He Qi-Bin, Zheng Ru-Hua, Wang Yi, Wang Lei, Tan Lu-Xuan, Meng Gui-Xia, Zhong Huan, Duan Jie, Gu Ai-Dong
Department of Gastroenterology, Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.
Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Quant Imaging Med Surg. 2022 Mar;12(3):1698-1705. doi: 10.21037/qims-21-462.
Cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) is a major problem for patients with hilar biliary obstruction. To date, it remains unclear whether air-contrast cholangiography (ACC) can reduce cholangitis in these patients. For this reason, our study assesses the efficacy of reducing cholangitis through ACC.
This paper presents a retrospective study conducted at a tertiary university hospital. We enrolled patients who were diagnosed with hilar structures and underwent ERCP between January 2012 and December 2018. From 2015 onwards, ACC was performed following the successful selective cannulation into the dilated intrahepatic bile duct of these patients. The primary aim was to assess patients with cholangitis in both an ACC group and iodine contrast cholangiography (ICC) group.
This study included 80 patients, 35 of whom received ACC and 45 who received ICC. There were no differences between the 2 groups in terms of the number of patients who underwent endoscopic papillotomy, endoscopic nasobiliary drainage, endoscopic biliary stent placement, or other technical procedures or complications. A total of 19 patients (23.8%) presented with fever (cholangitis) after the ERCP procedure (4 ACC, 15 ICC; 11.4% 33.3%, respectively; P=0.03). One patient in the ICC group who obtained a plastic stent for palliative drainage died 2 weeks post-ERCP. Among the other 18 cholangitis patients, 8 (1 ACC, 7 ICC) were treated with additional ERCP or percutaneous transhepatic biliary drainage (PTBD), while the remaining 10 only received antibiotics. One patient in the ICC group who obtained a plastic stent for palliative drainage died 2 weeks post-ERCP.
We found that ACC significantly reduced the incidence of cholangitis in patients with hilar obstruction.
内镜逆行胰胆管造影术（ERCP）后胆管炎是肝门部胆管梗阻患者的一个主要问题。迄今为止，空气对比胆管造影（ACC）能否降低这些患者的胆管炎发生率仍不清楚。因此，我们的研究评估了通过ACC降低胆管炎的疗效。
本文介绍了在一所三级大学医院进行的一项回顾性研究。我们纳入了2012年1月至2018年12月期间被诊断为肝门部结构并接受ERCP的患者。从2015年起，在这些患者成功选择性插管至扩张的肝内胆管后进行ACC。主要目的是评估ACC组和碘对比剂胆管造影（ICC）组中的胆管炎患者。
本研究纳入80例患者，其中35例接受ACC，45例接受ICC。两组在接受内镜乳头切开术、内镜鼻胆管引流、内镜胆管支架置入或其他技术操作或并发症的患者数量方面无差异。共有19例患者（23.8%）在ERCP术后出现发热（胆管炎）（4例ACC，15例ICC；分别为11.4%和33.3%；P = 0.03）。ICC组中1例接受姑息性引流塑料支架的患者在ERCP术后2周死亡。在其他18例胆管炎患者中，8例（1例ACC，7例ICC）接受了额外的ERCP或经皮经肝胆管引流（PTBD），其余10例仅接受抗生素治疗。ICC组中1例接受姑息性引流塑料支架的患者在ERCP术后2周死亡。
我们发现ACC显著降低了肝门部梗阻患者的胆管炎发生率。
