ABSTRACT
INTRODUCTION: Endoscopic sphincterotomy (ES) is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated complications and mortality of endoscopic retrograde cholangiopancreatography (ERCP). 2. PATIENTS AND METHODS: Between june 6, 1998 and june 6, 1999 553 ERCP were performed in our centers. Inclusion criteria for protocol were: ERCP indication, complete follow-up and informed consent. We prospectively studied complications of ECRP in consecutive patients treated at 2 institutions (San Martin Hospital, La Plata, Argentina and Hadassah University Hospital, Jerusalem, Israel). The follow-up was done during 365 days with a clinical examination, laboratory test and ultrasonography to determine the possible complications. 3. RESULTS: Of 553 ERCP, 43 had a complications; including pancreatitis in 16 cases, cholangitis in 12, hemorrhage in 5, perforation in 3 and miscellaneous in 7. 3-1) ES frequency: 241 patients (pts). 3-2) Follow-up: 365 days in 504 pts. 3-3) Sex and age: women 274 pts, men 230 pts. Age range 1 month to 90 year old. 3-4) Final diagnoses: choledocholitiasis (38.8%), strictures (18%), pancreatic cancer (4.3%), ampullary cancer (2.3%) and normal ERCP (24.4%). 4. CONCLUSIONS: The rate of complications after ES can vary in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique. Our percentage of complications (7.53%) coincide with consulted studies. Today, diagnostic ERCP has been challenged by magnetic resonance cholangiography (MRC). MRC provides images of the billary and pancreatic ducts that are nearly equal to those of ERCP without the procedural risk associated.
Subject(s)
Middle Aged , Humans , Male , Female , Infant , Child, Preschool , Child , Adult , Adolescent , Cholangiopancreatography, Endoscopic Retrograde , Aged, 80 and over , Follow-Up Studies , Prospective Studies , Risk FactorsABSTRACT
INTRODUCTION AND AIM: Endoscopic polipectomy and its further histopathologic study are current gold standard in diagnosis of colorectal polyps is. It was proposed that colonoscopy with high resolution videoendoscopes with or without magnification combined with indigo carmin dye (ICD) could distinguish between adenomatous and nonadenomatous polyps according to their pit pattern. The aim of this study was to establish sensitivity and specificity of chromoendoscopy with ICD using conventional videoendoscopes and fiber-endoscopes with videocamera, to make a differential diagnosis of polyp histology and their possible role in colon cancer screening. PATIENTS AND METHODS: Step 1: Using previous trial data, the first 20 polyps < = 1 cm was retrospectively correlated with their known histology to determine the pit pattern of each histologic type; this data was used in the step 2 patients. Step 2: 46 patients with colorectal polyps were enrolled in this prospective study. Polyps were sprayed with 0.4% ICD, after that the polyps were sorted into adenomatous or non, they were all removed and submitted for histophatologic evaluation. STATISTICAL ANALYSIS: The chi square method was used. RESULTS: 19 patients were evaluated with videoendoscopes (group 1) and 27 with fiberendoscopes (group 2); in seven cases the pattern of the polyps could not be identified and the patients were excluded. Group 1: coincidence prediction/histology 94.7% (p < 0.0001), sensitivity 100% and especificity 88%. Group 2: coincidence prediction/histology 65.8% (p < 0.05), sensitivity 86% and especificity 60%. CONCLUSIONS: Adenomatous and non-adenomatous polyps can be distinguished by chromoendoscopy with high sensitivity and specificity. However, because fiberendoscopy could ot be identify pit pattern in 15.2% and has a low negative predictive value we do not recommend to use it. Nevertheless, the results obtained with ideo-endoscopes involve potential usefulness in colon cancer screening and possible decrease in their risks and costs.