肝硬化患者的内镜逆行胰胆管造影术——一项聚焦不良事件的系统评价和荟萃分析
Endoscopic retrograde cholangiopancreatography in cirrhosis - a systematic review and meta-analysis focused on adverse events.
作者信息
Mashiana Harmeet Singh, Dhaliwal Amaninder Singh, Sayles Harlan, Dhindsa Banreet, Yoo Ji Won, Wu Qing, Singh Shailender, Siddiqui Ali A, Ohning Gordon, Girotra Mohit, Adler Douglas G
机构信息
Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States.
Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, United States.
出版信息
World J Gastrointest Endosc. 2018 Nov 16;10(11):354-366. doi: 10.4253/wjge.v10.i11.354.
AIM
To investigate indications and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotics, especially adverse events. Patients with cirrhosis undergoing ERCP are believed to have increased risk. However, there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis, especially focusing on adverse events.
METHODS
We performed a systematic appraisal of major literature databases, including PubMed and EMBASE, with a manual search of literature from their inception until April 2017.
RESULTS
A total of 6,505 patients from 15 studies were analyzed (male ratio 59%, mean age 59 years), 11% with alcoholic and 89% with non-alcoholic cirrhosis, with 56.2% Child-Pugh class A, and 43.8% class B or C. Indications for ERCP included choledocholithiasis 60.9%, biliary strictures 26.2%, gallstone pancreatitis 21.1% and cholangitis 15.5%. Types of interventions included endoscopic sphincterotomy 52.7%, biliary stenting 16.7% and biliary dilation 4.6%. Individual adverse events included hemorrhage in 4.58% (95%CI: 2.77-6.75%, = 85.9%), post-ERCP pancreatitis (PEP) in 3.68% (95%CI: 1.83-6.00%, = 89.5%), cholangitis in 1.93% (95%CI: 0.63-3.71%, = 87.1%) and perforation in 0.00% (95%CI: 0.00-0.23%, = 37.8%). Six studies were used for comparison of ERCP-related complications in cirrhosis non-cirrhosis, which showed higher overall rates of complications in cirrhosis patients with pooled OR of 1.63 (95%CI: 1.27-2.09, = 65%): higher rates of hemorrhage with OR of 2.05 (95%CI: 1.62-2.58, = 2.1%) and PEP with OR of 1.33 (95%CI: 1.04-1.70, =65%), but similar cholangitis rates with OR of 1.23 (95%CI: 0.67-2.26, = 44.3%).
CONCLUSION
There is an overall higher rate of adverse events related to ERCP in patients with cirrhosis, especially hemorrhage and PEP. A thorough risk/benefit assessment should be performed prior to undertaking ERCP in patients with cirrhosis.
目的
探讨内镜逆行胰胆管造影术（ERCP）在肝硬化患者中的适应证及治疗结果，尤其是不良事件。肝硬化患者接受ERCP被认为风险增加。然而，描述肝硬化患者ERCP手术适应证及治疗结果，尤其是关注不良事件的文献较少。
方法
我们对主要文献数据库进行了系统评估，包括PubMed和EMBASE，并手动检索了从数据库建立至2017年4月的文献。
结果
共分析了15项研究中的6505例患者（男性比例59%，平均年龄59岁），其中11%为酒精性肝硬化，89%为非酒精性肝硬化，Child-Pugh A级占56.2%，B级或C级占43.8%。ERCP的适应证包括胆总管结石60.9%、胆管狭窄26.2%、胆石性胰腺炎21.1%和胆管炎15.5%。干预类型包括内镜括约肌切开术52.7%、胆管支架置入术16.7%和胆管扩张术4.6%。个体不良事件包括出血4.58%（95%CI：2.77-6.75%，I² = 85.9%）、ERCP术后胰腺炎（PEP）3.68%（95%CI：1.83-6.00%，I² = 89.5%）、胆管炎1.93%（95%CI：0.63-3.71%）和穿孔0.00%（95%CI：0.00-0.23%，I² = 37.8%）。六项研究用于比较肝硬化患者与非肝硬化患者ERCP相关并发症，结果显示肝硬化患者总体并发症发生率较高，合并OR为1.63（95%CI：1.27-2.09，I² = 65%）：出血发生率较高，OR为2.05（95%CI：1.
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