Background: Deep sedation is essential during Endoscopic retrograde cholangiopancreatography (ERCP) in order to achieve therapeutic goals and avoid complication. Therefore, providing a suitable sedation is critical for the patients. The most common sedation protocol includes an intravenous (IV) benzodiazepine along with an intravenous narcotic. For the difficult-to-sedate patients, like addicted patients, general anesthesia should be considered as an alternative. Meperidine is commonly used because of the traditional belief that other narcotic agents may be associated with contraction of Oddi. However, it seems that using morphine for addicted patients may cause deeper sedation without Oddi sphincter contraction.Methods: This was a clinical trial study on 88 ERCP-candidate addicted patients assigned into two groups. The case group received morphine before starting ERCP and the control group only received the routine sedation regimen. The degree of sedation, patient movements, and the status of the sphincter of Oddi were evaluated during procedure time.Findings: The data about 44 patients of the case and 40 patients of control groups were analyzed. The mean age was 58.52±1.11 years. Evaluating the degree of sedation every 15 minutes during ERCP showed significant differences between the case and control group. In case group, the degree of sedation was significantly deeper. Furthermore, Oddi sphincter showed a significantly increased contraction in case group. However, only in one patient procedure failed.Conclusion: Administration of morphine in addicted patients can make deeper sedation during ERCP, without any significant problem related to contraction of the sphincter of Oddi.

Background: Post-Endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the life-threatening complications of ERCP. Numerous efforts have been made to decrease the risk of PEP; however, the results were controversial. The current study aimed to assess the efficacy of local epinephrine spray on PEP reduction. Methods: 124 patients undergone ERCP were randomly divided into two groups of intervention (n = 67) and control (n = 57). The intervention group was treated with 20 ml of local epinephrine 0. 02% on papilla immediately after ERCP, and the controls with similar volume of normal saline. Demographic factors, procedure-related factors (duration of procedure, volume of contrast, times of cannulation, precut sphinctrotomy, billiary balloon dilatation, asinarization, opacification, and number of pancreatic duct cannulations), as well as amylase, lipase, and hemoglobin levels at baseline and within 24 hour after the procedure were compared between the groups. Besides, the patients were assessed in terms of pancreatitis, bleeding, and perforation incidence within 12 and 24 hours after ERCP. Findings: The two assessed groups were similar in terms of demographic and procedural-related factors (P > 0. 050). Pancreatitis occurred in 1 patient (1. 5%) in intervention and 6 ones (10. 5%) in control group (P = 0. 036). The two groups were not statistically different in terms of amylase and lipase at baseline and after ERCP. Bleeding occurred only a case (1. 75%) in the control group and no one experienced perforation. Conclusion: Based on the findings of the current study, local epinephrine spray can remarkably lead to decreased pancreatitis incidence as compared to the control group; however, it cannot significantly affect the pancreatic enzymes level and pancreatitis severity.

Pancreatitis is the most common and important complication of Endoscopic retrograde cholangiopancreatography (ERCP). Several risk factors play a role in the formation and progression of pancreatitis. These risk factors may be related to the patient, procedure or operator. All of these risk factors should be considered and should be lowered as far as possible with attention to pathogenesis of the development of post-ERCP pancreatitis. The pathogenesis include sphincter spasm, infection, contrast toxicity and pancreatic secretion that induce the activation of proteolytic enzymesand inflammatory processes. Some methods and pharmacologic agents assessed for the prevention of pathway in the pathogenesis to decrease post-ERCP pancreatitis.

Aims: A catastrophic side effect of retroperitoneal perforation after ERCP is the development of pneumothorax. Due to this fatal unexpected complication, clinicians and gastrointestinal specialists should observe the patients regarding ERCP by proper physical examination. Patient & Methods: The patient was a 52-year-old woman with CBD stone who underwent surgery for severe abdominal pain after ERCP, but because of her general condition deterioration after surgery and the evidence of pneumothorax in chest x-ray, she underwent chest tube insertion and tissue debridement of necrotic tissue. Findings: Pancreatitis is a common complication post-ERCP; However, it tends to be right-sided or bilateral, while in our case, the pneumothorax involves the left side. This scarcity seems to be as a result of the adhesions between the retroperitoneum and anterior aortic sheath as an anatomic barrier. Conclusion: Post-ERCP pneumothorax can occur in different pathophysiological ways, but the most important step in this regard is to identify this ominous complication and take appropriate treatment as soon as possible.

Ampullary neoplasms are one of the causes of obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) is useful procedure for diagnosing and tissue sampling of ampullary neoplasms. Ampullectomy by resecting entire ampulla provides whole lesion for pathologic evaluation and also is appropriate for real pathologic staging for further management decision but ampullectomy considered as a heroic Endoscopic procedure. We share our experience in this field and explain our results.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an Endoscopic method for treatment of many biliary diseases. With respect to rapid recovery and more patient comfort, this procedure is currently performed under light general anesthesia (GA) or conscious sedation. Objectives: The current study aimed to clarify that intravenous sedation or light general anesthesia can be performed without great fear of anesthesia related complications in ERCP patients and sedative doses of propofol can be used safely in outpatient settings under the supervision of an expert anesthesiologist. Methods: This is a cross-sectional study on 1023 ERCP patients under light GA during 2014-2018 in Qom, Shahid Beheshti Hospital. Data were collected by a checklist and were analyzed by using chi-square test in SPSS V. 22. Results: From 1023 patients, 501 (48. 97 %) were male and 522 (51. 03 %) were female with a mean age of 47. 2 ± 6. 7 years. The most common finding in ERCP was choledocholithiasis (76. 15 %). The most common complication was hemodynamic instability (37. 01 %) followed by desaturation (11. 65 %) both of them ware anesthesia related. Prevalence of GI (gastrointestinal) related complications was 13. 39 %. The most common GI related complications were pancreatitis (7. 92 %) and bleeding (3. 32 %). Total mortality rate was 0. 88 %. Conclusions: ERCP-related complications are inevitable but can be controlled by early diagnosis and clinical experience. Severe complications and high risk patients may increase the mortality and morbidity of the procedure. Anesthesia related complications are more frequent than GI related unwanted events. Fortunately, the most common anesthesia related complications are readily manageable and are minor in nature when an expert anesthesiologist is present in the scene. Close monitoring of the patient's vital signs should be the mainstay of the safe procedure.