Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
BMC Gastroenterol. 2020 Jun 19;20(1):194. doi: 10.1186/s12876-020-01323-x.
Selective deep biliary cannulation is the first and the most important step before further biliary therapy. Transpancreatic sphincterotomy (TPS), and needle knife fistulotomy (NKF) were commonly used in patients with difficult cannulation, but few studies compare the outcome between TPS and NKF.
A total of 78 patients who met the criteria of difficult cannulation in the National Taiwan University hospital from October 2015 to October 2017 were retrospectively reviewed. Their baseline demographics, success rate of biliary cannulation, and the rate of adverse events were assessed.
31 patients and 47 patients underwent TPS and NKF for difficult biliary access, respectively. The characteristics of the 2 groups were similar, but patients in TPS group had more frequent pancreatic duct cannulation. Bile duct cannulation was successful in 23 patients (74.2%) in the TPS group and 39 (83.0%) in the NKF group (P = 0.34). There was no difference between the TPS and NKF in the rate of adverse events, including post-ERCP pancreatitis (PEP) (16.1% vs. 6.4%, p = 0.17), and hemorrhage (3.2% vs. 8.5%, p = 0.35). No perforation occurred.
Both TPS and NKF have good biliary access rate in patient with difficult cannulation. TPS has acceptable successful rate and similar complication rate, compared with NKF.
选择性胆管深部插管是进一步胆道治疗的第一步，也是最重要的一步。胰胆管括约肌切开术（TPS）和针刀窦道切开术（NKF）常用于困难插管患者，但很少有研究比较 TPS 和 NKF 的结果。
回顾性分析 2015 年 10 月至 2017 年 10 月期间在国立台湾大学医院符合困难插管标准的 78 例患者。评估其基线人口统计学特征、胆管插管成功率和不良事件发生率。
31 例患者接受 TPS，47 例患者接受 NKF 治疗困难胆道，两组患者的特征相似，但 TPS 组患者胰管插管更为频繁。TPS 组胆管插管成功 23 例（74.2%），NKF 组 39 例（83.0%）（P = 0.34）。两组不良事件发生率无差异，包括内镜逆行胰胆管造影术后胰腺炎（PEP）（16.1%比 6.4%，P = 0.17）和出血（3.2%比 8.5%，P = 0.35）。无穿孔发生。
对于困难插管患者，TPS 和 NKF 均有较好的胆管插管成功率。与 NKF 相比，TPS 具有可接受的成功率和相似的并发症发生率。
