ERCP——外科实习读书报告

Complications Related To Endoscopic Retrograde Cholangiopancreatography: A Comprehensive Clinical Review,Abstract,over 500,000 ERCP yearly in USindications, contraindications, potential complications, benefits, and alternatives to ERCP.,contraindications,Absolute contraindications pharyngeal or esophageal obstructionactive coagulopathy anaphylactic reaction to contrast dye Relative contraindicationsportal hypertension with esophageal and/or gastric varicesacute pancreatitis (except gallstone pancreatitis) recent myocardial infarctionsevere cardiopulmonary disease,Peri-procedural antibiotic,high-risk for developing infective endocarditis ，artificial prosthetic implant infections Antibiotics should be continued for 48-72 hours,Complications,pancreatitis cholangitisduodenal hemorrhagestent migrationduodenal perforation ,Complications,Short-term complications( 3 days)mainly infections associated with indwelling stents and inflammatory changes secondary to ductal manipulation.,pancreatitis,1% to 6%(a) new-onset or worsening abdominal pain (b) elevation of serum amylase three times above normal at 24 hours post procedure(c) requirement for 2 days of pancreatitisrelated hospitalization,risk factors,previous post-ERCP pancreatitis suspected sphincter of Oddi dysfunction, female genderabsence of chronic pancreatitisballoon dilatation of the biliary sphincterdifficult cannulationpancreatic sphincterotomy1 injections of contrast into the pancreatic ductage 60 years,three risk factors for post-ERCP pancreatitis were present: age 1 injection of contrast. Pancreatitis resolved following five days of hospitalization.,one study, stent placement enhanced ductal drainage past the hypertensive sphincter and reduced the incidence of pancreatitis from 26% to 7%.pharmacologic interventions:Neither somatostatin, nor its analogue, octreotide, appeared to reduce the rate of post-ERCP pancreatitis,Hemorrhagic complications,1-2%(A) Positioning of the ERCP equipment for a sphincterotomy; (B) Post-sphincterotomy oozing that evolved into (C) continued bleeding requiring epinephrine injection for control. (D) Self-limited post-sphincterotomy bleeding.,Perforations,0.3% to 0.6%(a) guidewire-related perforations (b) peri-ampullary perforations during sphincterotomy; (c) perforations that are remote from the papilla,Perforations,Retroperitoneal duodenal perforation following ERCP and sphincterotomy. The patient underwent successful nonoperative therapy: bowel rest, nasogastric suctioning, and broad-spectrum antibiotics,Cholangitis,1-3%Adequate biliary drainage stents and nasobiliary tubes,Cholecystitis,0.5% cholecystectomy,Complications of sphincterotomy,pancreatitis (5.2-5.4%) hemorrhage (2.0%),stent placement/manipulation,stent obstruction (often leading to infection/cholangitis)stent migrationrecurrent ductal stenosis post-stent removalPancreatitisbleeding,ERCP in pregnancy,Although symptomatic gallstone disease is common in pregnant women (incidence 10%), choledocholithiasis requiring intervention during pregnancy is rare (incidence 1%) postpartum period or until second trimester, relatively safer.,Conclusions,Operator experience, avoidance of unnecessary procedures, adequa