Deenadayalu Viju P, Blaut Urszula, 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, Temkit M'hamed, Lehman Glen A, Sherman Stuart
Indiana University Medical Center, Indianapolis, IN 46202, USA.
J Clin Gastroenterol. 2008 Nov-Dec;42(10):1103-9. doi: 10.1097/MCG.0b013e318159cbd1.
Pancreatitis is the most common major complication of endoscopic retrograde cholangiopancreatography (ERCP). Recent studies have suggested that obesity may serve as a prognostic indicator of poor outcome in non-ERCP-induced acute pancreatitis. However, to our knowledge, no one has ever investigated the potential association of obesity and ERCP-induced pancreatitis. Thus, the purpose of our study was to determine whether obesity conferred an increased risk and/or more severe course of post-ERCP pancreatitis.
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 reduces the incidence of post-ERCP pancreatitis. Body mass indices (BMIs) were available on 964 of the 1115 patients from the original study. A BMI > or = 30 kg/m2 was defined as obese (World Health Organization) and used as a cutoff point in this study. BMIs were analyzed in a retrospective fashion to determine whether obesity confers an increased risk and/or more severe course of post-ERCP pancreatitis. Data were collected before the ERCP, at the time of procedure, and 24 to 72 hours after discharge. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis.
Nine hundred sixty four patients were enrolled in the study. Pancreatitis occurred in 149 patients (15.5%) and was graded as mild in 101 (67.8%), moderate in 42 (28.2%), and severe in 6 (4.0%). The patients were categorized by BMI (kg/m2) using the following breakdowns: BMI < 20, 20 to < 25, 25 to < 30, and > or = 30, as well as BMI < 30 or > or = 30. The groups were similar with respect to the patient and procedure risk factors for post-ERCP pancreatitis except the group with BMI > or = 30 had a higher frequency of females, were younger, had less frequent chronic pancreatitis, a lower number of pancreatic duct injections, and fewer patients received more than 2 pancreatic duct injections. Of the patients with a BMI < 30, 119 (16.4%) developed post-ERCP pancreatitis compared with 30 (12.5%) of those with a BMI > or = 30 (P=0.14). There was no association between the presence of obesity and the severity of pancreatitis (P=0.74). Patients with a BMI < 20, 20 to < 25, 25 to < 30, and > or = 30 had a similar incidence of post-ERCP pancreatitis.
Obesity did not seem to confer an increased risk for ERCP-induced pancreatitis. A statistically significant association between obesity and the severity of ERCP-induced pancreatitis was not apparent.
胰腺炎是内镜逆行胰胆管造影术（ERCP）最常见的主要并发症。最近的研究表明，肥胖可能是非ERCP引起的急性胰腺炎预后不良的一个预后指标。然而，据我们所知，没有人研究过肥胖与ERCP引起的胰腺炎之间的潜在关联。因此，我们研究的目的是确定肥胖是否会增加ERCP术后胰腺炎的风险和/或使病程更严重。
通过明确的方案前瞻性收集了中西部胰胆组15个中心接受诊断性或治疗性ERCP并参与一项随机对照研究（评估预防性使用皮质类固醇是否能降低ERCP术后胰腺炎的发生率）的患者的160项变量数据库。原始研究中的1115例患者中有964例可获得体重指数（BMI）。BMI≥30 kg/m²被定义为肥胖（世界卫生组织），并在本研究中用作分界点。以回顾性方式分析BMI，以确定肥胖是否会增加ERCP术后胰腺炎的风险和/或使病程更严重。在ERCP前、手术时以及出院后24至72小时收集数据。使用标准化标准诊断并分级术后胰腺炎的严重程度。
964例患者纳入研究。149例患者（15.5%）发生胰腺炎，其中101例（67.8%）为轻度，42例（28.2%）为中度，6例（4.0%）为重度。根据BMI（kg/m²）将患者分类如下：BMI<20、20至<25、25至<30以及≥30，以及BMI<30或≥30。除BMI≥30的组女性比例较高、年龄较轻、慢性胰腺炎发生率较低、胰管注射次数较少且接受超过2次胰管注射的患者较少外，各亚组在ERCP术后胰腺炎的患者和手术风险因素方面相似。BMI<30的患者中，119例（16.4%）发生了ERCP术后胰腺炎，而BMI≥30的患者中这一比例为30例（12.5%）（P=0.14）。肥胖的存在与胰腺炎的严重程度之间无关联（P=0.74）。BMI<20、20至<25、25至<30以及≥30的患者ERCP术后胰腺炎的发生率相似。
肥胖似乎不会增加ERCP引起的胰腺炎的风险。肥胖与ERCP引起的胰腺炎严重程度之间无统计学上的显著关联。
