Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
Department of Biostatistics, University of Washington, Seattle, WA, USA.
Dig Dis Sci. 2024 Aug;69(8):3021-3028. doi: 10.1007/s10620-024-08516-4. Epub 2024 Jun 14.
Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure, but it poses challenges in patients with surgically altered gastrointestinal anatomy (SAGA). Alternative techniques like single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or push enteroscopy (PE) have been used, albeit with potential complications. Limited Latin American data exists on ERCP complications in SAGA patients. Our goal is to describe complications of ERCP in SAGA at a national referral institution.
Retrospective, single-center cohort study. All SAGA ERCP procedures performed at the Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán from January 2008 to May 2023 were included. Extracted data from records included procedure specifics, endoscope type, success, and complications. Complications were evaluated during procedure and 28-day post-procedure and classified using the AGREE system.
A total of 266 procedures in 174 patients were included, 74% were women, and the median age was 44 years. Predominant modified anatomy was Roux-en-Y biliary reconstruction (79%), followed by Whipple procedure (13%) and subtotal gastrectomy with Roux-en-Y reconstruction (6.0%). The main indications were cholangitis with stricture (31%), stricture (19%), and cholangitis (19%). DBE was used in 89%, PE in 7.5%, and SBE in 3.4%. Success rates were 77% endoscopic, 72% technical, and 69% therapeutic; in 30%, the procedure was unsuccessful. Complications happened in 18% of cases, most commonly cholangitis (7.5%), followed by perforation (2.6%) and hemorrhage (1.9%). According to the AGREE classification, 10.9% were grades 1 and 2, 6.4% were grade 3, and 0.4% were grade 4 complications. No significant differences emerged between groups with and without complications. Procedures increased over time, but complications and unsuccessful procedures remained stable.
ERCP complications align with international data, often not requiring invasive treatment. Enhanced exposure to such cases correlates with fewer complications and failures. Prospective studies are essential to identify complication and failure predictors.
内镜逆行胰胆管造影术（ERCP）是一种常见的操作，但在有外科改变的胃肠道解剖结构（SAGA）的患者中存在挑战。已经使用了替代技术，如单球囊小肠镜（SBE）、双球囊小肠镜（DBE）或推进式小肠镜（PE），尽管存在潜在的并发症。在 SAGA 患者中，关于 ERCP 并发症的拉丁美洲数据有限。我们的目标是描述在一家国家转诊机构中 SAGA 患者的 ERCP 并发症。
回顾性、单中心队列研究。纳入 2008 年 1 月至 2023 年 5 月在国家医学科学和营养萨尔瓦多·祖比兰胃肠内镜科进行的所有 SAGA ERCP 操作。从记录中提取的数据包括操作细节、内镜类型、成功率和并发症。并发症在操作期间和 28 天后进行评估，并使用 AGREE 系统进行分类。
共纳入 174 例患者的 266 例操作，74%为女性，中位年龄为 44 岁。主要的改良解剖结构是 Roux-en-Y 胆管重建（79%），其次是 Whipple 手术（13%）和 Roux-en-Y 重建的胃大部切除术（6.0%）。主要适应症为胆管炎伴狭窄（31%）、狭窄（19%）和胆管炎（19%）。DBE 使用率为 89%，PE 为 7.5%，SBE 为 3.4%。内镜成功率为 77%，技术成功率为 72%，治疗成功率为 69%；在 30%的病例中，操作不成功。并发症发生率为 18%，最常见的是胆管炎（7.5%），其次是穿孔（2.6%）和出血（1.9%）。根据 AGREE 分类，10.9%为 1 级和 2 级，6.4%为 3 级，0.4%为 4 级并发症。有并发症和无并发症的组之间没有显著差异。随着时间的推移，操作数量增加，但并发症和操作失败保持稳定。
ERCP 并发症与国际数据一致，通常不需要侵入性治疗。增加对这类病例的接触与并发症和失败的减少有关。前瞻性研究对于确定并发症和失败的预测因素至关重要。
