본문 바로가기
KERD
논문KCI 등재

Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management

2

조회

0

다운로드

5

인용

0

참고문헌

키워드

주제분류내과학

초록

Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

참고문헌 (75)

  1. Cappell MS, "Stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopancreatography in the United States", World J Gastroenterol, 25, pp.3468~3483 (2019)
  2. Dumonceau JM, "ERCP-related adverse events : European Society of Gastrointestinal Endoscopy(ESGE)Guideline", Endoscopy, 52, pp.127~149 (2020)
  3. ASGE Standards of Practice Committee, "Adverse events associated with ERCP", Gastrointest Endosc, 85, pp.32~47 (2017)
  4. Andriulli A, "Incidence rates of post-ERCP complications : a systematic survey of prospective studies", Am J Gastroenterol, 102, pp.1781~1788 (2007)
  5. Cotton PB, "Endoscopic sphincterotomy complications and their management : an attempt at consensus", Gastrointest Endosc, 37, pp.383~393 (1991)
  6. Banks PA, "Classification of acute pancreatitis--2012 : revision of the Atlanta classification and definitions by international consensus", Gut, 62, pp.102~111 (2013)
  7. Freeman ML, "Risk factors for post-ERCP pancreatitis : a prospective, multicenter study", Gastrointest Endosc, 54, pp.425~434 (2001)
  8. Inamdar S, "Pregnancy is a risk factor for pancreatitis after endoscopic retrograde cholangiopancreatography in a national cohort study", Clin Gastroenterol Hepatol, 14, pp.107~114 (2016)
  9. Cheng CL, "Risk factors for post-ERCP pancreatitis : a prospective multicenter study", Am J Gastroenterol, 101, pp.139~147 (2006)
  10. Masci E, "Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography : a meta-analysis", Endoscopy, 35, pp.830~834 (2003)
  11. Cennamo V, "Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? : meta-analysis of randomized controlled trials", Endoscopy, 42, pp.381~388 (2010)
  12. Itoi T, "Endoscopic hemostasis using covered metallic stent placement for uncontrolled post-endoscopic sphincterotomy bleeding", Endoscopy, 43, pp.369~372 (2011)
  13. Dumonceau JM, "Prophylaxis of post-ERCP pancreatitis : European Society of Gastrointestinal Endoscopy(ESGE)Guideline : updated June 2014", Endoscopy, 46, pp.799~815 (2014)
  14. Harewood GC, "Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla", Gastrointest Endosc, 62, pp.367~370 (2005)
  15. Syrén EL, "Outcome of ERCP related to case-volume", Surg Endosc, 36, pp.5339~5347 (2022)
  16. Elmunzer BJ, "A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis", N Engl J Med, 366, pp.1414~1422 (2012)
  17. Ishiwatari H, "No benefit of oral diclofenac on post-endoscopic retrograde cholangiopancreatography pancreatitis", Dig Dis Sci, 61, pp.3292~3301 (2016)
  18. Kato K, "Celecoxib oral administration for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis : a randomized prospective trial", Pancreas, 46, pp.880~886 (2017)
  19. Staritz M, "Effect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure", Gut, 26, pp.194~197 (1985)
  20. Wehrmann T, "Topical application of nitrates onto the papilla of Vater : manometric and clinical results", Endoscopy, 33, pp.323~328 (2001)
  21. Bai Y, "Glyceryl trinitrate for prevention of pancreatitis after endoscopic retrograde cholangiopancreatography : a meta-analysis of randomized, double-blind, placebo-controlled trials", Endoscopy, 41, pp.690~695 (2009)
  22. Sotoudehmanesh R, "A randomized trial of rectal indomethacin and sublingual nitrates to prevent post-ERCP pancreatitis", Am J Gastroenterol, 109, pp.903~909 (2014)
  23. Tomoda T, "Combination of diclofenac and sublingual nitrates is superior to diclofenac alone in preventing pancreatitis after endoscopic retrograde cholangiopancreatography", Gastroenterology, 156, pp.1753~1760 (2019)
  24. Wu M, "Aggressive hydration with lactated ringer solution in prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis", Medicine(Baltimore), 100, pp.e25598~ (2021)
  25. Sperna Weiland CJ, "Increased use of prophylactic measures in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis", Dig Dis Sci, 66, pp.4457~4466 (2021)
  26. Tarnasky PR, "Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction", Gastroenterology, 115, pp.1518~1524 (1998)
  27. Fan JH, "Updated meta-analysis of pancreatic stent placement in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis", World J Gastroenterol, 21, pp.7577~7583 (2015)
  28. Ito K, "Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? : a prospective randomized controlled trial", J Gastroenterol, 45, pp.1183~1191 (2010)
  29. Tse F, "Pancreatic duct guidewire placement for biliary cannulation for the prevention of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis", Cochrane Database Syst Rev, (5), pp.CD010571~ (2016)
  30. Freeman ML, "Pancreatic stent insertion : consequences of failure and results of a modified technique to maximize success", Gastrointest Endosc, 59, pp.8~14 (2004)
  31. Tse F, "Guidewire-assisted cannulation of the common bile duct for the prevention of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis", Cochrane Database Syst Rev, 3(3), pp.CD009662~ (2022)
  32. Cotton PB, "A lexicon for endoscopic adverse events : report of an ASGE workshop", Gastrointest Endosc, 71, pp.446~454 (2010)
  33. Cirocchi R, "A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system", Surgeon, 15, pp.379~387 (2017)
  34. Enns R, "ERCP-related perforations : risk factors and management", Endoscopy, 34, pp.293~298 (2002)
  35. Kumbhari V, "Algorithm for the management of ERCP-related perforations", Gastrointest Endosc, 83, pp.934~943 (2016)
  36. Langerth A, "ERCP-related perforations : a population-based study of incidence, mortality, and risk factors", Surg Endosc, 34, pp.1939~1947 (2020)
  37. Stapfer M, "Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy", Ann Surg, 232, pp.191~198 (2000)
  38. Parlak E, "Endoscopic closure of ERCP-related duodenal perforations by using endoclips : a case series", Surg Laparosc Endosc Percutan Tech, 23, pp.e225~ (2013)
  39. Tyberg A, "Endoscopic management of a GI perforation", Gastrointest Endosc, 82, pp.955~ (2015)
  40. Khater S, "Over-the-scope clip(OTSC)reduces surgery rate in the management of iatrogenic gastrointestinal perforations", Endosc Int Open, 5, pp.E389~ (2017)
  41. Hyun JJ, "Endoscopic suturing of a large type I duodenal perforation", VideoGIE, 4, pp.78~80 (2018)
  42. Zhang LY, "Endoscopic through-the-scope suturing", VideoGIE, 7, pp.46~51 (2021)
  43. Patil NS, "ERCP-related perforation : an analysis of operative outcomes in a large series over 12 years", Surg Endosc, 34, pp.77~87 (2020)
  44. Vezakis A, "Endoscopic retrograde cholangiopancreatography-related perforations : diagnosis and management", World J Gastrointest Endosc, 7, pp.1135~1141 (2015)
  45. Odemis B, "Can a fully covered self-expandable metallic stent be used temporarily for the management of duodenal retroperitoneal perforation during ERCP as a part of conservative therapy?", Surg Laparosc Endosc Percutan Tech, 26, pp.e9~ (2016)
  46. Theopistos V, "Non-operative management of type 2 ERCP-related retroperitoneal duodenal perforations : a 9-year experience from a single center", Gastroenterology Res, 11, pp.207~212 (2018)
  47. Arvanitakis M, "Endoscopic management of acute necrotizing pancreatitis : European Society of Gastrointestinal Endoscopy(ESGE)evidence-based multidisciplinary guidelines", Endoscopy, 50, pp.524~546 (2018)
  48. Paspatis GA, "Diagnosis and management of iatrogenic endoscopic perforations : European Society of Gastrointestinal Endoscopy(ESGE)position statement : update 2020", Endoscopy, 52, pp.792~810 (2020)
  49. Mashiana HS, "Endoscopic retrograde cholangiopancreatography in cirrhosis-a systematic review and meta-analysis focused on adverse events", World J Gastrointest Endosc, 10, pp.354~366 (2018)
  50. 김지연, "Bleeding Complications and Clinical Safety of Endoscopic Retrograde Cholangiopancreatography in Patients with Liver Cirrhosis", Yonsei Medical Journal, 60(5), pp.440~445 (2019), 연세대학교의과대학[DOI]
  51. Hyoung-Chul Oh, "Post-ERCP Bleeding in the Era of Multiple Antiplatelet Agents", Gut and Liver, 12(2), pp.214~218 (2018), 거트앤리버 소화기연관학회협의회
  52. Veitch AM, "Endoscopy in patients on antiplatelet or anticoagulant therapy : British Society of Gastroenterology(BSG)and European Society of Gastrointestinal Endoscopy(ESGE)guideline update", Gut, 70, pp.1611~1628 (2021)
  53. Parras Castañera E, "Predictive factors for post-ERCP bleeding : influence of direct oral anticoagulants", Rev Esp Enferm Dig, 113, pp.591~596 (2021)
  54. Nakaji S, "Hemodialysis is a strong risk factor for post-endoscopic sphincterotomy bleeding in patients with choledocholithiasis", Endosc Int Open, 6, pp.E568~ (2018)
  55. Bae SS, "Risk factor of bleeding after endoscopic sphincterotomy in average risk patients", Surg Endosc, 33, pp.3334~3340 (2019)
  56. Hyun Jik Lee, "Impact of Hospital Volume and the Experience of Endoscopist on Adverse Events Related to Endoscopic Retrograde Cholangiopancreatography: A Prospective Observational Study", Gut and Liver, 14(2), pp.257~264 (2020), 거트앤리버 소화기연관학회협의회
  57. ASGE Standards of Practice Committee, "The management of antithrombotic agents for patients undergoing GI endoscopy", Gastrointest Endosc, 83, pp.3~16 (2016)
  58. Feng Y, "Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis : a meta-analysis of randomized controlled trials", J Gastroenterol, 47, pp.655~663 (2012)
  59. Mirjalili SA, "The arterial supply of the major duodenal papilla and its relevance to endoscopic sphincterotomy", Endoscopy, 43, pp.307~311 (2011)
  60. Wilcox CM, "Patterns of bleeding after endoscopic sphincterotomy, the subsequent risk of bleeding, and the role of epinephrine injection", Am J Gastroenterol, 99, pp.244~248 (2004)
  61. Liu F, "Cap-assisted hemoclip application with forward-viewing endoscope for hemorrhage induced by endoscopic sphincterotomy : a prospective case series study", BMC Gastroenterol, 15, pp.135~ (2015)
  62. Aranez JL, "A novel, duodenoscope-friendly endoscopic clip for treating massive upper-GI bleeding secondary to a Dieulafoy lesion", VideoGIE, 3, pp.205~206 (2018)
  63. Bilal M, "Use of fully covered self-expanding metal biliary stents for managing endoscopic biliary sphincterotomy related bleeding", Endosc Int Open, 9, pp.E667~ (2021)
  64. Dunne R, "Post-endoscopic biliary sphincterotomy bleeding : an interventional radiology approach", Acta Radiol, 54, pp.1159~1164 (2013)
  65. ASGE Standards of Practice Committee, "Antibiotic prophylaxis for GI endoscopy", Gastrointest Endosc, 81, pp.81~89 (2015)
  66. Chen M, "Risk factor analysis of post-ERCP cholangitis : a single-center experience", Hepatobiliary Pancreat Dis Int, 17, pp.55~58 (2018)
  67. Navaneethan U, "ERCP-related adverse events in patients with primary sclerosing cholangitis", Gastrointest Endosc, 81, pp.410~419 (2015)
  68. Othman MO, "A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct", Gastrointest Endosc, 83, pp.151~157 (2016)
  69. Sethi A, "ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone : a single-center experience", Gastrointest Endosc, 73, pp.251~256 (2011)
  70. Harris A, "Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography(ERCP)", Endoscopy, 31, pp.718~724 (1999)
  71. Brand M, "Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography", Cochrane Database Syst Rev, (10), pp.CD007345~ (2010)
  72. Kager LM, "The role of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography; a retrospective single-center evaluation", Scand J Gastroenterol, 47, pp.245~250 (2012)
  73. Tonolini M, "Cross-sectional imaging of common and unusual complications after endoscopic retrograde cholangiopancreatography", Insights Imaging, 6, pp.323~338 (2015)
  74. Chandra S, "Endoscopic retrograde cholangio-pancreatography-obtained bile culture can guide antibiotic therapy in acute cholangitis", Dig Dis, 37, pp.155~160 (2019)
  75. Negm AA, "Routine bile collection for microbiological analysis during cholangiography and its impact on the management of cholangitis", Gastrointest Endosc, 72, pp.284~291 (2010)

관련 논문AI추천

Prevention and Management of Post-Endoscopic Retrograde Cholangiopancreatography ComplicationsMartin Freeman, Michel Kahaleh대한소화기내시경학회 · Clinical Endoscopy2012 · 제45권 제3호Prevention, Detection, and Management of Post-Endoscopic Retrograde Cholangiopancreatography PancreatitisKang Huapyong, Park Chang Hwan, Ryu Kihyun거트앤리버 소화기연관학회협의회 · Gut and Liver2025 · 제19권 제6호Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: The Endoscopic Technique강대환, Byeong Jun Song대한소화기내시경학회 · Clinical Endoscopy2014 · 제47권 제3호Impact of Hospital Volume and the Experience of Endoscopist on Adverse Events Related to Endoscopic Retrograde Cholangiopancreatography: A Prospective Observational Study허준, Chang Min Cho, Dong Wook Lee, Ho Gak Kim, Hyun Jik Lee, Hyunsoo Kim, Jimin Han, Kook Hyun Kim, Kwang Bum Cho, Min Kyu Jung, Tae Nyeun Kim, Yoon Suk Lee거트앤리버 소화기연관학회협의회 · Gut and Liver2020 · 제14권 제2호Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysisEbubekir Daglilar, Mustafa Gandhi, Saad Saleem, Umer Farooq, Zahid Ijaz Tarar대한소화기내시경학회 · Clinical Endoscopy2023 · 제56권 제5호Quality indicators in endoscopic retrograde cholangiopancreatography: a brief review of established guidelinesRajesh Puri, Zubin Dev Sharma대한소화기내시경학회 · Clinical Endoscopy2023 · 제56권 제3호

이 간행물의 다른 논문 (17건)