Abstract：
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure, but it poses challenges in patients with surgically altered gastrointestinal anatomy (SAGA). Alternative techniques like single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or push enteroscopy (PE) have been used, albeit with potential complications. Limited Latin American data exists on ERCP complications in SAGA patients. Our goal is to describe complications of ERCP in SAGA at a national referral institution.
METHODS: Retrospective, single-center cohort study. All SAGA ERCP procedures performed at the Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán from January 2008 to May 2023 were included. Extracted data from records included procedure specifics, endoscope type, success, and complications. Complications were evaluated during procedure and 28-day post-procedure and classified using the AGREE system.
RESULTS: A total of 266 procedures in 174 patients were included, 74% were women, and the median age was 44 years. Predominant modified anatomy was Roux-en-Y biliary reconstruction (79%), followed by Whipple procedure (13%) and subtotal gastrectomy with Roux-en-Y reconstruction (6.0%). The main indications were cholangitis with stricture (31%), stricture (19%), and cholangitis (19%). DBE was used in 89%, PE in 7.5%, and SBE in 3.4%. Success rates were 77% endoscopic, 72% technical, and 69% therapeutic; in 30%, the procedure was unsuccessful. Complications happened in 18% of cases, most commonly cholangitis (7.5%), followed by perforation (2.6%) and hemorrhage (1.9%). According to the AGREE classification, 10.9% were grades 1 and 2, 6.4% were grade 3, and 0.4% were grade 4 complications. No significant differences emerged between groups with and without complications. Procedures increased over time, but complications and unsuccessful procedures remained stable.
CONCLUSIONS: ERCP complications align with international data, often not requiring invasive treatment. Enhanced exposure to such cases correlates with fewer complications and failures. Prospective studies are essential to identify complication and failure predictors.
METHODS: Retrospective, single-center cohort study. All SAGA ERCP procedures performed at the Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán from January 2008 to May 2023 were included. Extracted data from records included procedure specifics, endoscope type, success, and complications. Complications were evaluated during procedure and 28-day post-procedure and classified using the AGREE system.
RESULTS: A total of 266 procedures in 174 patients were included, 74% were women, and the median age was 44 years. Predominant modified anatomy was Roux-en-Y biliary reconstruction (79%), followed by Whipple procedure (13%) and subtotal gastrectomy with Roux-en-Y reconstruction (6.0%). The main indications were cholangitis with stricture (31%), stricture (19%), and cholangitis (19%). DBE was used in 89%, PE in 7.5%, and SBE in 3.4%. Success rates were 77% endoscopic, 72% technical, and 69% therapeutic; in 30%, the procedure was unsuccessful. Complications happened in 18% of cases, most commonly cholangitis (7.5%), followed by perforation (2.6%) and hemorrhage (1.9%). According to the AGREE classification, 10.9% were grades 1 and 2, 6.4% were grade 3, and 0.4% were grade 4 complications. No significant differences emerged between groups with and without complications. Procedures increased over time, but complications and unsuccessful procedures remained stable.
CONCLUSIONS: ERCP complications align with international data, often not requiring invasive treatment. Enhanced exposure to such cases correlates with fewer complications and failures. Prospective studies are essential to identify complication and failure predictors.
摘要：
背景：内镜逆行胰胆管造影术（ERCP）是一种常见的手术，但它对手术改变胃肠解剖结构（SAGA）的患者提出了挑战。替代技术，如单气囊小肠镜检查（SBE），双气囊小肠镜（DBE），或使用推进式小肠镜检查（PE），尽管有潜在的并发症。关于SAGA患者ERCP并发症的拉丁美洲数据有限。我们的目标是在国家转诊机构描述SAGA中ERCP的并发症。
方法：回顾性，单中心队列研究。包括2008年1月至2023年5月在美国国家医学科学与营养研究所SalvadorZubirán胃肠内窥镜检查部门进行的所有SAGAERCP程序。从记录中提取的数据包括程序细节，内窥镜类型,成功,和并发症。术中和术后28天评估并发症，并使用AGREE系统进行分类。
结果：共纳入174例患者的266例手术，74%是女性,中位年龄为44岁。主要解剖改良为Roux-en-Y胆道重建（79%），其次是Whipple手术（13％）和胃大部切除术与Roux-en-Y重建（6.0％）。主要指征为胆管炎伴狭窄(31%),狭窄（19%），和胆管炎（19％）。89%使用DBE，PE在7.5%，SBE为3.4%。内镜成功率为77%，72％的技术，69%是治疗性的；在30%中，程序没有成功。18％的病例发生并发症，最常见的胆管炎（7.5%），其次是穿孔(2.6%)和出血(1.9%)。根据AGREE分类，10.9%为1级和2级，6.4%为3级，0.4%为4级并发症。有并发症和无并发症组之间没有显着差异。程序随着时间的推移而增加，但并发症和不成功的程序保持稳定。
结论：ERCP并发症与国际数据一致，通常不需要侵入性治疗。增强暴露于此类病例与更少的并发症和失败相关。前瞻性研究对于确定并发症和失败预测因素至关重要。
方法：回顾性，单中心队列研究。包括2008年1月至2023年5月在美国国家医学科学与营养研究所SalvadorZubirán胃肠内窥镜检查部门进行的所有SAGAERCP程序。从记录中提取的数据包括程序细节，内窥镜类型,成功,和并发症。术中和术后28天评估并发症，并使用AGREE系统进行分类。
结果：共纳入174例患者的266例手术，74%是女性,中位年龄为44岁。主要解剖改良为Roux-en-Y胆道重建（79%），其次是Whipple手术（13％）和胃大部切除术与Roux-en-Y重建（6.0％）。主要指征为胆管炎伴狭窄(31%),狭窄（19%），和胆管炎（19％）。89%使用DBE，PE在7.5%，SBE为3.4%。内镜成功率为77%，72％的技术，69%是治疗性的；在30%中，程序没有成功。18％的病例发生并发症，最常见的胆管炎（7.5%），其次是穿孔(2.6%)和出血(1.9%)。根据AGREE分类，10.9%为1级和2级，6.4%为3级，0.4%为4级并发症。有并发症和无并发症组之间没有显着差异。程序随着时间的推移而增加，但并发症和不成功的程序保持稳定。
结论：ERCP并发症与国际数据一致，通常不需要侵入性治疗。增强暴露于此类病例与更少的并发症和失败相关。前瞻性研究对于确定并发症和失败预测因素至关重要。
