Diagnostic value of endoscopic retrograde cholangiopancreatography and therapeutic value of endoscopic sphincterotomy in dogs with suspected hepatobiliary disorders.

Background: Conventional diagnostic methods have some limitations in diagnosing specific causes of canine hepatobiliary disorders. In the evaluation of the hepatobiliary system in dogs, ultrasonography (US) is the first imaging method of choice. Nonetheless, endoscopic retrograde cholangiopancreatography (ERCP) has also been proven to be a practicable technique for evaluating canine hepatobiliary (endoscopic retrograde cholangiography, ERC) and pancreatic duct (endoscopic retrograde pancreatography, ERP) disorders, providing additional therapeutic options by sphincterotomy (EST).

Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized controlled trial.

Background: Difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) increases the risk of post-ERCP pancreatitis (PEP). The purpose of this prospective, randomized, multicenter study was to compare two advanced rescue methods, transpancreatic biliary sphincterotomy (TPBS) and a double-guidewire (DGW) technique, in difficult common bile duct (CBD) cannulation.

Methods: Patients with native papilla and planned CBD cannulation were recruited at eight Scandinavian hospitals.

Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale.

Background: Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP). If CBD cannulation is difficult, an endoscopist can open the septum between the pancreatic and biliary duct with a sphincterotome to gain access. Long-term results of this procedure are unclear.

Dysphagia aortica in a young patient with Behcet's Disease: Case report.

Dysphagia aortica is a rare aetiology of dysphagia resulting from an abnormality in thoracic aorta that causes extrinsic compression on the oesophagus. Dysphagia aortica includes aortic aneurysm, aortic dissection or even tortuous aorta and is seldom considered in the differential diagnosis of dysphagia. Herein, we report a 30-year-old man with Behcet's disease who presented with rapid progressive dysphagia and diagnosed as dysphagia aortica caused by saccular aortic aneurysm complicated by large para-aortic haematoma compressing the oesophagus.

Criteria for difficult biliary cannulation: start to count.

Objective: In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of native papilla is defined as difficult in the presence of >5 papilla contacts, >5 min cannulation time or >1 unintended pancreatic duct cannulation (5-5-2). The aim is to test 5-5-2-criteria in a single-center practice predicting the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), and to study the efficacy of transpancreatic biliary sphincterotomy (TPBS) as an advanced method for biliary cannulation.

Methods: Prospectively collected data of 821 patients with native papilla were analyzed.

How patient-controlled sedation is adopted in clinical practice of sedation for endoscopic retrograde cholangiopancreatography? A prospective study of 1196 cases.

Objective: Patient-controlled sedation (PCS) has been shown to be a valid choice for sedation during endoscopic retrograde cholangiopancreatography (ERCP) in randomized studies. However, large-scale studies are lacking.

Material And Methods: A single center, prospective observational study to determine how sedation for ERCP is administered in clinical setting.

Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It provides practical advice on how to achieve successful cannulation and sphincterotomy at minimum risk to the patient. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis.

Objective: Extracorporeal shock wave lithotripsy (ESWL) combined with endotherapy (ET) is the standard treatment for pancreatic duct stones (PDS) in chronic pancreatitis (CP). Our aim was to report the short- and long-term results of ESWL and ET.

Material And Methods: Consecutively treated 83 patients with symptomatic PDS using ESWL and ET.

A prospective randomised study of dense Infinity cytological brush versus regularly used brush in pancreaticobiliary malignancy.

Background And Study Aims: Endoscopic retrograde cholangiopancreatography (ERCP) with a cytological sample is a valuable tool in the diagnosis of the aetiology of biliary stricture. Our aim was to evaluate whether a more dense Infinity® cytological brush is more sensitive in diagnosing malignancy than the regularly used brush.

Patients And Methods: We recruited 60 patients with a biliary stricture suspicious for malignancy for a randomised controlled trial.

Best practice in placement of percutaneous endoscopic gastrostomy with jejunal extension tube for continuous infusion of levodopa carbidopa intestinal gel in the treatment of selected patients with Parkinson's disease in the Nordic region.

Objective: Continuous infusion of levodopa carbidopa intestinal gel (LCIG) is associated with a significant improvement in the symptoms and quality of life of selected patients with advanced Parkinson's disease. Percutaneous endoscopic gastrostomy with jejunal extension (PEG/J) was first described in 1998 and has become the most common and standard technique for fixing the tubing in place for LCIG infusion.

Material And Methods: A workshop was held in Stockholm, Sweden, to discuss the PEG/J placement for the delivery of LCIG in Parkinson's disease patients with the primary goal of providing guidance on best practice for the Nordic countries.

Randomized multicenter study of multiple plastic stents vs. covered self-expandable metallic stent in the treatment of biliary stricture in chronic pancreatitis.

Background And Study Aims: The use of covered self-expandable metallic stents (cSEMS) in benign biliary indications is evolving. The aim of the study was to assess the safety and feasibility of cSEMS compared with multiple plastic stents in the treatment of benign biliary stricture (BBS) caused by chronic pancreatitis.

Patients And Methods: This was a prospective, multicenter, randomized study of 60 patients with BBS caused by chronic pancreatitis.

Assessment of indications for percutaneous endoscopic gastrostomy--development of a predictive model.

Objective: Percutaneous endoscopic gastrostomy (PEG) is used for long-term enteral nutrition in neurological patients with dysphagia (NEUR), in head and neck cancer patients prior to chemoradiation therapy (head and neck malignancy group [HNM]), or in cases of oropharyngeal or esophageal tumor obstruction or stricture (OBSTR). Considerable morbidity and overall mortality is reported. Aim was to analyze the complication rates and mortality with PEG and to identify subgroups with poor outcomes.

Endoscopic papillectomy, single-centre experience.

Background: Endoscopic removal of benign tumours of papilla is increasing. Our aim was to evaluate the outcome of endoscopic resection of papillary tumours.

Methods: In the years 2000-2012, 61 papillectomies were performed in Helsinki University Central Hospital.

Percutaneous endoscopic gastrostomy tube placement by otorhinolaryngologist-head and neck surgeons.

Conclusion: Percutaneous endoscopic gastrostomy (PEG) tube placement by an otorhinolaryngologist-head and neck surgeon is a feasible procedure with logistical advantages for the patient. Patient selection, co-morbidities, and the prognosis of the underlying disease are factors determining the outcome. Patient evaluation by a multidisciplinary team, with a gastroenterologist surgeon as a technical adviser, is proposed.

Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs.

Background: The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP).

Aims: To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis.

Patients And Methods: Prospective consecutive recording of 907 cannulations in Scandinavian centers done by experienced endoscopists.

Gastric outlet obstruction in gastric cancer: a comparison of three palliative methods.

Background: Gastric outlet obstruction (GOO) commonly occurs in advanced gastric cancer. Our aim was to evaluate the results of endoscopic stenting (ES), palliative resection (PR), and gastrojejunostomy (GJ) as palliation of GOO.

Methods: A total of 97 patients (50 ES, 26 PR, 21 GJ) were included in this retrospective study.

A randomized comparison of target-controlled propofol infusion and patient-controlled sedation during ERCP.

Background And Study Aims: Propofol is widely used during endoscopic retrograde cholangiopancreatography (ERCP) but high doses are recognized as a risk factor for sedation-related complications. The aim of this study was to compare target-controlled infusion (TCI) with patient self-administration (patient-controlled sedation, PCS) of propofol during ERCP. Propofol consumption, the ease of ERCP performance, and speed of recovery were recorded.

Dexmedetomidine impairs success of patient-controlled sedation in alcoholics during ERCP: a randomized, double-blind, placebo-controlled study.

Background: There is a lack of studies about procedural sedation of alcoholics. Dexmedetomidine is recommended for procedural sedation and reported effective for alcohol withdrawal. We evaluated the suitability of dexmedetomidine for sedation of alcoholics during endoscopic retrograde cholangiopancreatography (ERCP).

A prospective randomized study of thin versus regular-sized guide wire in wire-guided cannulation.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable tool in the diagnosis and management of various pancreatobiliary disorders. Our aim was to evaluate whether the combination of a thin guide wire and a thin sphincterotome would facilitate selective cannulation of the bile duct and reduce the incidence of post-ERCP pancreatitis (PEP) by reducing papillary trauma when compared with a regular-sized hydrophilic guide wire.

Methods: Between June 2011 and February 2012, we performed 100 biliary cannulations for a native papilla in a randomized controlled trial.

How to cannulate? A survey of the Scandinavian Association for Digestive Endoscopy (SADE) in 141 endoscopists.

Cannulation of the papilla vateri represents an enigmatic first step in endoscopic retrograde cholangiopancreaticography (ERCP). In light of falling numbers of (diagnostic) ERCP and novel techniques, e.g.

Endoscopic treatment of anastomotic biliary complications after liver transplantation using removable, covered, self-expandable metallic stents.

Objective: Anastomotic bile duct complications after liver transplantation (LT) have been treated endoscopically by dilation and plastic tube stenting, with the stent therapy having moved toward using covered, self-expandable metallic stents (cSEMS) in recent years. The aim of this study was to analyze therapy outcome of post-LT anastomotic complications using cSEMS.

Material And Methods: Seventeen post-LT patients had 29 cSEMS (Allium stent, n = 23; Wallstent, n = 4; Micro-Tech, n = 2) placed during endoscopic retrograde cholangiopancreatography (ERCP).

Stenting for malignant colorectal obstruction: a single-center experience with 101 patients.

Background: Self-expanding metal stents (SEMS) are used for colorectal obstruction preoperatively and palliatively. Limited data on the use of stents for obstruction caused by extracolonic malignancies exist, and the results are unclear. Our goal was to evaluate the efficacy and safety of SEMS for patients stented as a bridge to surgery and as palliation for colorectal cancer or extracolonic malignancies.

Patient-controlled sedation with propofol and remifentanil for ERCP: a randomized, controlled study.

Background: Deep sedation with propofol and an opioid is commonly used for ERCP but is associated with increased risk and may require the presence of an anesthesiologist. Delivery of propofol and a short-acting, potent opioid analgesic remifentanil by patients to themselves (patient-controlled sedation, PCS) could be another option. Comparative studies with propofol PCS for ERCP are lacking.

Management of difficult bile duct cannulation in ERCP.

In Encoscopic Retrograde Cholangiopancreatography (ERCP), the main concern is to gain access into the bile duct while avoiding the pancreatic duct because of the risk of post-ERCP pancreatitis. Difficult cannulation is defined as a situation where the endoscopist, using his/her regularly used cannulation technique, fails within a certain time limit or after a certain number of unsuccessful attempts. Different methods have been developed to manage difficult cannulation.

Outcome of patients after endoluminal stent placement for benign colorectal obstruction.

Objective: Self-expanding metal stents (SEMS) have been successfully used as a "bridge to surgery" or as palliation for acute malignant colorectal obstruction. Little data on the use of stents for benign obstruction exists and the results vary. The purpose of this study was to evaluate the efficacy and safety of SEMS in benign colorectal obstruction.