Clinical Endoscopy

Original Articles

Increased Risk of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography Following a Positive Intraoperative Cholangiogram: A Single-Center Experience: Lalitha M. Sitaraman, Rita M. Knotts, Judith Kim, Srihari Mahadev, David S. Lee; Clin Endosc 2021;54(1):107-112. Published online July 15, 2020; DOI: https://doi.org/10.5946/ce.2020.025

Background
/Aims: To determine if patients with a positive intraoperative cholangiogram (IOC) who undergo a subsequent endoscopic retrograde cholangiopancreatography (ERCP) have an increased risk of post-ERCP pancreatitis (PEP) compared to those who undergo ERCP directly for suspected common bile duct stones.
Methods
A retrospective case-control study was performed from 2010 to 2016. Cases included inpatients with a positive IOC at cholecystectomy who underwent subsequent ERCP. The control group included age-sex matched cohorts who underwent ERCP for choledocholithiasis. Multivariate logistic regression was used to assess the association between PEP and positive IOC, adjusting for matching variables and additional potential confounders.
Results
Of the 116 patients that met the inclusion criteria, there were 91 women (78%) in each group. Nine patients (7.8%) developed PEP in the IOC group, compared to 3 patients in the control group (2.6%). The use of pancreatic duct stents and rectal indomethacin was similar in both groups. After adjusting for age, sex, total bilirubin levels, and any stent placement, patients with a positive IOC had a significantly increased risk of PEP (odds ratio, 4.79; 95% confidence interval, 1.05–21.89; p<0.05).
Conclusions
In this single-center case-control study, there was a five-fold increased risk of PEP following a positive IOC compared to an age-sex matched cohort.

Citations

Citations to this article as recorded by

Is Routine Intraoperative Cholangiogram Necessary in Patients With Mild Acute Biliary Pancreatitis Undergoing Index Admission Cholecystectomy?
Natalie M Quarmby, Minh Tu Vo, Sivakumar Gananadha
The American Surgeon™.2024;[Epub] CrossRef
Accuracy of intraoperative cholangiography and outcomes of ERCP in hospitalized patients with suspected choledocholithiasis
Masuma Syed, Sanghee K. Choi, Nikhil Thiruvengadam, Kendrick Che, Paul Leonor, Esther Wu, Maryam B. Tabrizi, Jeffrey Kim, Stephen Min, James Scheiman, John J. Kim
iGIE.2023; 2(2): 117. CrossRef
Endoscopic retrograde cholangiopancreatography is not necessary in all patients with an abnormal intraoperative cholangiogram
Andrawus Beany, Anandpreet S Ghataura, Shaanan T E Yong, Kee F Loo, Rajvinder Singh, Biju George, Mohamed A Chinnaratha
JGH Open.2023; 7(11): 797. CrossRef
Endoscopic retrograde cholangiopancreatography‐related adverse events in Korea: A nationwide assessment
Dong Kee Jang, Jungmee Kim, Chang Nyol Paik, Jung‐Wook Kim, Tae Hee Lee, Jae‐Young Jang, Seung Bae Yoon, Jun Kyu Lee
United European Gastroenterology Journal.2022; 10(1): 73. CrossRef

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The Utility of Endoscopic Ultrasound in Patients with Isolated Elevations in Serum Amylase and/or Lipase: Lalitha M. Sitaraman, Amit H. Sachdev, Tamas A. Gonda, Amrita Sethi, John M. Poneros, Frank G. Gress; Clin Endosc 2019;52(2):175-181. Published online January 16, 2019; DOI: https://doi.org/10.5946/ce.2018.110

Abstract PDF PubReader ePub

Background
/Aims: The aim of this study was to describe the diagnostic yield of endoscopic ultrasound (EUS) in patients with isolated elevated levels of amylase and/or lipase.
Methods
A retrospective chart review was conducted at a large academic medical center from 2000 to 2016. Patients were selected based on having elevated amylase, lipase, or both, but without a diagnosis of pancreatitis or known pancreatobiliary disease. Patients were excluded if they had abnormal liver function tests or abnormal imaging of the pancreas.
Results
Of 299 EUS procedures performed, 38 met inclusion criteria. Symptoms were present in 31 patients, most frequently abdominal pain (87%). In 20 patients (53%), initial EUS most commonly found chronic pancreatitis (n=7; 18%), sludge (5; 13%), or new diagnosis of pancreas divisum (3; 8%). In the asymptomatic patients (7), 3 had a finding on EUS, most importantly sludge (2), stone (1), and pancreas divisum (1). No patients were diagnosed with a mass or pancreatic cyst. During the follow up period, 6 patients (22%) had cholecystectomy.
Conclusions
In our study of patients with isolated elevations in amylase and/or lipase without acute pancreatitis who underwent EUS, approximately 50% had a pancreatobiliary finding, most commonly chronic pancreatitis or biliary sludge.

Citations

Citations to this article as recorded by

Endosonographic features in patients with non-alcoholic early chronic pancreatitis improved with treatment at one year follow up
Kazutoshi Higuchi, Seiji Futagami, Hiroshi Yamawaki, Makoto Murakami, Kumiko Kirita, Shuhei Agawa, Go Ikeda, Hiroto Noda, Yasuhiro Kodaka, Nobue Ueki, Keiko Kaneko, Katya Gudis, Ryuji Ohashi, Katsuhiko Iwakiri
Journal of Clinical Biochemistry and Nutrition.2021; 68(1): 86. CrossRef
Do Patients with Pancreatic Hyperenzymemia without Abnormal Imaging Need Additional Endoscopic Ultrasound?
Jung Wan Choe, Jong Jin Hyun
Clinical Endoscopy.2019; 52(2): 97. CrossRef

9,538 View
162 Download
3 Web of Science
2 Crossref

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