Transpankreatik sfinkterotomi (Goff yöntemi) ERCP sonrası komplikasyonlar açısından yeterince güvenli midir?

Öz

Giriş ve Amaç: Transpankreatik sfinkterotomi, endoskopik retrograd kolanjiyopankreatografi sırasında biliyer kanülasyonun başarısız olduğu durumlarda, ortak safra kanalına erişim sağlamak amacıyla uygulanan ileri bir kanülasyon tekniğidir. Bu prosedür, sfinkterotom aracılığıyla pankreas ve safra kanalı arasındaki septumun kesilmesini içerir. Çalışmamızda, transpankreatik sfinkterotominin etkinlik ve güvenliğini, post-endoskopik retrograd kolanjiyopankreatografi pankreatiti ile diğer olası komplikasyonlar açısından klinik sonuçlarını değerlendirdik. Gereç ve Yöntem: 1 Şubat 2020 – 1 Eylül 2023 tarihleri arasında Mersin Üniversitesi Hastanesi'nde gerçekleştirilen endoskopik retrograd kolanjiyopankreatografi işlemleri retrospektif olarak incelendi. Çalışma grubu, ardışık olarak transpankreatik sfinkterotomi uygulanan 66 hasta ile 67 kişilik kontrol grubundan oluşmaktaydı. Veriler, hasta dosyaları ve hastane kayıtlarından elde edildi. Hastaların demografik özellikleri, biliyer kanülasyon başarı oranı, endoskopik retrograd kolanjiyopankreatografi sırasında gerçekleştirilen işlemler, işlem sonrası pankreatit gelişimi, diğer komplikasyonlar ve ilişkili risk faktörleri değerlendirildi. Bulgular: Transpankreatik sfinkterotomi grubunda 29 hastada (%43.9) post-endoskopik retrograd kolanjiyopankreatografi pankreatiti gelişirken, kontrol grubunda bu oran 10 hastada (%14.9) saptanmış ve fark istatistiksel olarak anlamlı bulunmuştur (p < 0.001). Hiperamilazemi oranı her iki grupta da %23.9 olup transpankreatik sfinkterotomi uygulamasıyla anlamlı ilişki göstermemiştir (p = 0.80). Kanama insidansı açısından da gruplar arasında fark izlenmemiştir (p = 0.55). Transpankreatik sfinkterotomi uygulaması ile diabetes mellitus, hipertansiyon, hiperlipidemi, kardiyovasküler hastalık, kronik böbrek yetmezliği, kronik obstrüktif akciğer hastalığı ve kolesistektomi öyküsü arasında anlamlı bir ilişki saptanmamıştır (sırasıyla p = 0.37; 0.06; 0.99; 0.39; 0.32; 0.15; 0.12). Ortalama hastanede yatış süresi transpankreatik sfinkterotomi grubunda 6.9 ± 3.8 gün, kontrol grubunda ise 3.7 ± 2.3 gün olup fark anlamlıdır (p = 0.008). Ayrıca transpankreatik sfinkterotomi uygulanan hastalarda post-prosedürel karın ağrısı daha şiddetli izlenmiştir (p < 0.001). Sonuç: Transpankreatik sfinkterotomi yöntemi kanülasyon başarısını artıran bir yöntemdir. Diğer taraftan transpankreatik sfinkterotomi yönteminin faydalı ancak post endoskopik retrograd kolanjiyopankreatografi pankreatiti açısından yeterince güvenli olmadığını düşünüyoruz.

Anahtar Kelimeler

• Transpankreatik sfinkterotomi
• ERCP
• post-endoskopik retrograd kolanjiyopankreatografi pankreatiti

Is transpancreatic sphincterotomy (Goff technique) sufficiently safe in terms of post-ERCP complications?

Öz

Backgorund and Aims: Transpancreatic sphincterotomy is an advanced cannulation technique used during endoscopic retrograde cholangiopancreatography to gain access to the common bile duct in cases where standard biliary cannulation fails. The procedure involves the incision of the septum between the pancreatic and bile ducts using a sphincterotome. This study aimed to evaluate the clinical outcomes of transpancreatic sphincterotomy in terms of its effectiveness and safety, focusing on the incidence of post- endoscopic retrograde cholangiopancreatography pancreatitis and other potential complications. Materials and Methods: Endoscopic retrograde cholangiopancreatography procedures performed between February 1, 2020, and September 1, 2023, at Mersin University Hospital were retrospectively reviewed. The study group included 66 patients who underwent transpancreatic sphincterotomy and a control group of 67 patients who did not. Data were obtained from patient files and hospital records. Demographic characteristics, biliary cannulation success rates, procedures performed during endoscopic retrograde cholangiopancreatography, post-endoscopic retrograde cholangiopancreatography pancreatitis incidence, other complications, and associated risk factors were evaluated. Results: Post- endoscopic retrograde cholangiopancreatography pancreatitis occurred in 29 patients (43.9%) in the transpancreatic sphincterotomy group and in 10 patients (14.9%) in the control group, showing a statistically significant difference (p < 0.001). The incidence of hyperamylasemia was identical in both groups (23.9%) and was not significantly associated with transpancreatic sphincterotomy (p = 0.80). No significant difference was observed between the groups regarding bleeding (p = 0.55). Transpancreatic sphincterotomy application was not significantly associated with diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease, or a history of cholecystectomy (p = 0.37, 0.06, 0.99, 0.39, 0.32, 0.15, and 0.12, respectively). The mean hospital stay was significantly longer in the transpancreatic sphincterotomy group compared with the control group (6.9 ± 3.8 vs. 3.7 ± 2.3 days, p = 0.008). Post-procedural abdominal pain was also more severe in the transpancreatic sphincterotomy group (p < 0.001). Conclusion: The transpancreatic sphincterotomy technique improves cannulation success; however, it is associated with a significantly increased risk of post- endoscopic retrograde cholangiopancreatography pancreatitis. While transpancreatic sphincterotomy can be beneficial in difficult cannulation cases, it may not be sufficiently safe in terms of endoscopic retrograde cholangiopancreatography pancreatitis risk.

Anahtar Kelimeler

• Transpancreatic sphincterotomy
• ERCP
• post-endoscopic retrograde cholangiopancreatography pancreatitis

Kaynakça

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