Effect Of Preoperative Endoscopic Ultrasonography On Endoscopic Retrograde Cholangiopancreatography In Patients With Biliary And Pancreatic Diseases

Background and ObjectiveThe application of endoscopic ultrasonography(EUS)is increasing and is mainly used in the diagnosis and treatment of patients with biliary and pancreatic diseases.Endoscopic retrograde cholangiopancreatography(ERCP)is an important method for the diagnosis and treatment of biliary and pancreatic diseases,but as an invasive procedure,it has certain trauma and risk.EUS is safe and has high accuracy in diagnosing biliary and pancreatic diseases,and can reduce the application of some diagnostic ERCP.At present,there is no clear conclusion on the effect of EUS examination before ERCP on the upcoming ERCP.The purpose of this study was to explore the effect of EUS examination before ERCP on ERCP in patients with biliary and pancreatic diseases,and to evaluate the necessity of EUS examination before ERCP.MethodsThe data of patients hospitalized for ERCP in Shenzhen Baoan People’s Hospital between February 2017 and April 2020 were retrospectively collected.EUS examinations were performed within 2 hours before ERCP and then ERCP were performed in the case group(EUS+ERCP group),while only ERCP was performed in the control group(simple ERCP group).According to the difficulty level of ERCP operation,it is further subdivided into two subgroups:simple operation group and complex operation group.The success rate of ERCP intubation,operation time,incidence of postoperative complications and radiation exposure were compared and analyzed in each group.Results1.General characteristics:A total of 166 patients(102 males)in the EUS+ERCP group and 166 patients(89 males)in the ERCP alone group were included.There was no significant difference in age,gender,indications for ERCP,and length of hospital stay between the two groups(P>0.05).2.ERCP operation:158 cases of EUS+ERCP were successfully intubated,159 cases of ERCP alone were successfully intubated,the difference in the success rate of ERCP intubation between the two groups had no statistical significance(P>0.05).The operation time of EUS+ERCP group was(36.3±22.5)min vs.(43.8 ± 24.1)min,P<0.05].There was a significant difference in the operation time between the simple operation group(P<0.05),but there was no significant difference in the operation time between the complex operation group(P>0.05).3.Postoperative complications:A total of 25 patients had complications,including 12 patients(7.6%)in EUS+ ERCP group and 13 patients(8.2%)in ERCP alone group.There was no significant difference in the incidence rate of postoperative complications between the two groups(P>0.05).4.ERCP radiation:The fluoroscopy time in the EUS+ERCP group was less than that in the ERCP alone group[(39.7±27.6)s vs.(49.9 ± 33.5)s,P<0.05].According to the analysis,the fluoroscopy time of the simple operation group of EUS+ERCP was shorter than that of the simple operation group of ERCP alone(P<0.05).The radiation dose of EUS+ERCP was(10.3± 7.3)mGy,and that of ERCP alone was(13.9±10.3)mGy,and the difference was statistically significant(P<0.05).There were significant differences in radiation dose between simple operation group and complex operation group(P<0.05).ConclusionsEUS examination before ERCP does not change the post-ERCP complication rate,but it can reduce the ERCP operation time,especially ERCP with low procedural difficulty.And the use of EUS reduces the fluoroscopy time and total radiation dose during ERCP.For patients with clear indications for ERCP,if conditions permit,we recommend that it is necessary to perform EUS examination before ERCP.