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- Title
Clinical Approach Strategy in Managing Complex Biliary Cases: Lesson Learned from a Tertiary Referral Private Hospital.
- Authors
Lesmana, Cosmas Rinaldi Adithya; Paramitha, Maria S.; Pratiwi, Yulia E.; Lesmana, Laurentius A.
- Abstract
Background: In the era of laparoscopic procedure, there are innovations in non-surgical management approaches for managing biliary tract disorders, such as therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and interventional endoscopic ultrasound (EUS). There is still no clear consensus yet in step-approach to managing difficult biliary disorders. Therefore, this study was performed to see the impact of endoscopic approach management on the outcomes of complex biliary cases. Method: A retrospective endoscopy database study within two years period was conducted. Characteristics of the study subjects, including demography and clinical data, were presented descriptively. The technical success rate was defined as the completion of the procedure performed on the patients. A bivariate analysis was conducted to evaluate the outcomes of therapy. Results: Sixty-one subjects in this retrospective database study were considered as complex biliary cases. In this study, 16.4% of the subjects underwent a combination of therapeutic ERCP and EUS in one session based on the complexity of the case; and 8.2% of the subjects underwent therapeutic ERCP with additional single operator cholangioscopy procedure. One subject underwent the rendezvous ERCP procedure through a percutaneous approach. Around 4.9% of the subjects underwent EUS-guided biliary drainage procedure. No significant association was observed between all mortality outcomes and baseline characteristics of the patients. There were also no significant associations between re-intervention procedures, as well as post-procedural pain or acute pancreatitis, with mortality outcomes. Conclusion: Complex biliary cases require a good clinical approach algorithm to decide which procedure comes first based on a comprehensive evaluation consisting of the patient's factor, expertise, cost, and the risk of complications.
- Subjects
ENDOSCOPIC ultrasonography; OPERATIVE ultrasonography; ENDOSCOPIC retrograde cholangiopancreatography; ENDOSCOPIC surgery; BILIARY tract; CHOLANGIOGRAPHY; BIVARIATE analysis; CHOLANGITIS
- Publication
Indonesian Journal of Gastroenterology, Hepatology & Digestive Endoscopy, 2024, Vol 25, Issue 1, p2
- ISSN
1411-4801
- Publication type
Article