Pancreatobiliary

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Performance of Published Criteria in Predicting Choledocholithiasis in Practice

Performance of Published Criteria in Predicting Choledocholithiasis in Practice

Choledocholithiasis can be identified through multiple means, including a right upper quadrant ultrasound, endoscopic ultrasound (EUS), endoscopic retrograde cholangiography (ERCP), magnetic resonance cholangiopancreatography (MRCP), and

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Pure Cut Current for Biliary Sphincterotomy Is Associated With Less Delayed Bleeding and May Reduce Post-ERCP Pancreatitis Risk

Pure Cut Current for Biliary Sphincterotomy Is Associated With Less Delayed Bleeding and May Reduce Post-ERCP Pancreatitis Risk

Thermal injury from biliary sphincterotomy is thought to play a role in at least a proportion of post-ERCP pancreatitis (PEP) cases. Thus, the present study

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Large Single-Use Duodenoscope Experience Shows High Success and Low Crossover Rates

Large Single-Use Duodenoscope Experience Shows High Success and Low Crossover Rates

Single-use duodenoscopes were developed to eliminate the risk of duodenoscope-associated transmission of infections. However, there are concerns that the performance of single-use duodenoscopes may not

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More Evidence for Early Cholecystectomy After Gallstone Pancreatitis

More Evidence for Early Cholecystectomy After Gallstone Pancreatitis

Same-admission cholecystectomy is recommended for patients with mild gallstone pancreatitis (GSP) to reduce recurrent GSP events and lower costs. However, adherence to same-admission cholecystectomy remains

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Fluoroscopy-Free ERCP for Choledocholithiasis Is Safe and Effective in a Pilot Study

Fluoroscopy-Free ERCP for Choledocholithiasis Is Safe and Effective in a Pilot Study

In select patients – most commonly during pregnancy – using a fluoroscopy-free approach to stone removal is preferred. Given some initial success with this approach

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Lessons Learned After Post-ERCP Mortality

Lessons Learned After Post-ERCP Mortality

ERCP is a vital endoscopic procedure for the management of pancreatobiliary disease but is associated with serious adverse events, including mortality. Although a central tenet

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Effectiveness of EUS Gallbladder Drainage as Primary Therapy for Malignant Biliary Obstruction

Effectiveness of EUS Gallbladder Drainage as Primary Therapy for Malignant Biliary Obstruction

ERCP is generally the first-line approach for palliation of distal malignant biliary obstruction (DMBO), but interest in the use of endoscopic ultrasound (EUS)-guided transmural drainage

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Fully Covered Self-Expanding Metal Stents Are Safe and May Be More Durable in Distal Malignant Biliary Obstruction

Fully Covered Self-Expanding Metal Stents Are Safe and May Be More Durable in Distal Malignant Biliary Obstruction

It is clear that metal stents are superior to plastic stents for palliation of distal malignant biliary obstruction (dMBO). Among self-expanding metal stents (SEMS), there

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Primary EUS Choledochoduodenostomy Is Safe and Efficacious in Malignant Biliary Obstruction

Primary EUS Choledochoduodenostomy Is Safe and Efficacious in Malignant Biliary Obstruction

Palliation of malignant biliary obstruction is required to facilitate oncologic therapy and relief of symptoms. Although this is almost always performed with ERCP, biliary cannulation

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Consensus Guidelines Recommend Monitored Anesthesia Care for Most ERCPs

Consensus Guidelines Recommend Monitored Anesthesia Care for Most ERCPs

Adequate patient sedation is essential for the successful completion of ERCP; however, delivery methods of anesthesia vary between providers, with most endoscopists favoring deep sedation

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Papillary Morphology Predicts Difficult Biliary Cannulation

Papillary Morphology Predicts Difficult Biliary Cannulation

Successful and safe ERCP requires the endoscopist to cannulate the duct of interest successfully and efficiently. Although operator skill clearly influences procedure success, there is

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True Rate of Post-ERCP Pancreatitis: Do Randomized Trials Provide the Answer?

True Rate of Post-ERCP Pancreatitis: Do Randomized Trials Provide the Answer?

Pancreatitis after ERCP is one of the most common and morbid adverse events following any gastrointestinal endoscopy procedure. It is imperative that the consent process

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Might Biliary Radiofrequency Ablation Be Less Effective Than We Thought?

Might Biliary Radiofrequency Ablation Be Less Effective Than We Thought?

Most inoperable malignant biliary strictures are best treated with self-expanding metal stents (SEMS); however, a significant portion of patients develop stent occlusion from neoplastic or

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Empiric Prophylactic Plastic Stenting for Disconnected Pancreatic Duct After Necrosectomy Is Not Uniformly Beneficial

Empiric Prophylactic Plastic Stenting for Disconnected Pancreatic Duct After Necrosectomy Is Not Uniformly Beneficial

Pancreatic necrosis often results in main pancreatic duct injury and eventual discontinuity, or so-called disconnected pancreatic duct syndrome (DPDS), with recurrent symptoms from duct obstruction

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ASGE Guideline on Screening for Pancreatic Cancer in High-Risk Cohorts

ASGE Guideline on Screening for Pancreatic Cancer in High-Risk Cohorts

Pancreatic ductal adenocarcinoma (PDAC) continues to have a dismal prognosis at the time of presentation. Survival is improved with diagnosis at an early stage, but

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Examining Cost-Utility Data for Interventions to Prevent Infection Transmission by Duodenoscopes

Examining Cost-Utility Data for Interventions to Prevent Infection Transmission by Duodenoscopes

Transmission of multidrug-resistant organisms between patients undergoing ERCP prompted the U.S. Food and Drug Administration to issue guidance for endoscopy departments to adopt intensified reprocessing

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Electrohydraulic Lithotripsy Safe and Effective for Clearing Obstructive Pancreatic Stones Near the Duodenum

Electrohydraulic Lithotripsy Safe and Effective for Clearing Obstructive Pancreatic Stones Near the Duodenum

Electrohydraulic lithotripsy (EHL) and laser lithotripsy are both well-established methods for the treatment of biliary and genitourinary stones. Several retrospective series have described successful pancreatoscopy-guided

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Cholecystectomy Optimally Performed Within 8 Weeks for Necrotizing Biliary Pancreatitis

Cholecystectomy Optimally Performed Within 8 Weeks for Necrotizing Biliary Pancreatitis

Cholecystectomy before hospital dismissal is advised for most cases of acute biliary pancreatitis (ABP). Surgery is often delayed in the setting of pancreatic necrosis to

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Further Validation for a Motorized Endoscopic Necrosectomy Device

Further Validation for a Motorized Endoscopic Necrosectomy Device

Many patients with walled-off pancreatic necrosis (WON) require debridement following minimally invasive drainage. This often entails serial procedures with cumulative expense and risk. These authors

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Surveillance Rather Than Immediate Resection Appears Advisable for Most Familial Adenomatous Polyposis-Related Ampullary Adenomas

Surveillance Rather Than Immediate Resection Appears Advisable for Most Familial Adenomatous Polyposis-Related Ampullary Adenomas

Ampullary, periampullary, and duodenal adenomas commonly occur in familial adenomatous polyposis (FAP). Their detection and management are fraught with challenges related to balancing the risk

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Incision Improves Success and Safety for Difficult Biliary Access Compared With Wire- or Stent-Guided Entry

Incision Improves Success and Safety for Difficult Biliary Access Compared With Wire- or Stent-Guided Entry

A variety of techniques have been described for achieving deep biliary cannulation, a necessary prelude to most endoscopic retrograde cholangiographic (ERCP) procedures. The rate of

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On Balance, Benefit of Sphincterotomy for Biliary Stenting Appears to Outweigh the Risk

On Balance, Benefit of Sphincterotomy for Biliary Stenting Appears to Outweigh the Risk

Limited reports have suggested that endoscopic biliary sphincterotomy (ES) at the time of transpapillary biliary stent placement may reduce the risk of post-ERCP pancreatitis (PEP).

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Are There Signs or Symptoms That Predate the Diagnosis of Pancreatic Cancer?

Are There Signs or Symptoms That Predate the Diagnosis of Pancreatic Cancer?

Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer mortality since most cancers are advanced at diagnosis. Early identification of these cancers is

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DNA Methylation Studies of Biliary Brush Cytology Samples Likely to Aid in Diagnosis of Cholangiocarcinoma

DNA Methylation Studies of Biliary Brush Cytology Samples Likely to Aid in Diagnosis of Cholangiocarcinoma

Establishing a firm diagnosis for indeterminate biliary strictures is often challenging. The current standard of practice is fluoroscopic and cholangioscopic characterization with brush and biopsy

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BILE Criteria to Assess ERCP Need in Cholangitis May Be More Sensitive, Less Cumbersome Than Others

BILE Criteria to Assess ERCP Need in Cholangitis May Be More Sensitive, Less Cumbersome Than Others

Biliary obstruction with associated cholangitis usually is managed with the use of endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction or stent decompression of the bile

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Covered Metal Stents Equal to Multiple Plastic Stents for Treatment of Biliary Strictures From Chronic Pancreatitis but Require Fewer Procedures

Covered Metal Stents Equal to Multiple Plastic Stents for Treatment of Biliary Strictures From Chronic Pancreatitis but Require Fewer Procedures

Compression of the distal bile duct within a fibrotic pancreas is one complication of chronic pancreatitis (CP), which can lead to chronic cholestasis, cholangitis, and

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Transpapillary Gallbladder Stent Placement Usually Successful as Destination Therapy

Transpapillary Gallbladder Stent Placement Usually Successful as Destination Therapy

Severe acute cholecystitis (AC) often is palliated with percutaneous or endoscopic drainage 6 to 12 weeks prior to preplanned interval cholecystectomy. Many patients with severe

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Radiofrequency Ablation Plus Stent Placement for Extrahepatic Cholangiocarcinoma Shows Benefit Over Stenting Alone

Radiofrequency Ablation Plus Stent Placement for Extrahepatic Cholangiocarcinoma Shows Benefit Over Stenting Alone

The optimal treatment for cholangiocarcinoma (CCA) or ampullary carcinoma (AC) is surgery. When deemed unresectable and not amenable to neoadjuvant therapy followed by liver transplantation,

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Better, but Insufficient Results From Duodenoscope Reprocessing With Double Wash and High-Level Disinfection or Liquid Chemical Sterilization

Better, but Insufficient Results From Duodenoscope Reprocessing With Double Wash and High-Level Disinfection or Liquid Chemical Sterilization

The potential for interpatient transmission of infections by contaminated duodenoscopes is a significant concern in the practice of ERCP. Pending further understanding and development of

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Cholecystectomy Before Dismissal Confirmed as Optimal in Large Population of Veterans With Biliary Pancreatitis

Cholecystectomy Before Dismissal Confirmed as Optimal in Large Population of Veterans With Biliary Pancreatitis

Multiple guidelines recommend performing cholecystectomy (CCy) before hospital dismissal for patients with mild gallstone pancreatitis that is not complicated by infection or necrosis. In this

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Hydrogen Peroxide, One Way or Another, Appears Beneficial During Endoscopic Necrosectomy

Hydrogen Peroxide, One Way or Another, Appears Beneficial During Endoscopic Necrosectomy

Management of walled-off pancreatic necrosis often benefits from direct transmural endoscopic necrosectomy. This retrospective chart review assessed the utility of hydrogen peroxide (H2O2) lavage as

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Best Conformation for Hilar Self-Expanding Metal Stents Remains Undefined

Best Conformation for Hilar Self-Expanding Metal Stents Remains Undefined

Bilateral placement of metal stents for malignant hilar strictures (MHS) can be challenging. Two approaches have been used, each with potential benefits and challenges.  In

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Updated Criteria for Prediction of Choledocholithiasis Add Specificity

Updated Criteria for Prediction of Choledocholithiasis Add Specificity

A variety of recommendations have been proposed for predicting choledocholithiasis based upon presenting signs, symptoms, initial laboratory studies, and imaging. In this retrospective study, the

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Further Evidence Supporting Early, Primary Use of Precut Sphincterotomy for Duct Access

Further Evidence Supporting Early, Primary Use of Precut Sphincterotomy for Duct Access

Deep access to the bile duct or the pancreatic duct is required in order to complete all subsequent therapeutic ERCP maneuvers. Precut sphincterotomy (PCS) refers

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First Single-Use Duodenoscope Measures up in Direct Comparison for Low-Complexity Procedures

First Single-Use Duodenoscope Measures up in Direct Comparison for Low-Complexity Procedures

The development of single-use (disposable) endoscopes is one approach to eliminating infection transmission between sequential patients during endoscopy. This single-center study randomized patients undergoing endoscopic

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Discovering Adverse Events By Phone – the Sweet Spot is 7 Days After ERCP

Discovering Adverse Events By Phone – the Sweet Spot is 7 Days After ERCP

Identification of adverse events following gastrointestinal endoscopy can be challenging due to patient reticence to present for mild to moderate problems and dispersed follow-up among