Fukatsu Hirotoshi, Kawamoto Hirofumi, Harada Ryo, Tsutsumi Koichiro, Fujii Masakuni, Kato Hironari, Hirao Ken, Nakanishi Takashi, Mizuno Osamu, Ogawa Tsuneyoshi, Ishida Etsuji, Okada Hiroyuki, Sakaguchi Kohsaku
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
Surg Endosc. 2009 Sep;23(9):2066-72. doi: 10.1007/s00464-008-9969-x. Epub 2008 Jun 5.
Although needle-knife precut papillotomy (NKPP) is considered a useful alternative for achieving selective biliary cannulation, controversy remains regarding the technical proficiency needed to perform the procedure and its safety. This study evaluated whether procedural experience with NKPP predicted either successful cannulation or the development of complications.
This study retrospectively investigated 104 patients, out of 589 consecutive patients with native papillary, who underwent NKPP performed by a single endoscopist between October 2002 and July 2006. To demonstrate changes in NKPP, the 104 patients were divided chronologically into two groups according to periods: period A (October 2002 to September 2004) and period B (October 2004 to July 2006).
Of the 104 consecutive patients who underwent NKPP, 41 (41/267, 15%) were treated in period A and 63 (63/322, 20%) in period B. There was no significant difference in the overall success rate between periods A (90%) and B (98%) (p = 0.08). However, the initial success rate was higher in period B (95%) than in period A (80%) (p < 0.05). The complication rates were not significantly different between the two groups (10% vs 16%; p = 0.56). Although all complications involved pancreatitis, severe pancreatitis was not observed.
Whereas the initial success rate for NKPP can increase with procedural experience, the complication rate does not seem to decrease. Furthermore, the need for NKPP does not appear to decrease with increasing endoscopic retrograde cholangiopancreatography (ERCP) experience.
尽管针刀乳头预切开术（NKPP）被认为是实现选择性胆管插管的一种有用替代方法，但对于执行该操作所需的技术熟练程度及其安全性仍存在争议。本研究评估了NKPP的操作经验是否能预测插管成功或并发症的发生。
本研究回顾性调查了2002年10月至2006年7月间由一名内镜医师对589例原发性乳头患者中的104例进行NKPP的情况。为了显示NKPP的变化，根据时间将104例患者按时间段分为两组：A组（2002年10月至2004年9月）和B组（2004年10月至2006年7月）。
在104例连续接受NKPP的患者中，A组治疗了41例（41/267，15%），B组治疗了63例（63/322，20%）。A组（90%）和B组（98%）的总体成功率无显著差异（p = 0.08）。然而，B组的初始成功率（95%）高于A组（80%）（p < 0.05）。两组的并发症发生率无显著差异（10%对16%；p = 0.56）。虽然所有并发症均涉及胰腺炎，但未观察到严重胰腺炎。
虽然NKPP的初始成功率可随着操作经验的增加而提高，但并发症发生率似乎并未降低。此外，随着内镜逆行胰胆管造影（ERCP）经验的增加，对NKPP的需求似乎也未减少。
