Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China.
Dig Dis Sci. 2021 Dec;66(12):4467-4474. doi: 10.1007/s10620-020-06815-0. Epub 2021 Jan 19.
BACKGROUND/AIMS: Hemorrhage is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP). However, there is a lack of comparative studies on immediate and delayed hemorrhage. The present study aims to explore the relevant risk factors of immediate and delayed hemorrhage of ERCP and compare the similarities and differences.
ERCP cases conducted by our hospital between January 2017 and January 2020 were selected for retrospective analysis. Then age, gender, basic disease, laboratory examinations, and other relevant clinical information were collected for the analysis.
A total of 1009 ERCP cases were included in the present study. Among these cases, 76 patients were in the immediate hemorrhage group, 28 patients were in the delayed hemorrhage group, and 905 patients were in the non-hemorrhage group. The univariate analysis revealed that choledocholithiasis, pre-cut, and endoscopic papillary sphincterotomy (EST) were risk factors for immediate hemorrhage, while cholangitis, jaundice, coronary heart disease, pre-cut, high postoperative lipase at four hours and amylase at 24 h, high postoperative leukocyte, urea, bilirubin, low postoperative platelet counts and fibrinogen, and prolonged prothrombin time (PT) and thrombin time (TT) were risk factors for delayed hemorrhage. The logistic regression analysis revealed that EST, pre-cut, and activated partial thromboplastin time (APTT) were independent risk factors for immediate hemorrhage, while high amylase at 24 h after ERCP, high postoperative urea, prolonged TT, and coronary heart disease were independent risk factors for delayed hemorrhage.
Pre-cut was a common risk factor for immediate and delayed hemorrhage, while other risk factors were different.
背景/目的：内镜逆行胰胆管造影术（ERCP）后出血是一种严重的并发症。然而，目前缺乏关于即刻出血和延迟性出血的对比研究。本研究旨在探讨 ERCP 即刻和延迟性出血的相关危险因素，并比较其异同。
回顾性分析我院 2017 年 1 月至 2020 年 1 月期间进行的 ERCP 病例。然后收集年龄、性别、基础疾病、实验室检查等相关临床信息进行分析。
本研究共纳入 1009 例 ERCP 病例。其中，76 例为即刻出血组，28 例为延迟出血组，905 例为非出血组。单因素分析显示，胆总管结石、预切开和内镜乳头括约肌切开术（EST）是即刻出血的危险因素，而胆管炎、黄疸、冠心病、预切开、术后 4 小时高淀粉酶和 24 小时高脂肪酶、术后白细胞、尿素、胆红素升高、血小板计数和纤维蛋白原降低、凝血酶原时间（PT）和凝血酶时间（TT）延长是延迟出血的危险因素。Logistic 回归分析显示，EST、预切开和活化部分凝血活酶时间（APTT）是即刻出血的独立危险因素，而 ERCP 术后 24 小时高淀粉酶、术后高尿素、TT 延长和冠心病是延迟出血的独立危险因素。
预切开是即刻和延迟性出血的共同危险因素，而其他危险因素则不同。
