ABSTRACT
Objective To investigate the risk factors of standard selectivity biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) for patints with choledocholithiasis,and the effect and safety of assistant cannulation methods.Methods The clinical data were retrospectively analyzed in 372 patients,who received ERCP for choledocholithiasis in the Yijishan Hospital of Wannan Medical College from January 2014 to December 2014.The risk factors of standard biliary cannulation were assessed by univariate and multivariate logistic regression analysis.The success rate of assistant biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) of standard biliary cannulation were compared with doubleguide wire technique (DGT) and precut sphincterotomy (PS),which were used when standard biliary cannulation failed.Results The univariate analysis showed that floppy and long duodenal papilla (P=0.000),angulated common bile duct(P=0.013) were related to failure of standard biliary cannulation.Multivariate analysis showed that floppy and long papilla (P=0.000,OR=0.131,95％CI:0.056-0.307),angulated common bile duct (P =0.003,OR =0.378,95 ％ CI:0.197-0.726) were independent risk factors for standard biliary cannulation.The success rate of standard biliary cannulation was 83.3％ (310/372),62 cases undergone DGT or PS after standard biliary cannulation failure,and the total success rate of cannulation was 99.7％ (371/372).There were 29 cases suffered from PEP in 371 successful cases of biliary cannulation,including 18 cases (5.8％,18/310) of standard biliary cannulation,8 cases (16.3％,8/49) of DGT,and 3 cases (25.0％,3/12) of PS.The incidence of PEP by DGT (x2 =5.532,P =0.019) and PS (x2 =6.994,P=0.008) was significantly higher than that of standard biliary cannulation,but there was no statistical difference on the incidence of PEP between DGT and PS (x2 =0.079,P =0.778).Conclusion Floppy and long duodenal papilla and angulated common bile duct could easily induce the failure of standard biliary cannulation in ERCP for patients with choledocholithiasis.DGT and PS are effective assistant cannulation methods when the standard cannulation fails.
ABSTRACT
Objective To investigate the risk factors and prevention of the ERCP-related upper gastrointestinal bleeding in patients with choledocholithiasis.Methods The clinical data of 678 patients who received ERCP in Yijishan Hospital of Wannan Medical College between January 2014 and December 2014 were reviewed.Univariate and multivariate analyses were performed to define the independent risk factor(s) for delayed hemorrhage following ERCP.Results A total of 383 patients,in whom 157 were males and 226 were females,the age ranged from 19 to 88 years,were recruited to the study.ERCP-related upper gastrointestinal bleeding occurred in 41 patients(10.7％),intraoperative bleeding occurred in 27(7.0％) and postoperative hemorrhage in 14 (3.7％).Twenty-eight cases were mild bleeding,9 moderate (4 caused by laceration of the cardiac mucosa) and 4 were severe bleeding.All patients recovered and were discharged,and no death occurred.No single case required surgical conversion.Univariate analysis revealed that cholangitis,medical history of aspirin/clopidogrel,giant diverticulum and the major papilla inside the diverticulum were risk factors for delayed hemorrhage following ERCP (P ＜ 0.05).Multivariate analysis indicated that independent risk factors were associated with cholangitis (OR =4.125,95％ CI:1.306-13.031,P ＜ 0.05),medical history of aspirin/clopidogrel (OR =10.220,95％ CI:2.997-34.853,P ＜ 0.01) and major papilla occurred inside the diverticulum(OR =14.064,95％ CI:1.888-104.762,P ＜ 0.05).Conclusion Cholangitis,medical history of aspirin/clopidogrel and major papilla at the diverticulum may increase the risks for upper gastrointestinal bleeding in ERCP in patients with choledocholithiasis.However,the hemorrhage should be actively managed,especially in endoscopy,once the bleeding occurs.