Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province.
Department of Gastroenterology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, China.
Surg Laparosc Endosc Percutan Tech. 2021 Feb 16;31(5):533-538. doi: 10.1097/SLE.0000000000000924.
Selective biliary cannulation is a difficult part of endoscopic retrograde cholangiopancreatography (ERCP). Therefore, endoscopists have focused on how to improve the cannulation success rate and reduce the postoperative complication rate. This study aims to provide practical advice on safe operation for endoscopists.
Data from the ERCP database of our medical center from January 2008 to December 2017 were retrospectively reviewed. All patients underwent ERCP for the first time. Data pertaining to diseases, anatomic factors, difficult cannulation rates, cannulation success rates, and postoperative complication rates for various assistive cannulation techniques were analyzed by using the Pearson χ2 tests and Fisher exact tests.
The difficult cannulation rate was 8.1%. The main influencing factors were benign and malignant biliary stricture, duodenal papillae or ampullary tumors, thick and long duodenal papillae, peridiverticular papillae, ectopic papillae, edematous papillae, ulcerative papillae, anomalous pancreaticobiliary junction, and Billroth II gastrectomy. The postoperative complication rates and overall cannulation success rates of 7 assistive techniques were not statistically different (P>0.05), but the overall complication rates were statistically different (P<0.05). Needle-knife precut sphincterotomy had the highest rate of complications.
Benign and malignant biliary stricture, duodenal papillae or ampullary tumors, thick and long duodenal papillae, peridiverticular papillae, ectopic papillae, edematous papillae, ulcerative papillae, anomalous pancreaticobiliary junction, and Billroth II gastrectomy were the main factors of difficult selective biliary cannulation. The overall incidence of needle-knife precut sphincterotomy complications was higher than that of other techniques, but various assistive techniques were safe and effective in our single center.
选择性胆管插管是内镜逆行胰胆管造影（ERCP）的难点。因此，内镜医师一直致力于提高插管成功率，降低术后并发症发生率。本研究旨在为内镜医师的安全操作提供实用建议。
回顾性分析 2008 年 1 月至 2017 年 12 月我院 ERCP 数据库资料，所有患者均首次行 ERCP 检查。分析疾病、解剖因素、插管困难率、插管成功率及各种辅助插管技术术后并发症发生率，采用 Pearson χ2 检验和 Fisher 确切概率法。
插管困难率为 8.1%。主要影响因素有良性和恶性胆管狭窄、十二指肠乳头或壶腹肿瘤、乳头厚长、憩室旁乳头、异位乳头、水肿乳头、溃疡性乳头、胰胆管合流异常、毕Ⅱ式胃大部切除。7 种辅助技术的术后并发症发生率和总体插管成功率差异均无统计学意义（P>0.05），但总体并发症发生率差异有统计学意义（P<0.05）。针刀预切开括约肌切开术并发症发生率最高。
良性和恶性胆管狭窄、十二指肠乳头或壶腹肿瘤、乳头厚长、憩室旁乳头、异位乳头、水肿乳头、溃疡性乳头、胰胆管合流异常、毕Ⅱ式胃大部切除是导致选择性胆管插管困难的主要因素。针刀预切开括约肌切开术的总体并发症发生率高于其他技术，但在本中心，各种辅助技术安全有效。
