Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects: a randomized study

Background: The most common adverse event of endoscopic retrograde cholangiopancreatography is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. Some authors have stated that early precut may actually reduce post-ERCP pancreatitis risk. However, early precut as a preventive measure has not been compared to other preventive measures, such as pancreatic duct stent placement. Aim: To compare the efficacy of early precut sphincterotomy versus pancreatic duct stent placement in high-risk subjects undergoing endoscopic retrograde cholangiopancreatography for the prevention of post-endoscopic cholangiopancreatography. Materials and Methods: This was a single-blinded, randomized trial that took place in two tertiary referral centers in Buenos Aires, from November 2011 to December 2013. ERCP subjects presented at least one of the following risk factors: female sex, age less than 40 years, clinical suspicion of sphincter of Oddi dysfunction, previous pancreatitis, and/or common bile duct diameter of less than 8 mm. Only those who presented a difficult biliary cannulation were randomized into two groups: those who received early precut sphincterotomy and those in whom persistency of biliary cannulation was intended, with subsequent pancreatic duct stent placement after cholangiography was achieved. The incidence of post-ERCP pancreatitis, as well as other adverse events incidence, was compared. Results: Overall, 101 patients were enrolled, 51 in the pancreatic duct stent group and 50 in the early precut group. Pancreatitis rate was similar in both groups (3.92% vs. 4%, p NS). In all cases, pancreatitis was classified as mild. There were no deaths registered. Conclusion: Early precut was associated with an incidence of adverse events similar to pancreatic duct stent placement

Hemobilia secundaria a pseudoaneurisma de la arteria hepática

a hemobilia es la presencia de sangre en el árbol biliar ca-racterizada por la tríada: ictericia, dolor en hipocondrio de-recho (HD) y hemorragia digestiva alta (HDA). Las causas etiológicas son varias y se destacan en orden de frecuencia: las traumáticas (trauma hepático accidental y/o iatrogénico), las inflamatorias (colecistitis aguda y crónica), las infecciosas (colangitis, abscesos hepáticos, infecciones parasitarias) y las vasculares (aneurismas, vasculitis, malformaciones arteriove-nosas). Para el diagnóstico se dispone de múltiples exámenes complementarios tales como: imágenes (ecografía abdominal, tomografía computada, angio TC, resonancia magnética), endoscopía y la angiografía, no sólo como herramienta diag-nóstica sino también como modalidad terapéutica de elección. Se presenta el caso clínico de un paciente de sexo masculino, de 52 años de edad, con hemobilia secundaria a un pseudoa-neurisma de la arteria hepática y revisión de la literatura.Palabras claves