Hori Yasuki, Naitoh Itaru, Nakazawa Takahiro, Hayashi Kazuki, Miyabe Katsuyuki, Shimizu Shuya, Kondo Hiromu, Yoshida Michihiro, Yamashita Hiroaki, Umemura Shuichiro, Ban Tessin, Okumura Fumihiro, Sano Hitoshi, Takada Hiroki, Joh Takashi
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
J Gastroenterol Hepatol. 2014 Mar;29(3):648-52. doi: 10.1111/jgh.12336.
The opportunities of endoscopic retrograde cholangiopancreatography (ERCP)-related procedure for hemodialysis (HD) patients have been increasing recently. However, the complication rate of ERCPs in HD patients has not been evaluated sufficiently. We aimed to clarify the feasibility of ERCPs in HD patients.
We retrospectively reviewed 76 consecutive ERCPs for HD patients between January 2005 and December 2012 in one university hospital and three tertiary-care referral centers. Endoscopic sphincterotomy (EST) was performed in 21 HD patients. We evaluated the incidence and risk factors for complications of all ERCPs and EST in HD patients.
The incidence of pancreatitis, cholangitis, and cardiopulmonary complications for ERCPs in HD patients was 7.9% (6/76), 1.3% (1/76), and 1.3% (1/76), respectively. The mortality rate was 2.6% (2/76), and it occurred after acute pancreatitis in one patient and pneumonia in the other patient. The incidence of hemorrhage and pancreatitis with EST was 19% (4/21) and 4.8% (1/21), respectively. The duration of HD was significantly longer in the patients with hemorrhage after EST than without (19.5 vs 6 years; P = 0.029).
ERCP is feasible in HD patients. However, EST is not advisable because of the high hemorrhage rate, particularly for patients with a long duration of HD.
近年来，血液透析（HD）患者接受内镜逆行胰胆管造影（ERCP）相关手术的机会不断增加。然而，HD患者ERCP的并发症发生率尚未得到充分评估。我们旨在阐明HD患者行ERCP的可行性。
我们回顾性分析了2005年1月至2012年12月期间在一家大学医院和三家三级医疗转诊中心连续接受ERCP的76例HD患者。21例HD患者接受了内镜下括约肌切开术（EST）。我们评估了HD患者所有ERCP和EST并发症的发生率及危险因素。
HD患者ERCP后胰腺炎、胆管炎和心肺并发症的发生率分别为7.9%（6/76）、1.3%（1/76）和1.3%（1/76）。死亡率为2.6%（2/76），其中1例患者死于急性胰腺炎，另1例死于肺炎。EST后出血和胰腺炎的发生率分别为19%（4/21）和4.8%（1/21）。EST后出血患者的HD持续时间显著长于未出血患者（19.5年对6年；P = 0.029）。
HD患者行ERCP是可行的。然而，由于出血率高，EST并不可取，尤其是对于HD持续时间长的患者。
