Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study
Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study
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DOI：
10.1016/s0016-5107(98)70121-x
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发表时间：
1998-07-01
影响因子：
7.7
通讯作者：
Fratton, A
中科院分区：
文献类型：
--
作者：
Loperfido, S;Angelini, G;Fratton, A
背景资料：有一个诊断和治疗内镜逆行胰胆管造影术（ERCP）的并发症缺乏多中心的前瞻性研究。方法：我们研究了2769例连续患者接受ERCP在9个中心在特里威尼托地区的意大利超过2年的时间。6个中心每年对不到200名患者进行ERCP（小型中心）。预先定义了一般和ERCP特异性严重并发症。在ERCP时、出院前和30天内再次入院时收集数据。ERCP被定义为治疗性的，当内镜下括约肌切开术结果：1583例（1583例）、419例（419例）、701例（701例）发生严重并发症中重度胰腺炎36例（1.3%），胆管炎24例（0.87%），出血21例（0.76%），十二指肠穿孔16例（0.58%），其他14例（0.51%）。942例诊断性ERCP中发生严重并发症13例（1.38%），死亡2例（0.21%），而1827例治疗性ERCP中发生严重并发症98例（5.4%），死亡9例（0.49%），诊断性与治疗性ERCP并发症发生率差异有统计学意义（p < 0.0001）。小中心和预切被认为是治疗性ERCP总体主要并发症的独立危险因素，而以下危险因素与特定并发症相关：（1）胰腺炎：年龄小于70岁，胰管混浊，胆总管未扩张;（2）胆管炎：小中心，黄疸;（3）出血：小中心;（4）腹膜后十二指肠穿孔：预切开、壁内注射造影剂和Billroth II胃切除术。目前的数据支持在转诊中心集中ERCP的政策。更有选择性和更安全地使用预切可能会进一步限制ERCP的不良事件。
Background: There is a lack of multicenter prospective studies on complications of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods: We studied 2769 consecutive patients undergoing ERCP at nine centers in the Triveneto region of Italy over a 2-year period. Six centers performed ERCP on less than 200 patients per year (small centers). General and ERCP-specific major complications were predefined. Data were collected at the time of ERCP, before discharge, and in cases of readmission within 30 days. ERCP was defined as therapeutic when endoscopic sphincterotomy (n = 1583), precut (n = 419), or drainage (n = 701) had been carried out, singularly or in combination.Results: One hundred eleven major complications (4.0%) were recorded: moderate-severe pancreatitis 36 (1.3%), cholangitis 24 (0.87%), hemorrhage 21 (0.76%), duodenal perforation 16 (0.58%), others 14 (0.51%). Among 942 diagnostic ERCPs there were 13 major complications (1.38%) and 2 deaths (0.21%), whereas among 1827 therapeutic ERCPs there were 98 major complications (5.4%) and 9 deaths (0.49%).The difference in the incidence of complications between diagnostic and therapeutic ERCPs was statistically significant (p < 0.0001). Small center and precut were recognized as independent risk factors for overall major complications of therapeutic ERCP, whereas the following risk factors were identified in relation to specific complications: (1) pancreatitis: age less than 70 years, pancreatic duct opacification, and nondilated common bile duct; (2) cholangitis: small center, jaundice; (3) hemorrhage: small center; and (4) retroperitoneal duodenal perforation: precut, intramural injection of contrast medium, and Billroth II gastrectomy.Conclusions: Major complications are mostly associated with therapeutic procedures and low case volume. Present data support a policy of centralization of ERCP in referral centers. A more selected and safer use of precut may be expected to further limit the adverse events of ERCP.