Manaka Tomoo, Takikawa Tetsuya, Tarasawa Kunio, Kikuta Kazuhiro, Matsumoto Ryotaro, Tanaka Yu, Sano Takanori, Hamada Shin, Miura Shin, Kume Kiyoshi, Fujimori Kenji, Fushimi Kiyohide, Masamune Atsushi
Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machiachi, Aoba-ku, Sendai, 980-8575, Japan.
J Gastroenterol. 2025 May 2. doi: 10.1007/s00535-025-02254-8.
Endoscopic retrograde cholangiopancreatography (ERCP) is indispensable for the management of biliary and pancreatic diseases but carries a high risk of post-ERCP pancreatitis (PEP). This study aimed to clarify the current status and temporal trends of ERCP and PEP in Japan, including preventive measures.
We conducted a retrospective, population-based cohort study using the Diagnosis Procedure Combination database from April 1, 2016, to March 31, 2023. Trend analyses were performed for ERCP, PEP, nonsteroidal anti-inflammatory drugs (NSAIDs), and protease inhibitors. Additionally, factors associated with PEP and severe PEP were evaluated.
Among the 1,073,513 ERCP cases, PEP and severe PEP incidences were 85,212 (7.9%) and 4841 cases (0.5%), respectively. The mortality rate was 0.5% for severe PEP and 0.2% for non-severe cases. The number of ERCP procedures and the proportion of therapeutic ERCP increased over time. The incidence of PEP declined from 9.1% in the fiscal year 2016-2017 to 6.4% in the fiscal year 2022, while the incidence of severe PEP decreased from 0.5 to 0.33% over the same period. The usage rate of rectal NSAIDs increased from 16.4 to 27.6%, whereas that of protease inhibitors decreased from 70.5 to 53.5%. The administration of rectal NSAIDs at doses of 20-25 mg and 50 mg was associated with a reduced risk of severe PEP.
The number of ERCP procedures and the proportion of therapeutic ERCP have increased, whereas the incidences of PEP and severe PEP have decreased. Rectal NSAIDs may prevent the progression of PEP to severe disease.
内镜逆行胰胆管造影术（ERCP）对于胆管和胰腺疾病的治疗不可或缺，但术后胰腺炎（PEP）风险较高。本研究旨在阐明日本ERCP和PEP的现状及时间趋势，包括预防措施。
我们使用2016年4月1日至2023年3月31日的诊断程序组合数据库进行了一项基于人群的回顾性队列研究。对ERCP、PEP、非甾体抗炎药（NSAIDs）和蛋白酶抑制剂进行了趋势分析。此外，评估了与PEP和严重PEP相关的因素。
在1,073,513例ERCP病例中，PEP和严重PEP的发生率分别为85,212例（7.9%）和4841例（0.5%）。严重PEP的死亡率为0.5%，非严重病例为0.2%。ERCP手术数量和治疗性ERCP的比例随时间增加。PEP的发生率从2016 - 2017财年的9.1%下降到2022财年的6.4%，而严重PEP的发生率在同一时期从0.5%下降到0.33%。直肠NSAIDs的使用率从16.4%增加到27.6%，而蛋白酶抑制剂的使用率从70.5%下降到53.5%。给予20 - 25毫克和50毫克剂量的直肠NSAIDs与降低严重PEP的风险相关。
ERCP手术数量和治疗性ERCP的比例增加，而PEP和严重PEP的发生率下降。直肠NSAIDs可能预防PEP进展为严重疾病。
