胆胰疾病患者内镜下逆行胆胰管造影术术前胃潴留风险的预测研究

Risk Prediction of Gastric Retention Before Endoscopic Retrograde Cholangiopancreatography in Patients with Biliopancreatic Diseases

目的分析胃轻瘫主要症状指数(gastroparesis cardinal symptom index,GCSI)量表及胃潴留危险因素评估,对胆胰疾病患者发生胃潴留的预测效果。方法采用GCSI量表及相关危险因素调查表,在421名胆胰疾病患者内镜下逆行胆胰管造影术(endoscopic retrograde cholangiopancreatography,ERCP)术前进行评估,于术中观察验证是否有胃潴留。采用受试者工作特征(receiver operating characteristic,ROC)曲线法分析GCSI量表对胆胰疾病患者发生胃潴留的预测效果。结果胆胰疾病患者发生胃潴留GCSI量表最佳临界值为25分,其预测灵敏度、特异度分别为87.5%、91.4%,ROC曲线下面积为0.979。女性、胆胰恶性肿瘤、消化道梗阻为患者发生胃潴留的独立危险因素,其预测灵敏度、特异度分别为83.3%、77.1%,ROC曲线下面积为0.916。GCSI量表预测胆胰疾病患者胃潴留的准确度较高。结论GCSI量表可作为胆胰疾病患者ERCP术前筛查胃潴留的工具。对于GCSI量表评分≥25分的患者,可提前给予预防措施,从而保证ERCP的按期顺利实施。

Objective To analyze the effect of Gastroparesis Cardinal Symptom Index(GCSI)scale and gastric retention risk factor assessment questionnaire in predicting the incidence of gastric retention in patients with biliopancreatic diseases by using.Methods 421 patients were assessed before endoscopic retrograde cholangiopancreatography(ERCP)using GCSI scale and self-related risk factors questionnaire and then the occurrence of gastric retention were observed during ERCP.Receiver operating characteristic(ROC)curve method was used to analyze the GCSI scale score and risk factors to predict the gastric retention in patients with biliopancreatic diseases.Results In ROC curve,the optimal critical value of GCSI scale for patients with biliopancreatic diseases was 25,and the predictive sensitivity and specificity were 87.5%and 91.4%respectively,while the areas under the ROC curve was 0.979.Female,biliopancreatic malignancy,gastrointestinal obstruction were independent risk factors for gastric retention,and the predictive sensitivity and specificity were 83.3%and 77.1%respectively.The areas under the ROC curve was 0.916.GCSI scale was more accurate than risk factors in predicting gastric retention in patients with biliopancreatic diseases.Conclusions GCSI scale can be used as a routine screening method before ERCP.For patients with GCSI scores≥25,preventive measures could be taken before ERCP to ensure the safety and implementation of ERCP as planned.