Analysis On The Incidence Of Postoperative Complications And Related Risk Factors Of ERCP In High Altitude Areas

Objective:To investigate the incidence of PEP,biliary tract infection,gastrointestinal bleeding and perforation and their related risk factors after ERCP at high altitude.Methods:Data of patients who underwent ERCP surgery in Affiliated Hospital of Qinghai University from January 2017 to December 2019 were selected inspection check data and operation records,etc.,statistical ERCP and acute pancreatitis,gastrointestinal bleeding,postoperative patients with biliary tree the occurrence of infection and digestive tract perforation,analysis to identify the ERCP postoperative complications of the significant risk factors.Results:1.A total of 916 ERCP procedures were performed during this period,and clinical data of 896 patients were included according to the inclusion criteria.The incidence of PEP was 10.8%（97 cases）,and the probability of bleeding,infection,and perforation after ERCP was 3.3%（30 cases）,1.9%（17 cases）,and 0.1%（1 case）,respectively.One case died（0.1%）.2.Univariate logistic analysis of PEP showed that female patients,post-cholecystectomy,intubation time≥2min,operation time≥23min,pancreatic duct development,guidewire placement of the pancreatic duct,diverticulum,difficult intubation,and normal total bilirubin were all risk factors for PEP,while previous ERCP operation history was a protective factor for PEP.By collinear test and multivariate logistic analysis,female patients,normal total bilirubin,operation time≥23 min,pancreatic duct insertion,presence of diverticulum,and ENBD were identified as independent risk factors for acute pancreatitis after ERCP,while previous ERCP surgery history and pre-cut of the duodenal papilla were identified as independent protective factors for PEP.3.Univariate logistic analysis showed that intubation time≥2min,operation time≥38 min,intraoperative EST and intraoperative EPBD were all risk factors for postoperative bleeding after ERCP.By collinearity test and multivariate logistic analysis,the risk of postoperative bleeding after ERCP was increased by≥2 min of intubation time and intraoperative EST.4.Univariate logistic analysis of biliary tract infection showed that bile duct tumor,hilar bile duct stenosis,abnormal cholinesterase,abnormal NE%,catheterization time>0 min and intraoperative ERBD were all risk factors for biliary tract infection after ERCP,and bile duct stones were protective factors for biliary tract infection after ERCP.By collinearity test and multivariate logistic analysis,we identified that hilar bile duct stenosis,bile duct tumor and bb0 9min intubation time increased the incidence of biliary infection.5.In this study only 1 patients with digestive tract perforation,forⅡampulla around the damage caused by perforation,eventually died due to multiple organ dysfunction syndrome.6.Through to the altitude,Sa O₂,Pa O2,and PCO₂ count of high altitude factor comparison between groups,and into the logistic regression analysis,all did not identify factors associated with ERCP postoperative complications.Conclusions:1.PEP is the most frequently occurring complication after ERCP.Patients who are female,have normal total bilirubin,and have diverticula in the duodenum have a significantly increased risk of PEP,while patients who have previously undergone ERCP have a reduced risk of PEP.2.Hemorrhage after ERCP was most common in patients with ERCP operation,intubation time≥2 min,and intraoperative EST were more likely to have postoperative gastrointestinal bleeding.3.The most common biliary infection after ERCP was acute cholangitis,Patients with hilar bile duct stenosis or bile duct tumor are more prone to biliary infection after ERCP.4.Digestive tract perforation after ERCP is very rare,but it can easily lead to serious consequences and endanger the patient’s life.5.During ERCP,the operation and operation time should be reduced,and the operation should be conducted according to the standard procedures to avoid rough operation and reduce the occurrence of postoperative adverse events.6.The high altitude associated factors were not risk factors for postoperative complications of ERCP.