Kaneko Toru, Kida Mitsuhiro, Kurosu Takahiro, Kitahara Gen, Betto Tomohiro, Saito Yutaro, Koyama Shiori, Nomura Nao, Kusano Chika
Department of Gastroenterology, Kitasato University Medical Center, Kitamoto 364-8501, Saitama, Japan.
Department of Gastroenterology, Kitasato University Hospital, Sagamihara 252-0375, Kanagawa, Japan.
World J Gastrointest Endosc. 2025 Sep 16;17(9):108420. doi: 10.4253/wjge.v17.i9.108420.
Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation, which is often challenging and associated with complications. In difficult cannulation cases, early precutting is frequently used. However, its efficacy and optimal indications require further evaluation.
To evaluate the efficacy and safety of early precut (EP) in difficult bile duct cannulation.
This retrospective analysis of endoscopic retrograde cholangiopancreatography procedures was performed for bile duct cannulation in patients with naive papillae who required advanced cannulation techniques (ACTs). These patients were admitted between April 2020 and March 2024 and were analyzed for risk factors, success rates, and complications. Outcomes were compared between the EP group and the conventional other ACTs group, with a focus on cases with oral protrusion large (oral protrusion-L).
The need for ACTs was identified as an independent risk factor for complications [odds ratio (OR) = 5.4; 95% confidence interval: 1.887-15.53]. Malignant biliary strictures (OR = 2.58) and oral protrusion-L (OR = 2.77) were also identified as independent risk factors for requiring ACTs. The EP group had a significantly higher second-line cannulation success rate (97.9% 73.2%, = 0.001) and lower complication rate (8.3% 39.0%, = 0.001) than the other ACTs group. Additionally, similar benefits were observed in the oral protrusion-L cases.
This study provides compelling evidence that EP is a viable alternative and a superior strategy in cases requiring ACTs, particularly oral protrusion-L.
内镜逆行胰胆管造影术需要选择性胆管插管，这通常具有挑战性且会引发并发症。在困难插管病例中，早期预切开术经常被使用。然而，其疗效和最佳适应症需要进一步评估。
评估早期预切开术（EP）在困难胆管插管中的疗效和安全性。
对需要采用高级插管技术（ACTs）的初发乳头患者进行内镜逆行胰胆管造影术胆管插管的回顾性分析。这些患者于2020年4月至2024年3月入院，分析其危险因素、成功率和并发症。比较EP组和传统ACTs组的结果，重点关注大口腔隆起（口腔隆起-L）病例。
ACTs的需求被确定为并发症的独立危险因素[比值比（OR）=5.4；95%置信区间：1.887-15.53]。恶性胆管狭窄（OR=2.58）和口腔隆起-L（OR=2.77）也被确定为需要ACTs的独立危险因素。EP组的二线插管成功率显著高于其他ACTs组（97.9%对73.2%，P=0.001），并发症发生率低于其他ACTs组（8.3%对39.0%，P=0.001）。此外，在口腔隆起-L病例中也观察到了类似的益处。
本研究提供了令人信服的证据，表明在需要ACTs的病例中，尤其是口腔隆起-L病例，EP是一种可行的替代方法和更优策略。
