急性胆源性胰腺炎患者行 ERCP 比急性胆管炎更具挑战性——匈牙利 ERCP 注册数据分析。

ERCP is more challenging in cases of acute biliary pancreatitis than in acute cholangitis - Analysis of the Hungarian ERCP registry data.

机构信息

Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary; Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.

Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.

出版信息

Pancreatology. 2021 Jan;21(1):59-63. doi: 10.1016/j.pan.2020.11.025. Epub 2020 Dec 8.

DOI:10.1016/j.pan.2020.11.025

PMID:33309622

Abstract

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is an important therapeutic modality in acute biliary pancreatitis (ABP) cases with cholangitis or ongoing common bile duct obstruction. Theoretically, inflammation of the surrounding tissues would result in a more difficult procedure. No previous studies examined this hypothesis.

OBJECTIVES

ABP and acute cholangitis (AC) without ABP cases were compared to assess difficulty of ERCP.

METHODS

The rate of successful biliary access, advanced cannulation method, adverse events, cannulation and fluoroscopy time were compared in 240 ABP cases and 250 AC cases without ABP. Previous papillotomy, altered gastroduodenal anatomy, and cases with biliary stricture were excluded.

RESULTS

Significantly more pancreatic guidewire manipulation (adjusted odds ratio (aOR) 1.921 [1.241-2.974]) and prophylactic pancreatic stent use (aOR 4.687 [2.415-9.098]) were seen in the ABP than in AC group. Average cannulation time in the ABP patients (248 vs. 185 s; p = 0.043) were longer than in AC cases. No difference was found between biliary cannulation and adverse events rates.

CONCLUSION

ERCP in ABP cases seem to be more challenging than in AC. Difficult biliary access is more frequent in the ABP cases which warrants the involvement of an experienced endoscopist.

摘要

背景

内镜逆行胰胆管造影术（ERCP）是治疗伴有胆管炎或持续胆总管梗阻的急性胆源性胰腺炎（ABP）的重要治疗方法。理论上，周围组织的炎症会导致手术难度增加。以前没有研究检验过这一假说。

目的

比较 ABP 和无 ABP 的急性胆管炎（AC）病例，以评估 ERCP 的难度。

方法

排除有过乳头切开术、胃十二指肠解剖结构改变和有胆道狭窄的病例后，比较 240 例 ABP 病例和 250 例无 ABP 的 AC 病例的胆道成功进入率、高级插管方法、不良事件、插管和透视时间。

结果

ABP 组中胰腺导丝操作（调整后的优势比（aOR）1.921 [1.241-2.974]）和预防性胰管支架使用（aOR 4.687 [2.415-9.098]）明显多于 AC 组。ABP 患者的平均插管时间（248 秒 vs. 185 秒；p=0.043）长于 AC 病例。胆管插管和不良事件发生率无差异。