BACKGROUND: Intraoperative hemorrhage is a critical issue in the endoscopic evacuation of intracerebral hemorrhage (ICH). Refined and dedicated endoscopic instruments for hemostasis are required. In this technical report, a hemostatic procedure using a monoshaft bipolar cautery is described. TECHNIQUE AND INSTRUMENTATION: The endoscope and monoshaft bipolar cautery are combined into ...

STUDY OBJECTIVE: To estimate whether additional bleeding control can be safely achieved during laparoscopic myomectomy using bipolar electrosurgery over the suture sites in patients with blood oozing despite sufficient myometrial sutures. DESIGN: Retrospective case control study (Canadian Task Force classification II-1). SETTING: University teaching hospital. PATIENTS: One hundred twenty-six women ...

This article presents iatrogenic dermal burn injury as a complication of using a vented bipolar radiofrequency (RF) ablative device in shoulder arthroscopy. We have encountered 4 patients who have sustained second-degree skin burns after shoulder arthroscopy. The burns occurred from arthroscopic shoulder surgeries performed from 2004 to 2008. In each ...

Gallstone pancreatitis is a consequence of ampullary obstruction by common bile duct (CBD) calculi. Magnetic resonance cholangiopancreatography (MRCP) has been advocated for routine use to diagnose choledocholithiasis. However, the selective use of MRCP in clinically equivocal situations has not been explored until now. This study examines the diagnostic value of ...

The Swedish Registry for Gallstone Surgery and ERCP (GallRiks) is the first nationwide Web-based quality registry for gallstone surgery and ERCP in the world. In this article we report data from 11,074 ERCPs performed in 2007 and 2008. The aim of this study is to present outcomes, safety data, and ...

Comparative data regarding complications associated with ERCP alone or when performed with cholangiopancreatoscopy (CP) are lacking. To determine whether ERCP complications are more frequent when concomitant CP is performed. A retrospective query of a prospectively maintained database of ERCP, CP, and complications. Consensus criteria complications and additional adverse events (AEs), ...

Abstract In the general population, endoscopic retrograde cholangiopancreatography (ERCP) procedures are the gold standard in the treatment of bile duct stones. However, repeat endoscopic procedures and sometimes even open surgery are needed in difficult cases with retaining bile duct stones. The aim of the present study was to determine the ...

An 81-year-old woman was referred to our hospital with a diagnosis of acute cholangitis. Endoscopic retrograde cholangiography revealed a common bile duct (CBD) stone. In addition, CT showed thrombus of the right portal vein. Endoscopic sphincterotomy was performed to remove the CBD stone. Thrombosis was treated successfully with danaparoid sodium. ...

Information regarding the safety and feasibility of EUS-guided FNA (EUS/FNA) in surgically altered anatomy is limited. The aim of this study was to describe EUS outcomes for Billroth I and II, Whipple, Puestow, Roux-en-Y (including gastric bypass), esophagectomy, and Nissen fundoplication surgeries. Retrospective study. Single tertiary-care center. This study involved ...

There have been a few previous reports on attempted double-balloon endoscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis and an intact papilla. This study was designed to evaluate the usefulness of DBE-assisted ERCP in patients with Roux-en-Y anastomosis and an intact papilla of Vater. Thirteen DBE procedures ...

Accurate prediction of common bile duct (CBD) stones in acute biliary pancreatitis is warranted to select patients for early therapeutic endoscopic retrograde cholangiopancreatography (ERCP). We evaluated commonly used biochemical and radiological predictors of CBD stones in a large prospective cohort of patients with acute biliary pancreatitis who were undergoing early ...

Endoscopic papillary large balloon dilatation (EPLBD) after endoscopic sphincterotomy (EST) has recently become widely used for common bile duct (CBD) stone removal, but many clinicians remain concerned about post-procedural pancreatitis with increasing the balloon size to over 15 mm. We aimed to evaluate the safety and efficacy of EPLBD with ...

Needle knife fistulotomy is a useful alternative in gaining access to the biliary system when standard cannulation techniques have been exhausted. Where access cannot be achieved following fistulotomy the convention has been to abandon further endoscopic attempts. Recent experience at our center suggests that repeat ERCP is frequently successful. This ...

Endoscopic sphincterotomy (ES) is an established method to treat common bile duct (CBD) stones. Inevitable sequence after ES is a substantial risk of recurrent choledocholithiasis and occasional difficulty in removal of large or multiple CBD stones after ES even when mechanical lithotripsy (ML) is employed. In turn, a new endoscopic ...

ERCP after myocardial infarction (MI) or unstable angina (UnA) can potentially entail significant cardiovascular risks. To analyze the safety of ERCP after MI or UnA. Retrospective study. Adult patients less than 30 days after MI or UnA. Three hospitals from 1985 to 2010, encompassing 7600 ERCPs. ERCP. ERCP diagnosis, therapy, ...

The use of early precut during endoscopic retrograde cholangiopancreatography (ERCP) is controversial because of its association with a higher risk of complications. This study examined the efficacy and safety of a strategy of early precut for biliary access during difficult ERCP in a general hospital. Data from January 2007 to ...

To evaluate the effect of double balloon endoscope (DBE) on the endoscopic retrograde cholangiopancreatography (ERCP) success rate in patients with a history of Billroth II (B II) gastrectomy. From April 2006 to March 2007, 32 patients with a B II gastrectomy underwent 34 ERCP attempts. In all cases, the ERCP ...

Endoscopic sphincterotomy (ES) is a well-established standard method for treating common bile duct stones. However, biliary sphincter function is impaired after the treatment, and this may influence the long-term outcomes. In this study, we aimed to compare the long-term outcomes after ES with those after endoscopic papillary balloon dilation (EPBD) ...

Endoscopic retrograde cholangiopancreatography (ERCP), besides reducing the need for surgery in a wide spectrum of biliary disease, is increasingly be used for the treatment of biliary complications of surgery. In this paper, we review our experience with postoperative ERCPs required after biliary surgery with a special focus on side-to-side choledochoduodenostomy ...

The role of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) continues to mature. We will review the progress of pancreatobiliary endoscopy in the evaluation and treatment of benign and malignant pancreatobiliary diseases. First, minimizing contrast injection of the pancreas, wire-guided cannulation and prophylactic pancreatic stenting have been re-emphasized in recent ...

Based on the ampullary obstruction and reflux theory, six endoscopic retrograde cholangiopancreatography (ERCP) studies have investigated the effect of (early) biliary decompression versus conservative management on the course and outcome of patients with acute biliary pancreatitis (ABP) showing inconsistent and contradictory outcomes. We investigated the opinion and attitude of Dutch ...

The introduction of non-invasive imaging for biliary-pancreatic diseases has changed the indications and volumes of endoscopic retrograde cholangiopancreatography (ERCP) over time. This study aimed to provide national figures on ERCP in Norway over the last decade. Data from four national surveys on ERCP activity collected from 1998 to 2009 at ...

BACKGROUND: The development of laparoscopic cholecystectomy as a minimally invasive approach to eliminate gallstones, in conjunction with increasingly sophisticated techniques for removal of common bile duct (CBD) stones by endoscopic sphincterotomy, has revolutionized the treatment of choledocholithiasis. We describe a new technical approach to laparoscopic exploration of the CBD after ...

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential element in treating disease of the bilio-pancreatic system. In some patients, access to the bile ducts is limited due to operatively altered anatomy. The aim of this review is to illustrate the endoscopic procedure in these patients. We present the available evidence and ...

Endoscopic retrograde cholangiopancreatography (ERCP) is the first choice for diagnostic evaluation of the pancreatic and biliary tree and can be accompanied by a high diagnostic sensitivity and a poor therapeutic outcome. In the current study, we described our experiences in the indications, findings, and technical success of ERCP in a ...

The authors describe a new technique of performing endoscopic retrograde cholangiopancreatography in the sitting position with special emphasis on methods of stabilization of the duodenoscope during the procedure. The article is accompanied by an instructional video. The benefits of this comfortable alternative to the standard standing position and its potential ...

The endoscopic method is accepted as a first treatment modality in the management of extrahepatic bile duct. Most large stones can be removed with basket and mechanical lithotripsy after endoscopic sphincterotomy. Currently, in treating large extrahepatic bile duct stones, endoscopic papillary large balloon dilation with mid-incision endoscopic sphincterotomy is actively ...

BACKGROUND: Ampullary restenosis is a late complication of biliary endoscopic sphincterotomy. Long-term data are limited regarding both the rate of restenosis and complications resulting from repeat therapy. AIMS: To determine the incidence of post sphincterotomy restenosis and the effectiveness of endoscopic therapy in the management of this entity. METHODS: A ...

PURPOSE: A bile duct stone impacted at the duodenal papilla is an urgent condition that can rapidly lead to either suppurative cholangitis or acute pancreatitis due to almost complete obstruction of the bilio-pancreatic outflow. This study evaluated the clinical characteristics and results of endoscopic treatment for a bile duct stone ...

Endoscopic retrograde cholangiopancreatography (ERCP) is challenging to perform in patients with postsurgical gastrointestinal anatomy. We assessed the diagnostic and therapeutic success rates using single-balloon enteroscopy in patients with Roux-en-Y anastomosis. Patients who underwent single-balloon ERCP between April 2008 and February 2010 were retrospectively identified using a computerized endoscopy database. Diagnostic ...

The aim of this study was to evaluate the benefits and harms of primary closure versus T-tube drainage after common bile duct (CBD) exploration for choledocholithiasis. A literature search of MEDLINE (PubMed), EMBASE, and the Cochrane Library was done to identify randomized controlled trials assessing the benefits and harms of ...

Common bile duct stones (CBDS) that are seen in the Asian population are very different from those seen in the west. It is not infrequent to see multiple, large, and impacted stones and a hugely dilated CBD. Many of these patients have been managed by open CBD exploration (OCBDE), even ...

The study aims to evaluate the use of "critical view of safety" (CVS) for the prevention of bile duct injuries during laparoscopic cholecystectomy for acute biliary pathology as an alternative to routine intraoperative cholangiography (IOC). A policy of routine CVS to identify biliary anatomy and selective IOC for patients suspected ...

BACKGROUND: Ectopic opening of the common bile duct (CBD) into the GI tract is an extremely rare congenital anomaly. The clinical implications and frequency of this anomaly are not clearly known. OBJECTIVE: To present a case series of ectopic opening of the CBD into various sites of the upper digestive ...

Duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication, but it has a relatively high mortality risk. Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation. The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire ...

The aim of this study was to compare the efficacy and safety of laparoscopic primary closure of the common bile duct (CBD) combined with percutaneous transhepatic cholangiographic drainage (PTCD) and laparoscopic choledocholithotomy with T-tube placement for the treatment of CBD stones. Between January 1991 and July 2002, 50 patients with ...

There is no clear answer regarding use of precut technique versus conventional method in achieving successful biliary cannulation. To compare the effectiveness of precut technique with that of conventional biliary cannulation by meta-analysis of available randomized controlled trials (RCTs). Databases including MEDLINE, EMBASE, Cochrane Library, and Science Citation Index updated ...

More than half a million endoscopic retrograde cholangiopancreatography (ERCP) procedures are performed annually in the United States. The risk of severe complications after ERCP is less than 1%; however, autopsy pathologists see a select group of patients having fatality. Thirty-five autopsies were performed after ERCP over a 13-year period. Fourteen ...

BACKGROUND: The success rate of antegrade approach for chronic total occlusions (CTO) recanalization has not dramatically increased, especially in complex CTO subset. The retrograde technique may hold great promise. This report aimed to describe our experience of retrograde recanalization for CTO, focusing on its safety and feasibility. METHODS: We identified ...

BACKGROUND: The majority of literature on the precut technique is concerned with needle-knife sphincterotomy, whereas the comparison of transpancreatic sphincterotomy and needle-knife sphincterotomy has been rarely reported. Aim The aim of the study was to compare the success and the complication rates of transpancreatic sphincterotomy with needle-knife sphincterotomy. METHODS: During ...

Endoscopic retrograde cholangiopancreatography (ERCP) in patients after Billroth II or Roux-en-Y reconstruction is challenging because of difficulties in insertion of the endoscope into the afferent loop, which is a great distance away from the papilla of Vater, and cannulation into the desired duct from a reverse position. To facilitate ERCP, ...

Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically challenging procedure routinely performed by endoscopists. ERCP cannulation requires the insertion of a subcentimeter catheter through a tiny orifice at a distance of almost a meter from the operator. Only after successful cannulation of the bile duct can the real "business" of ...

When multiple treatment options are available, debate invariably persists regarding the optimal option. Confusion and controversy must then be resolved based on scientific evidence, but one needs to be practical because options depend on the available expertise. We aimed to evaluate the efficacy of endotherapy vis-à-vis surgery in patients with ...

To compare the effectiveness of laparoscopic common bile duct exploration in patients with failed endoscopic retrograde cholangiopancreatography (ERCP). This is a descriptive, comparative study. Patients with an indication of common bile duct exploration between February 2005 and October 2008 were included. We studied 2 groups: Group A: patients with failed ...

Laparoscopic cholecystectomy (LC) has become the standard for treatment of uncomplicated cholecystolithiasis. However, in cases of cholecystitis or cholecysto-choledocholithiasis, technical and skill requirements may make questionable the convenience of laparoscopy. Transcylindrical cholecystectomy (TC) is a modified minilaparotomy, performed gas-free through a single cylinder 3.8 cm in diameter and 10.0 cm ...

Although the ideal management of cholelithiasis and concomitant choledocholithiasis is controversial, the two-stage approach [endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, and common bile duct (CBD) clearance followed by laparoscopic cholecystectomy] is the most popular treatment regimen worldwide. However, sometimes ERCP fails to solve the problem of choledocholithiasis preoperatively. The aim of ...

BACKGROUND AND STUDY AIMS: Precut papillotomy is considered a risk factor for endoscopic retrograde cholangiopancreatography (ERCP)-related complications; however whether the complication risk is due to precut itself or to the prior prolonged attempts is still debated; therefore, early precut implementation has been suggested to reduce the complication rate. We conducted ...

Common bile duct (CBD) stones can cause serious morbidity or mortality, and evidence for them should be sought in all patients with symptomatic gallstones undergoing cholecystectomy. Routine intra-operative cholangiography (IOC) involves a large commitment of time and resources, so a policy of selective cholangiography was adopted. This study prospectively evaluated ...

BACKGROUND: Deep biliary cannulation (DBC) is a prerequisite to most endoscopic retrograde cholangiopancreatographies (ERCPs). Numerous techniques have been described to maximize success and minimize ERCP-related complications, most notably post-ERCP pancreatitis. Dye-free cannulation by using guidewires with hydrophilic tips has been proposed as a technique with a high rate of success ...

Laparoscopic common bile duct (CBD) exploration is regarded as a safe, definitive procedure for ductal calculi, avoiding the complications of endoscopic retrograde cholangiopancreatography. We aimed to evaluate the outcomes of laparoscopic CBD exploration carried out by trainees compared to those of an experienced consultant (R.W.M.). A prospective database of all ...