Gut Liver.  2014 Nov;8(6):674-679. 10.5009/gnl13301.

Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Acute Coronary Syndrome

• Koh HR
• Park CH
• Chung MW
• Park SY
• Hong YJ
• Jeong MH
• Kim HS
• Choi SK
• Rew JS

• KMID: 2070087
• DOI: http://doi.org/10.5009/gnl13301

Abstract

BACKGROUND/AIMS
Endoscopic retrograde cholangiopancreatography (ERCP) is considered a high-risk procedure in patients with previous acute coronary syndrome (ACS); however, clinical studies are rare in the literature. The aim of this study was to investigate the safety and efficacy of ERCP in patients with previous ACS.
METHODS
We retrospectively reviewed the medical records of patients with previous ACS who underwent ERCP between January 2007 and August 2012. The clinical characteristics, ERCP diagnoses, treatment results, and complications were analyzed.
RESULTS
Fifty patients underwent ERCP an average of 41.6 months after ACS. The most common indication for ERCP was calculous cholangitis. After deep biliary cannulation, endoscopic sphincterotomy, biliary stone removal and endoscopic biliary drainage were successfully performed. Immediate postsphincterotomy bleeding occurred in seven patients, which was successfully controlled using endoscopic therapy. Elevation of cardiac troponin I levels were observed in three patients (6%) before ERCP, and all of these patients were diagnosed with pancreatobiliary disease combined with recurrent ACS, which was treated with coronary artery stent insertion (n=2) and balloon angioplasty (n=1).
CONCLUSIONS
Therapeutic ERCP is effective and safe in patients with previous ACS. Cardiac troponin I elevation should be considered a warning sign for recurrent ACS in patients who undergo ERCP.

Keyword

Cholangiopancreatography, endoscopic retrograde; Acute coronary syndrome; Troponin I

MeSH Terms

Acute Coronary Syndrome/*blood/complications/therapy
Aged
Aged, 80 and over
Ampulla of Vater/*surgery
Angioplasty, Balloon, Coronary
Carcinoma/*surgery
Cholangiopancreatography, Endoscopic Retrograde/*methods
Cholangitis/etiology/*surgery
Cholelithiasis/complications/*surgery
Common Bile Duct Neoplasms/*surgery
Drainage
Female
Humans
Male
Middle Aged
Recurrence
Retrospective Studies
Risk Assessment
Sphincterotomy, Endoscopic
Stents
Troponin I/*blood
Troponin I