预切开括约肌切开术对内镜逆行胰胆管造影术后胰腺炎的影响：一项系统评价和荟萃分析
Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis.
作者信息
Choudhary Abhishek, Winn Jessica, Siddique Sameer, Arif Murtaza, Arif Zainab, Hammoud Ghassan M, Puli Srinivas R, Ibdah Jamal A, Bechtold Matthew L
机构信息
Abhishek Choudhary, Jessica Winn, Sameer Siddique, Murtaza Arif, Zainab Arif, Ghassan M Hammoud, Jamal A Ibdah, Matthew L Bechtold, Division of Gastroenterology, Department of Internal Medicine, University of Missouri-Columbia, M580 Health Sciences Center, Columbia, MO 65212, United States.
出版信息
World J Gastroenterol. 2014 Apr 14;20(14):4093-101. doi: 10.3748/wjg.v20.i14.4093.
AIM
To conduct a systemic review and meta-analysis to investigate the role of early precut technique. Multiple randomized controlled trails (RCTs) have reported conflicting results of the early precut sphincterotomy.
METHODS
MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and recent abstracts from major conference proceedings were searched (June 2013). Randomized and non-randomized studies comparing early precut technique with prolonged standard methods were included. Pooled estimates of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), cannulation and adverse events were analyzed by using odds ratio (OR). Random and fixed effects models were used as appropriate. Publication bias was assessed by funnel plots. Heterogeneity among studies was assessed by calculating I² measure of inconsistency.
RESULTS
Seven randomized and seven non-randomized trials met inclusion criteria. Meta-analysis of RCTs showed a decrease trend for PEP with early precut sphincterotomy but was not statistically significant (OR = 0.58; 95%CI: 0.32-1.05; P = 0.07). No heterogeneity was noted among the studies with I² of 0%.
CONCLUSION
Early precut technique for common bile duct cannulation decreases the trend of post-ERCP pancreatitis.
目的
进行一项系统评价和荟萃分析，以研究早期预切开技术的作用。多项随机对照试验（RCT）报告了早期预切开括约肌切开术的结果相互矛盾。
方法
检索了MEDLINE/PubMed、EMBASE、Cochrane对照试验中央注册库和系统评价数据库，以及主要会议论文集的近期摘要（2013年6月）。纳入了比较早期预切开技术与延长标准方法的随机和非随机研究。采用比值比（OR）分析内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）、插管成功率和不良事件的合并估计值。根据情况使用随机效应模型和固定效应模型。通过漏斗图评估发表偏倚。通过计算I²不一致性度量评估研究间的异质性。
结果
七项随机试验和七项非随机试验符合纳入标准。RCT的荟萃分析显示，早期预切开括约肌切开术使PEP有下降趋势，但无统计学意义（OR = 0.58；95%CI：0.32 - 1.05；P = 0.07）。研究间未发现异质性，I²为0%。
结论
胆总管插管的早期预切开技术可降低ERCP后胰腺炎的发生趋势。
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