Alkhatib Amer A, Abdel Jalil Ala A, Faigel Douglas O, Pannala Rahul, Crowell Michael, Harrison M E
Division of Gastroenterology, Cancer Treatment Centers of America, 10109 E 79th St, Tulsa, OK, 74133, USA,
Dig Dis Sci. 2015 Jun;60(6):1787-92. doi: 10.1007/s10620-014-3508-5. Epub 2015 Feb 4.
Different factors have been associated with prolonged fluoroscopy time (FT) during endoscopic retrograde cholangiopancreatography (ERCP).
We hypothesize that FT depends on both the anatomical location of the pathology managed during ERCP and the complexity of the ERCP.
Three centers participated in a retrospective multi-center cohort study. Data on patient demographics, ERCP complexity, and the location of pathology were collected. The relationships between FT and the location of pathology, ERCP complexity, patient demographics, and ERCP maneuvers, respectively, were analyzed. Prolonged FT was defined as a FT > 10 min.
A total of 442 cases underwent ERCP in three different centers (301 cases, 76 cases, and 65 cases in centers A, B, and C, respectively) by six endoscopists. The median FT for all cases was 282 (range 8-3,516) s. Mean FT increased progressively according to anatomical location in the order extrahepatic cases {n = 298; mean FT 292 [95 % confidence interval (CI) 263-322] s}, pancreatic cases [n = 27; mean FT 359 (95 % CI 200-517) s], and intrahepatic cases [n = 117; mean FT 736 s (95 % CI 635-836) s]. Mean FT increased progressively with the complexity scale, with mean FT for Grade I, 218 (95 % CI 138-299) s; Grade II, 295 (95 % 261-329) s; Grade III, 586 (95 % CI 508-663) s; Grade IV, 636 (95 % CI 437-834) s. Multivariable analysis confirmed that prolonged FT was independently associated with anatomical location of the targeted pathology during ERCP-but not with ERCP complexity and endoscopy center.
Prolonged FT during ERCP is associated most strongly with intrahepatic cases. FT can be used most effectively as a quality measure if it is stratified according to presence or absence of intrahepatic cases.
在内镜逆行胰胆管造影术（ERCP）期间，不同因素与透视时间延长（FT）有关。
我们假设FT取决于ERCP期间所处理病变的解剖位置以及ERCP的复杂性。
三个中心参与了一项回顾性多中心队列研究。收集了患者人口统计学、ERCP复杂性和病变位置的数据。分别分析了FT与病变位置、ERCP复杂性、患者人口统计学和ERCP操作之间的关系。延长的FT定义为FT>10分钟。
六位内镜医师在三个不同中心共进行了442例ERCP（A中心301例、B中心76例、C中心65例）。所有病例的中位FT为282（范围8 - 3516）秒。平均FT根据解剖位置按以下顺序逐渐增加：肝外病例{n = 298；平均FT 292 [95%置信区间（CI）263 - 322]秒}、胰腺病例[n = 27；平均FT 359（95%CI 200 - 517）秒]和肝内病例[n = 117；平均FT 736秒（95%CI 635 - 836）秒]。平均FT随着复杂性等级逐渐增加，I级平均FT为218（95%CI 138 - 299）秒；II级为295（95% 261 - 329）秒；III级为586（95%CI 508 - 663）秒；IV级为636（95%CI 437 - 834）秒。多变量分析证实，延长的FT与ERCP期间目标病变的解剖位置独立相关，但与ERCP复杂性和内镜中心无关。
ERCP期间延长的FT与肝内病例关联最为密切。如果根据肝内病例的有无进行分层，FT可最有效地用作质量指标。
