Funatsu Eiji, Masuda Atsuhiro, Takenaka Mamoru, Nakagawa Takashi, Shiomi Hideyuki, Yoshinaka Hayato, Kobayashi Takashi, Sakai Arata, Yagi Yosuke, Yoshida Masaru, Arisaka Yoshifumi, Okabe Yoshihiro, Kutsumi Hiromu, Azuma Takeshi
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Chibune General Hospital, Osaka, Japan.
Kobe J Med Sci. 2017 May 15;63(1):E1-E8.
Previous pancreatitis is a definite patient-related risk factor for pancreatitis after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis: PEP). However, the effects of differences in the history of PEP and acute pancreatitis on the occurrence of PEP have not been fully investigated. We examined the relationship between previous PEP or previous acute pancreatitis and procedural factors associated with PEP.
Clinical data on 1,334 consecutive patients undergoing ERCP between April 2006 and June 2010 were collected. A multivariate logistic regression analysis was conducted to assess the relationship between PEP and the cannulation time (<15 min vs. ≥15 min) or total procedure time (<30 min vs. ≥30 min) according to previous pancreatitis (previous PEP: pPEP or previous acute pancreatitis: pAP), with adjustments for clinical characteristics.
Longer cannulation times (≥15 min) correlated with the occurrence of PEP in the pPEP group (OR=2.97; 95% CI=1.10 to 8.43, P=0.03) and in patients without previous pancreatitis (non-preP group) (OR=2.43; 95% CI=1.41 to 4.14, P= 0.002), but not in the pAP group (OR=2.78; 95% CI=0.50 to 22.42, P= 0.25). In contrast, longer procedure times correlated with the occurrence of PEP in the pAP group (OR=3.93; 95% CI=1.11 to 16.5, P= 0.03), but not in the pPEP group (OR=2.79; 95% CI=0.92 to 9.18, P= 0.068) or non-preP group (OR=0.71; 95% CI=0.39 to 1.24, P= 0.23).
A higher risk of PEP with previous PEP was associated with longer cannulation times, whereas a higher risk of PEP with previous acute pancreatitis was associated with longer procedure times.
既往胰腺炎是内镜逆行胰胆管造影术后胰腺炎（ERCP术后胰腺炎：PEP）明确的患者相关危险因素。然而，既往PEP和急性胰腺炎病史的差异对PEP发生的影响尚未得到充分研究。我们研究了既往PEP或既往急性胰腺炎与PEP相关操作因素之间的关系。
收集了2006年4月至2010年6月期间连续1334例行ERCP患者的临床资料。根据既往胰腺炎（既往PEP：pPEP或既往急性胰腺炎：pAP）情况，进行多因素逻辑回归分析，以评估PEP与插管时间（<15分钟与≥15分钟）或总操作时间（<30分钟与≥30分钟）之间的关系，并对临床特征进行校正。
较长的插管时间（≥15分钟）与pPEP组（OR=2.97；95%CI=1.10至8.43，P=0.03）和无既往胰腺炎患者（非preP组）（OR=2.43；95%CI=1.41至4.14，P=0.002）的PEP发生相关，但与pAP组无关（OR=2.78；95%CI=0.50至22.42，P=0.25）。相反，较长的操作时间与pAP组的PEP发生相关（OR=3.93；95%CI=1.11至16.5，P=0.03），但与pPEP组（OR=2.79；95%CI=0.92至9.18，P=0.068）或非preP组无关（OR=0.71；95%CI=0.39至1.24，P=0.23）。
既往PEP发生PEP的较高风险与较长的插管时间相关，而既往急性胰腺炎发生PEP的较高风险与较长的操作时间相关。
