Tesis

Faktor-faktor yang Berhubungan dengan Kanulasi Bilier Sulit pada Tindakan Endoscopic Retrograde Cholangiopancreatography = Factors Associated with Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography Procedure.

Latar Belakang: Endoscopic Retrograde Cholangiopancreatography (ERCP) merupakan pemeriksaan yang digunakan untuk mendiagnosis dan menatalaksana penyakit pankreatobilier. Keberhasilan kanulasi bilier akan menentukan tindakan selanjutnya. Kanulasi bilier dengan kateter standar atau sfingterotom dilaporkan mengalami kegagalan pada 15-35 % kasus. Faktor-faktor yang berhubungan dengan kanulasi bilier sulit pada tindakan ERCP perlu diidentikasi sejak awal, sehingga dapat dilakukan pencegahan terhadap kejadian komplikasi paska tindakan ERCP. Tujuan: Penelitian ini bertujuan untuk mengetahui proporsi kanulasi bilier sulit dan faktor-faktor yang berhubungan dengan kanulasi bilier sulit pada tindakan ERCP. Metode: Penelitian ini menggunakan desain potong lintang yang dilakukan di Pusat Endoskopi Saluran Cerna (PESC) dan Unit Rekam Medis Pusat RSUPN Dr. Cipto Mangunkusumo (RSCM) dengan mengambil data-data dari rekam medik pasien yang menjalani ERCP pada tahun 2018-2020. Analisis bivariat dan multivariat dilakukan terhadap faktor-faktor yang berhubungan dengan kanulasi bilier sulit pada tindakan ERCP. Hasil: Penelitian ini mengevaluasi 194 subjek yang memenuhi kriteria inklusi. Proporsi kanulasi bilier sulit pada tindakan ERCP adalah 26,3%. Kelompok usia (OR 2,337, p=0,021), kadar bilirubin direk (OR 2,299, p=0,042), dan pengalaman operator ERCP (OR 3,061, p=0,002) merupakan faktor-faktor yang berhubungan dengan kanulasi bilier sulit pada tindakan ERCP. Jumlah penyakit komorbid, etiologi obstruksi bilier, striktur common bile duct (CBD) distal, dan divertikel periampula merupakan faktor-faktor yang tidak berhubungan dengan kanulasi bilier sulit pada tindakan ERCP. Simpulan: Proporsi kanulasi bilier sulit pada tindakan ERCP adalah 26,3%. Usia di atas 60 tahun, kadar bilirubin direk > 5 mg/dL, dan pengalaman operator ERCP yang kurang merupakan faktor-faktor yang meningkatkan kejadian kanulasi bilier sulit pada tindakan ERCP.
Kata kunci: Endoscopic Retrograde Cholangiopancreatography (ERCP), kanulasi bilier sulit.


Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is the standard procedure for diagnosis and treatment of pancreatobiliary disease. Successful biliary cannulation will determine the next procedure. Selective biliary cannulation with a standard ERCP catheter or sphincterotome reportedly fails in 1535 % cases. The factors associated with difficult biliary cannulation of ERCP procedure should be identified to prevent ERCP complications. Objective: The aim of this study was to determine the proportion of difficult biliary cannulation and the factors associated with difficult biliary cannulation in ERCP procedure. Methods: This research was conducted with cross sectional method in Gastrointestinal Endoscopy Center and Medical Record Unit Dr. Cipto Mangunkusumo National Central General Hospital, using medical records data from subjects who underwent ERCP from 2018-2020. Bivariate and multivariate analysis were performed for associated factors with difficult biliary cannulation. Results: There were 194 subjects that enrolled in this study. The proportion of difficult biliary cannulation in ERCP procedure was 26,3%. Age OR 2,337, p=0,021), direct bilirubin level (OR 2,299, p=0,042), and operator experience (OR 3,061, p=0,002) were statistically significant factors associated with difficult biliary cannulation in ERCP procedure. There was not significant correlation between difficult biliary cannulation with comorbid disease, etiology of biliary obstruction, distal common bile duct (CBD) stricture, and periampullary diverticulum. Conclusions: The proportion of difficult biliary cannulation in ERCP procedure was 26,3%. Age over 60 years old, direct bilirubin level > 5 mg/dL, and ERCP operator’s lack of experience were factors associated with increased incidence of difficult biliary cannulation in ERCP procedure.
Key words: Endoscopic Retrograde Cholangiopancreatography (ERCP), difficult biliary cannulation.