胆道置管困难对ERCP术后胰腺炎的影响：支架与吲哚美辛试验数据集的二次分析。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-03-01 DOI:10.1016/j.gie.2024.10.003

Samuel Han MD, MS , Jingwen Zhang MS , Valerie Durkalski-Mauldin PhD , Lydia D. Foster MS , Jose Serrano MD, PhD , Gregory A. Coté MD , Ji Young Bang MD , Shyam Varadarajulu MD , Vikesh K. Singh MD , Mouen Khashab MD , Richard S. Kwon MD , James M. Scheiman MD , Field F. Willingham MD , Steven A. Keilin MD , J. Royce Groce MD , Peter J. Lee MBBS , Somashekar G. Krishna MD , Amitabh Chak MD , Adam Slivka MD, PhD , Daniel Mullady MD , Georgios I. Papachristou MD, PhD

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引用次数: 0

摘要

背景和目的：胆道插管困难 (DBC) 是ERCP术后胰腺炎 (PEP) 的已知风险因素。为了更好地了解 DBC 如何增加 PEP 风险，我们研究了 DBC 技术方面与已知 PEP 风险因素之间的相互作用：这是一项多中心随机对照试验的二次分析，该试验比较了单独使用直肠吲哚美辛与联合使用直肠吲哚美辛和预防性胰管 (PD) 支架置入术对高危患者进行 PEP 预防。参与者被分为 3 组：1）术前有高 PEP 风险的 DBC；2）术前无高风险的 DBC；3）术前有高风险的非 DBC：共有 1601 人（84.1%）经历过 DBC，平均需要 12 次（标清 10 次）插管尝试，平均持续时间为 14.7 分钟（标清 14.9 分钟）。在术前风险较高的 DBC 中，PEP 率最高（20.7%），其次是术前风险较高的非 DBC（13.5%），然后是术前风险不高的 DBC（8.8%）。PD线通过次数的增加（aOR：1.97，95% CI：1.25-3.1）与DBC的PEP相关，但PD注射、胰腺括约肌切开术和插管尝试次数与PEP无关。将吲哚美辛与胰十二指肠支架植入术结合使用可降低 DBC 的 PEP 风险（aOR：0.61，95% CI：0.44-0.84）。这种保护作用在至少 4 个 PD 线程中都很明显：结论：在手术前风险因素的叠加作用下，DBC会带来更高的PEP风险。PD导丝穿刺似乎增加了DBC的最大PEP风险，但将吲哚美辛与PD支架置入术结合使用可降低这一风险，即使PD导丝穿刺次数增加也是如此。

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Impact of difficult biliary cannulation on post-ERCP pancreatitis: secondary analysis of the stent versus indomethacin trial dataset

Background and Aims

Difficult biliary cannulation (DBC) is a known risk factor for developing post-ERCP pancreatitis (PEP). To better understand how DBC increases PEP risk, we examined the interplay between technical aspects of DBC and known PEP risk factors.

Methods

This was a secondary analysis of a multicenter, randomized controlled trial comparing rectal indomethacin alone with the combination of rectal indomethacin and prophylactic pancreatic duct (PD) stent placement for PEP prophylaxis in high-risk patients. Participants were categorized into 3 groups: DBC with high preprocedure risk for PEP, DBC without high preprocedure risk for PEP, and non-DBC at high preprocedure risk for PEP.

Results

In all, 1601 participants (84.1%) experienced DBC, which required a mean of 12 cannulation attempts (standard deviation, 10) and mean duration of 14.7 minutes (standard deviation, 14.9). PEP rate was highest (20.7%) in DBC with a high preprocedure risk, followed by non-DBC with a high preprocedure risk (13.5%), and then DBC without a high preprocedure risk (8.8%). Increasing number of PD wire passages (adjusted odds ratio [aOR], 1.97; 95% confidence interval [CI], 1.25-3.1) was associated with PEP in DBC, but PD injection, pancreatic sphincterotomy, and number of cannulation attempts were not associated with PEP. Combining indomethacin with PD stent placement lowered the risk of PEP (aOR, .61; 95% CI, .44-.84) in DBCs. This protective effect was evident in up to at least 4 PD wire passages.

Conclusions

DBC confers higher PEP risk in an additive fashion to preprocedural risk factors. PD wire passages appear to add the greatest PEP risk in DBCs, but combining indomethacin with PD stent placement reduces this risk, even with increasing PD wire passages.

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.