Agustos 2020
Periampüller divertikül endoskopik retrograd kolanjiyopankreatografide kanülasyon basarisi vekomplikasyon sikligini etkiler mi?
Do periampullary diverticula affect cannulation success and frequency of complications in endoscopic retrograde cholangiopancreatography?
- Ana Sayfa
- Sayılar
- Agustos 2020
- Periampüller divertikül endoskopik retrograd kolanjiyopankreatografide kanülasyon basarisi vekomplikasyon sikligini etkiler mi?...
Bartin Devlet Hastanesi, 2Gastroenteroloji Klinigi, Bartin
Özet
Giris ve Amaç: Periampüller divertiküller, endoskopik retrograd kolanjiyopankreatografi islemi esnasinda özellikle yasli hastalarda sik rastlanan anomalilerdir. Periampüller divertiküllerin endoskopik retrograd kolanjiyopankreatografide teknik basari ve komplikasyonlar üzerine etkisi ile ilgili yapilan çalismalarin sonuçlari ise çeliskilidir. Çalismamizda periampüller divertikülü olan ve olmayan hastalar arasinda endoskopik retrograd kolanjiyopankreatografi islemi esnasinda kanülasyon basarisi ve erken komplikasyonlari karsilastirmayi ve bunlari etkileyen faktörleri degerlendirmeyi amaçladik. Gereç ve Yöntem: 2018-2020 yillari arasinda endoskopik retrograd kolanjiyopankreatografi yapilan hastalar retrospektif olarak çalismaya alindi. Hastalar periampüller divertikülü olmayan (n=574) ve olan (n=137) seklinde iki gruba ayrildi. Hastalarin tibbi kayitlari incelenerek her iki grup demografik ve klinik özellikleri, endoskopik retrograd kolanjiyopankreatografi islem özellikleri, komplikasyon ve mortalite oranlari açisindan karsilastirildi. Bulgular: Ortalama yasi 61.2±17.7, 465’i (%57.3) kadin olan 811 hastaya yapilan toplam 973 endoskopik retrograd kolanjiyopankreatografi islemi incelendi. Kanülasyon basarisi periampüller divertikülü olmayan grupta %97, periampüller divertikülü olan grupta %97.1 (p=0.96) saptandi. Endoskopik retrograd kolanjiyopankreatografide seans sayisi, islem basarisi, koledok tasi varligi, tas çikarmak için büyük balon ile papilla dilatasyon ihtiyaci ve biliyer stent konulma oranlari açisindan gruplar benzerdi (p >0.05). Periampüller divertikül bulunmayan grupta kanülasyon için ön kesi ihtiyaci daha yüksekti (sirasiyla; %25 vs %14.6, p=0.01). Endoskopik retrograd kolanjiyopankreatografiye bagli erken komplikasyonlar açisindan ise gruplar arasinda farklilik saptanmadi (periampüller divertikülü olmayanlarda n=21, %3.1, periampüller divertikülü olanlarda n=5, %3.6, p=0.75). Sonuç: Endoskopik retrograd kolanjiyopankreatografi esnasinda periampüller divertikül saptanmasi kanülasyon önünde bir engel olarak görülmemeli, hatta ön kesi ihtiyacini azaltarak kanülasyonu kolaylastirabilecegi dikkate alinmalidir. Çalismamizin sonuçlari periampüller divertiküllerin varliginin isleme bagli komplikasyonlar açisindan ek risk olusturmadigini göstermektedir
Abstract
Background and Aims: Periampullary diverticulas are frequent anomalies found during endoscopic retrograde cholangiopancreatography,especially in elderly patients. Previous study results on the effect ofperiampullary diverticula on technical success and complications inendoscopic retrograde cholangiopancreatography are controversial.In this study, we aimed to compare the cannulation success rate andearly complications between patients with and without periampullarydiverticula during endoscopic retrograde cholangiopancreatography,and to evaluate the factors affecting them. Material and Methods:Patients who underwent endoscopic retrograde cholangiopancreatography between 2018 and 2020 were retrospectively included in thestudy. The patients were divided into two groups: patients with periampullary diverticula (n = 137) and patients without periampullary diverticula (n = 574). Patients’ medical records were analyzed, and thegroups were compared in terms of dermographic and clinical features,cannulation success, need for precut sphincterotomy, balloon-papilladilatation, biliary stent placement, the number of endoscopic procedures, complications, and mortality. Results: A total of 973 endoscopicretrograde cholangiopancreatography procedures were performed on811 patients (465 [57.3%] women). The mean patient age was 61.2± 17.7 years. The cannulation success rate was 97% in the non- periampullary diverticula group and 97.1% (p = 0.96) in the periampullarydiverticula group. The groups were similar in terms of the number ofendoscopic retrograde cholangiopancreatography sessions, the successrate of the procedure, the presence of choledocolitiazis, the need forballoon-papilla dilatation, and biliary stent placement rates (p > 0.05).The need for precut sphincterotomy was higher in the non- periampullary diverticula group (25% vs. 14.6%, respectively; p = 0.01). Therewas no difference between the groups in terms of early complications related to endoscopic retrograde cholangiopancreatography (21[3.1%] in the non- periampullary diverticula group, and 5 [3.6%] in theperiampullary diverticula group; p = 0.75). Conclusion: Periampullarydiverticula detection during endoscopic retrograde cholangiopancreatography should not be considered an obstacle for cannulation success,and it can help facilitate the cannulation by reducing the need for precut sphincterotomy. The results of our study show that the presence ofperiampullary diverticula also does not increase the risk of procedure-related complications.
