Freeman M L, DiSario J A, Nelson D B, Fennerty M B, Lee J G, Bjorkman D J, Overby C S, Aas J, Ryan M E, Bochna G S, Shaw M J, Snady H W, Erickson R V, Moore J P, Roel J P
Hennepin County Medical Center, University of Minnesota, 701 Park Ave., Minneapolis, MN 55415, USA.
Gastrointest Endosc. 2001 Oct;54(4):425-34. doi: 10.1067/mge.2001.117550.
Post-ERCP pancreatitis is poorly understood. The goal of this study was to comprehensively evaluate potential procedure- and patient-related risk factors for post-ERCP pancreatitis over a wide spectrum of centers.
Consecutive ERCP procedures were prospectively studied at 11 centers (6 private, 5 university). Complications were assessed at 30 days by using established consensus criteria.
Pancreatitis occurred after 131 (6.7%) of 1963 consecutive ERCP procedures (mild 70, moderate 55, severe 6). By univariate analysis, 23 of 32 investigated variables were significant. Multivariate risk factors with adjusted odds ratios (OR) were prior ERCP-induced pancreatitis (OR 5.4), suspected sphincter of Oddi dysfunction (OR 2.6), female gender (OR 2.5), normal serum bilirubin (OR 1.9), absence of chronic pancreatitis (OR 1.9), biliary sphincter balloon dilation (OR 4.5), difficult cannulation (OR 3.4), pancreatic sphincterotomy (OR 3.1), and 1 or more injections of contrast into the pancreatic duct (OR 2.7). Small bile duct diameter, sphincter of Oddi manometry, biliary sphincterotomy, and lower ERCP case volume were not multivariate risk factors for pancreatitis, although endoscopists performing on average more than 2 ERCPs per week had significantly greater success at bile duct cannulation (96.5% versus 91.5%, p = 0.0001). Combinations of patient characteristics including female gender, normal serum bilirubin, recurrent abdominal pain, and previous post-ERCP pancreatitis placed patients at increasingly higher risk of pancreatitis, regardless of whether ERCP was diagnostic, manometric, or therapeutic.
Patient-related factors are as important as procedure-related factors in determining risk for post-ERCP pancreatitis. These data emphasize the importance of careful patient selection as well as choice of technique in the avoidance of post-ERCP pancreatitis.
内镜逆行胰胆管造影术（ERCP）后胰腺炎的发病机制尚不清楚。本研究的目的是在广泛的中心范围内全面评估ERCP术后胰腺炎潜在的与操作及患者相关的危险因素。
在11个中心（6个私立中心，5个大学中心）对连续进行的ERCP操作进行前瞻性研究。采用既定的共识标准在30天时评估并发症。
在1963例连续的ERCP操作中，131例（6.7%）发生了胰腺炎（轻度70例，中度55例，重度6例）。单因素分析显示，在32个研究变量中有23个具有统计学意义。校正比值比（OR）的多因素危险因素包括既往ERCP诱发的胰腺炎（OR 5.4）、疑似Oddi括约肌功能障碍（OR 2.6）、女性（OR 2.5）、血清胆红素正常（OR 1.9）、无慢性胰腺炎（OR 1.9）、胆管括约肌球囊扩张（OR 4.5）、插管困难（OR 3.4）、胰腺括约肌切开术（OR 3.1）以及向胰管内注入1次或更多次造影剂（OR 2.7）。小胆管直径、Oddi括约肌测压、胆管括约肌切开术以及较低的ERCP病例量并非胰腺炎的多因素危险因素，尽管平均每周进行超过2次ERCP操作的内镜医师在胆管插管方面的成功率显著更高（96.5%对91.5%，p = 0.0001）。包括女性、血清胆红素正常、复发性腹痛以及既往ERCP后胰腺炎在内的患者特征组合使患者发生胰腺炎的风险越来越高，无论ERCP是诊断性、测压性还是治疗性的。
在确定ERCP术后胰腺炎风险方面，与患者相关的因素和与操作相关的因素同样重要。这些数据强调了谨慎选择患者以及选择技术在避免ERCP术后胰腺炎方面的重要性。
