Risk of pancreatitis after endoscopic retrograde cholangiopancreatography and endoscopic biliary drainage.

BACKGROUND: Pancreatitis is the most common and serious complication to occur after endoscopic retrograde cholangiopancreatography (ERCP). It is often associated with additional diagnostic modalities and/or treatment of obstructive jaundice. The aim of this study was to determine the risk of post-ERCP pancreatitis associated with pancreaticobiliary examination and endoscopic biliary drainage (EBD). METHODS: A total of 740 consecutive ERCP procedures performed in 477 patients were analysed for the occurrence of pancreatitis. These included 470 EBD procedures and 167 procedures to further evaluate the pancreaticobiliary tract using brush cytology and/or biopsy, intraductal ultrasound and/or peroral cholangioscopy or peroral pancreatoscopy. The occurrence of post-ERCP pancreatitis was analysed retrospectively. RESULTS: The overall incidence of post-ERCP pancreatitis was 3.9% (29 of 740 procedures). The risk factors for post-ERCP pancreatitis were: being female (6.5%; odds ratio [OR] 2.5, P= 0.02); first EBD procedure without endoscopic sphincterotomy (ES) (6.9%; OR 3.0, P= 0.003), and performing additional diagnostic procedures on the pancreatobiliary duct (9.6%; OR 4.6, P < 0.0001). Pancreatitis after subsequent draining procedures was rare (0.4%; OR for first-time drainage 16.6, P= 0.0003). Furthermore, pancreatitis was not recognized in 59 patients who underwent ES. Seven patients with post-EBD pancreatitis were treated with additional ES. CONCLUSIONS: Invasive diagnostic examinations of the pancreaticobiliary duct and first-time perampullary biliary drainage without ES were high-risk factors for post-ERCP pancreatitis. Endoscopic sphincterotomy may be of use to prevent post-EBD pancreatitis.

Postmortem intravascular high-density fluid level (hypostasis): CT findings.

PURPOSE: To evaluate postmortem CT (PMCT) finding of hypostasis. METHODS: PMCT examinations were performed within 2 hours of death in 126 patients who arrived at our institution in nontraumatic cardiopulmonary arrest. RESULTS: PMCT showed hypostasis as high-density fluid level in the lumen of the heart or great vessels in 66 of 126 patients (52%). CONCLUSION: Hypostasis is observed as an intravascular high-density fluid level on PMCT.

Hyperattenuating aortic wall on postmortem computed tomography (PMCT).

PURPOSE: To quantitatively evaluate the finding of hyperattenuating aortic wall on postmortem computed tomography (PMCT) and investigate its causes. MATERIALS AND METHODS: Our subjects were 50 PMCT of non-traumatic deaths and 50 CT of living persons (live CT). The ascending aorta at the level of the carina was visually assessed regarding the presence or absence of hyperattanuating aortic wall and hematocrit effect on PMCT and live CT. The diameter, thickness of the aortic wall, and CT number (HU) of the aortic wall and the lumen were also measured. RESULTS: Hyperattenuating aortic wall was detected in 100% of PMCT and 2% of live CT. The diameter of the aortic wall was 2.9 +/- 0.5 cm on PMCT and 3.5 +/- 0.5 cm on live CT, showing a significant difference. The thickness of the aortic wall was 2 mm on PMCT. Hematocrit effect was observed in 46% of PMCT and in none of live CT. With PMCT, there was a significant difference between the CT numbers of the upper and lower half portions of the lumen (19.6 +/- 11.7/30.9 +/- 12.9), whereas, with live CT, there was no such significant difference (37.4 +/- 7.6/38.9 +/- 6.7), with the overall value of 38.2 +/- 6.7. The CT number of the aortic wall was 49.9 +/- 10.9 on PMCT. CONCLUSION: The causes of hyperattenuating aortic wall on PMCT are considered to be increased attenuation due to contraction of the aortic wall, a lack of motion artifact, and decreased attenuation of the lumen due to dilution of blood after massive infusion at the time of cardiopulmonary resuscitation.