Srinivasan Indu, Freeman Martin L
Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
Am J Gastroenterol. 2016 Dec;111(12):1848-1850. doi: 10.1038/ajg.2016.507.
Recent studies have revealed that deep pancreatic duct wire passage, even in the absence of contrast injection, is a major technique-related culprit in post-ERCP pancreatitis, unless followed by placement of a pancreatic stent. As guidewire cannulation becomes increasingly widespread, precise control of the guidewire is thus critical. The first randomized trial to compare endoscopist-controlled wire guided vs. assistant-controlled bile duct cannulation has shown a significant reduction in post ERCP pancreatitis when the physician manipulates the wire. Though there is no single universal solution to post-ERCP pancreatitis, careful attention to wire contol is emerging as an important aspect of safety in ERCP.
近期研究表明，即使不注射造影剂，胰管深部导丝插入也是内镜逆行胰胆管造影术后胰腺炎的主要技术相关病因，除非随后放置胰管支架。随着导丝插管越来越普遍，因此精确控制导丝至关重要。第一项比较内镜医师控制导丝引导与助手控制胆管插管的随机试验表明，当医生操作导丝时，内镜逆行胰胆管造影术后胰腺炎显著减少。虽然对于内镜逆行胰胆管造影术后胰腺炎没有单一的通用解决方案，但仔细关注导丝控制正成为内镜逆行胰胆管造影安全性的一个重要方面。
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