Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Gastrointest Endosc. 2009 Dec;70(6):1211-9. doi: 10.1016/j.gie.2009.08.007.
The use of a guidewire (GW) for cannulation of the bile duct during ERCP may prevent post-ERCP pancreatitis (PEP).
A systematic review and meta-analysis of GW-guided versus conventional contrast (CC)-guided bile duct cannulation for the prevention PEP.
A November 2008 search of gray literature, databases, reference lists, and meeting abstracts was conducted for randomized, controlled trials comparing GW and CC. Two independent reviewers extracted the data. The outcomes included PEP, primary cannulation success, and other adverse events.
From 2132 citations, 7 randomized, controlled trials (5 noncrossover trials and 2 crossover trials) were included. Among noncrossover trials only, there was significant reduction in PEP when using a GW (3.2%) compared with CC (8.7%) (relative risk [RR] 0.38; 95% CI, 0.19-0.76). Subgroup analysis showed a significantly lower occurrence of PEP after GW entry versus CC injection of the pancreatic duct (1.1% vs 9.5%; RR 0.19; 95% CI, 0.06-0.58). Among patients with a precut sphincterotomy from a failed primary cannulation, there was less PEP with GW cannulation compared with CC (2.4% vs 21.7%; RR 0.21; 95% CI, 0.04-1.04). The other adverse event rates were comparable between GW and CC groups (2% vs 2%; RR 1.05; 95% CI, 0.39-2.83). Primary cannulation success was significantly greater with GW use compared with CC (89% vs 78%; RR 1.19; 95% CI, 1.05-1.35).
ERCP GW cannulation reduces the risk of PEP compared with the use of CC. GW cannulation is associated with a higher cannulation success rate and less PEP after pancreatic duct entry.
在 ERCP 中使用导丝（GW）引导胆管插管可能会预防 ERCP 后胰腺炎（PEP）。
对 GW 引导与传统对比（CC）引导胆管插管预防 PEP 的系统评价和荟萃分析。
2008 年 11 月对随机对照试验进行了灰色文献、数据库、参考文献列表和会议摘要的搜索，比较了 GW 和 CC。两名独立的评审员提取数据。结果包括 PEP、初次插管成功率和其他不良事件。
从 2132 条引文，纳入了 7 项随机对照试验（5 项非交叉试验和 2 项交叉试验）。仅在非交叉试验中，使用 GW（3.2%）与 CC（8.7%）相比，PEP 的发生率显著降低（相对风险 [RR] 0.38；95%CI，0.19-0.76）。亚组分析显示，GW 进入与 CC 胰管注射后 PEP 的发生率显著降低（1.1% vs 9.5%；RR 0.19；95%CI，0.06-0.58）。在初次插管失败后进行预切开括约肌的患者中，GW 插管与 CC 相比，PEP 发生率较低（2.4% vs 21.7%；RR 0.21；95%CI，0.04-1.04）。GW 和 CC 组的其他不良事件发生率相当（2% vs 2%；RR 1.05；95%CI，0.39-2.83）。与 CC 相比，GW 使用率显著提高了初次插管成功率（89% vs 78%；RR 1.19；95%CI，1.05-1.35）。
与 CC 相比，ERCP GW 插管可降低 PEP 的风险。GW 插管与更高的插管成功率和胰管进入后较低的 PEP 发生率相关。
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