Erfan Arabpour, Amir Sadeghi, Sajad Shojaee, Negin Tabatabaie, Sina Khoshdel, Amirreza Pouladi, Mohammad Abdehagh, Mohammad Reza Zali
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引用次数: 0
Abstract
Background and objectives: Endoscopic retrograde cholangiopancreatography (ERCP)-related perforations (EPs) are rare but serious adverse events, with a reported frequency of 0.4% to 0.6% and mortality rates reaching 8%. The lack of a uniform classification system for injury patterns and evidence-based management guidelines poses significant challenges in clinical decision-making. This systematic review evaluates therapeutic approaches and outcomes of EPs using the Stapfer classification to address these gaps.
Methods: We conducted a systematic review of studies that utilized the Stapfer classification to categorize EPs into four types, ranked by severity: type I (lateral/medial duodenal wall perforation), type II (periampullary injuries), type III (bile duct injuries) and type IV (retroperitoneal air alone). The study protocol was registered in PROSPERO (ID CRD42023473841).
Results: Among 287 patients from 18 eligible studies, type-I perforations were associated with significantly higher mortality (adjusted OR = 3.17, 95% CI 1.45-6.99). Surgical management did not significantly increase mortality risk compared to non-operative treatment (adjusted OR = 1.99, 95% CI 0.66-6.00) but was linked to prolonged hospital stays (coefficient 8.58, 95% CI 2.71-14.46). In contrast, perforation type did not significantly influence hospitalization duration (coefficient - 0.64, 95% CI - 4.04 to 2.76).
Conclusions: Our findings underscore the need for individualized treatment strategies based on perforation type and patient-specific factors. While the Stapfer classification aids in risk stratification, the heterogeneity of current evidence limits generalizability. Large-scale prospective studies are essential to establish standardized management protocols.
背景与目的：内镜逆行胆管造影（ERCP）相关穿孔（EPs）是罕见但严重的不良事件，报道频率为0.4%至0.6%，死亡率达8%。缺乏损伤模式的统一分类系统和循证管理指南对临床决策提出了重大挑战。本系统综述使用Stapfer分类来评估EPs的治疗方法和结果，以解决这些差距。方法：我们对采用Stapfer分类法将EPs按严重程度分为四种类型的研究进行了系统回顾：I型（十二指肠壁外侧/内侧穿孔），II型（腹腹部周围损伤），III型（胆管损伤）和IV型（腹膜后空气单独）。研究方案已在PROSPERO注册（ID CRD42023473841）。结果：在18项符合条件的研究的287例患者中，i型穿孔与显著较高的死亡率相关（校正OR = 3.17, 95% CI 1.45-6.99）。与非手术治疗相比，手术治疗没有显著增加死亡风险（调整后OR = 1.99, 95% CI 0.66-6.00），但与住院时间延长有关（系数8.58,95% CI 2.71-14.46）。相比之下，穿孔类型对住院时间无显著影响（系数- 0.64,95% CI - 4.04 ~ 2.76）。结论：我们的研究结果强调了基于穿孔类型和患者特异性因素的个性化治疗策略的必要性。虽然斯塔弗分类有助于风险分层，但目前证据的异质性限制了普遍性。大规模的前瞻性研究对于建立标准化的管理方案至关重要。
期刊介绍：
The Indian Journal of Gastroenterology aims to help doctors everywhere practise better medicine and to influence the debate on gastroenterology. To achieve these aims, we publish original scientific studies, state-of -the-art special articles, reports and papers commenting on the clinical, scientific and public health factors affecting aspects of gastroenterology. We shall be delighted to receive articles for publication in all of these categories and letters commenting on the contents of the Journal or on issues of interest to our readers.
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