Debnath C R, Ahmed N, Debnath M R, Amin M R, Akther T, Tarafder A J, Ahmed S M, Zaman S, Debnath C J
Professor Dr Chitta Ranjan Debnath, Professor & Head, Department of Hepatology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh.
Mymensingh Med J. 2019 Apr;28(2):317-321.
Endoscopic retrograde cholangiopancreatography (ERCP) is a modern & universally established modality in the evaluation and treatment of suspected biliary and pancreatic disease. In Bangladesh, ERCP services are limited to few tertiary care centers mostly in the capital & large city. ERCP was 1st introduced in Mymensingh on 3rd April 2016 in a private hospital. Since then, Mymensingh Medical College Hospital (MMCH) provides ERCP services to a large volume of patients in collaboration with private center for diagnostic accuracy & therapeutic purpose. The aim of this study was to evaluate our experience in ERCP, to characterize & evaluate the aetiology, findings of ERCP & frequency of complications. This prospective type of study was carried out by the department of hepatology, MMCH from 3rd April 2016 to 10th July 2018 in collaboration with that private center where ERCP has been established. All patients undergoing ERCP during this period were included. Aetiology & findings were assessed at the time of ERCP & complications were assessed during procedure, index hospitalization & within 30 days after the procedure by telephone contact. A total of 301 consecutive ERCP were performed during the study period. Among them, 182(60.5%) were male & 119(39.5%) were female with an age range of 18-78 years. The most common indications for ERCP were: cholangiocarcinoma in 98(32.56%) & choledocholithiasis in 95(31.56%) followed by periampullary growth in 93(30.89%), suspected CBD stricture in 12(4%) & chronic pancreatitis in 2(0.66%). The most common findings were choledocholithiasis (32.56%), cholangiocarcinoma (32.56%), biliary obstruction due to periampullary growth (30.56%). Biliary fistula with distal bile duct stricture was found in (1.66%), bile duct stricture in (1.33%), chronic pancreatitis in (0.66%), and organic papillary stenosis with deformed bulb were discovered in (0.34%) case. All ERCPs were done for therapeutic purpose. Endoscopic sphincterotomy was the most common therapeutic procedure (87.04%) of which biliary stenting was done in (67.44%) & stone extraction in (33.71%). Stone extraction from biliary tree was successfully done in 94 cases (98.67%) but it was unsuccessful from biliary tree in 4 cases (1.33%) & also from pancreatic duct in a separate case. The most frequent complication was Post-ERCP pancreatitis in 9 patients (2.99%) followed by acute confusional state (1.33%). Post-ERCP cholangitis occurred in (0.99%) & death was reported in 2 cases (0.66%) due to anaesthetic hazard.
内镜逆行胰胆管造影术（ERCP）是评估和治疗疑似胆道及胰腺疾病的一种现代且广泛应用的方法。在孟加拉国，ERCP服务仅限于少数三级医疗中心，主要位于首都和大城市。2016年4月3日，ERCP首次在迈门辛的一家私立医院引入。从那时起，迈门辛医学院医院（MMCH）与私立中心合作，为大量患者提供ERCP服务，以实现诊断准确性和治疗目的。本研究的目的是评估我们在ERCP方面的经验，对病因、ERCP检查结果及并发症发生率进行特征描述和评估。这项前瞻性研究由MMCH肝病科于2016年4月3日至2018年7月10日与已开展ERCP的私立中心合作进行。纳入在此期间接受ERCP的所有患者。在ERCP时评估病因和检查结果，在操作过程中、首次住院期间以及术后30天内通过电话联系评估并发症。在研究期间共连续进行了301例ERCP。其中，男性182例（60.5%），女性119例（39.5%），年龄范围为18 - 78岁。ERCP最常见的适应证为：胆管癌98例（32.56%）、胆总管结石95例（31.56%），其次是壶腹周围肿物93例（30.89%）、疑似胆总管狭窄12例（4%）、慢性胰腺炎2例（0.66%）。最常见的检查结果为胆总管结石（32.56%）、胆管癌（32.56%）、壶腹周围肿物导致的胆道梗阻（30.56%）。发现胆瘘合并远端胆管狭窄的有（1.66%），胆管狭窄的有（1.33%），慢性胰腺炎的有（0.66%），发现有机性乳头狭窄伴球部变形的病例占（0.34%）。所有ERCP均用于治疗目的。内镜括约肌切开术是最常见的治疗方法（87.04%），其中进行胆道支架置入的占（67.44%），取石的占（33.71%）。94例（98.67%）成功从胆管取石，但4例（1.3*%*）胆管取石未成功，另有1例从胰管取石未成功。最常见的并发症是9例（2.99%）患者发生ERCP术后胰腺炎，其次是急性意识模糊状态（1.33%）。ERCP术后胆管炎发生率为（0.99%），2例（0.66%）患者因麻醉风险死亡。
