The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
Pancreatology. 2011;11(4):399-405. doi: 10.1016/S1424-3903(11)80094-3. Epub 2011 Aug 31.
Postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) is one of the most common and serious complications after endoscopic retrograde cholangiopancreatography (ERCP). This study aims to test the hypothesis that the incidence of PEP declined over time due to improved patient selection and/or endoscopic equipment and endoscopic techniques. Therefore, we compared the incidence and risk factors of PEP between four arbitrary chronologically stratified groups.
A total of 7,168 cases of ERCP procedures were retrospectively analyzed. According to the different developmental stages of ERCP equipment and techniques, cases were divided into four groups. The incidence rates and major risk factors for acute PEP were compared between groups.
Among the 7,168 cases, the overall incidence of PEP was 3.70% (265/7,168). When analyzed against each stage of ERCP development, the incidence of PEP was 4.09% (77/1,884) in stage I, 5.79% (86/1,489) in stage II, 3.95% (62/1,568) in stage III and 1.80% (40/2,227) in stage IV. By univariate analysis, pancreatic stent placement (OR: 0.300) and use of propofol-balanced anesthesia (OR: 0.632) seem to be protective factors for acute PEP. By multivariate analysis, the following risk factors for PEP could be identified: repeated cannulation (OR: 3.462), pancreatic duct injection (OR: 3.218), balloon dilation of biliary sphincter (OR: 2.847), papillae precut (OR: 2.493), nonselective high-pressure injection (OR: 1.428), excessive electrocoagulation incision (OR: 1.263), history of pancreatitis (OR: 3.843) and suspected sphincter of Oddi dysfunction (OR: 1.782).
Improved technical procedures were associated with a significant reduction in the incidence of PEP. Risks for developing PEP may be minimized by constant improvement in ERCP techniques, such as routine use of a guidewire, highly selective cannulation, pancreatic stent placement and cautious incision.
内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）是最常见和最严重的并发症之一。本研究旨在验证以下假说，即由于患者选择和/或内镜设备和内镜技术的改进，PEP 的发生率随时间降低。因此，我们比较了四个任意按时间顺序分层的组之间 PEP 的发生率和危险因素。
回顾性分析了 7168 例 ERCP 手术。根据 ERCP 设备和技术的不同发展阶段，将病例分为四组。比较各组急性 PEP 的发生率和主要危险因素。
在 7168 例患者中，PEP 的总发生率为 3.70%（265/7168）。在针对 ERCP 发展的每个阶段进行分析时，PEP 的发生率在第一阶段为 4.09%（77/1884），第二阶段为 5.79%（86/1489），第三阶段为 3.95%（62/1568），第四阶段为 1.80%（40/2227）。单因素分析表明，胰腺支架置入（OR：0.300）和使用丙泊酚平衡麻醉（OR：0.632）似乎是急性 PEP 的保护因素。多因素分析显示，PEP 的以下危险因素可识别：重复插管（OR：3.462）、胰管注射（OR：3.218）、胆管括约肌球囊扩张（OR：2.847）、乳头预切开（OR：2.493）、非选择性高压注射（OR：1.428）、过度电凝切开（OR：1.263）、胰腺炎史（OR：3.843）和可疑 Oddi 括约肌功能障碍（OR：1.782）。
技术程序的改进与 PEP 发生率的显著降低相关。通过不断改进 ERCP 技术，例如常规使用导丝、高度选择性插管、胰腺支架置入和谨慎切开，可以将发生 PEP 的风险降至最低。
