Gastroenterology and Hepatology Department, Meir Medical Center, Tchernichovsky 59, 77456, Kfar-Saba, Israel.
Surg Endosc. 2013 Jun;27(6):2117-21. doi: 10.1007/s00464-012-2720-7. Epub 2013 Feb 7.
Common bile duct (CBD) stones are a potentially life-threatening medical condition. Patients with proven CBD stones should undergo stone extraction. The aim of this study was to evaluate whether performing endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for symptomatic CBD stones in a single session reduces complications related to postponing treatment due to separate EUS and ERCP sessions, and to assess the safety in both options.
A total of 151 patients with EUS-proven CBD stones, with subsequent ERCP, treated in our department between January 2005 and December 2011 were included. Complications related to the procedures or sedation and complications due to the CBD stones when EUS and ERCP were not performed in a single session were assessed and compared to complications when the two procedures were performed in one session.
In total, 149 patients of the 151 (98.7 %) had a successful ERCP. Four (5 %) patients in the separate-session group (B) had a major complication compared to none in the single-session group (A) (p > 0.05). Group B received 14 % more midazolam during ERCP than group A (p < 0.05). No sedation-related complications were noted in either group. Eleven of the 80 patients in group B (13.8 %) experienced complications while waiting for ERCP compared to none in group A (p = 0.001, OR = 2.17, CI = 1.06-4.
EUS and ERCP done in a single session proved to be safe, with no increase in sedation- or procedure-related complications. Postponing treatment for symptomatic CBD stones exposes the patient to biliary complications, especially cholangitis.
胆总管（CBD）结石是一种潜在危及生命的医疗状况。已确诊 CBD 结石的患者应进行取石治疗。本研究旨在评估在单个疗程中同时进行内镜超声（EUS）和内镜逆行胰胆管造影术（ERCP）治疗有症状的 CBD 结石是否可以减少因分别进行 EUS 和 ERCP 治疗而延迟治疗相关的并发症，并评估两种治疗方案的安全性。
本研究共纳入了 2005 年 1 月至 2011 年 12 月期间在我科接受 EUS 确诊 CBD 结石并随后行 ERCP 治疗的 151 例患者。评估并比较了因未在单个疗程中同时进行 EUS 和 ERCP 而导致的与操作或镇静相关的并发症，以及因未在单个疗程中同时进行 EUS 和 ERCP 而导致的 CBD 结石相关并发症，与在单个疗程中同时进行两种操作时的并发症进行比较。
在总共 151 例患者中，149 例（98.7%）成功进行了 ERCP。与单疗程组（A 组）相比，在多疗程组（B 组）中有 4 例（5%）患者发生了严重并发症（p>0.05）。B 组患者在 ERCP 中接受的咪达唑仑剂量比 A 组多 14%（p<0.05）。两组均未出现与镇静相关的并发症。B 组中有 11 例（13.8%）患者在等待 ERCP 期间出现并发症，而 A 组中无患者出现（p=0.001，OR=2.17，CI=1.06-4.44）。
在单个疗程中同时进行 EUS 和 ERCP 是安全的，不会增加与镇静或操作相关的并发症。延迟治疗有症状的 CBD 结石会使患者面临胆道并发症的风险，尤其是胆管炎。
