内镜逆行胰胆管造影术中插管困难——基于成功插管和不良事件的针状刀预切开术与经胰括约肌切开术的比较
Difficult cannulation during endoscopic retrograde cholangiopancreatography-needle-knife precut versus transpancreatic sphincterotomy on the basis of successful cannulation and adverse events.
作者信息
Gustafsson Arvid, Tingstedt Bobby, Olsson Greger
机构信息
Department of Research and Development and Department of Surgery, Central Hospital, Region Kronoberg, Strandvägen 8, 351 85, Växjö, Sweden.
Department of Clinical Sciences Lund, Surgery, Lund University and Department of Surgery, Skåne University Hospital, Lund, Sweden.
出版信息
Surg Endosc. 2025 Feb;39(2):1200-1206. doi: 10.1007/s00464-024-11429-y. Epub 2024 Dec 29.
BACKGROUND
When cannulation is challenging during endoscopic retrograde cholangiopancreatography (ERCP), and the standard guidewire technique with sphincterotomy is unsuccessful, alternative cannulation techniques can be used to access the biliary tree. The purpose of this study was to compare the incidence of adverse events and cannulation success rates between transpancreatic sphincterotomy (TPS) and precut sphincterotomy (PCS).
METHODS
Data from the Swedish Registry for Gallstone Surgery and ERCP (GallRiks), collected from 2011 to 2022, were analyzed. A total of 105,303 ERCP procedures were recorded in GallRiks during the study period. After exclusions, the study population consisted of 47,486 ERCP procedures. Of these, 4547 received PCS and 3273 received TPS. The remaining 39,666 ERCP procedures with conventional sphincterotomy served as the control group. The primary endpoints were successful cannulation and adverse events within 30 days.
RESULTS
Successful cannulation was more frequent with the TPS technique than with the PCS technique (86.5% vs. 69.7%), but both groups had a lower cannulation rate than the control group (92.4%; OR-PCS 0.20, 95% CI 0.18-0.21; OR-TPS 0.58, 95% CI 0.52-0.64). The TPS group had a higher incidence of adverse events than the PCS group (24.1% vs. 18.8%) and both groups had a higher incidence of adverse events than the control group (15.5%; OR-PCS 1.25, 95% CI 1.15-1.36; OR-TPS 1.71, 95% CI 1.57-1.87). Adverse events for TPS were driven by a higher incidence of pancreatitis (10.5% vs. 6.4% vs. 4.5%; OR 2.53, 95% CI 2.23-2.86) and perforation (1.6% vs. 0.8% vs. 0.5%; OR 2.99, 95% CI 2.20-4.06) compared to both PCS and control.
CONCLUSION
TPS is more successful at cannulation than PCS; however, this success comes at a higher cost in terms of adverse events, particularly pancreatitis and perforation.
背景
在内镜逆行胰胆管造影术（ERCP）期间进行插管具有挑战性，且标准导丝技术联合括约肌切开术失败时，可采用其他插管技术进入胆管树。本研究的目的是比较经胰括约肌切开术（TPS）和预切开括约肌切开术（PCS）之间不良事件的发生率和插管成功率。
方法
分析了2011年至2022年从瑞典胆结石手术和ERCP登记处（GallRiks）收集的数据。在研究期间，GallRiks共记录了105303例ERCP手术。排除后，研究人群包括47486例ERCP手术。其中，4547例接受了PCS，3273例接受了TPS。其余39666例采用传统括约肌切开术的ERCP手术作为对照组。主要终点是30天内插管成功和不良事件。
结果
TPS技术的插管成功率高于PCS技术（86.5%对69.7%），但两组的插管率均低于对照组（92.4%；PCS的OR为0.20，95%CI为0.18 - 0.21；TPS的OR为0.58，95%CI为0.52 - 0.64）。TPS组的不良事件发生率高于PCS组（24.1%对18.8%），且两组的不良事件发生率均高于对照组（15.5%；PCS的OR为1.25，95%CI为1.15 - 1.36；TPS的OR为1.71，95%CI为1.57 - 1.87）。与PCS组和对照组相比，TPS组不良事件主要由胰腺炎发生率较高（10.5%对6.4%对4.5%；OR为2.53，95%CI为2.23 - 2.86）和穿孔发生率较高（1.6%对0.8%对0.5%；OR为2.99，95%CI为2.20 - 4.06）所致。
结论
TPS在插管方面比PCS更成功；然而，就不良事件而言，这种成功的代价更高，尤其是胰腺炎和穿孔。
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