This study analyzed 1,145 patients who underwent ERCP at a regional hospital in Mexico from 2002-2011. The complication rate was 2.1%, with hemorrhage being the most common complication at 1.2%. Precut/sphincterotomy was found to increase the risk of complications by 1.4 times compared to those without. The study concluded the complication rate was similar to other reports but could be reduced by only performing ERCP for therapeutic purposes and by highly qualified endoscopists.
Introduction: Prediction of readmission as a result of either delayed presentation of infection, or worse an anastomotic leak is difficult. Efficient reduction in the length of stay and being able to predict problematic patients who may be readmitted or develop complications would be advantageous. To date,
other tests including CRP have proven to be insufficiently sensitive for this task.
Introduction: Prediction of readmission as a result of either delayed presentation of infection, or worse an anastomotic leak is difficult. Efficient reduction in the length of stay and being able to predict problematic patients who may be readmitted or develop complications would be advantageous. To date,
other tests including CRP have proven to be insufficiently sensitive for this task.
New Predictors for Periampullary Resectabilityasclepiuspdfs
Background: Periampullary tumor involves ampullary, pancreatic, biliary and duodenal mucosa, and pancreaticoduodenectomy considered the curative option. Hence, imaging evaluation to describe the lesion is important. Furthermore, certain specific features could help in pre-operative prediction of resectability for periampullary cancers. The aim of this study is to find out any specific perioperative predictor of resectability on periampullary cancers. Patients and Methods: This is an observational cross-sectional hospital-based study done in tertiary hospital, a total of 79 patients were included in the study. Variables such as age, gender, symptoms (back pain, jaundice, etc.), investigations (bilirubin, alkaline phosphatase, etc.), and imaging (Triphasic computed tomography [CT], magnetic resonance cholangiopancreatography, endoscopic ultrasonography, etc.) were studied and the data collected and analyzed using SPSS 20. Results: Male was slightly predominant and male to female ratio was 1:0.9. The mean age was 50 years (SD ±6.54). Triphasic CT abdomen pancreatic protocol was the most effective modality of investigation. High bilirubin (>10 mg/dl) and back pain were statistically significant among patients with unresectable tumor. Conclusions: Back pain and high bilirubin could be helpful in pre-operative prediction of operability of periampullary cancers.
Systemic Lupus Erythematosus Female with (Diffuse Large B-Cell) Non-Hodgkin’s...asclepiuspdfs
Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystem complications arising from both underlying disease activity and therapy-related side effects. SLE’s association with lymphoma is a well-established phenomenon. Studies have reported a higher incidence of lymphoma in the SLE population compared with healthy cohorts.[1,2] A 45-year-old woman with SLE presented with fever, cough, sputum, loss of appetite, and fatigue for 4 months. Before that time, her (SLE) symptoms had been well controlled on hydroxychloroquine, azathioprine, and small dose prednisone. Physical examination at initial evaluation was remarkable for bilateral inspiratory crackles. Laboratory investigations were normal. Computed tomography to chest showed bilateral cavitary pulmonary nodules and masses. Bronchoscopy with transbronchial biopsy was done. The histopathology showed diffuse large B-cell non-Hodgkin’s lymphoma. The patient referred to oncology service, where they started her on 4 cycles of R-CHOP by followed 4 cycles of high-dose chemotherapy. She underwent hematopoietic stem cell transplantation and achieved complete remissions.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain...Dr. Ashvind Bawa
A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
Background: There is a global resolve among Clinicians towards adoption of imaging modalities in the evaluation of appendicitis because clinical algorithms have been disappointing. We sought to determine the authenticity of interobserver variability in ultrasound scan interpretation in a resourceconstrained mission hospital settings, northwestern region of Cameroon. Methods: In this study, we reviewed the standardized diagnostic approach in acute appendicitis and also performed prospective cross observational qualitative testing using sensitivity, specifi city, positive predictive value, negative predictive value, and accuracy to determine the interobserver variability of ultrasonography using the medical database of the two Mission Hospitals, northwestern region of Cameroon from January 2012 to December 2016. A sequential non-randomized convenient sampling was used and data was analyzed using the Statistical Package for the Social Sciences version 22.
Introduction: Endoscopic RetrogradeCholangiopancreatography (ERCP) has been advocated as a less invasive therapeutic
intervention for the diagnosis and management of various pancreaticobiliary diseases in the aging population. However, the procedure is not without risk. Published literatures have shown different adverse outcomes with the oldest patient documented to be at 97-years-old. This case report of a 99 years and 107 days old male is probably one of the oldest to be recorded to undergo ERCP worldwide, hence is a vital addition to current practice.
New Predictors for Periampullary Resectabilityasclepiuspdfs
Background: Periampullary tumor involves ampullary, pancreatic, biliary and duodenal mucosa, and pancreaticoduodenectomy considered the curative option. Hence, imaging evaluation to describe the lesion is important. Furthermore, certain specific features could help in pre-operative prediction of resectability for periampullary cancers. The aim of this study is to find out any specific perioperative predictor of resectability on periampullary cancers. Patients and Methods: This is an observational cross-sectional hospital-based study done in tertiary hospital, a total of 79 patients were included in the study. Variables such as age, gender, symptoms (back pain, jaundice, etc.), investigations (bilirubin, alkaline phosphatase, etc.), and imaging (Triphasic computed tomography [CT], magnetic resonance cholangiopancreatography, endoscopic ultrasonography, etc.) were studied and the data collected and analyzed using SPSS 20. Results: Male was slightly predominant and male to female ratio was 1:0.9. The mean age was 50 years (SD ±6.54). Triphasic CT abdomen pancreatic protocol was the most effective modality of investigation. High bilirubin (>10 mg/dl) and back pain were statistically significant among patients with unresectable tumor. Conclusions: Back pain and high bilirubin could be helpful in pre-operative prediction of operability of periampullary cancers.
Systemic Lupus Erythematosus Female with (Diffuse Large B-Cell) Non-Hodgkin’s...asclepiuspdfs
Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystem complications arising from both underlying disease activity and therapy-related side effects. SLE’s association with lymphoma is a well-established phenomenon. Studies have reported a higher incidence of lymphoma in the SLE population compared with healthy cohorts.[1,2] A 45-year-old woman with SLE presented with fever, cough, sputum, loss of appetite, and fatigue for 4 months. Before that time, her (SLE) symptoms had been well controlled on hydroxychloroquine, azathioprine, and small dose prednisone. Physical examination at initial evaluation was remarkable for bilateral inspiratory crackles. Laboratory investigations were normal. Computed tomography to chest showed bilateral cavitary pulmonary nodules and masses. Bronchoscopy with transbronchial biopsy was done. The histopathology showed diffuse large B-cell non-Hodgkin’s lymphoma. The patient referred to oncology service, where they started her on 4 cycles of R-CHOP by followed 4 cycles of high-dose chemotherapy. She underwent hematopoietic stem cell transplantation and achieved complete remissions.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain...Dr. Ashvind Bawa
A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
Background: There is a global resolve among Clinicians towards adoption of imaging modalities in the evaluation of appendicitis because clinical algorithms have been disappointing. We sought to determine the authenticity of interobserver variability in ultrasound scan interpretation in a resourceconstrained mission hospital settings, northwestern region of Cameroon. Methods: In this study, we reviewed the standardized diagnostic approach in acute appendicitis and also performed prospective cross observational qualitative testing using sensitivity, specifi city, positive predictive value, negative predictive value, and accuracy to determine the interobserver variability of ultrasonography using the medical database of the two Mission Hospitals, northwestern region of Cameroon from January 2012 to December 2016. A sequential non-randomized convenient sampling was used and data was analyzed using the Statistical Package for the Social Sciences version 22.
Introduction: Endoscopic RetrogradeCholangiopancreatography (ERCP) has been advocated as a less invasive therapeutic
intervention for the diagnosis and management of various pancreaticobiliary diseases in the aging population. However, the procedure is not without risk. Published literatures have shown different adverse outcomes with the oldest patient documented to be at 97-years-old. This case report of a 99 years and 107 days old male is probably one of the oldest to be recorded to undergo ERCP worldwide, hence is a vital addition to current practice.
Transanal Endoscopic Microsurgery in Young Patients: A Retrospective Studysemualkaira
Local excision of rectal lesions is considered an acceptable choice for elderly and high-risk patients, yet data is scarce regarding its application in young adults
Ochsner Sherren regimen Vs Appendectomy in Adults with Acute Appendicitis.QUESTJOURNAL
ABSTRACT: The main Objective of this study is to examine whether Ochsner Sherren regimen in adult patients with acute appendicitis is safe by correlating the interval from onset of symptoms to operation (total interval) with the degree of pathology and incidence of postoperative complications. Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to advanced pathology. This time-honored practice has been recently challenged by studies in pediatric patients, which suggested that acute appendicitis can be managed in an elective manner once antibiotic therapy is initiated. No such data are available in adult patients with acute appendicitis. A retrospective review of 480 patients who underwent an appendectomy for acute appendicitis between November2012 and October 2015 was conducted. The following parameters were monitored and correlated: demographics, time from onset of symptoms to arrival at the emergency room (patient interval) and from arrival to the emergency room to the operating room (hospital interval), physical, computed tomography (CT scan) and pathologic findings, complications, length of stay, and length of antibiotic treatment. Pathologic state was graded 1 (G1) for acute appendicitis, 2 (G2) for gangrenous acute appendicitis, 3 (G3) for perforation or phlegmon, and 4 (G4) for a periappendicular abscess. The risk of advanced pathology, defined as a higher pathology grade, increased with the total interval. When this interval was <12>71 hours group compared with total interval<12 hours. Although both prolonged patient and hospital intervals were associated with advanced pathology, prehospital delays were more profoundly related to worsening pathology compared with in-hospital delays . Advanced pathology was associated with tenderness to palpation beyond the right lower quadrant , guarding , rebound , and CT scan findings of peritoneal fluid , fecalith , dilation of the appendix , and perforation . Increased length of hospital stay and antibiotic treatment as well as postoperative complications also correlated with progressive pathology. In adult patients with acute appendicitis, the risk of developing advanced pathology and postoperative complications increases with time; therefore, delayed appendectomy is unsafe. As delays in seeking medical help are difficult to control, prompt appendectomy is mandatory. Because these conclusions are derived from retrospective data, a prospective study is required to confirm their validity
Risk factors of chronic liver disease amongst patients receiving care in a Ga...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
3. Endoscopic retrograde cholangiopancreatography at a regional hospital of the IMSS, 2002-2011 127
Table 1 Post-ERCP complication criteria
Mild Moderate Severe
Hemorrhage Clinical evidence of bleeding (not Transfusion 4 units with no Transfusion 5 units or surgery.
just endoscopic); Drop in need for surgery.
hemoglobin 3 g with no need for
transfusion.
Perforation Possibility or suspicion of contrast Perforation established, Medical treatment for more than
material leakage treated with fluids requiring treatment for more 10 days or surgical intervention.
or suction for at least 3 days. than 4 and up to 10 days.
Pancreatitis Clinical presentation of pancreatitis, Pancreatitis requiring Pancreatitis requiring
amylase 3 times its normal value hospitalization for 4 to 10 days. hospitalization for more than 10
in the first 24 postoperative hours days or hemorrhagic pancreatitis.
requiring hospitalization for 2 to 3
days.
Cholangitis Fever 38º at 24 to 48 hrs. Fever requiring hospitalization Septic shock or surgery.
3 days, endoscopic treatment, or
percutaneous intervention.
Adapted and modified from: Cotton PB et al.16
Table 2 Characteristics of patients that underwent ERCP Table 3 Etiology of patients that underwent ERCP
Variable n=1145 % Variable n=1145 %
Women 693 60,5 Choledocholithiasis 359 31,4
Age (years) Neoplasia 208 18,2
80 104 9,1 Cholangiocarcinoma 77 37,0
65-80 317 27,7 Bismuth I 67 87,0
50-65 297 25,9
50 427 37,3 Bismuth II 6 7,8
Jaundice 688 60,1 Bismuth III 1 1,2
Abnormal LFTs 718 62,7 Bismuth IV 3 3,9
Biliary lithiasis by ultrasound 137 12,0 Postoperative ductus choledocus 13 1,1
ligature
Biliary dyskinesia 2 0,2
History of pancreatitis 30 2,6
LFTs: Liver function tests.
after the procedure. In very few cases, follow-up coincided
with the patient’s admission to the emergency room or with
a direct communication from the patient’s relatives.
Age and endoscopic cut (precut/sphincterotomy) were
In relation to etiology, choledocolithiasis and pancreatic
factors associated with complications in this study. The odds
and biliary tumor frequency was 31,4% (n=359) and 18,2%
ratio for complication risk in the group of patients that re-
(n= 208), respectively, and cholangiocarcinoma represented
ceived treatment was 1,4 (95% CI: 1,02-5,43, p=0,045).
37,0% (n=77) of the tumor total. Therapeutic endoscopy re-
presented 51,0% of the total of studies performed. It is im-
portant to mention the therapeutic use of ERCP at our
hospital in postoperative lesions of the biliary tract, since
we had thirteen cases (1,1%) (table 3).
A total of 23,8% (n=271) of the patients were smokers, the Table 4 Post-ERCP complications
man-to-woman ratio was 1,8:1,0, and 1,2% (n=17) of the
Variable n=1145 %
patients presented with periampullary diverticula, making
access to the biliary tract difficult (9/17, 52,94%). Hemorrhage 14 1,2
The study complication frequency was 2,1% (n=24). He- Acute pancreatitis 6 0,5
morrhage was the most common finding and was self-limi- Respiratory distress 3 0,3
ted in the majority of cases. Injection of norepinephrine at
Cholangitis 1 0,1
1:10.000 and blood transfusion were required in only
one case (table 4). Follow-up was carried out at the outpa- Total 24 2,1
tient service of the Gastroenterology Department 30 days
4. 128 G.A. Reyes-Moctezuma et al
Discussion Conclusions
This cohort analysis is the first of its kind to be carried out in In conclusion, this study characterized a large series of en-
Northeastern Mexico. From a total of 1.145 patients that doscopic procedures (ERCP) in a regional hospital of the Ins-
underwent ERCP at this hospital unit over a 10-year period, tituto Mexicano del Seguro Social, in which the frequency
the frequency of complications observed in the present stu- and number of complications and contributing risk factors
dy was 2,1%, and they were associated with precut and were reported. Careful patient selection is important be-
sphincterotomy17. It should be mentioned that the complica- cause by combining the abovementioned information with
tion frequency found in our study was lower than that reported the technical ability of the therapeutic endoscopist, compli-
i n di f f e re nt pa r t s o f t h e w o r l d . We b e l i eve t h i s cations will be reduced. We suggest that ERCP be performed
is due to the fact that 49,0% of the procedures were diag- only by highly qualified endoscopists.
nostic. We have used precut more frequently over the last
few years and it is very likely that once the number of com- Financial disclosure
plications has been analyzed, it will be used even more.
Another factor that perhaps influenced our complication No financial support was received in relation to this article.
percentage is the fact that no residents participated in the pro-
cedures and they were always performed by 2 endoscopists; Conflict of Interest
of course this possibility would need to be confirmed
The authors declare that there is no conflict of interest.
through controlled studies. The order of frequency of com-
plications in published reports is: pancreatitis, hemorrhage,
cholangitis, and perforation16. In the present study, hemorr- Acknowledgements
hage (n=14) was the most frequent complication, followed We wish to thank all the medical and nonmedical colleagues
by pancreatitis (n=6), respiratory distress (n=3), and cholan- at the endoscopy unit for their help in collecting the data
gitis (n=1). Our 3 cases of respiratory distress (0,3%) alerted that allowed us to write this article.
us to the necessity of opportune management, given that
having different anesthesiologists working with us during
the procedure is a characteristic of our hospital. The drug that References
is predominantly used is a combination of propofol and fen-
tanyl, which could possibly contribute to the presentation 1. Yarmuch. J G, Navarrete MF, Lembach HJ, Molina JC.
of this complication4. Rendimiento de la Colangiopancreatografía por resonancia ma-
The definition of hemorrhage varies, and hemoglobin figu- gnética respecto a la Colangiopancreatografía endoscópica ret-
res from 2-3 g/dL are accepted; this is significant when rograda en el diagnóstico de coledocolitiasis. Rev Chilena de
blood transfusion is required18. In our study population there Cirugía 2008; 60: 122-6.
were 14 cases (1,2%) in which 93,0% of the patients presen- 2. Laokpessi A, Bouillet P, Sautereau D, et al. Value of magnetic
resonance cholangiography in the preoperative diagnosis of
ted with mild hemorrhage and only one patient (7,0%) pre-
common bile duct stones. Am J Gastroenterol 2001;96: 2354-9.
sented with moderate hemorrhage according to international 3. Shanmugam V, Beattie GC, Yule SR, et al. Is magnetic reso-
criteria16, requiring blood transfusion without surgery. This nance cholangiopancreatography the new gold standard in bil-
patient had the significant history of taking nonsteroidal iary imaging? Br J Radiol. 2005;78:888-93.
anti-inflammatory drugs, stressing the importance of ca- 4. Rex DK, Deenadayalu VP, Eid E, et al. endoscopist- Directed Ad-
rrying out a rigorous and detailed anamnesis of our patients. ministration of Propofol: A Worldwide safety Experience. Gas-
Pancreatitis frequency published in prospective studies is troenterology 2009; 137:1229-37.
from 1,3% to 7,6%19-21 and in our study it was 0,5%. As mentioned 5. Christoforidis E, Goulimaris I, Kanellos I, et al. Post-endoscopic
above, this could increase when a greater number of thera- retrograde cholangiopancreatography pancreatitis and hypera-
peutic endoscopies are performed, because precut and sphinc- mylasemia: patient-related and operative risk factors. Endos-
copy 2002;34:286-92.
terotomy are the risk factors for its presentation22-25. Another
6. Christensen M, Matzen P, Schulze S, et al. Complications of
factor that raises the number of complications is the ampulla of ERCP: a prospective study Gastrointest Endosc 2004;60:721-31.
Vater dilatation and the technical difficulty in cannulizing 7. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc
and gaining access to the biliary tract26-31, given that the 2002;56(6 Suppl): S273-82.
type and frequency of complications described in the literature 8. Mallery JS, Baron TH, Dominitz JA, et al. Complications of ERCP
vary up to 10,0%32-33. Gastrointest Endosc 2003;57:633-8.
Due to methodological problems as well as to diverse de- 9. Consulted 27 October 2008. http://www.endonurse.com/arti-
finitions, complication frequency is not yet completely cles/ins-outs-ercp.html
determined and fluctuates from 1,3% to 10,0%, with a mor- 10. Katz D, Nikfarjam M, Sfakiotaki A, Christophi C. Selective Endo-
tality of 2,0% to 4,0%. It must be clearly stated that ERCP is scopic Cholangiography for the Detection of Common Bile Duct
Stones in Patients with Cholelithiasis. Endoscopy 2004;36:1145-9.
a complex procedure with significant morbidity and mortali-
11. Saccomani G, Durante V, Magnolia MR et al. Combined endo-
ty that should be performed by qualified endoscopists with scopic treatment for cholelithiasis associated with choledocholith-
experience at the therapeutic level in order to reduce the iasis. Surg Endosc 2005;19:910-4.
percentage of complications34-35. There were no fatal outco- 12. Ganci C, Chan C, Bobadilla J, et al. Management of choledo-
mes in our study and the endoscopic studies were perfor- cholithiasis found during laparoscopic cholecystectomy: a
med by highly competent personnel. strategy based on the use postoperative endoscopic retrograde
5. Endoscopic retrograde cholangiopancreatography at a regional hospital of the IMSS, 2002-2011 129
cholangiography and sphincterectomy. Rev Invest Clin 24. American Society for Gastrointestinal Endoscopy. Complication
2001;53:17-20. of ERCP. Gastrointest Endosc 2003;57:633-8.
13. Madhotra R, Cotton PB, Vaughn J, et al. Analyzing ERCP prac- 25. Lella F, Bagnolo C, Colombo E, et al. A simple way of avoiding
tice by a modified degree of difficulty scale: a multicenter da- post-ERCP pancreatitis. Gastrointest Endosc 2004;59:830-4.
tabase analysis. Am J Gastroenterol 2000;95:2480-1. 26. Hajiro K, Tsujimura D, Inoue R, et a. Effect of FOY on hyperam-
14. Garcia-Cano LJ, Gonzalez-Martin JA, Morillas-Arino J, et al. ylasemia after endoscopic retrograde cholangiopancreatogra-
Complications of endoscopic retrograde cholangiopancreatog- phy. Gendai Iryo 1978;10:1375-9.
raphy. A study in a small ERCP unit. Rev Esp Enferm Dig 27. Shimizu Y, Takahashi H, Deura M. Prophylactic effects of preop-
2004;96:163-73. erative administration of gabexate mesilate (FOY) on post-ER-
15. Suissa A, Yassin K, Lavy A et al. Outcome and early complica- CP pancreatitis. Gendai Iryo 1979;11:540-4.
tions of ERCP: a prospective single center study. Hepatogastro- 28. Poon RT, Yeumg C, Lo Cm, Yeum WK, et al. Prophylactic effect
enterology 2005;52:352-5 of somatostatin on post-ERCP pancreatitis: a randomized con-
16. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterot- trolled trial. Gastrointest Endosc 1999;49:593-8.
omy complications and their management: an attempt at con- 29. Andriulli A, Clemente R, Solmi L, et al. Gabexate or somatosta-
sensus. Gastrointest Endosc 1991;37:383-93. tin administration before ERCP in patients at high risk for post-
17. Cotton PB, Garrow DA, Gallagher J, et al. Risk Factor for com- ERCP pancreatitis: a multicenter, placebo-controlled, rand-
plications after ERCP; a multivariate analysis of 11 497 proce- omized clinical trial. Gastrointest Endosc 2002;56:488-95.
dures over 12 years. Gastrointest Endosc 2009;70:80-8. 30. Tung-Ping PR, Sheung TF. Antisecretory Agents for Prevention of
18. Williams EJ, Taylor S, Fairclough P et al. Risk factor for compli- Post-ERCP Pancreatitis: Rationale for Use and Clinical Results.
cations following ERCP; results of a large scale, prospective J Pancreas (online) 2003;4:33-40.
multicenter study. Endoscopy 2007;39:793-801. 31. Freeman ML, Nelson DB, Sherman S, et al. Complications of
19. Freedman ML, Nelson DB, Sherman S et al. complications of endo- Endoscopic Biliary Sphincterotomy. N Engl J Med 1996;335:909-
scopic biliary sphincterotomy. N Engl J Med 1996;335:909-918. 18.
20. Loperfido S, Angelini G, Chilovi F et al. Major early complications 32. Sherman S, Lehman GA. Complications of endoscopic retro-
from diagnostic and therapeutic ERCP: a prospective multicenter grade cholangiopancreatography and endoscopic sphincteroto-
study. Gastrointest Endosc 1998;48:1-10. my: management and prevention. In: Brakin JS, O’phelan CA,
21. Sherman S. Ruffolo TA, Hawes RH, et al. Complications of endo- eds. Advanced therapeutic endoscopy. New York: Raven Press
scopic sphincterotomy. A prospective series with sphincter of 1990:201-10.
Oddi dysfunction and nondilated bile ducts. Gastroenterology 33. Ostroff JW, Shapiro HA. Complications of endoscopic retrograde
1991;101:1068-75. sphincterotomy. In: Jacobsen IM, ed. ERCP: diagnostic and thera-
22. Gottlieb K, Sherman S. ERCP and biliary endoscopic sphincter- peutic applications. New York: Elsevier Science 1989:61-73.
otomy induced pancreatitis. Gastrointest Endosc Clin N Am 34. Freeman ML. Understanding risk factors and avoiding complica-
1998;8:87-114. tions with endoscopic retrograde cholangiopancreatography. Curr
23. Vandervoort J, Soetikno RM, Tham TC et al. Risk factors for Gastroenterol Rep 2003;5:145-153
complications after performance of ERCP. Gastroinest Endosc 35. Masci E, Toti G, Mariani A, et al. Complications of diagnostic
2002;56:652-6. and therapeutic ERCP: a prospective multicenter study. Am J
Gastroenterol 2001;96:417-23.