Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea.
Dig Dis Sci. 2018 Nov;63(11):3141-3146. doi: 10.1007/s10620-018-5112-6. Epub 2018 May 16.
Previous studies evaluating the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with end-stage renal disease (ESRD) undergoing hemodialysis reported an increased risk of post-procedural bleeding. We investigated the safety and efficacy of ERCP for the treatment of choledocholithiasis in patients with ESRD undergoing long-term dialysis.
A total of 3466 patients who underwent ERCP due to choledocholithiasis between January 2000 and Feb 2018 were reviewed and analyzed retrospectively. Patients were divided into dialysis and non-dialysis group, and propensity score matching was used to minimize selection bias.
Patients of dialysis group (n = 39) and non-dialysis group (n = 78) were compared after propensity score matching. Among 39 patients of dialysis group, hemodialysis was used in 28 (71.8%) patients for renal replacement therapy, while 11 (28.2%) patients received peritoneal dialysis. The median duration of dialysis was 8 years (range 1-24 years). Overall success rate of ERCP was not different between two groups. The overall prevalence of post-procedural complications in dialysis group and non-dialysis group was 28.2 and 15.4%, respectively (p = 0.100). Post-procedural bleeding occurred more frequently in dialysis group than non-dialysis group (23.1 vs 5.1%, p = 0.004). All procedure-related bleeding episodes were successfully controlled using endoscopic management. Prevalence of post-ERCP pancreatitis, infection, and perforation were not significantly different between two groups (p > 0.05).
Overall success rate of complete ductal clearance was not different between dialysis and non-dialysis groups. The risk of post-procedural bleeding seems to be increased in patients with ESRD undergoing long-term dialysis.
先前评估接受血液透析的终末期肾病（ESRD）患者行内镜逆行胰胆管造影术（ERCP）安全性的研究报告称，术后出血风险增加。我们研究了长期透析的 ESRD 患者行 ERCP 治疗胆总管结石的安全性和疗效。
回顾性分析了 2000 年 1 月至 2018 年 2 月期间因胆总管结石而行 ERCP 的 3466 例患者。患者分为透析组和非透析组，并采用倾向评分匹配法以尽量减少选择偏倚。
在倾向评分匹配后比较了透析组（n=39）和非透析组（n=78）的患者。在透析组的 39 例患者中，28 例（71.8%）患者使用血液透析进行肾脏替代治疗，而 11 例（28.2%）患者接受腹膜透析。透析的中位时间为 8 年（范围 1-24 年）。两组 ERCP 总体成功率无差异。透析组和非透析组术后并发症总体发生率分别为 28.2%和 15.4%（p=0.100）。透析组术后出血发生率高于非透析组（23.1%比 5.1%，p=0.004）。所有与操作相关的出血均通过内镜治疗成功控制。两组术后胰腺炎、感染和穿孔的发生率无显著差异（p>0.05）。
完全胆管清除的总体成功率在透析组和非透析组之间无差异。长期透析的 ESRD 患者术后出血风险似乎增加。
