Less Post-ERCP Pancreatitis With Lactated Ringer's Plus Rectal Indomethacin Less Post-ERCP Pancreatitis With Lactated Ringer's Plus Rectal Indomethacin
Infusion of lactated Ringer's solution along with rectal administration of indomethacin was associated with lower rates of post-ERCP pancreatitis (PEP) in a randomized, placebo-controlled trial.Reuters Health Information
Biliary complications occur in up to 25% of patient following liver transplantation and are often managed by endoscopic retrograde cholangiopancreatography (ERCP). Pancreatitis is the most common adverse event after ERCP (PEP). Tacrolimus and rectal indomethacin have each been reported to reduce risk of PEP. We investigated the incidence of PEP in patients who have undergone ERCP after liver transplantation and the effectiveness of tacrolimus and/or indomethacin in reducing risk of PEP.
Authors: Pérez-Cuadrado Robles E, Kisoka P, Alexandre B, Deprez PH Abstract A 43-year-old female with hereditary chronic pancreatitis presented with increasing pancreatic pain and multiple pancreatic stones, despite extracorporeal shockwave lithotripsy and pancreatic stenting 12 months previously. Direct lithotripsy was performed via endoscopic retrograde cholangio-pancreatography and the stones were further evaluated. PMID: 31595757 [PubMed - as supplied by publisher]
Biliary cannulation represent a challenge for the endoscopists that approach to endoscopic retrograde cholangiopancreatography, with non-negligible rate of failure even in expert hands. In order to achieve the biliary tree, two main technique are nowadays mainly used, namely the contrast-assisted cannulation and the wire-guided cannulation (WGC) techniques. The WGC technique is widely used because it seems to be related to higher success rate of cannulation of the common bile duct and, at the same time, to lower rates of complications. Particularly, this approach is associated with lower risk of post endoscopic retrograde ...
Conclusion The results of the present study showed that, administration of melatonin 3 mg tablets plus indomethacin suppository 100 mg 1 h before ERCP could decrease the PEP rate and amylase and lipase levels compared to administration of indomethacin suppository 100 mg alone.
Publication date: Available online 30 September 2019Source: Arab Journal of GastroenterologyAuthor(s): Elias Makhoul, Joe El Mir, Marc HarbAbstractBackground and study aimsEndoscopic retrograde cholangiopancreatography (ERCP) is a commonly used procedure in the management of pancreatic and biliary diseases. Acute pancreatitis is the most common complication following ERCP. Among many medications, nonsteroidal anti-inflammatory drugs (NSAIDs) were subject of numerous trials concerning post ERCP pancreatitis (PEP) prophylaxis. By inhibiting phospholipase A2, these drugs could intervene in the pathogenesis of the disease ther...
Conclusion: Early laparoscopic cholecystectomy is safe and effective for patients with MAGP, but the indications and contraindications must be strictly controlled.
CONCLUSION Nonsurgical admissions of patients with cholecystitis are common, even among lower-risk patients. Routine admission to the surgical service should decrease LOS, resource utilization and costs. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
Conclusions Consistent with other published series, LA-ERCP yields excellent cannulation rates after RYGB. Successful treatment of pancreatic and Type 1 biliary SOD suggests that there is significant symptomatic benefit to treating this patient population. However, an overall complication rate of approximately 15 % with LAERCP leaves open the possibility for improvements in access techniques in post-RYGB patients. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
An 84-year-old woman presented with epigastric pain and was admitted for biliary pancreatitis. Laboratory results showed a lipase level of 1521 U/L, aspartate aminotransferase level of 183 U/L, alanine aminotransferase level of 102 U/L, total bilirubin level of 4.4 mg/dL, and alkaline phosphatase level of 80 U/L. Contrast-enhanced computed tomography showed a dilated common bile duct with peri-ampullary biliary stenosis (Figure A). A dilated bile duct with an abrupt terminus just above the duodenal wall and no drainage of contrast to duodenum was seen on endoscopic retrograde cholangiopancreatography (Figure B, arrow).
ConclusionNSAIDs were associated with a significant reduction in risk of PEP and moderate to severe PEP compared to the control group.