I know it’s a lot, but this is chaos magick at work. What is your deepest regret? How does it create a longing within you to make amends? Hypothetically – not literally – but if this was the end of the world, what would your most pressing and driving desire be? Retrograde moments are all about the “re-” aspect: rewind, remember, rework. When the planets are retrograde, they are as close as possible to the Earth, so they affect us on a transcendental (but also primal) level. The fact that this happens after the United States election and right before the inauguration is intense. Mars will stay retrograde until November 13th of this year and then hang out in sword-clanging Aries until early January of next year. Mars went Retrograde in Aries on September 9th. To be fair, to be blunt, and to be a tough-love-yet-essentially-optimistic friend, those days are upon us. The celestial forecast has you blasting Lingua Ignota, buying your new all-black Mad Max wardrobe, and looking for properties along the Canadian border, just in case you need to make a quick exit into kinder territory before the end of the world. 2001 54:425–434.There are some days where, as an astrologer in 2020, you are seven cups of herbal tea deep into fighting off an astro-inspired panic attack. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. 2011 98:1766–1774.įreeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Nationwide study of the treatment of common bile duct stones in Sweden between 19. Are we meeting the standards set for endoscopy? Gut. Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D, Riley SA, Veitch P, Wilkinson M, Williamson PR, Lombard M BSG Audit of ERCP. Evolution in the utilization of biliary interventions in the United States: results of a nationwide longitudinal study from 1998 to 2013. Huang RJ, Thosani NC, Barakat MT, Choudhary A, Mithal A, Singh G, Sethi S, Banerjee S. All rights reserved.ĪSGE Standards of Practice Committee, Chandrasekhara Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, Eloubeidi MA, Fanelli RD, Faulx AL, Gurudu SR, Kothari S, Lightdale JR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM. Published by Baishideng Publishing Group Inc. This may inform selection of experienced, high-volume endoscopists to perform these complex procedures.īiliary cannulation Complexity Endoscopic retrograde cholangiopancreatography Endoscopy Goff trans-pancreatic septotomy Needle knife precut sphincterotomy. These data suggest that complexity of cannulation at ERCP may be predicted based on patient/ampulla characteristics. Patients undergoing ERCP were older in 2018 compared to 2008 (69.7 ± 15.2 years vs 55.1 ± 14.7, P 4 cm, pancreatic uncinate mass, and bilirubin > 10 mg/dL predicted use of advanced cannulation techniques ( P < 0.03 for each).Ĭomplexity of cannulation at ERCP has sharply increased over the past 5 years, with an increased proportion of elderly patients and those with malignancy requiring advanced cannulation approaches. Cannulation approaches were classified as "standard" or "advanced" and duodenoscope position was labeled as "standard" (short position) or "non-standard" ( e.g., long, semi-long). To evaluate this phenomenon of perceived escalation in complexity of cannulation at ERCP and assessed potential underlying factors.ĭemographic/clinical variables and records of ERCP patients at the beginning (2008), middle (2013) and end (2018) of the last decade were reviewed retrospectively. This trend is noted despite increased endoscopist experience and annual ERCP volume over the same period. At our academic tertiary care medical center, we have noted patients referred for endoscopic retrograde cholangiopancreatography (ERCP) who increasingly require advanced cannulation techniques.
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