Re: Whipple and ERCP ( Melvyn )

[Guest guest]

Hi Melvyn;

It is possible to do an ERCP with biliary intervention after a

Whipple procedure, but it's best done by experienced endoscopists:

Endoscopy 38(12):1241-5(2006)

Endoscopic retrograde cholangiopancreatography in post-Whipple

patients.

Chahal P, Baron TH, Topazian MD, sen BT, Levy MJ, Gostout CJ

Division of Gastroenterology and Hepatology, Mayo Clinic College of

Medicine, Rochester, MN 55901, USA.

BACKGROUND AND STUDY AIMS: Endoscopic retrograde

cholangiopancreatography (ERCP) is an established modality for

evaluation and treatment of pancreaticobiliary disorders. However, it

is technically more challenging in patients with post-surgical

anatomy. The success rate of ERCP in patients with prior

pancreaticoduodenectomy (Whipple resection) is unknown. We assessed

the technical success and safety of ERCP in this patient population.

PATIENTS AND METHODS: Post pancreaticoduodenectomy patients who had

undergone ERCP between January 2002 and May 2005 were identified

through a computerized medical index system. ERCP was considered

successful if the duct of clinical interest had been cannulated and

endoscopic therapy had been performed when indicated. RESULTS: ERCP

was attempted 88 times in 51 patients with prior

pancreaticoduodenectomy, including 37 procedures for pancreatic

indications, 44 for biliary obstruction, and 7 for both biliary and

pancreatic indications. The overall technical success rate of ERCP

based on the intention behind the procedure was 51 % (45 of the 88

procedures). Success was significantly more likely for biliary

indications (37/44, 84 %) than for pancreatic indications (3/37, 8 %)

( P < or = .001). Complications occurred in 2 % of the procedures and

included one self- contained perforation treated medically and one

Mallory-Weiss tear. CONCLUSIONS: When performed by experienced

endoscopists, ERCP in patients with prior pancreaticoduodenectomy is

safe, with a high success rate for biliary indications and a low

success rate for pancreatic duct indications. Better methods of

achieving pancreatic duct cannulation after pancreaticoduodenectomy

are needed. PMID: 17163326.

Dave

(father of (23); PSC 07/03; UC 08/03)

> 1.Is that possible and ok to do ERCP and Stent when Whipple

procedure is done?

> 2.Will ERCP / Stent succeed for intrahepatic dilation of the

biliary tree ducts?

[Guest guest]

Hi ,

Thanks a lot for your useful post so that I can trust ERCP due to its high success of 84% for biliary indications.

Is there anything certain about ERCP that how long it lasts for intervention of intrahepatic biliary tree ducts? 6 months, 1 yr ? or more? I mean does it really cost to try it?

And how does Stent work ? is it ERCP or it’s something else?

You know I live in Tehran and I don’t think that endoscopists are expert enough for my case so whom in US or Europe can you suggest?

Melvyn

Hi Melvyn;It is possible to do an ERCP with biliary intervention after a Whipple procedure, but it's best done by experienced endoscopists:Endoscopy 38(12):1241- 5(2006)Endoscopic retrograde cholangiopancreatog raphy in post-Whipple patients.Chahal P, Baron TH, Topazian MD, sen BT, Levy MJ, Gostout CJDivision of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55901, USA.BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatog raphy (ERCP) is an established modality for evaluation and treatment of pancreaticobiliary disorders. However, it is technically more challenging in patients with post-surgical anatomy. The success rate of ERCP in patients with prior pancreaticoduodenec tomy (Whipple resection) is unknown. We assessed the technical success and safety of ERCP in this patient population. PATIENTS AND METHODS: Post pancreaticoduodenec tomy patients who had undergone ERCP between January 2002 and May 2005 were identified through a computerized medical index system. ERCP was considered successful if the duct of clinical interest had been cannulated and endoscopic therapy had been performed when indicated. RESULTS: ERCP was attempted 88 times in 51 patients with prior pancreaticoduodenec tomy, including 37 procedures for pancreatic indications, 44 for biliary obstruction, and 7 for both biliary and pancreatic indications. The overall technical success rate of ERCP based on the intention behind the procedure was 51 % (45 of the 88 procedures). Success was significantly more likely for biliary indications (37/44, 84 %) than for pancreatic indications (3/37, 8 %) ( P < or = .001). Complications occurred in 2 % of the procedures and included one self- contained perforation treated medically and one Mallory-Weiss tear. CONCLUSIONS: When performed by experienced endoscopists, ERCP in patients with prior pancreaticoduodenec tomy is safe, with a high success rate for biliary indications and a low success rate for pancreatic duct indications. Better methods of achieving pancreatic duct cannulation after pancreaticoduodenec tomy are needed. PMID: 17163326.Dave (father of (23); PSC 07/03; UC 08/03)> 1.Is that possible and ok to do ERCP and Stent when Whipple procedure is done? > 2.Will ERCP / Stent succeed for intrahepatic dilation of the biliary tree ducts?

[Guest guest]

Hi ,

Thanks a lot for your useful post so that I can trust ERCP due to its high success of 84% for biliary indications.

Is there anything certain about ERCP that how long it lasts for intervention of intrahepatic biliary tree ducts? 6 months, 1 yr ? or more? I mean does it really cost to try it?

And how does Stent work ? is it ERCP or it’s something else?

You know I live in Tehran and I don’t think that endoscopists are expert enough for my case so whom in US or Europe can you suggest?

Melvyn

Hi Melvyn;It is possible to do an ERCP with biliary intervention after a Whipple procedure, but it's best done by experienced endoscopists:Endoscopy 38(12):1241- 5(2006)Endoscopic retrograde cholangiopancreatog raphy in post-Whipple patients.Chahal P, Baron TH, Topazian MD, sen BT, Levy MJ, Gostout CJDivision of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55901, USA.BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatog raphy (ERCP) is an established modality for evaluation and treatment of pancreaticobiliary disorders. However, it is technically more challenging in patients with post-surgical anatomy. The success rate of ERCP in patients with prior pancreaticoduodenec tomy (Whipple resection) is unknown. We assessed the technical success and safety of ERCP in this patient population. PATIENTS AND METHODS: Post pancreaticoduodenec tomy patients who had undergone ERCP between January 2002 and May 2005 were identified through a computerized medical index system. ERCP was considered successful if the duct of clinical interest had been cannulated and endoscopic therapy had been performed when indicated. RESULTS: ERCP was attempted 88 times in 51 patients with prior pancreaticoduodenec tomy, including 37 procedures for pancreatic indications, 44 for biliary obstruction, and 7 for both biliary and pancreatic indications. The overall technical success rate of ERCP based on the intention behind the procedure was 51 % (45 of the 88 procedures). Success was significantly more likely for biliary indications (37/44, 84 %) than for pancreatic indications (3/37, 8 %) ( P < or = .001). Complications occurred in 2 % of the procedures and included one self- contained perforation treated medically and one Mallory-Weiss tear. CONCLUSIONS: When performed by experienced endoscopists, ERCP in patients with prior pancreaticoduodenec tomy is safe, with a high success rate for biliary indications and a low success rate for pancreatic duct indications. Better methods of achieving pancreatic duct cannulation after pancreaticoduodenec tomy are needed. PMID: 17163326.Dave (father of (23); PSC 07/03; UC 08/03)> 1.Is that possible and ok to do ERCP and Stent when Whipple procedure is done? > 2.Will ERCP / Stent succeed for intrahepatic dilation of the biliary tree ducts?

[Guest guest]

Hi ,

Thanks a lot for your useful post so that I can trust ERCP due to its high success of 84% for biliary indications.

Is there anything certain about ERCP that how long it lasts for intervention of intrahepatic biliary tree ducts? 6 months, 1 yr ? or more? I mean does it really cost to try it?

And how does Stent work ? is it ERCP or it’s something else?

You know I live in Tehran and I don’t think that endoscopists are expert enough for my case so whom in US or Europe can you suggest?

Melvyn

Hi Melvyn;It is possible to do an ERCP with biliary intervention after a Whipple procedure, but it's best done by experienced endoscopists:Endoscopy 38(12):1241- 5(2006)Endoscopic retrograde cholangiopancreatog raphy in post-Whipple patients.Chahal P, Baron TH, Topazian MD, sen BT, Levy MJ, Gostout CJDivision of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55901, USA.BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatog raphy (ERCP) is an established modality for evaluation and treatment of pancreaticobiliary disorders. However, it is technically more challenging in patients with post-surgical anatomy. The success rate of ERCP in patients with prior pancreaticoduodenec tomy (Whipple resection) is unknown. We assessed the technical success and safety of ERCP in this patient population. PATIENTS AND METHODS: Post pancreaticoduodenec tomy patients who had undergone ERCP between January 2002 and May 2005 were identified through a computerized medical index system. ERCP was considered successful if the duct of clinical interest had been cannulated and endoscopic therapy had been performed when indicated. RESULTS: ERCP was attempted 88 times in 51 patients with prior pancreaticoduodenec tomy, including 37 procedures for pancreatic indications, 44 for biliary obstruction, and 7 for both biliary and pancreatic indications. The overall technical success rate of ERCP based on the intention behind the procedure was 51 % (45 of the 88 procedures). Success was significantly more likely for biliary indications (37/44, 84 %) than for pancreatic indications (3/37, 8 %) ( P < or = .001). Complications occurred in 2 % of the procedures and included one self- contained perforation treated medically and one Mallory-Weiss tear. CONCLUSIONS: When performed by experienced endoscopists, ERCP in patients with prior pancreaticoduodenec tomy is safe, with a high success rate for biliary indications and a low success rate for pancreatic duct indications. Better methods of achieving pancreatic duct cannulation after pancreaticoduodenec tomy are needed. PMID: 17163326.Dave (father of (23); PSC 07/03; UC 08/03)> 1.Is that possible and ok to do ERCP and Stent when Whipple procedure is done? > 2.Will ERCP / Stent succeed for intrahepatic dilation of the biliary tree ducts?