Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
Dig Liver Dis. 2011 Oct;43(10):792-6. doi: 10.1016/j.dld.2011.05.010. Epub 2011 Jul 5.
Repeated attempts at cannulating the papilla of Vater and "needle-knife" precut sphincterotomy are independent risk factors for post-ERCP pancreatitis. Whether precut alone or repeated attempts at cannulation is the culprit factor in the development of post-ERCP pancreatitis remains controversial.
To retrospectively assess the role of precutting and multiple cannulation in the occurrence of post-ERCP pancreatitis in a consecutive series of patients with bile stone disease.
2004 patients who had undergone endoscopic retrograde cholangio-pancreatography over a 9-year period for bile stones were evaluated. Pancreatitis rate was assessed in relation to the number of cannulation attempts (<10 and ≥10) and precutting.
Procedures were successful in 1878 patients (93.7%). Cannulation was done without precutting in 1717 cases and with in 161. Pancreatitis occurred in 2.7% of patients who had undergone biliary cannulation without precutting and in 6.5% with (p=0.006). It was lower with <10 attempts than with ≥10 (p<0.0001), either without (p<0.0001) or with precutting (p<0.01). Pancreatitis rate did not differ without and with precutting when <10 attempts at cannulation were done, whilst it was lower when precut was done before 10 attempts than when 10 or more attempts were made without precutting (p=0.02).
Pancreatitis rate was lower when precut was done with <10 attempts than when ≥10 attempts were made without precutting. In experienced hands precut biliary sphincterotomy does not seem to be an independent risk factor for post-ERCP pancreatitis in patients undergoing endoscopic retrograde cholangio-pancreatography for bile duct stones.
多次尝试乳头切开术和“针刀”预切开括约肌切开术是内镜逆行胰胆管造影（ERCP）后胰腺炎的独立危险因素。在 ERCP 后胰腺炎的发展中，究竟是预切开术还是多次尝试插管是罪魁祸首，这一问题仍存在争议。
在连续系列胆石病患者中，回顾性评估预切开术和多次插管在 ERCP 后胰腺炎发生中的作用。
评估了 2004 例在 9 年期间因胆石症而行内镜逆行胰胆管造影术的患者。根据插管尝试次数（<10 次和≥10 次）和预切开术评估胰腺炎发生率。
1878 例（93.7%）患者的操作成功。1717 例无预切开术行胆管插管，161 例有预切开术行胆管插管。无预切开术的胆管插管患者中胰腺炎发生率为 2.7%，有预切开术的胆管插管患者中胰腺炎发生率为 6.5%（p=0.006）。与≥10 次插管相比，<10 次插管（无论有无预切开术）时胰腺炎发生率均较低（p<0.0001）。<10 次插管时，无论是否行预切开术，胰腺炎发生率均无差异，而当行 10 次或更多次无预切开术插管时，行预切开术的胰腺炎发生率低于行 10 次或更多次无预切开术插管时（p=0.02）。
当<10 次插管时行预切开术时，胰腺炎发生率低于≥10 次插管时无预切开术。在有经验的医生手中，在因胆管结石而行 ERCP 的患者中，预切开胆管括约肌切开术似乎不是 ERCP 后胰腺炎的独立危险因素。
