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Endoskopik retrograd kolanjiyopankreatografide kanülasyon başarısızlığı önlenebilir mi?

Year 2018, Volume: 2 Issue: 3, 253 - 256, 01.09.2018
https://doi.org/10.28982/josam.435834

Abstract

Amaç: Endoskopik retrograd kolanjiyopankreatografi (ERCP) sıklıkla hepatik, safra yolları ve pankreatik hastalıkların tanı ve tedavisinde kullanılır. Bununla birlikte, kanülasyon sırasında başarısızlık diğer müdahaleleri gerektirir. Bu çalışmanın amacı, ERCP sırasında başarısızlığı öngörmek için kullanılabilecek parametreleri oluşturmaktır.
Yöntemler: Olgu kontrol çalışması planlandı. Aralık 2016 - Şubat 2018 tarihleri arasında gerçekleştirilen ERCP işlemleri değerlendirildi. Hastalarda gerçekleştirilen mükerrer girişimler ve nedenleri, kanülasyon durumları kayıt edildi ve kanülasyonu etkileyen faktörler incelendi. İstatistik değerlendirmede tanımlayıcı analizler, kategorik veriler için Ki-kare testi ve sürekli veriler için t-testi testi kullanıldı. Analizlerde p değerinin 0,05 ve daha düşük olması istatistiksel olarak anlamlı kabul edildi.
Bulgular: Çalışma döneminde 288 hastaya uygulanan toplam 458 ERCP işlemi uygulandı. Hastaların 159’u kadın, 129’u erkek, kadın/erkek oranı 1,2, yaş ortalaması 59±17,9 ve yaş aralığı 17-105’di. ERCP endikasyonu değerlendirildiğinde 258 (%89,6) hastada koledokolityazis nedeniyle işlemin gerçekleştirildiği görüldü. İlk işlemde 229 hastada ERCP kateteri ile ve 28 hastada yardımcı yöntemler ile olmak üzere 257 (%89,3) hastada selektif koledok kanülasyonu başarılı oldu. 236 hastada 15 dakikadan az süre içinde kanülasyon başarılı oldu. 31 (%10,7) hastada kanülasyon ilk işlemde başarısız oldu. Başarısız olan hastalarda yaş ve cinsiyet açısından fark saptanmadı (sırasıyla p: 0,270, 0,256). Başarısızlık sebebi olarak geçirilmiş mide-duodenum ameliyatları, duodenum içi divertikül, pankreas başı tümörü görüldü. İlk işlemde başlıca koledokolityazis (n:214) olmak üzere 264 hastaya tanı konulabildi.
Sonuç: Hastanın cinsiyeti, yaşı ve duodenal divertikülü gibi yapısal farklılıkları ERCP sırasında kanülasyonun başarısını etkilemediği gösterildi. Billroth II ve Roux-en-Y gastrojejunostomi gibi üst karın ameliyatlarının kanülasyon başarı oranını düşürdüğü görüldü. Endoskopistlerin tecrübe seviyeleri ile kanülasyon başarısı arasında korelasyon olduğu düşünülmektedir.

References

  • 1. Cheng CL, Sherman S, Watkins JL, Barnett B, et al. Risk Factors for Post-ERCP Pancreatitis: A Prospective Multicenter Study. Am J Gastroenterol. 2006;101:139-47.
  • 2. Freeman ML, DiSario JA, Nelson DB, Fennerty MB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54:425-34.
  • 3. Fukatsu H, Kawamoto H, Kato H, et al. Evaluation of needleknife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors. Surgical Endoscopy and Other Interventional Techniques. 2008;22(3):717–23.
  • 4. Perdue DG, Freeman ML. ERCOST Study Group. Failed biliary ERCP: a prospective multicenter study of risk factors, complications and resource utilization. Gastrointestinal Endoscopy. 2004;59(5):192.
  • 5. Freeman ML. Adverse outcomes of endoscopic retrograde cholangiopancreatography. Rev Gastroenterol Dis. 2002;2:147-68.
  • 6. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc. 2002;56:273-82.
  • 7. Sherman S, Lehman GA. Complications of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. In: Barkin J, O’Phelan CA, eds. Advanced Therapeutic Endoscopy New York: Raven Press 1990:201-10.
  • 8. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96:417-23.
  • 9. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909-18.
  • 10. Freeman ML, Nelson DB, Sherman S, et al. Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complications study. Gastrointest Endosc. 1999;49:580-6.
  • 11. Leung JWC, Chan FKL, Sung JJY, Chung S. Endoscopic sphincterotomy- induced hemorrhage: a study of risk factors and the role of epinephrine injection. Gastrointest Endosc. 1995;42:550-4.
  • 12. Lobo DN, Balfour TW, Iftikhar SY. Periampullary diverticula: consequences of failed ERCP. Annals of the Royal College of Surgeons of England. 1998;80(5):326–31.
  • 13. Boix J, Lorenzo-Z´u˜niga V, A˜na˜nos F, Dom`enech E, Morillas RM, Gassull MA. Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques. 2006;16(4).208–11.
  • 14. Choudari CP, Sherman S, Fogel EL, et al. Success of ERCP at a referral center after a previously unsuccessful attempt. Gastrointestinal Endoscopy. 2000;52(4):478–83.
  • 15. Baron TH, Petersen BT, Mergener K, et al. Quality indicators for endoscopic retrograde cholangiopancreatography. American Journal of Gastroenterology. 2006;101(4): 892–97.

Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented?

Year 2018, Volume: 2 Issue: 3, 253 - 256, 01.09.2018
https://doi.org/10.28982/josam.435834

Abstract

Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used in the diagnosis and treatment of hepatic, biliary and pancreatic diseases. Failure during cannulation, however, requires other interventions. The purpose of this work is to create the parameters that can be used to predict failure during ERCP.
Methods: Case control study planned. ERCP procedures between December 2016 and February 2018 were evaluated. Duplicate attempts and causes, cannulation status were recorded and the factors affecting cannulation were examined. Descriptive analyzes were used for statistical evaluation, chi-square test for categorical data and t-test for continuous data. A p value of 0.05 or less was considered statistically significant in the analysis.
Results: A total of 458 ERCP procedures were performed in 288 patients during the study period. 159 of the patients were female, 129 were male, female / male ratio was 1.2, mean age was 59±17.9 and age range was 17-105. When ERCP indications were evaluated, 258 patients (89.6%) were treated due to choledocholithiasis. In the first procedure, selective choledochal cannulation was successful in 257 (89.3%) patients (229 patients with ERCP catheter and 28 patients with assisted methods), and these patients constituted study group. The remaining patients who cannulation was failed included in control group. There were no age and gender differences in the patients who failed cannulation (p: 0.270, 0.256, respectively). In failed cases, the duodenal diverticulum and pancreas head tumor were seen. In the first operation, 264 patients, mainly choledocholithiasis (n: 214), could be diagnosed.
Conclusion: It has been shown that the gender and age of the patient and structural differences such as the duodenal diverticulum do not affect the success of cannulation during ERCP. Upper abdominal operations like Billroth II and Roux-en-Y gastrojejunostomy reduce the success rate of cannulation. It is thought that the correlation between experience level of endoscopist and cannulation success.

References

  • 1. Cheng CL, Sherman S, Watkins JL, Barnett B, et al. Risk Factors for Post-ERCP Pancreatitis: A Prospective Multicenter Study. Am J Gastroenterol. 2006;101:139-47.
  • 2. Freeman ML, DiSario JA, Nelson DB, Fennerty MB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54:425-34.
  • 3. Fukatsu H, Kawamoto H, Kato H, et al. Evaluation of needleknife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors. Surgical Endoscopy and Other Interventional Techniques. 2008;22(3):717–23.
  • 4. Perdue DG, Freeman ML. ERCOST Study Group. Failed biliary ERCP: a prospective multicenter study of risk factors, complications and resource utilization. Gastrointestinal Endoscopy. 2004;59(5):192.
  • 5. Freeman ML. Adverse outcomes of endoscopic retrograde cholangiopancreatography. Rev Gastroenterol Dis. 2002;2:147-68.
  • 6. Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc. 2002;56:273-82.
  • 7. Sherman S, Lehman GA. Complications of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. In: Barkin J, O’Phelan CA, eds. Advanced Therapeutic Endoscopy New York: Raven Press 1990:201-10.
  • 8. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96:417-23.
  • 9. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909-18.
  • 10. Freeman ML, Nelson DB, Sherman S, et al. Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complications study. Gastrointest Endosc. 1999;49:580-6.
  • 11. Leung JWC, Chan FKL, Sung JJY, Chung S. Endoscopic sphincterotomy- induced hemorrhage: a study of risk factors and the role of epinephrine injection. Gastrointest Endosc. 1995;42:550-4.
  • 12. Lobo DN, Balfour TW, Iftikhar SY. Periampullary diverticula: consequences of failed ERCP. Annals of the Royal College of Surgeons of England. 1998;80(5):326–31.
  • 13. Boix J, Lorenzo-Z´u˜niga V, A˜na˜nos F, Dom`enech E, Morillas RM, Gassull MA. Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques. 2006;16(4).208–11.
  • 14. Choudari CP, Sherman S, Fogel EL, et al. Success of ERCP at a referral center after a previously unsuccessful attempt. Gastrointestinal Endoscopy. 2000;52(4):478–83.
  • 15. Baron TH, Petersen BT, Mergener K, et al. Quality indicators for endoscopic retrograde cholangiopancreatography. American Journal of Gastroenterology. 2006;101(4): 892–97.
There are 15 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research article
Authors

Yahya Kemal Çalışkan

Mustafa Uygar Kalaycı This is me

Publication Date September 1, 2018
Published in Issue Year 2018 Volume: 2 Issue: 3

Cite

APA Çalışkan, Y. K., & Kalaycı, M. U. (2018). Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented?. Journal of Surgery and Medicine, 2(3), 253-256. https://doi.org/10.28982/josam.435834
AMA Çalışkan YK, Kalaycı MU. Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented?. J Surg Med. September 2018;2(3):253-256. doi:10.28982/josam.435834
Chicago Çalışkan, Yahya Kemal, and Mustafa Uygar Kalaycı. “Can Failure of Choledochal Cannulation in Endoscopic Retrograde Cholangiopancreatography Be Prevented?”. Journal of Surgery and Medicine 2, no. 3 (September 2018): 253-56. https://doi.org/10.28982/josam.435834.
EndNote Çalışkan YK, Kalaycı MU (September 1, 2018) Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented?. Journal of Surgery and Medicine 2 3 253–256.
IEEE Y. K. Çalışkan and M. U. Kalaycı, “Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented?”, J Surg Med, vol. 2, no. 3, pp. 253–256, 2018, doi: 10.28982/josam.435834.
ISNAD Çalışkan, Yahya Kemal - Kalaycı, Mustafa Uygar. “Can Failure of Choledochal Cannulation in Endoscopic Retrograde Cholangiopancreatography Be Prevented?”. Journal of Surgery and Medicine 2/3 (September 2018), 253-256. https://doi.org/10.28982/josam.435834.
JAMA Çalışkan YK, Kalaycı MU. Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented?. J Surg Med. 2018;2:253–256.
MLA Çalışkan, Yahya Kemal and Mustafa Uygar Kalaycı. “Can Failure of Choledochal Cannulation in Endoscopic Retrograde Cholangiopancreatography Be Prevented?”. Journal of Surgery and Medicine, vol. 2, no. 3, 2018, pp. 253-6, doi:10.28982/josam.435834.
Vancouver Çalışkan YK, Kalaycı MU. Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented?. J Surg Med. 2018;2(3):253-6.