Can early precut reduce post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with difficult bile duct cannulation?

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is associated with a variety of adverse events(AEs).One of the most important AEs is post-ERCP pancreatitis(PEP),which is most common in cases of difficult biliary cannulation.Although the precut technique has been reported as a PEP risk factor,recent studies indicate that early precut could reduce PEP,and that precut itself is not a risk factor.AIM To evaluate the safety of the precut technique,especially in terms of PEP.METHODS We conducted a retrospective study,spanning the period from November 2011 through December 2021.It included 1556 patients,aged≥20 years,who underwent their initial ERCP attempt for biliary disease with a naïve papilla at the Kawasaki University General Medical Center.We compared the PEP risk between the early precut and the delayed precut group.RESULTS The PEP incidence rate did not significantly differ between the precut and nonprecut groups.However,the PEP incidence was significantly lower in the early precut group than the delayed precut group(3.5%vs 10.5%;P=0.02).The PEP incidence in the delayed precut group without pancreatic stent insertion(17.3%)was significantly higher compared to other cases(P<0.01).CONCLUSION Our findings indicate that early precut may reduce PEP incidence.If the precut decision is delayed,a pancreatic stent should be inserted to prevent PEP.

Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology

Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.

乳头扩约肌预切开术在困难插管内镜逆行胰胆管造影术中的疗效分析

目的探讨十二指肠乳头预切开术在内镜逆行胰胆管造影术(ERCP)中的应用,并评价其在ERCP中的作用和安全性。方法自2008年1月至2011年6月我院肝胆胰外科共完成内镜下逆行胰胆管造影术930例,其中选择性插管困难者采用常规方法不能完成而采用乳头预切开术108例,占11.6%。纳入标准为常规插管失败或反复进入胰管4次判定为选择性插管困难,术中改行乳头预切开术,根据病情完成ERCP检查和内镜下治疗。观察终点为治疗成功率和并发症发生率,并与同期常规ERCP插管病例资料对比分析。统计学处理采用SPSS 13.0统计软件,率的比较采用χ2检验,P<0.05为差异有统计学意义。结果本组乳头预切开术108例,ERCP成功103例,成功率95.4%。术后并发症7例,发生率6.5%,无十二指肠穿孔及死亡病例。同期822例常规ERCP诊治成功率97.7%,术后并发症63例,发生率7.7%。乳头预切开与常规选择性胆管插管两组患者的并发症发生率(χ2=0.141,P=0.707)及成功率(χ2=2.041,P=0.153)差异无统计学意义。结论乳头预切开术与常规ERCP相比不增加发生并发症的风险,可提高困难ERCP的成功率,但要严格掌握适应证,由经验丰富的医师进行。

针状刀预切开治疗胆管插管困难疾病52例

目的:探讨针状刀预切开在内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)胆总管插管困难中的应用价值.方法:连续收集52例胆总管插管困难胆总管疾病患者,分析在应用针状刀操作中的难点及操作技巧.结果:52例应用针状刀预切开患者中,插管成功41例,插管成功率为78.85%.其中乳头开口结石嵌顿预切开成功率100%、乳头开口下垂预切开成功率80%、乳头偏向预切开成功率66.67%、乳头过小预切开成功率50%、胆总管下段炎性狭窄预切开成功率71.43%、壶腹部肿瘤预切开成功率83.33%.结论:针状刀预切开在ERCP插管困难时可以起到有效地补救作用.

经内镜针刀括约肌切开术的临床应用

目的：探讨经内镜针刀括约肌切开术在临床中的应用价值。方法；对常规捕管失败的ERCP患者,进行针刀乳头前切开术和针刀开窗术治疗.结果：针刀乳头前切开术29例，针刀开窗术56例中，行ERCP成功81例（95．29％），并发症6例（7．06％），其中乳头部山101．3例（3．53％），胆管炎1例（1．18％），急性水肿性胰腺炎2例（2．44％），均经保守治疗后缓解。本组无穿孔和死亡并发症。结论：经内镜针刀括约肌切开术是一种安全、有效的非捕管乳头括约肌切开的方法．可作为常规ERCP和EST的重要补充手段，提高ERCP诊治的成功率。

内镜下逆行胰胆管造影术中选择性胆管插管困难时针状刀乳头预切开术的应用

目的：探讨针状刀乳头预切开术在内镜下逆行胰胆管造影术（ ERCP ）中选择性胆管插管困难时的作用及安全性。方法回顾性分析104例（针状刀组）行针状刀乳头预切开术患者的临床资料，观察预切开的效果和近期并发症，并与ERCP同期常规选择性插管成功1326例（常规组）做比较。结果全组104例行针状刀预切开后，选择性胆管插管成功97例，成功率93．3％。术后并发症8例（7．7％），包括出血4例，轻型胰腺炎2例，胆道感染2例；ERCP同期常规选择性插管成功1326例，并发症98例（7．4％）；针状刀预切开组与同期常规选择性插管成功组患者的并发症发生率差异无统计学意义（χ2＝0．055，P＞0．05）。结论在ERCP胆管插管困难时采用针状刀乳头括约肌预切开术是一种安全有效的方法，有效地提高ERCP的成功率，值得临床广泛应用。