内镜逆行胰胆管造影术后并发症的发生率：前瞻性研究的系统综述。

Incidence rates of post-ERCP complications: a systematic survey of prospective studies.

作者信息

Andriulli Angelo, Loperfido Silvano, Napolitano Grazia, Niro Grazia, Valvano Maria Rosa, Spirito Fulvio, Pilotto Alberto, Forlano Rosario

机构信息

Gastroenterology Unit, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.

出版信息

Am J Gastroenterol. 2007 Aug;102(8):1781-8. doi: 10.1111/j.1572-0241.2007.01279.x. Epub 2007 May 17.

DOI:10.1111/j.1572-0241.2007.01279.x

PMID:17509029

Abstract

OBJECTIVES

To provide health-care providers, patients, and physicians with an exhaustive assessment of prospective studies on rates of complications and fatalities associated with endoscopic retrograde cholangiopancreatography (ERCP).

METHODS

We searched MEDLINE (1977-2006) for prospective surveys on adult patients undergoing ERCP. "Grey literature" was sought by looking at cited references to identify further relevant studies. Data on postprocedural pancreatitis, bleeding, infections, perforations, and miscellaneous events as well as their associated fatalities were extracted independently by two reviewers. Sensitivity analysis was performed to test for data consistency between multicenter versus single center studies, and old (1977-1996) versus recent (1997-2005) reports.

RESULTS

In 21 selected surveys, involving 16,855 patients, ERCP-attributable complications totaled 1,154 (6.85%, CI 6.46-7.24%), with 55 fatalities (0.33%, CI 0.24-0.42%). Mild-to-moderate events occurred in 872 patients (5.17%, CI 4.83-5.51%), and severe events in 282 (1.67%, CI 1.47-1.87%). Pancreatitis occurred in 585 subjects (3.47%, CI 3.19-3.75%), infections in 242 (1.44%, CI 1.26-1.62%), bleeding in 226 (1.34%, CI 1.16-1.52%), and perforations in 101 (0.60%, CI 0.48-0.72%). Cardiovascular and/or analgesia-related complications amounted to 173 (1.33%, CI 1.13-1.53%), with 9 fatalities (0.07%, CI 0.02-0.12%). As compared with old reports, morbidity rates increased significantly in most recent studies: 6.27%versus 7.51% (P(c)= 0.029).

CONCLUSIONS

ERCP remains the endoscopic procedure that carries a high risk for morbidity and mortality. Complications continue to occur at a relatively consistent rate. The majority of events are of mild-to-moderate severity.

摘要

目的

为医疗保健提供者、患者及医师提供一份关于内镜逆行胰胆管造影术（ERCP）相关并发症及死亡率前瞻性研究的详尽评估。

方法

我们检索了MEDLINE（1977 - 2006年）中关于接受ERCP的成年患者的前瞻性调查。通过查看引用参考文献来寻找“灰色文献”，以确定更多相关研究。两名审阅者独立提取术后胰腺炎、出血、感染、穿孔及其他事件的数据及其相关死亡率。进行敏感性分析以检验多中心研究与单中心研究、旧报告（1977 - 1996年）与近期报告（1997 - 2005年）之间的数据一致性。

结果

在21项选定的调查中，涉及16,855例患者，ERCP相关并发症共计1,154例（6.85%，可信区间6.46 - 7.24%），死亡55例（0.33%，可信区间0.24 - 0.42%）。轻度至中度事件发生在872例患者中（5.17%，可信区间4.83 - 5.51%），重度事件发生在282例患者中（1.67%，可信区间1.47 - 1.87%）。胰腺炎发生在585例患者中（3.47%，可信区间3.19 - 3.75%），感染242例（1.44%，可信区间1.26 - 1.62%），出血226例（1.34%，可信区间1.16 - 1.52%），穿孔101例（0.60%，可信区间0.48 - 0.72%）。心血管和/或镇痛相关并发症共计173例（1.33%，可信区间1.13 - 1.53%），死亡9例（0.07%，可信区间0.02 - 0.12%）。与旧报告相比，近期研究中的发病率显著增加：6.27%对7.51%（P(c)=0.029）。