Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, Campus Box 8124, St. Louis, MO 63110, USA.
Dig Dis Sci. 2012 Dec;57(12):3271-8. doi: 10.1007/s10620-012-2269-2. Epub 2012 Jun 26.
Among cases of difficult biliary cannulation, alternatives include use of a pancreatic duct stent (PDS) or guidewire (PDW) to facilitate access. We compared the effectiveness of a PDS versus a PDW to facilitate common bile duct (CBD) cannulation.
We conducted a randomized, crossover trial at two endoscopy referral centers, limited to patients undergoing ERCP without a history of biliary sphincterotomy. After meeting predefined criteria for difficult cannulation, patients were randomized to using a PDS or PDW to facilitate CBD cannulation. Outcomes included cannulation rate within 6 min, overall cannulation rate, frequency of precut, and complication rates.
Among 442 eligible patients, 87 (19.7 %) met criteria for difficult cannulation. Forty two were randomized to PDW, 54 to PDS (including 9 PDW patients crossed over to PDS). The rate of CBD cannulation within 6 min was similar in the PDW (38.1 %) and PDS (51.9 %) groups (p = 0.18). In a secondary analysis limited to patients who successfully underwent PDW or PDS deployment, the rate was also comparable (PDW 59.3 %, PDS 65.1 %; p = 0.62). The overall frequency of CBD cannulation was 66.7 % in PDW and 90.7 % in PDS patients. Precut was required in 9.5 % of PDW and 25.9 % of PDS patients. Complication rates were similar, with 4 (4.6 %) patients having post-ERCP pancreatitis and 1 (1.1 %) having post-ERCP pain without confirmation of pancreatitis.
Use of a PDS or PDW facilitates CBD cannulation while maintaining a low complication rate and reducing the need for precut sphincterotomy in the majority of cases.
在困难的胆管插管病例中，替代方法包括使用胰管支架（PDS）或导丝（PDW）来促进进入。我们比较了 PDS 与 PDW 促进胆总管（CBD）插管的效果。
我们在两个内镜转诊中心进行了一项随机、交叉试验，仅限于没有胆道括约肌切开术病史的接受 ERCP 的患者。在满足困难插管的预设标准后，患者被随机分配使用 PDS 或 PDW 来促进 CBD 插管。结果包括 6 分钟内插管率、总体插管率、预切开频率和并发症发生率。
在 442 名符合条件的患者中，87 名（19.7%）符合困难插管标准。42 名患者被随机分配到 PDW 组，54 名患者被随机分配到 PDS 组（包括 9 名 PDW 患者交叉到 PDS 组）。在 6 分钟内 CBD 插管率在 PDW（38.1%）和 PDS（51.9%）组之间相似（p = 0.18）。在仅限于成功进行 PDW 或 PDS 放置的患者的二次分析中，比率也相似（PDW 59.3%，PDS 65.1%；p = 0.62）。PDW 患者的 CBD 插管总体成功率为 66.7%，PDS 患者为 90.7%。PDW 患者中有 9.5%需要预切开，PDS 患者中有 25.9%需要预切开。并发症发生率相似，4 名（4.6%）患者发生 ERCP 后胰腺炎，1 名（1.1%）患者发生 ERCP 后疼痛但未确诊胰腺炎。
使用 PDS 或 PDW 促进 CBD 插管，同时保持低并发症率，并减少大多数情况下对括约肌切开术的需求。
