Ronald M. Katon

Complications of Endoscopic Retrograde Cholangiopancreatography (ERCP): A study of 10,000 cases

Of 402 United States owners of side-viewing duodenoscopes surveyed, 222 (55%) responded, reporting 10,435 endoscopic retrograde cholangiopancreatograms. Procedure failed occurred in 30%, complications in 3%, and death in 0.2%. Complications included pancreatitis, cholangitis, pancreatic sepsis, instrumental injury to the gastrointestinal tract, and drug reactions. Pancreatitis was associated with injection into the pancreatic duct, sepsis with injection into an obstructed duct or pseudocyst, and injury with abnormal gastroduodenal anatomy. Experienced workers had a 15% incidence of complications, whereas inexperience gave 4 times the failures (62%) and twice the complications (7%). The causes of complications and their prevention are discussed.

Complications of upper gastrointestinal endoscopy in the gastrointestinal bleeder

ConclusionsEsophagogastroduodenoscopy, even with modern flexible fiberscopes, is associated with occasional life-threatening complications including perforation, hemorrhage, and various cardiopulmonary events. In the upper gastrointestinal bleeder, especially the elderly or those with active bleeding, risks may be appreciably higher, especially with respect to pulmonary aspiration, other cardiopulmonary events, and rebleeding.The importance of a good history and physical examination with special attention to drug history, bleeding disorders, dysphagia, or underlying cardiac, pulmonary, or hepatic disease is crucial. Sedatives should be used with caution and in the minimal dose necessary to produce the desired effect. Nasal O2 should be used if hypoxia exists. EKG should be performed in all patients, and cardiac monitoring carried out during the procedure if the clinical status dictates. Resuscitative equipment should be readily available and the endoscopic team should be versed in its use. Careful explanation of the procedure is mandatory for good patient cooperation and safety.Finally, vital signs, color, and sensorum should be closely monitored by a nurse during the procedure and following it until sedation wears off.

Endoscopic retrograde cholangiopancreatography (ERCP). Experience with 100 cases.

Endoscopic visualization of the papilla of Vater was achieved in 98 of our first 100 attempts. Cannulation was successful in 87% of cases, achieving pancreatography alone in 29, cholangiography alone in 27, and both in 31. The relevant duct was adequately visualized in 72.5% of patients with biliary tract disease and in 72% of those with pancreatic disease. Complications were acceptably few. The procedure has proven valuable in difficult cases of obstructive jaundice and biliary type pain syndromes without jaundice. Many questions remain, however, as to its value in the diagnosis and evaluation of pancreatic disease.

Endoscopic retrograde cholangiopancreatography in patients with gastrectomy and gastrojejunostomy (Billroth II). A case for the forward look

Endoscopic cannulation of the duodenal papilla in patients with gastrojejunostomy presents special problems that have been solved by these authors who recommend use of the forward viewing instrument. Particular caution is urged in endoscopy of the afferent limb.

USE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE DIAGNOSIS OF PANCREATIC FISTULA A case report and review of the literature

The diagnosis in a case of pancreaticocolonic fistula, presenting with gastrointestinal bleeding, was made by endoscopic retrograde cholangiopancreatography (ERCP) and verified surgically. The clinical picture and pathogenesis of pancreaticoenteric fistulas are reviewed.

Treatment of benign chronic gastric ulcer with ranitidine. A randomized, double-blind, and placebo-controlled six week trial.

A randomized, multicenter, double-blind, placebo-controlled study was conducted to determine whether ranitidine 150 mg b.i.d. for 6 weeks would expedite endoscopic healing or relief of symptoms in patients with benign gastric ulcer. Of 203 patients enrolled, 101 received ranitidine and 102 received placebo. Endoscopic evaluations were conducted at baseline and at 2 and 6 weeks. At 6 weeks 68% of the patients treated with ranitidine had healed compared with 53% in the placebo group (p = 0.02). In those patients who had not healed by 6 weeks, ranitidine provided greater relief from pain than placebo. More patients in the placebo group dropped out of the study because of worsening symptoms (13 versus 4, p = 0.04). No differences in laboratory abnormalities or incidence of adverse events were detected between the two study groups. These results indicate that ranitidine 150 mg b.i.d. is superior to placebo in the treatment of benign gastric ulcer.

Intramural barium in ischemic colitis: a new radiographic finding.

Two cases of ischemic colitis are presented, demonstrating a new radiographic finding of intramural dissection of barium. Colonoscopic findings were compatible with that diagnosis. Deep, discrete ulcerations were observed during the healing process. Both patients recovered and prolonged retention of the intramural barium was seen.