Robison Lindsay S, Varadarajulu Shyam, Wilcox C Mel
University of Alabama at Birmingham, Division of Gastroenterology and Hepatology, 703 19th Street South, ZRB 633, Birmingham, Alabama 35294-0007, USA.
World J Gastroenterol. 2007 Apr 21;13(15):2183-6. doi: 10.3748/wjg.v13.i15.2183.
To determine the rates of success and complications of precut biliary sphincterotomy (PBS) based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy (ES).
A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center. The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcome measures of the study were success and complications of PBS with a comparison to complications of ES.
A total of 2939 endoscopic retrograde cholangiopancreatographies (ERCPs) were performed during the study period, including 818 (28%) ES and 150 (5%) PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt (total 87%). Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% (10/50) vs 5% (38/818), P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopistos first attempt at precut (P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588).
Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.
根据既往经验确定预切开胆管括约肌切开术（PBS）的成功率及并发症发生率，并比较PBS与标准内镜括约肌切开术（ES）的并发症发生率。
对一家学术性三级转诊中心前瞻性收集的非随机数据进行回顾性评估。该研究纳入了在八年期间由一名未接受过PBS正规培训的内镜医师进行PBS和ES的所有患者。本研究的主要结局指标为PBS的成功率和并发症，并与ES的并发症进行比较。
在研究期间共进行了2939例内镜逆行胰胆管造影术（ERCP），其中包括818例（28%）ES手术和150例（5%）PBS手术。通过PBS首次选择性胆管插管在75%的患者中成功。在随后的尝试中，另有13%的患者实现了插管（总计87%）。PBS的并发症发生率比ES高45%，但差异无统计学意义[7%（10/50）对5%（38/818），P = 0.29]。PBS的并发症均不严重。内镜医师首次预切开尝试的成功率有显著上升趋势（P = 0.0393，Cochran-Armitage趋势精确检验，Z = -1.7588）。
尽管缺乏该技术的专门培训，但PBS的成功率较高，并发症发生率与其他经验丰富的中心报告相似或更低。这些结果表明，内镜经验以及或许天生的内镜技能可能在该手术的结局中发挥重要作用。
