Our Experience in Single Center Endoscopic Retrograde Cholangiopancreatography

Yıl 2021, Cilt: 18 Sayı: 2, 233 - 239, 27.08.2021

Esat Taylan Uğurlu , Mehmet Tercan

https://doi.org/10.35440/hutfd.908948

Cited By: 1

Öz

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is used in the diagnosis and treatment of benign and malignant pathologies of the biliary tract and pancreas. ERCP is a complex application that requires knowledge, skills and practice. It differs from other endoscopic applications with the use of different techniques and equipment and possibility of more complications.
Our aim in this study is to share the 19-month experience of a general surgery of ERCP unit.
Materials and Methods: This study retrospectively evaluated 513 patients that were diagnosed with cholestasis, obstructive cholangitis / pancreatitis or bile leakage between May 15, 2019 and December 31, 2020 and were applied ERCP in clinical, medical and radiological data.
Results: The age distribution of the participants was between 18-109 and the mean age was 58.54 ± 20.16 years. The gender distribution was 356 women (69.4%), 157 men (30.6%). The most common diagnoses were cholestasis, obstructive icterus, acute pancreatitis or cholangitis due to bile duct obstruction. Among the patients, 452 were common bile duct stones, 15 were pancreatic head tumors, 11 were common bile duct tumors, and 10 were papillae tumors. 10 patients were processed for Oddi Sphincter Dysfunction. Among 499 patients who came with bile duct obstruction, 63 were hospitalized with the diagnosis of acute biliary pancreatitis and 38 with the diagnosis of acute cholangitis. The procedure time varied from 20 minutes to 90 minutes (average processing time 37 minutes). After ERCP, 56 of the patients developed amylazemia that did not require treatment, 24 patients developed pancreatitis, which regressed with 3 days of medical treatment and 5 patients bleeding that did not require blood transfusion and could be controlled by adrenaline injection and balloon pressure. During a stone extraction, the basket and stone were trapped in a patient. There was no operative mortality.
Conclusion: Leaks and fistulas in the bile ducts are best shown with ERCP and treated endoscopically. We believe that endoscopist should determine the indication of the ERCP application correctly, know the potential complications, manage the treatment early, avoid unnecessary and complicated applications as much as possible since endoscopy includes very serious complications such as perforation, sepsis as much as it is effective.

Key Words: ERCP, Endoscopic Sphincterotomy, Cholangitis, Pancreatitis

Tek Merkezli Endoskopik Retrograt Kolanjiyopankreatografi Deneyimlerimiz

Öz

Amaç: Endoskopik retrograd kolanjiopankreatografi (ERCP), safra yolu ve pankreasın benign ve malign patolojilerinin tanı ve tedavisinde etkin bir biçimde kullanılmaktadır. ERCP bilgi, beceri ve pratik gerektiren kompleks bir uygulamadır. Diğer endoskopik uygulamalardan farklı teknik ve ekipmanın kullanımı ve daha fazla komplikasyon görülmesiyle ayrılır.
Bu çalışmadaki amacımız bir genel cerrahi ERCP ünitesinin 19 aylık deneyimini paylaşmaktır.
Materyal ve metod: Bu çalışmada15 Mayıs 2019-31Aralık 2020 tarihleri arasında klinik, medikal ve radyolojik verilerde kolestaz, obstruktif kolanjit/pankreatit veya safra kaçağı tanısı konulan ve ERCP işlemi yapılan 513 hastanın verileri retrospektif olarak değerlendirmiştir.
Bulgular: Çalışmaya alınan hastaların yaş dağılımı 18-109 arasında ve yaş ortalaması 58,54±20,16 idi. Cinsiyet dağılımı; 356 kadın (%69,4), 157 erkek (%30,6) şeklinde idi. En sık safra yolu tıkanıklığına bağlı kolestaz, tıkanma ikteri, akut pankreatit veya kolanjit tanıları konulmuştu. Bu hastaların 452 si koledok taşı, 15’i pankreas başı tümörü, 11’i koledok tümörü ve 10’u papilla tümörü idi.10 hasta Oddi Sfinkter Disfonksiyonu( ODS) nedeniyle işleme alındı. Safra yolu tıkanılığı ile gelen 499 hastanın 63’ü akut biliyer pankreatit, 38 i akut kolanjit tanılarıyla yatırılmıştı. İşlem süresi 20 dakikayla 90 dakika arasında değişti (ortalama işlem süresi 37 dk). Hastaların ERCP sonrası, 56’sında tedavi gerektirmeyen amilazemi, 24‘ünde ortalama 3 günlük medikal tedaviyle gerileyen pankreatit, 5’inde kan transfüzyonu gerektirmeyen ve adrenalin enjeksiyonu ve balon baskısıyla kontrol edilebilen kanama gelişti. Bir hastada taş ekstraksiyonu sırasında basket ve taş papillada sıkışmıştı. Operatif mortalite olmadı.
Sonuç; Safra yollarındaki kaçaklar ve fistüller en iyi ERCP ile gösterilir ve endoskopik olarak tedavi edilir. Etkin olduğu kadar bünyesinde perforasyon, sepsis ve mortalite gibi çok ciddi komplikasyonları barındırdığından endoskopistin uygulamanın endikasyonunu doğru belirlemesi, potansiyel komplikasyonlarını bilmesi ve oluşan komplikasyonları erken bir şekilde tanıması ve tadavisini yönetmesi, komplikasyon yaratacak ve gereksiz uygulamalardan mumkun olduğunca kaçınması gerektiği kanaatindeyiz.

Anahtar Kelimeler

ERCP, endoskopik sfinkterotomi, kolanjit, pankreatit

Kaynakça

• 1. Galip E. Endoscopic Retrograde Cholangıopancreatography ın Bılıe Duct Dısorders. Turkiye Klinikleri J Int Med Sci. 2007;3(51):12-6
• 2. Adler DG, Baron TH, Davila RE, et al. Standards of Practice Committee of American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 2005; 62: 1–8.
• 3. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001; 96: 417-23
• 4. Kondo S, Isayama H, Akahane M, et al. Detection of common bile ductstones: comparison between endoscopic ultrasonography, magnetic resonanc cholangiography, and helical-computed-tomographic cholangiography.Eur J Radiol 2005;54:271-5.
• 5. Cohen, S., Bacon, B.R., Berlin, J.A. et al. National Institutes of Health State-of-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14 - 16, 2002. Gastrointest Endosc 2002; 56: 803 – 9
• 6. Değerli ZB, Yılmaz Ö, Gökharman FD, Koşar U. Sakarya Tıp ergisi.Pankreatikobilier Patolojilerde Manyetik Rezonans Kolanjiopankreatografi ile Endoskopik Retrograd Kolanjiopankreatografinin Karşılaştırılması,2012;2(4):174-180
• 7. Ahmad Cİ,Serter A. Magnetic Resonance CholangiographyTurkiye Klinikleri J Radiol-Special Topics. 2013;6(3):8-12.
• 8. Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc 2002; 56 (6 suppl):S165-9.
• 9. Sakai Y, Tsuyuguchi T, Ishihara T, et al. The use fulness of endoscopic transpapillary procedure inpost-cholecystectomy bile duct stricture and postcholecystectomy bile leakage. Hepatogastroenterology 2009; 56: 978-83.
• 10. Aksoz K, Unsal B, Yoruk G, et al. Endoscopic sphincterotomy alone in the management of low-grade biliary leaks due to cholecystectomy. DigEndosc2009; 21: 158-61.
• 11. Gallix BP, Regent D, Bruel JM. Use of magnetic resonance cholangiography in the diagnosis of choledocholithiazis. Abdom Imaging 2001; 26: 21-7
• 12. Moser AJ. Benign biliary strictures. Curr Treat Options Gastroenterol 2001; 4: 377-87.
• 13. Jablonska B, Lampe P. Iatrogenic bile duct injuries: etiology, diagnosis and management. World J Gatroenterol 2009; 15: 4097-104.
• 14. Pereira SP, Gillams A, Sgouros SN, Webster GJ, Hatfield AR. Prospective comparison of secretin-stimulated magnetic resonance cholangiopancreatography with manometry in the diagnosis of sphincter of Oddi dysfunction types II and III. Gut. 2007;56(6):809-813. doi:10.1136/gut.2006.099267
• 15. Cotton, P.B. ERCP: risks, prevention, and management. In: Advanced Digestive Endoscopy Series: ERCP Section. Cotton, P.B.; Ed Charleston, S.C., USA: The Digestive Disease Center at the Medical University of South Carolina (MUSC). Edited by: Peter, B. Cotton and Joseph, W.C. Leung. Blackwell Pub, 2005; 13: 339 – 404
• 16. Baron TH, Kozarek RA. Preoperative biliary stents in pancreatic cancer – Proceed with caution. N Engl J Med 2010; 362: 170-2.
• 17. Sainani NI, Catalano OA, Holalkere NS, Zhu AX,Hahn PF, Sahani DV. Cholangiocarcinoma: current and novel imaging techniques. Radiographics 2008;28: 1263-87.
• 18. Slattery JM, Sahani DV. What is the current state-of- the-art imaging for detection and staging of cholan- giocarcinoma. Oncologist 2006; 11: 913-22.
• 19. Chhibber S, Sharma AK, Kumar N, Ghumman S Puri SK. Pancreatic tumors: prospective evaluation using MR imaging with MR cholangiography and MR angiography. Indian J Radiol Imaging 2006; 16:515-21.
• 20. Miller FH, Rini NJ, Keppke AL. MRI of adeno- carcinoma of the pancreas. AJR Am J Roentgenol 2006;187: W365-74.
• 21. Vachiranubhap B, Kim YH, Balci NC, Semelka RC.Magnetic resonance imaging of adenocarcinoma of the pancreas. Top Magn Reson Imaging 2009; 20:3-9.
• 22. Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factorsfor complications after ERCP: a multivariateanalysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-8.
• 23. Adler DG, Baron TH, Davila RE, et al. Standards of PracticeCommittee of American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. GastrointestEndosc 2005; 62: 1–8.
• 24. Yamaner S, Bilsel Y, Bulut T, Bugra D, Buyukuncu Y, Akyuz A. Endoscopic Diagnosis and management of complications following surgery for gallstones. Surg Endosc.2002; 16: 1685-90.
• 25. Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001 Oct;54(4):425-34. doi: 10.1067/mge.2001.117550. PMID: 11577302.
• 26. Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multi¬variate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-8.2001;54:425-34.
• 27. Rustagi T, Jamidar PA. Endoscopic retrograde cholangiopancreatography-related adverse events: general overview. Gastrointest Endosc Clin N Am. 2015 Jan;25(1):97-106. doi: 10.1016/j.giec.2014.09.005. PMID: 25442961.
• 28. Silviera ML, Seamon MJ, Porshinsky B, Prosciak MP, Doraiswamy VA, Wang CF, et al. Complica¬tions related to endoscopic retrograde cholangio¬pancreatography: a comprehensive clinical review. J Gastrointestin Liver Dis 2009; 18: 73-82.
• 29. Machado NO. Management of duodenal perforation post-endoscopic retrograde cholangiopancreatog¬raphy. When and whom to operate and what factors determine the outcome? A review article. JOP 2012; 13: 18-25