ERCP Preoperative Gargle Of Compound Chlorhexidine To Reduce Intraoperative Study On Contamination Of Duodenoscope

Objective:Endoscopic Retrograde Cholangiopancreatography(ERCP)has played an important role in the diagnosis and treatment of pancreaticobiliary duct diseases since its birth in 1968.Acute Cholangitis is one of the common complications after ERCP.The incidence of acute suppurative Cholangitis is high.One of the causes of acute cholangitis is that during ERCP,the duodenum was contaminated by oral bacteria,and then was brought into the bile duct by operating instruments.At present,there are few reports about how to reduce the oral cavity contamination caused by Duodenum.At present,there are few researches on methods to reduce oral contamination of duodenoscope,and there is no consensus.In this study,patients with ERCP were taken as the research object,and the bacteria culture result of duodenoscope irrigation fluid was used as the research index to compare the three groups of compound chlorhexidine gargle gargle group,sterile saline gargle group,and non-gargle group to analyze whether oral gargle before operation can reduce the oral contamination of the duodenoscope,provide a theoretical basis for how to reduce the incidence of acute cholangitis after ERCP,and improve the preoperative preparations for ERCP provide experimental basis.Methods:1.Patients hospitalized in the Department of Gastroenterology of Chengde Central Hospital for biliary and pancreatic diseases from November2019 to November 2020 were selected.After assessment,ERCP examination and treatment were required.There were no contraindications for ERCP operation and no allergy to gargle components.According to the principle of random grouping,the patients were divided into compound chlorhexidine gargle with gargle group,sterile normal saline gargle group and no gargle group.A total of 288 cases of effective data were obtained.2.All pharyngeal swabs were taken 30min before ERCP for bacterial culture by plate scribing method.After taking pharyngeal swabs,the oral gargle group with compound chlorhexidine gargle and the sterile saline gargle group were instructed to perform oral gargle.During ERCP,the duodenoscope was inserted into the upper esophagus 20 cm away from the incisor teeth,and the three groups of duodenoscope rinse fluids were taken for bacterial culture by plate scriping method.3.The single-blind method was used to determine the statistical results,and the severity of bacterial contamination was determined according to the growth of bacteria zoning.4.SPSS 25.0 statistical software was used for statistical analysis.The mean±standard deviation(X±S)of measurement data reuse was expressed.Analysis of variance was used for comparison between multiple groups,and T test was used for comparison between two groups.Statistical data were expressed as percentage or rate(%),andχ~2test was used for comparison between groups.P<0.05 was considered statistically significant.Results:1.The age and gender of compound chlorhexidine gargle group,aseptic normal saline gargle group and no gargle group were statistically analyzed,and there was no significant difference(P>0.05).2.Comparison of the results of oral pharyngeal swab culture and duodenoscope rinse solution culture among the three groups:there was no statistical significance in the comparison of pharyngeal swab culture among the three groups(F=0.594,P=0.553);There were statistically significant differences in the results of duodenoscopic rinse culture among the three groups(F=117.00,P?0.01).3.Pharyngeal swab culture and duodenoscopic rinse fluid culture of patients in the three groups were compared:there was statistical significance in pharyngeal swab culture and digital colonoscopy rinse fluid culture of patients in the gargle group(t=18.45,P?0.01).There was significant difference between the results of pharyngeal swab culture and duodenoscope rinse solution culture in sterile saline gargle group(t=12.29,P?0.01).There was no significant difference between the results of throat swab culture and duodenoscope rinse solution culture in the group without gargle(t=0.415,P=0.678).4.Comparison of gargle effect between compound chlorhexidine gargle and sterile normal saline:there was no statistical significance in culture results of pharyngeal swabs between the two groups(t=-0.75,P=0.454).The culture results of duodenoscope rinse solution were compared between the two groups,and the difference was statistically significant(t=-5.18,P<0.01).Conclusion:1.Oral gargle can reduce the amount of bacteria in oropharynx and oral contamination of duodenoscope,suggesting that oral gargle before ERCP can improve oral contamination of duodenoscope and reduce or prevent the occurrence of acute cholangitis after ERCP.2.Both compound chlorhexidine gargle and aseptic saline gargle can reduce duodenoscope oral contamination.3.Compound chlorhexidine gargle is better than sterile normal saline in reducing the amount of bacteria in oropharynx.