Endoskopik Retrograd Kolanjiyopankreatografi Uygulanan Hastalarda Preoperatif Ekokardiyografi Gecikmesinin Kompozit Sonuçlara Etkisi

Öz

Amaç: Endoskopik retrograd kolanjiyopankreatografi (ERCP) uygulanan hastalarda işlem öncesi ekokardiyografi zamanlaması ile hastanede olumsuz sonuçlar arasındaki ilişkiyi değerlendirmek. Gereç ve Yöntemler: Bu retrospektif kohort çalışmasında, 2015 ile 2024 yılları arasında ERCP uygulanan 40-70 yaş arası hastalar dahil edildi. Demografik özellikler, eşlik eden hastalıklar, kardiyoloji konsültasyonu, hastaneye yatıştan transtorasik ekokardiyografiye (TTE) kadar geçen süre, yatıştan ERCP’ye kadar geçen süre ve TTE’den ERCP’ye kadar geçen süre kaydedildi. Birincil sonuç, hastanede ölüm, yoğun bakım ünitesine yatış, intravenöz inotropik destek ihtiyacı veya hemodiyaliz olarak tanımlanan birleşik bir son noktaydı. Sonuçlar: Toplam 224 hasta dahil edildi. Gruplar arasında yaş, cinsiyet, hipertansiyon, diyabet mellitus veya koroner arter hastalığı açısından anlamlı farklılıklar yoktu (tüm p > 0,05). Kombine sonlanım noktalarına sahip hastalarda malignite, olmayanlara göre daha sık görüldü (%27,3’e karşı %11,4, p = 0,035). Hastaneye yatıştan TTE’ye kadar geçen süre gruplar arasında anlamlı farklılık göstermezken, hastaneye yatıştan ERCP’ye kadar geçen süre kombine sonlanım noktalarına sahip hastalarda daha uzundu (5,0’a karşı 3,0 gün, p = 0,020). TTE-ERCP kategorilerinin dağılımı da anlamlı farklılık gösterdi (p = 0,007) ve TTE’den sonra %5 günlük gecikme, kombine sonlanım noktalarına sahip hastalarda daha sık görüldü (%22,7’ye karşı %6,4). Kardiyoloji konsültasyonu, kombine sonlanım noktası grubunda daha yaygındı (%63,6’ya karşı %40,6, p = 0,038). Birleşik sonlanım noktalarına sahip hastalarda ayrıca akut böbrek yetmezliği, pankreatit, başarısız ERCP, yoğun bakım ünitesine yatış, inotropik destek, hemodiyaliz ve hastane içi ölüm oranları da anlamlı derecede daha yüksekti (tüm p < 0,05). Sonuç: Daha uzun ERCP zamanlaması, özellikle TTE ve ERCP arasındaki uzun aralık, ERCP uygulanan hastalarda hastane içi olumsuz sonuçlarla ilişkiliydi.

Anahtar Kelimeler

• Ekokardiyografi
• ERCP
• akut pankreatit
• yoğun bakım
• mortalite

Impact of Preoperative Echocardiographic Delay on Composite Outcomes in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

Öz

Aim: To evaluate the association between pre-procedural echocardiographic timing and adverse in-hospital outcomes in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Material and Methods: In this retrospective cohort study, patients aged 40–70 years who underwent ERCP between 2015 and 2024 were included. Demographic characteristics, comorbidities, cardiology consultation, the interval from hospital admission to transthoracic echocardiography (TTE), the interval from admission to ERCP, and the interval from TTE to ERCP were recorded. The primary outcome was a composite endpoint defined as in-hospital mortality, intensive care unit admission, need for intravenous inotropic support, or hemodialysis. Results: A total of 224 patients were included. There were no significant differences between groups in age, sex, hypertension, diabetes mellitus, or coronary artery disease (all p > 0.05). Malignancy was more frequent in patients with composite endpoints than in those without (27.3% vs. 11.4%, p = 0.035). The admission-to-TTE interval did not differ significantly between groups, whereas the admission-to-ERCP interval was longer in patients with composite endpoints (5.0 vs. 3.0 days, p = 0.020). The distribution of TTE-to-ERCP categories also differed significantly (p = 0.007), and a delay of %5 days after TTE was more frequent in patients with composite endpoints (22.7% vs. 6.4%). Cardiology consultation was more common in the composite endpoint group (63.6% vs. 40.6%, p = 0.038). Patients with composite endpoints also had significantly higher rates of acute kidney injury, pancreatitis, failed ERCP, intensive care unit admission, inotropic support, hemodialysis, and in-hospital mortality (all p < 0.05). Conclusion: Longer ERCP timing, particularly a prolonged interval between TTE and ERCP, was associated with adverse in-hospital outcomes in patients undergoing ERCP.

Anahtar Kelimeler

• Echocardiography
• ERCP
• composite outcome
• acute pancreatitis
• mortality

Kaynakça

1. Buxbaum JL, Buitrago C, Lee A, et al. ASGE guideline on the management of cholangitis. Gastrointest Endosc. 2021;94(2):207-221.e14.
2. Cummings LC, Liang C, Mascha EJ, et al. Incidence of sedation-related adverse events during ERCP with anesthesia assistance: a multicenter observational study. Gastrointest Endosc. 2022;96(2):269-281.e1.
3. Zhou Y, Zhang YQ, Huang SJ, et al. Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: a propensity score-matched analysis. World J Gastroenterol. 2024;30(15):2118-2127.
4. Comoglu M, Acehan F, Sahiner ES, et al. Effect of urgent ERCP on clinical outcomes in acute cholangitis with concurrent acute gallstone pancreatitis: a propensity score matching analysis. J Hepatobiliary Pancreat Sci. 2025;32(8):591-601.
5. Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery. J Am Coll Cardiol. 2024;84(19):1869-1969.
6. Kim EK, Choi HM, Lee JH, et al. Practical role of preoperative echocardiography in low-risk non-cardiac surgery. Front Cardiovasc Med. 2023;10:1088496.
7. Zare-Zadeh S, Manns BJ, Chew DS, et al. Low-value preoperative cardiac testing before low-risk surgical procedures: a population-based cohort study. CMAJ Open. 2023;11(3):E451-E458.
8. Chang JS, Ravi B, Jenkinson RJ, et al. Impact of preoperative echocardiography on surgical delays and outcomes among adults with hip fracture. Bone Joint J. 2021;103-B(2):271-278.

9. Saad BN, Menken LG, Keller DM, et al. Does a delay to surgery for preoperative echocardiogram affect outcomes in patients with hip fracture? OTA Int. 2024;7(3):e338.
10. Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826-3924.
11. Iqbal U, Khara HS, Hu Y, et al. Emergent versus urgent ERCP in acute cholangitis: a systematic review and meta-analysis. Gastrointest Endosc. 2020;91(4):753-760.e4.
12. Lee SY, Park SH, Do MY, et al. Increased ERCP-related adverse event from premature urgent ERCP following symptom onset in acute biliary pancreatitis with cholangitis. Sci Rep. 2024;14(1):13663.
13. Kabaria S, Mutneja H, Makar M, Ahlawat S, Patel AV, Rustgi VK, Bhurwal A. Timing of endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis without cholangitis: a nationwide inpatient cohort study. Ann Gastroenterol. 2021 Jul-Aug;34(4):575-581.
14. Buonocore MR, Germani U, Castellani D, Petrogiannopoulos L, Pallio S, Piciucchi M, Sbrozzi-Vanni A, Zullo A, Manta R. Timing of endoscopic therapy for acute bilio-pancreatic diseases: a practical overview. Ann Gastroenterol. 2021;34(2):125-129.
15. Rivas A, Pherwani S, Mohamed R, et al. ERCP-related adverse events: incidence, mechanisms, risk factors, prevention, and management. Expert Rev Gastroenterol Hepatol. 2023;17(11):1101-1116.
16. Kaieda M, Saito H, Yokota K, et al. Impact of preoperative echocardiographic delay on timing of hip fracture surgery in elderly patients. SAGE Open Med. 2024;12:20503121231222345.