Jones Wesley B, Roettger Richard H, Cobb William S, Carbonell Alfredo M
Division of Minimal Access and Bariatric Surgery, Department of Academic Surgery, Greenville Hospital System University Medical Center, Greenville, SC 29605, USA.
Am Surg. 2009 Nov;75(11):1050-3.
Although surgeons can safely perform endoscopic retrograde cholangiopancreatography (ERCP), it has fallen within the domain of gastroenterologists. We sought to quantify the role of ERCP in a tertiary-care surgery department. The hospital discharge database was queried for all ERCPs performed from January 2007 to December 2007. Gastroenterologists performed all ERCPs in our query. Surgical patients were admitted and/or under the care of a surgeon; whereas nonsurgical patients had no surgeon involvement. Patient characteristics and diagnoses were compared between groups. ERCP procedural details were recorded. Surgical patients comprised 48 per cent (n = 151) of the total 311 ERCPs performed. The mean time interval from a surgeon's request for ERCP to actual procedure was 2.43 days (standard deviation [SD] 2.55; range, 0-13 days). The surgical group had significantly different diagnoses and underwent less diagnostic (22% vs 56%) and more therapeutic ERCPs (72% vs 38%). Surgical patients were more likely inpatients (82.1% vs 16.8%) with a longer length of stay (6.7 vs 3.9 days; P = 0.0029) compared with nonsurgical patients. We found surgical patients requiring ERCP differ significantly from nonsurgical patients, with a significant number of technical interventions being outsourced. Given the benefits of a surgical ERCP program and the potential volume of these unique patients, this procedure should be performed by appropriately trained surgeons.
尽管外科医生能够安全地进行内镜逆行胰胆管造影术（ERCP），但该技术已归入胃肠病学家的业务范围。我们试图量化ERCP在一家三级护理外科科室中的作用。查询了医院出院数据库中2007年1月至2007年12月期间进行的所有ERCP病例。在我们的查询中，所有ERCP均由胃肠病学家操作。外科患者入院时由外科医生收治和/或接受其护理；而非外科患者则没有外科医生参与。比较了两组患者的特征和诊断情况。记录了ERCP的操作细节。在总共311例ERCP中，外科患者占48%（n = 151）。从外科医生提出ERCP请求到实际操作的平均时间间隔为2.43天（标准差[SD]为2.55；范围为0至13天）。外科组的诊断有显著差异，诊断性ERCP较少（22%对56%），治疗性ERCP较多（72%对38%）。与非外科患者相比，外科患者更可能是住院患者（82.1%对16.8%），住院时间更长（6.7天对3.9天；P = 0.0029）。我们发现，需要进行ERCP的外科患者与非外科患者有显著差异，大量技术干预被外包。鉴于外科ERCP项目的益处以及这类特殊患者的潜在数量，该操作应由经过适当培训的外科医生进行。
