ABSTRACT
Objective To analyze the risk factors of post-ERCP pancreatitis (PEP) and to evaluate the relationship between cannulation time and PEP.Methods The data of cannulation time in 1 625 patients who underwent ERCP from 2010 to 2012 were retrospectively studied.The risk factors associated with PEP were analyzed by univariate and multivariate Logistic regression analysis.The effect of different cannulation time on PEP was evaluated.Results The incidence of overall PEP was 4.6％ (75/1 625) including 4.1％ (67/1 625)of mild and 0.5％ (8/1 625)of moderate-to-severe.Univariate analysis revealed that diabetes mellitus (P =0.02),choledocholithiasis (P =0.02),malignant biliary stenosis (P =0.007),duodenal stenosis (P =0.029),precut (P＜0.01),cannulation time ≥ 8 min (P＜0.01),blood platelet count ≥ 180× 109/L(P =0.089),alkaline phosphatase ≥ 120 U/L (P =0.083) and total bilirubin ≥ 17.1 μmol/L (P =0.094)were associated with PEP.Multivariate analysis revealed that precut (OR=1.93,95％CI:1.10-3.39,P=0.022),cannulation time ≥8 min (OR =3.50,95％CI:2.00-6.13,P＜0.01) and duodenum stenosis (OR=2.92,95％CI:1.08-7.86,P=0.034) were independent risk factors of PEP.Within 30 min of cannulation,longer cannulation time was accompanied with higher PEP rate.Conclusion The cannulation time is an independent risk factor of PEP.Overall PEP is increased when cannulation time is more than 8 min.
ABSTRACT
Objective To investigate risk factors decreasing cannulation success rate of trainees receiving hands-on ERCP training and to improve thelevel of ERCP training.Methods Clinical data of 1 193 ERCP cases involved in training in Xijing Hospital of Digestive Disease from December 2012 to December 2014 were retrospectively analyzed.Multivariate logistic regression analysis was performed to investigate the risk factors influencing cannulation success rate of trainees.Results There were 1 165 and 28 patients undergoing common biliary duct (CBD) cannulation and pancreatic duct(PD) cannulation respectively.The success rate of CBD cannulation by trainees was 58.5％(681/1 165)and the overall success rate was 97.9％(1 140/1 165).PD cannulation success rate by trainees was 39.3％ (11/28) and the overall success rate was 89.3％ (25/28).The overall complication incidence was 8.0％ (96/1 193)and the incidence of post-ERCP pancreatitis was 4.4％(53/1 193).Multivariate logistic regression analysis showed that the selective cannulation by trainees was more likely to fail in patients with malignant biliary stricture(OR =0.44,95％CI:0.28-0.67,P＜0.01),benign or undetermined biliary stricture(OR =0.32,95％ CI:0.17-0.60,P＜ 0.01),suspected sphincter of Oddi dysfunction(SOD) (OR =0.28,95％ CI:0.16-0.47,P＜ 0.01),coexisting hypertension (OR =0.65,95 ％ CI:0.44-0.96,P＜0.05),RDW ≥ 48 fL (OR =0.69,95％ CI:0.51-0.92,P＜ 0.05),PLT＜ 100 × 109/L (OR=1.68,95％CI:1.05-2.71,P＜0.05).Conclusion Biliary stricture,suspected sphincter of Oddi dysfunction,coexisting hypertension,abnormal RDW and PLT were independent risk factors influencing cannulation success rate by trainees during hands-on ERCP training.