Escalating complexity of endoscopic retrograde cholangiopancreatography over the last decade with increasing reliance on advanced cannulation techniques

作     者：Monique T Barakat Mohit Girotra Nirav Thosani Shivangi Kothari Subhas Banerjee 

作者机构：Divisions of Adult and Pediatric Gastroenterology and HepatologyStanford University Medical CenterCupertinoCA 95014United States Division of Gastroenterology and HepatologyUniversity of Miami Miller School of MedicineMiamiFL 33136United States Department of Internal MedicineDivision of GastroenterologyHepatology&NutritionUniversity of Texas Health Science Center HoustonHoustonTX 77030United States Division of Gastroenterology and HepatologyUniversity of Rochester Medical CenterRochesterNY 14627United States Division of Gastroenterology and HepatologyStanford University Medical CenterStanfordCA 94304United States 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2020年第26卷第41期

页      面：6391-6401页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Endoscopic retrograde cholangiopancreatography Biliary cannulation Goff trans-pancreatic septotomy Needle knife precut sphincterotomy Endoscopy Complexity 

摘      要：BACKGROUND At our academic tertiary care medical center, we have noted patients referred for endoscopic retrograde cholangiopancreatography(ERCP) who increasingly require advanced cannulation techniques. This trend is noted despite increased endoscopist experience and annual ERCP volume over the same *** To evaluate this phenomenon of perceived escalation in complexity of cannulation at ERCP and assessed potential underlying *** Demographic/clinical variables and records of ERCP patients at the beginning(2008), middle(2013) and end(2018) of the last decade were reviewed retrospectively. Cannulation approaches were classified as standard or advanced and duodenoscope position was labeled as standard(short position) or non-standard(e.g., long, semi-long).RESULTS Patients undergoing ERCP were older in 2018 compared to 2008(69.7 ± 15.2 years vs 55.1 ± 14.7, P 4 cm, pancreatic uncinate mass, and bilirubin 10 mg/d L predicted use of advanced cannulation techniques(P 0.03 for each).CONCLUSION Complexity of cannulation at ERCP has sharply increased over the past 5 years, with an increased proportion of elderly patients and those with malignancy requiring advanced cannulation approaches. These data suggest that complexity of cannulation at ERCP may be predicted based on patient/ampulla characteristics. This may inform selection of experienced, high-volume endoscopists to perform these complex procedures.