Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, Jiangsu, China.
Sci Rep. 2021 Mar 15;11(1):6059. doi: 10.1038/s41598-021-84655-2.
Transpancreatic sphincterotomy (TPS) can be an alternative approach of difficult biliary access in endoscopic retrograde cholangiopancreatography (ERCP). We aimed to evaluate the efficacy and safety of TPS compared to needle-knife precut (NKP), considering the early and late outcomes of both techniques. The prospectively collected clinical data, ERCP procedure findings, and outcomes of patients who underwent ERCP with difficult biliary access in our hospital from July 2016 to January 2018 were retrospectively analyzed. The patients were divided into two groups according to the applied secondary cannulation techniques. The propensity score matching (PSM) was applied to reduce the potential selection bias and unify the preventive measures of post-ERCP pancreatitis (PEP) in both groups. A total of 125 patients were enrolled in this study, with 54.4% male and a mean age of 63.29 ± 16.33 years. NKP group included 82 patients, and 43 patients received TPS. Prophylactic pancreatic stents were placed in all patients with TPS and 58.5% of patients with NKP. After applying PSM, the cohort was comprised to 86 patients with 43 patients in each TPS and NKP groups. Successful selective cannulation was achieved by 95.3% using TPS and by 93% using NKP. The mean procedure time was shorter in the TPS group without significant difference. Compared to NKP, using TPS did not affect the rate of PEP. Moreover, TPS was associated with less frequent post-ERCP bleeding and perforation, but without significant differences (all p > 0.05). Patients who received TPS or NKP had no symptoms related to papillary stenosis or chronic pancreatitis during the follow-up period. In conclusion, using TPS in difficult cannulation cases was useful to achieve success cannulation with an acceptable PEP rate and less frequent post-ERCP bleeding and perforation compared to NKP. There were no symptoms related to papillary stenosis or chronic pancreatitis during the follow-up period.
经胰管括约肌切开术（TPS）可以作为内镜逆行胰胆管造影术（ERCP）中困难胆管入路的一种替代方法。我们旨在评估 TPS 与针刀预切开（NKP）相比的疗效和安全性，同时考虑两种技术的早期和晚期结果。对 2016 年 7 月至 2018 年 1 月期间在我院因困难胆管入路而行 ERCP 的患者的临床资料、ERCP 操作发现和结果进行回顾性分析。根据应用的二级插管技术将患者分为两组。应用倾向评分匹配（PSM）来减少潜在的选择偏差，并统一两组预防 ERCP 后胰腺炎（PEP）的措施。本研究共纳入 125 例患者，其中 54.4%为男性，平均年龄为 63.29±16.33 岁。NKP 组包括 82 例患者，43 例患者接受 TPS。所有 TPS 患者均放置预防性胰管支架，58.5%的 NKP 患者放置胰管支架。应用 PSM 后，该队列由 86 例患者组成，每组 43 例患者。TPS 组的选择性插管成功率为 95.3%，NKP 组为 93%。TPS 组的平均操作时间更短，但无显著差异。与 NKP 相比，使用 TPS 并不影响 PEP 的发生率。此外，与 NKP 相比，TPS 与较少的 ERCP 后出血和穿孔相关，但无显著差异（均 P>0.05）。在随访期间，接受 TPS 或 NKP 的患者均无乳头狭窄或慢性胰腺炎相关症状。总之，与 NKP 相比，在困难插管病例中使用 TPS 有助于实现成功插管，且 PEP 发生率可接受，ERCP 后出血和穿孔发生率较低。在随访期间，无乳头狭窄或慢性胰腺炎相关症状。
