İbrahim Ethem ÇAKÇAK, Merve Yaren KAYABAŞ, Sıla Nur CANSIZ, Mustafa Numan YILMAZ, Doğan ALBAYRAK

Covid-19: ERCP’de Karşılaşılan Zorluklar Hakkında Bir Rerospektif Çalışma

GİRİŞ ve AMAÇ: Covid-19’un Endoskopik Retrograd Kolanjiyopankreatikografi (ERCP) üzerindeki etkilerini araştırmayı ve bundan sonraki olası salgın durumlarında nelere dikkat edilmesi gerektiğini araştırmayı amaçladık. YÖNTEM ve GEREÇLER: Çalışmamızda Mart 2019-Mart 2021 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’na ERCP (Endoskopik retrograd kolanjiyopankreatografi) için başvuran hastalar geriye dönük olarak değerlendirildi. Tanımlayıcı istatistikler olarak yüzdeler, ortalama, standart sapma, ortanca ve çeyrekler arası aralık kullanıldı. İki grubun karşılaştırılmasında normal dağılım göstermeyen değişkenler için Mann-Whitney U testi kullanıldı. Nitel değişkenlerin gruplar arasın karşılaştırmaları için Pearson Ki-Kare testi ve Fisher’s Exact ki-kare testi ile incelenmiştir. Tüm istatistiksel analizler için anlamlı değer 0.05 olarak belirlendi. BULGULAR: COVID-19 öncesi ERCP endikasyonları taş (%90.1), stent (%8) ve tümör (%1.1) iken, COVID-19 döneminde sıralama taş (%73.8), tümör (%13.7) ve stent (%12.4) olarak değişti.. ERCP’nin tanısal kullanımı büyük ölçüde azaltıldı (%0,7’den %0,0’a). Her iki dönemde de perforasyon saptanmadı, kanama olmadı ancak COVID-19 döneminde pankreatitte küçük bir artış (%4,7 ila %5,9) bulundu. COVID-19 öncesi dönemde hastaların %46,2’sinde taş tespit edildi ve tamamı başarıyla çıkarıldı, ancak COVID-19 döneminde hastaların %50,6’sında taş tespit edildi ve hastaların %1.3’ünde taşlar çıkarılamadı. TARTIŞMA ve SONUÇ: Covid-19 salgını döneminde hastaneye başvuruların gecikmesi ve hastaneye gelme korkusu nedeniyle ERCP sayısının azaldığı ve bu süreçte ERCP tanısı konan malignite sayısının arttığı gözlemlendi. Böyle salgın dönemlerinde daha planlı sağlık hizmetleri hem hastalar hem de sağlık personeli için daha iyi sonuçlar sağlayacaktır.

Covid-19: A Retrospective Study About The Challenges for ERCP

INTRODUCTION: We aimed to investigate the effects of Covid-19 on Endoscopic retrograde cholangiopancreatography (ERCP) and to investigate what should be considered in the next possible epidemic situations. METHODS: In our study, patients who applied to Trakya University School of Medicine, Department of General Surgery for ERCP (Endoscopic retrograde cholangiopancreatography) between March 2019 and March 2021 were evaluated, retrospectively. Percentages, mean, standard deviation, median and interquartile range were used as the descriptive statistics. Mann-Whitney U test was used for the variants which are contrary to the normal distribution range in the comparison of two groups. The relations between qualitative variants were studied by the Pearson Chi-Square test and Fisher’s Exact Chi-Square test. Significant value was determined as 0.05 for all statistical analyses. RESULTS: Prior to COVID-19, ERCP indications were in the order of stone (90.1%), stent removal (8%) and tumor (1.1%), while in the period of COVID-19, the ranking changed to stone (73.8%), tumor (13.7%), and stent removal (12.4%).. The diagnostic use of ERCP has been greatly reduced (from 0.7% to 0.0%). No perforation was detected in both periods, there was no bleeding, but a small increase (4.7% to 5.9%) was found in pancreatitis in the COVID-19 period. In the pre-COVID-19 period, stones were detected in 46.2% of the patients and all of them were successfully removed, but during the COVID-19 period, stones were detected in 50.6% of the patients and the stones could not be removed in 1.3% of the patients. DISCUSSION AND CONCLUSION: It was observed that the number of ERCPs decreased due to the delay in admissions to the hospital and the fear of coming to the hospital during the Covid-19 epidemic period, and the number of malignancies diagnosed with ERCP increased in this process. In such epidemic periods, more scheduled health services will provide better results for both patients and health personnel.

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1. Zimmon, D. S. (1975). The clinical value of endoscopic retrograde cholangiopancreatography. Bulletin of the New York Academy of Medicine, 51(4), 472.
2. Albert, J. G., & Riemann, J. F. (2002). ERCP and MRCP–when and why. Best Practice & Research Clinical Gastroenterology, 16(3), 399-41
3. Ahmed, M., Kanotra, R., Savani, G. T., Kotadiya, F., Patel, N., Tareen, S. et al. (2017). Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): a cross-sectional US experience. Endoscopy International Open, 5(04), E261-E271.
4. Chandrasekhara, V., Khashab, M. A., Muthusamy, V. R., Acosta, R. D., Agrawal, D., Bruining, D. H., & DeWitt, J. M. (2017). Adverse events associated with ERCP. Gastrointestinal endoscopy, 85(1), 32-47.
5. Cotton P. B. (1977). ERCP. Gut, 18(4), 316–341. https://doi. org/10.1136/gut.18.4.316
6. Cotton, P. B. (2001). ERCP is most dangerous for people who need it least. Gastrointestinal endoscopy, 54(4), 535-536. https://doi. org/10.1067/mge.2001.118446
7. Loperfido, S., Angelini, G., Benedetti, G., Chilovi, F., Costan, F., De Berardinis, F. et al. (1998). Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointestinal endoscopy, 48(1), 1-10.
8. Anderson, M. A., Fisher, L., Jain, R., Evans, J. A., Appalaneni, V., Ben- Menachem, T. et al.. (2012). Complications of ERCP. Gastrointestinal endoscopy, 75(3), 467-473.
9. Soetikno, R., Teoh, A. Y., Kaltenbach, T., Lau, J. Y., Asokkumar, R., Cabral-Prodigalidad, P. et al. (2020). Considerations in performing endoscopy during the COVID-19 pandemic. Gastrointestinal endoscopy, 92(1), 176-183.
10. Resál, T., Bor, R., Szántó, K., Fábián, A., Rutka, M., Sacco, M. et al. (2021). Effect of COVID-19 pandemic on the workflow of endoscopy units: an international survey. Therapeutic advances in gastroenterology, 14, 17562848211006678. https://doi.org/10.1177/17562848211006678
11. Tag-Adeen M, Yousef M, Osman H, et al. Impact of COVID-19 pandemic on endoscopic retrograde cholangiopancreatography; a single center experience (published online ahead of print, 2021 Oct 26). Rev Esp Enferm Dig. 2021;10.17235/reed.2021.8229/2021. doi:10.17235/reed.2021.8229/2021
12. John O’Grady, Jan Leyden, Padraic MacMathuna, Stephen Stewart & T. Barry Kelleher (2020) ERCP and SARS-COV-2: an urgent procedure that should be immune, Scandinavian Journal of Gastroenterology, 55:8, 976-978, DOI: 10.1080/00365521.2020.1789210
13. Voiosu, T., Voiosu, A., Boškoski, I., Arvanitakis, M., Bronswijk, M., Hollenbach, M. et al. (2020). Technical and clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in patients with COVID-19. Therapeutic advances in gastroenterology, 13, 1756284820980671. https://doi. org/10.1177/1756284820980671
14. Søreide, K., Hallet, J., Matthews, J. B., Schnitzbauer, A. A., Line, P. D., Lai, P. et al. (2020). Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. The British journal of surgery, 107(10), 1250–1261. https://doi.org/10.1002/bjs.11670
15. Layton, G. R., Chung,W.Y., Isherwood, J., Fraser, R. E., Issa, E., Robertson, G. S. et al. (2021). Endoscopic retrograde cholangiopancreatography in the COVID era: considerations for hepatobiliary and pancreatic surgery units. The British journal of surgery, 108(9), e290–e291. https://doi.org/10.1093/bjs/znab161
16. Lauro A, Pagano N, Impellizzeri G, Cervellera M, Tonini V. Emergency Endoscopy During the SARS-CoV-2 Pandemic in the North of Italy: Experience from St. Orsola University Hospital-Bologna. Dig Dis Sci. 2020;65:1559–1561
17. Repici A, Pace F, Gabbiadini R, Colombo M, Hassan C, Dinelli M ITALIAN GI-COVID19 Working Group. Endoscopy Units and the Coronavirus Disease 2019 Outbreak: A Multicenter Experience From Italy. Gastroenterology. 2020;159:363–366.e3.
18. Kim KH, Kim SB. Comparison of the impact of endoscopic retrograde cholangiopancreatography between pre-COVID-19 and current COVID-19 outbreaks in South Korea: Retrospective survey. World J Clin Cases. 2021;9(28):8404-8412. doi:10.12998/wjcc.v9.i28.8404
19. Donato, G., Forti, E., Mutignani, M., Laterra, M. A., Arese, D. et al. 2021). A multicenter survey on endoscopic retrograde cholangiopancreatography during the COVID-19 pandemic in northern and central Italy. Endoscopy international open, 9(4), E629–E634. https://doi.org/10.1055/a-1380-3419
20. Kim KH, Kim SB, Kim TN. Changes in endoscopic patterns before and during COVID-19 outbreak: Experience at a single tertiary center in Korean. World J Clin Cases. 2021;9(15):3576-3585. doi:10.12998/ wjcc.v9.i15.3576