ABSTRACT
Objective: To evaluate spectrum, efficacy and safety of Endoscopic retrogradecholangiopancreatography (ERCP) in pediatric population. Methods: Retrospective caserecord review of pediatric patients (age ≤15 y) undergoing ERCP between January 2011 toJune 2015 at a tertiary care referral hospital in New Delhi, India. The Indications for ERCP,cannulation success rate, procedure success rate and complications were recorded.Results: The mean (SD) age of the participants were 11.5 (3) years. 164 ERCP procedureswere done in 126 patients (67 males). All procedures were done under conscious sedation.The common indications for ERCP were choledocholithiasis (50, 30.5%), chronic calcificpancreatitis (38,23.2%), main pancreatic duct injury with leak (21,12.8%), and bile leak(12,7.3%). The cannulation success rate was 90.4% (114 out of 126), while proceduralsuccess rate was 86% (141 out of 164). Overall 8 complications were encountered; all weresuccessfully managed conservatively. Conclusions: ERCP in children can be successfullyperformed at centers with such expertise.
ABSTRACT
BACKGROUND: Though antroduodenal manometry (ADM) is an important research tool, experience on its clinical utility is scanty. METHODS: All ADM performed as a clinical service, using an 8-channel water perfusion system were retrospectively analyzed. Impact on clinical management was classified as: (1) new diagnosis made, (2) change in management (new drug, decision regarding surgical treatment), (3) further special investigation done, (4) referral to another specialty. RESULTS: ADM was successful in 32/33 (97%) patients (age 30 years [range 8-71]); 6 patients were < 12 years old. Clinical impression before ADM was: chronic intestinal pseudo-obstruction (CIPO) in 16 (50%), suspected gastroparesis in 11 (34.3%), dyspepsia in 5 (15.6%). Consequent to ADM in patients with CIPO, a new diagnosis was made in two (intestinal neuronal dysplasia and celiac disease), new drugs were started in five, surgery was performed in three and specific referral was sought in three. ADM confirmed gastroparesis in 9 of 11 patients. A new diagnosis was made in three patients, new drugs were started in three, and three were referred. In five dyspeptic patients, ADM was normal and no therapy was suggested. Overall, eleven patients with CIPO and four with gastroparesis benefited after ADM. CONCLUSION: ADM was found useful in CIPO and gastroparesis, helped in decision making regarding surgery; however in nonspecific indications its utility was limited.
Subject(s)
Adolescent , Adult , Aged , Child , Duodenum/physiology , Female , Gastroparesis/diagnosis , Humans , Intestinal Pseudo-Obstruction/diagnosis , Male , Middle Aged , Pyloric Antrum/physiologyABSTRACT
BACKGROUND: Patients with celiac disease who present with symptoms of gastrointestinal hypomotility have abnormal antroduodenal manometry. There are no data on antroduodenal manometry in malabsorption syndrome (MAS) due to causes other than celiac disease. METHODS: Fasting, post-prandial and post-octreotide antroduodenal motility parameters were compared in 18 untreated patients with MAS presenting with chronic diarrhea (tropical sprue 10, small bowel bacterial overgrowth 3, celiac disease 2, common variable immunodeficiency 1, AIDS with isosporidiasis and bacterial overgrowth 1, giardiasis 1) and 8 healthy subjects. RESULTS: Number of patients with MAS and controls having spontaneous migratory motor complexes (MMC) during fasting was comparable (11/18 vs 7/8; p=ns). Fasting contraction amplitude was weaker in MAS than in controls in the gastric antrum (median 42 [range 17-90] vs 80 [31-120] mmHg; p=0.001), proximal duodenum (50 [18-125] vs 72 [48-107]; p=0.013) and distal duodenum (45 [20-81] vs 76 [51-98]; p=0.001). In the fed state too, contraction amplitudes were weaker in patients with MAS in the antrum (32 [15-110] vs 76 [61-103] mmHg, p=0.002), proximal duodenum (57 [20-177] vs 73 [56-113]; p=0.07) and distal duodenum (45 [24-87] vs 75 [66-97]; p<0.0001). Patients with MAS had lower fasting and post-prandial antral and duodenal motility indices than healthy subjects. Intravenous octreotide induced MMC in all patients and controls. CONCLUSIONS: MAS due to various causes is associated with antroduodenal hypomotility typical of myopathic disorders.
Subject(s)
Adult , Duodenum/physiopathology , Female , Gastrointestinal Motility/physiology , Humans , Malabsorption Syndromes/etiology , Male , Middle Aged , Pyloric Antrum/physiopathologyABSTRACT
Tumor-associated gastroparesis, though reported in association with various malignancies, is rare in patients with cholangiocarcinoma. We report a 55-year-old woman who presented with dysphagia and recurrent vomiting. Esophagogastroduodenoscopy revealed dilated stomach and excess residue without organic obstruction. 99mTc sulfur colloid solid gastric emptying study, radio-opaque marker gut transit study, and esophageal manometry showed features suggestive of gastroparesis and achalasia cardia; electrogastrography revealed bradygastria. Cholangiocarcinoma was detected on CT scan performed after the patient developed jaundice two months later. The lesion was deemed surgically unresectable. She died four months later.