Ding Xiang, Zhang FuCheng, Wang YaoJun
Postgraduate Training Base of the General Hospital of Jinan Military Command, Liaoning Medical University, Jinan, Shandong, China.
Department of Gastroenterology, The General Hospital of Jinan Military Command, Jinan, Shandong, China.
Surgeon. 2015 Aug;13(4):218-29. doi: 10.1016/j.surge.2014.11.005. Epub 2014 Dec 24.
Pancreatitis is the most common and serious complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Prevention strategies targeting risk factors could be important to reduce the rate of post-ERCP pancreatitis. However, the risk factors for post-ERCP pancreatitis (PEP) are still debated. This systematic review and meta-analysis was performed to identify risk factors for PEP.
Medline (PubMed and Ovid), Cochrane Central Register of Controlled trials & Database of Systematic Reviews, Embase, Scopus, ScienceDirect, Springer links and WEB OF SCIENCE were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Eighteen probable risk factors were evaluated, and outcomes were expressed in the case of dichotomous variables, as an odds ratio (OR) (with a 95% confidence interval, (CI)).
When patient-related risk factors were analyzed, the ORs for female gender was 1.46 (95%CI: 1.30-1.64); for previous pancreatitis 2.03 (95%CI: 1.31-3.14); for previous PEP was 2.90 (95%CI: 1.87-4.48); for Sphincter of Oddi dysfunction (SOD) was 2.04 (95%CI: 1.73-2.33) and for Intraductal papillary mucinous neoplasm (IPMN) was 3.01 (95%CI: 1.34-6.77). Four endoscopy-related factors were confirmed: the OR for difficult cannulation was 3.49 (95%CI: 1.364-8.925); for endoscopic sphincterotomy (EST) it was 1.39 (95%CI: 1.09-1.79); for precut sphincterotomy it was 2.25 (95%CI: 1.70_2.96); and for main pancreatic duct injection it was 1.58 (95%CI: 1.21-2.08).
Female gender, previous pancreatitis, previous PEP, SOD, IPMN, difficult cannulation, EST, precut sphincterotomy and main pancreatic duct injection are risk factors for post-ERCP pancreatitis.
胰腺炎是诊断性和治疗性内镜逆行胰胆管造影术（ERCP）最常见且最严重的并发症。针对危险因素的预防策略对于降低ERCP术后胰腺炎的发生率可能至关重要。然而，ERCP术后胰腺炎（PEP）的危险因素仍存在争议。进行这项系统评价和荟萃分析以确定PEP的危险因素。
检索了Medline（PubMed和Ovid）、Cochrane对照试验中央注册库及系统评价数据库、Embase、Scopus、ScienceDirect、Springer链接和科学网中所有语言发表的研究。事先定义了纳入和排除标准。评估了18个可能的危险因素，对于二分变量，结果以比值比（OR）（及其95%置信区间（CI））表示。
分析患者相关危险因素时，女性的OR为1.46（95%CI：1.30 - 1.64）；既往有胰腺炎为2.03（95%CI：1.31 - 3.14）；既往有PEP为2.90（95%CI：1.87 - 4.48）；Oddi括约肌功能障碍（SOD）为为2.04（95%CI：1.73 - 2.33）；导管内乳头状黏液性肿瘤（IPMN）为3.01（95%CI：1.34 - 6.77）。确认了四个与内镜检查相关的因素：插管困难的OR为3.49（95%CI：1.364 - 8.925）；内镜括约肌切开术（EST）为1.39（95%CI：1.09 - 1.79）；预切开括约肌切开术为2.25（95%CI：1.70 - 2.96）；主胰管注射为1.58（95%CI：1.21 - 2.08）。
女性、既往有胰腺炎、既往有PEP、SOD、IPMN、插管困难、EST、预切开括约肌切开术和主胰管注射是ERCP术后胰腺炎 的危险因素。
