ERCP ved et norsk universitetssykehus i perioden 2009-2014. Effektivitet og sikkerhet ved ERCP

• Main Author: Aslam, Omeir
• Format: Dissertation
• Language: Norwegian

Abstract Background: From the end of 1960 till todays date, Endoscopic retrograde cholangiopancreatography (ERCP) have had an increased value in the clinical work. ERCP have in high grade replaced surgery in the treatment of biliary and pancreatic stones, drainage of obstructions, abscesses or cysts. As a consequence of the development of CT, MRCP and endoscopic ultrasonography as diagnostic tools most ERCP-procedures are now therapeutic. However, ERCP is the endoscopic procedure with most complication, and the highest mortality rate. Methods: All patients who underwent an attempted or completed ERCP procedure at Akershus University Hospital in the six-year period 2009-2014 were included in the study. The data for 2009-2013 were collected retrospectively, whereas for the year 2014 prospectively. The information was collected from the hospitals medical record system, DIPS, from the endoscopy database, Endobase, and from the national population register. The patient’s health conditions were classified after American Society of Anesthesiologists (ASA score) before the procedure. The patient’s complication risk was classified after the Clavien Dindo classification (CD). The intention of the ERCP procedure was registered as diagnostic, curative, palliative or preoperative ("bridge to surgery"). Results: A total of 894 patients, 473 women (52,9%), and 421 men (47,1%), who underwent 1379 ERCP-procedures (median number of ERCP per patient 1, range 1-12 procedures) were included in the present survey. The median age was 68 years (range 15-96 years). For 987 procedures (71,6%) the aim of the procedure was reached. An ASA-score 1-2 was recorded in 458 patients (51,3%) and 436 patients (48,7%) had ASA score 3-4. For 11,4% procedures the intension was diagnostic, 68,2% curative, and 23,7% palliative. In 944 procedures (68,5%) the indication was biliary concrements (stones), malignant biliary obstruction was indication in 316 (22,9%) procedures. Complication occurred in 191 procedures (13,9%), whereof 62 (4,3%) occurred intraoperatively, and 164 (11,9%) post-ERCP. Severe non-fatal complications (CD 3 or 4) occurred in 47 procedures (3,4%). The total 30 day mortality per procedure was 6,2% (86 deaths), however, in 70 patients death was unlikely to be related to the ERCP, whereas in 16 (1,2%) the cause of death was related to the ERCP procedure. Conclusion: A high proportion of patients are elderly and has an ASA-score of 3-4. Most ERCP-procedures are therapeutic; the mos