Clinical Study Of Common Complications After Difficult ERCP Incubation

Objective:This study aims to reduce the risk of Endoscopic retrograde cholangiopancreatography(ERCP)patients with difficult incubation by exploring the risk factors related to common postoperative complications in patients undergoing ERCP surgery and comparing the incidence and influencing factors of different complication.Method:This study retrospectively analyzed 308 patients(All patients were operated by doctors who were engaged in endoscopy for more than 10 years,skilled and experienced)who underwent ERCP surgery and difficulty in incubation at the digestive endoscope center of the Second Affiliated Hospital of Kunming Medical University from May 2016 to October 2019.Statistics of general hospitalization data and complications of patients were performed.We performed logistic regression analysis of uni variate and multivariate for each group of complications,and explored the influencing factors of complications in patients with ERCP difficult incubation.Results:1.General information:A total of 308 patients who completed the ERCP surgery and had difficulty intubation were included in the study.The overall postoperative complications were 22.73%(70/308);the average age was 53±25 years;the average length of hospital stay was 12±5 days,the average hospitalization cost was 16334.33± 12997.97 yuan,the average operation time was 40 ±23 minutes,and the average intubation time was 15 ± 10 minute.Post-ERCP pancreatitis occurred in 6.17%(19/308),of which two patients had postoperative severe pancreatitis and all were cured after conservative medical treatment.The incidence of hyperamylasemia was 11.36%(35/308),all of which were transient and did not progress to pancreatitis.The incidence of bleeding was 6.17%(19/308),all of which were intraoperative bleeding with endoscopic drug spraying or tissue hemostatic treatment with clamp.The incidence of postoperative infection was 5.84%(18/308),and there were no patients with severe infection no patients with severe infection.The incidence of perforation was 0.32%(1/308).One case was cured by conservative treatment.2.In the comparison of general data of patients,the variables included gender,age,length of hospital stay,hospitalization cost,operation time,intubation time,and contrast agent dose.Among them,the average age was shown:complication group(55.67 ± 15.53 years)vs.49.50±25.00 years;there were differences(P=0.017).Length of hospital stay:complications group(15±7 days)vs no complications group(11 ±5 days);there were differences(P<0.001).Hospitalization costs:complications group(25945.89 ± 17031.48 yuan)VS non-complication group(14804.79± 8860.19 yuan);there are differences(P<0.001).Intubation time:complications group(24.54±7.36min)vs non-complication group(13±8min);there are differences(P<0.001).Operation time:complications group(60± 17.25min)vs non-complication group(37±18min);there are differences(P<0.001).There was no significant difference in general data among the five groups.3.There was no significant difference in postoperative endoscopic diagnosis and surgical methods among the complications.4.The logistic regression analysis showed that the factors influencing the complications of ERCP intubation patients were:(1)Independent risk factors for postoperative pancreatitis included operation time greater than 60 min(P=0.002,OR=6.075,95%CI:1.893?19.489),EST(P=0.022,OR=3.907,95%CI:1.214?12.575),chronic pancreatitis(P=0.008,OR=8.897,95%CI:1.763?44.893)and abnormal bile-pancreatic duct confluence(P=0.02,OR=10.705,95%CI:1.454?78.843);ENBD was its protective factors(P=0.016,OR=0.185,95%Cl:0.047?0.726).(2)The independent risk factors for postoperative hyperamylemia included operation time(P<0.001,OR=1.095,95%Cl:1.044?1.148),intubation time(P<0.001,OR=1.153,95%CI:1.074?1.238),PST(P=0.006,OR=4.941,95%CI:1.594?15.319);ENBD was its protective factor(P=0.001,OR=0.186,95%CI:0.068?0.507)(3)The independent risk factors for bleeding included PST(P=0.004,OR=7.083,95%Cl:1.873?26.785),EST(P<0.001,OR=16.970,95%CI:5.079-56.694),combined diverticulum(P<0.001 OR=8.384,95%CI:2.564?27.412),bile duct stones(P<0.001,OR=8.431,95%CI:2.618?27.149)(4)The independent risk factors for postoperative infections included biliary stones(P<0.001,OR=15.484,95%CI:3.779?63.445).operation time(P=0.016,OR=1.053,95%CI:1.010?1.098),merger diverticula(P=0=005,OR=6.955,95%CI:1.809?26.737),bile duct stenosis(P=0.002,OR=8.176,95%CI:2.209?30.258);ENBD was the protective factor(P=0.005,OR=0.086,95%CI:0.016-0.472)Conclusion:1.Patients with difficulty in intubation have a greater risk of postoperative complications during ERCP surgery,and these patients should be more cautious when performing surgery.2.Postoperative complications in patients with difficult intubation that tend to be older,have longer operative time,and have longer intubation time.These patients have longer hospital stays and higher hospitalization costs.3.In ERCP patients with difficult intubation,the operation time>60 min,EST,chronic pancreatitis,and bile-pancreatic duct confluence are risk factors for PEP;operation time,intubation time,and PST are risk factors for hyperamylaseemia;PST,EST,combined diverticulum,and bile duct stones are risk factors for intraoperative bleeding;large bile duct stones,operation time,combined diverticulum,and bile duct stenosis are risk factors for postoperative infection4.ENBD as an important protective measure can significantly reduce the risk of PEP,hyperamylaseemia,and postoperative infection.