Sadeghi Amir, Arabpour Erfan, Abdehagh Mohammad, Zali Mohammad Reza
Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases Shahid Beheshti University of Medical Sciences Tehran Iran.
JGH Open. 2025 Jul 30;9(8):e70244. doi: 10.1002/jgh3.70244. eCollection 2025 Aug.
Needle-knife fistulotomy is an advanced technique for gaining biliary access in endoscopic retrograde cholangiopancreatography (ERCP). This study assesses the hypothesis of whether biliary stenting after needle-knife fistulotomy could improve the safety of the ERCP.
A retrospective review of the medical records of patients who referred for ERCP between 2021-2024 was performed. All patients with naïve papilla and choledocholithiasis who underwent needle-knife fistulotomy were included in the study. Patients were categorized into the two groups of with and without biliary stent.
Of the 402 included patients, 331 had successful stone extraction, among whom 50 (15.1%) and 281 (84.9%) recieved and not received a biliary stent, respectively. After 1:4 propensity score matching, age, sex, difficult cannulation, and pancreatic duct cannulation were comparable between the groups ( > 0.05). Patients with biliary stent had a borderline significant lower rate of post-ERCP pancreatitis (2.3% vs. 13.1%, = 0.054). No delayed perforation was observed in either groups. There were no significant differences in cholangitis and bleeding between the groups ( > 0.05).
This is the first study investigating the impact of prophylactic biliary stenting after needle-knife fistulotomy, suggesting that prophylactic biliary stenting after needle-knife fistulotomy and successful stone removal may improve the safety of ERCP by reducing the rate of post-ERCP pancreatitis. Further large-scale prospective studies are warranted to validate these findings.
针刀瘘管切开术是在内镜逆行胰胆管造影术（ERCP）中获取胆道通路的一种先进技术。本研究评估针刀瘘管切开术后胆道支架置入是否能提高ERCP安全性的假设。
对2021年至2024年间接受ERCP治疗的患者病历进行回顾性分析。所有接受针刀瘘管切开术的初发乳头和胆总管结石患者均纳入研究。患者分为放置和未放置胆道支架两组。
402例纳入患者中，331例结石成功取出，其中50例（15.1%）接受了胆道支架置入，281例（84.9%）未接受。经过1:4倾向评分匹配后，两组间年龄、性别、插管困难和胰管插管情况相当（>0.05）。放置胆道支架的患者ERCP术后胰腺炎发生率略低（2.3%对13.1%，P=0.054）。两组均未观察到延迟穿孔。两组间胆管炎和出血情况无显著差异（>0.05）。
这是第一项研究针刀瘘管切开术后预防性胆道支架置入影响的研究，表明针刀瘘管切开术后成功取石后预防性胆道支架置入可能通过降低ERCP术后胰腺炎发生率提高ERCP的安全性。需要进一步的大规模前瞻性研究来验证这些发现。
