Evaluation of complications after endoscopic retrograde cholangiopancreatography using a short type double balloon endoscope in patients with altered gastrointestinal anatomy: a single-center retrospective study of 1,576 procedures
Evaluation of complications after endoscopic retrograde cholangiopancreatography using a short type double balloon endoscope in patients with altered gastrointestinal anatomy: a single-center retrospective study of 1,576 procedures
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DOI：
10.1111/jgh.15019
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发表时间：
2020-04-05
影响因子：
4.1
通讯作者：
Okazaki, Kazuichi
中科院分区：
文献类型：
--
作者：
Tokuhara, Mitsuo;Shimatani, Masaaki;Okazaki, Kazuichi
背景与目的使用球囊辅助内镜（如双球囊内镜）进行内镜逆行胰胆管造影（ERCP），即使对于手术改变的患者也有效。但对气囊内镜下ERCP并发症的研究尚不多见。本文分析了双气囊内镜（DB-ERCP）并发症的特点及原因，提出了有效的处理方法。方法回顾性分析714例胃肠道解剖结构改变患者的1576次DB-ERCP检查结果。结果手术并发症发生率为5.8%。按并发症类型划分，穿孔3.2%，粘膜撕裂0.5%，出血1.0%，胰腺炎0.6%，呼吸系统疾病0.4%，其他0.2%。按手术重建方法的类型，胆肠吻合Roux-en-Y重建4.2%，不吻合胆肠的Roux-en-Y重建6.7%，胰管切除4.5%，保留幽门的胰管切除4.2%，Billroth II胃切除术（B-II）11.6%，其他重建方法（其他）7.4%。多因素分析计算的影响因素为B Ⅱ（优势比：1.864，95%可信区间：1.001- 3.471，P = 0.050）和是否存在幼稚乳头（优势比：3.268，95%可信区间：1.426- 7.490，P = 0.005）。结论DB-ERCP是一种安全的方法，总并发症发生率为5.8%，在可接受的范围内。最常见的并发症是消化道损伤，如穿孔。影响并发症发生的危险因素为B-Ⅱ和幼稚乳头的存在。DB-ERCP操作时应注意这些因素。
Background and Aim Endoscopic retrograde cholangiopancreatography (ERCP) using balloon-assisted endoscope such as double-balloon endoscope is even effective for patients with surgically altered anatomy. Yet comprehensive studies on complications of ERCP using balloon-assisted endoscope have not been made. We analyzed the characteristics and the causes of complications of ERCP using double-balloon endoscope (DB-ERCP) procedures and aimed to suggest effective managements. Methods A total of 1576 procedures of DB-ERCP in 714 patients with surgically altered gastrointestinal anatomy in our hospital were evaluated retrospectively using a statistic analysis. Results The overall complication occurrence rate was 5.8%. By type of complications are perforation 3.2%, mucosal laceration 0.5%, hemorrhage 1.0%, pancreatitis 0.6%, respiratory disorder 0.4%, and others 0.2%. By type of surgical reconstruction methods were Roux-en-Y reconstruction with choledocho-jejunal anastomosis 4.2%, Roux-en-Y reconstruction without choledocho-jejunal anastomosis 6.7%, pancreaticoduodenectomy 4.5%, pylorus preserving pancreaticoduodenectomy 4.2%, Billroth II gastrectomy (B-II) 11.6%, and other reconstruction method (others) 7.4%. The contributing factors calculated by a multivariate analysis were B-II (odds ratio: 1.864, 95% confidence interval: 1.001-3.471,P = 0.050) and the presence of naive papilla (odds ratio: 3.268, 95% confidence interval: 1.426-7.490,P = 0.005). Conclusions DB-ERCP is a safe method with a total complication rate of 5.8% that could be considered within an acceptable range. The most common complication was the injury of the digestive tract such as perforation. Affecting risk factors for complications were B-II and the presence of naive papilla. DB-ERCP procedures should be performed carefully of these factors.