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

作　　者：Monique T Barakat Mohit Girotra Nirav Thosani Shivangi Kothari Subhas Banerjee 

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

出　　处：《World Journal of Gastroenterology》2020年第41期6391-6401,共11页世界胃肠病学杂志（英文版）

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 

分 类 号：R57[医药卫生—消化系统]