Mehta S N, Pavone E, Barkun A N
Montreal General Hospital, Quebec, Canada.
Gastrointest Endosc. 1996 Oct;44(4):443-9. doi: 10.1016/s0016-5107(96)70097-4.
Because of possible complications, it has been common practice to admit most if not all patients undergoing therapeutic ERCP. Therefore, little descriptive data exist on the safety of outpatient therapeutic ERCP.
We assessed 262 consecutive ERCPs in 209 patients undergoing outpatient therapeutic ERCP over a 5-year period, with particular attention to the development of complications. All outpatient endoscopic sphincterotomies and stent placements performed over a 5-year period were prospectively entered into an ongoing data base that was used for the analysis. In addition, hospital and office records for all patients were retrospectively reviewed, including a 30 to 45 day follow-up in a private office setting.
Suspected or documented choledocholithiasis was the most common indication for ERCP and was present in 132 (50%), followed by malignant obstruction in 77 (29%), type I sphincter of Oddi dysfunction (on the basis of symptoms, liver test abnormalities, and bile duct dilatation) in 36 (14%), chronic pancreatitis in 10 (3.8%), HIV cholangiopathy in 4 (1.5%), and other conditions in 3 (1.1%). Overall, 181 patients (69%) underwent a sphincterotomy. The 30-day post-ERCP complication rate was 5.7% (95% CI: 3.2% to 9.3%), occurring in 15 of 262 cases. Complications necessitating hospitalization developed in 9 of the 262 ERCPs for a rate of 3.4% (95% CI: 1.6% to 6.4%). The mean duration of hospital stay among patients admitted for a complication was 2.7 +/- 1.8 days (range, 1 to 7 days). All patients were discharged without permanent sequelae. No 30-day procedure-related fatalities were reported.
In this selected series of 262 consecutive cases, endoscopic sphincterotomy and stent placement were safely performed in an ambulatory setting. Prior to recommending a generalized change in existing practice, however, this finding requires validation with larger series of cases, including the performance of other outpatient therapeutic ERCP techniques.
由于可能出现并发症，对于大多数（即便不是全部）接受治疗性内镜逆行胰胆管造影（ERCP）的患者，收入院治疗已成为惯例。因此，关于门诊治疗性ERCP安全性的描述性数据很少。
我们评估了209例患者在5年期间连续进行的262次ERCP，特别关注并发症的发生情况。在5年期间进行的所有门诊内镜括约肌切开术和支架置入术均前瞻性地录入一个正在使用的数据库，用于分析。此外，对所有患者的医院和门诊记录进行回顾性审查，包括在私人门诊环境下进行的30至45天随访。
疑似或确诊的胆总管结石是ERCP最常见的适应证，有132例（50%），其次是恶性梗阻77例（29%），I型Oddi括约肌功能障碍（根据症状、肝功能异常和胆管扩张）36例（14%），慢性胰腺炎10例（3.8%），HIV胆管病4例（1.5%），其他情况3例（1.1%）。总体而言，181例患者（69%）接受了括约肌切开术。ERCP术后30天并发症发生率为5.7%（95%可信区间：3.2%至9.3%），262例中有15例发生。262例ERCP中有9例出现需要住院治疗的并发症，发生率为3.4%（95%可信区间：1.6%至6.4%）。因并发症入院患者的平均住院时间为2.7±1.8天（范围1至7天）。所有患者出院时均无永久性后遗症。未报告30天内与手术相关的死亡病例。
在这组连续的262例病例中，内镜括约肌切开术和支架置入术在门诊环境下安全实施。然而，在建议对现有做法进行普遍改变之前，这一发现需要通过更多病例系列进行验证，包括其他门诊治疗性ERCP技术的应用情况。
