Borko Nojkov1, Mitchell S Cappell. 1. Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Abstract
BACKGROUND: ERCP after myocardial infarction (MI) or unstable angina (UnA) can potentially entail significant cardiovascular risks. OBJECTIVE: To analyze the safety of ERCP after MI or UnA. DESIGN: Retrospective study. PATIENTS: Adult patients less than 30 days after MI or UnA. SETTING: Three hospitals from 1985 to 2010, encompassing 7600 ERCPs. INTERVENTIONS: ERCP. MAIN OUTCOME MEASUREMENTS: ERCP diagnosis, therapy, efficacy, and complications. RESULTS: Thirteen patients (mean age 77.9 ± 11.4 years) underwent ERCP on average 6.9 ± 7.7 days after MI. ERCP indications were suspected choledocholithiasis/gallstone pancreatitis (n = 10); cholangitis (n = 7); obstructive jaundice with suspected pancreatic mass (n = 1); and biliary stent removal/replacement (n = 2). ERCP revealed choledocholithiasis (n = 8); previous stent (n = 2); and nonpathologic findings (n = 3). Therapies included balloon sweep (n = 11), sphincterotomy (n = 8), visible stones extracted by balloon sweep (n = 8), and biliary stent placement/replacement/removal (n = 3). Two mild complications occurred: hypotension during ERCP successfully treated with ephedrine and obstructing periampullary clot successfully removed at repeat ERCP. Eleven patients subsequently did well (mean hospital discharge 6.5 days after ERCP); 1 patient with metastatic ovarian cancer remained ventilator dependent, and another patient with multiple comorbidities had a fatal pulmonary embolus 10 days after ERCP. Six patients underwent ERCP 7.5 ± 5.2 days after UnA for suspected choledocholithiasis (n = 5) and bile duct injury (n = 1). ERCP findings included choledocholithiasis (n = 3), cystic duct leak (n = 1), ampullary stenosis (n = 1), and nonpathologic findings (n = 1). Sphincterotomy was performed in 5 patients, visible stones were extracted by balloon sweep in 3, and a biliary stent was inserted in 1. One mild complication occurred: hypotension during ERCP which was successfully treated with ephedrine. All 6 patients were discharged (mean 8.0 days after ERCP). LIMITATIONS: Small study size; retrospective study. CONCLUSIONS: This study suggests that therapeutic ERCP involves acceptable risks when performed soon after MI or UnA for suspected choledocholithiasis or other therapeutic indications and may be performed in such situations when strongly indicated.
BACKGROUND: ERCP after myocardial infarction (MI) or unstable angina (UnA) can potentially entail significant cardiovascular risks. OBJECTIVE: To analyze the safety of ERCP after MI or UnA. DESIGN: Retrospective study. PATIENTS: Adult patients less than 30 days after MI or UnA. SETTING: Three hospitals from 1985 to 2010, encompassing 7600 ERCPs. INTERVENTIONS: ERCP. MAIN OUTCOME MEASUREMENTS: ERCP diagnosis, therapy, efficacy, and complications. RESULTS: Thirteen patients (mean age 77.9 ± 11.4 years) underwent ERCP on average 6.9 ± 7.7 days after MI. ERCP indications were suspected choledocholithiasis/gallstone pancreatitis (n = 10); cholangitis (n = 7); obstructive jaundice with suspected pancreatic mass (n = 1); and biliary stent removal/replacement (n = 2). ERCP revealed choledocholithiasis (n = 8); previous stent (n = 2); and nonpathologic findings (n = 3). Therapies included balloon sweep (n = 11), sphincterotomy (n = 8), visible stones extracted by balloon sweep (n = 8), and biliary stent placement/replacement/removal (n = 3). Two mild complications occurred: hypotension during ERCP successfully treated with ephedrine and obstructing periampullary clot successfully removed at repeat ERCP. Eleven patients subsequently did well (mean hospital discharge 6.5 days after ERCP); 1 patient with metastatic ovarian cancer remained ventilator dependent, and another patient with multiple comorbidities had a fatal pulmonary embolus 10 days after ERCP. Six patients underwent ERCP 7.5 ± 5.2 days after UnA for suspected choledocholithiasis (n = 5) and bile duct injury (n = 1). ERCP findings included choledocholithiasis (n = 3), cystic duct leak (n = 1), ampullary stenosis (n = 1), and nonpathologic findings (n = 1). Sphincterotomy was performed in 5 patients, visible stones were extracted by balloon sweep in 3, and a biliary stent was inserted in 1. One mild complication occurred: hypotension during ERCP which was successfully treated with ephedrine. All 6 patients were discharged (mean 8.0 days after ERCP). LIMITATIONS: Small study size; retrospective study. CONCLUSIONS: This study suggests that therapeutic ERCP involves acceptable risks when performed soon after MI or UnA for suspected choledocholithiasis or other therapeutic indications and may be performed in such situations when strongly indicated.