Cotton Peter B, Garrow Donald A, Gallagher Joseph, Romagnuolo Joseph
Department of Medicine, Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina 29425-2900, USA.
Gastrointest Endosc. 2009 Jul;70(1):80-8. doi: 10.1016/j.gie.2008.10.039. Epub 2009 Mar 14.
Complications of ERCP are an important concern. We sought to determine predictors of post-ERCP complications at our institution.
GI TRAC is a comprehensive data set of patients who underwent ERCP at our institution from 1994 through 2006. Logistic regression models were used to evaluate 4 categories of complications: (1) overall complications, (2) pancreatitis, (3) bleeding, and (4) severe or fatal complications. Independent predictors of complications were determined with multivariable logistic regression.
A total of 11,497 ERCP procedures were analyzed. There were 462 complications (4.0%), 42 of which were severe (0.36%) and 7 were fatal (0.06%). Specific complications of pancreatitis (2.6%) and bleeding (0.3%) were identified. Overall complications were statistically more likely among individuals with suspected sphincter of Oddi dysfunction (SOD) (odds ratio [OR] 1.91) and after a biliary sphincterotomy (OR 1.32). Subjects with a history of acute or chronic pancreatitis (OR 0.78) or who received a temporary small-caliber pancreatic stent (OR 0.69) had fewer complications. Post-ERCP pancreatitis was more likely to occur after a pancreatogram via the major papilla (OR 1.70) or minor papilla (OR 1.54) and among subjects with suspected SOD with stent placement (OR 1.45) or without stent placement (OR 1.84). Individuals undergoing biliary-stent exchange had less-frequent pancreatitis (OR 0.38). Biliary sphincterotomy was associated with bleeding (OR 4.71). Severe or fatal complications were associated with severe (OR 2.38) and incapacitating (OR 7.65) systemic disease, obesity (OR 5.18), known or suspected bile-duct stones (OR 4.08), pancreatic manometry (OR 3.57), and complex (grade 3) procedures (OR 2.86).
This study characterizes a large series of ERCP procedures from a single institution and outlines the incidence and predictors of complications.
内镜逆行胰胆管造影术（ERCP）的并发症是一个重要问题。我们试图确定我院ERCP术后并发症的预测因素。
GI TRAC是我院1994年至2006年接受ERCP治疗患者的综合数据集。采用逻辑回归模型评估4类并发症：（1）总体并发症，（2）胰腺炎，（3）出血，（4）严重或致命并发症。通过多变量逻辑回归确定并发症的独立预测因素。
共分析了11497例ERCP手术。有462例并发症（4.0%），其中42例严重（0.36%），7例致命（0.06%）。确定了胰腺炎（2.6%）和出血（0.3%）的具体并发症。总体并发症在疑似Oddi括约肌功能障碍（SOD）的个体中（优势比[OR]1.91）和胆管括约肌切开术后（OR 1.32）在统计学上更常见。有急性或慢性胰腺炎病史的受试者（OR 0.78）或接受临时小口径胰管支架的受试者（OR 0.69）并发症较少。ERCP术后胰腺炎更可能发生在通过主乳头（OR 1.70）或副乳头（OR 1.54）进行胰管造影后，以及在疑似SOD且放置支架（OR 1.45）或未放置支架（OR 1.84）的受试者中。进行胆管支架置换的个体胰腺炎发生率较低（OR 0.38）。胆管括约肌切开术与出血相关（OR 4.71）。严重或致命并发症与严重（OR 2.38）和致残（OR 7.65）的全身性疾病、肥胖（OR 5.18）以及已知或疑似胆管结石（OR 4.08）、胰管测压（OR 3.57）和复杂（3级）手术（OR 2.86）相关。
本研究描述了来自单一机构的大量ERCP手术，并概述了并发症的发生率和预测因素。
