Surgical Post-Graduate Program, Universidade Federal do Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, 90035-002, Brazil.
Department of Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Surg Endosc. 2022 Mar;36(3):1838-1846. doi: 10.1007/s00464-021-08463-5. Epub 2021 Apr 6.
Choledocholithiasis is a common complication of cholelithiasis, occurring in up to 18% of patients. Multiple treatments are often performed during the course of the management of choledocholithiasis, sometimes without success. Our study was performed identify the factors predictive of the success of treatment with retrograde endoscopic cholangiopancreatography (ERCP).
This was a retrospective, case-control study that used data from a biliary disease database at Hospital de Clínicas de Porto Alegre (HCPA). Demographic, clinical, radiological and procedure-related variables were compared between patients with successful biliary clearance after one ERCP procedure (Group 1) and those with unsuccessful biliary clearance after one ERCP procedure (Group 2).
Three hundred twenty patients were included in Group 1, while 254 were included in Group 2. Multivariate analysis showed that older age, previous biliary exploration, elevated serum total bilirubin, choledocholithiasis above the level of the confluence of the hepatic ducts, stones retained in the cystic duct or Mirizzi syndrome, dilatation of the bile duct diagnosed during ERCP, and the need for suprapapillary opening were independently associated with the failure of the first ERCP to achieve bile duct clearance. The performance of imaging at the same institution prior to the procedure and the retention of stones in the duodenal papilla were associated with the success of endoscopic treatment.
The variables identified in this study, when considered in conjunction with the results of previously published studies, can be used to guide the choice of therapeutic methods for patients with choledocholithiasis in the future, given the significant difference in outcomes between the two groups. In the future, a prospective study should be performed to determine whether the same factors are predictive of the success of other methods of treatment (surgical or percutaneous).
胆总管结石是胆石症的常见并发症，在多达 18%的患者中发生。在胆总管结石的治疗过程中，通常会进行多种治疗，有时治疗并不成功。我们的研究旨在确定经逆行内镜胰胆管造影（ERCP）治疗成功的预测因素。
这是一项回顾性病例对照研究，使用了来自阿雷格里港临床医院（HCPA）胆病数据库的数据。比较了一组在一次 ERCP 后胆道通畅的患者（第 1 组）和一组在一次 ERCP 后胆道仍未通畅的患者（第 2 组）之间的人口统计学、临床、影像学和手术相关变量。
第 1 组 320 例，第 2 组 254 例。多变量分析显示，年龄较大、既往胆道探查、血清总胆红素升高、肝总管汇合上方的胆总管结石、胆囊管内结石或 Mirizzi 综合征、ERCP 时胆管扩张以及需要在胰管开口上方进行切开与首次 ERCP 未能清除胆管的失败独立相关。在术前与同一机构进行影像学检查以及在十二指肠乳头保留结石与内镜治疗的成功相关。
在考虑了本研究中确定的变量以及先前发表的研究结果后，这些变量可用于指导未来胆总管结石患者治疗方法的选择，因为两组之间的治疗结果存在显著差异。未来应进行前瞻性研究，以确定相同的因素是否可预测其他治疗方法（手术或经皮）的成功。
