Hung Tsung-Hsing, Tseng Chih-Wei, Chen Yen-Chun, Tseng Kuo-Chih, Hsieh Yu-Hsi, Tsai Chih-Chun
Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi.
School of Medicine, Tzu Chi University, Hualien.
Medicine (Baltimore). 2019 Jul;98(30):e16529. doi: 10.1097/MD.0000000000016529.
Although endoscopic papillary balloon dilation (EPBD) seems to cause fewer instances of bleeding, there are insufficient data to determine the optimal methods for decreasing the risk of bleeding in cirrhotic patients.In this study, we compared the bleeding risks following endoscopic biliary sphincterotomy (EST) vs EPBD in cirrhotic patients and identified clinical factors associated with bleeding and 30-day mortality.Taiwan's National Health Insurance Database was used to identify 3201 cirrhotic patients who underwent EST or EPBD between January 1, 2010, and December 31, 2013.We enrolled 2620 patients receiving EST and 581 patients receiving EPBD. The mean age was 63.1 ± 13.9 years, and 70.4% (2252/3201) were men. The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding was higher among patients treated with EST than those treated with EPBD (EST vs EPBD: 3.5% vs 1.9%). Independent predisposing factors for bleeding included EST, renal function impairment, and antiplatelet or anticoagulant therapy. The overall 30-day mortality was 4.0% (127/3201). Older age, renal function impairment, hepatic encephalopathy, bleeding esophageal varices, ascites, hepatocellular carcinoma, biliary malignancy, and pancreatic malignancy were associated with higher risks for 30-day mortality.To decrease post-ERCP hemorrhage, EPBD is the preferred method in patients with cirrhosis, especially for those who have renal function impairment or are receiving antiplatelet or anticoagulant therapy.
尽管内镜下乳头球囊扩张术（EPBD）似乎导致出血的情况较少，但目前尚无足够数据来确定降低肝硬化患者出血风险的最佳方法。在本研究中，我们比较了肝硬化患者接受内镜下胆管括约肌切开术（EST）与EPBD后的出血风险，并确定了与出血及30天死亡率相关的临床因素。利用台湾全民健康保险数据库，识别出在2010年1月1日至2013年12月31日期间接受EST或EPBD的3201例肝硬化患者。我们纳入了2620例接受EST的患者和581例接受EPBD的患者。平均年龄为63.1±13.9岁，70.4%（2252/3201）为男性。接受EST治疗的患者内镜逆行胰胆管造影术（ERCP）后出血的发生率高于接受EPBD治疗的患者（EST与EPBD：3.5%对1.9%）。出血的独立易感因素包括EST、肾功能损害以及抗血小板或抗凝治疗。30天总死亡率为4.0%（127/3201）。年龄较大、肾功能损害、肝性脑病、食管静脉曲张出血、腹水、肝细胞癌、胆管恶性肿瘤和胰腺恶性肿瘤与30天死亡风险较高相关。为减少ERCP后出血，EPBD是肝硬化患者的首选方法，尤其是对于那些有肾功能损害或正在接受抗血小板或抗凝治疗的患者。
