无症状和症状胆固醇结石病患者ERCP后不良事件的比较风险:系统性审查和元分析
Itegbemie Obaitan1, Mouhand F H Mohamed2, Azizullah Beran3
1Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA. iobaitan@iu.edu.
Digestive diseases and sciences
|March 30, 2024
概括
与有症状的患者相比,无症状胆固醇病患者面临更高的ERCP后胰腺炎 (PEP) 风险. 其他不良事件类似,强调需要仔细讨论和在无症状病例中预防PEP.
科学领域:
- 胃肠病学 胃肠病学
- 内镜手术 进行内镜手术
- 临床结果 临床结果
背景情况:
- 内镜逆行胆血管细胞造影 (ERCP) 是胆固醇病的标准,但存在风险.
- 指导方针支持ERCP用于症状性石头;其用于无症状石头的使用仍在争论中.
- 无症状胆固醇胆病的实践模式在地理和机构上各不相同.
研究的目的:
- 为了比较无症状和症状胆固醇病患者之间的ERCP后不良事件.
- 评估ERCP后胰腺炎 (PEP) 和其他并发症的风险.
- 在无症状患者中为ERCP提供临床决策信息.
主要方法:
- 观察性研究的系统审查和元分析.
- 在PubMed,Embase和Web of Science数据库中进行了搜索.
- 计算ERCP后结果的聚合风险比率 (RR) 和95%置信区间 (CI).
主要成果:
- 包括6项研究,涉及2,178名患者 (392名无症状,1786名有症状).
- 无症状患者的PEP风险明显更高 (11.7%与4.8%相比;RR 2.59).
- 没有观察到ERCP后胆管炎,出血或穿孔率的显著差异.
结论:
- 在ERCP后,无症状胆固醇胆病患者的PEP风险增加.
- 其他ERCP并发症的风险在症状和无症状组之间是可比的.
- 临床医生应该讨论PEP风险,并利用预防措施,无症状的患者接受ERCP.
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