Gastroenterology and Hepatology Unit, The Canberra Hospital, Garran, Australia.
Research School of Finance, Actuarial Studies and Statistics and Biological Data Science Institute, Australian National University, Canberra, Australia.
Scand J Gastroenterol. 2022 Dec;57(12):1517-1521. doi: 10.1080/00365521.2022.2094723. Epub 2022 Jul 8.
ERCP is essential in managing pancreaticobiliary disease, with well-documented complications. Rates of clinically significant complications are about 10%, approximately half of which is related to post-ERCP pancreatitis (PEP). We aimed to quantify the effect of previous sphincterotomy on post-endoiscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
Data were collated from a contemporaneously collected database of 2876 consecutive ERCP procedures of a single operator in a tertiary referral centre. Analysis was conducted using R software, and logistic regression models.
Of 2876 procedures (mean age 63 years, 56% female), 120 (4.2%) developed PEP and 268 (9.3%) had prolonged/unplanned hospital admission. Univariate analysis showed patients with previous sphincterotomy 28/1054 (2.7%) had decreased risk of PEP compared with those without sphincterotomy 92/1822 (5.0%) (OR 0.52, = .0021). This difference was not evident when multivariate analysis for age, sex and indication was undertaken due to a particularly low risk of PEP in stent change patients (1.4%), which were disproportionately represented in the previous sphincterotomy group. The rate of prolonged/unplanned hospital admission was recorded for a total of 2876 patients, occurring in 184/1802 (10.1%) in the native ampulla group, versus 84/1045 (8.0%) in the previous sphincterotomy group.
The risk of PEP is halved by prior sphincterotomy. The presence of a biliary stent conferred an even lower risk of PEP (1.4%), but those without an stent at the time of ERCP had a similar risk of PEP (4.6%) of prolonged/unplanned hospitalisation to those with a native ampulla.
ERCP 在处理胰胆疾病方面至关重要，但也有明确记录的并发症。有临床意义的并发症发生率约为 10%，其中约一半与 ERCP 后胰腺炎（PEP）有关。我们旨在量化先前括约肌切开术对内镜逆行胰胆管造影（ERCP）后胰腺炎（PEP）的影响。
数据来自于一名单一操作者在三级转诊中心进行的 2876 例连续 ERCP 手术的同期收集数据库。使用 R 软件和逻辑回归模型进行分析。
在 2876 例手术中（平均年龄 63 岁，56%为女性），120 例（4.2%）发生 PEP，268 例（9.3%）出现延长/计划外住院。单因素分析显示，与无括约肌切开术的 92/1822 例（5.0%）相比，有 28/1054 例（2.7%）先前有括约肌切开术的患者 PEP 风险降低（OR 0.52，P=0.0021）。当进行多变量分析以调整年龄、性别和适应证时，这种差异并不明显，因为支架更换患者的 PEP 风险特别低（1.4%），而这些患者在先前括约肌切开术组中所占比例不成比例。共有 2876 例患者记录了延长/计划外住院的发生率，在原发性壶腹组中，184/1802 例（10.1%）发生延长/计划外住院，而在先前括约肌切开术组中，84/1045 例（8.0%）发生延长/计划外住院。
先前的括约肌切开术可使 PEP 的风险降低一半。存在胆管支架可使 PEP 的风险进一步降低（1.4%），但在 ERCP 时无支架的患者与有原发性壶腹的患者相比，PEP 或延长/计划外住院的风险相似（4.6%）。
