有关内镜下逆行胰胆管造影术的几点思考

内镜下逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）诞生于60年代后期，1974年内镜下乳头括约肌切开术首次报道。随着影像技术的进步，磁共振胆胰管成像因其无创、无射线、无需造影剂等优点己逐步取代诊断性ERCP，成为胰胆疾病首选的诊断方法。ERCP逐渐转向胰胆疾病的治疗，在短短几十年中ERCP取得了巨大的成就，成为当今胰胆疾病重要的治疗手段。[第一段]     

ERCP诊治指南（2010版）（三）

胰腺疾病的ERCP诊治指南 一、ERCP对胰腺疾病的诊断作用 1．单纯胰管造影（ERP）对于慢性胰腺炎、自身免疫性胰腺炎、侵及主胰管的肿瘤病变具有较高的诊断价值,但对其他病变,尤其是仅累及胰腺实质或分支胰管的病变则敏感性较低。     

ERCP临床应用进展

经内镜逆行胰胆管造影术 (ERCP)是 6 0年代后期发展起来的一项崭新的内镜诊疗技术 ,最初被用于胰胆管系统疾病的诊断。近 2 0余年来 ,随着影像学技术的不断发展 ,就诊断而言 ,磁共振胰胆管成像术 (MRCP)已逐步取代ERCP ,成为胰胆管系统疾病诊断方法的首选 ,其具有无创、无X线照射、不需造影剂等优点 ,是观察胰胆管结构的良好方法 ,而ER CP逐渐转向胰胆管系统疾病的治疗。自 1974年开展内镜下乳头括约肌切开术以来 ,胰胆管内镜治疗技术得到飞速发展 ,如今 ,内镜下括约肌切开术、鼻胰 /胆管引流术和内镜下支架植入等技术已广泛应用于临…     

ERCP诊治指南(2018版)

正自20世纪60年代内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)问世以来,开创了胆胰疾病新的治疗领域,随着医学材料科学、影像学及临床经验的积累,ERCP已不再局限于"造影术",括约肌切开、扩张、引流等ERCP相关的治疗技术也逐渐开始涌现。我国的ERCP技术起步于20世纪70年代初,历经近半个世纪的发展与推广,目前已经成为国内诊断和治疗胆胰疾病的重要手段。2010年,由中华医学会消化内镜学     

ERCP诊治指南（2010版）（二）

胆管良恶性狭窄的ERCP诊治 一、胆管狭窄的ERCP诊断 1．良性和恶性胆管狭窄在临床上一般均以梗阻性黄疸和（或）胆管炎为主要表现,通过血液检验和一线的影像学检查（如腹部超声、CT、MRI或MRCP等）,通常可确立诊断。ERCP作为二线的检查手段,在对于上述检查仍不能确诊或已确诊需要介入治疗时使用,不建议单纯实施ERCP诊断。     

ERCP诊治胆胰疾病的临床应用

目的 探讨经内镜逆行胰胆管造影术(ERCP)在胆胰疾病诊治中的应用和减少并发症发生的方法。方法 术前禁食6h，在全麻或镇静下行逆行胰胆管造影，根据检查结果，选择性镜下治疗。结果 诊断性ERCP逐渐转向较多的治疗性ERCP，ERCP在胆胰疾病诊治中的应用范围扩大。结论 治疗性ERCP是胆胰疾病微创治疗的发展趋势。     

ERCP诊治胆胰疾病的临床应用

目的 探讨ERCP在胆胰疾病诊治中的应用方法及如何减少并发症的发生。方法 术前禁食6h，在全麻或镇静下行逆行胰胆管造影，根据检查结果，选择性镜下治疗。结果 ERCP成功率为87．3％，经内镜治疗的75例患者有1例发生穿孔，2例合并胰腺炎。结论 治疗性ERCP是胆胰疾病微创治疗的发展趋势。     

加贝酯在ERCP诊治术后的临床应用评价

目的观察加贝酯在预防ERCP术后引起的高淀粉酶血症和急性胰腺炎的有效性。方法两组行ERCP的病人,试验组应用加贝酯。观察试验组和对照组患者术后血清淀粉酶的变化。结果试验组术后高淀粉酶血症及急性胰腺炎发生率明显低于对照组(P<0.05)。结论加贝酯能有效预防ERCP术后高淀粉酶血症及急性胰腺炎的发生。     

ERCP和EST术的配合及护理

内镜逆行胰胆管造影(ERCP)和十二指肠乳头括约肌切开术(EST)已成为胰胆管疾病常用的诊断和治疗手段，合理、积极的护理配合是确保ERCP和EST顺利完成的一个重要因素。本文总结44例ERCP检查和9例EST的护理体会，现报告如下。     

MRCP对ERCP胆管插管难度预测的价值

目的:探讨磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)对内镜下逆行胆胰管造影术(endoscopic retrograde cholangiopancreatography,ERCP)胆管插管难度预测的价值.方法:采用回顾性分析方法,收集93例术前行MRCP检查的ERCP患者,根据ERCP胆管插管难易程度将患者分为ERCP胆管插管困难组(A组,30例)和非困难组(B组,63例).对两组患者MRCP图像上相关解剖学指标(包括胆总管直径、胰管直径、胆胰管汇合角度、胆胰管汇合点与十二指肠内壁间距、胆胰管末端间距)进行观察和测量,比较分析两组患者MRCP图像上述解剖指标数据的差别,探讨其对ERCP胆管插管难度预测的价值.结果:ERCP胆管插管成功率为98.92%.两组患者MRCP上胆总管直径、胆胰管汇合角度存在差异(4.48±1.27 vs 6.73±2.32;25.89±14.40 vs 43.37±24.88,P<0.05),而两组患者性别、年龄、胰管直径、胆胰管汇合点与十二指肠内壁间距、胆胰管末端间距的差异无统计学意义.ERCP胆管插管难度与MRCP图像上胆总管直径、胆胰管汇合角度有相关性(P<0.05),而与胰管直径、胆胰管汇合点与十二指肠内壁间距、胆胰管末端间距无相关性.结论:ERCP术前常规行MRCP检查对判定ERCP胆管插管难易程度有一定指导意义.     

Bacteremia following diagnostic and therapeutic ERCP.

The occurrence of bacteremia in association with diagnostic or therapeutic ERCP was studied in 180 patients undergoing a total of 194 examinations. Nineteen (15%) of 126 diagnostic procedures and 18 (27%) of 68 therapeutic procedures were associated with bacteremia (p less than 0.1). Nine patients had polymicrobial bacteremia and a total of 16 species were detected. Different streptococci, mainly alpha-hemolytic, were the most common bacteria which were identified in 38% of the bacteremic patients. There were no significant differences with regard to the occurrence of fever, pancreatitis, or septic complications between the diagnostic and therapeutic groups of patients. Neither did the complication rate in patients with bacteremia differ from that in patients without bacteremia, whether the procedure was diagnostic or therapeutic. Complication rates did not differ between patients with and patients without pancreaticobiliary obstruction. However, the majority of patients with biliary stasis had drainage with relief of the obstruction at the time of the diagnostic ERCP. We conclude that general routine antibiotic prophylaxis is not indicated in patients undergoing diagnostic or therapeutic ERCP. The question whether such prophylaxis should be given with certain diagnoses or treatments, or in patients with valvular heart disease, remains to be answered in controlled randomized studies.     

Use of a double-channel duodenoscope for diagnostic and therapeutic ERCP

BACKGROUND: A double-channel duodenoscope has the potential to shorten ERCP procedure time or improve procedure success rates because tasks can be done in parallel through variably situated accessory channels. METHODS: We prospectively evaluated a prototype double-channel duodenoscope in 102 patients, recording findings, procedural success, and potential advantages or problems associated with the instrument. RESULTS: Both channels were used in 79 cases (77%) and a single-channel in the remainder. Ninety-nine percent (101 of 102) of diagnostic and 95% (87 of 92) of therapeutic ERCPs were successful. Instrument advantages included decreased procedure time (23%), cannulation/procedural ease (16%), and miscellaneous (6%). Disadvantages were noted in 15% of the patients and were related to instrument diameter and diameter of the accessory channels. CONCLUSIONS: Additional study of second generation dual-channel duodenoscopes appears warranted.     

ERCP update: diagnostic and therapeutic applications.

Endoscopic retograde cholangiopancreatography (ERCP) is currently utilized to evaluate jaundice, both intra- and extrahepatic, and can differentiate between these by demonstrating specific anatomic lesions. ERCP is definitive in the evaluation of gallbladder disease when other modalities are indefinite. For the first time outside the operating room, the pancreatic duct can be opacified by ERCP. The newest application of ERCP, endoscopic papillotomy (EP), has revolutionized the treatment of common bile duct gallstones and stenosis of the duct, offering a safe and effective alternative to repeated surgery, especially in those patients at risk. Because of these diverse and effective applications, ERCP has become firmly established in our diagnostic armamentarium.     

诊断性与治疗性ERCP早期并发症与处理

目的 探讨诊断性及治疗性ERCP早期并发症发生情况及处理。方法 回顾总结了我国23年间8579例次诊断性与治疗性ERCP临床资料。分析了早期并发症发生情况。种类、处理及预后。结果 23年间8579例ERCP诊疗中，共发生早期并发症112例（1.31%)，其中诊断性ERCP发生率为1.30%(95/7290)，治疗性ERCP为1.32%(17/1289)，并发水肿型胰腺炎38例（0.44%)，胆道感染30例（0.35%)，消化道大出血26例（0.30%)，药物反应8例（0.09%)，结石及取石篮嵌顿5例（0.06%)，肠穿孔3例（0.03%)，急性出血坏死型胰腺炎1例（0.01%)，后腹膜腔积气1例（0.01%）。112例并发症中，经内科保守治疗痊愈106例（94.6%)，外科手术治疗5例（4.5%(。1例死亡。结论 诊断性ERCP并发症中以急性胰腺炎发生率为高，可能与插管困难，反复显影，注射造影剂压力过大，量过多有关；治疗性ERCP并发症中以出血为常见，与操作技术，伴有黄疸及糖尿病等因素有关。绝大多数并发症可经内科保守治疗而得以痊愈，仅极少数患者需外科手术处理。     

胰腺分裂症的ERCP诊断与治疗价值（附10例临床分析）

目的探讨胰腺分裂症(Pancreatic     

Complications of diagnostic and therapeutic ERCP: a prospective multicenter study

OBJECTIVES: Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP/ES) can be associated with unforeseeable complications, especially when involving postprocedural pancreatitis. The aim of the study was to investigate risk factors for complications of ERCP/ES in a prospective multicentric study. METHODS: One hundred fifty variables were prospectively collected at time of ERCP/ES and before hospital discharge over 2 years, in consecutive patients undergoing the procedure in nine endoscopic units in the Lombardy region of Italy. More than 150 ERCPs were performed in each center per year by a single operator or by a team of no more than three endoscopists. RESULTS: Two thousand four hundred sixty-two procedures were performed; 18 patients were discharged because the papilla of Vater was not reached (duodenal obstruction, previous gastrectomy, etc.). Two thousand four hundred forty-four procedures were considered in 2103 patients. Overall complications occurred in 121 patients (4.95% of cases): pancreatitis in 44 patients (1.8%), hemorrhage in 30 (1.13%), cholangitis in 14 (0.57%), perforation during ES in 14 (0.57%), and others in 14 (0.57%); deaths occurred in three patients (0.12%). In multivariate analysis, the following were significant risk factors: a) for pancreatitis, age (< or = 60 yr), use of precutting technique, and failed clearing of biliary stones, and b) for hemorrhage, precut sphincterotomy and obstruction of the orifice of the papilla of Vater. CONCLUSIONS: The results of our study further contribute to the assessment of risk factors for complications related to ERCP/ES. It is crucial to identify high risk patients to reduce complications of the procedures.     

Postcholecystectomy syndrome in northern India--study on the diagnostic and therapeutic role of ERCP

One hundred and twenty two patients with postcholecystectomy syndrome were studied by endoscopic retrograde cholangiopancreatography (ERCP). The procedure was successful in 105 patients (85.3%) and it accurately detected abnormality of the pancreatico-biliary system in 71 patients (67.6%). ERCP results were abnormal in 82.6% of patients with biliary symptoms, with or without jaundice, compared with 34.7% of patients with non-biliary symptoms (P less than 0.001). Though ERCP showed abnormality in all patients with biliary symptoms and jaundice, as many as 70.4% of patients without jaundice had abnormal ERCP. The commonest abnormality was retained/recurrent stones (37/105 patients). Patients with biliary strictures presented significantly more often with jaundice compared with patients with biliary stones (74.3% vs 22.3%). In 19 of the 37 patients with retained biliary stones endoscopic sphincterotomy was performed and it was successful in 16 patients (84.2%). Our data indicates that ERCP detects the anatomical level as well as the nature of lesion accurately, and is essential and safe in the diagnosis and management of patients with postcholecystectomy syndrome.