In Encoscopic Retrograde Cholangiopancreatography(ERCP),the main concern is to gain access into the bile duct while avoiding the pancreatic duct because of the risk of post-ERCP pancreatitis.Diffi cult cannulation is ...In Encoscopic Retrograde Cholangiopancreatography(ERCP),the main concern is to gain access into the bile duct while avoiding the pancreatic duct because of the risk of post-ERCP pancreatitis.Diffi cult cannulation is defined as a situation where the endoscopist,using his/her regularly used cannulation technique,fails within a certain time limit or after a certain number of unsuccessful attempts.Different methods have been developed to manage diffi cult cannulation.The most common solution is to perform a precut papillotomy either with a needle knife or with a sphincterotome with or without a guide wire.This review describes different methods to overcome cases of difficult cannulation.We will discuss the success rate and complication rates associated with different methods of reaching the biliary tract.展开更多
Diarrhea is a common side effect of chemotherapy.Pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed,albeit rarely,with certain chemotherapeutic agents.We present fo...Diarrhea is a common side effect of chemotherapy.Pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed,albeit rarely,with certain chemotherapeutic agents.We present four cases of severe colitis in patients undergoing treatment with taxane-based chemotherapy for pancreatic,lung and breast cancer.None of them had recently received antibiotics.One patient presented with a bowel perforation and three had endoscopic findings of pseudomembranous colitis.Two of these three patients had negative stool toxin assays for Clostridium difficile.In the patient presenting with perforation,an emergency left hemicolectomy was performed and the pathological findings in the colon were acute inflammation and ischemic necrosis;the other three patients were treated with oral vancomycin and/or oral or intravenous metronidazole leading to complete resolution of the symptoms.Apart from pseudomembranous colitis,we describe patients presenting with neutropenic enterocolitis as well as ischemic colitis after docetaxel use.These cases provide some insight into the spectrum and varied clinical presentations of severe colitis associated with taxane-based chemotherapy.展开更多
文摘In Encoscopic Retrograde Cholangiopancreatography(ERCP),the main concern is to gain access into the bile duct while avoiding the pancreatic duct because of the risk of post-ERCP pancreatitis.Diffi cult cannulation is defined as a situation where the endoscopist,using his/her regularly used cannulation technique,fails within a certain time limit or after a certain number of unsuccessful attempts.Different methods have been developed to manage diffi cult cannulation.The most common solution is to perform a precut papillotomy either with a needle knife or with a sphincterotome with or without a guide wire.This review describes different methods to overcome cases of difficult cannulation.We will discuss the success rate and complication rates associated with different methods of reaching the biliary tract.
文摘Diarrhea is a common side effect of chemotherapy.Pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed,albeit rarely,with certain chemotherapeutic agents.We present four cases of severe colitis in patients undergoing treatment with taxane-based chemotherapy for pancreatic,lung and breast cancer.None of them had recently received antibiotics.One patient presented with a bowel perforation and three had endoscopic findings of pseudomembranous colitis.Two of these three patients had negative stool toxin assays for Clostridium difficile.In the patient presenting with perforation,an emergency left hemicolectomy was performed and the pathological findings in the colon were acute inflammation and ischemic necrosis;the other three patients were treated with oral vancomycin and/or oral or intravenous metronidazole leading to complete resolution of the symptoms.Apart from pseudomembranous colitis,we describe patients presenting with neutropenic enterocolitis as well as ischemic colitis after docetaxel use.These cases provide some insight into the spectrum and varied clinical presentations of severe colitis associated with taxane-based chemotherapy.
