Cheng Yan, Feng Jiahui, Chen Xiaojia, Lin Jun, Wang Hongling
Department of Gastroenterology, Zhongnan Hospital, Wuhan University, Wuhan, 430000, China.
Wuhan University, wuhan, China.
Eur J Med Res. 2025 Feb 25;30(1):135. doi: 10.1186/s40001-025-02391-z.
Endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in the diagnosis and treatment of biliary and pancreatic diseases, and its success rate and therapeutic effect are considerable, and its use in patients with gastrointestinal tract reconstruction is also increasing. The anatomical structure of the digestive tract has been changed in these patients, which makes the use of endoscopic retrograde cholangiopancreatography technically more challenging. The aim of this study was to investigate the efficacy of transendoscopic retrograde cholangiopancreatography in patients after gastrointestinal reconstruction and its risk factors for postoperative complications.
A retrospective analysis was conducted on clinical data of 522 patients who underwent ERCP for diagnostic and therapeutic purposes after gastrointestinal reconstruction surgery at Zhongnan Hospital, Wuhan University, from January 2017 to December 2023. Univariate analysis, multicollinearity testing, and binary logistic regression were performed to explore the factors associated with ERCP efficacy and complications.
A total of 522 patients were included in the study. The success rate of intubation was 96.93% (506/522), the success rate of cannulation was 91.09% (466/506), and the therapeutic success rate was 95.28% (444/466). Multivariate logistic regression analysis of failed intubation showed that independent risk factors included total gastrectomy (P = 0.000, OR = 7.114, 95% CI 2.454-20.622), gastrojejunostomy (P = 0.000, OR = 46.881, 95% CI 10.250-214.423), and the use of a forward-viewing endoscope (P = 0.010, OR = 2.322, 95% CI 1.228-4.389). Post-ERCP complications included hyperamylasemia in 67 cases (12.84%), acute pancreatitis in 13 cases (2.49%), acute cholangitis in 3 cases (0.57%), bleeding in 3 cases (0.57%), and perforation in 2 cases (0.38%). Univariate analysis of the complications showed that a history of cholecystectomy (P = 0.042, OR = 1.800, 95% CI 1.015-3.193) was an independent risk factor for hyperamylasemia; difficult cannulation (P = 0.000, OR = 47.619, 95% CI 13.317-170.275) was an independent risk factor for acute pancreatitis; and a history of pancreatitis (P = 0.040, OR = 42.75, 95% CI 3.399-537.620) was an independent risk factor for bleeding.
ERCP performed in patients after gastrointestinal reconstruction at our hospital achieved a high success rate. Total gastrectomy, gastrojejunostomy, and the use of a forward-viewing endoscope were independent risk factors for failed intubation. A history of cholecystectomy, recurrent cannulation, and a history of pancreatitis were identified as independent risk factors for hyperamylasemia, acute pancreatitis, and bleeding, respectively.
内镜逆行胰胆管造影术（ERCP）已广泛应用于胆胰疾病的诊断和治疗，其成功率和治疗效果可观，在胃肠道重建患者中的应用也日益增加。这些患者的消化道解剖结构发生了改变，这使得内镜逆行胰胆管造影术的操作在技术上更具挑战性。本研究旨在探讨经内镜逆行胰胆管造影术在胃肠道重建术后患者中的疗效及其术后并发症的危险因素。
对2017年1月至2023年12月在武汉大学中南医院接受胃肠道重建手术后因诊断和治疗目的而行ERCP的522例患者的临床资料进行回顾性分析。进行单因素分析、多重共线性检验和二元逻辑回归，以探讨与ERCP疗效和并发症相关的因素。
本研究共纳入522例患者。插管成功率为96.93%（506/522），插管成功率为91.09%（466/506），治疗成功率为95.28%（444/46）。插管失败的多因素逻辑回归分析显示，独立危险因素包括全胃切除术（P = 0.000，OR = 7.114，95%CI 2.454 - 20.622）、胃空肠吻合术（P = 0.000，OR = 46.881，95%CI 10.250 - 214.423）以及使用前视内镜（P = 0.010，OR = 2.322，95%CI 1.228 - 4.389）。ERCP术后并发症包括高淀粉酶血症67例（12.84%）、急性胰腺炎13例（2.49%）、急性胆管炎3例（0.57%）、出血3例（0.57%）、穿孔2例（0.38%）。并发症的单因素分析显示，胆囊切除术史（P = 0.042，OR = 1.800，95%CI 1.015 - 3.193）是高淀粉酶血症的独立危险因素；插管困难（P = 0.000，OR = 47.619，95%CI 13.317 - 170.275）是急性胰腺炎的独立危险因素；胰腺炎病史（P = 0.040，OR = 42.75，95%CI 3.399 - 537.620）是出血的独立危险因素。
我院对胃肠道重建术后患者进行的ERCP成功率较高。全胃切除术、胃空肠吻合术和使用前视内镜是插管失败的独立危险因素。胆囊切除术史、反复插管和胰腺炎病史分别被确定为高淀粉酶血症、急性胰腺炎和出血的独立危险因素。
