Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Germany.
St. Nikolaus-Stiftshospital, Andernach, Germany.
Medicine (Baltimore). 2022 Feb 4;101(5):e28606. doi: 10.1097/MD.0000000000028606.
Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for minimally-invasive treatment of biliary or pancreatic tract disease. When treating patients on intensive care units (ICU) with ERCP, interventionalists are faced with considerably higher morbidity compared to patients in ambulatory settings. However, data on complications and outcome of critical ill patients undergoing emergency ERCP are limited.A retrospective analysis of 102 patients treated on ICUs undergoing 121 ERCP procedures at the University Hospital of Essen, Germany between 2002 and 2016 was performed. Indications, interventional success, outcome including survival and procedure-related complications were analyzed. Patients' condition pre-ERCP was categorized by using the "Simplified Acute Physiology Score" (SAPS 3).66/102 patients (64.7%) were referred to ERCP from surgical ICU, 36/102 (35.3%) from nonsurgical ICU. The majority of patients were male (63.7%), the mean age was 54.1 ± 14.9 [21-88] years. Indications for ERCP were biliary complications after liver transplantation (n = 34, 33.3%), biliary leakage after hepatobiliary surgery (n = 32, 31.4%), and cholangitis/biliary sepsis (n = 36; 35.3%), respectively. 117/121 (96.7%) ERCPs were successful, 1 patient (1.0%) died during ERCP. Post-ERCP pancreatitis occurred in 11.8% of interventions. The median simplified acute physiology score 3 was 65 points, predicting a risk-adjusted estimated mortality of 48.8%, corresponding to an observed mortality of 52.2% (P = n.s.).ERCP is safe in critically ill patients on ICU, it does not increase overall mortality rate and has a relatively low rate of procedure-associated complications.
经内镜逆行胰胆管造影术（ERCP）是微创治疗胆道或胰管疾病的金标准。当在重症监护病房（ICU）治疗 ERCP 患者时，与门诊患者相比，介入医生面临着更高的发病率。然而，关于在紧急 ERCP 下接受治疗的危重症患者的并发症和结果的数据有限。
回顾性分析了 2002 年至 2016 年期间德国埃森大学医院 ICU 中 102 例接受 121 例 ERCP 治疗的患者。分析了适应证、介入成功率、包括生存和与程序相关的并发症在内的结果。患者在 ERCP 前的病情采用“简化急性生理学评分”（SAPS 3）进行分类。66/102 例（64.7%）患者来自外科 ICU，36/102 例（35.3%）患者来自非外科 ICU。大多数患者为男性（63.7%），平均年龄为 54.1±14.9[21-88]岁。ERCP 的适应证为肝移植后胆道并发症（n=34，33.3%）、肝胆手术后胆漏（n=32，31.4%）和胆管炎/胆道败血症（n=36，35.3%）。121 例 ERCP 中有 117 例（96.7%）成功，1 例（1.0%）患者在 ERCP 期间死亡。ERCP 后胰腺炎发生率为 11.8%。简化急性生理学评分 3 中位数为 65 分，预测风险调整后的死亡率为 48.8%，观察到的死亡率为 52.2%（P=无统计学意义）。
在 ICU 上的危重症患者中，ERCP 是安全的，它不会增加总体死亡率，且与程序相关的并发症发生率相对较低。
