Complicaciones de la Colangiopancreatografia retrogada endoscopica / Complications of endoscopic retrograde cholangiopancreatography

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.

Substance P in rectal mucosa of children with chronic constipation

Niveles de Substancia P fueron determinados por radioinmunoassay en la mucosa rectal de 17 niños con constipación, idiopática crónica y comparados con la de 9 ninõs sin constipación. En el grupo de niños con constipación, los niveles de Sustancia P fueron menores que aquellos de los controles: 47,6+-11 vs. 79,4+-11 pg/mg de peso húmero de tejido respectivamente (la diferencia no obtuvo significación estadística). Niveles de Sustancia P en la mucosa rectal de niños con soiling (11/17) no fueron diferentes de los niveles en niños constipados sin soiling (46,0+-13 vs. 50,5+-19). En niños con constipación, los niveles de Sustancia P no varían de acuerdo a la edad o la duración de síntomas. Los niveles de Sustancia P en la mucosa rectal de niños controles (sin constipación) fueron similares a aquellos que previamente observamos en adultos normales, y los niveles en niños constipados fueron intermediarios entre estos niveles normales y los de adultos constipados. Estas observaciones sugieren un problema de motilidad como factor importante en la patogenesis de la constipación crónica en niños.

Estudio prospectivo randomizado para comparar la eficacia entre stents standards plásticos y de poliuretano en la obstrucción biliar maligna / Randomized prospective study to compare the efficiency between standard plastic stents and polyurethane stents in biliary tract malignant obstruction

The aim of this paper is to compare the efficiency between standard plastic stents and polyurethane stents used in biliary tract malignant obstruction. The main problem of the plastic prosthesis is their early occlusion. On the other hand there is the hypothesis that due to the less porousness of the polyurethane surface, there might be lesser adherence and consequently a late occlusion. Thirty-eight patients in two groups of 19 were evaluated prospectively and at random in the Jerusalem Hadassah Hospital and the HIGA San Martín La Plata. They had biliary tract obstruction due to inoperable tumors. Biliary endoprosthesis (plastic standard or polyurethane 10 French diameter) were placed, according to the randomization, after a previous staging with clinical examination, laboratory analysis and images. The follow-up with the same parameters was monthly done. Twelve of the 38 patients were female and 26 male; age average 62.73 (range 81-49). The stents were placed in 17 patients with biliary cancer, 14 pancreatic cancer, 2 papila cancer, 2 gallbladder cancer with bile duct invasion and 3 liver metastasis with biliary tract compression. The clinical and laboratory parameters in 36 patients at 30 days improved. On the contrary, 2 (1 plastic standard and 1 polyurethane stent) did not improve. There were 29 deaths due to the basic illness and not related to the endoscopic method. The mean obstruction occurred at 12.76 weeks (range 32-4) in the standard stents and 12.05 (range 24-2) in the polyurethane ones. CONCLUSION: There were no significant differences in the two groups patients.