Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, C3-GAS, Seattle, WA, 98101, USA.
Surg Endosc. 2019 Feb;33(2):448-453. doi: 10.1007/s00464-018-6317-7. Epub 2018 Jul 9.
The utility of the American Society for Gastrointestinal Endoscopy (ASGE) grading scale assessing complexity of endoscopic retrograde cholangiopancreatography (ERCP) has not been evaluated in clinical practice.
Patients that underwent ERCP between January 2015 and December 2015 were included. Procedural difficulty was graded according to the grading system proposed by the ASGE workshop. Technical success rates and complications were recorded.
A total of 1355 ERCPs were performed on 934 patients. Patients were equally divided with respect to gender and had a mean age of 58 years (range 29-86). 391 cases were grade 1, 2 (29%), 695 were grade 3 (51%), and 269 were grade 4 (20%). Altered anatomy was observed in 88% of grade 4 patients. Cannulation was achieved in 98% of cases graded 1-3 and in 88% of cases graded 4 (p < 0.05). Complications were recorded in 10% of all cases with post-ERCP pancreatitis (5.4%) and procedure-related bleeding (1.5%) being the more common ones. No statistically significant difference was noted between the groups with regard to complications. Three perforations were seen in grade 1-3 cases (0.3%) compared to 4 cases in grade 4 cases (1.5%), (p = 0.01).
The grading system proposed by the ASGE workshop can aid in predicting cannulation success and perforation rates in ERCP. Based on this retrospective study, the most complex ERCP procedures can be achieved with encouraging rates of success. There is a need to validate our study with prospective ones performed in other high-volume centers.
美国胃肠内镜学会（ASGE）评估内镜逆行胰胆管造影术（ERCP）复杂性的分级量表在临床实践中尚未得到评估。
纳入 2015 年 1 月至 2015 年 12 月期间行 ERCP 的患者。根据 ASGE 研讨会提出的分级系统对手术难度进行分级。记录技术成功率和并发症。
共对 934 例患者的 1355 例 ERCP 进行了研究。患者在性别方面平均分为两组，平均年龄为 58 岁（范围 29-86 岁）。391 例为 1 级（29%），695 例为 2 级（51%），269 例为 3 级（20%）。4 级患者中有 88%存在解剖结构改变。1-3 级的插管成功率为 98%，4 级的插管成功率为 88%（p<0.05）。所有病例中有 10%发生并发症，其中胰腺炎（5.4%）和与操作相关的出血（1.5%）更为常见。各组之间在并发症方面无统计学差异。1-3 级中发生 3 例穿孔（0.3%），4 级中发生 4 例穿孔（1.5%）（p=0.01）。
ASGE 研讨会提出的分级系统可帮助预测 ERCP 中的插管成功率和穿孔率。基于这项回顾性研究，最复杂的 ERCP 操作可以成功完成，且成功率较高。需要在其他高容量中心进行前瞻性研究来验证我们的研究。
