Complications in Patients with Surgically Altered Gastrointestinal Anatomy Undergoing Endoscopic Retrograde Cholangiopancreatography: 15-Year Experience at a Tertiary Care Center in Latin America.

Autor: Ruiz-Manriquez J; Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico., Olivas-Martinez A; Department of Biostatistics, University of Washington, Seattle, WA, USA., Terán-Ellis SMY; Department of Vascular Surgery, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico., Chávez-García LC; Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico., Jasso-Baltazar EA; Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico., Ruiz-Romero D; Hospital Ángeles Acoxpa, Mexico City, Mexico., Valdovinos-Andraca F; Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico., Zamora-Nava LE; Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Av. Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico. luiseduardozn@gmail.com.
Jazyk: angličtina
Zdroj: Digestive diseases and sciences [Dig Dis Sci] 2024 Aug; Vol. 69 (8), pp. 3021-3028. Date of Electronic Publication: 2024 Jun 14.
DOI: 10.1007/s10620-024-08516-4
Abstrakt: Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure, but it poses challenges in patients with surgically altered gastrointestinal anatomy (SAGA). Alternative techniques like single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or push enteroscopy (PE) have been used, albeit with potential complications. Limited Latin American data exists on ERCP complications in SAGA patients. Our goal is to describe complications of ERCP in SAGA at a national referral institution.
Methods: Retrospective, single-center cohort study. All SAGA ERCP procedures performed at the Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán from January 2008 to May 2023 were included. Extracted data from records included procedure specifics, endoscope type, success, and complications. Complications were evaluated during procedure and 28-day post-procedure and classified using the AGREE system.
Results: A total of 266 procedures in 174 patients were included, 74% were women, and the median age was 44 years. Predominant modified anatomy was Roux-en-Y biliary reconstruction (79%), followed by Whipple procedure (13%) and subtotal gastrectomy with Roux-en-Y reconstruction (6.0%). The main indications were cholangitis with stricture (31%), stricture (19%), and cholangitis (19%). DBE was used in 89%, PE in 7.5%, and SBE in 3.4%. Success rates were 77% endoscopic, 72% technical, and 69% therapeutic; in 30%, the procedure was unsuccessful. Complications happened in 18% of cases, most commonly cholangitis (7.5%), followed by perforation (2.6%) and hemorrhage (1.9%). According to the AGREE classification, 10.9% were grades 1 and 2, 6.4% were grade 3, and 0.4% were grade 4 complications. No significant differences emerged between groups with and without complications. Procedures increased over time, but complications and unsuccessful procedures remained stable.
Conclusion: ERCP complications align with international data, often not requiring invasive treatment. Enhanced exposure to such cases correlates with fewer complications and failures. Prospective studies are essential to identify complication and failure predictors.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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