胰管支架表面括约肌预切开在ERCP困难胆管插管中的应用效果

目的 探讨胰管支架表面括约肌预切开(PPDS)在ERCP困难胆管插管中的应用效果.方法 回顾性统计分析2016年6月1日至2021年5月31日上海交通大学医学院附属瑞金医院北部院区所有ERCP术病例资料,将在ERCP操作过程中导丝意外进入胰管的困难胆管插管者,根据术中选择插管方法,分为两组:(1)PPDS组,(2)双导...

Efficacy of precut over a pancreatic duct stent for difficult biliary cannulation in ERCP

Objective To evaluate the efficacy of precut over a pancreatic duct stent (PPDS) for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP). Methods A retrospective analysis was conducted on the clinical data of all patients underwent ERCP in Ruijin Hospital between Jun. 1 2016 and May 31 2021. According to the selected method during difficult biliary cannulation if guidewire entered pancreatic duct unintendedly, patients were divided into two groups: (1) PPDS group, (2) double-guidewire (DGW)/transpancreatic sphincterotomy (TPS) group. The success rate of biliary cannulation and ERCP-related complication between the two groups were compared. Results Among 880 ERCP, 85 patients were enrolled in this study, 37 patients in PPDS group, and 48 patients in DGW/TPS group. There was no statistical difference in age, sex, preoperative common bile duct diameter, serum total bilirubin, or etiology between the two groups (P>0.05). In PPDS group, 35 patients (94.6%, 35/37) had successful biliary cannulation; no post-ERCP pancreatitis (PEP), bleeding, perforation occurred in PPDS group. In DGW/TPS group, 40 patients (83.3%, 40/48) had successful biliary cannulation; 10 patients (20.8%, 10/48) had ERCP-related complications, with PEP in 9 patients, bleeding in 2 patients (1 patient had both PEP and bleeding), no perforation occurred. The success rate of biliary cannulation between the two groups had no significant difference (χ²=2.55, P=0.18), while the total ERCP-related complication incidence had significant difference (χ²=8.74, P=0.003). All patients were cured. Conclusion Precut over a pancreatic duct stent (PPDS) has high success rate of biliary cannulation, which can reduce ERCP-related complication incidence. PPDS is safe and simple.