Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, PL340, 00029 Helsinki, Finland.
Surg Endosc. 2013 May;27(5):1662-7. doi: 10.1007/s00464-012-2653-1. Epub 2012 Dec 13.
Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable tool in the diagnosis and management of various pancreatobiliary disorders. Our aim was to evaluate whether the combination of a thin guide wire and a thin sphincterotome would facilitate selective cannulation of the bile duct and reduce the incidence of post-ERCP pancreatitis (PEP) by reducing papillary trauma when compared with a regular-sized hydrophilic guide wire.
Between June 2011 and February 2012, we performed 100 biliary cannulations for a native papilla in a randomized controlled trial. Having given their written informed consent, patients were randomly assigned to a 0.025-inch guide wire and sphincterotome group (n = 50) or to a 0.035-inch guide wire and sphincterotome group (n = 50). Number of cannulation attempts, number of accidental guide wire passages into the pancreatic duct, secondary cannulation techniques after failed primary cannulation, time to change the technique, and time for successful cannulation were collected in a database. Patients were followed up after ERCP, and all post-ERCP complications were recorded.
Primary cannulation was successful in 80 %. With accessory techniques, cannulation of the biliary duct was achieved in every case except one. There was no difference in primary cannulation rate between the 0.025-inch and 0.035-inch wire groups (n = 40 in each group). PEP was diagnosed in two patients (2.0 %), one in each study group. Postsphincterotomy bleeding occurred in one patient (1.0 %).
The thickness of the hydrophilic guide wire does not appear to affect either the success rate of primary cannulation or the risk of complications.
内镜逆行胰胆管造影（ERCP）是诊断和治疗各种胰胆管疾病的有价值的工具。我们的目的是评估与常规尺寸亲水导丝相比，使用细导丝和细括约肌切开刀是否会通过减少乳头创伤来促进胆管的选择性插管，并降低 ERCP 后胰腺炎（PEP）的发生率。
在一项随机对照试验中，我们于 2011 年 6 月至 2012 年 2 月对 100 例原发性乳头行胆道插管。患者在获得书面知情同意后，随机分配至 0.025 英寸导丝和括约肌切开刀组（n = 50）或 0.035 英寸导丝和括约肌切开刀组（n = 50）。记录插管尝试次数、导丝意外进入胰管的次数、初次插管失败后的辅助插管技术、改变技术的时间和成功插管的时间。在 ERCP 后对患者进行随访，并记录所有 ERCP 后并发症。
80%的患者初次插管成功。使用辅助技术，除 1 例外，所有患者均成功插管。0.025 英寸和 0.035 英寸导丝组初次插管成功率无差异（每组 n = 40）。两组各有 1 例（2.0%）患者诊断为 PEP。1 例（1.0%）患者发生术后括约肌切开出血。
亲水导丝的厚度似乎既不影响初次插管的成功率，也不影响并发症的风险。
