Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China.
Integrated Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou, 510632, China.
Dig Dis Sci. 2019 Aug;64(8):2088-2094. doi: 10.1007/s10620-019-05513-w. Epub 2019 Feb 18.
Endoscopic biliary sphincterotomy (EST) is commonly performed during therapeutic endoscopic retrograde cholangiopancreatography (ERCP), but is an independent risk factor for post-ERCP pancreatitis, bleeding and duodenal perforation. These are partly ascribed to the electrosurgical current mode used for EST, and currently the optimal current model for EST remains controversial. In this study, we aimed to compare the rate of complications undergoing EST using the Endocut versus the blended current.
A systematic search of databases was performed for relevant published and prospective studies including randomized clinical trials (RCTs) to compare Endocut with blended current modes for EST. Data were collected from inception until 1 July 2018, using post-ERCP pancreatitis, bleeding and perforation as primary outcomes.
Three RCTs including a total of 594 patients met the inclusion criteria. Our meta-analysis results showed the rate of post-ERCP pancreatitis, primarily mild to moderate pancreatitis, was no different between Endocut versus blended current modes [risk ratio (RR) 0.61, 95% confidence interval (CI) 0.25-1.52, P = 0.29]. However, the risk of endoscopically bleeding events, primarily mild bleeding, was lower in studies using Endocut versus blended current (RR 0.54, 95% CI 0.31-0.95, P = 0.03). Notably, none of the patients experienced perforation in these three trials.
The rate of post-ERCP pancreatitis was not significantly different when using the Endocut versus blended current during EST. Nevertheless, compared with the blended current, Endocut reduced the incidence of endoscopically evident bleeding; however, the available data were insufficient to assess the perforation risk.
内镜下胆管括约肌切开术（EST）常用于治疗性内镜逆行胰胆管造影术（ERCP），但它是 ERCP 后胰腺炎、出血和十二指肠穿孔的独立危险因素。这些部分归因于 EST 中使用的电外科电流模式，目前 EST 的最佳电流模式仍存在争议。在这项研究中，我们旨在比较使用 Endocut 与混合电流进行 EST 的并发症发生率。
系统地检索了数据库中有关的已发表和前瞻性研究，包括随机临床试验（RCT），以比较 Endocut 与 EST 的混合电流模式。数据从研究开始收集到 2018 年 7 月 1 日，将 ERCP 后胰腺炎、出血和穿孔作为主要结局。
符合纳入标准的三项 RCT 共纳入 594 例患者。我们的荟萃分析结果表明，Endocut 与混合电流模式之间，主要是轻度至中度胰腺炎的 ERCP 后胰腺炎发生率没有差异[风险比（RR）0.61，95%置信区间（CI）0.25-1.52，P=0.29]。然而，在使用 Endocut 的研究中，内镜下出血事件（主要是轻度出血）的风险较低（RR 0.54，95%CI 0.31-0.95，P=0.03）。值得注意的是，在这三项试验中，没有患者发生穿孔。
在 EST 中使用 Endocut 与混合电流时，ERCP 后胰腺炎的发生率没有显著差异。然而，与混合电流相比，Endocut 降低了内镜下明显出血的发生率；然而，现有数据不足以评估穿孔风险。
