gaining access to the bile and pancreatic ducts, sphincterotomy, choledocholithiasis extraction, and biliary and pancreatic stent insertion are the more difficult procedures in digestive endoscopy 2.

The complexity of the procedure entails a morbidity that seems to be higher in centers performing few explorations. Though no unanimously accepted compliccaciones exist, copmlicaciones standards have been fixed in ERCPs per year 3more than one sphincterotomy every week 4ppst at least 40 sphincterotomies per year for each endoscopist 5. Nevertheless, the distribution and access of patients to health resources can generate the need to perform this technique in hospitals in which a limited volume of procedures is annually expected.

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We present our cppre regarding ERCP-related complications in a small unit. This means an approximate average of 84 procedures per year. In alternate explorations, each of them acted as first or main endoscopist, while the other helped him as second endoscopist. Patients were under conscious sedation with meperidine and diazepam or midazolam, administered by endoscopists themselves. Overall, the same team of nurses and endoscopy assistants was present at each exploration.

Heart rate and oxygen blood saturation were monitored during ERCP. Oxygen was administered to patients by means of a nasal cannula. ERCPs were performed in a room with fluoroscopy facilities within the radiology department. All complicacjones gave their informed consent for the procedure after receiving adequate medical information. Therapeutic duodenoscopes with powt working channel of 4.


Vater’s papilla cannulation, sphincterotomy, dilatation, stent insertion, and other ERCP maneuvers were performed as previously described When cannulation failed after using standard cannulae or sphincterotomes, a tapered-tip sphincterotome loaded with a 0. A diagnostic failure was considered when the desired duct could not be cannulated. Therapeutic failure was defined domplicaciones the lack of effective endoscopic treatment in general, an adequate duct drainage when necessary.

Procedures for choledocolithiasis that could not be completed were not considered a therapeutic failure, if a stent was inserted to maintain a temporary drainage. All ERCPs were performed on an in-patient regime.

Patients remained at hospital at least for compljcaciones night after the procedure. In the following days, the occurrence of complications was ruled out. Complications were graded according to a consensus Data relative to procedures and complications were gathered in a prospective way, though the global analysis was performed in a retrospective way.

Statistical analyses were carried out by using the Rsigma software program. A p value below 0. Five hundred and seven ERCPs were performed. There were 55 There were 28 5. There was no mortality related to pancreatitis. All of them needed endoscopic sclerotherapy on the bleeding source and blood transfusion. Two patients needed 5 or more unit of packed red blood cells, and these complications were accordingly graded as severe.

Neither surgery nor therapeutic angiography were needed. A duodenal perforation complicacioes place far from the papillary area pots three patients 0. The first one happened in the afferent loop of a Billroth II gastrectomy. The second perforation developed in a stenosed and deformed peptic duodenal bulb.

complicaciones post-cpre by agustina Lopez on Prezi Next

The third one was secondary to a 15 cm-long biliary plastic stent previously inserted to treat a benign stricture, which perforated the duodenum. All patients underwent surgery and no mortality occurred as a consequence of the perforation. In three women perforation took place within the papillary area 0. A false route developed in a patient when trying to recannulate the bile duct after a sphincterotomy had been performed.

A guidewire had not been left in place, and a retroperitoneal contrast injection occurred. In another patient, a perforation was induced by a large sphincterotomy in the setting of an intradiverticular papilla. These two patients recovered satisfactorily with medical treatment.

The third of these perforations took place in an elderly patient with cholangitis. This perforation followed a precut and the patient died. A patient with a complex hilar neoplasm presented with a biliary perforation probably related to dilatation, before stent insertion.

The patient developed an abdominal abscess. His general condition adviced that no type of aggressive treatment be attempted, and the patient died a few days later. Therefore, bilioduodenal perforations were 7 1. A previously unknown Zenker’s diverticulum was perforated in another patient. The diagnosis was immediately reached on observing mediastinal structures.

It was also confirmed by water-soluble contrast extravasation from the esophagus. The patient underwent surgery and finally recovered after a complicated postoperative period.

In five of such cases, it was secondary to retained choledocholithiasis after ERCP, or to plastic biliary stents inserted in hilar tumors. They all evolved satisfactorily with medical treatment. The remaining cholangitis happened in a patient who was later diagnosed of leukemia, and needed admission to an ICU. Two patients developed cholecystitis. One of them, a patient with a neoplasm of the head of the pancreas in whom a plastic biliary stent had been previously inserted, died.

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Therefore, there were 8 1. An elderly patient in whom an ERCP was performed for cholangitis died after presenting a cardio-respiratory arrest on arriving at his ward after the procedure. This complication may be probably related to sedative medication during the endoscopic procedure. Another patient with ischemic heart disease developed a few hours after the endoscopic procedure congestive heart failure and pulmonary edema.

He recovered after ten days in an ICU. Finally, a 12 cm-long pancreatic stent broke within pkst pancreas. It had been inserted to treat a pleuro-pancreatic fistula in a patient with chronic pancreatitis.

The distal part of the stent remained within Wirsung’s duct after having tried to extract it once the posy had cured. The patient needed a distal pancreatectomy following unsuccessful attempts at endoscopic extraction. Thus, the majority were graded as mild to moderate and patients recovered with medical treatment.

There were no differences in use between the various ERCP groups. Logically, access to the bile duct was prevented in the failed ERCP group. ERCP is the most difficult technique in digestive endoscopy. This is the range within which figures from a great number of published series lay Table III. Overall, data from our study, with With regard to acute pancreatitis, the usual definition is an at least three-fold increase of serum amylase for more than 24 hours, together with abdominal pain, which needs hospitalization.

If ERCP is performed on an outpatient regime and cimplicaciones published series is retrospective, patients may complaint with mild abdominal pain at home, which really corresponds to a mild pancreatitis. This attack will remains undiagnosed and, therefore, unreported. Acute pancreatitis was the most frequent complication discovered. Besides, prospective multicentre series -like that of Masci 23 – find fewer complications when compared to single-centre serie -as that of Vandervoort 25 for instance.

Probably, in multicentre series some mild complications may be missed out. Otherwise, these are most frequently reported in all series. For example, in papers in which drugs are studied for the prevention of post-ERCP pancreatitis, the frequency of this complication in the control group is higher than in usual series ERCP is a very complex procedure which cannot be performed by all endoscopists Not only is necessary a long learning period, but also skills already acquired should be maintained by performing the procedure in a steady and usual manner.

Ideally, few endoscopists should perform more ERCPs 2.