Novikov Aleksey A, Fieber Jennifer H, Saumoy Monica, Rosenblatt Russell, Mekelburg Shirley A Cohen, Shah Shawn L, Crawford Carl V
Department of Gastroenterology, Doylestown Hospital, Doylestown, Pennsylvania, United States.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Endosc Int Open. 2021 Jun;9(6):E927-E933. doi: 10.1055/a-1320-0041. Epub 2021 May 27.
Acute pancreatitis (AP) is an increasingly common indication for hospitalization in the United States. The necessity for endoscopic retrograde cholangiopancreatography (ERCP) and the timing of ERCP in acute gallstone-related pancreatitis without cholangitis (AGPNC) is controversial. The aim of this study was to evaluate the association of ERCP and its performance during admission with mortality and length of stay (LOS) in patients with AGPNC. We queried the Nationwide Inpatient Sample (NIS) from 2004 to 2014 to identify all patients with admissions for gallstone AP. We excluded patients with chronic pancreatitis or concurrent cholangitis, and those who were transferred from elsewhere for treatment. Our primary outcome measure was inpatient mortality. Our secondary outcome measure was hospital length of stay (LOS). We identified 491,011 records eligible for analysis. Of the patients, 30.6 % (150,101) had AGPNC. There were 1.34 deaths per 100 admissions in patients with AGPNC. The average LOS was 5.88 (± 6.38) days with a median stay of 4 days (range, 3-7). When adjusted for age, Elixhauser Comorbidity Index, and severe pancreatitis, patients with ERCP during admission were 43 % less likely to die. ERCP performed between Days 3 and 9 of hospitalization resulted in a significant mortality benefit. Among those who had ERCP, a shorter wait time for ERCP was associated with a shorter LOS after adjustment for demographics and severity of illness. ERCP performed during inpatient admission for AGPNC was associated with decreased mortality. These data support early ERCP in patients with acute gallstone pancreatitis without cholangitis.
在美国，急性胰腺炎（AP）是住院治疗中越来越常见的病症。对于无胆管炎的急性胆石性胰腺炎（AGPNC），内镜逆行胰胆管造影（ERCP）的必要性以及ERCP的时机存在争议。本研究的目的是评估AGPNC患者住院期间进行ERCP及其操作与死亡率和住院时间（LOS）之间的关联。
我们查询了2004年至2014年的全国住院患者样本（NIS），以确定所有因胆石性AP入院的患者。我们排除了患有慢性胰腺炎或并发胆管炎的患者，以及从其他地方转来治疗的患者。我们的主要结局指标是住院死亡率。次要结局指标是住院时间（LOS）。
我们确定了491,011条符合分析条件的记录。其中，30.6%（150,101例）为AGPNC患者。AGPNC患者每100例入院中有1.34例死亡。平均住院时间为5.88（±6.38）天，中位住院时间为4天（范围为3 - 7天）。在对年龄、埃利克斯豪泽合并症指数和重症胰腺炎进行校正后，住院期间接受ERCP的患者死亡可能性降低了43%。在住院第3天至第9天进行ERCP可显著降低死亡率。在接受ERCP的患者中，在对人口统计学和疾病严重程度进行校正后，ERCP的等待时间越短，住院时间越短。
AGPNC患者住院期间进行ERCP与死亡率降低相关。这些数据支持对无胆管炎的急性胆石性胰腺炎患者尽早进行ERCP。
