Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Osaka, Japan.
Department of Hygiene and Public Health, Kansai Medical University Hirakata Hospital, Osaka, Japan.
J Gastroenterol Hepatol. 2020 Aug;35(8):1387-1396. doi: 10.1111/jgh.15019. Epub 2020 Apr 5.
Endoscopic retrograde cholangiopancreatography (ERCP) using balloon-assisted endoscope such as double-balloon endoscope is even effective for patients with surgically altered anatomy. Yet comprehensive studies on complications of ERCP using balloon-assisted endoscope have not been made. We analyzed the characteristics and the causes of complications of ERCP using double-balloon endoscope (DB-ERCP) procedures and aimed to suggest effective managements.
A total of 1576 procedures of DB-ERCP in 714 patients with surgically altered gastrointestinal anatomy in our hospital were evaluated retrospectively using a statistic analysis.
The overall complication occurrence rate was 5.8%. By type of complications are perforation 3.2%, mucosal laceration 0.5%, hemorrhage 1.0%, pancreatitis 0.6%, respiratory disorder 0.4%, and others 0.2%. By type of surgical reconstruction methods were Roux-en-Y reconstruction with choledocho-jejunal anastomosis 4.2%, Roux-en-Y reconstruction without choledocho-jejunal anastomosis 6.7%, pancreaticoduodenectomy 4.5%, pylorus preserving pancreaticoduodenectomy 4.2%, Billroth II gastrectomy (B-II) 11.6%, and other reconstruction method (others) 7.4%. The contributing factors calculated by a multivariate analysis were B-II (odds ratio: 1.864, 95% confidence interval: 1.001-3.471, P = 0.050) and the presence of naïve papilla (odds ratio: 3.268, 95% confidence interval: 1.426-7.490, P = 0.005).
DB-ERCP is a safe method with a total complication rate of 5.8% that could be considered within an acceptable range. The most common complication was the injury of the digestive tract such as perforation. Affecting risk factors for complications were B-II and the presence of naïve papilla. DB-ERCP procedures should be performed carefully of these factors.
经内镜逆行胰胆管造影术（ERCP）使用球囊辅助内镜，如双球囊内镜，即使对于手术改变解剖结构的患者也同样有效。然而，对于使用球囊辅助内镜的 ERCP 并发症的综合研究尚未进行。我们分析了使用双球囊内镜（DB-ERCP）的 ERCP 操作的特点和并发症的原因，并旨在提出有效的处理方法。
回顾性分析了我院 714 例手术改变胃肠道解剖结构的患者共 1576 例 DB-ERCP 手术的统计学资料。
总的并发症发生率为 5.8%。并发症类型包括穿孔 3.2%、黏膜撕裂伤 0.5%、出血 1.0%、胰腺炎 0.6%、呼吸障碍 0.4%和其他 0.2%。手术重建方法类型为胆肠吻合 Roux-en-Y 重建 4.2%、无胆肠吻合 Roux-en-Y 重建 6.7%、胰十二指肠切除术 4.5%、保留幽门的胰十二指肠切除术 4.2%、Billroth II 胃切除术（B-II）11.6%和其他重建方法（其他）7.4%。多因素分析计算的影响因素为 B-II（比值比：1.864，95%置信区间：1.001-3.471，P=0.050）和存在未切开乳头（比值比：3.268，95%置信区间：1.426-7.490，P=0.005）。
DB-ERCP 是一种安全的方法，总并发症发生率为 5.8%，在可接受范围内。最常见的并发症是消化道损伤，如穿孔。影响并发症风险的因素是 B-II 和存在未切开的乳头。DB-ERCP 操作应谨慎考虑这些因素。
