在ERCP后临床显著出血的发生率,预测因素和结果:当代多中心研究
Kirles Bishay1,2, Yibing Ruan3,4, Alan N Barkun5
1Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
The American journal of gastroenterology
|July 8, 2024
概括
临床上显著的ERCP后出血 (CSPEB) 影响1.5%的手术,特别是在高风险干预后. 抗血栓管理对于减轻风险和改善患者的治疗结果至关重要.
科学领域:
- 胃肠病学 胃肠病学
- 干预性内镜检查是干预性的内镜检查.
- 肝病学 肝病学是一种肝病学.
背景情况:
- 临床上显著的后内镜逆行性胆道血管细胞造影 (ERCP) 出血 (CSPEB) 是一种已知的并发症.
- 目前对CSPEB风险和相关因素的估计是有限的.
研究的目的:
- 为了确定CSPEB的风险因素.
- 确定与CSPEB相关的结果.
- 评估抗血栓药物对CSPEB风险的影响.
主要方法:
- 从2018年至2023年对ERCP数据进行前性多中心分析.
- 包括所有患者30天的随访时间.
- 基于特定的临床标准 (血,黑色素,血) 和后果 (血红蛋白下降,输血,内镜,长期住院) 的CSPEB定义.
- 使用Firth逻辑回归来识别重大风险因素的统计分析.
主要成果:
- 在8517个ERCP中,CSPEB发生在1.5%的ERCP中,高风险干预后的发病率更高 (2.3%).
- 包括P2Y12抑制剂,华法林,达比加特兰,里瓦罗克萨班和阿皮克萨班在内的抗血栓剂在高风险手术后与CSPEB显著相关.
- 在关节切除术期间的手术内出血也是一个危险因素.
- CSPEB与内镜检查,输血的需求增加以及同时发生心肺呼吸系统事件的更高率有关.
结论:
- 与抗血小板治疗相关的CSPEB风险可能被低估.
- 在高风险的ERCP手术之前,对抗血栓药物的低最佳管理是令人担忧的.
- 优化周围手术抗血栓药物管理是必不可少的,可以作为质量改善举措的目标.
相关概念视频
01:26Endoscopic Procedures V: ERCP
170
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
Patient...
170
01:28Esophageal Varices-II: Clinical Features and Management
57
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
57
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
125
Biopharmaceutical studies constitute a vital field aiming to enhance drug delivery methods and refine therapeutic approaches, drawing upon diverse interdisciplinary knowledge. In research methodologies, the choice between controlled and non-controlled studies significantly influences the study's reliability and accuracy.
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
125
01:28Esophageal Perforation-II: Clinical Manifestations and Management
54
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
54
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
109
Peptic ulcer disease (PUD) presents with diverse symptoms depending on the location and severity of the ulcer. Clinical manifestations of peptic ulcer include dull pain and a burning sensation in the mid-epigastric region.
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
109
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
160
Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
160