Takano Yuichi, Nagahama Masatsugu, Niiya Fumitaka, Kobayashi Takahiro, Yamamura Eiichi, Maruoka Naotaka
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
Endosc Int Open. 2018 Aug;6(8):E1015-E1019. doi: 10.1055/a-0599-6260. Epub 2018 Aug 10.
In endoscopic retrograde cholangiopancreatography (ERCP), precutting is widely used when achieving biliary cannulation is difficult. However, no consensus has been reached with regard to the best time to initiate precutting.
We retrospectively examined 63 patients who underwent precutting for naïve papilla with difficulty in biliary cannulation between 2009 and 2016. The outcomes of the early precut group (≤ 20 min from cannulation until initiating precutting) and the late precut group (> 20 min) were compared.
Of the 63 patients, 17 (27 %) were in the early precut group and 46 (73 %) were in the late precut group; median time until the initiating precutting was 28 minutes (7 - 50). No significant difference was observed between the two groups in terms of clinical features (age, sex, and indication for ERCP), precutting method, and rate of pancreatic duct stent placement. Significantly higher rates of successful biliary cannulation were observed in the early precut group (16/17; 94 %) than in the late precut group (32/46; 70 %) ( < 0.05). In 13 patients in whom precutting was commenced after 40 minutes, the rate of successful biliary cannulation was very low at 53 % (7/13). No significant difference was found between the two groups in terms of incidence of complications (pancreatitis in 5 patients and bleeding in 1 patient).
In actual clinical practice, precutting is commenced approximately 30 minutes after cannulation; however, to successfully achieve biliary cannulation, precutting is recommended to be performed within 20 minutes. Precutting is effective when little inflammation and swelling of the ampulla of Vater is observed. This study was limited in that it was single-center, retrospective and had a small subject sample.
在内镜逆行胰胆管造影术（ERCP）中，当胆管插管困难时，预切开术被广泛应用。然而，关于何时开始预切开术的最佳时机尚未达成共识。
我们回顾性研究了2009年至2016年间63例因初次乳头插管困难而接受预切开术的患者。比较了早期预切开组（插管至开始预切开≤20分钟）和晚期预切开组（>20分钟）的结果。
63例患者中，17例（27%）在早期预切开组，46例（73%）在晚期预切开组；开始预切开的中位时间为28分钟（7 - 50分钟）。两组在临床特征（年龄、性别和ERCP指征）、预切开方法和胰管支架置入率方面无显著差异。早期预切开组的胆管插管成功率（16/17；94%）显著高于晚期预切开组（32/46；70%）（P<0.05）。在40分钟后开始预切开的13例患者中，胆管插管成功率非常低，为53%（7/13）。两组并发症发生率（5例胰腺炎和1例出血）无显著差异。
在实际临床实践中，预切开术在插管后约30分钟开始；然而，为了成功实现胆管插管，建议在20分钟内进行预切开术。当观察到 Vater壶腹炎症和肿胀较小时，预切开术是有效的。本研究的局限性在于它是单中心、回顾性的，且样本量较小。
