Mengmeng Zhang, Xi Wu, Dongsheng Wu, Qingwei Jiang, Yunlu Feng, Qiang Wang, Shengyu Zhang, Aiming Yang
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引用次数: 0
Abstract
Background: The unplanned repeated endoscopic retrograde cholangiopancreatography (ERCP) in patients with common bile duct stone (CBDS) remains unclear.
Objectives: To identify risk factors of unplanned repeated ERCP and its impact on clinical outcomes.
Design: Retrospective cohort study.
Methods: Patients who underwent ERCP for CBDSs from January 2013 to October 2023 were consecutively reviewed. Risk factors for unplanned repeated ERCP within 1 month were evaluated using logistic regression. The impact of unplanned repeated ERCP on adverse events, including ampullary bleeding, CBDSs recurrence, and biliary infection, was explored.
Results: A total of 1241 patients were included, of which 50 patients underwent unplanned repeated ERCP in 1 month primarily because of unrelieved biliary obstruction or cholangitis. The repeated ERCP group had higher proportions of irregular papilla (42.0% vs 21.7%, p < 0.001), stones locating in superior common bile duct (CBD; 18.0% vs 8.8%, p = 0.05), larger CBD diameter (median 1.2 vs 1.0 cm, p = 0.002), or larger CBDS diameter (median 1.0 vs 0.8 cm, p = 0.004) than the unrepeated group. In the multivariate analysis, irregular papilla (odds ratio (OR) 3.494, p = 0.024), post-ERCP fever (OR 7.532, p < 0.001), post-ERCP abdominal pain (OR 2.810, p = 0.05), post-/pre-ERCP total bilirubin levels ⩾1.2 times (OR 6.973, p = 0.007), and post-/pre-ERCP transaminase levels ⩾1.2 times (OR 3.944, p = 0.026) were independent risk factors for unplanned repeated ERCP. The incidence of adverse events in the long term was higher in the repeated group than the unrepeated group (12.0% vs 5.0%, p = 0.068). Unplanned repeated ERCP, although not an independent factor, is partially relevant with increased likelihood of long-term adverse events (univariate OR 2.570, p = 0.038).
Conclusion: Papillary morphology, post-ERCP symptoms, and serum biochemical parameters may help predict the occurrence of unplanned repeated ERCP in patients with CBDS. Unplanned repeated ERCP does not have a significant impact on the long-term prognosis.
背景：胆总管结石（CBDS）患者的非计划重复内镜逆行胆管造影（ERCP）尚不清楚。目的：探讨计划外重复ERCP的危险因素及其对临床预后的影响。设计：回顾性队列研究。方法：对2013年1月至2023年10月接受ERCP治疗cbds的患者进行回顾性分析。采用logistic回归评价1个月内发生计划外重复ERCP的危险因素。我们探讨了计划外重复ERCP对不良事件的影响，包括壶腹出血、cbds复发和胆道感染。结果：共纳入1241例患者，其中50例患者主要因未缓解的胆道梗阻或胆管炎在1个月内进行了计划外重复ERCP。与未重复组相比，重复ERCP组不规则乳头的比例更高（42.0% vs 21.7%, p p = 0.05）， CBD直径更大（中位值1.2 vs 1.0 cm, p = 0.002）， CBDS直径更大（中位值1.0 vs 0.8 cm, p = 0.004）。在多变量分析中，不规则乳头（优势比（OR） 3.494, p = 0.024）、ERCP后发热（OR 7.532, p = 0.05）、ERCP后/前总胆红素水平大于或等于1.2倍（OR 6.973, p = 0.007）和ERCP后/前转转酶水平大于或等于1.2倍（OR 3.944, p = 0.026）是意外重复ERCP的独立危险因素。长期不良事件发生率重复组高于未重复组（12.0% vs 5.0%, p = 0.068）。计划外重复ERCP虽然不是一个独立因素，但与长期不良事件的可能性增加部分相关（单因素OR为2.570,p = 0.038）。结论：乳突形态、ERCP后症状和血清生化指标可能有助于预测CBDS患者发生计划外重复ERCP。计划外重复ERCP对远期预后无显著影响。
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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