导丝引导胆管选择性插管对ERCP术后胰腺炎影响的系统评价

目的 系统评价导丝引导胆管选择性插管与传统地造影剂辅助插管相比,能否降低ERCP术后胰腺炎(post-ERCP panereatitis,PEP)的发生率.方法 检索Cochrane临床对照试验资料库、MEDLINE、EMBASE、Science Citation Index、中国生物医学文献数据库,以及2002-2008年相关会参考文献,全面收集关于导丝引导胆管选择性插管对PEP影响的文摘,并且手工检索入选文献的议随机对照试验进行Meta分析.结果 共7篇随机对照试验包括2474例胆管选择性插管的ERCP患者被纳入评价.Meta分析结果显示,导丝引导胆管选择性插管和造影剂辅助插管比较,可降低PEP发生率(RR=0.46,95%可信区间0.25～0.85,P=0.01).但是,排除摘要和分配隐藏不清楚的试验进行敏感性分析后,两个插管方法 对PEP发生率差异无统计学意义(RR=0.66,95%可信区间0.28～1.54,P=0.33).结论 导丝引导胆管选择性插管可能是减少PEP发生的有效方法 ,但由于纳入系统评价的试验有限,还需开展随机对照试验证实.

Effect of guide-wire assisted biliary cannulation on post-ERCP pancreatitis: a meta-analysis

Objective To compare the effect of guide-wire assisted cannulation and traditional con-trast assisted cannulation on the occurrence post-endoscopic retrograde cholangiopancreatography(ERCP) pan-creatitis(PEP). Methods The effect of guide-wire assisted biliary cannulation on the incidence of PEP was systematically evaluated by searching for literatures on prospective randomized controlled trials(RCTs) on the Cochrane Controlled Trials Register (Issue 4, 2008), MEDLINE (1966-Oct, 2008), EMBASE (1966-Oct 2008), Science Citation Index(1966-Oct, 2008), CBMdisk(1970-Sep, 2008) and conference abstracts(2002 -2008). A meta-analysis of these clinical trials was performed. Results Seven RCTs, with a total of 2474 patients enrolled, were retrieved. Meta-analysis demonstrated a lower risk for PEP after guide-wire assisted bil-iary cannulation (RR=0.46, 95% CI 0.25-0.85, P=0.01). However, sub-category analysis showed that it was not statistically superior to contrast assisted cannulation in reduction of PEP (RR=0.66, 95% CI 0.28-1.54, P=0.33). Conclusion Guide-wire assisted biliary cannulation might be effective in preventing PEP, but further RCTs are warranted due to the limitations of trials included in this analysis.