ERCP for common bile duct stones in the elderly: refining the procedure to improve outcomes.

Removal of common bile duct stones in patients with a previous cholecystectomy was one of the first indications for ERCP with biliary sphincterotomy. Thanks to a minimally invasive procedure, patients were prevented from having a new operation. Subsequently, as the technique proved to be successful, ERCP was extended to all patients with choledocholithiasis, regardless of whether or not they had gallbladder.

Endoscopic drainage of malignant distal biliary obstruction. Will endoscopic retrograde cholangiopancreatography no longer be necessary?

We read with interest the Editorial from Vila et al. on the paradigm shift for endoscopic biliary drainage of malignant distal biliary obstruction (MDBO) which places Endoscopic Ultrasound (EUS) drainage as the first option instead of traditional ERCP drainage. The modern biliary endoscopist must have the duodenoscope in one hand and the therapeutic echoendoscope in the other.

How to take advantage of a failed precut to achieve biliary cannulation in ERCP.

After nearly 50 years of therapeutic endoscopic retrograde cholangio-pancreatography (ERCP), deep cannulation of the desired duct, whether biliary or pancreatic, remains primarily an art. Most ERCP procedures are performed for biliary drainage.

Straight plastic stents in tumors at the hepatic hilum and related duodenal perforations.

We read with interest the paper on the endoscopic treatment of a duodenal perforation related to a plastic biliary stent that was reported by Roa et al. We would like to add some comments about biliary stents inserted during endoscopic retrograde cholangiopancreatography (ERCP) to palliate malignant jaundice in hilar strictures. It is our belief that the most convenient strategy in non-operable patients should be the insertion of at least one uncovered self-expanding metal stent.

The best plastic pancreatic stent to prevent post-ERCP pancreatitis.

We consider very interesting the comments made by Serrano Díaz et al. on pancreatic stents inserted as prophylaxis for acute post-ERCP pancreatitis. As we recently stated in an editorial related to the prevention of this frequent complication, the aggressive way in which the pancreatic gland may respond to contact with the devices that are used for common bile duct cannulation via the papilla of Vater is almost philosophically surprising.

Should we administer rectal anti-inflammatory drugs in all ERCPs in order to prevent pancreatitis? At least, it does not harm!

Acute pancreatitis is the most common complication of endoscopic retrograde cholangio-pancreatography (ERCP). The sensitivity of the pancreas, which may respond with such violence to the slightest pressure exerted at the entrance to its main duct in the papilla of Vater, is even philosophically surprising. In fact, each touch on the papilla increases the potential for pancreatitis development.

Pancreatic stent insertion after an unintentional guidewire cannulation of the pancreatic duct during ERCP.

Introduction: the guidewire (GW) may enter the pancreatic duct during common bile duct (CBD) cannulation attempts in endoscopic retrograde cholangiopancreatography (ERCP). After GW passage into the pancreas, the most effective maneuver for CBD cannulation and pancreatitis prevention has not been determined.

Aim: to study CBD cannulation and post-ERCP pancreatitis rates when a pancreatic stent is inserted after an unintentional GW cannulation of the pancreatic duct.

Fully covered self-expanding metal stents in the management of difficult common bile duct stones.

Background And Objectives: plastic biliary stents are often used after an ERCP session without complete common bile duct stones (CBDS) extraction. Sometimes, the volume of biliary drainage with these stents may be insufficient. We present our experience with the use of fully covered self-expanding metal stents (FCSEMS) in the setting of incomplete CBDS extraction.

Diagnostic yield and impact of capsule endoscopy on management of patients with gastrointestinal bleeding of obscure origin.

This study assessed diagnostic yield and impact of capsule endoscopy on patient management. Seventy-five patients with obscure gastrointestinal bleeding were included. Clinical and followup information was collected by review of patient records and with personal contact with the referring physicians.