Kim M H, Lee S K, Lee M H, Myung S J, Yoo B M, Seo D W, Min Y I
Dept. of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Endoscopy. 1997 Feb;29(2):82-5. doi: 10.1055/s-2007-1004080.
A prospective, randomized study was carried out to compare the success and complication rates associated with the forward-viewing endoscope and side-viewing duodenoscope in conducting endoscopic retrograde cholangiopancreatography (ERCP) and needle-knife sphincterotomy in patients with a Billroth II gastrectomy.
The study included 45 patients with a Billroth II gastrectomy who required ERCP and endoscopic sphincterotomy (EST) for evaluation and management of pancreaticobiliary disease. The patients were randomly assigned to receive ERCP and EST with either a forward-viewing endoscope or a side-viewing duodenoscope.
Cannulation of the papilla was successful in 68% (15 of 22) in the side-viewing duodenoscope group, and in 87% (20 of 23) in the forward-viewing endoscope group. Failures of cannulation occurred in seven patients in the side-viewing duodenoscope group, caused by jejunal perforation during insertion (n = 4), by a long afferent loop (n = 1), by a complaint of severe abdominal pain (n = 1), and by failure to enter the afferent loop (n = 1). In the forward-viewing endoscope group, failure occurred in three patients due to the long afferent loop (n = 2) and to an inability to cannulate despite identification of the papilla (n = 1). Sphincterotomy was successfully completed in eight of ten patients (80%) in the side-viewing duodenoscope group, and in ten of twelve patients (83%) in the forward-viewing endoscope group.
For ERCP and EST in patients with Billroth II gastrectomy, the forward-viewing endoscope is as effective as the side-viewing duodenoscope, but it may be the safer of the two instruments. The forward-viewing endoscope can be recommended for ERCP and EST in patients with a Billroth II gastrectomy.
开展一项前瞻性随机研究，比较前视内镜和侧视十二指肠镜在毕Ⅱ式胃切除术后患者进行内镜逆行胰胆管造影（ERCP）及针刀括约肌切开术时的成功率和并发症发生率。
该研究纳入45例因胰胆疾病需要进行ERCP和内镜括约肌切开术（EST）的毕Ⅱ式胃切除术后患者。将患者随机分配接受使用前视内镜或侧视十二指肠镜进行ERCP和EST。
侧视十二指肠镜组乳头插管成功率为68%（22例中的15例），前视内镜组为87%（23例中的20例）。侧视十二指肠镜组有7例插管失败，原因包括插入过程中肠穿孔（4例）、输入袢过长（1例）、严重腹痛主诉（1例）以及未能进入输入袢（1例）。前视内镜组有3例失败，原因是输入袢过长（2例）以及尽管识别出乳头但无法插管（1例）。侧视十二指肠镜组10例患者中有8例（80%）成功完成括约肌切开术，前视内镜组12例患者中有10例（83%）成功完成。
对于毕Ⅱ式胃切除术后患者的ERCP和EST，前视内镜与侧视十二指肠镜效果相当，但可能是两种器械中更安全的。对于毕Ⅱ式胃切除术后患者的ERCP和EST，可推荐使用前视内镜。
