Ikeda Yuki, Ono Michihiro, Ohmori Ginji, Ameda Saki, Arihara Yohei, Yamada Michiko, Abe Tomoyuki, Maeda Masahiro
Department of Gastroenterology, Steel Memorial Muroran Hospital, Muroran, 050-0076, Japan.
Surg Endosc. 2023 Jan;37(1):120-126. doi: 10.1007/s00464-022-09426-0. Epub 2022 Jul 18.
A precut procedure is sometimes required for difficult biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP). However, it is unclear whether the biliary access rate has improved for early precut procedures compared to conventional techniques. This study aimed to identify the benefit of early precut sphincterotomy in cases showing difficult biliary access.
Between April 2017 and August 2021, consecutive patients who underwent precutting for difficult biliary cannulation were retrospectively enrolled. The outcomes of early (≤ 10 min from start of cannulation) and delayed (> 10 min) precut groups were evaluated. All adverse events were defined according to Cotton criteria.
A total of 70 patients were enrolled in this study. The biliary cannulation rate for a first ERCP was significantly higher in the early compared to delayed precut group (95% vs. 73.3%; P = 0.015). A difference in overall cannulation rate between the two groups was not observed (97.5% vs. 83.3%; P > 0.05). Significantly higher rates of prophylactic pancreatic stents were described in the delayed compared to early precut group (36.7% vs. 12.5%; P = 0.009). Significant differences in the frequency of pancreatitis, bleeding, penetration, and perforation were not noted between the two groups. Overall, the success rate was statistically significant between the experienced and less experienced endoscopists (87.2% vs. 63.9%; P = 0.017).
Early precutting within 10 min from the start of cannulation in ERCP is safe and effective in cases with a difficult biliary cannulation, and can improve the biliary cannulation rate.
在内镜逆行胰胆管造影术（ERCP）期间，有时需要采用预切开术来应对困难的胆管插管。然而，与传统技术相比，早期预切开术的胆管插管成功率是否有所提高尚不清楚。本研究旨在确定在胆管插管困难的病例中早期预切开括约肌切开术的益处。
回顾性纳入2017年4月至2021年8月期间因困难胆管插管而接受预切开术的连续患者。对早期（插管开始后≤10分钟）和延迟（>10分钟）预切开组的结果进行评估。所有不良事件均根据科顿标准定义。
本研究共纳入70例患者。早期预切开组首次ERCP的胆管插管成功率显著高于延迟预切开组（95%对73.3%；P=0.015）。两组的总体插管成功率未观察到差异（97.5%对83.3%；P>0.05）。延迟预切开组预防性胰管支架置入率显著高于早期预切开组（36.7%对12.5%；P=0.009）。两组之间胰腺炎、出血、穿透和穿孔的发生率无显著差异。总体而言，经验丰富和经验不足的内镜医师之间的成功率有统计学差异（87.2%对63.9%；P=0.017）。
在ERCP插管开始后10分钟内进行早期预切开术在胆管插管困难的病例中是安全有效的，并且可以提高胆管插管成功率。
