Department of Gastroenterology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK.
Endoscopy. 2012 Jul;44(7):674-83. doi: 10.1055/s-0032-1309345. Epub 2012 Jun 13.
STUDY BACKGROUND AND AIMS: Predicting outcome at endoscopic retrograde cholangiopancreatography (ERCP) remains difficult. Our aim was to identify the risk factors for failed ERCP.
A prospective multicenter study of ERCP was performed in 66 hospitals across England. Data on 4561 patients were collected using a structured questionnaire completed at the time of ERCP.
In total 3209 patients had not had an ERCP prior to the study period. Considering their first ever ERCP, 2683 (84 %) were successfully cannulated, 2241(70 %) had all intended therapy completed, 360 (11 %) had some intended therapy completed, and 608 (19 %) were considered to have had a failed procedure. For first ever ERCP, factors associated with incomplete procedure (odds ratio and 95 % confidence interval) were: Billroth surgery (9.2, 3.2 - 26.7), precutting (2.0, 1.6 - 2.7), common bile duct (CBD) stone size and number (3.2, 2.1 - 4.8 for multiple, large stones), interventions in the pancreatic duct (3.4, 1.6 - 7.0), and CBD stenting (2.8, 2.2 - 3.5). Analysis of the 1352 patients who had undergone an ERCP prior to the study period indicated previous failed ERCP was also predictive of incomplete therapy (1.5, 1.1 - 2.1). The modified Schutz score correlated with ERCP completion, as did the Morriston score, even when modified to include only variables measurable before the procedure.
This study confirms that patient- and procedure-based variables are key predictors of technical success and validates current methods of rating ERCP difficulty. Of note, a correlation between outcome and institutional factors, such as unit and endoscopist caseload, was not demonstrated.
经内镜逆行胰胆管造影术（ERCP）的结果预测仍然较为困难。本研究旨在明确 ERCP 失败的危险因素。
在英格兰的 66 家医院进行了一项前瞻性多中心 ERCP 研究。通过在 ERCP 时完成的结构化问卷收集了 4561 例患者的数据。
共有 3209 例患者在研究期间之前未进行过 ERCP。考虑到他们的首次 ERCP，2683 例（84%）成功进行了胆管插管，2241 例（70%）完成了所有预期的治疗，360 例（11%）完成了部分预期的治疗，608 例（19%）被认为手术失败。对于首次 ERCP，与操作不完整相关的因素（比值比和 95%置信区间）为：毕罗氏手术（9.2，3.2-26.7）、预切开（2.0，1.6-2.7）、胆总管（CBD）结石大小和数量（多发、大结石时为 3.2，2.1-4.8）、胰管介入（3.4，1.6-7.0）和 CBD 支架置入（2.8，2.2-3.5）。对研究前曾进行过 ERCP 的 1352 例患者的分析表明，先前的 ERCP 失败也是治疗不完整的预测因素（1.5，1.1-2.1）。改良的 Schutz 评分与 ERCP 完成情况相关，Morriston 评分也是如此，即使将其修改为仅包含术前可测量的变量也是如此。
本研究证实了患者和手术相关的变量是技术成功的关键预测因素，并验证了目前评估 ERCP 难度的方法。值得注意的是，结果与机构因素（如单位和内镜医师的工作量）之间没有相关性。
