RESUMO
INTRODUCTION: conflicting results have been reported regarding the influence of the annual volume of endoscopic retrograde cholangiopancreatography (ERCP) on outcome. OBJECTIVE: to evaluate the influence of case volume on ERCP outcomes. PATIENTS AND METHODS: an analysis of a prospective database was performed, comparing the outcomes of ERCP in three consecutive periods defined by the number of endoscopists performing ERCP: five endoscopists in period I (P1), four in period II (P2) and three in period III (P3). Only patients with biliary ERCP in accessible and naïve papilla were included. Primary variables were cannulation rates and adverse effects (AE). The American Society of Gastrointestinal Endoscopy (ASGE) complexity grades III and IV were considered as highly complex procedures. RESULTS: a total of 2,561 patients were included: 727 (P1), 972 (P2) and 862 (P3). There were no differences in age and sex between groups (p > 0.05). The cannulation rate was significantly higher in P2 and P3: 92.4 % vs 93.3 % vs 93 % (p = 0.037). The AE rate was 13.8 %, 12.6 % and 10.3 % (p > 0.05), respectively. The rate of post-ERCP pancreatitis was significantly lower in P3: 8.5 %, 7.3 % and 5 % (p = 0.01). The rate of complex procedures was 12 %, 14.8 % and 27 % (p < 0.0001), respectively. Two endoscopists participated in all periods and only one had significantly improved outcomes. Cannulation and post-ERCP pancreatitis rates remained significantly better in P3 after adjusting for sex, complexity and endoscopist. CONCLUSION: a higher annual volume of ERCP per endoscopist was associated with a higher rate of cannulation and a lower rate of post-ERCP pancreatitis, despite the greater complexity of the procedures. These beneficial effects seem to differ between endoscopists.
Assuntos
Sistema Biliar , Pancreatite , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Cateterismo/efeitos adversos , Cateterismo/métodos , Pancreatite/epidemiologia , Pancreatite/etiologia , Pancreatite/prevenção & controle , Doença IatrogênicaRESUMO
Introducción: la influencia del volumen anual de colangiopancreatografía retrógrada endoscópica (CPRE) en sus resultados ha sido analizada con resultados contradictorios.Objetivo: evaluar la influencia del volumen de CPRE en sus resultados. Material y métodos: análisis sobre base de datos prospectiva comparando los resultados de la CPRE en tres periodos definidos por el número de endoscopistas que la realizan: periodo I, con cinco endoscopistas; periodo II, con cuatro; y periodo III, con tres. Incluimos CPRE biliar en papila acce sible y virgen. Las variables principales fueron las tasas de canulación y los efectos adversos. Los grados de complejidad III y IV, según la clasificación de la Sociedad Americana de Endoscopia Digestiva (ASGE, por sus siglas en inglés), se consideraron procedimientos de alta complejidad. Resultados: fueron incluidos 2.561 pacientes: 727 (periodo I), 972 (periodo II) y 862 (periodo III). No hubo diferencias en edad y sexo entre grupos (p > 0,05). La tasa de canulación fue significativamente mayor en los periodos II y III: 92,4 % vs. 93,3 % vs. 93 % (p = 0,037). La tasa de efectos adver sos (EA) fue de 13,8 %, 12,6 % y 10,3 % (p > 0,05). La tasa de pancreatitis post-CPRE fue significativamente menor en el periodo III: 8,5 %, 7,3 % y 5 % (p = 0,01). El porcentaje de procedimientos de alta complejidad fue de 12 %, 14,8 % y 27 % (p < 0,0001), respectivamente. La regresión logística mostró tasas de canulación y pancreatitis post-CPRE significativamente mejores en el periodo III tras ajustar por sexo, complejidad y endoscopista. Conclusión: un mayor volumen anual de CPRE por endoscopista se asoció con mayor tasa de canulación y menor tasa de pancreatitis post-CPRE, a pesar de la mayor complejidad de los procedimientos. Estos efectos beneficiosos parecen diferir entre endoscopistas(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Competência Clínica , 34600 , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Estudos ProspectivosRESUMO
No disponible
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Humanos , Masculino , Idoso de 80 Anos ou mais , Linfoma de Burkitt/patologia , Neoplasias Gástricas/patologiaRESUMO
No disponible
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Humanos , Masculino , Adulto , Veia Porta/fisiopatologia , Hipertensão Portal/complicações , Trombose Venosa/etiologia , Infecções por HIV/complicações , Melena/etiologiaAssuntos
Infecções por HIV/complicações , Hipertensão Portal/etiologia , Veias Mesentéricas , Veia Porta , Trombose Venosa/complicações , Adulto , Anemia/etiologia , Biópsia , Transfusão de Eritrócitos , Varizes Esofágicas e Gástricas/etiologia , Humanos , Fígado/patologia , Masculino , Melena/etiologiaRESUMO
La fístula pancreaticopleral es una rara complicación de la pancreatitis aguda o crónica, que requiere de tratamiento médico (análogos de somatostatina), endoscópico o quirúrgico para su resolución, siendo el primero de estos de elección. Presentamos el caso de un varón de 64 años que presenta disrupción completa del conducto de Wirsung, diagnosticada mediante ecoendoscopia y complicada con colección subfrénica, perforación diafragmática y posterior empiema. En este caso se ensayó sin éxito tratamiento médico y posteriormente endoscópico, que permitió finalmente la resolución de la lesión anatómica. El paciente precisó además una intervención quirúrgica para conseguir la evacuación de la colección pleural (AU)
Pancreaticopleural fistula is a rare complication of acute or chronic pancreatitis, requiring medical (somatostatin), endoscopic or surgical treatment, with medical treatment being the first option. We describe the case of a 64-year-old man who showed complete disruption of Wirsung's duct that was diagnosed through ultrasound endoscopy and was complicated by the development of a subphrenic collection, diaphragm perforation and subsequent empyema. Medical therapy was attempted without success, and anatomical restoration of the duct was achieved after endoscopic treatment. The patient also required surgery to evacuate the pleural collection (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Fístula Pancreática/complicações , Pancreatite Necrosante Aguda/complicações , Colangiopancreatografia Retrógrada Endoscópica , Endossonografia , Somatostatina/uso terapêutico , DrenagemRESUMO
Pancreaticopleural fistula is a rare complication of acute or chronic pancreatitis, requiring medical (somatostatin), endoscopic or surgical treatment, with medical treatment being the first option. We describe the case of a 64-year-old man who showed complete disruption of Wirsung's duct that was diagnosed through ultrasound endoscopy and was complicated by the development of a subphrenic collection, diaphragm perforation and subsequent empyema. Medical therapy was attempted without success, and anatomical restoration of the duct was achieved after endoscopic treatment. The patient also required surgery to evacuate the pleural collection.
