Güitrón A, Adalid R
Departamento de Endoscopia Digestiva, Hospital de Especialidades Núm, Torreón, Coah.
Rev Gastroenterol Mex. 1996 Oct-Dec;61(4):342-7.
Endoscopic sphincterotomy (ES) by itself is safe and effective, with acceptable rates of morbidity and mortality. However, for various reasons ES cannot be successfully completed in all cases, and other treatment options must be considered, including precut or guided sphincterotomy. Results from studies evaluating precut sphincterotomy are conflicting.
The aim of this prospective trial was to assess the safety and efficacy of standard, guided and precut endoscopic sphincterotomy.
During a period of 5 years, endoscopic retrograde cholangiopancreatography (ERCP) was performed 1,000 times. Of five hundred seven patients, 364 were women and 143 men, had biliary obstruction and were candidates for ES, which was successful in 477 (94%). Sixteen (3.3%) complications occurred, but only 6 (1.25%) were serious. Procedure-related mortality occurred in one patient (0.2%).
In 346 patients (68.2%) we performed standard ES, in 86 (16.9%) precut, in 45 (8.9%) guided and in 30 (6.0%) ES cannot be successfully completed. Morbidity rate for endoscopic management of three-sphincterotomy types is similar, with 3.7% in standard ES, 2.3% in precut and 2.2 in guided sphincterotomy.
Standard ES, precut and guided sphincterotomy are safety and efficacy and complication rate can be lowered if the procedure is strictly focused to local anatomy and therapeutic requirements.
内镜括约肌切开术（ES）本身是安全有效的，发病率和死亡率在可接受范围内。然而，由于各种原因，并非所有病例都能成功完成ES，必须考虑其他治疗选择，包括预切开或引导下括约肌切开术。评估预切开括约肌切开术的研究结果相互矛盾。
这项前瞻性试验的目的是评估标准、引导和预切开内镜括约肌切开术的安全性和有效性。
在5年期间，共进行了1000次内镜逆行胰胆管造影（ERCP）。507例患者中，女性364例，男性143例，患有胆道梗阻，均为ES的候选者，其中477例（94%）ES成功。发生了16例（3.3%）并发症，但只有6例（1.25%）为严重并发症。1例患者（0.2%）发生了与手术相关的死亡。
346例患者（68.2%）接受了标准ES，86例（16.9%）接受了预切开，45例（8.9%）接受了引导下ES，30例（6.0%）ES未能成功完成。三种类型括约肌切开术的内镜治疗发病率相似，标准ES为3.7%，预切开为2.3%，引导下括约肌切开术为2.2%。
标准ES、预切开和引导下括约肌切开术是安全有效的，如果手术严格针对局部解剖结构和治疗需求，可以降低并发症发生率。
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