Zagalsky David, Guidi Martin Alejandro, Curvale Cecilia, Lasa Juan, de Maria Julio, Ianniccillo Hernan, Hwang Hui Jer, Matano Raúl
Endoscopia, Hospital Posadas.
Gastroenterologia, Hospital El Cruce, Argentina.
Rev Esp Enferm Dig. 2016 Sep;108(9):258-562. doi: 10.17235/reed.2016.4348/2016.
The most common adverse event of endoscopic retrograde cholangiopancreatography is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. Some authors have stated that early precut may actually reduce post-ERCP pancreatitis risk. However, early precut as a preventive measure has not been compared to other preventive measures, such as pancreatic duct stent placement.
To compare the efficacy of early precut sphincterotomy versus pancreatic duct stent placement in high-risk subjects undergoing endoscopic retrograde cholangiopancreatography for the prevention of post-endoscopic cholangiopancreatography.
This was a single-blinded, randomized trial that took place in two tertiary referral centers in Buenos Aires, from November 2011 to December 2013. ERCP subjects presented at least one of the following risk factors: female sex, age less than 40 years, clinical suspicion of sphincter of Oddi dysfunction, previous pancreatitis, and/or common bile duct diameter of less than 8 mm. Only those who presented a difficult biliary cannulation were randomized into two groups: those who received early precut sphincterotomy and those in whom persistency of biliary cannulation was intended, with subsequent pancreatic duct stent placement after cholangiography was achieved. The incidence of post-ERCP pancreatitis, as well as other adverse events incidence, was compared.
Overall, 101 patients were enrolled, 51 in the pancreatic duct stent group and 50 in the early precut group. Pancreatitis rate was similar in both groups (3.92% vs 4%, p NS). In all cases, pancreatitis was classified as mild. There were no deaths registered.
Early precut was associated with an incidence of adverse events similar to pancreatic duct stent placement.
内镜逆行胰胆管造影术最常见的不良事件是胰腺炎。预切开括约肌切开术被视为一个危险因素。一些作者指出，早期预切开实际上可能降低内镜逆行胰胆管造影术后胰腺炎的风险。然而，早期预切开作为一种预防措施尚未与其他预防措施进行比较，如胰管支架置入术。
比较早期预切开括约肌切开术与胰管支架置入术在接受内镜逆行胰胆管造影术的高危患者中预防内镜逆行胰胆管造影术后胰腺炎的疗效。
这是一项单盲随机试验，于2011年11月至2013年12月在布宜诺斯艾利斯的两个三级转诊中心进行。接受内镜逆行胰胆管造影术的患者至少具备以下危险因素之一：女性、年龄小于40岁、临床怀疑Oddi括约肌功能障碍、既往胰腺炎和/或胆总管直径小于8mm。只有那些胆管插管困难的患者被随机分为两组：接受早期预切开括约肌切开术的患者和打算持续进行胆管插管、在完成胆管造影后随后置入胰管支架的患者。比较内镜逆行胰胆管造影术后胰腺炎的发生率以及其他不良事件的发生率。
总体而言，共纳入101例患者，胰管支架组51例，早期预切开组50例。两组的胰腺炎发生率相似（3.92%对4%，p无统计学意义）。在所有病例中，胰腺炎均被分类为轻度。无死亡病例记录。
早期预切开与胰管支架置入术的不良事件发生率相似。
