液体脂肪餐后的内镜逆行胰胆管造影术：对胆总管深部插管时间的影响

Barrie M, Klein S D, Brown C A, Edge M D, Affronti J A, Cai Q

Division of Digestive Diseases, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA.

Endoscopy. 2006 Mar;38(3):241-8. doi: 10.1055/s-2005-921116.

BACKGROUND AND STUDY AIM

Endoscopic retrograde cholangiopancreatography (ERCP) is an important gastrointestinal endoscopic procedure in the study and treatment of pancreaticobiliary diseases. The critical step of the procedure is cannulation of the common bile duct (CBD) and/or the pancreatic duct. Cannulation can be a technical challenge at times. Fat is a natural stimulator for bile secretion and relaxation of the sphincter of Oddi. The objective of this study was to determine the effect of a liquid fatty meal on deep CBD cannulation during ERCP.

PATIENTS AND METHODS

We performed a randomized double-blind study in 84 patients to examine the effect of a liquid fatty meal on deep CBD cannulation during ERCP, in a teaching medical center. In the study group, each patient had a liquid fatty meal orally about 1 hour before the procedure. In the control group, each patient had the same volume of a non-fat meal. The appearance of the major papilla, the cannulation rate, the cannulation time, and the fluoroscopy time during cannulation were compared for the two groups.

RESULTS

The orifice of the CBD/pancreatic duct was much more easily identified in the group who ingested the fatty meal. Compared with the non-fat meal group, in the fatty meal group the mean and the median deep CBD cannulation times were shorter, at 8.0 minutes vs. 14.7 minutes ( P = 0.005) and 8.0 minutes vs. 11.5 minutes ( P = 0.008), respectively. Additionally, in the fatty meal group, the mean and the median fluoroscopy times during deep CBD cannulation were lower, at 3.3 minutes vs. 6.1 minutes ( P = 0.040) and 2.5 minutes vs. 3.9 minutes ( P = 0.013), respectively. There were no complications, such as aspiration, associated with the liquid meals given shortly before the ERCP procedure.

CONCLUSIONS

To avoid prolonged cannulation and unnecessary radiation exposure, patients should have a liquid fatty meal before ERCP procedures.

背景与研究目的

内镜逆行胰胆管造影术（ERCP）是胰腺胆管疾病研究与治疗中一项重要的胃肠道内镜检查程序。该程序的关键步骤是对胆总管（CBD）和/或胰管进行插管。有时插管可能是一项技术挑战。脂肪是胆汁分泌和奥迪括约肌松弛的天然刺激物。本研究的目的是确定液体脂肪餐对ERCP期间胆总管深部插管的影响。

患者与方法

我们在一家教学医疗中心对84例患者进行了一项随机双盲研究，以检查液体脂肪餐对ERCP期间胆总管深部插管的影响。在研究组中，每位患者在手术前约1小时口服液体脂肪餐。在对照组中，每位患者摄入相同体积的无脂餐。比较两组患者主乳头的外观、插管率、插管时间和插管期间的透视时间。

结果

摄入脂肪餐的组中，胆总管/胰管开口更容易识别。与无脂餐组相比，脂肪餐组胆总管深部插管的平均时间和中位数时间更短，分别为8.0分钟对14.7分钟（P = 0.005）和8.0分钟对11.5分钟（P = 0.008）。此外，在脂肪餐组中，胆总管深部插管期间的平均透视时间和中位数透视时间更低，分别为3.3分钟对6.1分钟（P = 0.040）和2.5分钟对3.9分钟（P = 0.013）。ERCP手术前不久给予的液体餐未引发诸如误吸等并发症。