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1
Needle knife sphincterotomy does not increase the risk of pancreatitis in patients with difficult biliary cannulation.针状刀括约肌切开术不会增加困难胆道插管患者胰腺炎的风险。
Clin Gastroenterol Hepatol. 2013 Apr;11(4):430-436.e1. doi: 10.1016/j.cgh.2012.12.017. Epub 2013 Jan 11.
2
A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis.直肠用吲哚美辛预防 ERCP 后胰腺炎的随机试验。
N Engl J Med. 2012 Apr 12;366(15):1414-22. doi: 10.1056/NEJMoa1111103.
3
Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease.预切开括约肌、重复插管和 ERCP 后胰腺炎在胆管结石病患者中的应用。
Dig Liver Dis. 2011 Oct;43(10):792-6. doi: 10.1016/j.dld.2011.05.010. Epub 2011 Jul 5.
4
Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review.经内镜逆行胰胆管造影术后胰腺炎预防用胰管支架：荟萃分析和系统评价。
Gastrointest Endosc. 2011 Feb;73(2):275-82. doi: 10.1016/j.gie.2010.10.039.
5
Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study.高、低容量中心和专家与非专家操作人员行 ERCP 术后胰腺炎的危险因素：一项前瞻性多中心研究。
Am J Gastroenterol. 2010 Aug;105(8):1753-61. doi: 10.1038/ajg.2010.136. Epub 2010 Apr 6.
6
Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials.早期预切开术能否降低内镜逆行胰胆管造影相关并发症的风险？随机对照试验的荟萃分析。
Endoscopy. 2010 May;42(5):381-8. doi: 10.1055/s-0029-1243992. Epub 2010 Mar 19.
7
Needle-knife sphincterotomy: factors predicting its use and the relationship with post-ERCP pancreatitis (with video).针状刀括约肌切开术：预测其使用的因素与 ERCP 后胰腺炎的关系（附视频）。
Gastrointest Endosc. 2010 Feb;71(2):266-71. doi: 10.1016/j.gie.2009.09.024. Epub 2009 Dec 8.
8
Prophylactic pancreas stenting followed by needle-knife fistulotomy in patients with sphincter of Oddi dysfunction and difficult cannulation: new method to prevent post-ERCP pancreatitis.对Oddi括约肌功能障碍且插管困难的患者先进行预防性胰腺支架置入，然后行针刀瘘管切开术：预防内镜逆行胰胆管造影术后胰腺炎的新方法。
Dig Endosc. 2009 Jan;21(1):8-13. doi: 10.1111/j.1443-1661.2008.00819.x.
9
An analysis of the factors associated with the development of complications in patients undergoing precut sphincterotomy: a prospective, controlled, randomized, multicenter study.经括约肌预切开术患者并发症发生相关因素分析：一项前瞻性、对照、随机、多中心研究。
Am J Gastroenterol. 2009 Oct;104(10):2412-7. doi: 10.1038/ajg.2009.345. Epub 2009 Jun 23.
10
Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years.内镜逆行胰胆管造影术后并发症的危险因素：一项对12年间11497例手术的多因素分析。
Gastrointest Endosc. 2009 Jul;70(1):80-8. doi: 10.1016/j.gie.2008.10.039. Epub 2009 Mar 14.

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.

DOI:10.3748/wjg.v20.i14.4093
PMID:24744601
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3983468/
Abstract

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.

摘要

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。