Department of Gastroenterology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 2000 Xiang'an East Road, Xiamen, 361102, Fujian, China.
Department of Medical Engineering, The 305 Hospital of PLA, Beijing, China.
Surg Endosc. 2022 Jul;36(7):4795-4801. doi: 10.1007/s00464-021-08822-2. Epub 2021 Oct 26.
Radiation exposure is inherently involved in endoscopic retrograde cholangiopancreatography (ERCP), which could cause radiation-induced injury to endoscopists with long-term exposure. Nonradiation ERCP has been applied to pregnant patients. Conceivably, the same techniques could be used to benefit endoscopists. This study was designed to evaluate the effectiveness and safety of nonradiation-to-endoscopist (NRE) ERCP, compared with standard ERCP.
A retrospective, single-center study was conducted from August 2010 to December 2015. Patients aged 18-90 years and with choledocholithiasis (< 15 mm) or distal biliary stricture were eligible. Pre-ERCP evaluation with magnetic resonance cholangiopancreatography was mandatory. To overcome selection bias, we performed 1:2 match using propensity score matching (PSM) between NRE and standard groups. The primary endpoint was overall ERCP success rate. Secondary endpoints were cannulation success rate, stone clearance rate, complication rate, and duration of hospitalization.
A total of 329 patients met inclusion criteria. After PSM, 73 patients were included in the NRE group and 146 in the standard group. The ERCP overall success rate for NRE and standard groups was equivalent (94.5% vs. 93.2%, P = 0.70). There was no difference in cannulation success rates between the two groups (95.6% vs. 97.8%, P = 0.39). A total of 88.3% of patients in the NRE group and 93.9% of patients in the standard group had stones cleared at initial ERCP (P = 0.57). No difference in overall stone clearance rate between the two groups (95.0% vs. 93.9%, P = 0.77) was found after second ERCP. The complication rate (1.4% vs. 1.4%, P = 1.00) and hospital duration (8.3 ± 5.1 vs. 10.2 ± 8.8 days, P = 0.07) were not different between the two groups.
Although technically demanding, NRE-ERCP is both safe and feasible in selected patients compared with standard ERCP.
内镜逆行胰胆管造影术（ERCP）本身就存在放射暴露，长期接触可能会对内镜医生造成放射损伤。已经有非放射性 ERCP 应用于孕妇，理论上，同样的技术也可以使内镜医生受益。本研究旨在评估与标准 ERCP 相比，非辐射至内镜医生（NRE）ERCP 的有效性和安全性。
这是一项 2010 年 8 月至 2015 年 12 月进行的回顾性单中心研究。年龄在 18-90 岁之间、有胆总管结石（<15mm）或远端胆管狭窄的患者符合纳入标准。所有患者均在 ERCP 前行磁共振胰胆管成像检查。为了克服选择偏倚，我们采用倾向评分匹配（PSM）对 NRE 和标准组进行了 1:2 匹配。主要终点是总体 ERCP 成功率。次要终点是插管成功率、结石清除率、并发症发生率和住院时间。
共有 329 例患者符合纳入标准。经过 PSM 后，73 例患者纳入 NRE 组，146 例患者纳入标准组。NRE 组和标准组的 ERCP 总体成功率相当（94.5% vs. 93.2%，P=0.70）。两组插管成功率无差异（95.6% vs. 97.8%，P=0.39）。NRE 组和标准组初始 ERCP 时分别有 88.3%和 93.9%的患者清除了结石（P=0.57）。两组总体结石清除率无差异（95.0% vs. 93.9%，P=0.77），第二次 ERCP 后。两组的并发症发生率（1.4% vs. 1.4%，P=1.00）和住院时间（8.3±5.1 vs. 10.2±8.8 天，P=0.07）无差异。
与标准 ERCP 相比，在选择的患者中，NRE-ERCP 技术上具有挑战性，但安全且可行。
