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Association of procedure length on outcomes and adverse events of endoscopic retrograde cholangiopancreatography

Gastroenterology Report 2014年第2期2卷 140-144页

作者： Paresh P.Mehta Madhusudhan R.Sanaka Mansour A.Parsi Mazen J.Albeldawi john a.dumot Rocio Lopez Gregory Zuccaro john J.Vargo Digestive Disease Institute Department of Gastroenterology and HepatologyCleveland ClinicCleveland OHUSA Department of Quantitative Health Sciences Cleveland ClinicClevelandOHUSA

Objective:The aims of this study were to determine the effects of length of procedure on endoscopic retrograde cholangiopancreatography(ERCP)outcomes and adverse ***:All ERCP procedures,performed by experienced advanced endoscopists,in patients without prior papillary intervention from 2006 to 2008 were *** were arbitrarily divided into two groups:shorter procedures(SP),with a duration shorter than the overall mean procedure length,and longer procedures(LP),with a duration longer than overall mean procedure *** of procedure was defined as the time from endoscope insertion to endoscope ***:Two hundred and ninety-five procedures were included in the *** procedure length was 45.630.1 *** hundred and seventy-seven procedures(60%)were SP and 118(40%)were *** were no differences between the groups with regard to patients’ages,genders,race,or trainee *** cases were more likely to be biliary vs pancreatic or bi-ductal evaluations(P=0.03).LP had significantly higher complexity scores(34%with>3 vs 13%;P=0.046)and were more likely to require pre-cut papillotomy(39%vs 15%;P<0.001).There was no significant difference between the groups in overall completion rates(91.5%LP vs 96%SP;P=0.10)or adverse events(10.2%LP vs 6.2%SP;P=0.21).However,LP cases were associated with higher rates of post-ERCP bleeding(4.2%vs 0.6%;P=0.029).Conclusion:There was no significant difference in outcomes or overall adverse events between shorter and longer ERCP ***,longer procedures were associated with higher procedure complexity,higher utilization of pre-cut technique,and increased risk of bleeding.

关键词： endoscopic retrograde cholangiopancreatography(ERCP) duration of procedure adverse events pancreatitis

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Post-cholecystectomy symptoms were caused by persistence of a functional gastrointestinal disorder

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World Journal of Gastroenterology 2012年第12期18卷 1365-1372页

作者： Malte Schmidt Karl Sφndenaa john a.dumot Steven Rosenblatt Trygve Hausken Maria Ramnefjell Gro Njφlstad Geir Egil Eide Department of Surgery Haraldsplass Deaconess HospitalBergen N-5892Norway Digestive Disease Institute Cleveland ClinicClevelandOH 44101United States Department of General Surgery Cleveland ClinicClevelandOH 44101United States Department of Internal Medicine University of BergenBergen 5021Norway Department of Pathology Haukeland University HospitalBergen 5021Norway Department of Microbiology Haukeland University HospitalBergen 5021Norway Center for Clinical Research Haukeland University HospitalBergen 5021Norway Department of Public Health and Primary Care University of BergenBergen 5021Norway

AIM： To classify gallstone disease as a basis for assessment of post-choleolstectomy symptoms.METHODS： One hundred and fifty three patients with a clinical and ultrasonographic diagnosis of gallstones filled out a structured questionnaire on abdominal pain symptoms and functional gastrointestinal disorder （FGID） before and at six months after cholecystectomy. Symptom frequency groups （SFG） were categorized according to frequency of pain attacks. According to certain pain characteristics in gallstone patients, a gallstone symptom score was accorded on a scale from one to ten. A visual analogue scale was used to quan- tify pain. Operative specimens were examined for size and magnitude of stone contents as well as presence of bacteria. Follow-up took place after six months with either a consultation or via a mailed questionnaire. Results were compared with those obtained pre-operatively to describe and analyze symptomatic outcome.RESULTS： SFG groups were categorized as severe （24.2%）, moderate （38.6%）, and mild （22.2%） attack frequency, and a chronic pain condition （15%）. Pain was cured or improved in about 90% of patients and two-thirds of patients obtained complete symptom re- lief. Patients with the most frequent pain episodes were less likely to obtain symptom relief. FGID was present in 88% of patients pre-operatively and in 57% postoperatively （P = 0.244）. Those that became asymptomatic or improved with regard to pain also had most relief from FGID （P = 0.001）. No pre-operative FGID meant almost complete cure.CONCLUSION： Only one third of patients with FGID experienced postoperative relief, indicating that FGID was a dominant cause of post-cholecystectomy symptoms.

关键词： Gallstone symptoms Functional gastrointes-tinal disease Cholecystectomy Post-cholecystectomysymptoms

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