Moreira Marta, Tarrio Isabel, Andrade Alda João, Araújo Tarcísio, Fernandes João Sousa Silva, Canena Jorge, Lopes Luís
Department of Gastroenterology Hospital de Santa Luzia, Viana do Castelo, Portugal.
Department of Gastroenterology Hospital CUF, Viseu/Coimbra, Portugal.
GE Port J Gastroenterol. 2024 Feb 14;31(6):401-407. doi: 10.1159/000536398. eCollection 2024 Dec.
To access the common bile duct in endoscopic retrograde cholangiopancreatography (ERCP), needle-knife fistulotomy (NKF) can be associated with a shorter sphincterotomy compared to standard cannulation. We aimed to compare the success and safety of NKF versus standard cannulation in the treatment of choledocholithiasis.
A cohort of 379 naïve patients with choledocholithiasis who underwent ERCP between 2005 and 2022 was retrospectively analyzed. The patients were divided into two groups: group A (179 consecutive patients) underwent NKF, while group B (180 patients) received standard biliary access and were matched for stone characteristics and ERCP year.
Stone removal success rate for group A was significantly lower than that for group B in the initial ERCP (82.0% vs. 92.1%, = 0.003). In group A, success rates for stone removal were 90.2%, 80%, and 29.4% for stone sizes <10 mm, 10 mm-15 mm, and >15 mm, respectively ( < 0.001). In contrast, group B showed success rates of 99.2%, 81.5%, and 71.4% for the same stone size categories ( < 0.001). Pancreatitis occurred in 3.7% of group A and 5.8% of group B patients ( = 0.340). Regression analysis revealed that NKF cannulation, stone size (>10 mm), and having 4 or more stones were associated with lower stone removal success compared to standard cannulation in the initial ERCP (OR 0.34, = 0.015; stone size 10-15 mm: OR 0.20, < 0.001; stone size >15 mm: OR 0.05, < 0.001; 4 or more stones: OR 0.4, = 0.040).
The removal of common bile duct stones after NKF access, although safe and effective, is less successful than after a standard cannulation, especially at the baseline ERCP.
在内镜逆行胰胆管造影术（ERCP）中，为进入胆总管，与标准插管相比，针刀瘘管切开术（NKF）可能使括约肌切开术时间更短。我们旨在比较NKF与标准插管在治疗胆总管结石方面的成功率和安全性。
对2005年至2022年间接受ERCP的379例初发胆总管结石患者进行回顾性分析。患者分为两组：A组（179例连续患者）接受NKF，B组（180例患者）接受标准胆管通路，两组在结石特征和ERCP年份方面进行匹配。
在初次ERCP中，A组的结石清除成功率显著低于B组（82.0%对92.1%，P = 0.003）。在A组中，结石大小<10 mm、10 mm - 15 mm和>15 mm的结石清除成功率分别为90.2%、80%和29.4%（P < 0.001）。相比之下，B组相同结石大小类别的成功率分别为99.2%、81.5%和71.4%（P < 0.001）。A组3.7%的患者和B组5.8%的患者发生胰腺炎（P = 0.340）。回归分析显示，与初次ERCP中的标准插管相比，NKF插管、结石大小（>10 mm）以及有4颗或更多结石与较低的结石清除成功率相关（比值比0.34，P = 0.015；结石大小10 - 15 mm：比值比0.20，P < 0.001；结石大小>15 mm：比值比0.05，P < 0.001；4颗或更多结石：比值比0.4，P = 0.040）。
NKF通路后胆总管结石的清除虽然安全有效，但不如标准插管后成功，尤其是在初次ERCP时。
