Iqbal Amna, Ahmad Zohaib, Aziz Muhammad, Alharbi Abdulmajeed, Ali Hassam, Al-Chalabi Ahmed, Gangwani Manesh Kumar, Dahiya Dushyant Singh, Smith Wade Lee, Singh Shailendra, Alastal Yaseen, Kobeissy Abdallah
Department of Internal Medicine, University of Toledo, Toledo, OH, USA.
Department of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA.
Gastroenterology Res. 2024 Aug;17(4):151-158. doi: 10.14740/gr1738. Epub 2024 Jul 18.
Various endoscopic techniques are employed to achieve biliary cannulation when confronted with difficult biliary access. Every procedure carries its own risk in terms of bleeding, infection, pancreatitis, and cholangitis. Our meta-analysis aimed to compare pre-cut papillotomy and endoscopic ultrasound (EUS)-rendezvous in terms of technical success rates, and post-procedure pancreatitis and bleeding.
We conducted a systematic review and meta-analysis of studies that compared pre-cut papillotomy and EUS-rendezvous. The primary outcome was technical success by achieving biliary cannulation. Secondary outcomes were postoperative pancreatitis and bleeding. A random-effects model was used to calculate the risk ratios (RRs) and confidence intervals (CIs). A P value < 0.05 was considered statistically significant.
Our meta-analysis included four studies comparing pre-cut papillotomy and EUS-rendezvous. The studies included 13,659 total endoscopic retrograde cholangiopancreatography (ERCP) procedures, of whom 1,004 patients underwent alternate biliary cannulation procedures due to difficult biliary cannulation. The mean age of the study population was noted to be 49.5 years and males represented 53.3% of the total participants. Both procedures were similar in terms of technical success (RR: 0.95, 95% CI (0.88, 1.02)). No difference was found between rates of post procedure pancreatitis (RR: 1.82, 95% CI (0.80, 4.15)) and post procedure bleeding (RR: 2.80, 95% CI (0.67, 11.66)).
There was no difference in technical success of procedure or post-procedure complications such as pancreatitis and bleeding between pre-cut papillotomy and EUS-rendezvous technique. More randomized controlled trials (RCTs) are needed to compare both procedural techniques and complications rates. However, currently, both procedures are equally effective and safe during difficult biliary cannulation in the hands of experienced endoscopists.
面对胆管插管困难时，会采用各种内镜技术来实现胆管插管。每种操作在出血、感染、胰腺炎和胆管炎方面都有其自身的风险。我们的荟萃分析旨在比较预切开乳头括约肌切开术和内镜超声（EUS）引导下会师术在技术成功率、术后胰腺炎和出血方面的差异。
我们对比较预切开乳头括约肌切开术和EUS引导下会师术的研究进行了系统评价和荟萃分析。主要结局是通过实现胆管插管获得的技术成功。次要结局是术后胰腺炎和出血。采用随机效应模型计算风险比（RRs）和置信区间（CIs）。P值<0.05被认为具有统计学意义。
我们的荟萃分析纳入了四项比较预切开乳头括约肌切开术和EUS引导下会师术的研究。这些研究共纳入13659例内镜逆行胰胆管造影（ERCP）操作，其中1004例患者因胆管插管困难而接受了替代胆管插管操作。研究人群的平均年龄为49.5岁，男性占总参与者的53.3%。两种操作在技术成功方面相似（RR：0.95，95%CI（0.88，1.02））。术后胰腺炎发生率（RR：1.82，95%CI（0.80，4.15））和术后出血发生率（RR：2.80，95%CI（0.67，11.66））之间未发现差异。
预切开乳头括约肌切开术和EUS引导下会师术在操作的技术成功率或术后并发症如胰腺炎和出血方面没有差异。需要更多的随机对照试验（RCT）来比较这两种操作技术和并发症发生率。然而，目前，在经验丰富的内镜医师手中，这两种操作在胆管插管困难时同样有效且安全。
