经倾向评分匹配分析，内镜逆行胰胆管造影中采用医师控制导丝引导插管是一种有效的应对困难插管技术：一项回顾性研究。

Propensity score-matched analysis of physician-controlled wire-guided cannulation as an effective technique against difficult cannulation in endoscopic retrograde cholangiopancreatography: A retrospective study.

机构信息

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.

出版信息

PLoS One. 2023 Apr 28;18(4):e0285118. doi: 10.1371/journal.pone.0285118. eCollection 2023.

DOI:10.1371/journal.pone.0285118

PMID:37115752

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10146477/

Abstract

BACKGROUND

Advanced endoscopic retrograde cholangiopancreatography (ERCP) cannulation strategies for difficult cases could replace conventional techniques, in which assistants control guidewires. We aimed to compare the safety and efficacy of a new salvage cannulation strategy, physician-controlled wire-guided cannulation (PCWGC), with those of a conventional strategy.

METHODS

This retrospective study included patients with naïve papillae who underwent ERCP between January 2018 and December 2020. Patients, divided into two groups, received initial cannulation using a conventional catheter. After failed cannulation, the second attempt used PCWGC and double-guidewire technique (DGT) in the new and conventional strategy groups, respectively. Propensity score-matching (PSM) analysis compared outcomes between groups. Primary outcome included overall success rate, while secondary outcomes included cannulation time, adverse events, and cannulation difficulty subgroup analysis.

RESULTS

The new strategy group comprised 255 (47.6%) of 536 patients who underwent ERCP. The total cannulation success rate was 98.4% (vs. 97.2%, p = 0.318), with similar post-ERCP pancreatitis (PEP) (1.8% vs. 2.4%, p = 0.64) rates. Following 1:1 PSM, 219/438 patients were allocated to both the conventional and new strategy groups, and 46 patients from the difficult cannulation subgroup were distributed evenly among groups. No difference in overall cannulation success rate existed between the groups before (97.2% vs. 98.4%) and after PSM (96.8% vs. 98.2%). The primary cannulation success rate was higher in the conventional strategy group, while the secondary cannulation success rate was higher in the new strategy group. However, the difficult cannulation subgroup PSM results showed that only the salvage cannulation success rate was significant (9/23, 39.1% vs. 18/23, 78.3%, p = 0.007). In the difficult cannulation subgroup, the salvage cannulation success rate for PCWGC was four times higher than DGT (95% confidence interval; 1.129-14.175), with no significant difference in PEP rate (p = 0.571).

CONCLUSIONS

PCWGC demonstrated greater efficacy than the conventional salvage technique. PCWGC could be a safe and useful technique, especially for difficult biliary cannulation.

摘要

背景

对于困难病例，先进的内镜逆行胰胆管造影（ERCP）插管策略可以替代传统技术，传统技术中助手控制导丝。我们旨在比较新的挽救性插管策略——医生控制导丝引导插管（PCWGC）与传统策略的安全性和疗效。

方法

本回顾性研究纳入了 2018 年 1 月至 2020 年 12 月期间接受 ERCP 的初次胰胆管造影术插管的患者。将患者分为两组，两组均采用传统导管进行初次插管。初次插管失败后，新策略组和传统策略组分别采用 PCWGC 和双导丝技术（DGT）进行第二次尝试。采用倾向评分匹配（PSM）分析比较两组之间的结果。主要结果为总体成功率，次要结果包括插管时间、不良事件和插管难度亚组分析。

结果

新策略组包括 536 例患者中的 255 例（47.6%），接受 ERCP 治疗。总体插管成功率为 98.4%（vs. 97.2%，p=0.318），术后胰腺炎（PEP）发生率相似（1.8% vs. 2.4%，p=0.64）。1:1PSM 后，438 例患者中有 219 例被分配到传统策略组和新策略组，46 例困难插管亚组患者平均分配到两组。两组总体插管成功率在匹配前（97.2% vs. 98.4%）和匹配后（96.8% vs. 98.2%）均无差异。传统策略组的初次插管成功率较高，而新策略组的再次插管成功率较高。然而，困难插管亚组 PSM 结果表明，只有挽救性插管成功率有显著差异（9/23，39.1% vs. 18/23，78.3%，p=0.007）。在困难插管亚组中，PCWGC 的挽救性插管成功率是 DGT 的四倍（95%置信区间；1.129-14.175），PEP 发生率无显著差异（p=0.571）。