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End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients

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World Journal of Gastroenterology 2018年第41期24卷 4691-4697页

作者： tarek Sawas Fateh Bazerbachi Samir Haffar Won K Cho Michael J Levy John A Martin bret t.petersen Mark D topazian Vinay Chandrasekhara Barham K Abu Dayyeh Division of Gastroenterology and Hepatology Mayo Clinic Department of Gastroenterology Digestive Center for Diagnosis and Treatment Division of Gastroenterology and Hepatology Georgetown University Medstar Washington Hospital Center

AIM to determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangio-pancreatography (ERCP) adverse events (AEs). MEtHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) 2011-2013. We identified adult patients who underwent ERCP using the International Classification of Diseases 9^(th) Revision (ICD-9-CM). Included patients were divided into three groups: ESRD, chronic kidney disease (CKD), and control. the primary outcome was post-ERCP AEs including pancreatitis, bleeding, and perforation determined based on specific ICD-9-CM codes. Secondary outcomes were length of hospital stay, in-hospital mortality, and admission cost. AEs and mortality were compared using multivariate logistic regression *** there were 492175 discharges that underwent ERCP during the 3 years. the ESRD and CKD groups contained 7347 and 39403 hospitalizations respectively, whereas the control group had 445424 hospitalizations. Post-ERCP pancreatitis (PEP) was significantly higher in the ESRD group (8.3%) compared to the control group (4.6%) with adjusted odd ratio (aOR) = 1.7 (95% CI: 1.4-2.1, ~aP ted with significantly higher ERCP-related bleeding (5.1%) compared to the control group 1.5% (aOR = 1.86, 95%CI: 1.4-2.4, ~aP tal mortality 7.1% vs 1.15% in the control OR = 6.6 (95%CI: 5.3-8.2, ~aP tal stay with adjusted mean difference (aMD) = 5.9 d (95% CI: 5.0-6.7 d, ~aP talization charges aMD = $+82064 (95%CI: $68221-$95906, ~aP tor for post-ERCP AEs and is associated with higher hospital mortality. Careful selection and close monitoring is warranted to improve outcomes.

关键词： End-stage renal disease Nationwide Inpatient Sample Endoscopic retrograde cholangiopancreatography

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Percutaneous transluminal angioplasty balloons for endoscopic ultrasound-guided pancreatic duct interventions

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World Journal of Gastrointestinal Endoscopy 2022年第8期14卷 487-494页

作者： Jad P AbiMansour Barham K Abu Dayyeh Michael J Levy Andrew C Storm John A Martin bret t.petersen Ryan J Law Mark D topazian Vinay Chandrasekhara Department of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905United States

BACKGROUND Endoscopic ultrasound(EUS)-guided main pancreatic duct(PD)access may be used when conventional endoscopic retrograde cholangiopancreatography(ERCP)techniques *** use of a percutaneous transluminal angioplasty balloon(PtAB),originally developed for vascular interventions,can be used to facilitate transmural(e.g.,transgastric)PD access and to dilate high-grade pancreatic *** to describe the technique,efficacy,and safety of PtABs for EUS-guided PD *** Patients who underwent EUS with use of a PtAB from March 2011 to August 2021 were retrospectively identified from a tertiary care medical center supply *** included 3-4 French angioplasty catheters with 3-4 mm balloons designed to use over a 0.018-inch *** primary outcome was technical *** outcomes included incidence of adverse events(AEs)and need for early *** A total of 23 patients were identified(48%female,mean age 55.8 years).Chronic pancreatitis was the underlying etiology in 13(56.5%)patients,surgically altered anatomy(SAA)with stricture in 7(30.4%),and SAA with post-operative leak in 3(13.0%).technical success was achieved in 20(87%)*** AE rate was 26%(n=6).All AEs were mild and included 1 pancreatic duct leak,2 cases of post-procedure pancreatitis,and 3 admissions for post-procedural *** patients required early *** EUS-guided use of PtABs for PD access and/or stricture management is feasible with an acceptable safety profile and can be considered in patients when conventional ERCP cannulation fails.

关键词： Dilating balloon Pancreatic duct intervention Chronic pancreatitis Anastomotic stricture

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