Navaneethan Udayakumar, Konjeti Rajesh, Venkatesh Preethi Gk, Sanaka Madhusudhan R, Parsi Mansour A
Udayakumar Navaneethan, Preethi GK Venkatesh, Madhusudhan R Sanaka, Mansour A Parsi, Section for Advanced Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
World J Gastrointest Endosc. 2014 May 16;6(5):200-8. doi: 10.4253/wjge.v6.i5.200.
To study the cannulation and complication rates of early pre-cut sphincterotomy vs persistent attempts at cannulation by standard approach.
Systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published up to February 2013. The main outcome measurements were cannulation rates and post-endoscopic retrograde cholangiopancreatography (ERCP) complications. A comprehensive systematic search of the Cochrane library, PubMed, Google scholar, Scopus, National Institutes of Health, meta-register of controlled trials and published proceedings from major Gastroenterology journals and meetings until February 2013 was conducted using keywords. All Prospective randomized controlled trials (RCT) studies which met our inclusion criteria were included in the analysis. Prospective non-randomized studies and retrospective studies were excluded from our meta-analysis. The main outcomes of interest were post-ERCP pancreatitis, overall complication rates including cholangitis, ERCP-related bleeding, perforation and cannulation success rates.
Seven RCTs with a total of 1039 patients were included in the meta-analysis based on selection criteria. The overall cannulation rate was 90% in the pre-cut sphincterotomy vs 86.3% in the persistent attempts group (OR = 1.98; 95%CI: 0.70-5.65). The risk of post-ERCP pancreatitis (PEP) was not different between the two groups (3.9% in the pre-cut sphincterotomy vs 6.1% in the persistent attempts group, OR = 0.58, 95%CI: 0.32-1.05). Similarly, there was no statistically significant difference between the groups for overall complication rate including PEP, cholangitis, bleeding, and perforation (6.2% vs 6.9%, OR = 0.85, 95%CI: 0.51-1.41).
This meta-analysis suggests that pre-cut sphincterotomy and persistent attempts at cannulation are comparable in terms of overall complication rates. Early pre-cut implementation does not increase PEP complications.
研究早期预切开括约肌切开术与标准方法持续插管尝试的插管成功率及并发症发生率。
系统检索截至2013年2月发表在PubMed、EMBASE、科学网和考克兰图书馆上的相关研究。主要观察指标为插管成功率和内镜逆行胰胆管造影术（ERCP）后并发症。使用关键词对考克兰图书馆、PubMed、谷歌学术、Scopus、美国国立卫生研究院、对照试验元注册库以及主要胃肠病学杂志和会议截至2013年2月发表的会议记录进行全面系统检索。所有符合纳入标准的前瞻性随机对照试验（RCT）研究均纳入分析。前瞻性非随机研究和回顾性研究被排除在我们的荟萃分析之外。主要关注的结果是ERCP后胰腺炎、包括胆管炎、ERCP相关出血、穿孔在内的总体并发症发生率以及插管成功率。
根据选择标准，7项RCT共1039例患者被纳入荟萃分析。预切开括约肌切开术的总体插管成功率为90%，而持续尝试组为86.3%（比值比[OR]=1.98；95%置信区间[CI]：0.70 - 5.65）。两组之间ERCP后胰腺炎（PEP）的风险无差异（预切开括约肌切开术组为3.9%，持续尝试组为6.1%，OR = 0.58，95%CI：0.32 - 1.05）。同样，包括PEP、胆管炎、出血和穿孔在内的总体并发症发生率在两组之间无统计学显著差异（6.2%对6.9%，OR = 0.85，95%CI：0.51 - 1.41）。
该荟萃分析表明，预切开括约肌切开术与持续插管尝试在总体并发症发生率方面具有可比性。早期实施预切开术不会增加PEP并发症。
