Department of Gastroenterology, Jiujiang No.1 People's Hospital, Jiujiang, China.
Department of Gastroenterology, Fourth Military Medical University, No. 986 Hospital, Xi'an, China.
BMC Gastroenterol. 2022 Nov 30;22(1):497. doi: 10.1186/s12876-022-02593-3.
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus totalis (SIT) is rarely understood due to its rarity. Patient position and endoscope manipulation were the main concerns in published case reports. The aim of this study was to investigate the efficacy and safety of ERCP in SIT patients.
Patients with SIT who underwent ERCP were enrolled in nine endoscopic centers in China. ERCP procedural details and complications in SIT patients were retrieved from electronic medical record. The data was retrospectively analyzed.
From 2011 to 2021, totally 14 patients with SIT undergoing ERCP were identified. The mean age was 56.8 years old and the male-female ratio was 5:2. The main indication for ERCP was common bile duct stones (13/14, 92.9%). All procedure were performed by experienced endoscopists. 21.4% (3/14) of patients were under regular position (prone), while 78.6% under modified position (supine, left or right lateral). Difficult cannulation was occurred in 71.4% (10/14) of patients. The rate of successful cannulation was 85.7% (12/14). Complication occurred in 3 patients (3/14, 21.4%), including 1 bleeding, 1 pneumonia and 1 acute myocardial infarction. No post-pancreatitis or death happened. Compared to patients in modified position, those in prone position had numerically less successful cannulations (66.7% vs. 90.9%) and higher adverse events (33.3% vs. 18.2%).
ERCP in patient with SIT is challenging even for experienced endoscopists, modified patient positions might have potential benefits concerning more successful cannulations and less complications. More case experiences are need for comprehensive understanding of ERCP in patients with SIT.
由于其罕见性，完全性内脏反位（SIT）患者的内镜逆行胰胆管造影术（ERCP）很少被理解。在已发表的病例报告中，患者的体位和内镜操作是主要关注点。本研究旨在探讨 ERCP 在 SIT 患者中的疗效和安全性。
纳入中国 9 家内镜中心的 SIT 行 ERCP 的患者。从电子病历中提取 SIT 患者的 ERCP 操作细节和并发症。对数据进行回顾性分析。
2011 年至 2021 年，共确定了 14 例 SIT 行 ERCP 的患者。平均年龄为 56.8 岁，男女比例为 5:2。ERCP 的主要适应证是胆总管结石（13/14，92.9%）。所有操作均由经验丰富的内镜医生完成。21.4%（3/14）的患者处于常规体位（俯卧位），78.6%的患者处于改良体位（仰卧位、左侧或右侧卧位）。71.4%（10/14）的患者存在插管困难。插管成功率为 85.7%（12/14）。3 例（3/14，21.4%）患者发生并发症，包括 1 例出血、1 例肺炎和 1 例急性心肌梗死。无胰腺炎后或死亡发生。与改良体位患者相比，俯卧位患者的插管成功率较低（66.7%比 90.9%），并发症发生率较高（33.3%比 18.2%）。
即使对于有经验的内镜医生来说，SIT 患者的 ERCP 也具有挑战性，改良患者体位可能在提高插管成功率和减少并发症方面具有潜在优势。需要更多的病例经验来全面了解 SIT 患者的 ERCP。
