胆囊切除术后>1年内良性症状的首次ERCP的增加与较差的结果有关
Nikhil R Thiruvengadam1, Monica Saumoy2, Douglas E Schaubel3
1Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, California; Center for Endoscopic Innovation, Research, and Training, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
概括
胆囊切除术后的晚期内逆行胆道血管瘤学 (ERCP) 的发生率正在上升,尽管非侵入性成像增加了. 这些程序具有很高的风险,包括新的慢性阿片类药物使用,特别是在肠-大脑相互作用障碍患者中.
科学领域:
- 胃肠病学 胃肠病学
- 肝病学 肝病学是一种肝病学.
- 胆道医学 胆道医学
背景情况:
- 胆固醇胆病的诊断往往依赖于内镜逆行胆固醇细胞造影 (ERCP).
- 患有胆囊切除术病史的患者仍然可能患上胆固醇胆固醇病.
- 较少侵入性的成像选择旨在减少ERCP的利用.
研究的目的:
- 确定在胆囊切除术 (晚期ERCP) 后一年以上接受首次ERCP的患者的发病率,特征和结果.
- 分析ERCP晚期和胆道成像利用的时间趋势.
- 为了确定与经历ERCP晚期相关的患者因素.
主要方法:
- 从2005-2021年对商业保险索赔数据库 (Optum Clinformatics) 的分析.
- 包括接受胆囊切除术的成年人,重点关注那些在非恶性征兆中患有晚期ERCP的人.
- 多变量后勤回归用于识别ERCP晚期预测因素.
主要成果:
- 晚期ERCP的发生率从2005年到2021年增加了八倍,尽管非侵入性胆道成像的增加.
- 只有44%的ERCP晚期手术导致了胆结石的去除.
- 观察到高比例的ERCP后胰腺炎 (7.1%),住院 (13.1%),和新的慢性阿片类药物使用 (9.7%).
结论:
- 晚期ERCP的发病率在胆囊切除术后显著增加.
- 诸如肠-大脑相互作用障碍和代谢功能障碍等并发症 脂肪性肝病与晚期ERCP的增加有关.
- 晚期ERCP与不成比例高的不良事件发生率有关,包括新的慢性阿片类药物开始.
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