Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography(ERCP).Pancreatic duct stent insertion after ERCP has been widely accepted as the standard of care for the prevention of thi...Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography(ERCP).Pancreatic duct stent insertion after ERCP has been widely accepted as the standard of care for the prevention of this complication in high-risk patients.Unfortunately,the placement of pancreatic stents requires higher level of endoscopic expertise and is not always feasible due to anatomic considerations.Therefore,effective non-invasive pharmacologic prophylaxis remains appealing,particularly if it is inexpensive,easily administered,has a low risk side effect profile and is widely available.There have been multiple studies evaluating potential pharmacologic candidates for post-ERCP pancreatitis(PEP) prophylaxis,most of them yielding disappointing results.A recently published large,multicenter,randomized controlled trial reported that in high risk patients a single dose of rectal indomethacin administered immediately after the ERCP significantly decreased the incidence of PEP compare to placebo.展开更多
AIM:To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires(GWs) when used in wire-guided cannulation(WGC).METHODS:A single center,randomized study was conducted between April 2011 and March 201...AIM:To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires(GWs) when used in wire-guided cannulation(WGC).METHODS:A single center,randomized study was conducted between April 2011 and March 2013. This study was approved by the Medical Ethics Committee at our hospital. Informed,written consent was obtained from each patient prior to study enrollment. Three hundred and twenty-two patients with a na?ve papilla of Vater who underwent endoscopic retrograde cholangiopancreatography(ERCP) for the purpose of selective bile duct cannulation with WGC were enrolled in this study. Fifty-three patients were excluded based on the exclusion criteria,and 269 patients were randomly allocated to two groups by a computer and analyzed:the 0.025-inch GW group(n = 109) and the 0.035-inch GW group(n = 160). The primary endpoint was the success rate of selective bile duct cannulation with WGC. Secondary endpoints were the success rates of the pancreatic GW technique and precutting,selective bile duct cannulation time,ERCP procedure time,the rate of pancreatic duct stent placement,the final success rate of selective bile duct cannulation,andthe incidence of post-ERCP pancreatitis(PEP).RESULTS:The primary success rates of selective bile duct cannulation with WGC were 80.7%(88/109) and 86.3%(138/160) for the 0.025-inch and the 0.035-inch groups,respectively(P = 0.226). There were no statistically significant differences in the success rates of selective bile duct cannulation using the pancreatic duct GW technique(46.7% vs 52.4% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.884) or in the success rates of selective bile duct cannulation using precutting(66.7% vs 63.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.893). The final success rates for selective bile duct cannulation using these procedures were 92.7%(101/109) and 97.5%(156/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.113). There were no significant differences in selective bile duct cannulation time(median ± interquartile range:3.7 ± 13.9 min vs 4.0 ± 11.2 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.851),ERCP procedure time(median ± interquartile range:32 ± 29 min vs 30 ± 25 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.184) or in the rate of pancreatic duct stent placement(14.7% vs 15.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.832). The incidence of PEP was 2.8%(3/109) and 2.5%(4/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.793).CONCLUSION:The thickness of the GW for WGC does not appear to affect either the success rate of selective bile duct cannulation or the incidence of PEP.展开更多
Biliary endoscopic sphincterotomy(EST) refers to the cutting of the biliary sphincter and intraduodenal segment of the common bile duct following selective cannulation, using a high frequency current applied with a sp...Biliary endoscopic sphincterotomy(EST) refers to the cutting of the biliary sphincter and intraduodenal segment of the common bile duct following selective cannulation, using a high frequency current applied with a special knife, sphincterotome, inserted into the papilla. EST is either used solely for the treatment of diseases of the papilla of Vater, such as sphincter of Oddi dysfunction or to facilitate subsequent therapeutic biliary interventions, such as stone extraction, stenting, etc. It is a prerequisite for biliary interventions, thus every practitioner who performs endoscopic retrograde cholangiopancreatography needs to know different techniques and the clinical and anatomic parameters related to the efficacy and safety of the procedure. In this manuscript, we will review the indications, contraindications and techniques of biliary EST and the management of its complications.展开更多
目的:探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)时尽早经胰管括约肌预切开后胆管插管的安全性.方法:前瞻性观察2011-10/2013-08在我院行ERCP治疗的患者,将112例符合入选标准的患者纳入研究.按1...目的:探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)时尽早经胰管括约肌预切开后胆管插管的安全性.方法:前瞻性观察2011-10/2013-08在我院行ERCP治疗的患者,将112例符合入选标准的患者纳入研究.按1∶3的比例随机分为两组:A组导丝首次进入胰管即行经胰管括约肌预切开;B组继续尝试常规胆管插管15 min,15 min内胆管插管成功者为B1组,15 min胆管插管仍失败或导丝反复进入胰管5次时再行经胰管括约肌预切开者为B2组.统计各组胆管插管成功率、胆管插管时间、X线照射时间、并发症的发生率和术后急性胰腺炎相关的危险因素.结果:A组所用胆管插管时间、X线照射时间均比B2组短,差异有统计学意义(7.9 min vs 16.9min,5.8 min vs 10.4 min,P<0.05).A组与B2组的胆管插管成功率,无统计学差异,但B2组胰腺炎发生率明显高于A组(26.9%vs 3.4%,P=0.02).多变量分析提示:插管时间>10 min、导丝进入胰管>2次是术后急性胰腺炎的危险因素.结论:对ERCP首次插管导丝进入胰管的患者尽早行经胰管括约肌预切开是安全的,有利于减少急性胰腺炎的发生率.展开更多
文摘Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography(ERCP).Pancreatic duct stent insertion after ERCP has been widely accepted as the standard of care for the prevention of this complication in high-risk patients.Unfortunately,the placement of pancreatic stents requires higher level of endoscopic expertise and is not always feasible due to anatomic considerations.Therefore,effective non-invasive pharmacologic prophylaxis remains appealing,particularly if it is inexpensive,easily administered,has a low risk side effect profile and is widely available.There have been multiple studies evaluating potential pharmacologic candidates for post-ERCP pancreatitis(PEP) prophylaxis,most of them yielding disappointing results.A recently published large,multicenter,randomized controlled trial reported that in high risk patients a single dose of rectal indomethacin administered immediately after the ERCP significantly decreased the incidence of PEP compare to placebo.
文摘AIM:To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires(GWs) when used in wire-guided cannulation(WGC).METHODS:A single center,randomized study was conducted between April 2011 and March 2013. This study was approved by the Medical Ethics Committee at our hospital. Informed,written consent was obtained from each patient prior to study enrollment. Three hundred and twenty-two patients with a na?ve papilla of Vater who underwent endoscopic retrograde cholangiopancreatography(ERCP) for the purpose of selective bile duct cannulation with WGC were enrolled in this study. Fifty-three patients were excluded based on the exclusion criteria,and 269 patients were randomly allocated to two groups by a computer and analyzed:the 0.025-inch GW group(n = 109) and the 0.035-inch GW group(n = 160). The primary endpoint was the success rate of selective bile duct cannulation with WGC. Secondary endpoints were the success rates of the pancreatic GW technique and precutting,selective bile duct cannulation time,ERCP procedure time,the rate of pancreatic duct stent placement,the final success rate of selective bile duct cannulation,andthe incidence of post-ERCP pancreatitis(PEP).RESULTS:The primary success rates of selective bile duct cannulation with WGC were 80.7%(88/109) and 86.3%(138/160) for the 0.025-inch and the 0.035-inch groups,respectively(P = 0.226). There were no statistically significant differences in the success rates of selective bile duct cannulation using the pancreatic duct GW technique(46.7% vs 52.4% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.884) or in the success rates of selective bile duct cannulation using precutting(66.7% vs 63.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.893). The final success rates for selective bile duct cannulation using these procedures were 92.7%(101/109) and 97.5%(156/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.113). There were no significant differences in selective bile duct cannulation time(median ± interquartile range:3.7 ± 13.9 min vs 4.0 ± 11.2 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.851),ERCP procedure time(median ± interquartile range:32 ± 29 min vs 30 ± 25 min for the 0.025-inch and 0.035-inch groups,respectively; P = 0.184) or in the rate of pancreatic duct stent placement(14.7% vs 15.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.832). The incidence of PEP was 2.8%(3/109) and 2.5%(4/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.793).CONCLUSION:The thickness of the GW for WGC does not appear to affect either the success rate of selective bile duct cannulation or the incidence of PEP.
文摘Biliary endoscopic sphincterotomy(EST) refers to the cutting of the biliary sphincter and intraduodenal segment of the common bile duct following selective cannulation, using a high frequency current applied with a special knife, sphincterotome, inserted into the papilla. EST is either used solely for the treatment of diseases of the papilla of Vater, such as sphincter of Oddi dysfunction or to facilitate subsequent therapeutic biliary interventions, such as stone extraction, stenting, etc. It is a prerequisite for biliary interventions, thus every practitioner who performs endoscopic retrograde cholangiopancreatography needs to know different techniques and the clinical and anatomic parameters related to the efficacy and safety of the procedure. In this manuscript, we will review the indications, contraindications and techniques of biliary EST and the management of its complications.
文摘目的:探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)时尽早经胰管括约肌预切开后胆管插管的安全性.方法:前瞻性观察2011-10/2013-08在我院行ERCP治疗的患者,将112例符合入选标准的患者纳入研究.按1∶3的比例随机分为两组:A组导丝首次进入胰管即行经胰管括约肌预切开;B组继续尝试常规胆管插管15 min,15 min内胆管插管成功者为B1组,15 min胆管插管仍失败或导丝反复进入胰管5次时再行经胰管括约肌预切开者为B2组.统计各组胆管插管成功率、胆管插管时间、X线照射时间、并发症的发生率和术后急性胰腺炎相关的危险因素.结果:A组所用胆管插管时间、X线照射时间均比B2组短,差异有统计学意义(7.9 min vs 16.9min,5.8 min vs 10.4 min,P<0.05).A组与B2组的胆管插管成功率,无统计学差异,但B2组胰腺炎发生率明显高于A组(26.9%vs 3.4%,P=0.02).多变量分析提示:插管时间>10 min、导丝进入胰管>2次是术后急性胰腺炎的危险因素.结论:对ERCP首次插管导丝进入胰管的患者尽早行经胰管括约肌预切开是安全的,有利于减少急性胰腺炎的发生率.
