Niiya Fumitaka, Tamai Naoki, Yamawaki Masataka, Noda Jun, Azami Tetsushi, Takano Yuichi, Nishimoto Fumiya, Nagahama Masatsugu
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
J Hepatobiliary Pancreat Sci. 2025 Feb;32(2):151-159. doi: 10.1002/jhbp.12091. Epub 2024 Nov 28.
Nonexpert endoscopists cannot achieve high-quality performance during difficult biliary cannulation, representing a significant challenge; precutting is an effective approach for managing these cases. Transpancreatic biliary sphincterotomy (TPBS) is considered more effective than needle-knife precutting owing to its wire-guided technique, which may be suitable for nonexpert endoscopists; however, comparisons between nonexpert and expert endoscopists performing TPBS are not well documented.
Consecutive patients who underwent TPBS between January 2010 and April 2024 were evaluated. Rates of successful biliary duct cannulation, time to TPBS and bile duct cannulation, and adverse events were compared between both groups. Logistic regression analysis was conducted to identify factors associated with successful bile duct cannulation using TBPS.
The study included 140 patients (77 and 63 in the nonexpert and expert groups, respectively). The rates of successful biliary cannulation and overall adverse events (including pancreatitis, 9.1% vs. 9.5%) were 88.3% and 93.7% (p = .38) and 15.6% and 9.5% (p = .32) in the nonexpert and expert groups, respectively. Multivariate analysis revealed that early TPBS (<22 min) was a significant predictive factor for successful bile duct cannulation.
TBPS may be an effective technique for nonexpert endoscopists; additionally, early TPBS is a significant predictive factor for successful bile duct cannulation.
非专业内镜医师在困难的胆管插管过程中无法实现高质量操作，这是一项重大挑战；预切开术是处理这些病例的有效方法。经胰胆管括约肌切开术（TPBS）因其导丝引导技术被认为比针刀预切开术更有效，这可能适用于非专业内镜医师；然而，关于非专业和专业内镜医师进行TPBS的比较尚无充分记录。
对2010年1月至2024年4月期间接受TPBS的连续患者进行评估。比较两组胆管插管成功率、TPBS及胆管插管时间和不良事件。进行逻辑回归分析以确定使用TPBS成功胆管插管的相关因素。
该研究纳入140例患者（非专业组77例，专业组63例）。非专业组和专业组的胆管插管成功率分别为88.3%和93.7%（p = 0.38），总体不良事件发生率分别为15.6%和9.5%（p = 0.32）（包括胰腺炎，9.1%对9.5%）。多因素分析显示，早期TPBS（<22分钟）是胆管插管成功的重要预测因素。
TPBS可能是一种对非专业内镜医师有效的技术；此外，早期TPBS是胆管插管成功的重要预测因素。
