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Abstract：
Background and study aims To assess the outcomes of urgent endoscopic retrograde cholangiopancreatography (ERCP) performed with a single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis. Patients and methods Between 2021 and 2022 consecutive patients with moderate-to-severe cholangitis were prospectively enrolled to undergo urgent ERCP with SUD. Technical success was defined as the completion of the planned procedure with SUD. Multivariate analysis was used to identify factors related to incidence of adverse events (AEs) and mortality. Results Thirty-five consecutive patients (15 female, age 81.4±6.7 years) were enrolled. Twelve (34.3%) had severe cholangitis; 26 (74.3%) had an American Society of Anesthesiologists (ASA) score ≥3. Twenty-eight patients (80.0%) had a naïve papilla. Biliary sphincterotomy and complete stone clearance were performed in 29 (82.9%) and 30 patients (85.7%), respectively; in three cases (8.6%), concomitant endoscopic ultrasound-gallbladder drainage was performed. Technical and clinical success rates were 100%. Thirty-day and 3-month mortality were 2.9% and 14.3%, respectively. One patient had mild post-ERCP pancreatitis and two had delayed bleeding. No patient or procedural variables were related to AEs. ASA score 4 and leucopenia were related to 3-month mortality; on multivariate analysis, leukopenia was the only variable independently related to 3-month mortality (odds ratio 12.8; 95% confidence interval 1.03-157.2; P =0.03). Conclusions The results of this \"proof of concept\" study suggest that SUD use could be considered safe and effective for urgent ERCP for acute cholangitis. This approach abolishes duodenoscope contamination from infected patients without impairing clinical outcomes.
摘要：
背景与研究的目的是评估在中度至重度胆管炎患者中使用一次性十二指肠镜（SUD）进行紧急内镜逆行胰胆管造影（ERCP）的结果。患者和方法在2021年至2022年之间，连续的中重度胆管炎患者被前瞻性地纳入接受紧急ERCP治疗的SUD。技术成功被定义为SUD计划程序的完成。多因素分析用于确定与不良事件（AE）发生率和死亡率相关的因素。结果连续35例患者(15例女性,年龄81.4±6.7岁）。12人（34.3％）患有严重胆管炎；26人（74.3％）的美国麻醉医师协会（ASA）评分≥3。28例患者（80.0%）有原始乳头。29例(82.9%)和30例(85.7%)患者行胆道括约肌切开术和结石完全清除,分别有3例(8.6%)，同时进行内镜超声-胆囊引流.技术和临床成功率为100%。30天和3个月死亡率分别为2.9%和14.3%,分别。一名患者患有轻度ERCP后胰腺炎，两名患者出血延迟。没有患者或手术变量与AE相关。ASA4分和白细胞减少与3个月死亡率相关；在多因素分析中，白细胞减少是与3个月死亡率独立相关的唯一变量（比值比12.8；95％置信区间1.03-157.2；P=0.03）。结论这项“概念验证”研究的结果表明，对于急性胆管炎的紧急ERCP治疗，SUD的使用被认为是安全有效的。这种方法消除了感染患者的十二指肠镜污染，而不会损害临床结果。
