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

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World Journal of Gastroenterology 2020年第41期26卷 6391-6401页

作者： Monique T Barakat Mohit Girotra Nirav Thosani Shivangi Kothari Subhas Banerjee Divisions of Adult and Pediatric Gastroenterology and Hepatology Stanford University Medical CenterCupertinoCA 95014United States Division of Gastroenterology and Hepatology University of Miami Miller School of MedicineMiamiFL 33136United States Department of Internal Medicine Division of GastroenterologyHepatology&NutritionUniversity of Texas Health Science Center HoustonHoustonTX 77030United States Division of Gastroenterology and Hepatology University of Rochester Medical CenterRochesterNY 14627United States Division of Gastroenterology and Hepatology Stanford University Medical CenterStanfordCA 94304United States

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.

关键词： Endoscopic retrograde cholangiopancreatography Biliary cannulation goff trans-pancreatic septotomy Needle knife precut sphincterotomy Endoscopy Complexity

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