Parveen Shaheena, Shah Altaf H, Gulzar Ghulam M, Sodhi Jaswinder S, Khan Mushtaq A, Tiwari Avinash, Mir Tariq A, Sharma Ankush, Ahmad Syed N, Dar Nazir A
Department of Gastroenterology.
Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
Ann Med Surg (Lond). 2023 Apr 11;85(5):1705-1711. doi: 10.1097/MS9.0000000000000613. eCollection 2023 May.
Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically demanding endoscopic procedure with significant adverse events that mandate appropriate training, competence and careful decision-making. The American Society for Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE) updated a list of quality indicators and performance measures for pancreatobiliary endoscopy. Nevertheless, real-life data are scarce, especially from developing countries. The study aimed to assess overall quality, procedural success, and indications of ERCP at our center.
An audit of our endoscopy center at the start of the study for quality and performance indicators and a retrospective analysis of the 4 years of the prospectively maintained data of patients who underwent ERCP regarding procedural success and indications was done.
The study showed that ERCP is performed by meeting good quality standards, but structured training, sedation practice, and microbiological surveillance are subpar. A total of 3544 procedures were carried out with successful cannulation of the naive papilla in 93%, with 60% of procedures carried out on females, 80.5% of procedures done for benign diseases, and 19.5% on suspected or proven malignancy (47% men and 53% women) with perihilar obstruction being commonest in both sexes (32-33%) followed by carcinoma gallbladder in women (21%) and distal cholangiocarcinoma in men (27%). Among benign diseases (2711), 12% had benign pancreatic diseases, and 64.8% had common bile duct (CBD) stones, with 31% of CBD stones requiring more than one session for clearance.
ERCP at our center is performed by meeting quality standards and by competent endoscopists with good procedural success. Improving sedation strategies, microbiological surveillance, and training programs remains an unmet need.
内镜逆行胰胆管造影术（ERCP）是技术要求最高的内镜操作，会引发重大不良事件，因此需要进行适当培训、具备相应能力并谨慎决策。美国胃肠内镜学会（ASGE）和欧洲胃肠内镜学会（ESGE）更新了胰胆内镜检查的质量指标和性能指标清单。然而，实际数据匮乏，尤其是来自发展中国家的数据。本研究旨在评估我们中心ERCP的整体质量、操作成功率及适应证。
在研究开始时对我们的内镜中心进行质量和性能指标审核，并对接受ERCP患者的前瞻性维护数据进行回顾性分析，以了解操作成功率和适应证。
研究表明，ERCP操作符合良好质量标准，但结构化培训、镇静操作和微生物监测存在不足。共进行了3544例操作，初次乳头插管成功率为93%，60%的操作针对女性，80.5%的操作针对良性疾病，19.5%针对疑似或确诊恶性肿瘤（男性47%，女性53%），肝门周围梗阻在两性中最为常见（32 - 33%），其次是女性的胆囊癌（21%）和男性的远端胆管癌（27%）。在良性疾病（2711例）中，12%患有良性胰腺疾病，64.8%患有胆总管结石，31%的胆总管结石需要多次手术才能清除。
我们中心的ERCP操作符合质量标准，内镜医师能力较强且操作成功率较高。改善镇静策略、微生物监测和培训项目仍是未满足的需求。
