Shavakhi Ahmad, Zobeiri Mehdi, Khodadoostan Mahsa, Zobeiri Mohammad Javad, Shavakhi Alireza
Department of Gastroenterology and Hepatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Gastroenterology and Hepatology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
J Res Med Sci. 2023 Feb 21;28:7. doi: 10.4103/jrms.jrms_150_22. eCollection 2023.
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the main therapeutic and sometimes diagnostic methods in biliary and pancreatic diseases. A grading system for the difficulty of ERCP (grade one to four, the higher grade represents the more complexity of the procedure) has been developed by the American Society for Gastrointestinal Endoscopy (ASGE). This study aimed to assess the prevalence of ERCP-related complications, their common risk factors, and specifically the role of difficulty of the procedure based on ASGE grading.
This cross-sectional study was performed on 620 ERCP-operated patients over 4 years in two tertiary referral centers affiliated with Isfahan University of Medical Sciences. Data about the difficulty of procedures based on the ASGE grading scale, complications including pancreatitis, bleeding, infection, perforation, arrhythmia, respiratory suppression, aspiration, and major common risk factors were collected.
The overall prevalence of complications was 11.6% including pancreatitis 8.2%, perforation 0.8%, gastrointestinal bleeding 1.3%, cholangitis 2.4%, and cardiopulmonary problems 0.5% (arrhythmia 0.3% and respiratory depression 0.2%). Patients with pancreatic contrast injection (66.7% vs. 11.3% = 0.04) and sphincter of Oddi dysfunction (SOD) (44.4% vs. 11.1%; = 0.01) showed a statistically significant higher overall complication rate. The association of these risk factors remained significant in multivariable logistic regression analysis. Patients with pancreatic contrast injection also showed a statistically significant higher prevalence of post-ERCP pancreatitis (66.7% vs. 11.3% = 0.04). Furthermore, a significantly higher prevalence of arrhythmia (3.6% vs. 0; = 0.008) was observed among patients with difficult cannulation. Based on the ASGE difficulty grading score, most of the patients were classified as grade 2 (74.2%) and 3 and 4 (23.4%). No statistically significant difference was noted between the difficulty-based groups in terms of complications.
The current study showed that the most critical risk factors of ERCP-induced complications were pancreatic contrast injection and SOD. ASGE grading scale for ERCP complexity did not predict the occurrence of complications in our study population.
内镜逆行胰胆管造影术（ERCP）是治疗胆道和胰腺疾病的主要方法之一，有时也用于诊断。美国胃肠内镜学会（ASGE）制定了ERCP难度分级系统（一级至四级，级别越高表示操作越复杂）。本研究旨在评估ERCP相关并发症的发生率、常见危险因素，特别是基于ASGE分级的操作难度的作用。
这项横断面研究在伊斯法罕医科大学附属的两家三级转诊中心对620例接受ERCP手术的患者进行了为期4年的研究。收集了基于ASGE分级量表的操作难度数据、包括胰腺炎、出血、感染、穿孔、心律失常、呼吸抑制、误吸等并发症以及主要常见危险因素的数据。
并发症的总体发生率为11.6%，其中胰腺炎8.2%，穿孔0.8%，胃肠道出血1.3%，胆管炎2.4%，心肺问题0.5%（心律失常0.3%，呼吸抑制0.2%）。进行胰腺造影剂注射的患者（66.7%对11.3%；P = 0.04）和Oddi括约肌功能障碍（SOD）患者（44.4%对11.1%；P = 0.01）的总体并发症发生率在统计学上显著更高。在多变量逻辑回归分析中，这些危险因素之间的关联仍然显著。进行胰腺造影剂注射的患者ERCP术后胰腺炎的发生率在统计学上也显著更高（66.7%对11.3%；P = 0.04）。此外，插管困难的患者中心律失常的发生率显著更高（3.6%对0；P = 0.008）。根据ASGE难度分级评分，大多数患者被归类为2级（74.2%）以及3级和4级（23.4%）。在基于难度的组之间，并发症方面未观察到统计学上的显著差异。
当前研究表明，ERCP引起并发症的最关键危险因素是胰腺造影剂注射和SOD。在我们的研究人群中，ERCP复杂性的ASGE分级量表并未预测并发症的发生。
