Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Dig Dis Sci. 2012 Dec;57(12):3286-92. doi: 10.1007/s10620-012-2271-8. Epub 2012 Jun 20.
The aim of this retrospective study was to evaluate the success rate and complications of three precut techniques of sphincterotomy after failure of conventional techniques of cannulation of common bile duct (CBD).
Between January 2003 and October 2011, 2,903 consecutive ERCPs were performed in patients with naïve major papilla. In 283 patients in whom biliary cannulation was not achieved, precut technique was performed and these patients were included in the study.
A total of 274 patients were included in the final analysis. Needle-knife papillotomy (NKP) was performed in 129 cases (47.1 %), suprapapillary fistulotomy (SPF) in 78 patients (28.5 %), and transpancreatic sphincterotomy (TPS) in 67 cases (24.5 %). No significant difference was observed in the initial and eventual success rate of biliary cannulation between the three groups. Overall, complications occurred in 54 patients (19.7 %), of which 33 (25.6 %) were with NKP, 6 (7.7 %) with SPF and 15 (22.4 %) with TPS, respectively, a difference statistically significant favoring the SPF group (p = 0.006). Post-procedure acute pancreatitis was developed in 27 cases (20.9 %) with NKP, compared to two cases (2.6 %) with SPF and 15 cases (22.4 %) with TPS, a difference statistically significant favoring the SPF group. No difference was observed between the groups with regard to the occurrence of post-procedure hemorrhage and perforation.
The three types of precut sphincterotomy have no different overall CBD cannulation rates; SPF reduces post-ERCP pancreatitis risk.
本回顾性研究旨在评估三种经乳头括约肌预切开术治疗传统胆管插管失败后的成功率和并发症。
2003 年 1 月至 2011 年 10 月，对 2903 例初次接受治疗的主乳头患者进行了内镜逆行胰胆管造影术（ERCP）。在 283 例未能成功进行胆道插管的患者中，进行了预切开技术，这些患者被纳入研究。
共有 274 例患者最终被纳入分析。在 129 例（47.1%）中进行了针刀切开术（NKP），在 78 例（28.5%）中进行了经乳头上方切开术（SPF），在 67 例（24.5%）中进行了经胰管切开术（TPS）。三组患者胆管插管的初始和最终成功率无显著差异。总体而言，54 例（19.7%）患者发生并发症，其中 NKP 组 33 例（25.6%），SPF 组 6 例（7.7%），TPS 组 15 例（22.4%），SPF 组差异有统计学意义（p=0.006）。NKP 组发生术后急性胰腺炎 27 例（20.9%），SPF 组 2 例（2.6%），TPS 组 15 例（22.4%），SPF 组差异有统计学意义。三组间术后出血和穿孔的发生率无差异。
三种经乳头括约肌预切开术的总体胆管插管成功率无差异；SPF 降低了 ERCP 术后胰腺炎的风险。
