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Tu1603 Predicting Factors of Delayed Versus Early Definitive ERCP for Stone Clearance in Patients With Common Bile Duct Stone and Acute Cholangitis Managed With Temporary Biliary Stenting
Abstracts
Tu1603 Predicting Factors of Delayed Versus Early Definitive ERCP for Stone Clearance in Patients With Common Bile Duct Stone and Acute Cholangitis Managed With Temporary Biliary Stenting Raymond S. Tang*1, Siu Fung Lam1, Pui Y. Chan1, Man C. Tang1, Wai H. Leung1, Yiwei He1, Thomas Y. Lam1, Siew C. Ng1, Francis K. Chan1, James Y. Lau2 1 Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong; 2Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong Background: While ERCP with endoscopic sphincterotomy (ES) and stone extraction can be safely performed as definitive treatment in the majority of patients with common bile duct (CBD) stone on initial presentation, temporary stent placement for biliary drainage is often preferred in patients with severe acute cholangitis and sepsis. The optimal timing of subsequent definitive ERCP for stone clearance in this subgroup of patients is not well defined. This study aims to identify predicting factors of the timing of definitive ERCP for stone clearance in patients managed with temporary biliary stenting for acute cholangitis and CBD stone. Methods: Retrospective review of an ERCP database in a university hospital from January 2013 to December 2014 was performed. Patients who underwent ERCP with temporary biliary stenting for acute cholangitis and CBD stone were identified. Early definitive ERCP was defined as a follow up ERCP done 7 days after the index ERCP, while delayed definitive ERCP was defined as a follow up ERCP done > 7 days after the index ERCP. Patients’ demographics, clinical parameters at the time of the ERCP, and ERCP findings were collected. Logistic regression was used to identify predicting factors of the timing of definitive ERCP. Results: A total of 1611 ERCPs were performed in the study period, of which 613 ERCPs were done for bile duct stones. 91 patients with CBD stone and acute cholangitis underwent temporary biliary stenting for initial management. 8 patients were excluded because they had partial stone clearance before stenting or no subsequent definitive ERCP. 83 patients were included in the analysis: 34 patients had early definitive ERCP (mean age 73; 64.7% male) and 49 patients (mean age 75; 51.0% male) had delayed definitive ERCP for stone clearance. The mean time intervals between the index ERCP and the definitive ERCP were 4.4 days (range 2-7) in the early group and 44.6 days (range 8-162) in the delayed group (Table 1). The proportion of patients with CBD stone 10mm was significantly higher in the delayed definitive ERCP group (41.2% in early group vs 65.3% in delayed group, pZ0.030). While age, presence of hypotension, need for pressor support, intensive care unit admission, and CBD stone 10mm on index ERCP were found to have odds ratios (OR) > 1 on univariate logistic regression analysis for delayed definitive ERCP for stone clearance, only CBD stone 10mm was shown to be a statistically significant predictor on both univariate and multivariate logistic regression (univariate: OR 2.69, p Z 0.031, multivariate: OR 2.50, p Z 0.050) (Table 2). Conclusion: In patients with CBD stone and acute cholangitis managed with temporary biliary stenting, the finding of CBD stone 10mm on index ERCP was a significant predictor for delayed definitive ERCP for stone clearance.
Tu1732 The Usefulness of Argon Plasma Coagulation Ablation Subsequent to Endoscopic SNARE Papillectomy for Ampulla Adenoma Kwangwoo Nam*, Tae Jun Song, Min Keun Cho, Dongwook Oh, Do Hyun Park, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim Gastroenterology, Asan Medical Center, Seoul, Korea (the Republic of) Background and Aims: Endoscopic snare papillectomy (ESP) of major ampulla is safe and effective alternative to surgical resection of ampulla adenoma. Argon plasma coagulation (APC) is widely used in ESP as adjuvant thermal ablation for bleeding control and residual tumor. However, the safety and effectiveness of subsequent APC ablation during ESP are not fully evaluated. The aim of this study is to evaluate the short-term and long-term outcomes of APC ablation as adjuvant therapy of ESP. Patients and Methods: The data of patients who had undergone ESP for ampulla adenoma between September 2005 and August 2015 were retrospectively analyzed. Results: The 114 patients underwent ESP for ampulla adenoma with curative intent. The mean patient age was 5611 years old and 80 (70.2%) patients were male. The mean tumor size was 1.660.83 cm. After ESP, adjuvant APC ablation was performed in 67 (58.8%) patients. There were no significant differences in procedure-related adverse events including pancreatitis (ESP alone vs. ESP+APC group; 14.9% vs. 6.0%, pZ0.196), cholangitis (ESP alone vs. ESP+APC group; 10.6% vs. 1.5%, pZ0.08) or perforation (ESP alone vs. ESP + APC group; 2.1% vs. 1.5%, pZ1.0). However, bleeding events occurred less frequently after APC ablation (ESP alone vs. ESP+APC group; 21.3% vs. 7.5%, odds ratioZ0.298, p<0.05). During follow-up period (mean 907877 days), recurrence rate (ESP alone vs. ESP+APC group; 23.4% vs. 26.9%, pZ0.676) and papillary stenosis (ESP alone vs. ESP+APC group; 4.3% vs. 9.0%, pZ0.467) were not significantly different. Conclusion: During ESP procedure, additional APC ablation may have beneficial effect in decreasing bleeding events.
Tu1733 Needle Knife Precutting Papillotomy Doesn’t Seem to Be a Risk Factor of Post ERCP Pancreatitis at the Selective Biliary Deep Cannulation Hirofumi Kawamoto*, Tomohiro Tanikawa, Noriyo Urata, Takahito Oka, Jun Nakamura, Mitsuhiko Suehiro, Ken Nishino, Miwa Kawanaka, Ken Haruma General Medicine 2, Kawasaki Medical School, Okayama, Japan Background and Aims: To attain the selective biliary cannulation (BC), conventional cannulation (CC) or wire-guided cannulation (WG) or pancreatic guidewire cannulation (PG) are employed in one of these or in combination. Precutting papillotomy (PP) increases the success rate of DC, however it was known as one of the risk factors to induce post-ERCP pancreatitis (PEP). We retrospectively analyzed the outcomes of patients who received ERC-related treatment to identify whether PP is a risk factor or not. Patients and Methods: Between April, 2011 and September, 2015, ERC-related treatment was performed on 511 consecutive patents (223 males, mean
AB622 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
www.giejournal.org
Tu1603 Predicting Factors of Delayed Versus Early Definitive ERCP for Stone Clearance in Patients With Common Bile Duct Stone and Acute Cholangitis Managed With Temporary Biliary Stenting Raymond S. Tang*1, Siu Fung Lam1, Pui Y. Chan1, Man C. Tang1, Wai H. Leung1, Yiwei He1, Thomas Y. Lam1, Siew C. Ng1, Francis K. Chan1, James Y. Lau2 1 Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong; 2Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong Background: While ERCP with endoscopic sphincterotomy (ES) and stone extraction can be safely performed as definitive treatment in the majority of patients with common bile duct (CBD) stone on initial presentation, temporary stent placement for biliary drainage is often preferred in patients with severe acute cholangitis and sepsis. The optimal timing of subsequent definitive ERCP for stone clearance in this subgroup of patients is not well defined. This study aims to identify predicting factors of the timing of definitive ERCP for stone clearance in patients managed with temporary biliary stenting for acute cholangitis and CBD stone. Methods: Retrospective review of an ERCP database in a university hospital from January 2013 to December 2014 was performed. Patients who underwent ERCP with temporary biliary stenting for acute cholangitis and CBD stone were identified. Early definitive ERCP was defined as a follow up ERCP done 7 days after the index ERCP, while delayed definitive ERCP was defined as a follow up ERCP done > 7 days after the index ERCP. Patients’ demographics, clinical parameters at the time of the ERCP, and ERCP findings were collected. Logistic regression was used to identify predicting factors of the timing of definitive ERCP. Results: A total of 1611 ERCPs were performed in the study period, of which 613 ERCPs were done for bile duct stones. 91 patients with CBD stone and acute cholangitis underwent temporary biliary stenting for initial management. 8 patients were excluded because they had partial stone clearance before stenting or no subsequent definitive ERCP. 83 patients were included in the analysis: 34 patients had early definitive ERCP (mean age 73; 64.7% male) and 49 patients (mean age 75; 51.0% male) had delayed definitive ERCP for stone clearance. The mean time intervals between the index ERCP and the definitive ERCP were 4.4 days (range 2-7) in the early group and 44.6 days (range 8-162) in the delayed group (Table 1). The proportion of patients with CBD stone 10mm was significantly higher in the delayed definitive ERCP group (41.2% in early group vs 65.3% in delayed group, pZ0.030). While age, presence of hypotension, need for pressor support, intensive care unit admission, and CBD stone 10mm on index ERCP were found to have odds ratios (OR) > 1 on univariate logistic regression analysis for delayed definitive ERCP for stone clearance, only CBD stone 10mm was shown to be a statistically significant predictor on both univariate and multivariate logistic regression (univariate: OR 2.69, p Z 0.031, multivariate: OR 2.50, p Z 0.050) (Table 2). Conclusion: In patients with CBD stone and acute cholangitis managed with temporary biliary stenting, the finding of CBD stone 10mm on index ERCP was a significant predictor for delayed definitive ERCP for stone clearance.
Tu1732 The Usefulness of Argon Plasma Coagulation Ablation Subsequent to Endoscopic SNARE Papillectomy for Ampulla Adenoma Kwangwoo Nam*, Tae Jun Song, Min Keun Cho, Dongwook Oh, Do Hyun Park, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim Gastroenterology, Asan Medical Center, Seoul, Korea (the Republic of) Background and Aims: Endoscopic snare papillectomy (ESP) of major ampulla is safe and effective alternative to surgical resection of ampulla adenoma. Argon plasma coagulation (APC) is widely used in ESP as adjuvant thermal ablation for bleeding control and residual tumor. However, the safety and effectiveness of subsequent APC ablation during ESP are not fully evaluated. The aim of this study is to evaluate the short-term and long-term outcomes of APC ablation as adjuvant therapy of ESP. Patients and Methods: The data of patients who had undergone ESP for ampulla adenoma between September 2005 and August 2015 were retrospectively analyzed. Results: The 114 patients underwent ESP for ampulla adenoma with curative intent. The mean patient age was 5611 years old and 80 (70.2%) patients were male. The mean tumor size was 1.660.83 cm. After ESP, adjuvant APC ablation was performed in 67 (58.8%) patients. There were no significant differences in procedure-related adverse events including pancreatitis (ESP alone vs. ESP+APC group; 14.9% vs. 6.0%, pZ0.196), cholangitis (ESP alone vs. ESP+APC group; 10.6% vs. 1.5%, pZ0.08) or perforation (ESP alone vs. ESP + APC group; 2.1% vs. 1.5%, pZ1.0). However, bleeding events occurred less frequently after APC ablation (ESP alone vs. ESP+APC group; 21.3% vs. 7.5%, odds ratioZ0.298, p<0.05). During follow-up period (mean 907877 days), recurrence rate (ESP alone vs. ESP+APC group; 23.4% vs. 26.9%, pZ0.676) and papillary stenosis (ESP alone vs. ESP+APC group; 4.3% vs. 9.0%, pZ0.467) were not significantly different. Conclusion: During ESP procedure, additional APC ablation may have beneficial effect in decreasing bleeding events.
Tu1733 Needle Knife Precutting Papillotomy Doesn’t Seem to Be a Risk Factor of Post ERCP Pancreatitis at the Selective Biliary Deep Cannulation Hirofumi Kawamoto*, Tomohiro Tanikawa, Noriyo Urata, Takahito Oka, Jun Nakamura, Mitsuhiko Suehiro, Ken Nishino, Miwa Kawanaka, Ken Haruma General Medicine 2, Kawasaki Medical School, Okayama, Japan Background and Aims: To attain the selective biliary cannulation (BC), conventional cannulation (CC) or wire-guided cannulation (WG) or pancreatic guidewire cannulation (PG) are employed in one of these or in combination. Precutting papillotomy (PP) increases the success rate of DC, however it was known as one of the risk factors to induce post-ERCP pancreatitis (PEP). We retrospectively analyzed the outcomes of patients who received ERC-related treatment to identify whether PP is a risk factor or not. Patients and Methods: Between April, 2011 and September, 2015, ERC-related treatment was performed on 511 consecutive patents (223 males, mean
AB622 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
www.giejournal.org