Yüksek Asa Skoruna Sahip ERKP Endikasyonu Olan Hastalarda ERKP’nin Güvenliliğinin Değerlendirilmesi

Abstract

ERCP (Endoscopic Retrograde Cholangiopancreatography) is an invasive procedure performed under sedation and is considered a relatively safe procedure. Since its first description in 1968, it has been an invaluable method for the diagnosis and treatment of pancreaticobiliary diseases. However, despite adhering to technological advances, educational programs, and safety protocols, ERCP has been associated with a higher rate of complications than most other endoscopic procedures; pancreatitis, cholangitis, bleeding, perforation are common complications. For this reason, it is recommended to use scoring systems that will provide risk estimation before the procedure. The ASA scoring system, which is known to accurately predict perioperative/postoperative morbidity and mortality, is also used in endoscopic procedures performed under sedation. And a higher ASA score is assumed to be associated with more adverse events. In this study, the safety of endoscopic retrograde cholangiopancreatography was investigated in patients over the age of 18 who were categorized according to ASA class. Between November 2018 and April 2021, 517 patients [341 (49.9%) female, median age 56.5 (18-95)] who underwent ERCP 683 times for various indications at Hacettepe University Hospital Medical Faculty Endoscopy Unit were included in the study. Demographic data, comorbidities, admission/service unit, ERKP indication, ERKP findings, procedures and complications after ERCP were analyzed of the patients. The patients included in the study were divided into two groups according to their ASA score; Group 1 includes patients with an ASA score of 1-2, while group 2 includes patients with an ASA score of 3-4-5. While 506 procedures with an ASA score of 1-2 were recorded in group 1, 177 procedures with an ASA score of 3-4-5 were included in group 2. In the statistical analyzes performed, the mean age of group 1 was lower than group 2 [53.38 ±16.89 x 65.44 ±14.85 and p=<0.001]. When both groups are evaluated in terms of comorbidities, there are higher rates of comorbidity in group 2 patients compared to group 1 [255 (50.4%) x 164 (92.7%) and p=<0.001]. When both groups are compared, patients diagnosed with malignant disease are usually in group 2 [51 (10.1%) x 85 (48%) and p=<0.001]. The hospitalization period of the patients in group 1 was shorter than the patients in group 2 [ 8.76±7.54 x 12.80±10.53 and p=<0.001]. Adverse events after ERKP were reported in 95 of 683 procedures; however, there weren't statistically significant difference between the two groups [65 (12.8%) x 30 (16.9%) and p=0.175]. The most common complication in both groups were reported as cholangitis [32 (6.3%) x 14 (7.9%) and p=0.331]. While acute pancreatitis was seen in 12 (2.3%) patients after the procedure in group 1, it was not seen in group 2. While bleeding was detected in 5 (0.9%) patients in group 1, it was detected in 7 (3.9%) patients in group 2; although there is no statistically significant difference, it is a borderline value (p=0.055). Perforation was detected at 5 (0.9%) patients in group 1 and 1 (0.5%) patient in group 2; there was no statistically significant difference (p=0.677). Sepsis was detected at 7 (%1,3) patients in group 1 and 3 (%1,6) patients in group 2; there was no statistically significant difference (p=0.766). No procedural death occurred after ERCP. Twenty patients who were followed up died due to different reasons not related to the procedure, depending on the course of the current acute diseases. As expected, these patients were included in group 2. Despite the advances in ERKP techniques, post-procedure complications are still not completely prevented. One study demonstrated an increased risk of any adverse event or serious adverse event in patients undergoing esophagogastroscopy and colonoscopy in correlation with the ASA score, but this association did not occur in ERKP; however, while evaluating the sedation-related and nonspecific complications of ERCP in this study, the specific complications were not evaluated. For this reason, the specific complications of ERCP were evaluated in our study. In our study, in which 683 patients who underwent ERCP were analyzed retrospectively, it was observed that high ASA score did not lead to a significant difference in morbidity and mortality. Thus, we wanted to state that adverse events are independent of the ASA score, and that ERCP can be performed safely, especially in the high-risk patient group. Therefore, ERCP may be safer than alternative invasive procedures and may be preferred primarily in patients with high ASA scores.