PMID- 28791317
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220310
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 5
IP  - 8
DP  - 2017 Aug
TI  - New approach to decrease post-ERCP adverse events in patients with primary 
      sclerosing cholangitis.
PG  - E710-E717
LID - 10.1055/s-0043-102398 [doi]
AB  - BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) 
      is often performed in patients with primary sclerosing cholangitis (PSC). Our aim 
      was to validate a treatment approach with the objective of decreasing ERCP 
      related adverse events (AEs). PATIENTS AND METHODS: All patients who had 
      undergone ERCP for PSC during the period from 2002 - 2012 were identified (group 
      I). This group had traditional ERCP (no bile aspiration prior to contrast 
      injection with balloon dilation and stent placement for treatment of dominant 
      strictures). To decrease ERCP-related AEs, we changed the ERCP approach in which 
      bile aspiration was performed prior to contrast injection and balloon dilation 
      alone was performed for treatment of dominant strictures. This was tested 
      prospectively in all patients undergoing ERCP for PSC from 2012 - 2014 (group 
      II). RESULTS: The risk of overall AEs and cholangitis was relatively less in 
      group II compared with group I [(2.1 % vs. 10.3 %; P  = .38) and (0 % vs. 4.4 %; 
      P  = .68)]. On bivariate analysis, change in ERCP approach was associated with 
      decreased risk of post-procedure cholangitis (0 % vs. 10.2 %, P =  .03) and 
      overall AE (0 % vs. 18.6 %, P =  .03). There were no AEs in 22/46 patients in 
      group II who had bile aspiration with balloon dilation. On multivariate analysis, 
      only biliary stent placement was associated with increased risk of AEs (OR 4.10 
      (1.32 - 12.71); P  = .02) and cholangitis (OR 5.43, 1.38 - 21.38; P  = .02) 
      respectively. CONCLUSION: Biliary aspiration and avoidance of stenting approach 
      after dilation of strictures during ERCP in PSC patients appears to be associated 
      with decreased risk of cholangitis and overall AEs. Future prospective randomized 
      controlled trials are needed to validate our observation.
FAU - Navaneethan, Udayakumar
AU  - Navaneethan U
AD  - Center for Interventional Endoscopy, Orlando, Florida, United States.
AD  - Department of Gastroenterology and Hepatology, Digestive Disease Institute, 
      Cleveland Clinic, Cleveland, Ohio, United States.
FAU - Lourdusamy, Dennisdhilak
AU  - Lourdusamy D
AD  - Department of Gastroenterology and Hepatology, Digestive Disease Institute, 
      Cleveland Clinic, Cleveland, Ohio, United States.
FAU - Gutierrez, Norma G
AU  - Gutierrez NG
AD  - Department of Gastroenterology and Hepatology, Digestive Disease Institute, 
      Cleveland Clinic, Cleveland, Ohio, United States.
FAU - Zhu, Xiang
AU  - Zhu X
AD  - Center for Interventional Endoscopy, Orlando, Florida, United States.
FAU - Vargo, John J
AU  - Vargo JJ
AD  - Department of Gastroenterology and Hepatology, Digestive Disease Institute, 
      Cleveland Clinic, Cleveland, Ohio, United States.
FAU - Parsi, Mansour A
AU  - Parsi MA
AD  - Department of Gastroenterology and Hepatology, Digestive Disease Institute, 
      Cleveland Clinic, Cleveland, Ohio, United States.
LA  - eng
PT  - Journal Article
DEP - 20170807
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC5546902
COIS- Competing interests Dr. Navaneethan is a consultant for AbbVie, Janssen and 
      Takeda. Dr. Parsi is a consultant for Boston Scientific. Dr. Vargo is a 
      consultant for Olympus.
EDAT- 2017/08/10 06:00
MHDA- 2017/08/10 06:01
PMCR- 2017/08/01
CRDT- 2017/08/10 06:00
PHST- 2016/04/27 00:00 [received]
PHST- 2016/12/30 00:00 [accepted]
PHST- 2017/08/10 06:00 [entrez]
PHST- 2017/08/10 06:00 [pubmed]
PHST- 2017/08/10 06:01 [medline]
PHST- 2017/08/01 00:00 [pmc-release]
AID - 10.1055/s-0043-102398 [doi]
PST - ppublish
SO  - Endosc Int Open. 2017 Aug;5(8):E710-E717. doi: 10.1055/s-0043-102398. Epub 2017 
      Aug 7.