Nowa wersja platformy, zawierająca wyłącznie zasoby pełnotekstowe, jest już dostępna.
Przejdź na
Preferencje help
Widoczny [Schowaj] Abstrakt
Liczba wyników

Znaleziono wyników: 6

Liczba wyników na stronie
first rewind previous Strona / 1 next fast forward last
Wyniki wyszukiwania
w słowach kluczowych:  ERCP
help Sortuj według:

help Ogranicz wyniki do:
first rewind previous Strona / 1 next fast forward last
Post-endoscopic pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Depending on the presence of risk factors, PEP can occur in 4,1% to about 43% of patients. According to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines, only three to patient-associated risk factors have been identified: suspected sphincter of Oddi dysfunction (SOD) (OR 4.09), female gender (OR 2.23), and previous pancreatitis (OR 2.46). Another three procedure-associated factors include cannulation attempt duration > 10 minutes (OR 1.76), more than one pancreatic guidewire passage (OR 2.77, CI: 1.79 – 4.30), and pancreatic injection (OR 2.2, CI: 1.60 – 3.01). Importantly, analyses of cumulative risk due to coexistence of several factors emphasize the importance of female sex, difficult cannulation, CBD diameter <5 mm, young age, and many other factors. Unfortunately, studies performed to date have included only small numbers of patients with several co-existing risk factors. Therefore, further analysis of other risk factors and the cumulative risk related to their co-occurrence is necessary. Based on current evidence, special care must be given to patients with several risk factors. Also, care should be given to proper qualification of patients, use of guidewires, early pre-cut incision, protective Wirsung’s duct stenting, and rectal NSAID administration.
Spontaneous choledocho-duodenal fistula is mostly associated with choledocholithiasis. Symptoms of fistula are non-specific therefore its diagnosis is usually made incidentally during diagnosis of other bile duct diseases. ERCP is a method which plays the basic role in diagnosis and treatment of fistula between common bile duct and duodenum.
Content available remote Quality assurance of sphincterotomy: A prospective single-centre survey
Quality assurance becomes an increasingly important part of clinical medicine and of the field of endoscopy. Endoscopic sphincterotomy is associated with a fairly high complication rate. We aimed to assess our quality of sphincterotomy for benchmarking by using a prospective electronic database registry, and to identify potential risk factors for post-interventional complications. Over 2 years, 471 sphincterotomies were performed in a single tertiary referral centre. Patient- and procedure-related variables were prospectively recorded with the support of a multi-centre international sphincterotomy registry. Multivariate analysis was performed. The overall post-interventional complication rate was 9.3%. Pancreatitis happened in 5.5%, bleeding in 2.1%, perforation in 1.3%, and cholangitis in 0.4%. In the multivariate analysis following variables remained highly significant and predictive for complications: ‘papilla only in lateral view’ (p=0.001), antiplatelet therapy (p=0.024), and opacification with contrast up to the pancreatic tail (p=0.001). The primary success rate of sphincterotomy was 95.1%. The rate of post-interventional pancreatitis did not differ significantly regardless of the presence of prophylactic pancreatic stent (p=0.56). The outcome of sphincterotomy in our centre matches with literature data. The extent of pancreatic duct opacification has an influence on the pancreatitis rate. Prevention of pancreatitis by inserting pancreatic stents is not confirmed.
The utilization of MST strandard for description of gentroenterological diseases is presented. Three representative referring to colonoscopy, gastroscopy and ERCP are considered. The need of electronic atlas illustrating gantroenterological representative cases is also suggested.
Content available remote Geometric transformations in the shape analysis of selected biomedical structures
The article presents an algorithm of the transformation straightening outer contours of objects, allowing to transform bilogical structures of interest, visible in medical images, from two-dimensional space of the image into two-dimensional graph, representing contours of the straightened object with its possible outer morphological changes, indicating the progress of pathological processes. The developed method is based on a sequence of geometric transformations of the analyzed objects in the image, and its operation was described in detail and illustrated by examples of transformation of main pancreatic ducts, appearing in X-ray images acquired by ERCP, as well as by graphs showing outer morphology of blood vessels in the fundus of the eye and morphology of renal sinuses from kidneys roengenograms. The proposed method is universal, and due to the fact that the transformation preserves and exposes pathologic morphological changes, such as abnormal lateral branches, local dilatations or projections it can also be used in the recognition and analysis of other structure images acquired by various techniques of computer tomography, e.g. celebral vessels, bile ducts, coronary vessels of fragments of gastroin-testinal tract. The graphs of the structures of interest obtained as a result of the transformation straightening outer contours of objects are a starting point for the recognition of morphological changes, important for diagnosis, using syntactic methods of pattern recognition.
Background One of the numerous sub-areas of interventional radiology is the use of X-rays in gastroenterology. X-ray fluoroscopy is applied in therapeutic procedures, including endoscopic retrograde cholangiopancreatography (ERCP) that is frequently performed. The ERCP procedure is aimed at imaging the pancreatic duct and biliary tracts. Material and Methods In this paper radiation risk to the gastrenterologist performing ERCP procedures was investigated. The procedures were performed by a single gastroenterologist in the ERCP Laboratory, University Clinical Hospital Military Memorial Medical Academy – Central Veterans’ Hospital in Łódź, Poland. The study comprised 2 series of measurements, one taken during the procedures with continuous fluoroscopy mode, the other during procedures with fluoroscopy in pulsed mode at a frequency of 3 pulses/s. Exposure parameters, anatomical data of patient and dose equivalents for the eyes, skin of the hand and the effective dose for whole body of the gastroenterologist were recorded during each procedure. Results The collected data cover 70 ERCP procedures – 40 procedures were controlled by continuous fluoroscopy and 30 by pulsed fluoroscopy. The results reveal that pulsed fluoroscopy makes it possible to reduce doses received by the gastroeneterologist from 45% to 60% compared to continuous fluoroscopy. Conclusions Endoscopic retrograde cholangiopancreatography procedures can cause radiation risk to the gastroenterologist performing them. The use of continuous fluoroscopy can result in achieving an equivalent dose to eye lens nearly 20 mSv per year, i.e., the decreased annual limit recommended by the International Commission on Radiological Protection (ICRP). Med Pr 2017;68(6):735–741
Wstęp Wykorzystanie promieniowania rentgenowskiego (rtg.) w gastroenterologii stanowi jeden z licznych podobszarów radiologii interwencyjnej. W gastroenterologii fluoroskopia rtg. jest używana w procedurach terapeutycznych, z których częsta jest endoskopowa cholangiopankreatografia wsteczna (ECPW). Procedura ECPW pokazuje radiologiczny obraz dróg żółciowych i przewodu trzustkowego. Materiał i metody W ramach niniejszej pracy przeprowadzono ocenę narażenia na promieniowanie rtg. gastroenterologa wykonującego zabiegi ECPW pod kontrolą fluoroskopii. Badania przeprowadzono w Pracowni ECPW Uniwersyteckiego Szpitala Klinicznego im. Wojskowej Akademii Medycznej – Centralnego Szpitala Weteranów w Łodzi, gdzie gastroenterolog wykonuje je samodzielnie. Realizując cel pracy, wykonano 2 serie pomiarów – pierwsza składała się z zabiegów wykonanych w trybie fluoroskopii ciągłej, druga – z zabiegów, które wykonano w trybie fluoroskopii impulsowej (o częstotliwości 3 pulsy/s). Podczas każdej procedury rejestrowano parametry ekspozycji, dane anatomiczne pacjenta, a także otrzymywane przez gastroenterologa równoważniki dawek dla soczewek oczu i skóry dłoni oraz dawkę efektywną dla całego ciała. Wyniki Zebrano dane dotyczące ogółem 70 zabiegów ECPW, w tym 40 zabiegów wykonanych w trybie fluoroskopii ciągłej i 30 – w trybie fluoroskopii impulsowej. Na podstawie uzyskanych wyników stwierdzono, że gastroenterolog wykonujący procedury ECPW w trybie fluoroskopii impulsowej otrzymuje dawki promieniowania niższe o 45–60% niż podczas pracy w trybie fluoroskopii ciągłej. Wnioski Procedury ECPW mogą być źródłem narażenia na promieniowanie rtg. dla wykonującego je gastroenterologa. Używanie trybu fluoroskopii ciągłej może pozwolić na osiągnięcie obniżonej wartości rocznego limitu dawki równoważnej dla soczewek oczu (tj. 20 mSv), rekomendowanej przez Międzynarodową Komisję Ochrony Radiologicznej (International Commission on Radiological Protection – ICRP). Med. Pr. 2017;68(6):735–741
first rewind previous Strona / 1 next fast forward last
JavaScript jest wyłączony w Twojej przeglądarce internetowej. Włącz go, a następnie odśwież stronę, aby móc w pełni z niej korzystać.