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Journal of Gastrointestinal Surgery

, Volume 23, Issue 5, pp 1055–1068 | Cite as

Endoscopic Management of Acute Biliopancreatic Disorders

  • Ryan M. Juza
  • Eric M. PauliEmail author
Evidence-Based Current Surgical Practice
  • 43 Downloads

Abstract

Purpose

Endoscopy is playing an ever-increasing role in the management of acute biliopancreatic disorders. With the management paradigm shifting away from more invasive surgical approaches, surgeons need to be aware of the treatment options available to improve patient care. Our manuscript serves to improve surgeons’ knowledge and understanding of these emerging treatment modalities to expand their algorithmic approach to biliopancreatic disorders.

Methods

Specific acute biliopancreatic disorders were identified from the literature and personal practice to create a structured review of common problems experienced by a surgeon of the gastrointestinal tract. An exhaustive literature review was performed to identify and analyze endoscopic treatment modalities for these disorders.

Results

Endoscopic therapies continue to expand rapidly with a robust supportive literature. Data on endoscopic treatment strategies for acute biliopancreatic disorders demonstrate valuable improvements in outcomes in a number of these disorders.

Discussion

Acute biliopancreatic disorders represent one of the most challenging pathophysiologies that a surgeon of the gastrointestinal tract may face. This manuscript represents a review of available endoscopic instrumentation as well as the author’s interpretation of the current literature regarding indications and outcomes of endoscopic management for acute biliopancreatic disorders. Although this article does not supplant formal training in therapeutic endoscopy, surgeons reading this article should understand the role endoscopy plays in the management of acute biliopancreatic disorders.

Keywords

Endoscopy Therapeutic endoscopy Choledocholithiasis Endoscopic retrograde cholangiopancreatography ERCP Cholangiogram Pseudocyst Pancreatic necrosis Biliopancreatic disorders 

Notes

CME/MOC Questions8 multiple choice (A-D)

Outcomes of single session versus multi-session ERCP and cholecystectomy for the treatment of choledocholithiasis/biliary pancreatitis demonstrate that single session treatment has:
  • Similar length of stay and decreased cost

  • Decreased length of stay and similar cost

  • Decreased length of stay and decreased cost

  • Increased length of stay but decreased cost

Balloon-assisted endoscopy to facilitate ERCP in post-RYGB patients with choledocholithiasis has a biliary cannulation rate of:
  • > 90%

  • 20-30%

  • 50-60%

  • < 10%

Endoscopic options for management of acute cholecystitis in patients who are deemed poor surgical candidates include:
  • Percutaneous transhepatic cholecystostomy tube

  • Endoscopic creation of a cholecystoenteric fistula

  • Endoscopic sphincterotomy

  • No available endoscopic options

Postoperative bile leak complicates 1% of all cholecystectomies. The most sensitive study for detecting leak is
  • ERCP

  • Focused ultrasonography

  • HIDA

  • Computed tomography (CT) scan

The role of ERCP in pancreatic trauma includes:
  • ERCP is the gold standard diagnostic test for traumatic pancreatic ductal injuries

  • ERCP is useful in the diagnosis of occult pancreatic main duct injuries

  • ERCP with sphincterotomy is recommended in all cases of suspected pancreatic trauma

  • There is no role for ERCP in pancreatic trauma

The most common complication of ERCP with sphincterotomy is
  • Sepsis

  • Perforation

  • Bleeding

  • Pancreatitis

Adjuncts for reducing the incidence of post-ERCP pancreatitis include:
  • Rectal NSAIDs

  • Rectal Steroids

  • IV acetaminophen

  • Oral NSAIDs

Which of the following statements about single session ERCP and cholecystectomy is true?
  • The antegrade wire rendezvous technique via a cystic ductotomy can help facilitate cannulation of the biliary system

  • On table fluoroscopy is not necessary

  • Single session ERCP and cholecystectomy should not be performed due to increased adverse events

  • Patient position is not a challenge to single session ERCP and cholecystectomy

Author Contribution

Each author has participated sufficiently in this work to take public responsibility for appropriate portions of the content.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Division of Minimally Invasive and Bariatric Surgery, Department of General SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA

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