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Endoscopic retrograde cholangiopancreatography-related early perforations:A study of effects of procedure duration,complexity,and endoscopist experience

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World Journal of Gastrointestinal endoscopy 2023年第11期15卷 641-648页

作者： Mark Aloysius Hemant Goyal Tejas Nikumbh Niraj James Shah Ghassan M Hammoud Pritesh Mutha Mairin Joseph-Talreja Savio John Ganesh Aswath Vaibhav Wadhwa Nirav Thosani Division of Gastroenterology Department of Internal MedicineSUNY Upstate Medical UniversitySyracuseNY13210United States Department of Surgery The University of Texas Health Science CenterHoustonTX 77030United States Department of Internal Medicine The Wright Center for Graduate Medical EducationScrantonPA 18510United States Department of Medicine Division of Digestive DiseasesThe University of Missouri at ColumbiaColumbiaMO 65211United States Division of Gastroenterology Department of Internal MedicineSUNY Upstate Medical UniversitySyracuseNY 13210United States

BACKGROUND Perforations(Perf)during endoscopic retrograde cholangiopancreatography(ERCP)are rare(<1%)but potentially fatal events(up to 20%mortality).Given its rarity,most data is through case series studies from centers or analysis of large *** a meta-analysis has shown fewer adverse events as a composite(bleeding,pancreatitis,Perf)during ERCP performed at high-volume centers,there is very little real-world data on endoscopist and center procedural volumes,ERCP duration and complexity on the occurrence of *** To study the profile of Perf related to ERCP by center and endoscopist procedure volume,ERCP time,and complexity from a national endoscopic *** from clinical outcomes research initiative-national endoscopic database(2000-2012)who underwent ERCP were stratified based on the endoscopist and center volume(quartiles),and total procedure duration and complexity grade of the ERCP based on procedure *** effects of these variables on the Perf that occurred were *** variables were compared between Perf and no perforations(NoPerf)using the Mann-Whitney U test as the data demonstrated significant skewness and *** A total of 14153 ERCPs were performed by 258 endoscopists,with 20 reported Perf(0.14%)among 16 *** patient age in years 61.6±14.8 vs 58.1±18.8(Perf ***,P=NS).The cannulation rate was 100%and 91.5%for Perf and NoPerf groups,respectively.13/20(65%)of endoscopists were high-volume performers in the 4th quartile,and 11/20(55%)of Perf occurred in centers with the highest volumes(4th quartile).Total procedure duration in minutes was 60.1±29.9 vs 40.33±23.5(Perf vs NoPerf,P<0.001).Fluoroscopy duration in minutes was 3.3±2.3 vs 3.3±2.6(Perf vs NoPerf P=NS).50%of the procedures were complex and greater than grade 1 difficulty.3/20(15%)patients had prior biliary surgery.13/20(65%)had sphincterotomies performed with stent *** occurred in only 1/20(0.5%).CONCLUSION

关键词： Endoscopic retrograde cholangiopancreatography endoscopy complications Perforations

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