12031

Endoskopik retrograd kolanjiyopankreatografinin endikasyonları, sonuçları ve komplikasyonları: Doğu Karadeniz’deki üçüncü basamak bir merkezin 3 yıllık verileri

Bu çalışmanın amacı merkezimizde yapılan endoskopik retrograd kolanjiyopankreatografi işlemlerinin endikasyon, teknik başarı ve sonuçlarını gözden geçirmektir. Gereç ve Yöntem: Karadeniz Teknik Üniversitesi Tıp Fakültesi Hastanesi, endoskopi ünitesinde Şubat 2017- Şubat 2020 tarihleri arasında endoskopik retrograd kolanjiyopankreatografi yapılan ardışık 524 hastanın sonuçları retrospektif olarak değerlendirildi. Her prosedürden önce hastalardan resmi yazılı onay alındı. Bulgular: Çalışmamızda 524 hastaya toplam 620 endoskopik retrograd kolanjiyopankreatografi işlemi gerçekleştirilmiştir. Hastaların 285’i (%54.3) kadın, 239’u (%45.6) erkek olup yaş ortalaması 64.5 (18- 103) idi. Hastaların %97.8’inde endoskopik retrograd kolanjiyopankreatografi terapötik amaçla yapıldı. En sık endikasyon koledokolitiyazis (%68.5) ve safra yollarında dilatasyon ve kolestaz bulgularının olması (%20.8) idi. Hastaların 506’sında (%96.6) başarılı selektif koledok kanülasyonu sağlandı ve bunların 32’sinde (%7.8) iğne uçlu sfinkterotom ile ön kesi yapıldı. En sık tespit edilen bulgular koledokolitiyazis (%61.8), koledok dilatasyonu veya benign biliyer stenoz (%12.2) ve malign biliyer stenoz (%8.0) idi. En sık yapılan terapötik işlemler endoskopik sfinkterotomi 450 (%85.8), balon veya basket ile taş çıkarma 263 (%50.2) ve stent yerleştirilmesi 158 (%30.2) idi. Genel komplikasyon oranı %4.9 olup en sık görüleni %2.3 ile pankreatit idi. Serimizde 2 hastada (%0.4) mortalite gelişti. Sonuç: Endoskopik retrograd kolanjiyopankreatografi ciddi komplikasyon riski taşımasına rağmen uygun endikasyonda yapıldığında pankreatobiliyer hastalıkların tedavisinde etkili ve güvenli bir yöntemdir. Endoskopik retrograd kolanjiyopankreatografi ilişkili morbidite ve mortaliteyi azaltmak için olası komplikasyonların erken tanısı ve uygun yönetimi çok önemlidir

Indications, results, and complications of endoscopic retrograde cholangiopancreatography: 3-year data of a third-level center in the Eastern Black Sea Region

The aim of this study was to review the indications, technical success, and results of endoscopic retrograde cholangiopancreatography in our center. Materials and Methods: The results of 524 patients who underwent consecutive endoscopic retrograde cholangiopancreatography between February 2017 and February 2020 in the endoscopy unit of Karadeniz Technical University, Faculty of Medicine, were evaluated retrospectively. Formal written consent was obtained from all patients prior to each procedure. Results: A total of 620 endoscopic retrograde cholangiopancreatography procedures were performed in 524 patients. Two hundred eighty five of the patients (54.3%) were female and 239 (45.6%) male, with an average age of 64.5 (18– 103). In 97.8% of the patients, endoscopic retrograde cholangiopancreatography was conducted for therapeutic purposes. Choledocholithiasis (68.5%) and dilatation and cholestasis findings in the biliary tract (20.8%) were the most common endoscopic retrograde cholangiopancreatography indications. Successful selective common bile duct cannulation was achieved in 506 of the patients (96.6%), and precut sphincterotomy with needle knife sphincterotomy was performed in 32 (7.8%) of them. The most common findings were choledocholithiasis (61.8%), common bile duct dilatation, or benign (12.2%) and malignant (8.0%) biliary stenosis. On the other hand, the most common therapeutic procedures were endoscopic sphincterotomy in 450 patients (85.8%), stone extraction with balloon or basket in 263 (50.2%), and stent placement in 158 (30.2%). The overall complication rate was 4.9%, and the most frequent complication was pancreatitis with a rate of 2.3%. In this series, two patients (0.4%) died. Conclusion: Despite the possibility of severe complications, endoscopic retrograde cholangiopancreatography is an efficient and safe procedure for the treatment of pancreaticobiliary diseases when done with appropriate indications. Early diagnosis and effective treatment of potential complications are very important to reduce endoscopic retrograde cholangiopancreatography related morbidity and mortality.

PDF

___

1. McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg 1968;167:752-6.
2. Salerno R, Mezzina N, Ardizzone S. Endoscopic retrograde cholangiopancreatography, lights and shadows: Handle with care. World J Gastrointest Endosc 2019;11:219-30.
3. Moffatt DC, Yu BN, Yie W, Bernstein CN. Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study. Gastrointest Endosc 2014;79:615-22.
4. Kwak N, Yeoun D, Arroyo-Mercado F, et al. Outcomes and risk factors for ERCP-related complications in a predominantly black urban population. BMJ Open Gastroenterol 2020;7:e000462.
5. Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020;52:127-49.
6. Tunç N, Kılıç S, Şahin A, et al. Endoscopic retrograde cholangiopancreatography complications: frequency, contributing factors, and management. Endoscopy Gastrointestinal 2018;26:12-6.
7. Kıraç CO, Asıl M, Demir A. 4 yıllık endoskopik retrograd kolanjiopank-reatografi vakalarımızın retrospektif değerlendirilmesi. Genel Tıp Derg 2016;26:53-7.
8. Atamanalp SS, Yıldırgan Mİ, Kantarcı A. Endoscopic retrograde cholangiopancreatography (ERCP): outcomes of 3136 cases over 10 years. Turk J Med Sci 2011;41:615-21.
9. Sarıtaş Ü, Gören İ, Şenol A. Terapotik ERCP komplikasyonları için risk faktörleri: Tek merkezli prospektif çalışma. Akademik Gastroenteroloji Dergisi 2006;5:163-8.
10. Mariani A, Segato S, Anderloni A, et al. Prospective evaluation of ERCP performance in an Italian regional database study. Dig Liver Dis 2019;51:978-84.
11. Choudhury BN, Deka UJ, Baruah BJ, et al. Indications, outcomes and complications of therapeutic endoscopic retrograde cholangiopancreatography procedures in a tertiary care centre in North East India. Int J Res Med Sci 2020;8:2606-11.
12. Jain PK, Vinay BN. Indications and complications of endoscopic retrograde cholangiopancreatography procedures in a tertiary care centre. Int J Adv Med 2016;3:838-41. 13. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012; revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11.
14. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446-54.
15. ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA, Muthusamy VR, et al. Adverse events associated with ERCP. Gastrointest Endosc 2017;85:32-47.
16. Sahar N, La Selva D, Gluck M, et al. The ASGE grading system for ERCP can predict success and complication rates in a tertiary referral hospital. Surg Endosc 2019;33:448-53.
17. Testoni PA, Mariani A, Aabakken L, et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016;48:657-83.
18. Chen Q, Jin P, Ji X, Du H, Lu J. Management of difficult or failed biliary access in initial ERCP: A review of current literature. Clin Res Hepatol Gastroenterol 2019;43:365-72.
19. Sundaralingam P, Masson P, Bourke MJ. Early precut sphincterotomy does not increase risk during endoscopic retrograde cholangiopancreatography in patients with difficult biliary access: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol 2015;13:1722-9.e2.
20. Basat O, Köklü S, Çiçek B, Parlak E, Şahin B. Endoskopik retrograd kolanjiopankreatografi komplikasyonları: Tek merkezli retrospektif çalışma. Akademik Gastroenteroloji Dergisi 2006;5:169-72.
21. Serrano JPR, de Moura DTH, Bernardo WM, et al. Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopicretrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. Endosc Int Open 2019;7:E477–86.
22. Matsubayashi CO, Ribeiro IB, de Moura DTH, et al. Is endoscopic balloon dilation still associated with higher rates of pancreatitis?: a systematic review and meta-analysis. Pancreas 2020;49:158-74.
23. Suna N, Ödemiş B, Dişibeyaz S, et al. Bleeding after endoscopic sphincterotomy: A single-center retrospective study. Endoscopy Gastrointestinal 2018;26:1-5.