2nd Surgical Department, District Hospital Radomska, 27-200 Starachowice, Poland.
World J Gastroenterol. 2013;19(14):2227-33. doi: 10.3748/wjg.v19.i14.2227.
To compare the efficacy, complications and post-procedural hyperamylasemia in endoscopic pre-cut conventional and needle knife sphincterotomy.
We performed a retrospective analysis of two pre-cut sphincterotomy (PS) techniques, pre-cut conventional sphincterotomy (PCS), and pre-cut needle knife (PNK). The study included 143 patients; the classic technique was used in 59 patients (41.3%), and the needle knife technique was used in 84 patients (58.7%). We analyzed the efficacy of bile duct access, the need for a two-step procedure, the rates of complications and hyperamylasemia 4 h after the procedure, "endoscopic bleeding" and the need for bleeding control. Furthermore, to assess whether the anatomy of the Vater's papilla, indications for the procedure or the need for additional procedures could inform the choice of the PS method, we evaluated the additive hyperamylasemia risk 4 h after the procedure with respect to the above mentioned variables.
The bile duct access efficacy with PNK and PCS was 100% and 96.6%, respectively, and the difference between the two groups was not significant (P = 0.06). However, the needle knife technique required two-step access significantly more often, in 48.8% vs 8.5% of cases (P < 0.0001). The only complication noted was post-ercp pancreatitis (PEP), which was observed in 4/84 (4.8%) and 2/59 (3.4%) patients submitted to PNK and PSC, respectively; the difference between the two procedures was not significant (P = 0.98). An analysis of other consequences of the techniques yielded the following results in the PNK and PCS groups: hyperamylasemia 4 h after the procedure > 80 U/L, 41/84 vs 23/59 (P = 0.32); hyperamylasemia 4 h after the procedure > 240 U/L, 19/84 vs 11/59 (P = 0.71); pancreatic pain, 13/84 vs 7/59 (P = 0.71); endoscopic bleeding, 10/84 vs 8/59 (P = 0.97); and the need for bleeding control, 10/84 vs 7/59 (P = 0.79). In the next part of the study, we analyzed the influence of the method chosen on the risk of hyperamylasemia with respect to an indication for endoscopic retrograde cholangiopancreatography, papillary anatomy and concomitant procedures performed. We determined that the hyperamylasemia risk was increased by more than threefold [odds ratio (OR) = 3.38; P = 0.027] after PCS in patients with a flat Vater's papilla and more than fivefold (OR = 5.3; P = 0.049) after the PNK procedure in patients who required endoscopic homeostasis.
PCS and PNK do not differ in terms of efficacy or complication rates, but PNK is more often associated with the necessity for a two-step procedure.
比较内镜预切开常规括约肌切开术和针刀括约肌切开术的疗效、并发症和术后高淀粉酶血症。
我们对两种预切开括约肌切开术（PS）技术进行了回顾性分析，即传统预切开括约肌切开术（PCS）和针刀预切开术（PNK）。研究包括 143 例患者；经典技术用于 59 例（41.3%）患者，针刀技术用于 84 例（58.7%）患者。我们分析了胆管进入的疗效、两步手术的需要、术后 4 小时并发症和高淀粉酶血症的发生率、“内镜出血”和出血控制的需要。此外，为了评估 Vater 乳头的解剖结构、手术适应证或是否需要额外手术是否可以告知 PS 方法的选择，我们评估了术后 4 小时附加高淀粉酶血症风险与上述变量的关系。
PNK 和 PCS 的胆管进入疗效均为 100%，两组之间无显著差异（P = 0.06）。然而，针刀技术需要两步进入的情况明显更多，分别为 48.8%和 8.5%（P < 0.0001）。唯一观察到的并发症是内镜逆行胰胆管造影后胰腺炎（PEP），分别在 84 例患者中的 4 例（4.8%）和 59 例患者中的 2 例（3.4%）中观察到；两种手术之间无显著差异（P = 0.98）。对技术的其他后果进行分析后，在 PNK 和 PCS 组中得到以下结果：术后 4 小时淀粉酶>80 U/L，41/84 与 23/59（P = 0.32）；术后 4 小时淀粉酶>240 U/L，19/84 与 11/59（P = 0.71）；胰腺痛，13/84 与 7/59（P = 0.71）；内镜出血，10/84 与 8/59（P = 0.97）；出血控制需要，10/84 与 7/59（P = 0.79）。在研究的下一部分，我们分析了所选方法对高淀粉酶血症风险的影响，考虑到内镜逆行胰胆管造影的适应证、乳头解剖结构和同时进行的手术。我们发现，在 Vater 乳头平坦的患者中，PCS 后高淀粉酶血症的风险增加了三倍以上[比值比（OR）=3.38；P = 0.027]，而在需要内镜内稳态的患者中，PNK 手术后高淀粉酶血症的风险增加了五倍以上（OR = 5.3；P = 0.049）。
PCS 和 PNK 在疗效或并发症发生率方面没有差异，但 PNK 更常需要两步手术。
