Analysis of Severe Complications Recently after Endoscopic Sphincterotomy and Related Risk Factors_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Jian ¹ , DU Bo ² , HU Bing ²

1．The First Department of Surgery, People’s Hospital of Leshan City, Leshan 614000, Sichuan Province, China;;
2．Endoscopy Center of West China Hospital， Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Endoscopic sphincterotomy; Complications; Risk factor

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Objective To investigate the severe complications recently after endoscopic sphincterotomy (EST) and related risk factors.
Methods Two thousands one hundred and twenty patients after EST in People’s Hospital of Leshan city in recent 15 years were collected to be analyzed. The incidence rates of severe complications were observed and related risk factors were analyzed.
Results Thirty four cases (1.60%) in 2 120 patients presented severe complications in 72 h after EST: Nine were with hemorrhage, 23 with acute pancreatitis, 1 with duodenum perforation and 1 with septicemia. Acute pancreatitis was the most remarkable severe complication. The duodenal papilla with tumor or inflammation, and oddi dysfunction were the primary risk factors of hemorrhage or acute pancreatitis, respectively. The rate of oddi dysfunction patients with acute pancreatitis reached up to 44.68% (21/47).
Conclusions Acute pancreatitis is the most common severe complications recently after EST and sphincter of oddi dysfunction is the most remarkable risk factor.

Citation： WANG Jian ,DU Bo,HU Bing. Analysis of Severe Complications Recently after Endoscopic Sphincterotomy and Related Risk Factors. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(5): 486-490. doi: Copy

1.	李兆申, 许国铭. ERCP基本技术与临床应用 [M]. 济南：山东科学技术出版社, 2001: 36-37.
2.	李兆申, 许国铭, 孔振兴, 等. 诊断性与治疗性ERCP早期并发症与处理 [J]. 中华消化内镜杂志, 2002; 19（2）: 77-80.
3.	Testoni PA. Why the incidence of post-ERCP pancreatitis varies considerably? Factors affecting the diagnosis and the incidence of this complication [J]. JOP, 2002; 3(6): 195-201.
4.	张文萍. 饮食指导对减少EST术后并发症的作用 [J]. 医药论坛杂志, 2008; 29（23）: 117-118.
5.	李素芬, 刘竹娥, 罗艳丽, 等. ERCP及EST术后胰腺炎的预防及护理 [J]. 护士进修杂志, 2008; 23(18): 1666-1668.
6.	李守兰. EST术后并发症的预防和处理 [J]. 青海医药杂志, 2006; 36（8）: 61-62.
7.	Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy [J]. N Engl J Med, 1996; 335(13): 909-918.
8.	Hogan WJ, Sherman S, Pasricha P, et al. Sphincter of Oddi manometry[J]. Gastrointest Endosc, 1997; 45(3): 342-348.
9.	朱丽琴. 内镜下乳头括约肌切开取石术后并发症的观察 [J]. 护理研究, 2002; 16（7）: 410-411.
10.	贺冠海, 蔡阳, 钱锡元, 等. 内镜下乳头肌切开术后并发症的外科治疗 [J]. 中华普通外科杂志, 2002; 17（8）: 469-470.
11.	陈巍峰, 姚礼庆. ERCP及EST术后并发症的预防和治疗进展 [J]. 中华实用医学, 2004; 6（8）: 65-67.
12.	李兆申, 许国铭, 孙振兴, 等. ERCP及EST术后早期并发症及其处理的57例临床分析 [J]. 外科理论与实践, 1999; 4（1）: 36-38.
13.	刘霞, 卢高峰, 唐芙爱. 内镜下EST联合鼻胆管引流术治疗急性胆源性胰腺炎 [J]. 当代医学, 2009; 15（9）: 63-64.
14.	蔡阳, 朱玮, 封光华, 等. EST严重并发症的外科治疗 [J]. 中华肝胆外科杂志, 2005; 11（9）: 616-617.
15.	Mallery JS, Baron TH, Dominitz JA, et al. Complications of ERCP [J]. Gastrointest Endosc, 2003; 57(6): 633-638.
16.	白朝辉, 钱春红. 败血症的诊断与治疗 [J]. 医学信息, 2009; 22（7）: 1312.
17.	张啸, 钱礼. 内镜下乳头切开术的近期并发症 [J]. 中华消化内镜杂志, 1996; 13(2): 290-292.
18.	刘战培, 蒲青凡, 周勇. 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析 [J]. 中国普外基础与临床杂志, 2008; 15(3): 195-200.
19.	刘厚钰, 姚礼庆．现代内镜学 [M]．上海: 复旦大学出版社, 2001: 188-189.
20.	余文, 吴伟, 张少辉, 等. 急性胰腺炎发病机理的研究进展 [J]. 中国普外基础与临床杂志, 2006; 13(6): 733-736.
21.	陈震. 内镜十二指肠乳头括约肌切开术并发症的临床研究 [D]. 天津医科大学, 2008.
22.	魏莉, 王林恒, 陆星华, 等. 经内镜逆行胰胆管造影和经内镜乳头括约肌切开术并发急性胰腺炎的危险因素 [J]. 中华消化内镜杂志, 1998; 15(6): 374-375.
23.	Eversman D, Fogel EL, Rusche M, et al. Frequency of abnormal pancreatic and biliary sphincter manometry compared with clinical suspicion of sphincter of Oddi dysfunction [J]. Gastrointest Endosc, 1999; 50(5): 637-641.
24.	马變峰. EST术后并发症的原因及护理 [J]. 南方护理学报, 1999; 6（4）: 23-24.
25.	贾文钊, 祝金玲, 刘俊辉. X线钡餐检查后并发急性胃十二指肠穿孔4例报告 [J]. 中国普外基础与临床杂志, 1997; 4(1): 10.
26.	谢扬信, 徐成君, 谢芳. 十二指肠损伤10例分析 [J]. 中国普外基础与临床杂志, 2009; 16（4）: 275.

1. 李兆申, 许国铭. ERCP基本技术与临床应用 [M]. 济南：山东科学技术出版社, 2001: 36-37.
2. 李兆申, 许国铭, 孔振兴, 等. 诊断性与治疗性ERCP早期并发症与处理 [J]. 中华消化内镜杂志, 2002; 19（2）: 77-80.
3. Testoni PA. Why the incidence of post-ERCP pancreatitis varies considerably? Factors affecting the diagnosis and the incidence of this complication [J]. JOP, 2002; 3(6): 195-201.
4. 张文萍. 饮食指导对减少EST术后并发症的作用 [J]. 医药论坛杂志, 2008; 29（23）: 117-118.
5. 李素芬, 刘竹娥, 罗艳丽, 等. ERCP及EST术后胰腺炎的预防及护理 [J]. 护士进修杂志, 2008; 23(18): 1666-1668.
6. 李守兰. EST术后并发症的预防和处理 [J]. 青海医药杂志, 2006; 36（8）: 61-62.
7. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy [J]. N Engl J Med, 1996; 335(13): 909-918.
8. Hogan WJ, Sherman S, Pasricha P, et al. Sphincter of Oddi manometry[J]. Gastrointest Endosc, 1997; 45(3): 342-348.
9. 朱丽琴. 内镜下乳头括约肌切开取石术后并发症的观察 [J]. 护理研究, 2002; 16（7）: 410-411.
10. 贺冠海, 蔡阳, 钱锡元, 等. 内镜下乳头肌切开术后并发症的外科治疗 [J]. 中华普通外科杂志, 2002; 17（8）: 469-470.
11. 陈巍峰, 姚礼庆. ERCP及EST术后并发症的预防和治疗进展 [J]. 中华实用医学, 2004; 6（8）: 65-67.
12. 李兆申, 许国铭, 孙振兴, 等. ERCP及EST术后早期并发症及其处理的57例临床分析 [J]. 外科理论与实践, 1999; 4（1）: 36-38.
13. 刘霞, 卢高峰, 唐芙爱. 内镜下EST联合鼻胆管引流术治疗急性胆源性胰腺炎 [J]. 当代医学, 2009; 15（9）: 63-64.
14. 蔡阳, 朱玮, 封光华, 等. EST严重并发症的外科治疗 [J]. 中华肝胆外科杂志, 2005; 11（9）: 616-617.
15. Mallery JS, Baron TH, Dominitz JA, et al. Complications of ERCP [J]. Gastrointest Endosc, 2003; 57(6): 633-638.
16. 白朝辉, 钱春红. 败血症的诊断与治疗 [J]. 医学信息, 2009; 22（7）: 1312.
17. 张啸, 钱礼. 内镜下乳头切开术的近期并发症 [J]. 中华消化内镜杂志, 1996; 13(2): 290-292.
18. 刘战培, 蒲青凡, 周勇. 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析 [J]. 中国普外基础与临床杂志, 2008; 15(3): 195-200.
19. 刘厚钰, 姚礼庆．现代内镜学 [M]．上海: 复旦大学出版社, 2001: 188-189.
20. 余文, 吴伟, 张少辉, 等. 急性胰腺炎发病机理的研究进展 [J]. 中国普外基础与临床杂志, 2006; 13(6): 733-736.
21. 陈震. 内镜十二指肠乳头括约肌切开术并发症的临床研究 [D]. 天津医科大学, 2008.
22. 魏莉, 王林恒, 陆星华, 等. 经内镜逆行胰胆管造影和经内镜乳头括约肌切开术并发急性胰腺炎的危险因素 [J]. 中华消化内镜杂志, 1998; 15(6): 374-375.
23. Eversman D, Fogel EL, Rusche M, et al. Frequency of abnormal pancreatic and biliary sphincter manometry compared with clinical suspicion of sphincter of Oddi dysfunction [J]. Gastrointest Endosc, 1999; 50(5): 637-641.
24. 马變峰. EST术后并发症的原因及护理 [J]. 南方护理学报, 1999; 6（4）: 23-24.
25. 贾文钊, 祝金玲, 刘俊辉. X线钡餐检查后并发急性胃十二指肠穿孔4例报告 [J]. 中国普外基础与临床杂志, 1997; 4(1): 10.
26. 谢扬信, 徐成君, 谢芳. 十二指肠损伤10例分析 [J]. 中国普外基础与临床杂志, 2009; 16（4）: 275.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Severe Complications Recently after Endoscopic Sphincterotomy and Related Risk Factors

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