Bangarulingam Sanjay Y, Gossard Andrea A, Petersen Bret T, Ott Beverly J, Lindor Keith D
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Gastroenterol. 2009 Apr;104(4):855-60. doi: 10.1038/ajg.2008.161. Epub 2009 Mar 3.
Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed in patients with primary sclerosing cholangitis (PSC). The risk of complications associated with this procedure is not well established in these patients. The aim of this retrospective study was to compare the risk of ERCP complications in PSC vs. non-PSC patients.
We identified all Mayo Clinic patients who underwent ERCP in 2005. Procedural and clinical data were collected. Complications were defined as hospitalizations for pancreatitis, cholangitis, perforation, and bleeding.
A total of 168 patients with PSC and 981 patients without PSC had at least one ERCP examination in the calendar year 2005. PSC patients were younger (48 years+/-15 vs. 60 years+/-19, P<0.000) and had a higher prevalence of portal hypertension (31.5% vs. 4%, P<0.0001). PSC patients had more biopsies (39% vs. 15%, P<0.0001), brushings (37% vs. 8%, P<0.001), balloon dilatations (48% vs. 15%, P<0.0001), duct cytology (20% vs. 3%, P<0.0001) and intraductal ultrasounds (11% vs. 5%, P=0.007) than non-PSC patients. The duration of the procedure was longer in the PSC group (51 min+/-29 vs. 40 min+/-28, P<0.0001). The overall rate of complications in patients with PSC when compared to non-PSC patients was not significantly different (18/168 (11%) vs. 76/981(8%), P=0.2). The incidence of cholangitis was higher in the PSC group (4% vs. 0.2%, P<0.0002) despite routine use of antibiotics before the procedure in PSC patients. The duration of the procedure was longer in PSC patients who developed cholangitis (86 min+/-28 vs. 51 min+/-29, P=0.02). The risks of complications such as pancreatitis, perforation, and bleeding were not significantly different between the two groups despite their demographic and procedural variations. The duration of hospitalization due to complications was also not significantly different between the two groups.
Complications requiring hospitalizations occur in over 10% of PSC patients undergoing ERCP. Cholangitis occurs more often in PSC patients and correlates with the length of the procedure. Further studies to confirm the role of aggressive prophylactic antibiotics in patients with PSC who undergo prolonged procedures are warranted.
内镜逆行胰胆管造影术（ERCP）常用于原发性硬化性胆管炎（PSC）患者。该手术相关并发症的风险在这些患者中尚未完全明确。本回顾性研究的目的是比较PSC患者与非PSC患者ERCP并发症的风险。
我们确定了2005年在梅奥诊所接受ERCP的所有患者。收集了手术和临床数据。并发症定义为因胰腺炎、胆管炎、穿孔和出血而住院。
2005年共有168例PSC患者和981例非PSC患者至少接受了一次ERCP检查。PSC患者更年轻（48岁±15岁 vs. 60岁±19岁，P<0.000），门静脉高压患病率更高（31.5% vs. 4%，P<0.0001）。与非PSC患者相比，PSC患者接受活检（39% vs. 15%，P<0.0001）、刷检（37% vs. 8%，P<0.001）、球囊扩张（48% vs. 15%，P<0.0001）、胆管细胞学检查（20% vs. 3%，P<0.0001）和导管内超声检查（11% vs. 5%，P=0.007）的比例更高。PSC组手术时间更长（51分钟±29分钟 vs. 40分钟±28分钟，P<0.0001）。与非PSC患者相比，PSC患者的总体并发症发生率无显著差异（18/168（11%） vs. 76/981（8%），P=0.2）。尽管PSC患者在手术前常规使用抗生素，但PSC组胆管炎的发生率更高（4% vs. 0.2%，P<0.0002）。发生胆管炎的PSC患者手术时间更长（86分钟±28分钟 vs. 51分钟±29分钟，P=0.02）。尽管两组在人口统计学和手术操作方面存在差异，但胰腺炎、穿孔和出血等并发症的风险无显著差异。两组因并发症导致的住院时间也无显著差异。
接受ERCP的PSC患者中，超过10%会发生需要住院治疗的并发症。胆管炎在PSC患者中更常见，且与手术时间长短相关。有必要进行进一步研究以证实积极预防性使用抗生素在接受长时间手术的PSC患者中的作用。
