ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
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DOI：
10.1055/a-1075-4080
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发表时间：
2020-02-01
期刊：
影响因子：
9.3
通讯作者：
van Hooft, Jeanin E.
中科院分区：
文献类型：
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作者：
Dumonceau, Jean-Marc;Kapral, Christine;van Hooft, Jeanin E.
主要建议预防1 ESGE建议所有无非甾体抗炎药禁忌症的患者在内镜逆行胰胆管造影术（ERCP）前立即常规直肠给予100 mg双氯芬酸或吲哚美辛。强烈推荐，中等质量证据。2 ESGE建议在选定的ERCP术后胰腺炎高风险患者中进行预防性胰腺支架植入术（导丝意外插入/胰管不透明，双导丝插管）。强烈推荐，中等质量证据。3 ESGE建议在插入单个塑料支架或未覆盖/部分覆盖的自膨式金属支架以缓解胆道梗阻之前，不要进行常规内镜下胆道括约肌切开术。弱推荐，中等质量证据。4 ESGE建议不要在ERCP前常规使用抗生素预防。强烈推荐，中等质量证据。5 ESGE建议在预期胆道引流不完全的情况下，对于严重免疫功能低下的患者，以及在进行胆管镜检查时，在ERCP前预防抗生素。弱推荐，中等质量证据。6 ESGE提示，对于未使用抗凝剂且无黄疸的患者，在ERCP前无需常规进行凝血检查。弱推荐，低质量证据。治疗7 ESGE建议不要在ERCP后胰腺炎患者中进行挽救性胰腺支架术。弱推荐，低质量证据。8 ESGE建议临时放置胆道完全覆盖的自膨式金属支架，用于标准止血方法难以治疗的括约肌切开术后出血。弱推荐，低质量证据。9 ESGE建议通过腹部超声或计算机断层扫描（CT）对ERCP术后胆管炎患者进行评估，如果保守治疗没有改善，则考虑重复ERCP。重复ERCP时应采集胆汁样本进行微生物检查。弱推荐，低质量证据。
Main Recommendations Prophylaxis 1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration. Strong recommendation, moderate quality evidence. 2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation). Strong recommendation, moderate quality evidence. 3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction. Weak recommendation, moderate quality evidence. 4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP. Strong recommendation, moderate quality evidence. 5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy. Weak recommendation, moderate quality evidence. 6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced. Weak recommendation, low quality evidence. Treatment 7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis. Weak recommendation, low quality evidence. 8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities. Weak recommendation, low quality evidence. 9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP. Weak recommendation, low quality evidence.