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1

Risk factors of pancreatitis after endoscopic sphincterotomy. Review of literature and practical remarks based on approximately 10,000 ERCPs

100%

Jamry A.

Polish Journal of Surgery

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2017

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tom 89(5)

29-33

EN

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.

2

ERCP with Removal of Concrements Through Choledocho-Duodenal Fistula - A Case Report

100%

Sebastian M. , Wierzbicki J. , Rudnicki J.

Polish Journal of Surgery

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2010

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tom 82

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nr 5

289-291

EN

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.

3

Quality assurance of sphincterotomy: A prospective single-centre survey

75%

Sulz M. , Sagmeister M. , Schelling M. , Binek J. , Borovicka J. , Ulmer H. , Meyenberger C.

Open Medicine

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2012

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tom 7

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nr 1

9-19

EN

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.

4

Geometric transformations in the shape analysis of selected biomedical structures

63%

Ogiela M.

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1998

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tom Vol. 4, no 3-4

27-36

EN

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.