Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan, ROC.
Sci Rep. 2022 Mar 23;12(1):4942. doi: 10.1038/s41598-022-09117-9.
Predictors of needle-knife pre-cut papillotomy (NKP) failure for patients with difficult biliary cannulation has not been reported. Between 2004 and 2016, 390 patients with difficult biliary cannulation undergoing NKP were included in this single-center study. Following NKP, deep biliary cannulation failed in 95 patients (24.4%, NKP-failure group) and succeeded in 295 patients (75.6%, NKP-success group). Patient and technique factors were used to identify the predictors of initial NKP failure. Compared with the NKP-success group, periampullary diverticulum (28.4% vs. 18%, p = 0.028), surgically altered anatomy (13.7% vs. 7.1%, p = 0.049), number of cases performed by less experienced endoscopists, and bleeding during NKP (38.9% vs. 3.4%, p < 0.001), were significantly more frequent in the NKP-failure group. On multivariate analysis, surgically altered anatomy (OR 2.374, p = 0.045), endoscopists' experience (OR 3.593, p = 0.001), and bleeding during NKP (OR 21.18, p < 0.001) were significantly associated with initial failure of NKP. In conclusion, NKP is a highly technique-sensitive procedure, as endoscopists' experience, bleeding during NKP, and surgically altered anatomy were predictors of initial NKP failure.
对于行经皮肝穿刺胆道造影（PTC）术前预切开（NKP）困难的患者，尚未有研究报道其 NKP 失败的预测因素。本研究为单中心研究，纳入了 2004 年至 2016 年间 390 例行 NKP 的困难胆道插管患者。在 NKP 后，95 例患者（24.4%，NKP 失败组）出现深部胆管插管失败，295 例患者（75.6%，NKP 成功组）成功插管。研究使用患者和技术因素来确定初始 NKP 失败的预测因素。与 NKP 成功组相比，壶腹周围憩室（28.4% vs. 18%，p=0.028）、手术改变的解剖结构（13.7% vs. 7.1%，p=0.049）、经验较少的内镜医生操作的病例数以及 NKP 期间出血（38.9% vs. 3.4%，p<0.001）在 NKP 失败组中更为常见。多因素分析显示，手术改变的解剖结构（OR 2.374，p=0.045）、内镜医生的经验（OR 3.593，p=0.001）和 NKP 期间出血（OR 21.18，p<0.001）与 NKP 初始失败显著相关。总之，NKP 是一项高度依赖技术的操作，内镜医生的经验、NKP 期间出血和手术改变的解剖结构是初始 NKP 失败的预测因素。
