Öz
Objective: This study aimed to compare the complications of outpatient and inpatient endoscopic retrograde cholangiopancreatography (ERCP) procedures in patients with bile duct stones and to investigate whether it is a safe approach to perform outpatient ERCP or not.
Materials and Methods: This prospective study consisted of 203 patients who had undergone ERCP for the first time with a diagnosis of choledocholithiasis between January 2013-July 2013.
Results: Of the patients included in the study, 102 had undergone outpatient and 101 had undergone inpatient ERCP. Complications following ERCP occurred in 9.8% of the outpatient group (pancreatitis in 5.9%, hemorrhage in 1.9%, cholangitis in 1%, perforation in 1%), while they occurred in the 11.9% of the inpatient group (pancreatitis in 6.9%, bleeding in 1%, cholangitis in 2%, perforation in 2%) (p=0.230, p=0.386, p=0.386, p=0.333, respectively; total complication comparison p=0.618). An amylase level below 150 U/L at the 4th hour after ERCP had a negative predictive value of 99.4% for pancreatitis to be negative. When the 4th hour amylase value of 300 U/L was taken as a limit, it had a positive predictive value of 52.1% in terms of pancreatitis positive. Additionally, the outpatient procedure was more cost-effective when the two groups were compared in terms of the cost [873.6±272.2 Turkish lira (TL) vs 1389.7±612.6 TL, p=0.001].
Conclusion: Our study demonstrated that outpatient ERCP was safe and costeffective in selected cases with bile duct stones. The 4th hour amylase level below 150 U/L after ERCP showed that patients can be safely sent home and that the amylase value above 3-fold at the 4th hour can be considered the limit value for admission to the hospital for pancreatitis.
Anahtar Kelimeler
Kaynakça
- 1. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-93.
- 2. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-18.
- 3. Johanson JF, Cooper G, Eisen GM, Freeman M, Goldstein JL, Jensen DM, et al. Quality assessment of ERCP. Endoscopic retrograde cholangiopacreatography. Gastrointest Endosc 2002; 56: 165-9.
- 4. Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, et al. American Society for Gastrointestinal Endoscopy. Complications of ERCP. Gastrointest Endosc 2003; 57: 633-8.
- 5. Rábago L, Guerra I, Moran M, Quintanilla E, Collado D, Chico I, et al. Is outpatient ERCP suitable, feasible, and safe? The experience of a Spanish community hospital. Surg Endosc 2010; 24: 1701-6.
- 6. Hui CK, Lai KC, Wong WM, Yuen MF, Ng M, Chan CK, et al. Outpatients undergoing therapeutic endoscopic retrograde cholangiopancreatography: six-hour versus overnight observation. J Gastroenterol Hepatol 2004; 19: 1163-8.
- 7. Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Terzoudis S, Pilpilidis I, et al. Outpatient therapeutic endoscopic retrograde cholangiopancreatography is safe in patients aged 80 years and older. Endoscopy 2011; 43: 128-33.
- 8. Thomas PR, Sengupta S. Prediction of pancreatitis following endoscopic retrograde cholangiopancreatography by the 4-h post procedure amylase level. J Gastroenterol Hepatol 2001; 16: 923-6.
- 9. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-11.
- 10. Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 52-8.
- 11. Gottlieb K, Sherman S, Pezzi J, Esber E, Lehman GA. Early recognition of post-ERCP pancreatitis by clinical assessment and serum pancreatic enzymes. Am J Gastroenterol 1996; 91: 1553-7.
- 12. Dumonceau JM, Andriulli A, Deviere J, Mariani A, Rigaux J, Baron TH, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy 2010; 42: 503-15.
- 13. Dumonceau JM, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014. Endoscopy 2014; 46: 799-815.
- 14. Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 127-49.
- 15. Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification. Adv Clin Exp Med 2018; 27: 149-54.
Öz
Kaynakça
- 1. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-93.
- 2. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-18.
- 3. Johanson JF, Cooper G, Eisen GM, Freeman M, Goldstein JL, Jensen DM, et al. Quality assessment of ERCP. Endoscopic retrograde cholangiopacreatography. Gastrointest Endosc 2002; 56: 165-9.
- 4. Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, et al. American Society for Gastrointestinal Endoscopy. Complications of ERCP. Gastrointest Endosc 2003; 57: 633-8.
- 5. Rábago L, Guerra I, Moran M, Quintanilla E, Collado D, Chico I, et al. Is outpatient ERCP suitable, feasible, and safe? The experience of a Spanish community hospital. Surg Endosc 2010; 24: 1701-6.
- 6. Hui CK, Lai KC, Wong WM, Yuen MF, Ng M, Chan CK, et al. Outpatients undergoing therapeutic endoscopic retrograde cholangiopancreatography: six-hour versus overnight observation. J Gastroenterol Hepatol 2004; 19: 1163-8.
- 7. Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Terzoudis S, Pilpilidis I, et al. Outpatient therapeutic endoscopic retrograde cholangiopancreatography is safe in patients aged 80 years and older. Endoscopy 2011; 43: 128-33.
- 8. Thomas PR, Sengupta S. Prediction of pancreatitis following endoscopic retrograde cholangiopancreatography by the 4-h post procedure amylase level. J Gastroenterol Hepatol 2001; 16: 923-6.
- 9. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-11.
- 10. Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 52-8.
- 11. Gottlieb K, Sherman S, Pezzi J, Esber E, Lehman GA. Early recognition of post-ERCP pancreatitis by clinical assessment and serum pancreatic enzymes. Am J Gastroenterol 1996; 91: 1553-7.
- 12. Dumonceau JM, Andriulli A, Deviere J, Mariani A, Rigaux J, Baron TH, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy 2010; 42: 503-15.
- 13. Dumonceau JM, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - updated June 2014. Endoscopy 2014; 46: 799-815.
- 14. Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 127-49.
- 15. Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification. Adv Clin Exp Med 2018; 27: 149-54.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Gastroenteroloji ve Hepatoloji |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Mart 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 23 Sayı: 1 |