Bülent ÖDEMİŞ, Hakan YILDIZ, İsmail TAŞKIRAN, Erkan PARLAK

Koledok Taşı için Ayaktan ERCP Güvenli midir?

Amaç: Bu çalışmada safra yolu taşı olan hastalara ayaktan ve yatırılarak uygulanan endoskopik retrograd kolanjiyopankreatografi (ERCP) prosedürünün komplikasyonları karşılaştırılarak, ayaktan ERCP işleminin emniyetli bir yaklaşım olup olmadığı araştırılmıştır. Gereç ve Yöntemler: Çalışmaya, 2013 Ocak-Temmuz ayları arasında safra yolu taşı tanısı almış olup ilk defa ERCP uygulanan 203 vaka prospektif olarak alınmıştır. Bulgular: ERCP yapılan vakaların 102’si ayaktan, 101’i yatırılarak uygulanan hastalardı. Ayaktan grupta ERCP sonrası komplikasyon toplam %9,8 (pankreatit %5,9, kanama %1,9, kolanjit %1, perforasyon %1), yatan grupta %11,9 (pankreatit %6,9, kanama %1, kolanjit %2, perforasyon %2) olarak saptandı (sırasıyla p=0,230, p=0,386, p=0,386, p=0,333 toplam komplikasyon kıyaslaması p=0,618). ERCP sonrası 4. saat amilaz ölçümünün 150 U/L’den düşük olması pankreatit olmama açısından %99,4 oranında negatif prediktif değere sahipti. 4. saat amilaz değerinin sınırı 300 kabul edildiğinde pankreatit olma açısından %52,1 oranında pozitif prediktif değere sahipti. Aynı zamanda iki grup maliyet açısından da kıyaslandığında ayaktan grup daha avantajlıydı [873,6±272,2 Türk lirası (TL) vs 1389,7±612,6 TL, p=0,001]. Sonuç: Bu çalışma safra yolu taşı olan seçilmiş hastalarda ayaktan ERCP işleminin emniyetli ve maliyet açısından daha etkin olduğunu, ERCP sonrası 4. saat amilaz ölçümünün 150 U/L’den düşük olması hastaları emniyetli bir şekilde taburcu edebileceğimizi aynı zamanda 4.saat amilaz ölçümünün 3 katın üzerinde olmasının pankreatit açısından hastaneye yatış için limit değer olabileceğini göstermiştir.

Is Outpatient ERCP Safe for Choledocholithiasis?

Objective: This study aimed to compare the complications of outpatient and inpatient endoscopic retrograde cholangiopancreatography (ERCP) procedures in patients with bile duct stones and to investigate whether it is a safe approach to perform outpatient ERCP or not. Materials and Methods: This prospective study consisted of 203 patients who had undergone ERCP for the first time with a diagnosis of choledocholithiasis between January 2013-July 2013. Results: Of the patients included in the study, 102 had undergone outpatient and 101 had undergone inpatient ERCP. Complications following ERCP occurred in 9.8% of the outpatient group (pancreatitis in 5.9%, hemorrhage in 1.9%, cholangitis in 1%, perforation in 1%), while they occurred in the 11.9% of the inpatient group (pancreatitis in 6.9%, bleeding in 1%, cholangitis in 2%, perforation in 2%) (p=0.230, p=0.386, p=0.386, p=0.333, respectively; total complication comparison p=0.618). An amylase level below 150 U/L at the 4th hour after ERCP had a negative predictive value of 99.4% for pancreatitis to be negative. When the 4th hour amylase value of 300 U/L was taken as a limit, it had a positive predictive value of 52.1% in terms of pancreatitis positive. Additionally, the outpatient procedure was more cost-effective when the two groups were compared in terms of the cost [873.6±272.2 Turkish lira (TL) vs 1389.7±612.6 TL, p=0.001]. Conclusion: Our study demonstrated that outpatient ERCP was safe and costeffective in selected cases with bile duct stones. The 4th hour amylase level below 150 U/L after ERCP showed that patients can be safely sent home and that the amylase value above 3-fold at the 4th hour can be considered the limit value for admission to the hospital for pancreatitis

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