Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, PR China.
J Clin Gastroenterol. 2018 Aug;52(7):573-578. doi: 10.1097/MCG.0000000000001077.
It is generally accepted that precut sphincterotomy during endoscopic retrograde cholangiopancreatography (ERCP) increases the risk of pancreatitis. However, patients with difficult biliary access may be different. We implemented a meta-analysis to explore the effects of early and delayed precut sphincterotomy on post-ERCP pancreatitis in patients with difficult biliary access.
We searched studies in PubMed, EMBASE, and the Cochrane Central Register of Randomized Controlled Trials for meeting requirement in which precut sphincterotomy was compared with persistent standard cannulation during ERCP. The primary outcomes included the overall cannulation success rate and the incidence of post-ERCP pancreatitis. The secondary outcomes included primary cannulation success and the overall complication rate.
Six studies (898 patients) were included. The present meta-analysis found no significant difference in overall cannulation success rate and overall complication rate between early precut sphincterotomy and persistent standard cannulation. However, early precut sphincterotomy not only increased the primary cannulation success rate [Mantel Haenszel test relative risk, 1.87; 95% confidence interval (CI), 1.15-3.04] but also decreased the overall risk of pancreatitis (Peto odds ratio, 0.49; 95% CI, 0.30-0.80). For persistent standard cannulation, no significant difference was observed in the pancreatitis rate between no salvage precut and delayed salvage precut sphincterotomy (Peto odds ratio, 0.96; 95% CI, 0.49-1.85).
Compared with persistent standard cannulation, an early precut sphincterotomy exhibited a reduced risk of pancreatitis. In addition, a delayed precut sphincterotomy after persistent attempts did not increase the occurrence of pancreatitis and this is the first meta-analysis to present this conclusion.
人们普遍认为，内镜逆行胰胆管造影术（ERCP）中的预切开括约肌切开术会增加胰腺炎的风险。然而，对于胆道困难的患者，情况可能有所不同。我们进行了一项荟萃分析，以探讨在胆道困难的患者中，早期和延迟预切开括约肌切开术对 ERCP 后胰腺炎的影响。
我们在 PubMed、EMBASE 和 Cochrane 中央对照试验注册库中搜索符合要求的研究，这些研究比较了 ERCP 中预切开括约肌切开术与持续标准插管。主要结局包括总体插管成功率和 ERCP 后胰腺炎的发生率。次要结局包括首次插管成功率和总体并发症发生率。
纳入了 6 项研究（898 例患者）。本荟萃分析发现，早期预切开括约肌切开术与持续标准插管在总体插管成功率和总体并发症发生率方面无显著差异。然而，早期预切开括约肌切开术不仅提高了首次插管成功率[Mantel Haenszel 检验相对风险，1.87；95%置信区间（CI），1.15-3.04]，而且降低了总体胰腺炎风险（Peto 优势比，0.49；95%CI，0.30-0.80）。对于持续标准插管，无补救性预切开和延迟补救性预切开括约肌切开术的胰腺炎发生率之间无显著差异（Peto 优势比，0.96；95%CI，0.49-1.85）。
与持续标准插管相比，早期预切开括约肌切开术可降低胰腺炎的风险。此外，持续尝试后进行延迟预切开括约肌切开术不会增加胰腺炎的发生，这是首次提出这一结论的荟萃分析。
