Hospital Santa Marcelina, São Paulo, SP, Brasil.
Faculdade Santa Marcelina, São Paulo, SP, Brasil.
Arq Gastroenterol. 2021 Oct-Dec;58(4):509-513. doi: 10.1590/S0004-2803.202100000-91.
A successful bile duct cannulation is a prerequisite for the realization of endoscopic retrograde cholangiopancreatography (ERCP). When biliary cannulation is not possible, needle-knife fistulotomy (NKF) can be performed. However, when biliary access is not successfully achieved even after performing NKF, it is possible to interrupt the procedure, and repeat the ERCP after a short interval.
The aim of this study is to analyze if repeating an ERCP after a short interval of 48 hours is effective in achieving biliary access after an initial NKF was unsuccessfully performed.
A total of 1024 patients with a naive papilla, that underwent ERCP between the years of 2009-2019, were retrospectively reviewed. Difficult biliary cannulation was identified in 238 of these cases and NKF was performed. Success of biliary cannulation, NKF success at the first and second ERCPs, the associations between the type of the papilla, biliary dilatation, and overall success of NKF and adverse events rates were evaluated.
Biliary access was initially achieved in 183 (76.8%) cases. Of the 55 (23.1%) remaining cases a second attempt was performed after 48 hours, and biliary access was successfully achieved in 46 (83.6%) of them. The overall success of NKF after the first and second ERCP, the success rate was 96.2%. Papilla located out of its normal position was related to a minor chance of success at NKF (P<0.05).
We conclude that when biliary access is not achieved after the performance of a NKF, a second attempt is safe and effective and should be attempted.
成功的胆管插管是实现内镜逆行胰胆管造影（ERCP）的前提。当胆管插管不可行时，可以进行针刀窦切开术（NKF）。然而，即使在进行 NKF 后仍然无法获得胆道通路时，可以中断该过程，并在短时间间隔后重复进行 ERCP。
本研究旨在分析在初始 NKF 不成功后，在 48 小时的短时间间隔后重复进行 ERCP 是否能有效地实现胆道通路。
回顾性分析了 2009 年至 2019 年间接受 ERCP 治疗的 1024 例初次乳头切开术的患者。这些患者中有 238 例存在胆管插管困难，并进行了 NKF。评估胆管插管的成功率、NKF 在第一次和第二次 ERCP 中的成功率、乳头类型、胆管扩张与 NKF 整体成功率的关系以及不良事件发生率。
183 例（76.8%）患者最初获得了胆道通路。在其余 55 例（23.1%）患者中，在 48 小时后进行了第二次尝试，其中 46 例（83.6%）获得了胆道通路。第一次和第二次 ERCP 后 NKF 的总体成功率为 96.2%。乳头位置异常与 NKF 成功率较低相关（P<0.05）。
当进行 NKF 后仍无法获得胆道通路时，再次尝试是安全有效的，应尝试进行。
