Análisis de los factores de riesgo de la pancreatitis post-colangiopancreatografía retrógrada endoscópica
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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ANTECEDENTE: la colangiopancreatografía retrograda endoscópica (CPRE) es un procedimiento endoscópico quirúrgico, que entre sus complicaciones la pancreatitis post-CPRE (PPC) es frecuente, con tasas de morbi-mortalidad variada. Los factores de riesgo asociados, se comportan de diferente forma entre una población y otra.
OBJETIVO: determinar los factores de riesgo asociados a la pancreatitis aguda post CPRE.
METODOLOGIA: estudio analítico, correlacional, de cohorte transversal, retroprospectivo, se analizaron 289 pacientes que se realizó CPRE en el Hospital Teodoro Maldonado Carbo, entre diciembre/2018 hasta septiembre/2020. Se realizo un análisis bivariado, y regresión logística multivariada para los factores de riesgo.
RESULTADOS: Los pacientes sometidos a CPRE, la canulación biliar fue 98.3%; y el número de PPC del 7.6%, relación 1:1 hombre mujer. El análisis multivariado para el riesgo de PPC, se identificó los factores relacionados al paciente: grupo >60 años (15.8%, p=0.178), vía biliar extrahepática no dilatada y múltiples litos (p=0.017), tamaño de los cálculos biliares >10mm (p=0.018); y los factores relacionados al procedimiento: tiempo de canulación >10 minutos (p=0.027), técnica de canulación precorte (p=0.003), , esfinteroplastia con balón >12mm (p=0.0001), opacificaciones del conducto pancreático (p=0.004), numero de canulaciones del conducto pancreático >2 (p=0.0001). La regresión logística mostró que el tiempo de canulación (Exp(B)= 3,499) y la técnica de canulación (Exp(B)= 781423,319) son factores de riesgo independientes.
CONCLUSION: Los factores de riesgos para desarrollar PPC pueden minimizarse mediante la evaluación del paciente e indicación previo al procedimiento, y mejora constante técnica al realizar la CPRE.
Palabras clave: CPRE, PANCREATITIS POST-CPRE., FACTORES DE RIESGO, COMPLICACION
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic surgical procedure, among its complications, post-ERCP pancreatitis (CPP) is frequent, with varied morbidity and mortality rates. The associated risk factors behave differently between one population and another. OBJECTIVE: to determine the risk factors associated with post-ERCP acute pancreatitis. METHODOLOGY: Analytical, correlational, cross-sectional, retro-prospective cohort study, analyzed 289 patients who underwent ERCP at the Teodoro Maldonado Carbo Hospital, between December / 2018 and September / 2020. A uni-bivariate analysis and multivariate logistic regression were performed for risk factors. RESULTS: In patients undergoing ERCP, biliary cannulation was 98.3%; and the number of PPC of 7.6%, ratio 1: 1 male female. The multivariate analysis for the risk of CPP identified the factors related to the patient: group> 60 years (15.8%, p = 0.178), non-dilated extrahepatic bile duct and multiple stones (p = 0.017), gallstone size> 10mm (p = 0.018); and the factors related to the procedure: cannulation time> 10 minutes (p = 0.027), precut cannulation technique (p = 0.003), balloon sphincteroplasty> 12mm (p = 0.0001), pancreatic duct opacifications (p = 0.004) , number of pancreatic duct cannulations> 2 (p = 0.0001). The logistic regression showed that the cannulation time (Exp (B) = 3.499) and the cannulation technique (Exp (B) = 781423.319) are independent risk factors. CONCLUSION: The risk factors for developing CPP can be minimized through the evaluation of the patient and indication prior to the procedure, and constant technical improvement when performing ERCP. Keywords: ERCP, POST-ERCP PANCREATITIS., RISK FACTORS, COMPLICATION
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic surgical procedure, among its complications, post-ERCP pancreatitis (CPP) is frequent, with varied morbidity and mortality rates. The associated risk factors behave differently between one population and another. OBJECTIVE: to determine the risk factors associated with post-ERCP acute pancreatitis. METHODOLOGY: Analytical, correlational, cross-sectional, retro-prospective cohort study, analyzed 289 patients who underwent ERCP at the Teodoro Maldonado Carbo Hospital, between December / 2018 and September / 2020. A uni-bivariate analysis and multivariate logistic regression were performed for risk factors. RESULTS: In patients undergoing ERCP, biliary cannulation was 98.3%; and the number of PPC of 7.6%, ratio 1: 1 male female. The multivariate analysis for the risk of CPP identified the factors related to the patient: group> 60 years (15.8%, p = 0.178), non-dilated extrahepatic bile duct and multiple stones (p = 0.017), gallstone size> 10mm (p = 0.018); and the factors related to the procedure: cannulation time> 10 minutes (p = 0.027), precut cannulation technique (p = 0.003), balloon sphincteroplasty> 12mm (p = 0.0001), pancreatic duct opacifications (p = 0.004) , number of pancreatic duct cannulations> 2 (p = 0.0001). The logistic regression showed that the cannulation time (Exp (B) = 3.499) and the cannulation technique (Exp (B) = 781423.319) are independent risk factors. CONCLUSION: The risk factors for developing CPP can be minimized through the evaluation of the patient and indication prior to the procedure, and constant technical improvement when performing ERCP. Keywords: ERCP, POST-ERCP PANCREATITIS., RISK FACTORS, COMPLICATION
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PANCREATITIS, COLANGIOPANCREATOGRAFIA RETROGADA, PERIODO POSOPERATORIO, COMPLICACIONES, FACTORES DE RIESGO, EPIDEMIOLOGIA ANALITICA, ESTUDIOS RETROASPECTIVOS, HOSPITAL DE ESPECIALIDADES DR. TEODORO MALDONADO CARBO, CANTON GUAYAQUIL, ECUADOR