Kuroda Taira, Miyata Hideki, Kanemitsu-Okada Kozue, Yanagihara Emi, Saneto Hironobu, Murakami Taisei, Izumoto Hirofumi, Onishi Kei, Kitahata Shogo, Kawamura Tomoe, Iwasaki Ryuichiro, Tada Fujimasa, Tsubouchi Eiji, Hiraoka Atsushi, Ninomiya Tomoyuki
Gastroenterology Center, Ehime Prefectural Central Hospital, Kasugamachi, Matsuyama, Ehime, 790-0024, Japan.
Dig Dis Sci. 2025 Feb;70(2):843-852. doi: 10.1007/s10620-024-08598-0. Epub 2024 Sep 12.
Selective biliary cannulation in endoscopic retrograde cholangiopancreatography can be challenging due to factors like papillary morphology. Various patterns indicate cannulation difficulty, but the combinations causing difficulty and the optimal cannulation method for each scenario are unclear.
This study aimed to identify cannulation difficulty patterns and develop a predictive scoring system for selecting the appropriate cannulation method.
We retrospectively compared 776 patients with naïve papilla, dividing them into conventional contrast cannulation (N = 510) and salvage technique (N = 266) groups. The salvage group included patients using pancreatic duct guidewire placement and/or wire-guided cannulation due to difficulties with the contrast method. Papillary morphology (Haraldsson's classification), periampullary diverticulum (PAD), and scope operability were analyzed using multiple regression to identify risk factors for cannulation difficulties. Factors were scored based on hazard ratios to access combinations causing difficulties.
The salvage group had more older patients and higher frequencies of type 2 (small), type 3 (protruding or pendulous), type 4 (creased or ridged) papillae, PAD, and poor scope operability. Significant risk factors in the multivariate analysis included type 2 [odds ratio (OR) 6.88], type 3 (OR 7.74), type 4 (OR 4.06) papillae, PAD (OR 2.26), and poor scope operability (OR 4.03). Pattern recognition scores were significantly higher in the salvage group (1.31 vs. 3.43, P < 0.0001).
Type 2-4 papillae, PAD, and poor scope operability are significant risk factors for cannulation difficulty. Pattern recognition scores based on these factors can predict cannulation difficulty and aid in selecting between conventional and salvage methods.
在内镜逆行胰胆管造影术中，由于乳头形态等因素，选择性胆管插管可能具有挑战性。各种形态表明插管困难，但导致困难的组合以及每种情况的最佳插管方法尚不清楚。
本研究旨在识别插管困难模式，并开发一种预测评分系统以选择合适的插管方法。
我们回顾性比较了776例初诊乳头患者，将他们分为传统造影剂插管组（N = 510）和挽救技术组（N = 266）。挽救组包括因造影剂方法困难而使用胰管导丝置入和/或导丝引导插管的患者。使用多元回归分析乳头形态（哈拉尔德松分类）、壶腹周围憩室（PAD）和内镜可操作性，以确定插管困难的危险因素。根据风险比为各因素评分，以找出导致困难的组合。
挽救组老年患者更多，2型（小）、3型（突出或下垂）、4型（皱折或隆起）乳头、PAD及内镜可操作性差的频率更高。多变量分析中的显著危险因素包括2型乳头（比值比[OR] 6.88）、3型乳头（OR 7.74）、4型乳头（OR 4.06）、PAD（OR 2.26）和内镜可操作性差（OR 4.03）。挽救组的模式识别评分显著更高（1.31对3.43，P < 0.0001）。
2 - 4型乳头、PAD和内镜可操作性差是插管困难的显著危险因素。基于这些因素的模式识别评分可预测插管困难，并有助于在传统方法和挽救方法之间进行选择。
