Gastroenterology and Endoscopy Department, ASST Maggiore Hospital, Largo Ugo Dossena 2, 26013, Crema (CR), Italy.
Department of Clinical Medicine and Surgery, Diseases of the Liver and Biliary System Unit, University "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy.
Surg Endosc. 2024 Sep;38(9):5187-5198. doi: 10.1007/s00464-024-11095-0. Epub 2024 Jul 23.
In surgically altered anatomy (SAA), endoscopic retrograde cholangiopancreatography (ERCP) can be challenging, and it remains debatable the choice of the optimal endoscopic approach within this context. We aim to show our experience and evaluate the technical and clinical success of endoscopic treatment performed in the setting of adverse events (AE) after pancreaticoduodenectomy (PD).
This study was conducted on a retrospective cohort of patients presenting biliopancreatic complications after PD from 01/01/2012 to 31/12/2022. All patients underwent ERCP at our Endoscopy Unit. Clinical, instrumental data, and characteristics of endoscopic treatments were collected.
133 patients were included (80 M, mean age = 65 y.o.) with a total of 296 endoscopic procedures (median = 2 procedures/treatment). The indications for ERCP were mainly biliary AE (76 cases, 57.1%). Technical success was obtained in 121 patients of 133 (90.9%). 112 out of 133 (84.2%) obtained clinical success. Nine patients out of 112 (8%) experienced AEs. Clinical success rates were statistically different between patients with biliary or pancreatic disease (93.4% vs 73.6%, p < 0.0001). Septic patients were 38 (28.6%) and showed a worse prognosis than non-septic ones (clinical success: 65.7% vs 91.5%, p = 0.0001). During follow-up, 9 patients (8%), experienced recurrence of the index biliopancreatic disease with a median onset at 20 months (IQR 6-40.1).
Our case series demonstrated that the use of a pediatric colonoscope in ERCP procedures for patients with AEs after PD is both safe and effective in treating the condition, even in a long-term follow-up.
在手术改变的解剖结构（SAA）中，内镜逆行胰胆管造影（ERCP）可能具有挑战性，在这种情况下，哪种内镜方法是最佳选择仍存在争议。我们旨在展示我们的经验，并评估在胰腺十二指肠切除术后（PD）不良事件（AE）背景下进行的内镜治疗的技术和临床成功率。
本研究回顾性分析了 2012 年 1 月 1 日至 2022 年 12 月 31 日期间在 PD 后出现胆胰并发症的患者队列。所有患者均在我们的内镜科进行 ERCP。收集了临床、仪器数据以及内镜治疗的特征。
共纳入 133 例患者（80 例男性，平均年龄 65 岁），共进行了 296 次内镜操作（中位数 2 次/次治疗）。ERCP 的适应证主要为胆道 AE（76 例，57.1%）。133 例患者中有 121 例（90.9%）获得技术成功。133 例患者中有 112 例（84.2%）获得临床成功。9 例（8%）患者发生 AE。胆道疾病或胰腺疾病患者的临床成功率存在统计学差异（93.4% vs 73.6%，p<0.0001）。9 例（28.6%）患者为感染性患者，预后较非感染性患者差（临床成功率：65.7% vs 91.5%，p=0.0001）。在随访期间，9 例（8%）患者的指数胆胰疾病复发，中位发病时间为 20 个月（IQR 6-40.1）。
我们的病例系列表明，在 PD 后 AE 患者的 ERCP 中使用小儿结肠镜是安全有效的，即使在长期随访中也是如此。
