Kawakami Hiroshi, Kubota Yoshimasa, Kawahata Shuhei, Kubo Kimitoshi, Kawakubo Kazumichi, Kuwatani Masaki, Sakamoto Naoya
Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Dig Endosc. 2016 Apr;28 Suppl 1:77-95. doi: 10.1111/den.12621.
In 1970, a Japanese group reported the first use of endoscopic retrograde cholangiopancreatography (ERCP), which is now carried out worldwide. Selective bile duct cannulation is a mandatory technique for diagnostic and therapeutic ERCP. Development of the endoscope and other devices has contributed to the extended use of ERCP, which has become a basic procedure to diagnose and treat pancreaticobiliary diseases. Various techniques related to selective bile duct cannulation have been widely applied. Although the classical contrast medium injection cannulation technique remains valuable, use of wire-guided cannulation has expanded since the early 2000s, and the technique is now widely carried out in the USA and Europe. Endoscopists must pay particular attention to a patient's condition and make an attendant choice about the most effective technique for selective bile duct cannulation. Some techniques have the potential to shorten procedure time and reduce the incidence of adverse events, particularly post-ERCP pancreatitis. However, a great deal of experience is required and endoscopists must be skilled in a variety of techniques. Although the development of the transpapillary biliary cannulation approach is remarkable, it is important to note that, to date, there have been no reports of transpapillary cannulation preventing post-ERCP pancreatitis. In the present article, selective bile duct cannulation techniques in the context of recent Japanese randomized controlled trials and cases of precut sphincterotomy are reviewed and discussed.
1970年，一个日本团队报告了首次使用内镜逆行胰胆管造影术（ERCP），如今该技术在全球范围内广泛开展。选择性胆管插管是诊断性和治疗性ERCP的一项必备技术。内镜及其他设备的发展推动了ERCP的广泛应用，它已成为诊断和治疗胰胆疾病的一项基本操作。与选择性胆管插管相关的各种技术已得到广泛应用。尽管传统的造影剂注射插管技术仍然很有价值，但自21世纪初以来，导丝引导插管的应用有所增加，目前该技术在美国和欧洲广泛开展。内镜医师必须特别关注患者的病情，并对选择性胆管插管的最有效技术做出适当选择。一些技术有可能缩短操作时间并降低不良事件的发生率，尤其是ERCP术后胰腺炎。然而，这需要丰富的经验，内镜医师必须熟练掌握多种技术。尽管经乳头胆管插管方法的发展显著，但需要注意的是，迄今为止，尚无经乳头插管预防ERCP术后胰腺炎的报道。在本文中，结合近期日本的随机对照试验和预切开括约肌切开术病例，对选择性胆管插管技术进行了综述和讨论。
