Endoskopik retrograd kolanjiyopankreatografinin endikasyonları, sonuçları ve komplikasyonları: Doğu Karadeniz'deki üçüncü basamak bir merkezin 3 yıllık verileri

Öz

Giriş ve Amaç: Bu çalışmanın amacı merkezimizde yapılan endoskopik retrograd kolanjiyopankreatografi işlemlerinin endikasyonlarını, bulgularını, teknik başarısını ve sonuçlarını gözden geçirmekti. Gereç ve Yöntem: Karadeniz Teknik Üniver¬sitesi Tıp Fakültesi Hastanesi, endoskopik retrograd kolanjiyopankreatografi ünitesinde Şubat 2017- Şubat 2020 tarihleri arasında ardışık endoskopik retrograd kolanjiyopankreatografi yapılan 524 hastanın sonuçları retrospektif olarak değerlendirildi. Her prosedürden önce hastalardan resmi yazılı onay alındı. Bulgular: Çalışmamızda 524 hastaya toplam 620 endoskopik retrograd kolanjiyopankreatografi işlemi gerçekleştirilmiştir. Hastaların 285’i (%54.3) kadın, 239’u (%45.6) erkek olup yaş ortalaması 64.5 (18-103) idi. Hastaların %97.8’inde endoskopik retrograd kolanjiyopankreatografi terapötik amaçla yapıldı. En sık endikasyon koledokolitiyazis (%68.5) ve safra yollarında dilatasyon ve kolestaz bulgularının olması (%20.8) idi. Hastaların 506’sında (%96.6) sfinkterotom ile selektif koledok kanülasyonu yapıldı ve bunların 32’sinde (%7.8) iğne uçlu sfinkterotom ile ön kesi yapıldı. En sık tespit edilen bulgular koledokolitiyazis (%61.8), koledok dilatasyonu veya benign biliyer stenoz (%12.2) ve malign biliyer stenoz (%8.0) idi. En sık yapılan terapötik işlemler endoskopik sfinkterotomi 450 (%85.8), balon veya basket ile taş çıkarma 263 (%50.2) ve stent yerleştirilmesi 158 (%30.2) idi. Genel komplikasyon oranı %4.9 olup en sık görüleni %2.3 ile pankreatit idi. Serimizde 2 hastada (%0.4) mortalite gelişti. Sonuç: Endoskopik retrograd kolanjiyopankreatografi ciddi komplikasyon riski taşımasına rağmen uygun endikasyonda yapıldığında pankreatobiliyer hastalıkların tedavisinde etkili ve güvenli bir yöntemdir. Endoskopik retrograd kolanjiyopankreatografi ilişkili morbidite ve mortaliteyi azaltmak için olası komplikasyonların erken tanısı ve uygun yönetimi çok önemlidir.

Anahtar Kelimeler

• ERCP
• endoskopik retrograd kolanjiyopankreatografi
• endoskopik sfinkterotomi

Indications, results, and complications of endoscopic retrograde cholangiopancreatography: 3-year data of a third-level center in the Eastern Black Sea Region

Öz

Background and Aims: The aim of this study was to review the indications, observations, technical success, and results of endoscopic retrograde cholangiopancreatography (ERCP) in our center. Materials and Methods: The results of 524 patients who underwent consecutive ERCP between February 2017 and February 2020 in the ERCP unit of Karadeniz Technical University, Faculty of Medicine, were evaluated retrospectively. Moreover, formal written consent was obtained from all patients prior to each procedure. Results: A total of 620 ERCP procedures were performed in 524 patients. Further, 285 of the patients (54.3%) were female and 239 (45.6%) male, with an average age of 64.5 (18–103). In 97.8% of the patients, ERCP was conducted for clinical purposes. Choledocholithiasis (68.5%) and dilatation and cholestasis findings in the biliary tract (20.8%) were the most common ERCP indications. Selective common bile duct cannulation was performed with sphincterotome in 506 patients (96.6%), and precut sphincterotomy with needle knife sphincterotomy was performed in 32 (7.8%) of them. The most common findings were choledocholithiasis (61.8%), common bile duct dilatation, or benign (12.2%) and malignant (8.0%) biliary stenosis. On the other hand, the most common therapeutic procedures were endoscopic sphincterotomy in 450 patients (85.8%), stone extraction with balloon or basket in 263 (50.2%), and stent placement in 158 (30.2%). The overall complication rate was 4.9%, and the most frequent was pancreatitis with a rate of 2.3%. In this series, two patients (0.4%) died. Conclusion: Despite the possibility of severe complications, ERCP is an efficient and safe procedure for the treatment of pancreaticobiliary diseases when done with appropriate indications. Early diagnosis and effective treatment of potential complications are very important to reduce ERCP-related morbidity and mortality.

Anahtar Kelimeler

• ERCP
• endoscopic retrograde cholangiopancreatography
• endoscopic sphincterotomy

Kaynakça

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