Comparison of Urologist- vs Gastroenterologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreaticolithiasis.
Comparison of Urologist- vs Gastroenterologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreaticolithiasis.
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DOI：
10.1016/j.cgh.2020.07.042
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Elmunzer BJ
中科院分区：
文献类型：
--
作者：
Jaben IL;Coté GA;Forster E;Moran RA;Broussard KA;Scott N;Cotton PB;Keane T;Elmunzer BJ
体外冲击波碎石术(ESWL)治疗胰胆管结石最常见的是泌尿科医生。我们研究了从泌尿科医生过渡到胃肠医生指导的体外冲击波碎石术对病例复杂性、操作措施和导管清除的影响。我们对2014年至2019年在一个中心接受ESWL治疗胰胆管结石的患者进行了回顾性研究。我们收集了人口学、临床、放射学和程序数据一式两份，并比较了泌尿科医生(2014年1月至2017年2月；18名患者，0.47名患者/月)与胃肠科医生(2017年3月至2019年12月；61名患者；1.79名患者/月)进行手术期间的病例复杂性和处理措施。我们还比较了胰管结石的特征和技术成功的数据(通过成像分析确定的胆管清晰度)。在泌尿科医生和胃肠科医生进行ESWL手术期间，患者的人口统计学、合并症、胰腺结石形态或转诊至ESWL的时间没有差异。患者在胃肠病期间的平均每次ESWL电击次数(4341次)高于泌尿外科期间(3117次)(P<；.001)。胃肠病组(66%)患者接受同一时段逆行胰胆管造影术的比例(66%)高于泌尿科组(6%)(P<；.001)。胃肠病期患者的部分或完全导管清除的比例(71%)高于泌尿科患者的比例(44%)(P=0.04)。在泌尿科期间，ESWL后住院的患者比例较高，尽管这两个时期捕获的不良事件没有差异。从泌尿科医生指导的ESWL过渡到胃肠科医生指导的ESWL并不影响病例复杂性或等待ESWL的时间。然而，过渡确实导致了更多的程序量，更多的电击每一次ESWL治疗，并改善了导管清除。
Extracorporeal shock wave lithotripsy (ESWL) for pancreaticolithiasis is most commonly performed by urologists. We investigated the effects of transitioning from urologist- to gastroenterologist-directed ESWL on case complexity, process measures, and duct clearance. We performed a retrospective study of patients who underwent ESWL for pancreaticolithiasis from 2014 through 2019 at a single center. We collected demographic, clinical, radiographic, and procedural data in duplicate and compared case complexity and process measures between the periods the procedure was performed by urologists (January 2014 through February 2017; 18 patients, 0.47 patients/month) vs gastroenterologists (March 2017 through December 2019; 61 patients; 1.79 patients/month). We also compared data on pancreatic duct stone characteristics and technical success (duct clearance, determined by imaging analysis). There were no differences in patient demographics, comorbidities, pancreatic stone morphology, or time from referral to ESWL during the period the procedure was performed by urologists vs gastroenterologists. Patients received a higher mean number of ESWL shocks per session during the gastroenterology period (4341) than during the urology period (3117) (P < .001). A higher proportion of patients underwent same-session endoscopic retrograde cholangiopancreatography during the gastroenterology time period (66%) than the urology time period (6%) (P < .001). A higher proportion of patients had partial or complete duct clearance during the gastroenterology period (71%) than during the urology period (44%) (P = .04). During the urology period, a higher proportion of patients were hospitalized following ESWL, although there was no difference in captured adverse events between the periods. Transition from urologist- to gastroenterologist-directed ESWL did not affect case complexity or wait times for ESWL. However, the transition did result in increased procedure volume, more shocks per ESWL session, and improved duct clearance.
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影响因子：
7.7
作者：
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通讯作者：
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影响因子：
120.7
作者：
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影响因子：
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作者：
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影响因子：
3.4
作者：
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1.4
作者：
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