Division of Gastroenterology and Hepatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, 705-718, South Korea.
Surg Endosc. 2019 Oct;33(10):3334-3340. doi: 10.1007/s00464-018-06623-8. Epub 2019 Jan 2.
For therapeutic endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (ES) is necessary but it can lead to complications such as bleeding. Thus, we investigated the risk factors of post-ES bleeding in average risk patients.
We retrospectively reviewed the medical records of patients who had been treated for ERCP between April 2006 and March 2013. The length of the ES incision was defined as minimal (up to proximal hooding fold), medium (between minimal and full length), and full (up to superior margin of sphincter opening). Exclusion criteria were as follows: if performed precut sphincterotomy or balloon dilatation, patients having altered anatomy or anticoagulant medications.
A total of 3620 patients underwent ERCP and 1121 patients who underwent biliary ES were enrolled. Post-ES bleeding occurred in 108 of 1121 patients (9.6%) and mostly minor bleeding (94 patients, 87%). Length of ES was the only risk factor for post-ES bleeding in multivariate analysis. Complete hemostasis was achieved by endoscopic modalities and no serious complication developed after hemostasis.
In average risk patients, length of ES was independent risk factor for post-ES bleeding and endoscopic hemostasis was safe and effective.
对于治疗性内镜逆行胰胆管造影（ERCP），内镜下括约肌切开术（ES）是必要的，但它会导致出血等并发症。因此，我们研究了平均风险患者 ES 后出血的危险因素。
我们回顾性分析了 2006 年 4 月至 2013 年 3 月期间接受 ERCP 治疗的患者的病历。ES 切口的长度定义为最小（至近端 hooding 褶皱）、中等（最小至全长）和最大（至括约肌开口的上缘）。排除标准如下：如果进行预切开括约肌切开术或球囊扩张术、解剖结构改变或抗凝药物的患者。
共有 3620 例患者接受 ERCP 检查，其中 1121 例患者接受了胆道 ES，108 例（9.6%）发生了 ES 后出血，其中 94 例（87%）为轻微出血。多因素分析显示，ES 长度是 ES 后出血的唯一危险因素。内镜治疗可达到完全止血，止血后无严重并发症发生。
在平均风险患者中，ES 长度是 ES 后出血的独立危险因素，内镜止血安全有效。
