Gadour Eyad, Agu Okwudili, Musharaf Mutwakil, Dixon Megan, Askar Amr, Hafeez Siddrah, Shafiq Yousuf, Arabiyat Abdalla, Moradi Julia
Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR.
Cureus. 2021 Sep 9;13(9):e17861. doi: 10.7759/cureus.17861. eCollection 2021 Sep.
Background The British Society of Gastroenterology (BSG) recommended that during the COVID-19 pandemic, endoscopy units perform endoscopic retrograde cholangiopancreatography (ERCP) for obstructive biliary pathologies in an emergency. We assessed the local performance of ERCP during the first wave of COVID-19 at our local endoscopy center, in particular the technique to common bile duct (CBD) cannulation. Methodology All ERCP procedures performed from January to June 2020 were retrospectively assessed and compared with procedures performed between January and June 2019 at the Royal Lancaster Infirmary. The indications for ERCP, success rate, and complications were studied separately. Correlation analysis was conducted using Spearman's rank correlation coefficient. The binary logistic regression model was used to compute the factors associated with successful ERCP. Significance was established when the two-sided P-value < 0.05. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 25 for Windows (SPSS Inc., Chicago, IL, USA, 2017). Results A total of 281 ERCP were included in this study, with 169 and 112 performed during the first six months of 2019 and 2020, respectively. A statistically significant (0.0087) higher proportion of cases with liver dysfunction presented for ERCP before the COVID-19 outbreak (152, 89.94%). All patients before COVID-19 underwent wire control-assisted ERCP, while 82 (73.21%) received assisted ERCP during the first wave (P < 0.001). There was no statistically significant difference (P = 0.10) in the number of patients who underwent sphincterotomy before and during the first wave of COVID-19, with 97 (57.39%) and 76 (67.85%), respectively. The success rate of ERCP before COVID-19 was relatively high, accounting for 146 (86.39%) patients in contrast to 87 (77.67%) patients during the first wave (P = 0.074). Sphincterotomy ( = 2.800, P = 0.028) and stent insertion ( = 0.852, P = 0.046) were statistically significant predictors of ERCP outcomes. There was no statistically significant impact of cholangitis on the success of ERCP ( = 1.672, P = 0.109). Conclusion The first wave of COVID-19 had a statistically proven negative impact on the expected standards of ERCP performance. Although the complication rate was significantly higher during the first wave case difficulty, the American Society of Anesthesia (ASA) status was not assessed on an individual basis. Both ASA status and case difficulty are now included in our endoscopy selection process. We recommend adding the complexity of cases and ASA to the local and national recording databases. This is a rare study on UK-based hospitals.
背景 英国胃肠病学会（BSG）建议，在新冠疫情期间，内镜科室应在紧急情况下对梗阻性胆道疾病进行内镜逆行胰胆管造影（ERCP）。我们评估了当地内镜中心在新冠疫情第一波期间ERCP的实际操作情况，尤其是胆总管（CBD）插管技术。方法 回顾性评估2020年1月至6月期间进行的所有ERCP手术，并与2019年1月至6月在皇家兰卡斯特医院进行的手术进行比较。分别研究ERCP的适应证、成功率和并发症。使用Spearman等级相关系数进行相关性分析。采用二元逻辑回归模型计算与ERCP成功相关的因素。当双侧P值<0.05时具有统计学意义。使用适用于Windows的社会科学统计软件包（SPSS）25版（SPSS公司，美国伊利诺伊州芝加哥，2017年）进行统计分析。结果 本研究共纳入281例ERCP手术，2019年和2020年前六个月分别进行了169例和112例。在新冠疫情爆发前，因肝功能障碍接受ERCP的病例比例在统计学上显著更高（152例，89.94%）。新冠疫情前所有患者均接受导丝控制辅助ERCP，而在第一波疫情期间，82例（73.21%）接受了辅助ERCP（P<0.001）。在新冠疫情第一波之前和期间接受括约肌切开术的患者数量在统计学上无显著差异（P=0.10），分别为97例（57.39%）和76例（67.85%）。新冠疫情前ERCP的成功率相对较高，有146例（86.39%）患者，而第一波疫情期间为87例（77.67%）患者（P=0.074）。括约肌切开术（=2.800，P=0.028）和支架置入（=0.852，P=0.046）是ERCP结果的统计学显著预测因素。胆管炎对ERCP成功与否无统计学显著影响（=1.672，P=0.109）。结论 新冠疫情第一波对ERCP的预期操作标准产生了经统计学证实的确切负面影响。尽管第一波疫情期间并发症发生率显著更高，但未对美国麻醉医师协会（ASA）状态进行个体评估。目前我们的内镜检查选择过程中已纳入ASA状态和病例难度。我们建议将病例复杂性和ASA纳入当地及国家记录数据库。这是一项针对英国医院的罕见研究。
