2017- 2022 yılları arasında ERCP yapılan hastalarda gelişen komplikasyonların retrospektif incelenmesi
Retrospective analysis of complications arising in patients undergoing ERCP between 2017 and 2022
Yazar: ECE ALTINKAYNAK
Danışman: PROF. DR. MACİT GÜLTEN
Bursa Uludağ Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2023
Konu: Gastroenteroloji = Gastroenterology ; İç Hastalıkları = Internal diseases
Dizin: ERCP =

Özet:
ENDOSKOPİK RETROGRAD KOLANJİOPANKREATOGRAFİ (ERCP); SAFRA YOLLARI VE
PANKREAS HASTALIKLARININ TANI VE TEDAVİSİNDE KULLANILAN İNVAZİV BİR YÖNTEMDİR.
ERCP'NİN EN SIK GÖRÜLEN KOMPLİKASYONLARI; PANKREATİT, KANAMA, KOLANJİT,
KOLESİSTİT VE PERFORASYONDUR. ÇALIŞMAMIZDA 01.12.2017-01.12.2022 TARİHLERİ ARASINDA BURSA
ULUDAĞ ÜNİVERSİTESİ TIP FAKÜLTESİ İÇ HASTALIKLARI ANABİLİM DALI GASTROENTEROLOJİ
BÖLÜMÜNDE ERCP YAPILAN VE KOMPLİKASYON GELİŞEN HASTALARIN DEMOGRAFİK
ÖZELLİKLERİNİN, ERCP BULGULARININ, ERCP ESNASINDA GERÇEKLEŞTİRİLEN
MÜDAHALELERİN, İŞLEME BAĞLI KOMPLİKASYONLARIN, ERCP ESNASINDA
GERÇEKLEŞTİRİLEN MÜDAHALELER İLE KOMPLİKASYONLAR ARASINDAKİ İLİŞKİLERİN VE TEDAVİ
SONRASI KLİNİK DURUMLARININ RETROSPEKTİF OLARAK İNCELENMESİ VE DEĞERLENDİRİLMESİ
AMAÇLANMIŞTIR. ÇALIŞMAYA ALINAN HASTALARIN BİLGİLERİNE HASTANEMİZ BİLGİ SİSTEMİ
DİJİTAL ORTAMINDAN RETROSPEKTİF OLARAK ULAŞILMIŞTIR. 5 YILLIK SÜREÇTE 1934 ERCP İŞLEMİ YAPILMIŞTIR. 150 HASTADA İŞLEM SONRASI KARIN AĞRISI ŞİKAYETİ GELİŞMİŞTİR. 102(%5,2) HASTADA KOMPLİKASYON
TESPİT EDİLMİŞTİR. HASTALARIN 58'İNDE (%2,9) PANKREATİT, 29'UNDA (%1,4) KOLANJİT,
7'SİNDE (%0,36) KANAMA, 8'İNDE (%0,41) PERFORASYON, 6'SINDA (%0,31) KOLESİSTİT, 4'ÜNDE (%0,2) APSE GELİŞMİŞTİR. ERCP YAPILAN HASTALARIN 5'İ (%0,25) EXİTUS OLMUŞTUR. HASTALARIN 2'Sİ PANKREATİT, 2'Sİ KOLANJİT, 1'İ PANKREATİT VE APSE NEDENİYLE EXİTUS OLMUŞTUR. KOMPLİKASYON GELİŞEN HASTALARIN 70'İ KADIN, 32'Sİ ERKEKTİR. YAŞ ORTALAMALARI 56,9±15,7'DİR. KANAMA GELİŞMESİ İLE YAŞ ARASINDA İSTATİSTİK OLARAK ANLAMLI BİR İLİŞKİ GÖZLENMİŞTİR (P=0,045). KANAMA GELİŞEN HASTALARIN
ÇOĞUNLUĞUNUN ≥65 YAŞ OLDUĞU GÖRÜLMÜŞTÜR. PANKREATİK KANALA GUİDE WİRE KAÇIŞI İLE KOMPLİKASYONLAR ARASINDA İSTATİSTİKSEL OLARAK ANLAMLI FARKLILIK SAPTANMIŞTIR(P=0,032). PANKREATİK KANALA
GUİDE WİRE KAÇIŞI OLAN HASTALARIN 22'SİNDE (%81,5) PANKREATİT GELİŞTİĞİ TESPİT
EDİLMİŞTİR. HASTALARIMIZIN KOMORBİTELERİNİN, KULLANDIĞI İLAÇLARIN VE METABOLİK RİSK
FAKTÖRLERİNİN ARAŞTIRILMAMASI VE ÇALIŞMAMIZIN RETROSPEKTİF OLMASI ÇALIŞMAMIZ
İÇİN KISITLILIK OLUŞTURMAKTADIR. HASTA RİSK FAKTÖRLERİ İNCELENEREK, PROSPEKTİF BİR
ÇALIŞMA YAPILMASININ DAHA GÜVENİLİR SONUÇLAR ELDE EDİLMESİNE KATKI
SAĞLAYACAĞINI DÜŞÜNMEKTEYİZ.

Abstract:
Endoscopic retrograde cholangiopancreatography (ERCP) is an
invasive procedure used for the diagnosis and treatment of biliary and
pancreatic diseases. The most common complications of ERCP include
pancreatitis, bleeding, cholangitis, cholecystitis, and perforation.
The aim of our study was to retrospectively examine and evaluate the
demographic characteristics of patients who underwent ERCP and developed
complications, ERCP findings, interventions performed during the procedure,
procedure-related complications, the relationship between interventions
performed during ERCP and complications, and post-treatment clinical
outcomes in the Department of Gastroenterology, Division of Internal
Medicine, Uludağ University Medical Faculty between December 1, 2017, and
December 1, 2022. The information of the included patients was retrieved
retrospectively from the hospital information system in digital format.
During a five-year period, a total of 1934 ERCP procedures were
performed. Post-procedure abdominal pain was reported in 150 patients.
Complications were detected in 102 patients (5.2%). Among them, 58 patients
(2.9%) developed pancreatitis, 29 patients (1.4%) developed cholangitis, 7
patients (0.36%) experienced bleeding, 8 patients (0.41%) had perforation, 6
patients (0.31%) developed cholecystitis, and 4 patients (0.2%) had abscess
formation. Among the patients who underwent ERCP, 5 (0.25%) died. Two
patients died due to pancreatitis, two due to cholangitis, one due to pancreatitis
and abscess. Of the patients who developed complications, 70 were female and 32
were male. The mean age was 56.9±15.7. There was a statistically significant
relationship between the development of bleeding ixatüreix (p=0.045). The
majority of patients who experienced bleeding were ≥65 years old.
Statistically significant differences were observed between
complications and the escape of guide wire into the pancreatic duct (p=0.032).
It was determined that 22 patients (81.5%) who experienced guide wire escape
into the pancreatic duct developed pancreatitis.
The limitations of our study include the lack of investigation into
patients' comorbidities, medication use, and metabolic risk factors, as well as
the retrospective ixatüre of the study. We believe that conducting a prospective
study by examining patient risk factors would contribute to obtaining more
reliable results.