Division of Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
Division of Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.
BMJ Open Gastroenterol. 2020 Sep;7(1). doi: 10.1136/bmjgast-2020-000462.
There is a lack of literature on postendoscopic retrograde cholangiopancreatography (ERCP) complications in predominantly black urban populations of low socioeconomic status. The aim of this study was to determine the incidence and predictors of post-ERCP complications in this patient population.
Retrospective review of ERCP cases performed at two hospitals from 2007 to 2017 was performed. The categories of complications evaluated were overall complications, severe or fatal complications, pancreatitis, bleeding, infection, perforation and cardiopulmonary events. Predictors of complications were determined by univariate analysis.
A total of 1079 ERCP procedures were reviewed. There were 106 complications (9.8%). Twenty-one were severe (1.9%) and 20 were fatal (1.9%). Both post-ERCP pancreatitis (PEP) and post-ERCP bleeding occurred in 18 patients (1.7%) each. Risk factors for overall complications were male sex (OR 1.54), ASA grade IV or V (OR 2.19), prior history of PEP (OR 6.98) and pancreatic duct stent placement (OR 2.75). Those who were ASA grade III or lower (OR 0.4) or who underwent biliary stone extraction (OR 0.62) had fewer complications. PEP was more likely in those with a prior history of PEP (OR 37.6). Those with a suspected or known biliary duct stone had less frequent pancreatitis (OR 0.32). Post-ERCP bleeding was more likely in the presence of cholangitis (OR 8.72).
Outcomes of ERCP in a predominantly black urban population demonstrate a lower incidence of PEP and all-cause mortality compared with historical data reported in the general population. Potential risk factors for post-ERCP complications were identified but require larger studies for validation.
在社会经济地位较低的以黑人为主要人口的城市人群中，关于内镜逆行胰胆管造影（ERCP）后并发症的文献较少。本研究旨在确定该患者人群中 ERCP 后并发症的发生率和预测因素。
对 2007 年至 2017 年在两家医院进行的 ERCP 病例进行回顾性分析。评估的并发症类别包括总体并发症、严重或致命并发症、胰腺炎、出血、感染、穿孔和心肺事件。通过单因素分析确定并发症的预测因素。
共回顾了 1079 例 ERCP 操作。有 106 例并发症（9.8%）。21 例为严重并发症（1.9%），20 例为致命并发症（1.9%）。PEP 和 ERCP 后出血各发生在 18 例患者（1.7%）。总体并发症的危险因素包括男性（OR 1.54）、ASA 分级 IV 或 V（OR 2.19）、既往 PEP 史（OR 6.98）和胰管支架置入（OR 2.75）。ASA 分级 III 或更低（OR 0.4）或接受胆道结石取石术（OR 0.62）的患者并发症较少。有 PEP 既往史的患者（OR 37.6）更有可能发生 PEP。有疑似或已知胆管结石的患者发生胰腺炎的频率较低（OR 0.32）。存在胆管炎的患者更有可能发生 ERCP 后出血（OR 8.72）。
在以黑人为主要人口的城市人群中，ERCP 的结果显示 PEP 和全因死亡率的发生率低于一般人群中报告的历史数据。确定了 ERCP 后并发症的潜在危险因素，但需要更大的研究来验证。
