Dietary approaches following endoscopic retrograde cholangiopancreatography: A survey of selected endoscopists

AIM: To describe the dietary recommendations of experienced endoscopists for patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and the factors that influence these recommendations.METHODS: Selected U.S. endoscopists with ERCP experience were surveyed by e-mail. A questionnaire with three hypothetical ERCP cases of patients at low, medium and high risk for development of post-ERCP pancreatitis (PEP) was shown. For each scenario, respondents were asked to recommend a post-procedure diet and time to first oral intake. Respondents were also asked about the effect of various clinical factors on their recommendations, including risk of PEP.RESULTS: 97/187 selected ASGE members (51.9%) responded. When risk of PEP was either low, medium or high, 53%, 88% and 96% recommended a diet of clear liquids/NPO respectively, and 2%, 5% and 18% recommended delaying first oral intake until the following day. About 88% of respondents gave the same type of diet to patients at high as those with moderate-risk of PEP (P = 0.04). However, 37% and 43% of respondents gave different types of diet to patients at low vs moderate-risk and low-risk vs high-risk of PEP respectively (P < 0.001). No statistically significant associations were found regarding the effect of other clinical factors or respondent demographics.CONCLUSION: Most experienced endoscopists limit diet to NPO/clear liquids after ERCP for patients at high or moderate risk of post-ERCP pancreatitis. About half allow a low-fat or regular diet in patients at low risk.     

Neural ganglia visualized by endoscopic ultrasound

OBJECTIVES: To describe visualization of gastrointestinal neural ganglia by endoscopic ultrasound (EUS). METHODS: We retrospectively identified patients in whom neural ganglia were visualized during EUS and the diagnosis of ganglion confirmed by EUS guided fine needle aspiration (FNA) cytology. RESULTS: Ten patients were identified. Celiac ganglia were visualized in nine, and a perirectal ganglion was visualized in one. Ganglia appeared as discrete hypoechoic structures, often with associated hypoechoic threads that may represent neural rami. Aspiration of ganglia yielded scant material and caused transient pain. Ganglia were best visualized with linear array echoendoscopes. Celiac ganglia (but not the perirectal ganglion) were retrospectively identified on computed tomography scans. CONCLUSIONS: Gastrointestinal neural ganglia can be imaged by EUS and their identity confirmed by EUS FNA.     

Improved predictors of outcome in postcholecystectomy pain

BACKGROUND: Endoscopic interventions have limited efficacy in sphincter of Oddi dysfunction (SOD) Type 3. Improved predictors of response to treatment are needed. METHODS: Patients with postcholecystectomy pain underwent a standardized history and physical examination and were then managed individually. Long-term outcome was determined by record review and telephone interview. Initial predictors of response to treatment were assessed. RESULTS: Mean follow-up for the 74 subjects was 36 months. Fifty were improved, and 24 had persistent pain. Patients were likely to respond to sphincterotomy if their pain was not continuous, if it was accompanied by nausea or vomiting, and if there had been a pain free interval after cholecystectomy of at least 1 year. When 2 or 3 of these predictors were present, 85% of SOD Type 2 patients and 56% of Type 3 patients had a good response. Initial history and examination features also predicted response to treatment of neuropathic pain. CONCLUSION: Among patients with postcholecystectomy pain, specific features of the initial history and examination predict response to treatment with higher accuracy than the SOD grade. These predictors identify a subset of Type 3 patients likely to respond to sphincterotomy.