AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of pa...AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or postERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.展开更多
BACKGROUND Acute severe variceal bleeding(AVB)refractory to medical and endoscopic therapy is infrequent but associated with high mortality.Historical cohort studies from 1970-1980s no longer represent the current pop...BACKGROUND Acute severe variceal bleeding(AVB)refractory to medical and endoscopic therapy is infrequent but associated with high mortality.Historical cohort studies from 1970-1980s no longer represent the current population as balloon tamponade is no longer first-line therapy for variceal bleeding;treatments including vasoactive therapies,intravenous antibiotics,endoscopic variceal band ligation are routinely used,and there is improved access to definitive treatments including transjugular intrahepatic portosystemic shunts.However,only a few studies from the current era exist to describe the practice of balloon tamponade,its outcomes,and predictors with a requirement for further updated information.AIM To describe current management of AVB requiring balloon tamponade and identify the outcomes and predictors of mortality,re-bleeding and complications.METHODS A retrospective multi-centre cohort study of 80 adult patients across two large tertiary health networks from 2008 to 2019 in Australia who underwent balloon tamponade using a Sengstaken-Blakemore tube(SBT)were included for analysis.Patients were identified using coding for balloon tamponade.The primary outcome of this study was all-cause mortality at 6 wk after the index AVB.Secondary outcomes included re-bleeding during hospitalisation and complications of balloon tamponade.Predictors of these outcomes were determined using univariate and multivariate binomial regression.RESULTS The all-cause mortality rates during admission and at 6-,26-and 52 wk were 48.8%,51.2%and 53.8%,respectively.Primary haemostasis was achieved in 91.3%and re-bleeding during hospitalisation occurred in 34.2%.Independent predictors of 6 wk mortality on multivariate analysis included the Model for Endstage Liver disease(MELD)score(OR 1.21,95%CI 1.06-1.41,P=0.006),advanced hepatocellular carcinoma(OR 11.51,95%CI 1.61-82.20,P=0.015)and re-bleeding(OR 13.06,95%CI 3.06-55.71,P<0.001).There were no relevant predictors of re-bleeding but a large proportion in which this occurred did not survive 6 wk(76.0%vs 24%).Although mucosal trauma was the most common documented complication after SBT insertion(89.5%),serious complications from SBT insertion were uncommon(6.3%)and included 1 patient who died from oesophageal perforation.CONCLUSION In refractory AVB,balloon tamponade salvage therapy is associated with high rates of primary haemostasis with low rates of serious complications.Re-bleeding and mortality however,remain high.展开更多
文摘AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or postERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.
文摘BACKGROUND Acute severe variceal bleeding(AVB)refractory to medical and endoscopic therapy is infrequent but associated with high mortality.Historical cohort studies from 1970-1980s no longer represent the current population as balloon tamponade is no longer first-line therapy for variceal bleeding;treatments including vasoactive therapies,intravenous antibiotics,endoscopic variceal band ligation are routinely used,and there is improved access to definitive treatments including transjugular intrahepatic portosystemic shunts.However,only a few studies from the current era exist to describe the practice of balloon tamponade,its outcomes,and predictors with a requirement for further updated information.AIM To describe current management of AVB requiring balloon tamponade and identify the outcomes and predictors of mortality,re-bleeding and complications.METHODS A retrospective multi-centre cohort study of 80 adult patients across two large tertiary health networks from 2008 to 2019 in Australia who underwent balloon tamponade using a Sengstaken-Blakemore tube(SBT)were included for analysis.Patients were identified using coding for balloon tamponade.The primary outcome of this study was all-cause mortality at 6 wk after the index AVB.Secondary outcomes included re-bleeding during hospitalisation and complications of balloon tamponade.Predictors of these outcomes were determined using univariate and multivariate binomial regression.RESULTS The all-cause mortality rates during admission and at 6-,26-and 52 wk were 48.8%,51.2%and 53.8%,respectively.Primary haemostasis was achieved in 91.3%and re-bleeding during hospitalisation occurred in 34.2%.Independent predictors of 6 wk mortality on multivariate analysis included the Model for Endstage Liver disease(MELD)score(OR 1.21,95%CI 1.06-1.41,P=0.006),advanced hepatocellular carcinoma(OR 11.51,95%CI 1.61-82.20,P=0.015)and re-bleeding(OR 13.06,95%CI 3.06-55.71,P<0.001).There were no relevant predictors of re-bleeding but a large proportion in which this occurred did not survive 6 wk(76.0%vs 24%).Although mucosal trauma was the most common documented complication after SBT insertion(89.5%),serious complications from SBT insertion were uncommon(6.3%)and included 1 patient who died from oesophageal perforation.CONCLUSION In refractory AVB,balloon tamponade salvage therapy is associated with high rates of primary haemostasis with low rates of serious complications.Re-bleeding and mortality however,remain high.
