Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Pudong New District, Shanghai, 200120, China.
Surg Endosc. 2021 Aug;35(8):4849-4856. doi: 10.1007/s00464-021-08417-x. Epub 2021 Mar 17.
Selective biliary cannulation (SBC) is currently accepted as the first challenge of endoscopic retrograde cholangiopancreatography (ERCP), especially in patients with altered anatomy such as Billroth II gastrectomy. A rotatable sphincterotome (RS) might be considered useful for guiding the directional axis of SBC. This study aimed to evaluate the efficacy and safety of RS for biliary cannulation in patients with prior Billroth II gastrectomy.
This is a retrospective cohort study conducted to compare the efficacy and safety between RS (RS group) and conventional sphincterotome of pulling arciform knife (PAF, PAF group). The success rate of SBC and endoscopic sphincterotomy (EST) were evaluated in both the groups. Moreover, the outcomes of the procedure and adverse events were also compared between the two groups.
Eighty-six consecutive prior Billroth II gastrectomy patients who underwent ERCP with RS or PAF during the study period were enrolled. After excluding 7 patients, there were 41 patients in the RS group and 38 in the PAF group. The baseline characteristics were similar in both the groups. There was no significant difference in the clinical success rates of SBC in RS group (95.12%) versus PAF group (84.21%), (P = 0.1082). Successful SBC within 5 min was 87.80% in RS group and 23.68% in PAF group (P < 0.0001). The success rate of EST was 89.74% in RS group and 28.13% in PAF group (P < 0.0001). The incidence of post-ERCP pancreatitis (PEP) showed significant differences between RS (2.44%) and PAF groups (21.05%; P = 0.0061).
Although RS has comparable success rates of SBC over PAF in patients with prior Billroth II gastrectomy, RS has facilitated the procedure by increasing the success rate of EST and SBC within 5 min, and the incidence of PEP was lowered as well.
选择性胆管插管（SBC）目前被认为是内镜逆行胰胆管造影（ERCP）的首要挑战，特别是在解剖结构改变的患者中，如毕罗氏 II 式胃切除术。旋转式括约肌切开刀（RS）可能被认为有助于指导 SBC 的定向轴。本研究旨在评估 RS 在毕罗氏 II 式胃切除术后患者胆管插管中的疗效和安全性。
这是一项回顾性队列研究，比较 RS（RS 组）和传统的拉弓式刀括约肌切开刀（PAF，PAF 组）在 SBC 和内镜括约肌切开术（EST）中的疗效和安全性。评估两组 SBC 和 EST 的成功率。此外，还比较了两组患者的操作结果和不良事件。
在研究期间，86 例连续接受 RS 或 PAF 行 ERCP 的毕罗氏 II 式胃切除术后患者被纳入研究。排除 7 例患者后，RS 组 41 例，PAF 组 38 例。两组患者的基线特征相似。RS 组 SBC 的临床成功率（95.12%）与 PAF 组（84.21%）无显著差异（P=0.1082）。RS 组 5min 内 SBC 成功率为 87.80%，PAF 组为 23.68%（P<0.0001）。RS 组 EST 成功率为 89.74%，PAF 组为 28.13%（P<0.0001）。RS 组（2.44%）与 PAF 组（21.05%）的术后胰腺炎（PEP）发生率有显著差异（P=0.0061）。
尽管 RS 在毕罗氏 II 式胃切除术后患者中 SBC 的成功率与 PAF 相当，但 RS 增加了 EST 和 5min 内 SBC 的成功率，降低了 PEP 的发生率，从而使操作更加顺利。
