Early transpancreatic sphincterotomy reduces post-ERCP pancreatitis risk

doi:10.16139/j.1007-9610.2020.04.008

Abstract

Abstract:

Objective To investigate the effect of transpancreatic sphincterotomy(TPS) on post-ERCP pancreatitis (PEP) during endoscopic retrograde cholangiopancreatography (ERCP) for difficult biliary intubation. Methods A total of 103 cases undergoing ERCP in our hospital from June 2018 to November 2019 were analyzed retrospectively. Complications including PEP were compared between the cases in the group(42 cases) of early TPS in which the patients had sphincterotomy immediately after guidewire running into pancreatic duct for the second time and the cases in the control group (61 cases) in which the guidewire had entered pancreatic duct for more than 2 times before successful bile duct access by selective intubation or TPS. Results All the patients in both groups had biliary intubation successfully. However, the operative time in group of early TPS was much shorter than that in the control group [(9.59±1.54) min vs. (13.33±2.09) min, P=0.022]. There were 3 cases of PEP in the group of early TPS and 15 cases in the control group with statistical difference (P=0.033). All the cases of PEP were mild and recovered after conservative treatment. There were no biliary infections or postoperative bleedings in both groups. Logistic multivariate analysis showed that the time of intubation (≥10 min) and the times (>2 times) for the guidewire entering the pancreatic duct are the risk factors for PEP. Conclusions Early TPS when guidewire enters pancreatic duct ≤2 times would be safe. It could be helpful to shorten the time of intubation, increase the success rate of intubation and reduce the incidence of PEP.

Key words: Endoscopic retrograde cholangiopancreatography, Transpancreatic sphincterotomy, Post-ERCP pancreatitis

CLC Number:

R657.51

TANG Rui, DING Jun, LI Fu, HUANG Jinxin, Zhang Xiwen. Early transpancreatic sphincterotomy reduces post-ERCP pancreatitis risk[J]. Journal of Surgery Concepts & Practice, 2020, 25(04): 306-310.

Figures/Tables 5

References 16

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分组	n	男/女	年龄（岁）	结石	良性狭窄/梗阻	恶性狭窄/梗阻
早期经胰管预切开组	42	23/19	57.4±14.2	13（31.0）	23（54.7）	6（14.3）
对照组	61^a)	35/26	60.2±17.3	22（36.0）	28（46.0）	11（18.0）

分组	胆管插管时间	X线照射时间
早期经胰管预切开组	9.6±1.5	4.3±0.9
对照组	13.3±2.1	8.8±2.8
P值	0.025	0.003

分组	n	PEP
早期经胰管预切开组	42	3（7.1）
对照组	61	15（24.6）
χ²值		5.250
P值		0.033

危险因素	B	S.E	Wald	Df	P值	Ex（B）	Ex（B）95%CI
插管时间>10 min	2.149	0.818	6.898	1	0.009	8.577	1.725~42.64
导丝进入胰管>2次	1.820	0.756	5.796	1	0.016	6.172	1.403~27.155
年龄	0.002	0.023	0.004	1	0.947	1.002	0.957~1.049
性别	-0.616	0.735	0.702	1	0.402	0.540	0.128~2.281
经胰管方向Oddi括约肌预切开^a)	-0.630	0.782	0.649	1	0.420	0.532	0.115~2.466