维普中文期刊产品整合服务

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

查看全文 作　　者：Monique T [1]Barakat;Mohit [2]Girotra;Nirav [3]Thosani;Shivangi [4]Kothari;Subhas [5]Banerjee 高影响力作者 机构地区：[1]Divisions of Adult and Pediatric Gastroenterology and Hepatology,Stanford University Medical Center,Cupertino,CA 95014,United States;[2]Division of Gastroenterology and Hepatology,University of Miami Miller School of Medicine,Miami,FL 33136,United States;[3]Department of Internal Medicine,Division of Gastroenterology,Hepatology&Nutrition,University of Texas Health Science Center Houston,Houston,TX 77030,United States;[4]Division of Gastroenterology and Hepatology,University of Rochester Medical Center,Rochester,NY 14627,United States;[5]Division of Gastroenterology and Hepatology,Stanford University Medical Center,Stanford,CA 94304,United States高影响力机构 出　　处：《World Journal of Gastroenterology》索引2020年第26卷第41期,共11页高影响力期刊 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 period.AIM To evaluate this phenomenon of perceived escalation in complexity of cannulation at ERCP and assessed potential underlying factors.METHODS 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 < 0.05). Increased ampullary distortion and peri-ampullary diverticula were noted in 2018(P < 0.001). ERCPs were increasingly performed with a non-standard duodenoscope position, from 2.2%(2008) to 5.6%(2013) and 16.1%(2018)(P < 0.001). Utilization of more than one advanced cannulation technique for a given ERCP increased from 0.7%(2008) to 0.9%(2013) to 6.6%(2018)(P < 0.001). Primary mass size > 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
相关文献

参考文献(35)

引证文献(5)

网站首页 | 关于我们 | 联系我们 | 产品服务 | 客服中心 | 广告服务 | 版权声明 | 网站联盟 | 友情链接 | 售卡网点

版权所有© 渝B2-20050021-1　渝公网安备 50019002500403号　违法和不良信息举报中心

互联网出版许可证 新出网证(渝)字10号 全国400电话 - 免长途话费