Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy.
Gastrointest Endosc. 2012 Feb;75(2):339-46. doi: 10.1016/j.gie.2011.09.002. Epub 2011 Nov 9.
Guidewire (GW) cannulation can reduce the risk of post-ERCP pancreatitis (PEP) by avoiding the opacification of the main pancreatic duct.
To compare the effects of conventional contrast ERCP and GW cannulation of the common bile duct on the rate of PEP in low- and high-risk patients.
Prospective, comparative-intervention single-center study.
Tertiary referral center.
Patients with biliary disease with an intact papilla were prospectively examined by ERCP.
Biliary cannulation using a sphincterotome with contrast injection (ConI) or a hydrophilic GW without contrast injection.
Pancreatitis rate in the GW group and the contrast injection (ConI) group.
PEP occurred in 60 of 1249 patients (4.8%), 35 of 678 (5.2%) in the GW group and 25 of 571 (4.4%) in the ConI group (not significant). The overall rate of PEP was significantly higher in high-risk patients (12.2%) than in low-risk patients (3.5%) (P < .001), but was similar for the 2 techniques within each of these 2 groups. In patients with unintended main pancreatic duct (MPD) cannulation or opacification, the rate of PEP was not significantly different with the GW (15.2%) and ConI (8.4%) techniques but was associated with a significantly higher rate of pancreatitis (11.9%) than in patients in whom the contrast medium or GW did not enter the MPD (3.5%) (P < .001). Multivariate analysis indicated that more than 10 papillary cannulation attempts, MPD cannulation or opacification, suspected sphincter of Oddi dysfunction, and precut methods were significant risk factors independently associated with PEP.
Lack of randomization.
For selective cannulation of the CBD, the risk of inducing PEP is similar with the ConI and GW techniques in high-risk and low-risk patients. Any manipulation of the MPD must be considered a high-risk factor for PEP, such as multiple attempts on the papilla or use of the precut method.
导丝（GW）插管可以通过避免主胰管显影来降低内镜逆行胰胆管造影（ERCP）后胰腺炎（PEP）的风险。
比较常规对比 ERCP 和 GW 胆管插管对低危和高危患者 PEP 发生率的影响。
前瞻性、对照干预性单中心研究。
三级转诊中心。
前瞻性检查有完整乳头的胆系疾病患者行 ERCP。
使用括约肌切开刀进行胆管插管，同时注射造影剂（ConI）或不注射造影剂的亲水性 GW。
GW 组和 ConI 组的胰腺炎发生率。
在 1249 例患者中，60 例（4.8%）发生 PEP，GW 组 35 例（5.2%），ConI 组 25 例（4.4%），差异无统计学意义。高危患者的总体 PEP 发生率（12.2%）明显高于低危患者（3.5%）（P<.001），但在这两组中，两种技术的发生率相似。在意外主胰管（MPD）插管或显影的患者中，GW（15.2%）和 ConI（8.4%）技术的 PEP 发生率无显著差异，但与对比剂或 GW 未进入 MPD 的患者相比，胰腺炎发生率明显更高（11.9%）（P<.001）。多变量分析表明，超过 10 次乳头插管尝试、MPD 插管或显影、可疑 Oddi 括约肌功能障碍、预切开方法是与 PEP 独立相关的显著危险因素。
缺乏随机分组。
对于选择性胆管插管，在高危和低危患者中，ConI 和 GW 技术引起 PEP 的风险相似。任何 MPD 操作都应视为 PEP 的高危因素，如多次乳头尝试或使用预切开方法。
