Management of ERCP complications

IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Partha Pal , Mohan Ramchandani
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引用次数: 0

Abstract

Managing complications of ERCP poses a significant clinical challenge to endoscopists. ERCP complications can occur even after all preventive measures, which can lead to significant morbidity and even mortality. Major complications include pancreatitis, bleeding, perforation, cholangitis, and sedation-related adverse events. Early recognition of post-ERCP pancreatitis (PEP) is feasible by monitoring clinical parameters and specific cutoffs of serum amylase and lipase at 2–6 h post-ERCP. Pancreatic stenting for PEP is not recommended and can increase the incidence of infected necrosis in addition to being technically challenging. Post-sphincterotomy bleeds can be treated by diluted epinephrine with or without thermal therapy, or mechanical therapy (clips or fully covered metallic stents) failing which angiographic embolization and rarely open surgical vessel ligation may be warranted. Post-ERCP perforations can lead to significant morbidity and are usually treated with endoscopic closure of the defect, diverting bile flow, draining collections, and reducing fluid load at the site of perforation failing which surgery may be warranted. Broad-spectrum antibiotics with endoscopic or radiologic drainage of undrained segments help treat post-ERCP cholangitis. Hypoxia and hypertension are the most common sedation-related adverse events without long-term consequences except aspiration pneumonia (<0.5%). Awareness with a high index of suspicion is crucial for timely diagnosis and management of uncommon post-ERCP complications.

ERCP并发症的处理
处理ERCP并发症是内镜医师面临的一项重大临床挑战。即使采取了所有预防措施,ERCP 并发症仍有可能发生,从而导致严重的发病率甚至死亡率。主要并发症包括胰腺炎、出血、穿孔、胆管炎和镇静相关不良事件。通过监测临床参数以及ERCP术后2-6小时血清淀粉酶和脂肪酶的特定临界值,可以早期识别ERCP术后胰腺炎(PEP)。不建议对 PEP 进行胰腺支架植入术,除了技术难度大之外,还会增加感染性坏死的发生率。括约肌切开术后出血可通过稀释的肾上腺素配合或不配合热疗或机械疗法(夹子或完全覆盖的金属支架)进行治疗,如果治疗失败,可能需要进行血管造影栓塞,很少需要进行开放性手术血管结扎。胃食管反流术后穿孔可导致严重的发病率,通常采用内镜下闭合缺损、转移胆汁流向、引流积液和减少穿孔部位液体负荷的方法进行治疗,否则可能需要进行手术。广谱抗生素配合内镜或放射线引流未排出的部分有助于治疗ERCP术后胆管炎。除吸入性肺炎(<0.5%)外,缺氧和高血压是最常见的镇静相关不良事件,不会造成长期后果。高度怀疑的意识对于及时诊断和处理不常见的ERCP术后并发症至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.50
自引率
0.00%
发文量
23
审稿时长
69 days
期刊介绍: Each topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology.
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