van den Hazel S J, Wolfhagen E H, van Buuren H R, van de Meeberg P C, Van Leeuwen D J
Division of Gastroenterology and Hepatology, Academic Medical Center of the University of Amsterdam, The Netherlands.
Endoscopy. 2000 Oct;32(10):779-82. doi: 10.1055/s-2000-7708.
Direct endoscopic retrograde cholangiopancreatography (ERCP) has become the standard for establishing the diagnosis of primary sclerosing cholangitis (PSC), while endoscopic procedures play an increasingly important therapeutic role. However, many believe that this procedure carries a significant risk of infection and other complications. We assessed the incidence of complications within 1 week of ERCP in patients with PSC.
In a multicenter study, patients who underwent ERCP for (suspected) PSC were prospectively followed for the occurrence of complications after the procedure.
A total of 106 ERCPs performed in 83 patients were evaluated. Complications occurred on ten occasions (9%): pancreatitis (n = 3), cholangitis (n = 2), increase of cholestasis (n = 2), postsphincterotomy bleeding (n = 1), cystic duct perforation (n = 1), and venous thrombosis (n = 1). All complications resolved quickly with proper therapy. Complications were more likely when ERCP was done to evaluate specific complaints such as jaundice or recurrent cholangitis (9/59) than after a purely diagnostic ERCP (1/47 relative risk [RR] 7.2, 95% confidence interval [CI] 1.00 to 153). Therapeutic interventions performed during ERCP (e.g. placement of endoprosthesis, dilation of strictures) also increased the risk of postprocedural complications (RR 4.5, 95 % CI 0.94 to 30).
ERCP is a safe method for establishing the diagnosis of PSC in asymptomatic patients (2 % complication rate). Although ERCP in symptomatic patients carries a higher risk (14%), this can be justified by the benefits of endoscopic therapy.
直接内镜逆行胰胆管造影术（ERCP）已成为确立原发性硬化性胆管炎（PSC）诊断的标准方法，同时内镜操作在治疗方面发挥着越来越重要的作用。然而，许多人认为该操作存在显著的感染及其他并发症风险。我们评估了PSC患者在ERCP术后1周内并发症的发生率。
在一项多中心研究中，对因（疑似）PSC接受ERCP的患者术后并发症的发生情况进行前瞻性随访。
共评估了83例患者接受的106次ERCP。发生并发症10次（9%）：胰腺炎（3例）、胆管炎（2例）、胆汁淤积加重（2例）、括约肌切开术后出血（1例）、胆囊管穿孔（1例）和静脉血栓形成（1例）。经适当治疗，所有并发症均迅速缓解。当ERCP用于评估黄疸或复发性胆管炎等特定症状时（9/59），发生并发症的可能性高于单纯诊断性ERCP后（1/47，相对风险[RR]7.2，95%置信区间[CI]1.00至153）。ERCP期间进行的治疗干预（如放置内支架、扩张狭窄）也增加了术后并发症的风险（RR 4.5，95%CI 0.94至30）。
ERCP是在无症状患者中确立PSC诊断的安全方法（并发症发生率2%）。尽管有症状患者接受ERCP的风险较高（14%），但内镜治疗的益处可证明其合理性。
