Analysis Of High Risk Factors For Post-ERCP Acute Cholecystitis In The Common Bile Duct

Objective:The purpose of this study was to analyze the ERCP-related clinical cases who underwent ERCP in the surgical ERCP center of the first hospital of Lanzhou university, from January 1st 2013 to December 31 st 2014.then making univariate analysis and multiple logistic regression analysis, to study the high risk factors of post-ERCP acute cholecystitis in the common bile duct stones and guide the clinical work, for high risk patients whom underwent ERCP because of common bile duct stones, we need to take actions to prevent the occurrence of post-ERCP acute cholecystitis.Method:1302 ERCP-related clinical cases were collected retrospectively from January 1st 2013 to December 31 st 2014 in the surgical ERCP center, for whom underwent ERCP in the first hospital of Lanzhou university. According to inclusion criteria and exclusion criteria, 238 clinical cases was eventually selected as research object who underwent ERCP because of common bile duct stones. All these cases were divided into post-ERCP acute cholecystitis group(23cases) and non-acute cholecystitis group(215cases). Analysis of high risk factors included age, gender, body mass index, hypertension, diabetes, duodenal diverticulum, size of gallstones, number of gallstones, size and number of common bile duct stones, common bile duct diameter, pre-operation blood examination(WBC, N%, AST,ALT, TBIL, DBIL, IBIL, ALP, GGT, CHOL, TG, Glu, AMY),cystic duct development, Endoscopic Sphincterotomy, length of Endoscopic Sphincterotomy, lithotripsy, Endoscopic Papillary Balloon Dilation, Endoscopic Retrograde biliary drainage,number of Endoscopic Retrograde biliary drainage, length of Endoscopic Retrograde biliary drainage, type of Endoscopic Retrograde biliary drainage, Endoscopic nasobiliary drainage, time of removing Endoscopic nasobiliary drainage, residual stone, postoperation blood examination, Postoperative antibiotics, etc. All the clinical data were collected for statistic analysis, firstly Univariate analysis was applied for all these data, Chi-square test or Fisher exact test for count data, Independent sample T test or Wilcoxon rank sum test for measurement data, then all the related factors which had statistical significance were put into multiple logistic regression analysis, to analyze the high risk factors for post-ERCP acute cholecystitis in the common bile duct stones, Regarding P<0.05 as the inspection level which means differences were statistical significance between the two group, IBM SPSS 19.0 was used for the analysis of all the statistical data.Result:In the 238 clinical cases who underwent ERCP because of common bile duct stones, Post-ERCP acute cholecystitis occurred in 23 clinical cases, the incidence rate was 9.66%, Accounting for 1.77% of the 1302 clinical cases who underwent ERCP because of bile duct stones or other cholecystopancreatic disease. In the univariate analysis, the high risk factors including length of Endoscopic Sphincterotomy, length of Endoscopic Retrograde Biliary Drainage, number and size of common bile duct stones, common bile duct diameter and so on were related with the post-ERCP acute cholecystitis of the common bile duct stones(P<0.05), others were not discovered(P>0.05). Putting the related factors into the multiple logistic regression analysis, which showed that the length of Endoscopic Retrograde Biliary Drainage(P=0.019,B=-1.243,OR=0.289,CI=0.102-0.815) was the independent high risk factor for post-ERCP acute cholecystitis in the common bile stones.Conclusion:The high risk factors of post-ERCP acute cholecystitis in the common bile duct stones are the result of the interaction of various factors, but the length of Endoscopic Retrograde Biliary Drainage is the independent affecting factor for acute cholecystitis, Appropriate length of Endoscopic Retrograde Biliary Drainage which could provide protective factor may reduce the incidence rate of post-ERCP acute cholecystitis. As a consequence, In clinic, Choosing suitable length of Endoscopic Retrograde Biliary Drainage is essential for patients who need Endoscopic Retrograde Biliary Drainage during ERCP to prevent the incidence of post-ERCP acute cholecystitis in the common bile duct stones. In this study, though old age, hypertension, diabetes and other factors are not discovered relevant with post-ERCP acute cholecystitis, these factors should not be excluded completely which may have associations with the occurrence of post-ERCP acute cholecystitis in common bile duct stones, directly or indirectly influenced in some ways, large numbers of clinical studies are still essential to be confirmed.