ercp-外科实习读书报告课件

ComplicationsRelatedToEndoscopicRetrogradeCholangiopancreatography:AComprehensiveClinicalReviewAbstractover500,000ERCPyearlyinUSindications,contraindications,potentialcomplications,benefits,andalternativestoERCP.contraindicationsAbsolutecontraindicationspharyngealoresophagealobstructionactivecoagulopathyanaphylacticreactiontocontrastdye

Relativecontraindicationsportalhypertensionwithesophagealand/orgastricvaricesacutepancreatitis(exceptgallstonepancreatitis)recentmyocardialinfarctionseverecardiopulmonarydisease

Peri-proceduralantibiotichigh-riskfordevelopinginfectiveendocarditis，artificialprostheticimplantinfectionsAntibioticsshouldbecontinuedfor48-72hoursComplicationspancreatitischolangitisduodenalhemorrhagestentmigrationduodenalperforation……ComplicationsShort-termcomplications(<3days)sedation-and/orendoscopyrelated,bleeding,infection,perforation,andcardiopulmonaryeventsLong-termcomplications(>3days)mainlyinfectionsassociatedwithindwellingstentsandinflammatorychangessecondarytoductalmanipulation.pancreatitis1%to6%(a)new-onsetorworseningabdominalpain(b)elevationofserumamylasethreetimesabovenormalat24hourspostprocedure(c)requirementfor>2daysofpancreatitisrelatedhospitalizationriskfactorspreviouspost-ERCPpancreatitissuspectedsphincterofOddidysfunction,femalegenderabsenceofchronicpancreatitisballoondilatationofthebiliarysphincterdifficultcannulationpancreaticsphincterotomy>1injectionsofcontrastintothepancreaticductage<60yearsthreeriskfactorsforpost-ERCPpancreatitiswerepresent:age<60years,non-therapeuticERCP,and>1injectionofcontrast.Pancreatitisresolvedfollowingfivedaysofhospitalization.onestudy,stentplacementenhancedductaldrainagepastthehypertensivesphincterandreducedtheincidenceofpancreatitisfrom26%to7%.pharmacologicinterventions:Neithersomatostatin,noritsanalogue,octreotide,appearedtoreducetherateofpost-ERCPpancreatitisHemorrhagiccomplications1-2%(A)PositioningoftheERCPequipmentforasphincterotomy;(B)Post-sphincterotomyoozingthatevolvedinto(C)continuedbleedingrequiringepinephrineinjectionforcontrol.(D)Self-limitedpost-sphincterotomybleeding.Perforations0.3%to0.6%(a)guidewire-relatedperforations(b)peri-ampullaryperforationsduringsphincterotomy;(c)perforationsthatareremotefromthepapillaPerforationsRetroperitonealduodenalperforationfollowingERCPandsphincterotomy.Thepatientunderwentsuccessfulnonoperativetherapy:bowelrest,nasogastricsuctioning,andbroad-spectrumantibioticsCholangitis1-3%AdequatebiliarydrainagestentsandnasobiliarytubesCholecystitis0.5%cholecystectomyComplicationsofsphincterotomypancreatitis(5.2-5.4%)hemorrhage(2.0%)stentplacement/

manipulationstentobstruction(oftenleadingtoinfection/cholangitis)stentmigrationrecurrentductalstenosispost-stentremovalPancreatitisbleedingERCPinpregnancyAlthoughsymptomaticgallstonediseaseiscommoninpregnantwomen(incidence>10%),choledocholithiasisrequiringinterventionduringpregnancyisrare(incidence<1%)

postpartumperiodoruntilsecondtrimester,relativelysafer.ConclusionsOperatorexperience,avoidanceofunnecessaryp