4 Yıllık endoskopik retrograd kolanjiyopankreatografi vakalarımızın retrospektif değerlendirilmesi

Amaç: Endoskopik retrograd kolanjiyopankreatografi (ERCP), pankreatikobiliyer hastalıkların tanı ve tedavisinde altın standart yöntemdir. Biz bu çalışmada son 4 yıllık ERCP deneyimimizi gözden geçirmeyi amaçladık.Gereç ve yöntem: Necmettin Erbakan Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniğinde son 4 yılda ERCP yapılan hastalar çalışma kapsamına alındı. Veriler hastane arşiv sisteminden retrospektif olarak elde edildi.Bulgular: 1155 hastaya toplam 1471 ERCP işlemi yapılmıştı. Hastaların 664'ü kadın ve 491'i erkek ve ortalama yaş 60,2 yaş idi (10-97 years). En sık ERCP endikasyonu hiperbilirubinemi ve serum ALP ve GGT düzeylerinde artış idi (703 patients, %47,8). 1250 hastada (%85) standart sfinkterotomla kanülasyon başarılı olurken 217 (%14,8) hastaya iğne uçlu sfinkterotomla önkesi yapılmış ve bu hastaların 104'ü (%7) önkesi sonrası kanüle edilebilmişlerdi. Total kanülasyon başarısı %92,0 idi. 152 hastada ERCP ile ilişkili komplikasyonlar saptandı. En sık komplikasyon 113 hastada (%7,7) saptanan post-ERCP pankreatit idi. İğne uçlu sfinkterotomla önkesi yapılan hastalarda post-ERCP pankreatit gelişme sıklığı belirgin olarak yüksekti (%17,1). 1 hasta şiddetli post-ERCP pankreatit ve buna bağlı multiorgan yetmezliği nedeniyle öldü. ERCP ile ilişkili kanama 5 (%0,3) ve perforasyon 3 (%0,2) hastada saptandı.Sonuç: ERCP çeşitli pankreatikobiliyer hastalıkların tedavisinde hala altın standart yerini korumaktadır. İnvaziv olması nedeniyle ERCP'nin tanı için kullanılmaması ve terapötik amaçla kullanılmasının uygun olacağı kanaatindeyiz.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standart technique for the diagnosis and treatment of pancreaticobiliary diseases. In this study we aimed to evaluate our ERCP experience of the last four years.Material and Methods: Patients to whom ERCP is performed in the Gastroenterology Clinic of Necmettin Erbakan University Faculty of Medicine in the last 4 years were included in the study. Data were collected retrospectively from the medical records of the hospital archive system.Results: 1471 ERCP procedures were performed to 1155 patients. 664 patients were female (%57,5) and 491 were male with a mean age of 60,2 years (10-97 years). The most common indication for ERCP was hyperbilirubinemia and elevation of serum ALP and GGT levels (703 patients, 47,8% ). Selective cannulation with standard sphincterotome was achieved in 1250 patients (85,0%). Precut sphincterotomy with needle knife sphincterotome was performed in 217 patients (14,8%) and in 104 patients (7,0%) cannulation was successfull. Total cannulation success was 92%. In 152 patients (10,3%) ERCP related complications were detected.The most frequent complication was post-ERCP pancreatitis (113 patients, 7,7%). Post ERCP pancreatitis rate was significantly higher among patients to whom precut needle knife sphincterotomy was performed (17,1%). 1 patient died due to multiorgan failure associated with postERCP pancreatitis. ERCP related bleeding and perforation were detected in 5 (0,3%) and 3 (0,2%) patients respectively.Conclusions: ERCP is still the gold standard method for the treatment of various pancreaticobiliary diseases. Due to its invasive nature it shouldn't be performed for diagnostic purposes and reserved for therapeutic interventions.

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