Intubation;Difficult
Conditions
Keywords
ERCP, periampullary diverticula, difficulty cannulation, complication, biliary disorder
Brief summary
To study the influence of different types of periampullary diverticulum(PAD) on ERCP difficult cannulation and postoperative complications.
Detailed description
Periampullary diverticula (PAD) are extraluminal out-pouching of the duodenum mucosa often occurring within a radius of 2-3 cm from the ampulla of Vater or hepatopancreatic ampulla. More PAD cases have been identified over recent years, and it's generally believed that up to 27% of elderly cases may have PAD. Several classifications of PAD have been proposed, and the most commonly used distinguishes intraluminal and extraluminal diverticula. Recent studies suggest that PAD is a risk factor for the development of bile duct diseases, and it may cause endoscopic retrograde cholangiopancreatography (ERCP) procedures to fail, but some other studies have come to the opposite conclusion. During ERCP procedures, the investigators found that different types of PAD seem to have some differences in the size of the diverticulum, difficulty in intubation, and complications. The investigators plan to this retrospectively study collecting 4 years of cases to evaluate the clinical features of different types of PAD in terms of difficult cannulation and complications.
Interventions
OTHERRoutine ERCP
Sponsors
Hepatopancreatobiliary Surgery Institute of Gansu Province
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* 18-90 years old ERCP patients * With native papilla
Exclusion criteria
* Unwillingness or inability to consent for the study * Coagulation dysfunction (INR\> 1.5) and low peripheral blood platelet count (\<50×10\^9 / L) or using anti-coagulation drugs * Previous ERCP * Prior surgery of Bismuth Ⅱ, Roux-en-Y and Cholangiojejunostomy * Preoperative coexistent diseases: acute pancreatitis, GI tract hemorrhage or perforation, severe liver disease(such as decompensated liver cirrhosis, liver failure and so on), septic shock * Biliary-duodenal fistula confirmed during ERCP * Pregnant women or breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difficulty cannulation | 1 month | The inability to achieve selective biliary cannulation by the standard ERCP technique within 10 minutes or 5 attempts or failure of access to the major papilla. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diameter of common bile duct | 1 month | Maximum diameter of common bile duct observed during ERCP |
| X-ray exposure time | 1 month | The total radiography time during ERCP |
| Pancreatic duct insertion times | 1 month | Times of any accessories goes into the pancreatic duct, no matter how depth |
| Post-ERCP pancreatitis | 1 month | Upper abdominal pain with serum amylase elevation more than 3 times after the procedure |
| Diameter of diverticulum | 1 month | Maximum diameter of PAD observed during ERCP |
| Acute cholangitis | 1 month | Intermittent chills and fever after ERCP |
| Operation time | 1 month | From successful biliary intubation to end of operation |
| Secondary treatment rate | 1 month | Some patients require secondary treatment, including management of primary diseases and complications |
| Hospital stay | 1 month | Length of stay in hospital |
| Perforation | 1 month | CT scan shows retroperitoneal space fluid or gas |
Countries
China
Outcome results
None listed