Re: How Dangerous is the ERCP?

[Guest guest]

,

There are

risks. My 8-year-old did his and fared well. I think pancreatitis is the

biggest worry to be honest. Not that those other things aren’t good to

at least be aware of. I was a wreck going in too. My biggest suggestion I

would make is to make sure the person doing the ERCP is someone who has done plenty.

Noah’s doc had done many since he had mostly done adult…not many

ped patients need them…so we were referred over to him and he ordered a

smaller scope. I wish you well. Check in Monday when you are done and home

and all has gone well which I am sure it will. J

Mom of Zoe (13) My very normal (teenager normal) soccer player;

Noah (8) Indeterminate colitis, PSC, Osteopenia (1-4 lumbar

vertebrae);

Aidan (4 1/2) Moderately-severe SNHL bilaterally

Recycle

Yourself

Become an

Organ Donor

[Guest guest]

,

There are

risks. My 8-year-old did his and fared well. I think pancreatitis is the

biggest worry to be honest. Not that those other things aren’t good to

at least be aware of. I was a wreck going in too. My biggest suggestion I

would make is to make sure the person doing the ERCP is someone who has done plenty.

Noah’s doc had done many since he had mostly done adult…not many

ped patients need them…so we were referred over to him and he ordered a

smaller scope. I wish you well. Check in Monday when you are done and home

and all has gone well which I am sure it will. J

Mom of Zoe (13) My very normal (teenager normal) soccer player;

Noah (8) Indeterminate colitis, PSC, Osteopenia (1-4 lumbar

vertebrae);

Aidan (4 1/2) Moderately-severe SNHL bilaterally

Recycle

Yourself

Become an

Organ Donor

[Guest guest]

,

There are

risks. My 8-year-old did his and fared well. I think pancreatitis is the

biggest worry to be honest. Not that those other things aren’t good to

at least be aware of. I was a wreck going in too. My biggest suggestion I

would make is to make sure the person doing the ERCP is someone who has done plenty.

Noah’s doc had done many since he had mostly done adult…not many

ped patients need them…so we were referred over to him and he ordered a

smaller scope. I wish you well. Check in Monday when you are done and home

and all has gone well which I am sure it will. J

Mom of Zoe (13) My very normal (teenager normal) soccer player;

Noah (8) Indeterminate colitis, PSC, Osteopenia (1-4 lumbar

vertebrae);

Aidan (4 1/2) Moderately-severe SNHL bilaterally

Recycle

Yourself

Become an

Organ Donor

[Guest guest]

Dear ,

I am so sorry that you are having to face this problem. I wish you well.

The man you are speaking about is probably my son, Joe. He is doing well,

getting stronger, at home now with his wife. Joe will need another ERCP in

August or September.

The risk of ERCP is disclosed when you sign your permit, read it carefully

and ask your doctor if you have any questions. I beleive there is a 1%

chance of getting pancreatitis, which is what happened to Joe. This is

rather a rare occurence, but everyone needs to be alert for the symptoms of

pancreatitis should this occur because early and aggressive treatment is

important for survival. You are right that the skill of the physician is

important. Discuss the issue of possible pancreatitis with your physician

prior to your procedure. Joe was quite sick with severe jaundice, itching,

nausea, fevers, and malaise when he presented for the ERCP, and then he had

two ERCP's within a month. This may have contributed to his risk of

complications. The pancreas is an organ that does not like to be messed

with, bumped, touched or otherwise violated. But, again, discuss your

concerns with your doctor prior to your procedure! I believe CT and/or MRI

can also be valuable tools to confirm PSC.

Sincerely,

Chris

mother of Joe, UC 1987, J-pouch 1999, PSC, pancreatitis March 2006

How Dangerous is the ERCP?

>I have my first ERCP scheduled for this Monday. It's to confirm the

>diagnosis. I was

> feeling okay about it, understanding that pancreatitis is a possible side

> effect, but

> then I read the post about the man who had multiple organ failure and

> almost died as

> a result. Are there any risk factors involved that determine a person's

> chance of

> having a complication? I know the experience of the doctor is something

> to consider,

> but other than that? Now I'm nervous.

>

> Any helpful information before Monday would be hugely appreciated.

>

> Thanks.

>

>

> PSC June 2006

>

>

>

>

>

>

>

>

[Guest guest]

Dear ,

I am so sorry that you are having to face this problem. I wish you well.

The man you are speaking about is probably my son, Joe. He is doing well,

getting stronger, at home now with his wife. Joe will need another ERCP in

August or September.

The risk of ERCP is disclosed when you sign your permit, read it carefully

and ask your doctor if you have any questions. I beleive there is a 1%

chance of getting pancreatitis, which is what happened to Joe. This is

rather a rare occurence, but everyone needs to be alert for the symptoms of

pancreatitis should this occur because early and aggressive treatment is

important for survival. You are right that the skill of the physician is

important. Discuss the issue of possible pancreatitis with your physician

prior to your procedure. Joe was quite sick with severe jaundice, itching,

nausea, fevers, and malaise when he presented for the ERCP, and then he had

two ERCP's within a month. This may have contributed to his risk of

complications. The pancreas is an organ that does not like to be messed

with, bumped, touched or otherwise violated. But, again, discuss your

concerns with your doctor prior to your procedure! I believe CT and/or MRI

can also be valuable tools to confirm PSC.

Sincerely,

Chris

mother of Joe, UC 1987, J-pouch 1999, PSC, pancreatitis March 2006

How Dangerous is the ERCP?

>I have my first ERCP scheduled for this Monday. It's to confirm the

>diagnosis. I was

> feeling okay about it, understanding that pancreatitis is a possible side

> effect, but

> then I read the post about the man who had multiple organ failure and

> almost died as

> a result. Are there any risk factors involved that determine a person's

> chance of

> having a complication? I know the experience of the doctor is something

> to consider,

> but other than that? Now I'm nervous.

>

> Any helpful information before Monday would be hugely appreciated.

>

> Thanks.

>

>

> PSC June 2006

>

>

>

>

>

>

>

>

[Guest guest]

Dear ;

From what I have read, the risk of complications of ERCP is

considerably less when ERCP is used for diagnostic purposes (2%) in

comparison to therapeutic purposes (14%) [e.g. placement of a stent

or dilitation of a stricture]:

___________________

Endoscopy. 2000 Oct;32(10):779-82.

Prospective risk assessment of endoscopic retrograde cholangiography

in patients with primary sclerosing cholangitis. Dutch PSC Study

Group.

van den Hazel SJ, Wolfhagen EH, van Buuren HR, van de Meeberg PC,

Van Leeuwen DJ.

Division of Gastroenterology and Hepatology, Academic Medical Center

of the University of Amsterdam, The Netherlands.

vandenhazel@...

BACKGROUND AND STUDY AIMS: Direct endoscopic retrograde

cholangiopancreatography (ERCP) has become the standard for

establishing the diagnosis of primary sclerosing cholangitis (PSC),

while endoscopic procedures play an increasingly important

therapeutic role. However, many believe that this procedure carries

a significant risk of infection and other complications. We assessed

the incidence of complications within 1 week of ERCP in patients

with PSC. PATIENTS AND METHODS: In a multicenter study, patients who

underwent ERCP for (suspected) PSC were prospectively followed for

the occurrence of complications after the procedure. RESULTS: A

total of 106 ERCPs performed in 83 patients were evaluated.

Complications occurred on ten occasions (9%): pancreatitis (n = 3),

cholangitis (n = 2), increase of cholestasis (n = 2),

postsphincterotomy bleeding (n = 1), cystic duct perforation (n =

1), and venous thrombosis (n = 1). All complications resolved

quickly with proper therapy. Complications were more likely when

ERCP was done to evaluate specific complaints such as jaundice or

recurrent cholangitis (9/59) than after a purely diagnostic ERCP

(1/47 relative risk [RR] 7.2, 95% confidence interval [CI] 1.00 to

153). Therapeutic interventions performed during ERCP (e.g.

placement of endoprosthesis, dilation of strictures) also increased

the risk of postprocedural complications (RR 4.5, 95 % CI 0.94 to

30). CONCLUSIONS: ERCP is a safe method for establishing the

diagnosis of PSC in asymptomatic patients (2 % complication rate).

Although ERCP in symptomatic patients carries a higher risk (14%),

this can be justified by the benefits of endoscopic therapy.

Publication Types:

Multicenter Study

PMID: 11068837

___________________

Although there is evidence that antibiotics can reduce the risk of

cholangitis following ERCP, there is controversy as to whether this

reduces the risk of pancreatitis. But this study suggests that it

does reduce risk of both cholangitis and pancreatitis:

___________________

J Gastrointest Surg. 2001 Jul-Aug;5(4):339-45; discussion 345.

Post-ERCP pancreatitis: reduction by routine antibiotics.

Raty S, Sand J, Pulkkinen M, Matikainen M, Nordback I.

Department of Surgery, Tampere University Hospital, P.O. Box 2000,

FIN 33521 Tampere, Finland.

Cholangitis and pancreatitis are severe complications of endoscopic

retrograde cholangiopancreatography (ERCP). Antibiotics have been

considered important in preventing cholangitis, especially in those

with jaundice. Some have suggested that bacteria may play a role in

the induction of post-ERCP pancreatitis. It is not clear, however,

whether the incidence of post-ERCP pancreatitis could be reduced by

antibiotic prophylaxis, as is the case with septic complications. In

this prospective study, a total of 321 consecutive patients were

randomized to the following two groups: (1) a prophylaxis group (n =

161) that was given 2 g of cephtazidime intravenously 30 minutes

before ERCP, and (2) a control group (n = 160) that received no

antibiotics. All patients admitted to the hospital for ERCP who had

not taken any antibiotics during the preceding week were included.

Patients who were allergic to cephalosporins, patients with immune

deficiency or any other condition requiring antibiotic prophylaxis,

patients with clinical jaundice, and pregnant patients were

excluded. In the final analysis six patients were excluded because

of a diagnosis of bile duct obstruction but with unsuccessful

biliary drainage that required immediate antibiotic treatment. The

diagnosis of cholangitis was based on a rising fever, an increase in

the C-reactive protein (CRP) level, and increases in leukocyte count

and liver function values, which were associated with bacteremia in

some. The diagnosis of acute pancreatitis was based on clinical

findings, and increases in the serum amylase level (>900 IU/L), CRP

level, and leukocyte count with no increase in liver chemical

values. The control group had significantly more patients with post-

ERCP pancreatitis (15 of 160 in the prophylaxis group vs. 4 of 155

in the control group; P = 0.009) and cholangitis (7 of 160 vs. 0 of

155; P = 0.009) compared to the prophylaxis group. Nine patients in

the prophylaxis group (6%) and 15 patients in the control group (9%)

had remarkably increased serum amylase levels (>900 IU/L) after

ERCP, but clinical signs of acute pancreatitis with leukocytosis,

CRP reaction, and pain developed in four of nine patients in the

prophylaxis group compared to 15 of 15 patients with hyperamylasemia

in the control group (P = 0.003). In a multivariate analysis, the

lack of antibiotic prophylaxis (odds ratio 6.63, P = 0.03) and

sphincterotomy (odds ratio 5.60, P = 0.05) were independent risk

factors for the development of post-ERCP pancreatitis. We conclude

that antibiotic prophylaxis effectively decreases the risk of

pancreatitis, in addition to cholangitis after ERCP, and can thus be

routinely recommended prior to ERCP. These results suggest that

bacteria could play a role in the pathogenesis of post-ERCP

pancreatitis

Publication Types:

Clinical Trial

Randomized Controlled Trial

PMID: 11985972

___________________

As mentioned, another key factor is the experience of the

endoscopist, but there also appear to be patient-specific risk

factors such as suspected sphincter of Oddi dysfunction:

___________________

Rev Gastroenterol Disord. 2002 Fall;2(4):147-68.

Adverse outcomes of endoscopic retrograde cholangiopancreatography.

Freeman ML.

University of Minnesota Medical School, Division of

Gastroenterology, Department of Medicine, Hennepin County Medical

Center, Minneapolis, Minnesota, USA.

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved

from a diagnostic tool into a primarily therapeutic procedure for a

variety of biliary and pancreatic problems. ERCP can, however, cause

a wide range of short-term complications, including pancreatitis,

hemorrhage, and perforation. In general, complications appear to be

associated primarily with patient-related factors and the technical

skill of the endoscopist. Overall, the risk factors for

complications include suspected sphincter of Oddi dysfunction and

technique-related variables, such as difficult cannulation, precut

sphincterotomy in inexperienced hands, failure to achieve drainage,

and percutaneous transhepatic biliary access. Reviewed here are

specific risk factors for post-ERCP pancreatitis and hemorrhage. A

risk-factor assessment may be useful to help the endoscopist decide

whether or not to perform ERCP and aids in making decisions

regarding the techniques to be used. The principal strategies to

reduce complications of ERCP include improving the training and

education of endoscopists regarding risk factors; avoiding

marginally indicated ERCP and preferentially using alternative

imaging techniques; making referrals to advanced centers for complex

or high-risk cases; and, in due course, concentrating ERCP practices

among fewer endoscopists performing more ERCPs.

Publication Types:

Review

PMID: 12481167

___________________

So, you might ask what their policies are on adminstering

antibiotics, and what their post-ERCP complication rates are?

I'll be wishing you all the best for Monday.

Best regards,

Dave

(father of (21); PSC 07/03; UC 08/03)

>

> I have my first ERCP scheduled for this Monday. It's to confirm

the diagnosis. I was feeling okay about it, understanding that

pancreatitis is a possible side effect, but then I read the post

about the man who had multiple organ failure and almost died as a

result. Are there any risk factors involved that determine a

person's chance of having a complication? I know the experience of

the doctor is something to consider, but other than that? Now I'm

nervous. Any helpful information before Monday would be hugely

appreciated.

[Guest guest]

Dear ;

From what I have read, the risk of complications of ERCP is

considerably less when ERCP is used for diagnostic purposes (2%) in

comparison to therapeutic purposes (14%) [e.g. placement of a stent

or dilitation of a stricture]:

___________________

Endoscopy. 2000 Oct;32(10):779-82.

Prospective risk assessment of endoscopic retrograde cholangiography

in patients with primary sclerosing cholangitis. Dutch PSC Study

Group.

van den Hazel SJ, Wolfhagen EH, van Buuren HR, van de Meeberg PC,

Van Leeuwen DJ.

Division of Gastroenterology and Hepatology, Academic Medical Center

of the University of Amsterdam, The Netherlands.

vandenhazel@...

BACKGROUND AND STUDY AIMS: Direct endoscopic retrograde

cholangiopancreatography (ERCP) has become the standard for

establishing the diagnosis of primary sclerosing cholangitis (PSC),

while endoscopic procedures play an increasingly important

therapeutic role. However, many believe that this procedure carries

a significant risk of infection and other complications. We assessed

the incidence of complications within 1 week of ERCP in patients

with PSC. PATIENTS AND METHODS: In a multicenter study, patients who

underwent ERCP for (suspected) PSC were prospectively followed for

the occurrence of complications after the procedure. RESULTS: A

total of 106 ERCPs performed in 83 patients were evaluated.

Complications occurred on ten occasions (9%): pancreatitis (n = 3),

cholangitis (n = 2), increase of cholestasis (n = 2),

postsphincterotomy bleeding (n = 1), cystic duct perforation (n =

1), and venous thrombosis (n = 1). All complications resolved

quickly with proper therapy. Complications were more likely when

ERCP was done to evaluate specific complaints such as jaundice or

recurrent cholangitis (9/59) than after a purely diagnostic ERCP

(1/47 relative risk [RR] 7.2, 95% confidence interval [CI] 1.00 to

153). Therapeutic interventions performed during ERCP (e.g.

placement of endoprosthesis, dilation of strictures) also increased

the risk of postprocedural complications (RR 4.5, 95 % CI 0.94 to

30). CONCLUSIONS: ERCP is a safe method for establishing the

diagnosis of PSC in asymptomatic patients (2 % complication rate).

Although ERCP in symptomatic patients carries a higher risk (14%),

this can be justified by the benefits of endoscopic therapy.

Publication Types:

Multicenter Study

PMID: 11068837

___________________

Although there is evidence that antibiotics can reduce the risk of

cholangitis following ERCP, there is controversy as to whether this

reduces the risk of pancreatitis. But this study suggests that it

does reduce risk of both cholangitis and pancreatitis:

___________________

J Gastrointest Surg. 2001 Jul-Aug;5(4):339-45; discussion 345.

Post-ERCP pancreatitis: reduction by routine antibiotics.

Raty S, Sand J, Pulkkinen M, Matikainen M, Nordback I.

Department of Surgery, Tampere University Hospital, P.O. Box 2000,

FIN 33521 Tampere, Finland.

Cholangitis and pancreatitis are severe complications of endoscopic

retrograde cholangiopancreatography (ERCP). Antibiotics have been

considered important in preventing cholangitis, especially in those

with jaundice. Some have suggested that bacteria may play a role in

the induction of post-ERCP pancreatitis. It is not clear, however,

whether the incidence of post-ERCP pancreatitis could be reduced by

antibiotic prophylaxis, as is the case with septic complications. In

this prospective study, a total of 321 consecutive patients were

randomized to the following two groups: (1) a prophylaxis group (n =

161) that was given 2 g of cephtazidime intravenously 30 minutes

before ERCP, and (2) a control group (n = 160) that received no

antibiotics. All patients admitted to the hospital for ERCP who had

not taken any antibiotics during the preceding week were included.

Patients who were allergic to cephalosporins, patients with immune

deficiency or any other condition requiring antibiotic prophylaxis,

patients with clinical jaundice, and pregnant patients were

excluded. In the final analysis six patients were excluded because

of a diagnosis of bile duct obstruction but with unsuccessful

biliary drainage that required immediate antibiotic treatment. The

diagnosis of cholangitis was based on a rising fever, an increase in

the C-reactive protein (CRP) level, and increases in leukocyte count

and liver function values, which were associated with bacteremia in

some. The diagnosis of acute pancreatitis was based on clinical

findings, and increases in the serum amylase level (>900 IU/L), CRP

level, and leukocyte count with no increase in liver chemical

values. The control group had significantly more patients with post-

ERCP pancreatitis (15 of 160 in the prophylaxis group vs. 4 of 155

in the control group; P = 0.009) and cholangitis (7 of 160 vs. 0 of

155; P = 0.009) compared to the prophylaxis group. Nine patients in

the prophylaxis group (6%) and 15 patients in the control group (9%)

had remarkably increased serum amylase levels (>900 IU/L) after

ERCP, but clinical signs of acute pancreatitis with leukocytosis,

CRP reaction, and pain developed in four of nine patients in the

prophylaxis group compared to 15 of 15 patients with hyperamylasemia

in the control group (P = 0.003). In a multivariate analysis, the

lack of antibiotic prophylaxis (odds ratio 6.63, P = 0.03) and

sphincterotomy (odds ratio 5.60, P = 0.05) were independent risk

factors for the development of post-ERCP pancreatitis. We conclude

that antibiotic prophylaxis effectively decreases the risk of

pancreatitis, in addition to cholangitis after ERCP, and can thus be

routinely recommended prior to ERCP. These results suggest that

bacteria could play a role in the pathogenesis of post-ERCP

pancreatitis

Publication Types:

Clinical Trial

Randomized Controlled Trial

PMID: 11985972

___________________

As mentioned, another key factor is the experience of the

endoscopist, but there also appear to be patient-specific risk

factors such as suspected sphincter of Oddi dysfunction:

___________________

Rev Gastroenterol Disord. 2002 Fall;2(4):147-68.

Adverse outcomes of endoscopic retrograde cholangiopancreatography.

Freeman ML.

University of Minnesota Medical School, Division of

Gastroenterology, Department of Medicine, Hennepin County Medical

Center, Minneapolis, Minnesota, USA.

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved

from a diagnostic tool into a primarily therapeutic procedure for a

variety of biliary and pancreatic problems. ERCP can, however, cause

a wide range of short-term complications, including pancreatitis,

hemorrhage, and perforation. In general, complications appear to be

associated primarily with patient-related factors and the technical

skill of the endoscopist. Overall, the risk factors for

complications include suspected sphincter of Oddi dysfunction and

technique-related variables, such as difficult cannulation, precut

sphincterotomy in inexperienced hands, failure to achieve drainage,

and percutaneous transhepatic biliary access. Reviewed here are

specific risk factors for post-ERCP pancreatitis and hemorrhage. A

risk-factor assessment may be useful to help the endoscopist decide

whether or not to perform ERCP and aids in making decisions

regarding the techniques to be used. The principal strategies to

reduce complications of ERCP include improving the training and

education of endoscopists regarding risk factors; avoiding

marginally indicated ERCP and preferentially using alternative

imaging techniques; making referrals to advanced centers for complex

or high-risk cases; and, in due course, concentrating ERCP practices

among fewer endoscopists performing more ERCPs.

Publication Types:

Review

PMID: 12481167

___________________

So, you might ask what their policies are on adminstering

antibiotics, and what their post-ERCP complication rates are?

I'll be wishing you all the best for Monday.

Best regards,

Dave

(father of (21); PSC 07/03; UC 08/03)

>

> I have my first ERCP scheduled for this Monday. It's to confirm

the diagnosis. I was feeling okay about it, understanding that

pancreatitis is a possible side effect, but then I read the post

about the man who had multiple organ failure and almost died as a

result. Are there any risk factors involved that determine a

person's chance of having a complication? I know the experience of

the doctor is something to consider, but other than that? Now I'm

nervous. Any helpful information before Monday would be hugely

appreciated.

[Guest guest]

Dear ;

From what I have read, the risk of complications of ERCP is

considerably less when ERCP is used for diagnostic purposes (2%) in

comparison to therapeutic purposes (14%) [e.g. placement of a stent

or dilitation of a stricture]:

___________________

Endoscopy. 2000 Oct;32(10):779-82.

Prospective risk assessment of endoscopic retrograde cholangiography

in patients with primary sclerosing cholangitis. Dutch PSC Study

Group.

van den Hazel SJ, Wolfhagen EH, van Buuren HR, van de Meeberg PC,

Van Leeuwen DJ.

Division of Gastroenterology and Hepatology, Academic Medical Center

of the University of Amsterdam, The Netherlands.

vandenhazel@...

BACKGROUND AND STUDY AIMS: Direct endoscopic retrograde

cholangiopancreatography (ERCP) has become the standard for

establishing the diagnosis of primary sclerosing cholangitis (PSC),

while endoscopic procedures play an increasingly important

therapeutic role. However, many believe that this procedure carries

a significant risk of infection and other complications. We assessed

the incidence of complications within 1 week of ERCP in patients

with PSC. PATIENTS AND METHODS: In a multicenter study, patients who

underwent ERCP for (suspected) PSC were prospectively followed for

the occurrence of complications after the procedure. RESULTS: A

total of 106 ERCPs performed in 83 patients were evaluated.

Complications occurred on ten occasions (9%): pancreatitis (n = 3),

cholangitis (n = 2), increase of cholestasis (n = 2),

postsphincterotomy bleeding (n = 1), cystic duct perforation (n =

1), and venous thrombosis (n = 1). All complications resolved

quickly with proper therapy. Complications were more likely when

ERCP was done to evaluate specific complaints such as jaundice or

recurrent cholangitis (9/59) than after a purely diagnostic ERCP

(1/47 relative risk [RR] 7.2, 95% confidence interval [CI] 1.00 to

153). Therapeutic interventions performed during ERCP (e.g.

placement of endoprosthesis, dilation of strictures) also increased

the risk of postprocedural complications (RR 4.5, 95 % CI 0.94 to

30). CONCLUSIONS: ERCP is a safe method for establishing the

diagnosis of PSC in asymptomatic patients (2 % complication rate).

Although ERCP in symptomatic patients carries a higher risk (14%),

this can be justified by the benefits of endoscopic therapy.

Publication Types:

Multicenter Study

PMID: 11068837

___________________

Although there is evidence that antibiotics can reduce the risk of

cholangitis following ERCP, there is controversy as to whether this

reduces the risk of pancreatitis. But this study suggests that it

does reduce risk of both cholangitis and pancreatitis:

___________________

J Gastrointest Surg. 2001 Jul-Aug;5(4):339-45; discussion 345.

Post-ERCP pancreatitis: reduction by routine antibiotics.

Raty S, Sand J, Pulkkinen M, Matikainen M, Nordback I.

Department of Surgery, Tampere University Hospital, P.O. Box 2000,

FIN 33521 Tampere, Finland.

Cholangitis and pancreatitis are severe complications of endoscopic

retrograde cholangiopancreatography (ERCP). Antibiotics have been

considered important in preventing cholangitis, especially in those

with jaundice. Some have suggested that bacteria may play a role in

the induction of post-ERCP pancreatitis. It is not clear, however,

whether the incidence of post-ERCP pancreatitis could be reduced by

antibiotic prophylaxis, as is the case with septic complications. In

this prospective study, a total of 321 consecutive patients were

randomized to the following two groups: (1) a prophylaxis group (n =

161) that was given 2 g of cephtazidime intravenously 30 minutes

before ERCP, and (2) a control group (n = 160) that received no

antibiotics. All patients admitted to the hospital for ERCP who had

not taken any antibiotics during the preceding week were included.

Patients who were allergic to cephalosporins, patients with immune

deficiency or any other condition requiring antibiotic prophylaxis,

patients with clinical jaundice, and pregnant patients were

excluded. In the final analysis six patients were excluded because

of a diagnosis of bile duct obstruction but with unsuccessful

biliary drainage that required immediate antibiotic treatment. The

diagnosis of cholangitis was based on a rising fever, an increase in

the C-reactive protein (CRP) level, and increases in leukocyte count

and liver function values, which were associated with bacteremia in

some. The diagnosis of acute pancreatitis was based on clinical

findings, and increases in the serum amylase level (>900 IU/L), CRP

level, and leukocyte count with no increase in liver chemical

values. The control group had significantly more patients with post-

ERCP pancreatitis (15 of 160 in the prophylaxis group vs. 4 of 155

in the control group; P = 0.009) and cholangitis (7 of 160 vs. 0 of

155; P = 0.009) compared to the prophylaxis group. Nine patients in

the prophylaxis group (6%) and 15 patients in the control group (9%)

had remarkably increased serum amylase levels (>900 IU/L) after

ERCP, but clinical signs of acute pancreatitis with leukocytosis,

CRP reaction, and pain developed in four of nine patients in the

prophylaxis group compared to 15 of 15 patients with hyperamylasemia

in the control group (P = 0.003). In a multivariate analysis, the

lack of antibiotic prophylaxis (odds ratio 6.63, P = 0.03) and

sphincterotomy (odds ratio 5.60, P = 0.05) were independent risk

factors for the development of post-ERCP pancreatitis. We conclude

that antibiotic prophylaxis effectively decreases the risk of

pancreatitis, in addition to cholangitis after ERCP, and can thus be

routinely recommended prior to ERCP. These results suggest that

bacteria could play a role in the pathogenesis of post-ERCP

pancreatitis

Publication Types:

Clinical Trial

Randomized Controlled Trial

PMID: 11985972

___________________

As mentioned, another key factor is the experience of the

endoscopist, but there also appear to be patient-specific risk

factors such as suspected sphincter of Oddi dysfunction:

___________________

Rev Gastroenterol Disord. 2002 Fall;2(4):147-68.

Adverse outcomes of endoscopic retrograde cholangiopancreatography.

Freeman ML.

University of Minnesota Medical School, Division of

Gastroenterology, Department of Medicine, Hennepin County Medical

Center, Minneapolis, Minnesota, USA.

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved

from a diagnostic tool into a primarily therapeutic procedure for a

variety of biliary and pancreatic problems. ERCP can, however, cause

a wide range of short-term complications, including pancreatitis,

hemorrhage, and perforation. In general, complications appear to be

associated primarily with patient-related factors and the technical

skill of the endoscopist. Overall, the risk factors for

complications include suspected sphincter of Oddi dysfunction and

technique-related variables, such as difficult cannulation, precut

sphincterotomy in inexperienced hands, failure to achieve drainage,

and percutaneous transhepatic biliary access. Reviewed here are

specific risk factors for post-ERCP pancreatitis and hemorrhage. A

risk-factor assessment may be useful to help the endoscopist decide

whether or not to perform ERCP and aids in making decisions

regarding the techniques to be used. The principal strategies to

reduce complications of ERCP include improving the training and

education of endoscopists regarding risk factors; avoiding

marginally indicated ERCP and preferentially using alternative

imaging techniques; making referrals to advanced centers for complex

or high-risk cases; and, in due course, concentrating ERCP practices

among fewer endoscopists performing more ERCPs.

Publication Types:

Review

PMID: 12481167

___________________

So, you might ask what their policies are on adminstering

antibiotics, and what their post-ERCP complication rates are?

I'll be wishing you all the best for Monday.

Best regards,

Dave

(father of (21); PSC 07/03; UC 08/03)

>

> I have my first ERCP scheduled for this Monday. It's to confirm

the diagnosis. I was feeling okay about it, understanding that

pancreatitis is a possible side effect, but then I read the post

about the man who had multiple organ failure and almost died as a

result. Are there any risk factors involved that determine a

person's chance of having a complication? I know the experience of

the doctor is something to consider, but other than that? Now I'm

nervous. Any helpful information before Monday would be hugely

appreciated.

[Guest guest]

Hi

I had my fourth ERCP in a year and a half. This time to check if I

have overlap with autoimmune hepitatis, it showed I didn't.

During my first ERCP they had terrible trouble getting the tube down

my throat, I had told them I could not even watch sword swallowers

on TV without gagging - they didn't believe me!!! Next 3 they

sedated me so I was out to it all the way through. So if you have

the same gagging reflex do let them know and discuss if you can be

heavily sedated before the ERCP starts. (A friend who also has had

an ERCP had no problems swallowing and breathing, so its an

individual thing).

Apart from the last time when I had to stay overnight in hospital

due to me vomiting the iodine up and a small amount of blood, they

have gone well.

After all the ERCPS I have found that my upper abdomen is tender,

well something had been rummaging in there, and my throat was

slightly sore.

I was told if I was unfortunate to suffer pancreatitis they will

know within a few of hours - a raised temperature and high (or is

it low) blood pressure, so can take immediate action.

It may be a good idea to pack an overnight bag - include mints to

soothe your throat.

Good luck and let us know how you get on.

Best wishes from the bottom of the world in New Zealand.

In , " jglr23 " <jglr23@> wrote:

> >

> > I have my first ERCP scheduled for this Monday. It's to confirm

> the diagnosis. I was feeling okay about it, understanding that

> pancreatitis is a possible side effect,

[Guest guest]

Hi

I had my fourth ERCP in a year and a half. This time to check if I

have overlap with autoimmune hepitatis, it showed I didn't.

During my first ERCP they had terrible trouble getting the tube down

my throat, I had told them I could not even watch sword swallowers

on TV without gagging - they didn't believe me!!! Next 3 they

sedated me so I was out to it all the way through. So if you have

the same gagging reflex do let them know and discuss if you can be

heavily sedated before the ERCP starts. (A friend who also has had

an ERCP had no problems swallowing and breathing, so its an

individual thing).

Apart from the last time when I had to stay overnight in hospital

due to me vomiting the iodine up and a small amount of blood, they

have gone well.

After all the ERCPS I have found that my upper abdomen is tender,

well something had been rummaging in there, and my throat was

slightly sore.

I was told if I was unfortunate to suffer pancreatitis they will

know within a few of hours - a raised temperature and high (or is

it low) blood pressure, so can take immediate action.

It may be a good idea to pack an overnight bag - include mints to

soothe your throat.

Good luck and let us know how you get on.

Best wishes from the bottom of the world in New Zealand.

In , " jglr23 " <jglr23@> wrote:

> >

> > I have my first ERCP scheduled for this Monday. It's to confirm

> the diagnosis. I was feeling okay about it, understanding that

> pancreatitis is a possible side effect,

[Guest guest]

Hi

I had my fourth ERCP in a year and a half. This time to check if I

have overlap with autoimmune hepitatis, it showed I didn't.

During my first ERCP they had terrible trouble getting the tube down

my throat, I had told them I could not even watch sword swallowers

on TV without gagging - they didn't believe me!!! Next 3 they

sedated me so I was out to it all the way through. So if you have

the same gagging reflex do let them know and discuss if you can be

heavily sedated before the ERCP starts. (A friend who also has had

an ERCP had no problems swallowing and breathing, so its an

individual thing).

Apart from the last time when I had to stay overnight in hospital

due to me vomiting the iodine up and a small amount of blood, they

have gone well.

After all the ERCPS I have found that my upper abdomen is tender,

well something had been rummaging in there, and my throat was

slightly sore.

I was told if I was unfortunate to suffer pancreatitis they will

know within a few of hours - a raised temperature and high (or is

it low) blood pressure, so can take immediate action.

It may be a good idea to pack an overnight bag - include mints to

soothe your throat.

Good luck and let us know how you get on.

Best wishes from the bottom of the world in New Zealand.

In , " jglr23 " <jglr23@> wrote:

> >

> > I have my first ERCP scheduled for this Monday. It's to confirm

> the diagnosis. I was feeling okay about it, understanding that

> pancreatitis is a possible side effect,

[Guest guest]

My doctor explained to me that I will be completely under anesthesia and won't

wake

up until the recovery room. He is also going to give me antibiotics before and

after

the procedure to lessen the chance of infection.

Also, this is being used diagnostically, but once they're in if they see a

blockage they

will go ahead and do the stent.

Yes, it was Joe's story that made me nervous. My liver doc told my gastro guy

that I

am almost cursed when it comes to the rarities. I have Graves' disease, along

with 2%

of the population. I had severe pain after my liver biopsy that landed me in

the

hospital for three more days on heavy meds. I have PSC, when most PSCers are

men.

Etc, etc. My gastro guy told me he wanted me to come into the procedure with a

different attitude. I'm trying, but it's tough.

dx PSC June 2006

[Guest guest]

My doctor explained to me that I will be completely under anesthesia and won't

wake

up until the recovery room. He is also going to give me antibiotics before and

after

the procedure to lessen the chance of infection.

Also, this is being used diagnostically, but once they're in if they see a

blockage they

will go ahead and do the stent.

Yes, it was Joe's story that made me nervous. My liver doc told my gastro guy

that I

am almost cursed when it comes to the rarities. I have Graves' disease, along

with 2%

of the population. I had severe pain after my liver biopsy that landed me in

the

hospital for three more days on heavy meds. I have PSC, when most PSCers are

men.

Etc, etc. My gastro guy told me he wanted me to come into the procedure with a

different attitude. I'm trying, but it's tough.

dx PSC June 2006

[Guest guest]

My doctor explained to me that I will be completely under anesthesia and won't

wake

up until the recovery room. He is also going to give me antibiotics before and

after

the procedure to lessen the chance of infection.

Also, this is being used diagnostically, but once they're in if they see a

blockage they

will go ahead and do the stent.

Yes, it was Joe's story that made me nervous. My liver doc told my gastro guy

that I

am almost cursed when it comes to the rarities. I have Graves' disease, along

with 2%

of the population. I had severe pain after my liver biopsy that landed me in

the

hospital for three more days on heavy meds. I have PSC, when most PSCers are

men.

Etc, etc. My gastro guy told me he wanted me to come into the procedure with a

different attitude. I'm trying, but it's tough.

dx PSC June 2006

[Guest guest]

-

My son has has 14 ERCPs and only had problems with the first one with

pancreatitis, but he had a HUGE stone obstructing his common bile duct

then and that was more than likely the reason why he got pancreatitis

that time. He was very sick with the pancreatitis but also has other

major medical problems (severe short bowel) he recovered well with

antibiotics and even though he was miserable for a few days he didn't

have any long term consequences. You are right that the experience of

the dr doing the procedure is important and in my opinion it is

important to give propholactic (sp?) antibiotics too, but that is not

an absolute either. There are reports that MRCP can be as effective in

confirming diagnosis as ERCP, but obviously no therapeutic benefit (if

needed) is possible with MRCP.

Good luck

Lori

lucky mom blessed with wonderfully wild triplets including one with

short bowel syndrome, PSC, eosinophilic gastritis, FTT, portal

hypertension and g tube feeds

www.caringbridge.org/visit/braden

>

> I have my first ERCP scheduled for this Monday. It's to confirm the

diagnosis. I was

> feeling okay about it, understanding that pancreatitis is a possible

side effect, but

> then I read the post about the man who had multiple organ failure

and almost died as

> a result. Are there any risk factors involved that determine a

person's chance of

> having a complication? I know the experience of the doctor is

something to consider,

> but other than that? Now I'm nervous.

>

> Any helpful information before Monday would be hugely appreciated.

>

> Thanks.

>

>

> PSC June 2006

>

[Guest guest]

-

My son has has 14 ERCPs and only had problems with the first one with

pancreatitis, but he had a HUGE stone obstructing his common bile duct

then and that was more than likely the reason why he got pancreatitis

that time. He was very sick with the pancreatitis but also has other

major medical problems (severe short bowel) he recovered well with

antibiotics and even though he was miserable for a few days he didn't

have any long term consequences. You are right that the experience of

the dr doing the procedure is important and in my opinion it is

important to give propholactic (sp?) antibiotics too, but that is not

an absolute either. There are reports that MRCP can be as effective in

confirming diagnosis as ERCP, but obviously no therapeutic benefit (if

needed) is possible with MRCP.

Good luck

Lori

lucky mom blessed with wonderfully wild triplets including one with

short bowel syndrome, PSC, eosinophilic gastritis, FTT, portal

hypertension and g tube feeds

www.caringbridge.org/visit/braden

>

> I have my first ERCP scheduled for this Monday. It's to confirm the

diagnosis. I was

> feeling okay about it, understanding that pancreatitis is a possible

side effect, but

> then I read the post about the man who had multiple organ failure

and almost died as

> a result. Are there any risk factors involved that determine a

person's chance of

> having a complication? I know the experience of the doctor is

something to consider,

> but other than that? Now I'm nervous.

>

> Any helpful information before Monday would be hugely appreciated.

>

> Thanks.

>

>

> PSC June 2006

>

[Guest guest]

-

My son has has 14 ERCPs and only had problems with the first one with

pancreatitis, but he had a HUGE stone obstructing his common bile duct

then and that was more than likely the reason why he got pancreatitis

that time. He was very sick with the pancreatitis but also has other

major medical problems (severe short bowel) he recovered well with

antibiotics and even though he was miserable for a few days he didn't

have any long term consequences. You are right that the experience of

the dr doing the procedure is important and in my opinion it is

important to give propholactic (sp?) antibiotics too, but that is not

an absolute either. There are reports that MRCP can be as effective in

confirming diagnosis as ERCP, but obviously no therapeutic benefit (if

needed) is possible with MRCP.

Good luck

Lori

lucky mom blessed with wonderfully wild triplets including one with

short bowel syndrome, PSC, eosinophilic gastritis, FTT, portal

hypertension and g tube feeds

www.caringbridge.org/visit/braden

>

> I have my first ERCP scheduled for this Monday. It's to confirm the

diagnosis. I was

> feeling okay about it, understanding that pancreatitis is a possible

side effect, but

> then I read the post about the man who had multiple organ failure

and almost died as

> a result. Are there any risk factors involved that determine a

person's chance of

> having a complication? I know the experience of the doctor is

something to consider,

> but other than that? Now I'm nervous.

>

> Any helpful information before Monday would be hugely appreciated.

>

> Thanks.

>

>

> PSC June 2006

>

[Guest guest]

y son has had many ERCPs since he was 11. Once he did get pancreatitis but did well the rest of the time. Like any other procedure it is important to weigh the risks and benefits of having it done. And as other people have said, make sure your dr has done many. Good luck. Martijglr23 wrote: I have my first ERCP scheduled for this Monday. It's to confirm the diagnosis. I was feeling okay about it, understanding that pancreatitis is a possible side effect, but then I read the post about the man who had multiple organ failure and almost died as a result. Are there any risk factors involved that determine a person's chance of having a complication? I know the experience of the doctor is something to consider, but other than that? Now I'm nervous. Any

helpful information before Monday would be hugely appreciated.Thanks.PSC June 2006

[Guest guest]

y son has had many ERCPs since he was 11. Once he did get pancreatitis but did well the rest of the time. Like any other procedure it is important to weigh the risks and benefits of having it done. And as other people have said, make sure your dr has done many. Good luck. Martijglr23 wrote: I have my first ERCP scheduled for this Monday. It's to confirm the diagnosis. I was feeling okay about it, understanding that pancreatitis is a possible side effect, but then I read the post about the man who had multiple organ failure and almost died as a result. Are there any risk factors involved that determine a person's chance of having a complication? I know the experience of the doctor is something to consider, but other than that? Now I'm nervous. Any

helpful information before Monday would be hugely appreciated.Thanks.PSC June 2006

[Guest guest]

Thanks for all of your input everyone. Let's hope this thing happens without a

hitch.

Ugh.

I had an MRCP done in 2004 but they found nothing interesting on it. These new

docs

have checked it out too and feel that ERCP is the way to go. I guess I agree.

I'll check in after it's over. Hopefully I'll feel up to that tomorrow night.