Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Dig Dis Sci. 2024 Oct;69(10):3962-3969. doi: 10.1007/s10620-024-08603-6. Epub 2024 Aug 31.
Precut over a pancreatic duct stent (PPDS) and transpancreatic precut sphincterotomy (TPS) with immediate pancreatic duct stent placement are techniques employed to promote biliary access during endoscopic retrograde cholangiopancreatography (ERCP) in cases of challenging biliary cannulation. However, limited data are available to compare the efficacy of these two pancreatic stent-assisted precut sphincterotomy techniques.
The aim of this study was to compare the efficacy of PPDS versus TPS.
A retrospective analysis was performed on the clinical data of consecutive patients who underwent ERCP between April 1, 2019 and May 31, 2023. According to the selected cannulation approaches, patients were assigned to two groups. In the PPDS group, a pancreatic duct stent was initially placed, followed by needle-knife precut over the stent. In the TPS group, transpancreatic precut sphincterotomy was initially performed, followed by immediate pancreatic stent placement. The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) between the two groups were analysed.
Among 864 patients who underwent ERCP, 46 patients were equally enrolled in the two groups. Selective bile duct cannulation was successfully achieved in 42 out of 46 (91.3%) cases using the PPDS and in 32 out of 46 (69.6%) cases using TPS technique alone, indicating significantly higher success rate of bile duct cannulation with PPDS compared to TPS (91.3% vs. 69.6%, P = 0.009). The overall success rates for bile duct cannulation were 93.5% and 97.8% in the PPDS and TPS groups, respectively, with no significant difference identified (P = 0.307). PEP occurred in 0 and 4 (8.7%) cases in the PPDS and TPS groups, respectively, with no significant difference between the two groups (8.7% vs. 0%, P = 0.117). There were no cases of bleeding or perforation in either group.
Both PPDS and TPS followed by immediate pancreatic duct stent placement are viable options. TPS stands out for its simplicity and cost-effectiveness, while PPDS is more appropriate for patients who are at a high-risk of developing PEP.
在具有挑战性的胆管插管情况下，为了促进内镜逆行胰胆管造影术（ERCP）中的胆管进入，使用经胰管预切开过胰管支架（PPDS）和经胰预切开括约肌切开术（TPS）并立即放置胰管支架是两种技术。然而，比较这两种胰管支架辅助预切开括约肌切开术技术的疗效的相关数据有限。
本研究旨在比较 PPDS 与 TPS 的疗效。
对 2019 年 4 月 1 日至 2023 年 5 月 31 日连续接受 ERCP 的患者的临床资料进行回顾性分析。根据选择的插管方法，将患者分为两组。在 PPDS 组中，首先放置胰管支架，然后在支架上用针刀预切开胰管。在 TPS 组中，首先进行经胰预切开括约肌切开术，然后立即放置胰管支架。分析两组患者的胆管插管成功率和内镜逆行胰胆管造影术后胰腺炎（PEP）的发生率。
在 864 例行 ERCP 的患者中，46 例患者平均分为两组。使用 PPDS 成功完成选择性胆管插管 42 例（91.3%），单独使用 TPS 技术成功完成胆管插管 32 例（69.6%），表明 PPDS 胆管插管成功率明显高于 TPS（91.3% vs. 69.6%，P=0.009）。PPDS 组和 TPS 组的胆管插管总成功率分别为 93.5%和 97.8%，差异无统计学意义（P=0.307）。PPDS 组和 TPS 组 PEP 的发生率分别为 0 和 4（8.7%），两组间无统计学差异（8.7% vs. 0%，P=0.117）。两组均无出血或穿孔病例。
PPDS 和 TPS 联合立即放置胰管支架都是可行的选择。TPS 的优点是简单且具有成本效益，而 PPDS 更适合有发生 PEP 高风险的患者。
