Cheng Chi-Liang, Sherman Stuart, Watkins James L, Barnett Jeffrey, Freeman Martin, Geenen Joseph, Ryan Michael, Parker Harrison, Frakes James T, Fogel Evan L, Silverman William B, Dua Kulwinder S, Aliperti Giuseppe, Yakshe Paul, Uzer Michael, Jones Whitney, Goff John, Lazzell-Pannell Laura, Rashdan Abdullah, Temkit M'hamed, Lehman Glen A
Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
Am J Gastroenterol. 2006 Jan;101(1):139-47. doi: 10.1111/j.1572-0241.2006.00380.x.
Pancreatitis is the most common and serious complication of diagnostic and therapeutic ERCP. The aim of this study is to examine the potential patient- and procedure-related risk factors for post-ERCP pancreatitis in a prospective multicenter study.
A 160-variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group and participating in a randomized controlled study evaluating whether prophylactic corticosteroids will reduce the incidence of post-ERCP pancreatitis. Data were collected prior to the procedure, at the time of procedure, and 24-72 h after discharge. Post-ERCP pancreatitis was diagnosed and its severity graded according to consensus criteria.
Of the 1,115 patients enrolled, diagnostic ERCP with or without sphincter of Oddi manometry (SOM) was performed in 536 (48.1%) and therapeutic ERCP in 579 (51.9%). Suspected sphincter of Oddi dysfunction (SOD) was the indication for the ERCP in 378 patients (33.9%). Pancreatitis developed in 168 patients (15.1%) and was graded mild in 112 (10%), moderate in 45 (4%), and severe in 11(1%). There was no difference in the incidence of pancreatitis or the frequency of investigated potential pancreatitis risk factors between the corticosteroid and placebo groups. By univariate analysis, the incidence of post-ERCP pancreatitis was significantly higher in 19 of 30 investigated variables. In the multivariate risk model, significant risk factors with adjusted odds ratios (OR) were: minor papilla sphincterotomy (OR: 3.8), suspected SOD (OR: 2.6), history of post-ERCP pancreatitis (OR: 2.0), age <60 yr (OR: 1.6), > or =2 contrast injections into the pancreatic duct (OR: 1.5), and trainee involvement (OR: 1.5). Female gender, history of recurrent idiopathic pancreatitis, pancreas divisum, SOM, difficult cannulation, and major papilla sphincterotomy (either biliary or pancreatic) were not multivariate risk factors for post-ERCP pancreatitis.
This study emphasizes the role of patient factors (age, SOD, prior history of post-ERCP pancreatitis) and technical factors (number of PD injections, minor papilla sphincterotomy, and operator experience) as the determining high-risk predictors for post-ERCP pancreatitis.
胰腺炎是诊断性和治疗性内镜逆行胰胆管造影术（ERCP）最常见且最严重的并发症。本研究旨在通过一项前瞻性多中心研究，探究ERCP术后胰腺炎潜在的患者相关及操作相关风险因素。
按照既定方案前瞻性收集了一个包含160个变量的数据库，这些数据来自中西部胰胆疾病研究组15个中心接受诊断性或治疗性ERCP的患者，这些患者参与了一项评估预防性使用皮质类固醇是否会降低ERCP术后胰腺炎发生率的随机对照研究。在操作前、操作时以及出院后24至72小时收集数据。根据共识标准诊断ERCP术后胰腺炎并对其严重程度进行分级。
在纳入的1115例患者中，536例（48.1%）接受了诊断性ERCP，其中有或没有进行Oddi括约肌测压（SOM），579例（51.9%）接受了治疗性ERCP。378例患者（33.9%）的ERCP指征为疑似Oddi括约肌功能障碍（SOD）。168例患者（15.1%）发生了胰腺炎，其中112例（10%）为轻度，45例（4%）为中度，11例（1%）为重度。皮质类固醇组和安慰剂组在胰腺炎发生率或所调查的潜在胰腺炎风险因素频率方面没有差异。通过单因素分析，在30个被调查变量中的19个变量中，ERCP术后胰腺炎的发生率显著更高。在多因素风险模型中，调整后的优势比（OR）显示的显著风险因素为：小乳头括约肌切开术（OR：3.8）、疑似SOD（OR：2.6）、ERCP术后胰腺炎病史（OR：2.0）、年龄<60岁（OR：1.6）、向胰管内注入造影剂≥2次（OR：1.5）以及实习医生参与操作（OR：1.5）。女性性别、复发性特发性胰腺炎病史、胰腺分裂症、SOM、插管困难以及大乳头括约肌切开术（胆管或胰腺）不是ERCP术后胰腺炎的多因素风险因素。
本研究强调了患者因素（年龄、SOD、ERCP术后胰腺炎既往史）和技术因素（胰管内造影剂注入次数、小乳头括约肌切开术以及术者经验）作为ERCP术后胰腺炎决定性高风险预测因素的作用。
