Laasch H-U, Tringali A, Wilbraham L, Marriott A, England R E, Mutignani M, Perri V, Costamagna G, Martin D F
Academic Dept. of GI-Radiology, South Manchester University Hospitals, Manchester and University of Central Lancashire, Preston, United Kingdom.
Endoscopy. 2003 Aug;35(8):669-74. doi: 10.1055/s-2003-41515.
The aim of the study was to compare two steerable endoscopic retrograde cholangiopancreatography (ERCP) catheters with regard to speed and safety in cannulating the common bile duct.
A standard cannula, a short-nosed sphincterotome, and a bendable catheter were used. At two tertiary centres, a total of 312 patients were randomly assigned to receive treatment with one of three catheters and either by a trainee or an expert endoscopist. When cannulation failed, a further attempt was made with a different catheter. If this failed, a change in operator or other manoeuvres followed. The following were assessed: time to cholangiography and deep cannulation, number of attempts and success rates of cannulation, number of pancreatic duct injections, success of catheter cross-over, and complication rates.
Both steerable catheters were significantly better for the initial cholangiogram than the standard catheter (standard catheter 75 %, bendable catheter 84 %, sphincterotome 88 %; P = 0.038), with no significant differences between the bendable catheter and the sphincterotome. Both were also better for deep cannulation of the bile duct (standard cannula 66 %, bendable catheter 69 %, sphincterotome 78 %; P = 0.15). When the standard catheter failed, a steerable catheter succeeded in 26 % of cases. Trainees experienced greater benefit from using steerable catheters. For experts, the bendable catheter was the quickest to achieve cholangiography and deep cannulation. Further manoeuvres had an 85-90 % success rate in allowing biliary access. Twenty of 23 needle-knife papillotomies (87 %) were successful when other methods had failed. The overall ERCP success rate was 97 %. Pancreatitis occurred in 5.3 % of cases.
Steerable catheters allow faster access and can succeed when a standard catheter fails. If cannulation is difficult, changing the catheter should be considered at an early stage. Needle-knife papillotomy is a successful technique in expert hands.
本研究旨在比较两种可操控性内镜逆行胰胆管造影（ERCP）导管在胆管插管的速度和安全性方面的差异。
使用标准插管、短鼻括约肌切开刀和可弯曲导管。在两个三级医疗中心，共312例患者被随机分配接受三种导管之一的治疗，治疗者为实习医生或专家内镜医师。当插管失败时，换用不同的导管再次尝试。若再次失败，则更换操作者或采取其他操作。评估以下指标：胆管造影和深部插管时间、尝试次数和插管成功率、胰管注射次数、导管交叉成功率以及并发症发生率。
两种可操控性导管在初始胆管造影方面均显著优于标准导管（标准导管75%，可弯曲导管84%，括约肌切开刀88%；P = 0.038），可弯曲导管与括约肌切开刀之间无显著差异。两者在胆管深部插管方面也更具优势（标准插管66%，可弯曲导管69%，括约肌切开刀78%；P = 0.15）。当标准导管插管失败时，可操控性导管在26%的病例中成功。实习医生使用可操控性导管获益更大。对于专家而言，可弯曲导管实现胆管造影和深部插管最快。进一步操作在实现胆管通路方面成功率为85% - 90%。当其他方法失败时，23例针刀乳头切开术中有20例（87%）成功。ERCP总体成功率为97%。5.3%的病例发生胰腺炎。
可操控性导管能更快实现胆管通路，且在标准导管失败时可能成功。若插管困难，应尽早考虑更换导管。针刀乳头切开术在专家手中是一项成功的技术。
