Gastroenterology and Hepatology Unit, Canberra Hospital, Garran, 2605, Australia.
Australian National University, Acton, 2600, Australia.
Surg Endosc. 2022 Mar;36(3):2025-2031. doi: 10.1007/s00464-021-08488-w. Epub 2021 Apr 19.
Although complications from endoscopic retrograde cholangiopancreatography (ERCP) are well described, procedure duration has received scant attention. The relationship between ERCP duration and patient demographics, indications, results and complications were examined.
A contemporaneously recorded database of 2572 consecutive ERCPs performed between 2008 and 2018 by a single endoscopist was analysed. Those taking under 40 min were compared with those taking over 40 min.
Of 2572 cases, 2213 took under 40 min and 359 took over 40 min. Emergency cases (relative risk 2.10), older age (66.6 vs 61.6 years p value < 0.01) and no previous sphincterotomy (relative risk 1.94) were factors which resulted in prolonged procedures. The indication of change or removal of stent for benign conditions resulted in fewer prolonged procedures (relative risk 0.37). Indications of pancreatitis, cholangitis and positive intraoperative cholangiogram were not associated with procedure length. Findings of biliary stricture(s) (relative risk 2.02) and failure to cannulate desired duct (relative risk 3.69) were associated with prolonged procedures. Choledocholithiasis (relative risk 0.62), dilated bile duct without stricture/stone (relative risk 0.46) and normal ductal anatomy (relative risk 0.50) resulted in fewer prolonged procedures. Procedures taking over 40 min had increased risks of complications resulting in unplanned or prolongation of hospitalisation (relative risk 1.41) and pancreatitis (relative risk 1.74).
Prolonged procedures had increased rates of pancreatitis and unplanned/prolonged hospitalisation. Failed access to desired duct, advanced age, biliary strictures, no previous sphincterotomy and unplanned emergency cases were associated with prolonged procedures.
虽然内镜逆行胰胆管造影术（ERCP）的并发症已有详细描述，但该手术的操作时间却很少受到关注。本研究旨在分析 ERCP 操作时间与患者人口统计学、适应证、结果和并发症之间的关系。
分析了 2008 年至 2018 年间由同一位内镜医生进行的 2572 例连续 ERCP 患者的同期记录数据库。将操作时间少于 40 分钟的患者与操作时间超过 40 分钟的患者进行比较。
在 2572 例患者中，2213 例操作时间少于 40 分钟，359 例操作时间超过 40 分钟。急诊情况（相对风险 2.10）、年龄较大（66.6 岁 vs 61.6 岁，p 值<0.01）和无先前括约肌切开术（相对风险 1.94）是导致手术时间延长的因素。良性病变行支架更换或取出的适应证与手术时间延长无关（相对风险 0.37）。胰腺炎、胆管炎和术中胆管造影阳性的指征与手术时间无关。发现胆管狭窄（相对风险 2.02）和未能插管到预期胆管（相对风险 3.69）与手术时间延长相关。胆总管结石（相对风险 0.62）、无狭窄/结石的扩张胆管（相对风险 0.46）和正常胆管解剖（相对风险 0.50）与手术时间缩短相关。操作时间超过 40 分钟与并发症风险增加相关，导致计划外或住院时间延长（相对风险 1.41）和胰腺炎（相对风险 1.74）。
延长手术时间与胰腺炎和计划外/延长住院时间的发生率增加有关。未能进入预期胆管、高龄、胆管狭窄、无先前括约肌切开术和计划外急诊情况与手术时间延长有关。
