Risikofaktoren für Infektionen nach ERCP: Ergebnisse einer prospektiven Analyse von 2349 ERCP-Untersuchungen

Zusammenfassung

In einer mehrjährigen prospektiven klinischen Beobachtungsstudie sollten Risikofaktoren für das Auftreten von Infektionen nach ERCP ermittelt werden.

Methoden: Es wurden 2349 ERCP-Untersuchungen in 1805 Behandlungsfällen von 1544 Patienten eingeschlossen. Infektionen traten in 2,0 % (n = 46) auf. Für das Auftreten dieses Ereignisses wurden geeignete statistische Methoden, wie die logistische Regressionsanalyse und die GEE-Analyse, angewandt, um Risikofaktoren zu ermitteln.

Ergebnisse: In der abschließenden Analyse war die Verabreichung einer antibiotischen Dauertherapie ein signifikanter protektiver Faktor, der die Häufigkeit von Infektionen auf signifikant senken konnte (OR 0,41; p = 0,0234). Die einmalige Antibiotikagabe dagegen konnte das Infektionsrisiko nicht senken. In der vorliegenden Arbeit konnten mehrere Risikofaktoren ermittelt werden. Bei einem Zustand nach Cholezystektomie sind vor allem Index-ERCP-Untersuchungen mit einem erhöhten Infektionsrisiko behaftet (OR 5,2; p = 0,004). Alle anderen Risikofaktoren gelten auch oder speziell bei repetitiven ERCP-Untersuchungen und wurden mithilfe der GEE-Analyse ermittelt. Die Diagnose einer malignen Gallengangsstenose (OR 3,3; p = 0,013) und eines schlechten biliären Kontrastmittelabflusses (OR 3,5; p = 0,009) waren mit einem besonders hohen Infektionsrisiko behaftet. Aber auch bei Leberzirrhose (OR 2,8; p = 0,034) und bei rezidivierender akuter Pankreatitis (OR 2,5; p = 0,029) war das Infektionsrisiko noch signifikant erhöht. Endoskopiker mit einer geringen ERCP-Frequenz (< 100/Jahr) wiesen eine signifikant erhöhte Infektionsrate auf (OR 2,5; p = 0,012).

Schlussfolgerungen: Die ERCP ist und bleibt eine komplexe technisch anspruchsvolle und mit einem nennenswerten Komplikationsrisiko behaftete Untersuchung, die nur von geübten Endoskopikern bzw. in Zentren mit hohen Untersuchungsaufkommen durchgeführt werden sollte. Bei Vorliegen der oben genannten Risikofaktoren empfiehlt sich die periinterventionelle Antibiotikagabe über mehrere Tage.

Abstract

Risk-factors for infections following ERCP procedures were evaluated in a prospective study over three years.

Methods: 2349 ERCP procedures in 1805 clinical cases of 1544 patients were included. Infections occurred in 2.0 % (n = 46). Appropriate methods were used for evaluation of risk-factors for infections post ERCP, i. e. logistic regression analysis for index-procedures (first ERCP in life-time) and GEE analysis (generalized estimating equations) for repetitive ERCP procedures.

Results: Continuous administration of antibiotics during the hospital stay was a protective factor, which reduced the incidence of infections significantly (OR 0.41; p = 0.0234). Single shot administration of antibiotics could not reduce the risk of infection. Several risk factors for infections were significant in this study. A history of cholecystectomy was associated with infections especially in index-procedures (OR 5.2; p = 0.004). All other risk-factors were significant especially in repetitive ERCP procedures. The diagnosis of malignant biliary obstruction (OR 3.3; p = 0.013) and poor biliary contrast drainage (OR 3.5; p = 0.009) were associated with a high disk of infection. Additionally, the risk of infection was increased in case of liver cirrhosis (OR 2.8; p = 0.034) and recurrent acute pancreatitis (OR 2.5; p = 0.029). Endoscopists with a low personal ERCP frequency (< 100 ERCP per year) had a significant higher rate of infections than others (OR 2.5; p = 0.012).

Conclusions: ERCP is still a very complex, technically difficult and risky endoscopic intervention, which should be performed by experienced and trained endoscopists or in institutions with a high ERCP case load. Antibiotic prophylaxis over several days is recommended if risk-factors for infections are present.

Schlüsselwörter

ERCP - endoskopische Sphinkterotomie (EST) - endoskopische Papillotomie (EPT) - Komplikationen - Cholangitis - Cholezystitis - Risikofaktor

Key words

ERCP - endoscopic sphicterotomie (EST) - endoscopic papillotomie (EPT) - complications - cholangitis - cholecystitis - risk-factor

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