Ulus Travma Acil Cerrahi Derg. 2017; 23(5): 395-399 | DOI: 10.5505/tjtes.2017.05435

Bir acil cerrahi kliniðinin endoskopik retrograd kolanjiyopankreatografi komplikasyonlarý ile ilgili deneyimi

Osman Þimsek, Arife Þimsek, Sefa Ergun, Mehmet Velidedeoðlu, Kaya Sarýbeyoðlu, Salih Pekmezci
Ýstanbul Üniversitesi Cerrahpaþa Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul

AMAÇ: Bu çalýþmanýn amacý farklý endoskopi merkezleri tarafýndan kliniðimize yönlendirilen endoskopik retrograd kolanjiyopankreatografi (ERCP) komplikasyonlarý ile ilgili deneyimimizi aktarmaktýr.
GEREÇ VE YÖNTEM: ERCP komplikasyonu nedeniyle Ekim 2005–Ocak 2014 tarihleri arasýnda acil cerrahi kliniðimize yönlendirilen 54 hastanýn kayýtlarý geriye dönük incelendi.
BULGULAR: Çalýþmada 25 kadýn, 29 erkek hasta yer aldý. Pankreatit en sýk görülen komplikasyon (%38.8) idi. Perforasyon (%27.7), enfeksiyon
(%20.3) ve kanama (%12.9) diðer sýk görülen komplikasyonlardý. En yüksek oran perforasyonlu hastalarda (%40) olmak üzere olgularýn %22.2’si ölüm ile sonuçlandý. Ölen olgularýn ortalama yaþý 75.9 idi (daðýlým, 47–94). Ölümlerin %41.6’sý ERCP sonrasý ilk hafta, %33.3’ü ikinci hafta içerisinde gerçekleþti. Ölen hastalarýn %50’sinde malign bir hastalýk mevcuttu (birisinde metastatik meme kanseri, birisinde safra kesesi tümörü, birisinde duedonum tümörü, üçünde periampuller tümör). Ölen hastalarýn %50’sinde kardiyopulmoner ve/veya serebrovasküler hastalýklar da mevcuttu.
TARTIÞMA: Risk faktörlerini bilerek uygun yönetimin saðlanmasý komplikasyon oranýný en aza indirse de tamamen ortadan kaldýramaz. Orta ve ciddi dereceli komplikasyonlar özellikle yüksek riskli hastalarda mortaliteyi artýrabilir.

Anahtar Kelimeler: Endoskopi, enfeksiyon, ERCP, komplikasyon, pankreatit, perforasyon.

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Managing endoscopic retrograde cholangiopancreatography-related complications in patients referred to the surgical emergency unit

Osman Þimsek, Arife Þimsek, Sefa Ergun, Mehmet Velidedeoðlu, Kaya Sarýbeyoðlu, Salih Pekmezci
Department of General Surgery, Ýstanbul University, Cerrahpaþa Faculty of Medicine, Ýstanbul-Turkey

BACKGROUND: The goal of this study was to present our experience in the management of endoscopic retrograde cholangiopan- creatography-related complications in patients referred to our surgical emergency unit by various endoscopy centers.
METHODS: A retrospective investigation was conducted on the records of the 54 patients who were referred to our surgical emer- gency unit between October 2005 and January 2014 due to endoscopic retrograde cholangiopancreatography-related complications.
RESULTS: There were 25 and 29 female and male patients, respectively. Pancreatitis was the most common complication (38.8%). Perforation (27.7%), infection (20.3%), and bleeding (12.9%) were the other complications. In 22.2% of cases, patients were died. The mortality rate was the highest in patients with perforation (40%). The mean age of the patients who were died due to complications was 75.9 years (range, 47–94 years). In total, 41.6% of the patients were died within the first week and 33.3% were died within the second week following ERCP. Nearly half of these patients had a cancerous disease (one had metastatic breast cancer, one had a gallbladder cancer, one had a duodenal cancer, and the other three had periampullary cancers) and 50% of the patients who died also had cardiopulmonary and/or cerebrovascular disorders.
CONCLUSION: Comprehending and managing the main risk factors can minimize complications; however, they would not be elimi- nated. Moderate and severe complications may increase the mortality rates, particularly in high-risk patients.

Keywords: Complication, endoscopy, ERCP, infection, pancreatitis, perforation.

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