The impact of transpancreatic pre-cut sphincterotomy on stone recurrence after endoscopic retrograde cholangiopancreatography in patients with common bile duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

KANG Kui , ZHANG Bo , CHEN Di , QING Sheng , WANG Lei , NIU Ziwei ,  LIAO Yuan

Department of Gastroenterology, Beijing Aerospace General Hospital, Beijing 100076, P. R. China;

Corresponding?author：

LIAO Yuan, Email: liaoyuan515@126.com

Keywords：

common bile duct stone; transpancreatic pre-cut sphincterotomy; endoscopic retrograde cholangiopancreatography; stone recurrence

DOI：

10.7507/1007-9424.202603078

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Objective To evaluate the effect of transpancreatic pre-cut sphincterotomy on recurrence after endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stone. Methods A total of 102 patients with common bile duct stone who underwent ERCP stone extraction at Beijing Aerospace General Hospital from January 2022 to January 2024 were retrospectively collected. Using propensity score matching to adjust equilibrium, 45 patients were divided into the transpancreatic pre-cut sphincterotomy group and 45 were in the control group (standard cannulation method). Compare stone recurrence rate, surgical parameters, liver function indicators, inflammatory factors, oxidative stress markers and adverse events between the two groups. Results The improvement of postoperative indicators of the transpancreatic pre-cut sphincterotomy group including total bilirubin [(5.18±1.30) μmol/L vs. (1.64±0.88) μmol/L, P<0.001], alkaline phosphatase [(16.45±4.82) U/L vs. (9.12±3.04) U/L, P<0.001], alanine aminotransferase [(6.83±2.21) U/L vs. (3.57±1.92) U/L, P<0.001], C-reactive protein [(3.34±1.15) mg/L vs. (1.53±0.87) mg/L, P<0.001], interleukin-6 [(5.72±1.90) pg/mL vs. (3.02±1.48) pg/mL, P<0.001], tumor necrosis factor-α [(6.84±2.35) pg/mL vs. (3.44±1.98) pg/mL, P<0.001], malondialdehyde [(2.40±0.79) nmol/mL vs. (1.16±0.72) nmol/mL, P<0.001], superoxide dismutase [(–17.36±5.52) U/mL vs. (–7.43±4.46) U/mL, P<0.001] were superior to the control group. The overall stone recurrence rate was lower in the transpancreatic pre-cut sphincterotomy group [11.11%(5/45) vs. 33.33%(15/45), P=0.011]. The adverse events rate was decreased in the transpancreatic pre-cut sphincterotomy group [22.22% (10/45) vs. 8.89% (4/45), P=0.037], accompanied by a reduced risk of adverse events [RR=0.523, 95%CI (0.280, 0.964)]. Conclusion Transpancreatic pre-cut sphincterotomy effectively reduces the risk of stone recurrence and adverse events following ERCP for common bile duct stone, while promoting postoperative recovery of liver function.

Citation： KANG Kui, ZHANG Bo, CHEN Di, QING Sheng, WANG Lei, NIU Ziwei, LIAO Yuan. The impact of transpancreatic pre-cut sphincterotomy on stone recurrence after endoscopic retrograde cholangiopancreatography in patients with common bile duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(8): 1091-1098. doi: 10.7507/1007-9424.202603078 Copy

1.	Dhote A, Micelli Lupinacci R, Peschaud F. Side-to-side choledochoduodenostomy for common bile duct stones [J]. J Visc Surg, 2022, 159(1): 59-64.
2.	Lammert F, Wittenburg H. Gallstones: prevention, diagnosis, and treatment [J]. Semin Liver Dis, 2024, 44(3): 394-404.
3.	陶麗瑩, 王宏光, 郭享, 等. ERCP聯合經口膽道鏡治療膽囊結石合并膽總管結石 [J]. 中華肝膽外科雜志, 2025, 31(6): 406-409.
4.	黨夢源, 柯懿哲, 高玉婷, 等. 內鏡逆行胰膽管造影(ERCP)技術治療膽道結石研究進展 [J]. 現代消化及介入診療, 2025, 30(5): 626-630.
5.	黃安華, 張誠, 楊玉龍, 等. 經鼻膽管留置胰管導絲預防細徑胰管膽囊結石和膽總管結石患者ERCP術后胰腺炎的療效觀察 [J]. 中華肝膽外科雜志, 2023, 29(12): 892-896.
6.	Watanabe M, Okuwaki K, Iwai T, et al. Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography for asymptomatic common bile duct stones on surgically altered anatomy: a high risk factor for post-endoscopic retrograde cholangiopancreatography pancreatitis [J]. J Hepatobiliary Pancreat Sci, 2024, 31(1): 25-33.
7.	Saito H, Kadono Y, Shono T, et al. Post-endoscopic retrograde cholangiopancreatography pancreatitis after conservative treatment for symptomatic bile duct stones [J]. JMA J, 2023, 6(2): 156-164.
8.	陶麗瑩, 王宏光, 郭慶梅, 等. 經口膽胰管鏡聯合內鏡逆行胰膽管造影經十二指腸乳頭膽囊息肉切除的療效及安全性分析 [J]. 臨床肝膽病雜志, 2025, 41(3): 513-517.
9.	Joseph D, Muraleedharanpillai R, Kolassery S, et al. Clinical profiles and outcomes of patients undergoing endoscopic retrograde cholangiopancreatography in a tertiary care center [J/OL]. Cureus, 2024, 16(2): e55065. doi: 10.7759/cureus.55065.
10.	中華醫學會消化內鏡學分會ERCP學組, 中國醫師協會消化醫師分會膽胰學組, 國家消化系統疾病臨床醫學研究中心. 中國ERCP指南 (2018版) [J]. 中華消化內鏡雜志, 2018, 35(11): 777-813.
11.	European Association for the Study of the Liver (EASL). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones [J]. J Hepatol, 2016, 65(1): 146-181.
12.	王平, 宋振順, 周嘉, 等. LC+LCBDE+PS與ERCP+EST+LC治療膽囊結石合并膽總管結石的臨床對比 [J]. 肝膽胰外科雜志, 2024, 36(2): 95-99.
13.	Saito H, Kadono Y, Shono T, et al. Factors predicting difficult biliary cannulation during endoscopic retrograde cholangiopancreatography for common bile duct stones [J]. Clin Endosc, 2022, 55(2): 263-269.
14.	Yan C, Zheng J, Tang H, et al. Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015-2023) [J]. BMC Med Inform Decis Mak, 2024, 24(1): 143. doi: 10.1186/s12911-024-02541-z.
15.	李靖竹, 王槐志, 雙擁七林. 慢性復發性胰腺炎伴胰管結石行保留十二指腸, 膽總管, Oddi’s括約肌的胰頭整塊全切除術(王氏手術) 1例報道 [J]. 中國普外基礎與臨床雜志, 2025, 32(2): 175-177.
16.	Chandrasekhara V, Khashab MA, Muthusamy VR, et al. Adverse events associated with ERCP [J]. Gastrointest Endosc, 2017, 85(1): 32-47.
17.	朱梁飛, 王小永, 姚杰, 等. 雙鏡聯合膽總管一期縫合術治療老年膽囊結石合并膽總管結石的療效及對肝功能, 應激反應的影響 [J]. 中國普通外科雜志, 2024, 33(8): 1330-1336.
18.	Zhang W, Hou SL, Zhang LC. Endoscopic ultrasound-guided rendezvous technique for the treatment of choledocholithiasis with difficult cannulation [J]. Rev Esp Enferm Dig, 2025, 117(10): 591. doi: 10.17235/reed.2023.10056/2023.
19.	Afify S, Elsabaawy M, Al-Arab AE, et al. Impact of periampullary diverticulum on endoscopic retrograde cholangiopancreatography: bridging the gap between fiction and reality [J]. Prz Gastroenterol, 2024, 16(4): 446-453.
20.	Mamontov I, Tamm T, Kramarenko K, et al. Small common bile duct - the risk factor for post-ERCP pancreatitis in patients with choledocholithiasis [J]. Wiad Lek, 2024, 77(12): 2388-2393.
21.	Ye Q, Zhang J, Ou X, et al. Efficacy and safety of three endoscopic techniques for small common bile duct stones (≤ 10 mm): a multicenter, retrospective, cohort study with propensity score matching [J]. Surg Endosc, 2023, 37(3): 1863-1869.
22.	Kadokura M, Takenaka Y, Yoda H, et al. Asymptomatic common bile duct stones are associated with increased risk of post-endoscopic retrograde cholangiopancreatography pancreatitis [J]. JMA J, 2021, 4(2): 141-147.
23.	Chen C, Tao R, Hu QH, et al. Effect of duodenal papilla morphology on biliary cannulation and complications in patients with common bile duct stones [J]. Hepatobiliary Pancreat Dis Int, 2025, 24(3): 316-322.
24.	Cotton PB. ASGE guidelines for ERCP competence [J]. Gastrointest Endosc, 2017, 86(6): 1190. doi: 10.1016/j.gie.2017.07.008.
25.	周懌, 朱恒波, 汪浩鵬, 等. 膽總管結石患者ERCP術后并發胰腺炎影響因素及列線圖模型構建 [J]. 臨床誤診誤治, 2025, 38(5): 59-65.
26.	Akay T, Sari E. Identification of risk factors involved in recurrence after common bile duct stone removal with ERCP: a retrospective observational study [J]. Medicine (Baltimore), 2022, 101(9): e29037. doi: 10.1097/MD.0000000000029037.
27.	Jagtap N, Kumar JK, Chavan R, et al. EUS versus MRCP to perform ERCP in patients with intermediate likelihood of choledocholithiasis: a randomised controlled trial [J/OL]. Gut, 2022, gutjnl-2021l-325080l. doi: 10.1136/gutjnl-2021-325080.

1. Dhote A, Micelli Lupinacci R, Peschaud F. Side-to-side choledochoduodenostomy for common bile duct stones [J]. J Visc Surg, 2022, 159(1): 59-64.
2. Lammert F, Wittenburg H. Gallstones: prevention, diagnosis, and treatment [J]. Semin Liver Dis, 2024, 44(3): 394-404.
3. 陶麗瑩, 王宏光, 郭享, 等. ERCP聯合經口膽道鏡治療膽囊結石合并膽總管結石 [J]. 中華肝膽外科雜志, 2025, 31(6): 406-409.
4. 黨夢源, 柯懿哲, 高玉婷, 等. 內鏡逆行胰膽管造影(ERCP)技術治療膽道結石研究進展 [J]. 現代消化及介入診療, 2025, 30(5): 626-630.
5. 黃安華, 張誠, 楊玉龍, 等. 經鼻膽管留置胰管導絲預防細徑胰管膽囊結石和膽總管結石患者ERCP術后胰腺炎的療效觀察 [J]. 中華肝膽外科雜志, 2023, 29(12): 892-896.
6. Watanabe M, Okuwaki K, Iwai T, et al. Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography for asymptomatic common bile duct stones on surgically altered anatomy: a high risk factor for post-endoscopic retrograde cholangiopancreatography pancreatitis [J]. J Hepatobiliary Pancreat Sci, 2024, 31(1): 25-33.
7. Saito H, Kadono Y, Shono T, et al. Post-endoscopic retrograde cholangiopancreatography pancreatitis after conservative treatment for symptomatic bile duct stones [J]. JMA J, 2023, 6(2): 156-164.
8. 陶麗瑩, 王宏光, 郭慶梅, 等. 經口膽胰管鏡聯合內鏡逆行胰膽管造影經十二指腸乳頭膽囊息肉切除的療效及安全性分析 [J]. 臨床肝膽病雜志, 2025, 41(3): 513-517.
9. Joseph D, Muraleedharanpillai R, Kolassery S, et al. Clinical profiles and outcomes of patients undergoing endoscopic retrograde cholangiopancreatography in a tertiary care center [J/OL]. Cureus, 2024, 16(2): e55065. doi: 10.7759/cureus.55065.
10. 中華醫學會消化內鏡學分會ERCP學組, 中國醫師協會消化醫師分會膽胰學組, 國家消化系統疾病臨床醫學研究中心. 中國ERCP指南 (2018版) [J]. 中華消化內鏡雜志, 2018, 35(11): 777-813.
11. European Association for the Study of the Liver (EASL). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones [J]. J Hepatol, 2016, 65(1): 146-181.
12. 王平, 宋振順, 周嘉, 等. LC+LCBDE+PS與ERCP+EST+LC治療膽囊結石合并膽總管結石的臨床對比 [J]. 肝膽胰外科雜志, 2024, 36(2): 95-99.
13. Saito H, Kadono Y, Shono T, et al. Factors predicting difficult biliary cannulation during endoscopic retrograde cholangiopancreatography for common bile duct stones [J]. Clin Endosc, 2022, 55(2): 263-269.
14. Yan C, Zheng J, Tang H, et al. Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015-2023) [J]. BMC Med Inform Decis Mak, 2024, 24(1): 143. doi: 10.1186/s12911-024-02541-z.
15. 李靖竹, 王槐志, 雙擁七林. 慢性復發性胰腺炎伴胰管結石行保留十二指腸, 膽總管, Oddi’s括約肌的胰頭整塊全切除術(王氏手術) 1例報道 [J]. 中國普外基礎與臨床雜志, 2025, 32(2): 175-177.
16. Chandrasekhara V, Khashab MA, Muthusamy VR, et al. Adverse events associated with ERCP [J]. Gastrointest Endosc, 2017, 85(1): 32-47.
17. 朱梁飛, 王小永, 姚杰, 等. 雙鏡聯合膽總管一期縫合術治療老年膽囊結石合并膽總管結石的療效及對肝功能, 應激反應的影響 [J]. 中國普通外科雜志, 2024, 33(8): 1330-1336.
18. Zhang W, Hou SL, Zhang LC. Endoscopic ultrasound-guided rendezvous technique for the treatment of choledocholithiasis with difficult cannulation [J]. Rev Esp Enferm Dig, 2025, 117(10): 591. doi: 10.17235/reed.2023.10056/2023.
19. Afify S, Elsabaawy M, Al-Arab AE, et al. Impact of periampullary diverticulum on endoscopic retrograde cholangiopancreatography: bridging the gap between fiction and reality [J]. Prz Gastroenterol, 2024, 16(4): 446-453.
20. Mamontov I, Tamm T, Kramarenko K, et al. Small common bile duct - the risk factor for post-ERCP pancreatitis in patients with choledocholithiasis [J]. Wiad Lek, 2024, 77(12): 2388-2393.
21. Ye Q, Zhang J, Ou X, et al. Efficacy and safety of three endoscopic techniques for small common bile duct stones (≤ 10 mm): a multicenter, retrospective, cohort study with propensity score matching [J]. Surg Endosc, 2023, 37(3): 1863-1869.
22. Kadokura M, Takenaka Y, Yoda H, et al. Asymptomatic common bile duct stones are associated with increased risk of post-endoscopic retrograde cholangiopancreatography pancreatitis [J]. JMA J, 2021, 4(2): 141-147.
23. Chen C, Tao R, Hu QH, et al. Effect of duodenal papilla morphology on biliary cannulation and complications in patients with common bile duct stones [J]. Hepatobiliary Pancreat Dis Int, 2025, 24(3): 316-322.
24. Cotton PB. ASGE guidelines for ERCP competence [J]. Gastrointest Endosc, 2017, 86(6): 1190. doi: 10.1016/j.gie.2017.07.008.
25. 周懌, 朱恒波, 汪浩鵬, 等. 膽總管結石患者ERCP術后并發胰腺炎影響因素及列線圖模型構建 [J]. 臨床誤診誤治, 2025, 38(5): 59-65.
26. Akay T, Sari E. Identification of risk factors involved in recurrence after common bile duct stone removal with ERCP: a retrospective observational study [J]. Medicine (Baltimore), 2022, 101(9): e29037. doi: 10.1097/MD.0000000000029037.
27. Jagtap N, Kumar JK, Chavan R, et al. EUS versus MRCP to perform ERCP in patients with intermediate likelihood of choledocholithiasis: a randomised controlled trial [J/OL]. Gut, 2022, gutjnl-2021l-325080l. doi: 10.1136/gutjnl-2021-325080.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The impact of transpancreatic pre-cut sphincterotomy on stone recurrence after endoscopic retrograde cholangiopancreatography in patients with common bile duct stones

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