Wiersema M J, Sandusky D, Carr R, Wiersema L M, Erdel W C, Frederick P K
Department of Medicine, St. Vincent Hospitals and Health Services, Indianapolis, Indiana, USA.
Gastrointest Endosc. 1996 Feb;43(2 Pt 1):102-6. doi: 10.1016/s0016-5107(06)80108-2.
Detailed imaging of the common bile duct and main pancreatic duct is possible with endosonography. Utilizing a custom manufactured flexible needle, we have developed a technique of performing endosonography-guided cholangiopancreatography (EGCP).
Of 205 patients undergoing ERCP, complete ductography was not possible in 11 patients. Employing a linear scanning echoendoscope in conjunction with a 4 cm, 22 to 23 gauge aspiration needle, transduodenal cholangiography (n = 10) or transgastric pancreatography (n = 1) was attempted.
Successful ductography was possible in 8 of 11 patients (EGCP success 73% vs ERCP 0%, p < .001, Fisher's exact test). In 5 patients, abnormalities identified on EGCP subsequently led to repeat ERCP with precut sphincterotomy. In all of these cases 100% agreement was found between EGCP and ERCP findings. One postprocedure case of pancreatitis occurred in a patient who underwent EGCP at the same setting as the failed ERCP. No early or late complications occurred in the patient group with EGCP performed at a separate setting.
EGCP allows an alternative method for obtaining cholangiopancreatography in those patients in whom ERCP is unsuccessful. Further studies are necessary to define the safety and success rate of this new procedure.
内镜超声检查可对胆总管和主胰管进行详细成像。我们利用定制的柔性针，开发了一种进行内镜超声引导下胰胆管造影（EGCP）的技术。
在205例行内镜逆行胰胆管造影（ERCP）的患者中，11例无法完成完整的胆管造影。使用线性扫描超声内镜结合4厘米、22至23号穿刺针，尝试进行经十二指肠胆管造影（n = 10）或经胃胰管造影（n = 1）。
11例患者中有8例成功完成胆管造影（EGCP成功率73%，而ERCP为0%，p <.001，Fisher精确检验）。在5例患者中，EGCP发现的异常随后导致重复ERCP并进行预切开括约肌切开术。在所有这些病例中，EGCP和ERCP的检查结果完全一致。1例胰腺炎发生在与失败的ERCP相同情况下接受EGCP的患者术后。在单独进行EGCP的患者组中未发生早期或晚期并发症。
EGCP为ERCP失败的患者提供了一种获得胰胆管造影的替代方法。需要进一步研究来确定这种新方法的安全性和成功率。
