Daley, A.C.; Finch, P.J.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA72
Academic Journal
Introduction: Difficult cannulation of the bile duct in jaundiced patients can be aided by precut or needle knife sphincterotomy. We have recently used snare ampullectomy instead, because of dissatisfaction with these techniques, and present an audit of our results. Aim: To audit outcome measures in ERCP patients and assess the safety and efficacy of snare ampullectomy [SA]. Methods: Records of all patients undergoing ERCP in this hospital over 6 years (including 3 years of SA were reviewed to assess indications, procedures, and outcome including complications (abdominal pain, pancreatitis bleeding, perforation, aelayed discharge, readmission within 7 days) and 30 day mortality. Resu ts: 724 patients (61% female median age 67 underwent ERCP by a single endoscopist. Indications included biliary colic (49%), jaundice/abnormal LFTs (38%), and prior pancreatitis with gall stones (11%). Overall success in cannulating the intended duct was 88%. When precut was employed, the success rate was 58%, but with SA, this rose to 88%. The rate of any complication for all ERCPs was 6%, and of pancreatitis was 2%. There were no perforations and 7 bleeds, none requiring transfusion. 30 day mortality was 5% with a median age of 79 years. 43 patients underwent SA including 3 for ampullary neoplasms. In a case with a polya gastrectomy, a stent was inserted to guide the snare, but was cut through by the heating. A stepwise logistic regression model was used to assess the contribution of ES (n = 256), precut (n = 19), and SA to all complications, and revealed significant effects for precut (p < 0.01 odds ratio [OR] 6.2, 95% CI 2.2 to 17.2), SA (p = 0.02 OR 2.9, 95% CI 1.2 to 6.8) and ES (p < 0.01, OR 2.9, 95% CI 1.5 to 5.7). Significant effects in pancreatitis were found for precut (p < 0.01, OR 14.9, 95% CI 4.0 to 56.1), and SA (p = 0.03, OR 4.4, 95% CI 1.2 to 16.3) but not for ES. No significant effect in 30 day mortality was found for precut (p = 0.98), SA (p = 0.24) or ES (p = 0...


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