摘要
Background and study aims:Endoscopic pancreatic sphinc-terotomy is indispensable for many therapeutic endoscopic maneuvers,but is also associated with a higher risk of pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP) .In this study,this subgroup of patients was investigated in order to identify risk factors and protective factors.Patients and methods:A retrospective chart review identified 572 endoscopic pancreatic sphincterotomies that met the inclusion criteria.Charts were examined for indications,endoscopic technique,and outcomes,including pancreatitis.Results:A total of 477 patients underwent 572 endoscopic pancreatic sphincterotomies during a 5-year period.Indications for sphincterotomy included chronic pancreatitis(n = 398) ,access for tissue sampling(n = 52) ,acute recurrent pancreatitis(n = 45) ,transpapillary drainage of a pancreatic pseudocyst(n = 32) ,precut access to the common bile duct(n = 29) ,and others(n = 16) .Pancreatic duct drainage was performed in 69.1% of the procedures(nasopancreatic catheter,n = 290,or pancreatic stent placement,n = 105) .Post-ERCP pancreatitis occurred in 69 cases(12.1%) and was severe in 10.The multivariate analysis identified female sex as being associated with a higher risk of pancreatitis,while an elevated C-reactive protein level,pancreatic ductal stones,sphincterotomy at only the major papilla,and pancreatic duct drainage with a nasopancreatic catheter or stent were associated with a lower risk.Conclusions:This large series of patients undergoing endoscopic pancreatic sphincterotomy provides further evidence that both patient characteristics and technical factors modify the risk profile for post-ERCP pancreatitis.In addition to providing further definition of which patients are at risk,it also suggests that pancreatic duct drainage is an independently significant protective maneuver.
Background and study aims:Endoscopic pancreatic sphinc-terotomy is indispensable for many therapeutic endoscopic maneuvers,but is also associated with a higher risk of pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP) .In this study,this subgroup of patients was investigated in order to identify risk factors and protective factors.Patients and methods:A retrospective chart review identified 572 endoscopic pancreatic sphincterotomies that met the inclusion criteria.Charts were examined for indications,endoscopic technique,and outcomes,including pancreatitis.Results:A total of 477 patients underwent 572 endoscopic pancreatic sphincterotomies during a 5-year period.Indications for sphincterotomy included chronic pancreatitis(n = 398) ,access for tissue sampling(n = 52) ,acute recurrent pancreatitis(n = 45) ,transpapillary drainage of a pancreatic pseudocyst(n = 32) ,precut access to the common bile duct(n = 29) ,and others(n = 16) .Pancreatic duct drainage was performed in 69.1% of the procedures(nasopancreatic catheter,n = 290,or pancreatic stent placement,n = 105) .Post-ERCP pancreatitis occurred in 69 cases(12.1%) and was severe in 10.The multivariate analysis identified female sex as being associated with a higher risk of pancreatitis,while an elevated C-reactive protein level,pancreatic ductal stones,sphincterotomy at only the major papilla,and pancreatic duct drainage with a nasopancreatic catheter or stent were associated with a lower risk.Conclusions:This large series of patients undergoing endoscopic pancreatic sphincterotomy provides further evidence that both patient characteristics and technical factors modify the risk profile for post-ERCP pancreatitis.In addition to providing further definition of which patients are at risk,it also suggests that pancreatic duct drainage is an independently significant protective maneuver.
