Saito Hirokazu, Kakuma Tatsuyuki, Kadono Yoshihiro, Urata Atsushi, Kamikawa Kentaro, Imamura Haruo, Tada Shuji
Department of Gastroenterology, Kumamoto City-Hospital, Kumamoto, Japan.
Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto, Japan.
Endosc Int Open. 2017 Sep;5(9):E809-E817. doi: 10.1055/s-0043-107615. Epub 2017 Sep 5.
Endoscopic removal of asymptomatic common bile duct stones (CBDS) is generally recommended. Although many reports have described the risk of complications in endoscopic retrograde cholangiopancreatography (ERCP), no studies have addressed this problem in the context of asymptomatic CBDS. This study examines the risk of complications arising in ERCP for asymptomatic CBDS.
This retrospective study included 425 patients with naive papilla who underwent therapeutic ERCP for choledocholithiasis at 2 institutions in Japan for 2 years. The risk of complications was examined in patients who were divided into the asymptomatic and symptomatic CBDS groups. We used propensity score analysis to adjust for confounding effects.
Complications were observed in 32 (7.5 %) of the 425 patients. Of the 358 patients with symptomatic CBDS, 14 patients (3.9 %) had complications. In contrast, of the 67 patients with asymptomatic CBDS, 18 patients (26.9 %) had complications. Propensity score analysis revealed that asymptomatic CBDS was a significant risk factor, with a significantly higher incidence of complications compared with symptomatic CBDS (odds ratio, 5.3). Moderate to severe complications were observed in 15 of 18 patients (83.3 %) in the asymptomatic CBDS group, with significantly more moderate to severe complications than those in the symptomatic CBDS (odds ratio, 6.7).
Asymptomatic CBDS carried a high risk of ERCP-related complications, and these were often more severe. In asymptomatic CBDS, endoscopic treatment should be carefully performed after considering the patient's background, and detailed explanation of its possible complications should be given to patients in advance.
通常建议通过内镜切除无症状胆总管结石（CBDS）。尽管许多报告描述了内镜逆行胰胆管造影术（ERCP）相关并发症的风险，但尚无研究探讨无症状CBDS情况下的这一问题。本研究旨在探讨无症状CBDS患者接受ERCP时发生并发症的风险。
这项回顾性研究纳入了425例乳头未处理过的患者，这些患者在日本的2家机构接受了为期2年的胆总管结石治疗性ERCP。将患者分为无症状CBDS组和有症状CBDS组，对并发症风险进行了研究。我们使用倾向评分分析来调整混杂效应。
425例患者中有32例（7.5%）出现并发症。在358例有症状CBDS患者中，14例（3.9%）出现并发症。相比之下，67例无症状CBDS患者中有18例（26.9%）出现并发症。倾向评分分析显示，无症状CBDS是一个显著的风险因素，与有症状CBDS相比，并发症发生率显著更高（优势比，5.3）。无症状CBDS组18例患者中有15例（83.3%）出现中度至重度并发症，中度至重度并发症明显多于有症状CBDS组（优势比，6.7）。
无症状CBDS患者发生ERCP相关并发症的风险较高，且这些并发症往往更严重。对于无症状CBDS患者，应在考虑患者背景后谨慎进行内镜治疗，并应提前向患者详细解释可能出现的并发症。
