Department of Gastroenterology, Changshu No.1 People's Hospital, Changshu Affiliated Hospital of Soochow University, Changshu, China.
Department of Gastroenterology, Zhangjiagang Aoyang Hospital, Zhangjiagang, China.
J Gastroenterol Hepatol. 2020 Jan;35(1):165-169. doi: 10.1111/jgh.14790. Epub 2019 Aug 7.
A few small retrospective studies recently found that endoscopic retrograde cholangiopancreatography (ERCP) in asymptomatic compared with symptomatic common bile duct stones (CBDSs) patients appeared to increase the risk of post-ERCP pancreatitis (PEP). This study aimed to determine the risk of ERCP in asymptomatic CBDS patients.
A total of 327 consecutive patients with native papilla were invited to participate into the study and divided into two groups: 53 in the asymptomatic group and 274 in the symptomatic group, who underwent CBDS removal by ERCP. Patient's characteristics and outcomes were analyzed.
A total of 46 (14.1%) patients had ERCP-related complications, including PEP, cholangitis, perforation, and bleeding. The overall complication rate in the asymptomatic group was higher than in the control group (26.4% vs 11.7%, P < 0.01). PEP was the most common complication (30/327, 9.2%). Of the 30 cases of PEP, 25 (83.3%) were mild, and the severity in both groups was similar (9/1/1 vs 16/2/1, P > 0.05). The incidence rate of PEP in the asymptomatic group was higher than in the symptomatic group (20.8% vs 6.9%, P < 0.01). Multivariate regression analysis identified asymptomatic CBDSs (odds ratio = 0.241, 95% confidence interval: 0.092-0.628) as being independently associated with PEP occurrence.
Asymptomatic CBDSs were associated with increased incidence of PEP compared with symptomatic CBDSs.
最近几项小型回顾性研究发现，与有症状的胆总管结石（CBDS）患者相比，无症状患者行内镜逆行胰胆管造影术（ERCP）似乎增加了术后胰腺炎（PEP）的风险。本研究旨在确定无症状 CBDS 患者行 ERCP 的风险。
共邀请 327 例原发性乳头患者参与研究，并分为无症状组（53 例）和有症状组（274 例），两组均行 ERCP 取 CBDS。分析患者的特征和结局。
共有 46 例（14.1%）患者发生与 ERCP 相关的并发症，包括 PEP、胆管炎、穿孔和出血。无症状组的总体并发症发生率高于对照组（26.4%比 11.7%，P<0.01）。PEP 是最常见的并发症（327 例中有 30 例，9.2%）。30 例 PEP 中，25 例（83.3%）为轻度，两组严重程度相似（9/1/1 比 16/2/1，P>0.05）。无症状组 PEP 的发生率高于有症状组（20.8%比 6.9%，P<0.01）。多因素回归分析发现无症状 CBDS（比值比=0.241，95%置信区间：0.092-0.628）与 PEP 的发生独立相关。
与有症状的 CBDS 相比，无症状 CBDS 与 PEP 发生率增加相关。
