ERCP komplikasyonları; sıklığı, etkileyen faktörler ve yönetimi

Yıl 2018, Cilt: 26 Sayı: 1, 12 - 16, 26.04.2018

Nurettin Tunç Salih Kılıç Abdurahman Şahin , Ulvi Demirel , Orhan Kürşat Poyrazoğlu İbrahim Halil Bahçecioğlu Mehmet Yalnız

https://doi.org/10.17940/endoskopi.434891

Cited By: 2

Öz

Giriş ve Amaç: Safra yolları ve pankreas hastalıklarının tanı ve tedavisinde yaygın olarak kullanılan bir yöntem olan endoskopik retrograt kolanjiopankreatikografi ile ciddi komplikasyonlar bildirilmiştir. Bu komplikasyonlar endoskopik retrograt kolanjiopankreatikografi işlemine bağlı sfinkterotomi yerinden kanama, pankreatit, kolanjit, perforasyon ile kardiyopulmoner komplikasyonlar (hipoksi, hipotansiyon ve aritmi gibi) ve ölümdür. Bu çalışmadaki amacımız endoskopik retrograt kolanjiopankreatikografi işlemi ile kompliklasyon gelişen hastalarda risk faktörlerini saptamak ve bu hastalarda uygun tanısal ve terapötik yaklaşımı belirlemektir. Gereç ve Yöntem: 2016 yılı içinde endoskopik retrograt kolanjiopankreatikografi işlemi yapılan 487 hastanın verileri retrospektif olarak elde edildi. Bulgular: Endoskopik retrograt kolanjiopankreatikografi işlemi uygulanan 487 vakanın 304’ü (%62,4) kadın, 183’ü (%37,6) erkekti. Ortalama yaş 61,53 (min-maks: 18-99) yıl idi. Post-endoskopik retrograt kolanjiopankreatikografi komplikasyonları 53 (%10,8) vakada görülmüş; 37’si (%7,6) pankreatit, 15’i (%3,1) kanama, 1’i (%0,2) duodenum perforasyonu olarak raporlanmıştı. İğne uçlu sfinkterotom ile ön kesi yapılan 2/67 (%2,9) vakada post-endoskopik retrograt kolanjiopankreatikografi pankreatiti gelişmiş olmasına karşı ön kesi yapılmayan 65/420 (%8,33) vakada post-endoskopik retrograt kolanjiopankreatikografi pankreatiti gelişmişti. Post-endoskopik retrograt kolanjiopankreatikografi pankreatiti iğne uçlu sfinkterotom ile ön kesi yapılanlarda daha az oranda görülmekle birlikte istatistiksel olarak anlamlı değildi (p: 0,127). Yapılan endoskopik retrograt kolanjiopankreatikografinin kaçıncı endoskopik retrograt kolanjiopankreatikografi işlemi olduğu ve post-endoskopik retrograt kolanjiopankreatikografipankreatiti ilişkisi karşılaştırıldığında post-endoskopik retrograt kolanjiopankreatikografi pankreatiti gelişimi ilk kez endoskopik retrograt kolanjiopankreatikografi yapılanlarda (%91) anlamlı olarak daha sık gözlenmiş (p: 0,041), post endoskopik retrograt kolanjiopankreatikografi komplikasyon olarak mortalite hiç izlenmemişti. Sonuç: Post endoskopik retrograt kolanjiopankreatikografi pankreatiti endoskopik retrograt kolanjiopankreatikografinin en sık komplikasyonudur. Endoskopik retrograt kolanjiopankreatikografi ile ciddi komplikasyonlar görülebilmesine rağmen uygun endikasyonda endoskopik retrograt kolanjiopankreatikografi yapılması ve oluşan komplikasyonların erken tanınması morbidite ve mortalitenin önlenmesinde en önemli adımdır.

Anahtar Kelimeler

Post endoskopik retrograt kolanjiopankreatikografi komplikasyonlar

Endoscopic retrograde cholangiopancreatography: frequency, contributing factors and management

Öz

Background and Aims: Serious complications have been reported with endoscopic retrograde cholangiopancreatography, a widely used method for the diagnosis and treatment of bile duct and pancreatic diseases. These complications include hemorrhage from the sphincterotomy site due to the endoscopic retrograde cholangiopancreatography procedure; pancreatitis; cholangitis; cardiopulmonary complications such as perforation, hypoxia, and hypotension, arrhythmia; and death. Our aim in this study is to determine the risk factors in patients with complications of the endoscopic retrograde cholangiopancreatography procedure and to determine the appropriate diagnostic and therapeutic approach in these patients. Materials and Methods: Data on 487 patients undergoing endoscopic retrograde cholangiopancreatography in 2016 were retrospectively reviewed. Results: A total of 487 patients underwent endoscopic retrograde cholangiopancreatography, 304 (62.4%) women and 183 (37.6%) men. The mean age was 61.53 (range: 18-99) years. Post-endoscopic retrograde cholangiopancreatography complications occurred in 53 (10.8%) patients; 37 (7.6%) reported pancreatitis; 15 (3.1%), bleeding; and 1 (0.2%), duodenal perforation. Post-endoscopic retrograde cholangiopancreatography improved in 2/67 (2.9%) cases with needle knife pre-cut sphincterotomy and did not develop in cases of standard sphincterotomy 65/420 (8.33%). Post- endoscopic retrograde cholangiopancreatography was less frequent in pre-cut sphincterotomy constructs, but the difference was not statistically significant (p=0.127). When the number of endoscopic retrograde cholangiopancreatography and post-ERCP cases who developed pancreatitis was compared, post-endoscopic retrograde cholangiopancreatography pancreatitis was significantly more frequent for the first time endoscopic retrograde cholangiopancreatography applied (91%) (p=0.041). Mortality was not observed in post-ERCP pancreatitis. Conclusion: Post-endoscopic retrograde cholangiopancreatography pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography. Although serious complications can be seen with endoscopic retrograde cholangiopancreatography, the technique should be used with the appropriate indications, and early identification of complications is the most important step in preventing morbidity and mortality.

Anahtar Kelimeler

Post-endoscopic retrograde cholangiopancreatography complications, pancreatitis

Kaynakça

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