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Second endoscopic retrograde cholangiopancreatography after failure of initial biliary cannulation: A single institution retrospective experience.
Experimental and Therapeutic Medicine ( IF 2.4 ) Pub Date : 2022-02-18 , DOI: 10.3892/etm.2022.11226
Xin Deng 1 , Rui Liao 1 , Long Pan 1 , Chengyou Du 1 , Qiao Wu 1
Affiliation  

Endoscopic retrograde cholangiopancreatography (ERCP) is not always successful when difficult biliary cannulation occurs. A second ERCP seems to be a worthwhile option following initial failure cannulation; however, relevant data are limited. Thus, the aim of the present study was to determine the outcomes of repeating ERCP in patients in whom the first biliary cannulation with or without precut sphincterotomy failed. It retrospectively analyzed 4,136 patients who underwent an initial biliary access between June 2016 and September 2020. Data from our databases were analyzed. Efficacy was based on the cannulation rate of the second ERCP and safety was assessed in terms of adverse events. Of 94 patients, 56 (59.6%) underwent a second ERCP and the success rate in biliary cannulation was 83.9% (47 of 56). The median operative time in the second ERCP was shorter than that in the initial procedure (47 vs. 65 min, P<0.001). A total of 5 patients (8.9%) suffered from mild ERCP-associated complications following the second ERCP. Compared with patients that did not undergo a second ERCP, patients that underwent a second ERCP had a lower 30-day mortality rate (13.2 vs. 1.8%, P=0.038). In addition, by univariate and multivariate analysis, it was observed that normal preoperative serum bilirubin levels and an interval time of <3 days were correlated with the cannulation failure of a second ERCP (OR=9.211, P=0.019, OR=6.765, P=0.041, respectively). A second ERCP following failure of an initial biliary cannulation appears to be safe and effective. For most clinically stable patients with an unsuccessful initial ERCP, a second ERCP after 2-4 days may be an optimal strategy. Preoperative normal serum bilirubin levels may be a risk factor that can be used for predicting cannulation failure of a second ERCP procedure.

中文翻译:

初始胆管插管失败后的第二次内镜逆行胰胆管造影:单一机构回顾性经验。

当发生困难的胆管插管时,内镜逆行胰胆管造影 (ERCP) 并不总是成功。在初始插管失败后,第二个 ERCP 似乎是一个值得的选择;但是,相关数据有限。因此,本研究的目的是确定在第一次胆管插管伴或不伴括约肌切开术失败的患者中重复 ERCP 的结果。它回顾性分析了 2016 年 6 月至 2020 年 9 月期间接受初始胆道通路的 4,136 名患者。分析了来自我们数据库的数据。疗效基于第二次 ERCP 的插管率,并根据不良事件评估安全性。在 94 名患者中,56 名(59.6%)接受了第二次 ERCP,胆管插管成功率为 83.9%(56 名中的 47 名)。第二次 ERCP 的中位手术时间短于初次手术(47 对 65 分钟,P<0.001)。共有 5 名患者 (8.9%) 在第二次 ERCP 后出现轻度 ERCP 相关并发症。与未接受第二次 ERCP 的患者相比,接受第二次 ERCP 的患者 30 天死亡率较低(13.2% vs. 1.8%,P=0.038)。此外,通过单变量和多变量分析,观察到正常的术前血清胆红素水平和<3天的间隔时间与第二次ERCP的插管失败相关(OR=9.211,P=0.019,OR=6.765,P = 0.041,分别)。初始胆管插管失败后的第二次 ERCP 似乎是安全有效的。对于大多数临床稳定且初始 ERCP 不成功的患者,2-4 天后进行第二次 ERCP 可能是最佳策略。术前正常血清胆红素水平可能是可用于预测第二次 ERCP 手术插管失败的风险因素。
更新日期:2022-02-18
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