Tanikawa Tomohiro, Miyake Keisuke, Kawada Mayuko, Ishii Katsunori, Fushimi Takashi, Urata Noriyo, Wada Nozomu, Nishino Ken, Suehiro Mitsuhiko, Kawanaka Miwa, Shiraha Hidenori, Haruma Ken, Kawamoto Hirofumi
Department of General Internal Medicine 2, Kawasaki Medical School, Okayama 7008505, Japan.
World J Gastrointest Endosc. 2024 Sep 16;16(9):519-525. doi: 10.4253/wjge.v16.i9.519.
Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a variety of adverse events (AEs). One of the most important AEs is post-ERCP pancreatitis (PEP), which is most common in cases of difficult biliary cannulation. Although the precut technique has been reported as a PEP risk factor, recent studies indicate that early precut could reduce PEP, and that precut itself is not a risk factor.
To evaluate the safety of the precut technique, especially in terms of PEP.
We conducted a retrospective study, spanning the period from November 2011 through December 2021. It included 1556 patients, aged ≥ 20 years, who underwent their initial ERCP attempt for biliary disease with a naïve papilla at the Kawasaki University General Medical Center. We compared the PEP risk between the early precut and the delayed precut group.
The PEP incidence rate did not significantly differ between the precut and non-precut groups. However, the PEP incidence was significantly lower in the early precut group than the delayed precut group (3.5% 10.5%; = 0.02). The PEP incidence in the delayed precut group without pancreatic stent insertion (17.3%) was significantly higher compared to other cases ( < 0.01).
Our findings indicate that early precut may reduce PEP incidence. If the precut decision is delayed, a pancreatic stent should be inserted to prevent PEP.
内镜逆行胰胆管造影术（ERCP）与多种不良事件（AE）相关。其中最重要的不良事件之一是ERCP术后胰腺炎（PEP），在胆管插管困难的病例中最为常见。尽管预切开技术已被报道为PEP的危险因素，但最近的研究表明，早期预切开可降低PEP的发生率，且预切开本身并非危险因素。
评估预切开技术的安全性，尤其是在PEP方面。
我们进行了一项回顾性研究，时间跨度为2011年11月至2021年12月。研究纳入了1556例年龄≥20岁、在川崎大学综合医学中心首次因胆道疾病对未处理的乳头进行ERCP的患者。我们比较了早期预切开组和延迟预切开组的PEP风险。
预切开组和非预切开组的PEP发生率无显著差异。然而，早期预切开组的PEP发生率显著低于延迟预切开组（3.5%对10.5%；P = 0.02）。未插入胰管支架的延迟预切开组的PEP发生率（17.3%）显著高于其他病例（P < 0.01）。
我们的研究结果表明，早期预切开可能降低PEP的发生率。如果预切开的决定被延迟，应插入胰管支架以预防PEP。
