BACKGROUND/OBJECTIVE: Different major duodenal papilla morphology pose various challenges of cannulation and development of ERCP complications. These morphologies may guide the endoscopist in his cannulation approach and complication prevention. The aim of this study is to determine the major duodenal papilla morphologies of ERCP patients in Manila Doctors Hospital and their associated cannulation difficulties, failure, and complications. METHODS: This is a retrospective cross-sectional study of 246 ERCPs at the Manila Doctors Hospital from January 2017 to December 2018 with naive duodenal papillae classified according to Watanabe (2019) as follows: oral protrusion (small, regular, large) and papilla pattern (annular, unstructured, longitudinal, isolated, gyrate). Association of papilla morphology with cannulation difficulties, failure, and complications were analyzed using logistic regression. RESULTS: Among protrusions, small oral protrusions were more difficult to cannulate compared to regular (OR 0.493, p=0.017) and large protrusions (OR 0.702, p=0.426). Large protrusions had the highest risk for failed cannulation (OR 2.04, p=0.445). Among papilla patterns, unstructured papilla patterns had the highest risk for difficult (OR 3, p=0.008) and failed cannulation (OR 7.08, p=0.020). Complications developed in 7 in- patients with 3 (1.73%) post-ERCP pancreatitis, 1 (0.58%) post- sphincterotomy bleeding, and 1 (0.58%) cholangitis and 2 (1.16%) mortalities. One had myocardial infarction 2 days post-ERCP and another had septic shock after 2 days despite endoscopic biliary drainage and antibiotics. CONCLUSION Among protrusions, small oral protrusions had the highest risk for difficult cannulation while large protrusions had the highest risk for failed cannulation. Among papilla patterns, unstructured papilla patterns had the highest risk for difficult and failed cannulation.
ERCP

OBJECTIVE: Cardiac complications are the most important source of morbidity and mortality during and after non-cardiac procedures, especially among diabetic patients. At present, the Philippine General Hospital (PGH) uses the 1977 Goldman Cardiac Risk Index, which includes nine independent variables. In 1999, the Lee Revised Cardiac Index was developed, which incorporated only six clinical variables, including diabetes mellitus. This study compared the accuracy of the two indices in predicting major cardiac complications among patients with diabetes mellitus undergoing major elective non-cardiac surgery.

METHODOLOGY: Non-probability convenience sampling was used. All subjects were interviewed, examined, and risk-stratified using the Goldman and Lee indices. Pre-operative and post-operative 12-lead electrocardiography (ECG) was done. All patients ^ere followed up until the day of discharge and the incidence of major cardiac complications was defined in a checklist.

RESULTS: Major cardiac complications occurred in 13 (14 percent) of the 90 subjects included in the study. Lee Class III was shown to be the best cut-off point for the clinical prediction of major cardiac complications in major non-cardiac surgery, having a positive LR of 2.54. The area under the receiver operating characteristics (ROC) curve for the Lee index was 0.76 (95 percent CI 0.66-0.85, p=0.001), while that for the Goldman index was 0.56 (95 percent CI 0.45-0.66, p=0.53). The difference of 0.21 between the areas under the ROC curve of the two indices was significant (95 percent CI 0.027-0.39, p= 0.025).

CONCLUSION: The Lee index is superior to the Goldman index in predicting major cardiac complications among diabetic patients undergoing major elective non-cardiac surgery who do not have major clinical predictors of increased perioperative cardiovascular risk.

Human ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Diabetes