用于复杂胆管结石取出的高级内镜逆行胰胆管造影（ERCP）技术：一家转诊中心的12年经验

Advanced ERCP techniques for the extraction of complex biliary stones: a single referral center's 12-year experience.

作者信息

Brown Nicholas G, Camilo Joel, Nordstrom Eric, Yen Roy D, Fukami Norio, Brauer Brian C, Wani Sachin, Amateau Stuart K, Attwell Augustin R, Shah Raj J

机构信息

a Division of Gastroenterology and Hepatology , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.

b Department of Medicine , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.

出版信息

Scand J Gastroenterol. 2018 May;53(5):626-631. doi: 10.1080/00365521.2018.1441434. Epub 2018 Apr 12.

DOI:10.1080/00365521.2018.1441434

PMID:29644909

Abstract

OBJECTIVES

Advanced ERCP techniques (AETs) for difficult biliary stones include peroral cholangioscopy (POC) with electrohydraulic/laser lithotripsy (EHL/LL), endoscopic papillary large balloon dilation (EPLBD) and mechanical lithotripsy (ML). We assess the efficacy of AETs.

METHODS

A retrospective query for AETs.

PRIMARY OUTCOME

Complete duct clearance. Secondary outcome: Complete duct clearance by technique. Statistical Analysis version 9.3 (SAS Inc., Cary, NC).

RESULTS

From 1/00 to 10/12, 349 patients were identified of which 222 (80% had prior ERCPs) had AETs. 211 with sufficient follow-up underwent 295 ERCPs; 280 of which were AET's. Index AETs: POC with EHL/LL (n = 46/211, 22%), ML (n = 84/211, 40%), EPLBD with mean balloon size of 11.5 ± 1.7 mm (n = 39/211, 18%) and combination AETs (n = 42/211, 20%). Stone characteristics: 76% had ≥1 stone, 81% extrahepatic and 32% had strictures. Number of stones (mean 2.5 and range 1-20) did not differ among groups. EPLBD had higher percentage (95%) of extrahepatic stones (p = .0003). The 'Combination' and 'POC' groups had larger stones (mean 17.7 mm ±6.4 and 16.8 mm ±6.1, respectively; p < .001). Complete clearance: 209/211 (99%) at index AET 167/211 (79%) or after mean of 2.5 ± 0.7 AETs in 42/211 (20%). Partial clearance: 2/211 (1%). Clearance at index AETs was higher with EPLBD (90%, p = .014). Adverse Events: 7/280 (2.5%).

CONCLUSIONS

AETs achieved clearance in 99%. EPLBD had higher clearance at index AET likely owing to higher extrahepatic stones. Larger stones, but not number, were associated with increased combination AETs and total ERCPs.

摘要

目的

用于处理复杂胆管结石的高级内镜逆行胰胆管造影（ERCP）技术（AETs）包括经口胆管镜检查（POC）联合电液压/激光碎石术（EHL/LL）、内镜乳头大球囊扩张术（EPLBD）和机械碎石术（ML）。我们评估了AETs的疗效。

方法

对AETs进行回顾性查询。

主要结局

胆管结石完全清除。次要结局：按技术分类的胆管结石完全清除情况。采用统计分析软件9.3版（SAS公司，北卡罗来纳州卡里）。

结果

从2000年1月至2012年10月，共识别出349例患者，其中222例（80%曾接受过ERCP）接受了AETs。211例有充分随访的患者接受了295次ERCP；其中280次为AETs。首次AETs：POC联合EHL/LL（n = 46/211，22%）、ML（n = 84/211，40%）、平均球囊大小为11.5±1.7 mm的EPLBD（n = 39/211，18%）以及联合AETs（n = 42/211，20%）。结石特征：76%有≥1枚结石，81%为肝外结石，32%有狭窄。结石数量（平均2.5枚，范围1 - 20枚）在各组间无差异。EPLBD组肝外结石的比例更高（95%，p = 0.0003）。“联合”组和“POC”组的结石更大（平均分别为17.7 mm±6.4和16.8 mm±6.1，p < 0.001）。完全清除：首次AETs时209/211（99%），167/211（79%）在平均2.5±0.7次AETs后清除，42/211（20%）。部分清除：2/211（1%）。首次AETs时EPLBD的清除率更高（90%，p = 0.014）。不良事件：7/280（2.5%）。