经内镜逆行胰胆管造影术（ERCP）中使用短型双气囊内镜对改变的胃肠道解剖结构患者的并发症评估：一项单中心回顾性研究 1576 例。
Evaluation of complications after endoscopic retrograde cholangiopancreatography using a short type double balloon endoscope in patients with altered gastrointestinal anatomy: a single-center retrospective study of 1,576 procedures.
机构信息
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.
出版信息
J Gastroenterol Hepatol. 2020 Aug;35(8):1387-1396. doi: 10.1111/jgh.15019. Epub 2020 Apr 5.
BACKGROUND AND AIM
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
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.
背景与目的
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。
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。
结果
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）。
结论
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。
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