Joshi D, Paranandi B, El Sayed G, Down J, Johnson G J, Chapman M H, Pereira S P, Webster G J M
Department of Gastroenterology, University College London Hospitals, London, UK.
Department of Anaesthesia, University College London Hospitals, London, UK.
Frontline Gastroenterol. 2015 Jan;6(1):32-37. doi: 10.1136/flgastro-2014-100495. Epub 2014 Sep 10.
Endoscopic retrograde cholangiopancreatography (ERCP) in the UK has been historically performed under conscious sedation. However, given the increasing complexity of cases, the role of propofol-assisted ERCP (propERCP) is increasing. We describe our experience of propERCP and highlight the importance of this service.
Our prospective ERCP database was interrogated between January 2013 and January 2014. Data collection included procedural information, patient demographics, American Association of Anaesthesiologists (ASA) status, Cotton grade of endoscopic difficulty and endoscopic and anaesthetic complications. Comparison was made with patients undergoing conscious sedation ERCP (sedERCP).
744 ERCPs were performed in 629 patients (53% male). 161 ERCPs were performed under propofol. PropERCP patients were younger compared with the sedERCP group (54 vs 66 years, p<0.0001) but ASA grade 1-2 status was similar (84% vs 78%, p=0.6). An increased number of Cotton grade 3-4 ERCPs were performed in the propERCP group (64% vs 34%, p<0.0001). Indications for propERCP included sphincter of Oddi manometry (27%), previously poorly tolerated sedERCP (26%), cholangioscopy (21%) and patient request (8%). 77% of cases were elective, 12% were urgent day-case transfers and 11% were urgent inpatients. 59% of cases were tertiary referrals. ERCP was completed successfully in 95% of cases. Anaesthetic and endoscopic complications were comparable between the two groups (5% and 7% vs 3% and 5%). Where sedERCP had been unsuccessful due to patient intolerance, the procedure was completed successfully using propofol.
PropERCP is safe and is associated with high endoscopic success. The need for propERCP is likely to increase given patient preference and the high proportion of complex procedures being undertaken. All endoscopy units should look to incorporate propofol-assisted endoscopy into aspects of their services.
在英国，内镜逆行胰胆管造影术（ERCP）传统上是在清醒镇静下进行的。然而，鉴于病例的复杂性日益增加，丙泊酚辅助ERCP（propERCP）的作用也在增加。我们描述了我们开展propERCP的经验，并强调了这项服务的重要性。
我们查询了2013年1月至2014年1月期间的前瞻性ERCP数据库。数据收集包括手术信息、患者人口统计学资料、美国麻醉医师协会（ASA）分级、内镜检查难度的科顿分级以及内镜和麻醉相关并发症。将其与接受清醒镇静ERCP（sedERCP）的患者进行比较。
629例患者共进行了744次ERCP（男性占53%）。其中161次ERCP是在丙泊酚麻醉下进行的。与sedERCP组相比，propERCP组患者更年轻（54岁对66岁，p<0.0001），但ASA 1-2级状态相似（84%对78%，p=0.6）。propERCP组进行的科顿3-4级ERCP数量增加（64%对34%，p<0.0001）。propERCP的适应证包括Oddi括约肌测压（27%）、先前对sedERCP耐受性差（26%）、胆管镜检查（21%）和患者要求（8%）。77%的病例为择期手术，12%为紧急日间手术转诊，11%为紧急住院患者。59%的病例为三级转诊。95%的病例ERCP成功完成。两组的麻醉和内镜并发症相当（分别为5%和7%对3%和5%）。当sedERCP因患者不耐受而未成功时，使用丙泊酚成功完成了手术。
PropERCP是安全的，且内镜成功率高。鉴于患者的偏好以及复杂手术比例较高，对propERCP的需求可能会增加。所有内镜检查单位应考虑将丙泊酚辅助内镜检查纳入其服务的各个方面。
