高危患者中环形尖端导丝辅助与传统内镜插管的比较。
Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients.
作者信息
Masci Enzo, Mangiavillano Benedetto, Luigiano Carmelo, Bizzotto Alessandra, Limido Eugenio, Cantù Paolo, Manes Gianpiero, Viaggi Paolo, Spinzi Giancarlo, Radaelli Franco, Mariani Alberto, Virgilio Clara, Alibrandi Angela, Testoni Pier Alberto
机构信息
Gastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, Italy.
Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, Italy.
出版信息
Endosc Int Open. 2015 Oct;3(5):E464-70. doi: 10.1055/s-0034-1392879. Epub 2015 Sep 15.
BACKGROUND
The guidewire biliary cannulation (GWC) technique may increase the cannulation rate and decrease the risk for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of our multicenter prospective randomized controlled trial was to determine if the use of an atraumatic loop-tip guidewire reduces the rate of post-ERCP pancreatitis (PEP) compared with the standard contrast-assisted cannulation (CC) technique.
METHODS
From June 2012 to December 2013, a total of 320 patients who had a naïve papilla and were referred for ERCP were randomly assigned to the GWC group (n = 160) or the CC group (n = 160). GWC or CC was randomly used. In cases of failed cannulation in both arms after crossover, biliary access was attempted with alternative techniques (e. g., dual-wire technique, pancreatic duct stenting, precut).
RESULTS
The biliary cannulation rates were 81 % in the GWC group and 73 % in the CC group (P = n. s.). Following crossover, cannulation was successful in 8 % and 11 % of patients in the GWC and CC groups, respectively. With use of an alternative technique, the cannulation rates were 98 % in the GWC group and 96 % in the CC group, respectively. The rates of PEP were 5 % in the GWC group and 12 % in the CC group (P = 0.027). The post-interventional complication rates did not differ between the two groups.
CONCLUSION
GWC with the new wire guide is associated with a lower rate of PEP in comparison with the CC technique. Clinical trial reference number: NCT01771419.
背景
导丝胆管插管（GWC）技术可能会提高插管成功率，并降低内镜逆行胰胆管造影（ERCP）术后胰腺炎的风险。我们这项多中心前瞻性随机对照试验的目的是确定与标准造影剂辅助插管（CC）技术相比，使用无创伤环形头导丝是否能降低ERCP术后胰腺炎（PEP）的发生率。
方法
2012年6月至2013年12月，共有320例初诊乳头且需接受ERCP的患者被随机分为GWC组（n = 160）和CC组（n = 160）。随机采用GWC或CC技术。若两组交叉操作后插管均失败，则尝试用其他技术进行胆管通路建立（如双导丝技术、胰管支架置入、预切开术）。
结果
GWC组胆管插管成功率为81%，CC组为73%（P值无统计学意义）。交叉操作后，GWC组和CC组分别有8%和11%的患者插管成功。采用其他技术后，GWC组和CC组的插管成功率分别为98%和96%。GWC组PEP发生率为5%，CC组为12%（P = 0.027）。两组介入后并发症发生率无差异。
结论
与CC技术相比，使用新型导丝的GWC技术与较低的PEP发生率相关。临床试验注册号：NCT01771419。
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