Chávez Rossell Miguel Anjel
Servicio de Gastroenterología, Hospital Nacional Arzobispo Loayza. Lima, Perú.
Rev Gastroenterol Peru. 2019 Oct-Dec;39(4):335-343.
Difficult biliary cannulation is a risk factor for post-ERCP pancreatitis. In these cases, precutting is the most used technique.
To demonstrate that precut fistulotomy is safe and effective.
Data from May 2016 to May 2018 were reviewed. Difficult cannulation was defined as: impacted lithiasis, inadvertent cannulation of the pancreatic duct on three occasions and inability to achieve deep biliary cannulation in 3 minutes. The outcome measures were successful biliary cannulation and post-ERCP Pancreatitis.
Precut fistulotomy was performed in 96 cases (67 women, 29 men). The success rate of biliary cannulation was 95.8% (92/96). Eighty patients had risk factors for post-ERCP pancreatitis: 29 had 1 risk factor, 26 had 2 risk factors, 19 had 3 risk factors, and 6 had four risk factors. Ampullary risk factors of difficult cannulation: impacted stone in the papilla: 9 cases, papilla bulging: 10 cases, lower location of the hole papillary 38 cases, partial location of the papillary pore 23 and papillary orifice stenosis 16 cases. Ten patients had periampullary diverticulum, 7 patients had normal bile duct. None of the patients experienced Pancreatitis. Three patients had early bleeding, one patient had late bleeding. One patient (2%) had a fever and was hospitalized.
In cases of difficult biliary cannulation, the precut fistulotomy is safe and effective.
困难胆管插管是内镜逆行胰胆管造影术（ERCP）后胰腺炎的一个危险因素。在这些情况下，预切开是最常用的技术。
证明预切开瘘管切开术是安全有效的。
回顾了2016年5月至2018年5月的数据。困难插管定义为：结石嵌顿、三次意外插管至胰管以及3分钟内无法实现深部胆管插管。观察指标为胆管插管成功和ERCP后胰腺炎。
96例患者（67例女性，29例男性）接受了预切开瘘管切开术。胆管插管成功率为95.8%（92/96）。80例患者有ERCP后胰腺炎的危险因素：29例有1个危险因素，26例有2个危险因素，19例有3个危险因素，6例有4个危险因素。困难插管的壶腹危险因素：乳头结石嵌顿9例，乳头膨出10例，乳头孔位置较低38例，乳头孔部分位置23例，乳头开口狭窄16例。10例患者有壶腹周围憩室，7例患者胆管正常。所有患者均未发生胰腺炎。3例患者早期出血，1例患者晚期出血。1例患者（2%）发热并住院。
在困难胆管插管的情况下，预切开瘘管切开术是安全有效的。
