H.O.U.S.E. 分类法：一种新型的内镜逆行胰胆管造影术（ERCP）复杂性分级量表。
The H.O.U.S.E. classification: a novel endoscopic retrograde cholangiopancreatography (ERCP) complexity grading scale.
作者信息
Olsson Greger, Arnelo Urban, Swahn Fredrik, Törnqvist Björn, Lundell Lars, Enochsson Lars
机构信息
Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery, Ryhov County Hospital, Jönköping, S-551 85, Sweden.
出版信息
BMC Gastroenterol. 2017 Mar 9;17(1):38. doi: 10.1186/s12876-017-0583-z.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging endoscopic procedure, harboring a wide range of complexities within every single investigation. Classifications of the complexity of ERCP have been presented, but do not include modern endoscopic treatment modalities. In order to be able to target resources and compare the results of different endoscopic centers, a new complexity grading system for ERCP is warranted. This study launches a new complexity grading scale for ERCP-the H.O.U.S.E.-classification.
METHODS
The medical record of every patient undergoing ERCP 2009-2011 at the Karolinska University Hospital was reviewed, regarding the complexity of the procedure, and categorized into one out of three-grades in the HOUSE classification system, and concomitantly graded according to the Cotton grading system. All ERCP-procedures were also registered in the Swedish registry for gallstone surgery and ERCP (GallRiks) and correlations between the grading systems and procedure related variables as well as outcomes were made.
RESULTS
Between 2009 and 2011, 2185 ERCPs were performed at the Karolinska University Hospital, Huddinge. One thousand nine hundred fifty-four of those were index-ERCPs. Another 23 patients were excluded due to lack of postoperative complication registrations, leaving 1931 ERCP procedures to be analyzed. The procedure times were 40 ± 0.7, 65 ± 1.5 and 106 ± 3.2 min, respectively (HOUSE 1-3). The corresponding pancreatitis rates were 3.4, 7.0 and 6.8% and the postoperative complication rates 11.1, 15.7 and 12.8%, respectively.
CONCLUSIONS
The HOUSE-classification is a novel grading scale for ERCP-complexity. The system can be implemented in clinical practice to allocate resources and allow the comparisons of results between different endoscopic centers. Further studies are warranted to further sharpen this instruments validitity and general clinical relevance.
背景
内镜逆行胰胆管造影术（ERCP）是一项技术要求较高的内镜操作，每次检查都存在各种复杂情况。虽然已有ERCP复杂性的分类，但未涵盖现代内镜治疗方式。为了合理分配资源并比较不同内镜中心的结果，需要一种新的ERCP复杂性分级系统。本研究推出了一种新的ERCP复杂性分级量表——HOUSE分类法。
方法
回顾了2009年至2011年在卡罗林斯卡大学医院接受ERCP的每位患者的病历，根据操作复杂性，在HOUSE分类系统中分为三个等级之一，并同时按照Cotton分级系统进行分级。所有ERCP操作也都记录在瑞典胆结石手术和ERCP登记处（GallRiks），分析了分级系统与操作相关变量及结果之间的相关性。
结果
2009年至2011年期间，胡丁厄的卡罗林斯卡大学医院共进行了2185例ERCP。其中1954例为首次ERCP。另外23例患者因缺乏术后并发症登记而被排除，共1931例ERCP操作可供分析。操作时间分别为40±0.7、65±1.5和106±3.2分钟（HOUSE 1 - 3级）。相应的胰腺炎发生率分别为3.4%、7.0%和6.8%，术后并发症发生率分别为11.1%、15.7%和12.8%。
结论
HOUSE分类法是一种新的ERCP复杂性分级量表。该系统可应用于临床实践，以分配资源并允许不同内镜中心之间比较结果。有必要进行进一步研究以提高该工具的有效性和一般临床相关性。
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