Heo Jun, Jung Min Kyu, Lee Jieun, Lee Dong Wook, Cho Chang Min, Cha Jung Guen
School of Medicine, Kyungpook National University, Daegu, The Republic of Korea.
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
PLoS One. 2024 Mar 12;19(3):e0300029. doi: 10.1371/journal.pone.0300029. eCollection 2024.
Perforation is one of the most serious complications of endoscopic retrograde cholangiopancreatography (ERCP). Conventional nonsurgical endoscopic treatments including intravenous antibiotic administration and plastic endoscopic biliary drainage are generally approved for the treatment of ERCP-related Stapfer type II perforation (perivaterian type). Biliary covered metal stent placement has recently been reported to have favorable outcomes in ERCP-related Stapfer type II perforations. We aimed to compare the outcomes of conventional endoscopic bile drainage and biliary covered self-expandable metal stent (SEMS) insertion in patients with Stapfer type II perforation.
Medical records of patients who underwent ERCP at Kyungpook National University Hospital in Daegu from 2011 to 2022 were retrospectively reviewed.
A total of 8,402 ERCP procedures were performed in our hospital. Sixty-six ERCP-related perforations (0.78%) were identified. Among them, 37 patients (56.1%) who had Stapfer type II perforations were enrolled. Thirteen and twenty-four patients received biliary covered SEMS insertion and conventional endoscopic bile drainage treatments, respectively. No significant differences were observed in the clinical success rate (92.3% vs. 91.7%, p = 1.000), hospital stay (9.46 ± 5.97 vs. 13.9 ± 13.2 days, p = 0.258), and post-ERCP-related fasting time (5.4 ± 3.4 vs 4.3 ± 3.0 days, p = 0.305). Complications including bleeding, post-ERCP pancreatitis, fever, and death were not significantly different between the two groups. The conventional endoscopic bile drainage group took less time for ERCP than the SEMS group (11.5 ± 5.2 vs. 18.5 ± 11.2 min, p = 0.013).
Compared with the conventional endoscopic bile drainage treatment method, biliary covered SEMS did not improve patient outcomes in ERCP-related Stapfer type II perforations.
穿孔是内镜逆行胰胆管造影术（ERCP）最严重的并发症之一。包括静脉注射抗生素和塑料内镜胆管引流在内的传统非手术内镜治疗通常被批准用于治疗ERCP相关的斯塔弗II型穿孔（壶腹周围型）。最近有报道称，胆管覆膜金属支架置入术在ERCP相关的斯塔弗II型穿孔治疗中取得了良好效果。我们旨在比较传统内镜胆管引流和胆管覆膜自膨式金属支架（SEMS）置入术在斯塔弗II型穿孔患者中的治疗效果。
回顾性分析2011年至2022年在大邱庆北国立大学医院接受ERCP治疗的患者的病历。
我院共进行了8402例ERCP手术。共发现66例ERCP相关穿孔（0.78%）。其中，37例（56.1%）为斯塔弗II型穿孔患者被纳入研究。13例和24例患者分别接受了胆管覆膜SEMS置入术和传统内镜胆管引流治疗。两组在临床成功率（92.3%对91.7%，p = 1.000）、住院时间（9.46±5.97天对13.9±13.2天，p = 0.258）和ERCP术后禁食时间（5.4±3.4天对4.3±3.0天，p = 0.305）方面均未观察到显著差异。两组在出血、ERCP术后胰腺炎、发热和死亡等并发症方面也无显著差异。传统内镜胆管引流组的ERCP操作时间比SEMS组短（11.5±5.2分钟对18.5±11.2分钟，p = 0.013）。
与传统内镜胆管引流治疗方法相比，胆管覆膜SEMS在ERCP相关的斯塔弗II型穿孔治疗中并未改善患者的治疗效果。
