Endoscopic sphincterotomy complications and their management: an attempt at consensus

Background Endoscopic sphincterotomy is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated risk factors for complications of this procedure and their outcomes. Methods We studied complications that occurred within 30 days of endoscopic biliary sphincterotomy in consecutive patients treated at 17 institutions in the United States and Canada from 1992 through 1994. Results Of 2347 patients, 229 (9.8 percent) had a complication, including pancreatitis in 127 (5.4 percent) and hemorrhage in 48 (2.0 percent). There were 55 deaths from all causes within 30 days; death was directly or indirectly related to the procedure in 10 cases. Of five significant risk factors for complications identified in a multivariate analysis, two were characteristics of the patients (suspected dysfunction of the sphincter of Oddi as an indication for the procedure and the presence of cirrhosis) and three were related to the endoscopic technique (difficulty in cannulating the bile duct,...

https://www.nejm.org/doi/pdf/10.1056/NEJM199609263351301

Complications of Endoscopic Biliary Sphincterotomy

International variations in cancer rates have been attributed, at least in part, to differences in dietary intake. Recently, it has been suggested that consumption of soyfoods may contribute to the relatively low rates of breast, colon, and prostate cancers in countries such as China and Japan. Soybeans contain a number of anticarcinogens, and a recent National Cancer Institute workshop recommended that the role of soyfoods in cancer prevention be investigated. In this review, the hypothesis that soy intake reduces cancer risk is considered by examining relevant in vitro, animal, and epidemiological data. Soybeans are a unique dietary source of the isoflavone genistein, which possesses weak estrogenic activity and has been shown to act in animal models as an antiestrogen. Genistein is also a specific inhibitor of protein tyrosine kinases; it also inhibits DNA topoisomerases and other critical enzymes involved in signal transduction. In vitro, genistein suppresses the growth of a wide range of can...

Soy intake and cancer risk: A review of the in vitro and in vivo data

A BSTRACT Background Endoscopic sphincterotomy is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated risk factors for complications of this procedure and their outcomes. Methods We studied complications that occurred within 30 days of endoscopic biliary sphincterotomy in consecutive patients treated at 17 institutions in the United States and Canada from 1992 through 1994. Results Of 2347 patients, 229 (9.8 percent) had a complication, including pancreatitis in 127 (5.4 percent) and hemorrhage in 48 (2.0 percent). There were 55 deaths from all causes within 30 days; death was directly or indirectly related to the procedure in 10 cases. Of five significant risk factors for complications identified in a multivariate analysis, two were characteristics of the patients (suspected dysfunction of the sphincter of Oddi as an indication for the procedure and the presence of cirrhosis) and three were related to the endoscopic technique (difficulty in cannulating the bile duct, achievement of access to the bile duct by “precut” sphincterotomy, and use of a combined percutaneous–endoscopic procedure). The overall risk of complications was not related to the patient’s age, the number of coexisting illnesses, or the diameter of the bile duct. The rate of complications was highest when the indication for the procedure was suspected dysfunction of the sphincter of Oddi (21.7 percent) and lowest when the indication was removal of bile-duct stones within 30 days of laparoscopic cholecystectomy (4.9 percent). As compared with those who performed fewer procedures, endoscopists who performed more than one sphincterotomy per week had lower rates of complications (8.4 percent vs. 11.1 percent, P 0.03). Conclusions The rate of complications after endoscopic biliary sphincterotomy can vary widely in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique, rather than to the age or general medical condition of the patient. (N Engl J Med 1996;335:909-18.)

Complications of endoscopic biliary sphincterotomy.

Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years.

Endoscopic sphincterotomy of the ampulla of Vater

A new very thin glass fiber endoscope ("baby scope") has been developed, which can be passed through the channel of a modified duodenoscope ("mother scope") for catheterization of the choledochus or of the pancreatic duct Peroral choledocho-pancreatoscopy (PCPS) was performed in 9 patients, the endoscopic results are presented Other new auxiliary instruments for diagnostic or therapeutic purposes in biliary or pancreatic diseases are described: a brushing catheter, a special biopsy forceps, a retention probe and a balloon-tipped catheter

[A new endoscopic method: the peroral choledocho-pancreatoscopy (author's transl)]

[A case-control study of cancer of the rectum and colon].

日本の大腸がんに関する疫学的考察 ｉｉ 直腸がん・結腸がんの背景因子に関する症例・対照研究:(2) 直腸癌•結腸癌の背景因子に関する症例•対照研究

1

Gastrin like hexapeptide-bovime serum albumin conjugate was antigenic for hexagastrin and cross-reacted with tetra and penta-gastrin.




2

Antibody activity was located in the IgG fraction of antiserum.




3

Inhibitory study cleared the possibility of radioimmunoassay of serum gastrin.

Kenji Murakami

Papers

Endoscopic sphincterotomy of the ampulla of Vater

[A new endoscopic method: the peroral choledocho-pancreatoscopy (author's transl)]

[A case-control study of cancer of the rectum and colon].

日本の大腸がんに関する疫学的考察ｉｉ直腸がん・結腸がんの背景因子に関する症例・対照研究:(2) 直腸癌•結腸癌の背景因子に関する症例•対照研究

On antigenicity of gastrin like hexapeptide

Kenji Murakami

Papers

Endoscopic sphincterotomy of the ampulla of Vater

[A new endoscopic method: the peroral choledocho-pancreatoscopy (author's transl)]

[A case-control study of cancer of the rectum and colon].

日本の大腸がんに関する疫学的考察 ｉｉ 直腸がん・結腸がんの背景因子に関する症例・対照研究:(2) 直腸癌•結腸癌の背景因子に関する症例•対照研究

On antigenicity of gastrin like hexapeptide

日本の大腸がんに関する疫学的考察ｉｉ直腸がん・結腸がんの背景因子に関する症例・対照研究:(2) 直腸癌•結腸癌の背景因子に関する症例•対照研究