Cross-sectional imaging of common and unusual complications after endoscopic retrograde cholangiopancreatography
Tóm tắt
Endoscopic retrograde cholangiopancreatography (ERCP) is currently a primarily therapeutic procedure that is extensively employed to treat several biliopancreatic disorders. Although widely considered a safe procedure, ERCP is associated with a non-negligible morbidity and occasional mortality. Due to the number and complexity of operative ERCPs performed, radiologists are increasingly faced with urgent requests for investigation of suspected post-procedural complications, which often have similar clinical and laboratory manifestations. This pictorial essay reviews the usual post-procedural CT findings, the clinical features and imaging appearances of common and unusual post-ERCP occurrences including interstitial oedematous and necrotising acute pancreatitis, haemorrhages, retroperitoneal and intraperitoneal duodenal perforations, infections and stent-related complications. Emphasis is placed on the pivotal role of multidetector CT, which is warranted after complex or prolonged ERCP procedures as it represents the most effective modality to detect and grade ERCP-related complications and to monitor nonsurgically treated patients. Timely diagnosis and optimal management require a combination of clinical and laboratory data with imaging appearances; therefore, this article aims to provide an increased familiarity with interpretation of early post-ERCP studies, particularly to triage those occurrences that require interventional or surgical treatment. In selected patients MRI allows imaging pancreatitis and abnormal collections without the use of ionising radiation.
Teaching Points
• Endoscopic retrograde cholangiopancreatography (ERCP) allows treating many biliopancreatic disorders. • Due to the number and complexity of procedures, post-ERCP complications are increasingly encountered. • Main complications include acute pancreatitis, haemorrhages, duodenal perforation and infections. • Diagnosis and management of complications rely on combined clinical, laboratory and imaging data. • Multidetector CT is most effective to diagnose, categorise and monitor post-ERCP complications.
Tài liệu tham khảo
Adler DG, Baron TH, Davila RE et al (2005) ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 62:1–8
Silviera ML, Seamon MJ, Porshinsky B et al (2009) Complications related to endoscopic retrograde cholangiopancreatography: a comprehensive clinical review. J Gastrointestin Liver Dis 18:73–82
Glomsaker TB, Hoff G, Kvaloy JT et al (2013) Patient-reported outcome measures after endoscopic retrograde cholangiopancreatography: a prospective, multicentre study. Scand J Gastroenterol 48:868–876
Siriwardana HP, Siriwardena AK (2005) Systematic appraisal of the role of metallic endobiliary stents in the treatment of benign bile duct stricture. Ann Surg 242:10–19
van Boeckel PG, Vleggaar FP, Siersema PD (2009) Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review. BMC Gastroenterol 9:96
Anderson MA, Fisher L, Jain R et al (2012) Complications of ERCP. Gastrointest Endosc 75:467–473
Kapral C, Duller C, Wewalka F et al (2008) Case volume and outcome of endoscopic retrograde cholangiopancreatography: results of a nationwide Austrian benchmarking project. Endoscopy 40:625–630
Stapfer M, Selby RR, Stain SC et al (2000) Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 232:191–198
Kwon CI, Song SH, Hahm KB et al (2013) Unusual complications related to endoscopic retrograde cholangiopancreatography and its endoscopic treatment. Clin Endosc 46:251–259
Glomsaker T, Hoff G, Kvaloy JT et al (2013) Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography. Br J Surg 100:373–380
Cotton PB (2006) Analysis of 59 ERCP lawsuits; mainly about indications. Gastrointest Endosc 63:378–382, quiz 464
Sartelli M, Viale P, Catena F et al (2013) 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg 8:3
Pannu HK, Fishman EK (2001) Complications of endoscopic retrograde cholangiopancreatography: spectrum of abnormalities demonstrated with CT. Radiographics 21:1441–1453
Paspatis GA, Dumonceau JM, Barthet M et al (2014) Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy 46:693–711
Wax BN, Katz DS, Badler RL et al (2006) Complications of abdominal and pelvic procedures: computed tomographic diagnosis. Curr Probl Diagn Radiol 35:171–187
Woods RW, Akshintala VS, Singh VK et al (2014) CT severity of post-ERCP pancreatitis: results from a single teriary medical center. Abdom Imaging 39:1162–1168
Catalano O, De Bellis M, Sandomenico F et al (2012) Complications of biliary and gastrointestinal stents: MDCT of the cancer patient. AJR Am J Roentgenol 199:W187–W196
Dubecz A, Ottmann J, Schweigert M et al (2012) Management of ERCP-related small bowel perforations: the pivotal role of physical investigation. Can J Surg 55:99–104
Zissin R, Shapiro-Feinberg M, Oscadchy A et al (2000) Retroperitoneal perforation during endoscopic sphincterotomy: imaging findings. Abdom Imaging 25:279–282
Tonolini M (2014) Reversible acute duodenitis as a complication of endoscopic biliary stenting. J Gastrointestin Liver Dis 23:8
Dumonceau JM, Andriulli A, Elmunzer BJ et al (2014) Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline-updated June 2014. Endoscopy 46:799–815
Zaheer A, Singh VK, Qureshi RO et al (2013) The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines. Abdom Imaging 38:125–136
Sheu Y, Furlan A, Almusa O et al (2012) The revised Atlanta classification for acute pancreatitis: a CT imaging guide for radiologists. Emerg Radiol 19:237–243
Pezzilli R, Romboli E, Campana D et al (2002) Mechanisms involved in the onset of post-ERCP pancreatitis. JOP 3:162–168
Pfau PR, Mosley RG, Said A et al (2006) Comparison of the effect of non-ionic and ionic contrast agents on pancreatic histology in a canine model. JOP 7:27–33
Johnson GK, Geenen JE, Johanson JF et al (1997) Evaluation of post-ERCP pancreatitis: potential causes noted during controlled study of differing contrast media. Midwest Pancreaticobiliary Study Group. Gastrointest Endosc 46:217–222
Goebel C, Hardt P, Doppl W et al (2000) Frequency of pancreatitis after endoscopic retrograde cholangiopancreatography with iopromid or iotrolan: a randomized trial. Eur Radiol 10:677–680
George S, Kulkarni AA, Stevens G et al (2004) Role of osmolality of contrast media in the development of post-ERCP pancreatitis: a metanalysis. Dig Dis Sci 49:503–508
Miller FH, Keppke AL, Dalal K et al (2004) MRI of pancreatitis and its complications: part 1, acute pancreatitis. AJR Am J Roentgenol 183:1637–1644
de Freitas Tertulino F, Schraibman V, Ardengh JC et al (2014) Diffusion-weighted magnetic resonance imaging indicates the severity of acute pancreatitis. Abdom Imaging
Horton KM, Jeffrey RB Jr, Federle MP et al (2009) Acute gastrointestinal bleeding: the potential role of 64 MDCT and 3D imaging in the diagnosis. Emerg Radiol 16:349–356
Jaeckle T, Stuber G, Hoffmann MH et al (2008) Acute gastrointestinal bleeding: value of MDCT. Abdom Imaging 33:285–293
So YH, Choi YH, Chung JW (2012) Selective embolization for post-endoscopic sphincterotomy bleeding: technical aspects and clinical efficacy. Korean J Radiol 13:73–81
Katsinelos P, Kountouras J, Chatzimavroudis G (2010) Endoscopic hemostasis using monopolar coagulation for postendoscopic sphincterotomy bleeding refractory to injection treatment. Surg Laparosc Endosc Percutan Tech 20:84–88
Tsou YK, Lin CH, Liu NJ (2009) Treating delayed endoscopic sphincterotomy-induced bleeding: epinephrine injection with or without thermotherapy. World J Gastroenterol 15:4823–4828
Maleux G, Bieden J, Laenen A et al (2014) Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome. Eur Radiol 24:2779–2786
Kim J, Lee SH, Paik WH et al (2012) Clinical outcomes of patients who experienced perforation associated with endoscopic retrograde cholangiopancreatography. Surg Endosc 26:3293–3300
Miller R, Zbar A, Klein Y et al (2013) Perforations following endoscopic retrograde cholangiopancreatography: a single institution experience and surgical recommendations. Am J Surg 206:180–186
Avgerinos DV, Llaguna OH, Lo AY et al (2009) Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations. Surg Endosc 23:833–838
Machado NO (2012) Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article. JOP 13:18–25
Polydorou A, Vezakis A, Fragulidis G et al (2011) A tailored approach to the management of perforations following endoscopic retrograde cholangiopancreatography and sphincterotomy. J Gastrointest Surg 15:2211–2217
Rabie ME, Mir NH, Al Skaini MS et al (2013) Operative and non-operative management of endoscopic retrograde cholangiopancreatography-associated duodenal injuries. Ann R Coll Surg Engl 95:285–290
Matlock J, Freeman ML (2005) Endoscopic therapy of benign biliary strictures. Rev Gastroenterol Disord 5:206–214
Judah JR, Draganov PV (2007) Endoscopic therapy of benign biliary strictures. World J Gastroenterol 13:3531–3539