Prophylaxis of post-ERCP pancreatitis: European society of gastrointestinal endoscopy (ESGE) guideline - Updated June 2014
Jean-Marc Dumonceau,Angelo Andriulli,B. Joseph Elmunzer,Alberto Mariani,Tobias Meister,Jacques Devière,T. Marek,Todd H. Baron,Cesare Hassan,Pier Alberto Testoni,Christine Kapral +10 more
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TLDR
Routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after ERCP in all patients without contraindication is recommended and needle-knife fistulotomy should be the preferred precut technique in patients with a bile duct dilated down to the papilla.Abstract:
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the prophylaxis of post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis. Main recommendations
1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before or after ERCP in all patients without contraindication. In addition to this, in the case of high risk for post-ERCP pancreatitis (PEP), the placement of a 5-Fr prophylactic pancreatic stent should be strongly considered. Sublingually administered glyceryl trinitrate or 250 µg somatostatin given in bolus injection might be considered as an option in high risk cases if nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated and if prophylactic pancreatic stenting is not possible or successful. 2 ESGE recommends keeping the number of cannulation attempts as low as possible. 3 ESGE suggests restricting the use of a pancreatic guidewire as a backup technique for biliary cannulation to cases with repeated inadvertent cannulation of the pancreatic duct; if this method is used, deep biliary cannulation should be attempted using a guidewire rather than the contrast-assisted method and a prophylactic pancreatic stent should be placed. 4 ESGE suggests that needle-knife fistulotomy should be the preferred precut technique in patients with a bile duct dilated down to the papilla. Conventional precut and transpancreatic sphincterotomy present similar success and complication rates; if conventional precut is selected and pancreatic cannulation is easily obtained, ESGE suggests attempting to place a small-diameter (3-Fr or 5-Fr) pancreatic stent to guide the cut and leaving the pancreatic stent in place at the end of ERCP for a minimum of 12 – 24 hours. 4 ESGE does not recommend endoscopic papillary balloon dilation as an alternative to sphincterotomy in routine ERCP, but it may be advantageous in selected patients; if this technique is used, the duration of dilation should be longer than 1 minute.read more
Citations
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Adverse events associated with ERCP
Vinay Chandrasekhara,Mouen A. Khashab,V. Raman Muthusamy,Ruben D. Acosta,Deepak Agrawal,David H. Bruining,Mohamad A. Eloubeidi,Robert D. Fanelli,Ashley L. Faulx,Suryakanth R. Gurudu,Shivangi Kothari,Jenifer R. Lightdale,Bashar J. Qumseya,Aasma Shaukat,Amy Wang,Sachin Wani,Julie Yang,John M. DeWitt +17 more
TL;DR: Vinay Chandrasekhara, MD, Mouen A. Khashab,MD, V. Raman Muthusamy, PhD, FASGE, Ruben D. Acosta, MD; Deepak Agrawal, MD , MPH, David H. Lightdale, MD*, MPH, FasGE, NASPGHAN Representative.
Journal ArticleDOI
Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated October 2017.
Jean-Marc Dumonceau,Andrea Tringali,Ioannis S. Papanikolaou,Daniel Blero,Benedetto Mangiavillano,Arthur Schmidt,Geoffroy Vanbiervliet,Guido Costamagna,Jacques Devière,Jesús García-Cano,Tibor Gyökeres,Cesare Hassan,Frédéric Prat,Peter D. Siersema,Jeanin E. van Hooft +14 more
TL;DR: Preoperative biliary drainage should be reserved for patients with cholangitis, severe symptomatic jaundice, or delayed surgery, or for before neoadjuvant chemotherapy in jaundiced patients.
Journal ArticleDOI
Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline
Pier Alberto Testoni,Alberto Mariani,Lars Aabakken,Marianna Arvanitakis,Erwan Bories,Guido Costamagna,Jacques Devière,Mário Dinis-Ribeiro,Jean-Marc Dumonceau,Marc Giovannini,Tibor Gyökeres,Michael Häfner,Jorma Halttunen,Cesare Hassan,Luis Felipe Dias Lopes,Ioannis S. Papanikolaou,Tony C.K. Tham,Andrea Tringali,Jeanin E. van Hooft,Earl J. Williams +19 more
TL;DR: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy and provides practical advice on how to achieve successful cannulation and sphincterotomy at minimum risk to the patient.
Journal ArticleDOI
Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline
Gianpiero Manes,Gregorios A. Paspatis,Lars Aabakken,Andrea Anderloni,Marianna Arvanitakis,Philippe Ah-Soune,Marc Barthet,Dirk Domagk,Jean-Marc Dumonceau,Jean-François Gigot,István Hritz,George Karamanolis,Andrea Laghi,Alberto Mariani,Konstantina D. Paraskeva,Jürgen Pohl,Thierry Ponchon,Fredrik Swahn,Rinze W. F. ter Steege,Andrea Tringali,Antonios Vezakis,Earl J. Williams,Jeanin E. van Hooft +22 more
TL;DR: ESGE recommends offering stone extraction to all patients with common bile duct stones, symptomatic or not, who are fit enough to tolerate the intervention and performing a laparoscopic cholecystectomy within 2 weeks from ERCP for patients treated for choledocholithiasis.
Journal ArticleDOI
ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Jean-Marc Dumonceau,Christine Kapral,Lars Aabakken,Ioannis S. Papanikolaou,Andrea Tringali,Geoffroy Vanbiervliet,Torsten Beyna,Mário Dinis-Ribeiro,István Hritz,Alberto Mariani,Gregorios A. Paspatis,Franco Radaelli,Sundeep Lakhtakia,Andrew Veitch,Jeanin E. van Hooft +14 more
TL;DR: Routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration is recommended.
References
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Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus
Peter A. Banks,Thomas L. Bollen,Christos Dervenis,Hein G. Gooszen,Colin D. Johnson,Michael G. Sarr,Gregory G. Tsiotos,Santhi Swaroop Vege +7 more
TL;DR: This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria and should encourage widespread adoption.
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Peter B. Cotton,Glen A. Lehman,J. Vennes,J.E. Geenen,R.C.G. Russell,William C. Meyers,C. Liguory,N. Nickl +7 more
TL;DR: This document is an attempt to provide guidelines for prevention and management of complications, based on a workshop of selected experts, and a comprehensive review of the literature, that emphasize the importance of specialist training, disinfection, drainage, and collaboration with surgical colleagues.
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Complications of Endoscopic Biliary Sphincterotomy
Martin L. Freeman,Douglas B. Nelson,Stuart Sherman,Haber Gb,Herman Me,P. J. Dorsher,J. P. Moore,Fennerty Mb,Michael E. Ryan,Michael J Shaw,Lande Jd,A. M. Pheley +11 more
TL;DR: 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 patients.
Journal ArticleDOI
Risk factors for post-ERCP pancreatitis: A prospective, multicenter study
Martin L. Freeman,James A. DiSario,Douglas B. Nelson,M. Brian Fennerty,John G. Lee,David J. Bjorkman,Carol Overby,Johannes Aas,Michael E. Ryan,G. S. Bochna,Michael J Shaw,Harry Snady,Robert V. Erickson,J. P. Moore,Joseph P. Roel +14 more
TL;DR: Combinations of patient characteristics including female gender, normal serum bilirubin, recurrent abdominal pain, and previous post-ERCP pancreatitis placed patients at increasingly higher risk of pancreatitis, regardless of whether ERCP was diagnostic, manometric, or therapeutic.
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