Department of Surgery, University of Louisville, 550 S. Jackson Street, Louisville, KY, 40202, USA.
Surg Endosc. 2018 Feb;32(2):799-804. doi: 10.1007/s00464-017-5746-z. Epub 2017 Jul 21.
Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is used for the management of many pancreaticobiliary disorders. It is generally safe with a few short-term complications. The risk factors for the development of post-ERCP cholangitis due to stent occlusion have not been previously described. This study identified such risk factors among patients undergoing ERCP and stent placement for pancreatic or biliary obstruction.
3648 ERCPs performed at the University of Louisville from 2008 to 2016 were reviewed. Data including patient demographics, diagnostic, laboratory, and ERCP related data were included. Patients were classified as having post-ERCP cholangitis if they developed jaundice, fever, right upper quadrant abdominal pain, and confirmatory findings of stent occlusion and/or purulent drainage at the time of repeat ERCP. These patients were compared to those who did not develop post-ERCP cholangitis using univariate and multivariate analyses.
A total of 431 patients met inclusion criteria. Of these, 57 (13.2%) developed post-ERCP cholangitis. The average age of patients was 57 years with 57% women and 43% men. On univariate analysis, patients developing post-ERCP cholangitis were more likely to be of increased age, have higher white blood cell count (WBC), total bilirubin (TBili), AST, ALT, and alkaline phosphatase (AlkPhos), and a decreased serum albumin level. Risk factors for post-ERCP cholangitis due to stent occlusion identified on multivariate analysis include: a diagnosis of cancer, the placement of multiple biliary stents at index ERCP, and low serum albumin level.
The development of post-ERCP cholangitis due to stent occlusion is strongly associated with the presence of malignancy, the placement of multiple biliary stents, and low serum albumin. A decreased threshold to monitor for stent occlusion, including routine liver function tests and prophylactic stent removal or exchange, should be employed in patients with these characteristics.
内镜逆行胰胆管造影术（ERCP）联合支架置入术被用于多种胰胆疾病的治疗。该操作通常较为安全，但存在少数短期并发症。然而，支架阻塞导致 ERCP 术后胆管炎的危险因素尚未被明确。本研究旨在确定接受 ERCP 联合支架置入术治疗胰胆梗阻的患者中，与支架阻塞相关的 ERCP 术后胆管炎的危险因素。
回顾了 2008 年至 2016 年在路易斯维尔大学进行的 3648 例 ERCP 检查。纳入的数据包括患者的人口统计学、诊断、实验室和 ERCP 相关数据。如果患者在重复 ERCP 时出现黄疸、发热、右上腹疼痛，并发现支架阻塞和/或脓性引流的明确证据，则将其诊断为 ERCP 术后胆管炎。使用单因素和多因素分析比较发生 ERCP 术后胆管炎和未发生 ERCP 术后胆管炎的患者。
共有 431 例患者符合纳入标准，其中 57 例（13.2%）发生 ERCP 术后胆管炎。患者的平均年龄为 57 岁，女性占 57%，男性占 43%。单因素分析显示，发生 ERCP 术后胆管炎的患者年龄更大，白细胞计数（WBC）、总胆红素（TBili）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和碱性磷酸酶（AlkPhos）更高，血清白蛋白水平更低。多因素分析确定的支架阻塞导致 ERCP 术后胆管炎的危险因素包括：诊断为癌症、在初次 ERCP 时放置多个胆道支架和低血清白蛋白水平。
支架阻塞导致的 ERCP 术后胆管炎与恶性肿瘤、放置多个胆道支架和低血清白蛋白水平密切相关。对于具有这些特征的患者，应降低监测支架阻塞的阈值，包括常规肝功能检查和预防性支架取出或更换。
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