Re: ERCPs and Contrast Dyes Questions

[Guest guest]

Hi,

My first several ERCPs were not successfully completed because my ducts swelled

shut. I don't know that the dye was the cause though. I have also had several

bouts of post-ERCP pancreatitis. None of my hospital stays lasted 10 days

though. I think 4 was my longest. My last ERCP was so non-eventful that I got to

go home the same day! That was a first. They give me profilactive antibiotics,

put me under general anesthesia, give me something for pain (I'm allergic to

morphine and demerol), something else to control the itching, and something else

to control the severe nausea. whatever the combination they do worked about as

well as one could hope for in our circumstances. Sorry I can't tell you how many

I've had. Three pre-dx, then yearly after 2000. Why are they doing the liver

biopsy? I only ever had one when they were trying to dx---I had two, six years

apart. They don't help much in the case of PSC. I feel safer getting the

scraping done to check for cancer that they do during a

successful ERCP. MRCPs (I've had 2) can't do that. I hope all works out for

you, Take care, Cheryl ID, PSC/AIH, UC, fibromyalgia, etc.

> Hi,

>

> I am getting ready to have my second ERCP in a couple of weeks. The

> last time I had the test was in January of 1992, and they had to abort

> the procedure because I had a reaction to the dye, and ended up with

> significant pancreatitis (and a 10 day hospitalization).

>

>

>

[Guest guest]

darcy-

i think you are right. all these problems are because many doctors don't have the ercp experience. i am sure of this. my doctor does them all day long several times a week. he has a light touch and people even come from out of state to have him do ercp. when another gastro could not help me after an egd he sent me to my doctor. in fact, he won an award for the top docs in the u.s. if you guys have problems with ercps do what darcy did. go find a more experienced doctor. i was banded once by my hep instead of my gastro and it really hurt. when i have an ercp i have twilight sleep and walk to my car every single time. i have never spent the night at the hospital. think about it you guys. i hate for you to be afraid to get this treatment. it works great. just ask chris klug.Create a Home Theater Like the Pros. Watch the video on AOL Home.

[Guest guest]

darcy-

i think you are right. all these problems are because many doctors don't have the ercp experience. i am sure of this. my doctor does them all day long several times a week. he has a light touch and people even come from out of state to have him do ercp. when another gastro could not help me after an egd he sent me to my doctor. in fact, he won an award for the top docs in the u.s. if you guys have problems with ercps do what darcy did. go find a more experienced doctor. i was banded once by my hep instead of my gastro and it really hurt. when i have an ercp i have twilight sleep and walk to my car every single time. i have never spent the night at the hospital. think about it you guys. i hate for you to be afraid to get this treatment. it works great. just ask chris klug.Create a Home Theater Like the Pros. Watch the video on AOL Home.

[Guest guest]

darcy-

i think you are right. all these problems are because many doctors don't have the ercp experience. i am sure of this. my doctor does them all day long several times a week. he has a light touch and people even come from out of state to have him do ercp. when another gastro could not help me after an egd he sent me to my doctor. in fact, he won an award for the top docs in the u.s. if you guys have problems with ercps do what darcy did. go find a more experienced doctor. i was banded once by my hep instead of my gastro and it really hurt. when i have an ercp i have twilight sleep and walk to my car every single time. i have never spent the night at the hospital. think about it you guys. i hate for you to be afraid to get this treatment. it works great. just ask chris klug.Create a Home Theater Like the Pros. Watch the video on AOL Home.

[Guest guest]

If you're allergic to the contrast media (iodine containing), you'll have an

allergic reaction. If it's a known reaction, it can be treated before the

procedure with steroids and Benadryl. MRCP does not require a contrast dye, but

it also cannot provide a therapeutic solution (dilatation and stenting). As far

as I know, if you do not use a contrast dye, you cannot image the bile ducts via

ERCP.

I've had three ERCPs. The first two resulted in pancreatitis - one at a local

metro hospital, and one at Mayo. The third one was for stent removal (at Mayo),

with no pancreatitis. I'd say the first one was minimally experienced with

ERCPs, as he could not dilate my CBD. The second two were done at Mayo, by an

endoscopist that ONLY does ERCPs (at 2:00 PM, I was his 12th of the day!). They

had no problems dilating and stenting (7 mm French).

The risk factors for post-ERCP pancreatitis are known. This abstract

(http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.2006.00380.x)

states:

Chi-Liang Cheng M.D, Stuart Sherman M.D, L. Watkins M.D, Barnett

M.D, Freeman M.D, ph Geenen M.D, M.D, on

M.D, T. Frakes M.D, Evan L. Fogel M.D, B. Silverman M.D, Kulwinder

S. Dua M.D, Giuseppe Aliperti M.D, Yakshe M.D, Uzer M.D, Whitney

M.D, Goff M.D, Lazzell-Pannell RN, Abdullah Rashdan M.D,

M'hamed Temkit MS, Glen A. Lehman M.D (2006) Risk Factors for Post-ERCP

Pancreatitis: A Prospective Multicenter Study

The American Journal of Gastroenterology 101 (1) , 139–147

doi:10.1111/j.1572-0241.2006.00380.x

RESULTS: Of the 1,115 patients enrolled, diagnostic ERCP with or without

sphincter of Oddi manometry (SOM) was performed in 536 (48.1%) and therapeutic

ERCP in 579 (51.9%). Suspected sphincter of Oddi dysfunction (SOD) was the

indication for the ERCP in 378 patients (33.9%). Pancreatitis developed in 168

patients (15.1%) and was graded mild in 112 (10%), moderate in 45 (4%), and

severe in 11(1%). There was no difference in the incidence of pancreatitis or

the frequency of investigated potential pancreatitis risk factors between the

corticosteroid and placebo groups. By univariate analysis, the incidence of

post-ERCP pancreatitis was significantly higher in 19 of 30 investigated

variables. In the multivariate risk model, significant risk factors with

adjusted odds ratios (OR) were: minor papilla sphincterotomy (OR: 3.8),

suspected SOD (OR: 2.6), history of post-ERCP pancreatitis (OR: 2.0), age <60 yr

(OR: 1.6), ≥2 contrast injections into the pancreatic duct (OR: 1.5), and

trainee involvement (OR: 1.5). Female gender, history of recurrent idiopathic

pancreatitis, pancreas divisum, SOM, difficult cannulation, and major papilla

sphincterotomy (either biliary or pancreatic) were not multivariate risk factors

for post-ERCP pancreatitis.

CONCLUSION: This study emphasizes the role of patient factors (age, SOD, prior

history of post-ERCP pancreatitis) and technical factors (number of PD

injections, minor papilla sphincterotomy, and operator experience) as the

determining high-risk predictors for post-ERCP pancreatitis.

Arne

56 - US 1977 - PSC 2000

---- Darcy Melzer dmelzer514@...> wrote:

I am wondering if anyone has had a similar situation, and then had to

have an additional ERCP (after a traumatic first one)? If so, were

they able to use different contrast methods, or able to use the scope

without any dye at all?

[Guest guest]

If you're allergic to the contrast media (iodine containing), you'll have an

allergic reaction. If it's a known reaction, it can be treated before the

procedure with steroids and Benadryl. MRCP does not require a contrast dye, but

it also cannot provide a therapeutic solution (dilatation and stenting). As far

as I know, if you do not use a contrast dye, you cannot image the bile ducts via

ERCP.

I've had three ERCPs. The first two resulted in pancreatitis - one at a local

metro hospital, and one at Mayo. The third one was for stent removal (at Mayo),

with no pancreatitis. I'd say the first one was minimally experienced with

ERCPs, as he could not dilate my CBD. The second two were done at Mayo, by an

endoscopist that ONLY does ERCPs (at 2:00 PM, I was his 12th of the day!). They

had no problems dilating and stenting (7 mm French).

The risk factors for post-ERCP pancreatitis are known. This abstract

(http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.2006.00380.x)

states:

Chi-Liang Cheng M.D, Stuart Sherman M.D, L. Watkins M.D, Barnett

M.D, Freeman M.D, ph Geenen M.D, M.D, on

M.D, T. Frakes M.D, Evan L. Fogel M.D, B. Silverman M.D, Kulwinder

S. Dua M.D, Giuseppe Aliperti M.D, Yakshe M.D, Uzer M.D, Whitney

M.D, Goff M.D, Lazzell-Pannell RN, Abdullah Rashdan M.D,

M'hamed Temkit MS, Glen A. Lehman M.D (2006) Risk Factors for Post-ERCP

Pancreatitis: A Prospective Multicenter Study

The American Journal of Gastroenterology 101 (1) , 139–147

doi:10.1111/j.1572-0241.2006.00380.x

RESULTS: Of the 1,115 patients enrolled, diagnostic ERCP with or without

sphincter of Oddi manometry (SOM) was performed in 536 (48.1%) and therapeutic

ERCP in 579 (51.9%). Suspected sphincter of Oddi dysfunction (SOD) was the

indication for the ERCP in 378 patients (33.9%). Pancreatitis developed in 168

patients (15.1%) and was graded mild in 112 (10%), moderate in 45 (4%), and

severe in 11(1%). There was no difference in the incidence of pancreatitis or

the frequency of investigated potential pancreatitis risk factors between the

corticosteroid and placebo groups. By univariate analysis, the incidence of

post-ERCP pancreatitis was significantly higher in 19 of 30 investigated

variables. In the multivariate risk model, significant risk factors with

adjusted odds ratios (OR) were: minor papilla sphincterotomy (OR: 3.8),

suspected SOD (OR: 2.6), history of post-ERCP pancreatitis (OR: 2.0), age <60 yr

(OR: 1.6), ≥2 contrast injections into the pancreatic duct (OR: 1.5), and

trainee involvement (OR: 1.5). Female gender, history of recurrent idiopathic

pancreatitis, pancreas divisum, SOM, difficult cannulation, and major papilla

sphincterotomy (either biliary or pancreatic) were not multivariate risk factors

for post-ERCP pancreatitis.

CONCLUSION: This study emphasizes the role of patient factors (age, SOD, prior

history of post-ERCP pancreatitis) and technical factors (number of PD

injections, minor papilla sphincterotomy, and operator experience) as the

determining high-risk predictors for post-ERCP pancreatitis.

Arne

56 - US 1977 - PSC 2000

---- Darcy Melzer dmelzer514@...> wrote:

I am wondering if anyone has had a similar situation, and then had to

have an additional ERCP (after a traumatic first one)? If so, were

they able to use different contrast methods, or able to use the scope

without any dye at all?

[Guest guest]

Hello "Iregener",

I certainly don't wish to frighten you any further... but this is another side of the complication coin.

I have had one ERCP - performed by one of the most experienced endoscopists in Holland - which resulted in an infected, necrotising pancreatitis and a ruptured duodenum. This complication very nearly killed me and I spent nearly 14 weeks in hospital, some of those weeks in the ICU. I have been left with some serious disabilities as a result of the MOFS/MODS (multi-organ failure/multi-organ dysfunction syndrome). I need a multitude of drugs, including immunosuppression, to keep chronic heart failure, pulmonary fibrosis, an increase since then in ALL inflammatory parameters, increased UC problems including hyperplastic masses in my rectum, increased spondyloarthritis problems, now requiring permanent custom bracing of the right leg, cataracts, Lupus, dermatological problems, crippling fatigue etc etc. I have had my career destroyed as I had to go into the disability system and I am physically badly restricted. I have already moved to one level living as I can no longer manage the stairs. I live alone and have increasing difficulties doing my shopping, housework... all the "routine" things in life.

I am told I have SIRS - systemic immune response syndrome.

I am 57 and this happened to me when I was 50......

I have had 2 MRCP's since then... there is NO WAY I will EVER allow another ERCP, I would not survive such a compilcation a 2nd time. The 2nd MRCP used Gadolinium to delineate the bile ducts - I developed an allergic reaction to the Gadolinium... so that's out too.

I have decided that in the circumstances I will "ignore" all the liver stuff and no longer even go for check-ups with a hepatologist. There is really no point. My GI, GP and all my other (now necessary) specialists "understand" my decision and are supportive.......

Good luck with your procedure.

DutchPat.

PS. My personal viewpoint from a very close perusal of the literature over the years, is that the statement "that they have never had a patient get pancreatitis from an ERCP" is misleading at best and unprofessional at worst. There isn't one single branch of medicine that experiences "no complications"........

That they don't want to worry you unduly is one thing, giving you an "ostrich" statement is something else all together. Even in the best hands and with no discernible (my case) problems, disasters can and do occur. Luckily not often, but......................

ERCPs and Contrast Dyes Questions

Posted by: "lregener" lregener@... lregener

Mon Mar 31, 2008 8:45 pm (PDT)

Hi,I am getting ready to have my second ERCP in a couple of weeks. Thelast time I had the test was in January of 1992, and they had to abortthe procedure because I had a reaction to the dye, and ended up withsignificant pancreatitis (and a 10 day hospitalization). I swore Iwould never swallow the tube again after that, so I did have the MRCP,which had a definitive finding of PSC.I am wondering if anyone has had a similar situation, and then had tohave an additional ERCP (after a traumatic first one)? If so, werethey able to use different contrast methods, or able to use the scopewithout any dye at all?The doctor who is doing the procedure is unreachable, and his gatekeepers keep assuring me that they have never had a patient getpancreatitis from an ERCP. But clearly, now they do. I am that patient.I am also thinking about backing out of the whole thing. I am alsoscheduled for a liver biopsy in April as well (which I have no problemwith). Does anyone have any feedback or words of wisdom that you wouldbe willing to pass along?ly I am pretty scared about this whole thing, and my gut (no punintended) says just walk away..... Many thanks.