不同内镜逆行胰胆管造影术复杂度分级量表在内镜医师培训中的效用比较

Comparison of the effectiveness of different endoscopic retrograde cholangiopancreatography complexity scales in the training of endoscopists

摘要:

目的 探讨不同内镜逆行胰胆管造影术（ERCP）的复杂度分级，在内镜医师培训中的效用。方法 收集2022年2月－2023年2月华东地区两家医院由进修培训医师完成ERCP治疗的237例患者的临床资料。所有ERCP病例均使用已提出的复杂度分级量表进行分类，包括：美国消化内镜学会（ASGE）分级量表、Morriston分级量表和HOUSE分级量表，并与肝胰壶腹解剖特征分类进行比较。记录患者插管成功率、手术治疗成功率和48 h内并发症发生率。结果 在每一分级中，按严重程度分为亚组，3种不同分级中，亚组组间插管成功率比较，差异有统计学意义（P = 0.000），亚组组间治疗成功率比较，差异有统计学意义（P = 0.000）；并发症发生率与ASGE分级（P = 0.361）、Morriston分级（P = 0.332）、HOUSE分级（P = 0.586）之间没有相关性。当只考虑具有原始乳头的病例时，新加入肝胰壶腹解剖特征分类，插管成功率取决于复杂度分级。ASGE组中，亚组间插管成功率比较，差异有统计学意义（P = 0.004）；Morriston组中，亚组间插管成功率比较，差异有统计学意义（P = 0.002）；HOUSE组中，亚组间插管成功率比较，差异有统计学意义（P = 0.000）；肝胰壶腹特征组中，亚组间插管成功率比较，差异有统计学意义（P = 0.000）；治疗成功率与插管成功率亦有相似的发现（P = 0.000）；并发症发生率与ASGE分级（P = 0.586）、Morriston分级（P = 0.443）、HOUSE分级（P = 0.306）和肝胰壶腹特征分类（P = 0.350）之间没有相关性。结论 使用肝胰壶腹解剖特征，作为胆管插管复杂度分类是可行的，其可以成为一种替代或附加手段，来预测胆管插管和手术治疗是否成功，未来也可用于评估内镜医师培训学习进度和技术水准。

Abstract:

Objective To explore the utility of different endoscopic retrograde cholangiopancreatography (ERCP) complexity scales in the training of endoscopists.Methods Clinical data of 237 patients treated by ERCP completed by trainee physicians at two hospitals in Eastern China from February 2022 to February 2023 were prospectively collected. All ERCP cases were classified using previously proposed complexity grading scales, including the American Society of Gastrointestinal Endoscopy (ASGE), Morriston and HOUSE grading scales, compared with the hepatopancreatic ampulla features classification. Successful intubation, successful surgical treatment and complication rates within 48 h were recorded.Results Within each grading, subgroups were divided according to severity, and the comparison of intubation success rates between subgroups in the 3 different grades showed statistically significant differences (P = 0.000). The treatment success rate and intubation success rate had similar findings (P = 0.000). There was no correlation between the complication rate and ASGE grading (P = 0.361), Morriston grading (P = 0.332), and HOUSE grading (P = 0.586). When only cases with primitive papillae were considered, the intubation success rate depended on the complexity grading after the newly added classification of hepatopancreatic ampulla features. In the ASGE group, the success rate of intubation was compared between different subgroups, and the difference was statistically significant (P = 0.004); in the Morriston group, the success rate of intubation was compared between different subgroups, and the success rate of intubation was statistically significant (P = 0.002); in the HOUSE group, the success rate of intubation was compared between different subgroups, and the difference was statistically significant (P = 0.000); In the hepatopancreatic ampulla characteristics group, the difference in intubation success rate was statistically significant when compared between different subgroups (P = 0.000). Similar findings were also found for treatment success rate and intubation success rate (P = 0.000). There was no correlation between the complication rate and ASGE group (P = 0.586), Morriston group (P = 0.443), HOUSE group (P = 0.306), and hepatopancreatic ampulla characteristics group (P = 0.350).Conclusion The use of hepatopancreatic ampulla features as a classification of biliary cannulation complexity is feasible and could be an alternative or additional means of predicting successful biliary cannulation and surgical treatment success and could be used in the future to assess endoscopist training and learning progress and technical standards.