Prevention And Treatment Of Complications Of ERCP

Background and purpose:Endoscopic retrograde cholangiopancreatography(endoscopic retrograde Cholangiopancreatograph,ERCP) has been widely used in the diagnosis and treatment of biliary and pancreatic diseases,but the incidence of complications is still high,How to prevent and cure common complications effectively becomes an urgent problem.In this study,6480 cases of ERCP were retrospectively analyzed and summarized,in order to improve the safety of ERCP further.Methods:Clinical data of 6480 patients with ERCP in Hunan People's Hospital from May 2008 to December 2016 were retrospectively analyzed and summarized,at the same time statistical analysis were conducted:?Univariate and multivariate analyses were performed to determine the relationship between the incidence of complications and the basic diseases;?The patients were divided into ENBD group and non ENBD group,the incidence of bleeding were compared between two groups;and according to the different treatment methods with pancreatitis,the patients were divided into two groups:the control group who treated with somatostatin or octreotide and the treatment group who treated with drugs combined with naso biliary drainage or naso pancreatic duct drainage,the differences of postoperative hospitalization days were compared between two groups;?The incidence of cholangitis were compared between ENBD group and non ENBD group,and according to whether or not using antibiotics,the two groups were further divided into two subgroups,the incidence of cholangitis was compared between the two subgroups;?The incidence of bleeding was compared between ENBD group and non ENBD group;?The patients was classified by the types of perforation,and further divided into conservative treatment group and surgical treatment group on the basis of classification,the difference of healing period was compared between different treatments.Result:1.A total of 6205 cases were diagnosed and treated successfully in 6480 ERCP cases,the success rate was 95.76%,there were 406 cases of acute pancreatitis after ERCP,cholangitis in 158 cases,bleeding in 74 cases,and perforation in 24 cases;2.Univariate analysis showed that hypertension,history of pancreatitis,and history of Billroth Type ? operation were risk factors for PEP,renal insufficiency,diabetes mellitus,history of pancreatitis were risk factors for cholangitis,liver cirrhosis,diabetes mellitus,hypertension,Recent anticoagulation history were risk factors for bleeding,there was no significant relationship between perforation and the above diseases.Logistic regression analysis showed that the history of pancreatitis and the history of Billroth Type ? surgery were independent risk factors for PEP,diabetes mellitus,history of pancreatitis were independent risk factors for cholangitis.In addition,cirrhosis and the recent history of anti-coagulation were independent risk factor for bleeding;3.The incidence of pancreatitis in ENBD group was 5.86%,lower than that in non ENBD group(7.15%),the difference was statistically significant(p=0.040);The average hospitalization day of control group who treated with enzyme inhibitor was 12.11 days,and the group who treated with drugs combined with naso biliary drainage or naso pancreatic duct drainage was 9.77 days,the two groups were in normal distribution and the variances were equal(F=2.581,p=0.109),Two independent sample t-test showed that there was significant difference between the two groups in the average hospitalization day(t=5.262,p<0.001);4.The incidence of cholangitis in ENBD group was 1.83%,lower than that in non ENBD group(3.18%),the difference was statistically significant(p=0.035);In ENBD group,the incidence of cholangitis in antibiotic subgroup was 2.01%,1.65%in non antibiotic subgroup,there was no significant difference in the incidence of cholangitis between the two subgroups(p=0.467).In non ENBD group,the incidence of cholangitis in antibiotic subgroup was 3.68%,2.80%in non antibiotic subgroup,there was no significant difference in the incidence of cholangitis between the two subgroups(p=0.155);5.The incidence of bleeding was 1.52%In ENBD group,higher than that in non ENBD group(0.91%),the difference was statistically significant(p=0.028);6.Perforation occurred in 24 cases,among them,there were 2 cases of type ?,8 cases of type ?,9 cases of type ?,and 5 cases of type?.Conservative treatment in 18 cases,6 cases were treated with operation,which included 2 cases of type I,3 cases of type ?,and 1 case of type ?.The patients' average healing time of conservative treatment group was significantly shorter than that of surgical treatment group in type ? perforation,the difference was statistically significant(p=0.025),there was no significant difference between the conservative treatment group and surgical treatment group of type ?perforation(p=0.120).Conclusion:1.The incidence of postoperative complications of ERCP is closely related to some basic diseases,specific diseases increase the risk of postoperative complications.3.ENBD can reduce the incidence of pancreatitis and cholangitis,but may be a predisposing factor for bleeding.3.The average hospitalization day of patients with pancreatitis who were treated with enzyme inhibitor combined with biliary drainage or pancreatic duct drainage were shorter than those treated with enzyme inhibitor alone.4.prophylactic use of antibiotics did not reduce the incidence of cholangitis.5.Most of the perforation can be treated with conservative methods,only a small number needed surgical treatment.