Lee Tae Hoon, Park Do Hyun, Park Ji-Young, Kim Eun Ok, Lee Yeon Seon, Park Jeong Hoon, Lee Suck-Ho, Chung Il-Kwun, Kim Hong Soo, Park Sang-Heum, Kim Sun-Joo
Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
Gastrointest Endosc. 2009 Mar;69(3 Pt 1):444-9. doi: 10.1016/j.gie.2008.04.064. Epub 2008 Nov 13.
Among the procedure-related factors associated with post-ERCP pancreatitis, selective cannulation of the common bile duct by insertion of a guidewire may be associated with fewer complications than conventional methods of cannulation with contrast injection to access the bile duct. However, the results of studies regarding the usefulness of wire-guided cannulation (WGC) are conflicting.
This prospective randomized trial was designed to determine whether WGC reduces the rate of post-ERCP pancreatitis.
A prospective randomized controlled trial.
Tertiary-care academic medical center.
A total of 300 consecutive patients with native papilla and pancreaticobiliary disease who were candidates for therapeutic ERCP were randomized from June 2006 to May 2007.
WGC without contrast injection or conventional cannulation with contrast injection.
Post-ERCP pancreatitis, risk factors, and procedure-related complications were evaluated prospectively.
A total of 3 patients (2%) in the WGC group and 17 patients (11.3%) in the conventional group had post-ERCP pancreatitis (P = .001). Among the cases of acute pancreatitis in the WGC group, 2 patients with suspected sphincter of Oddi dysfunction (SOD) and unintentional main pancreatic duct (PD) guidewire cannulation showed post-ERCP pancreatitis despite the use of WGC. In multivariate analysis, WGC was a protective factor (odds ratio 0.1; 95% CI, 0.024-0.490, P = .004), whereas female sex and SOD were risk factors for post-ERCP pancreatitis.
Our study population was a low-risk cohort.
WGC is associated with a lower rate of post-ERCP pancreatitis. However, WGC may not prevent post-ERCP pancreatitis in patients with suspected SOD and unintentional PD guidewire cannulation.
在与内镜逆行胰胆管造影术（ERCP）后胰腺炎相关的操作因素中，通过插入导丝选择性插管至胆总管可能比使用造影剂注射进行常规插管方法引发的并发症更少。然而，关于导丝引导插管（WGC）有效性的研究结果存在矛盾。
这项前瞻性随机试验旨在确定WGC是否能降低ERCP后胰腺炎的发生率。
一项前瞻性随机对照试验。
三级医疗学术医学中心。
2006年6月至2007年5月，共有300例连续性患有天然乳头及胰胆疾病且适合进行治疗性ERCP的患者被随机分组。
不使用造影剂注射的WGC或使用造影剂注射的常规插管。
前瞻性评估ERCP后胰腺炎、危险因素及与操作相关的并发症。
WGC组共有3例患者（2%）发生ERCP后胰腺炎，常规组有17例患者（11.3%）发生（P = .001）。在WGC组的急性胰腺炎病例中，2例疑似Oddi括约肌功能障碍（SOD）且意外将导丝插入主胰管（PD）的患者尽管使用了WGC仍发生了ERCP后胰腺炎。多因素分析显示，WGC是一个保护因素（比值比0.1；95%可信区间，0.024 - 0.490，P = .004），而女性性别和SOD是ERCP后胰腺炎的危险因素。
我们的研究人群是低风险队列。
WGC与较低的ERCP后胰腺炎发生率相关。然而，WGC可能无法预防疑似SOD且意外将导丝插入PD的患者发生ERCP后胰腺炎。
