內鏡逆行胰膽管造影術中選擇性膽管插管困難的循證處理_《中國循證醫學雜志》

作者：

陳鳳媛 ¹ ,  陳世耀 ²

1. 復旦大學附屬上海市第五人民醫院消化科（上海 200240）；2. 復旦大學循證醫學中心（上海 200032）;

關鍵詞：

內鏡逆行胰膽管造影術插管術臨床證據

DOI：

10.7507/1672-2531.20100593

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目的　內鏡逆行胰膽管造影（ERCP）術中選擇性膽管插管困難（DSBC）是臨床常見的問題，針對1例DSBC患者，通過檢索當前最佳證據，為臨床合理處理提供依據。
方法　全面檢索Cochrane 圖書館（2010年第1期）、ACP online、NGC（1998～2010.6）、PubMed（1950～2010.6）及CBM（1994～2010.6），查找與ERCP及DSBC有關的系統評價和隨機對照試驗，并對所獲得的證據進行質量評價。
結果　最終納入18篇文獻。當前證據表明，預切開術可提高DSBC患者插管成功率，對有經驗的內鏡醫生而言安全有效，并能減少操作時間；胰管占據技術較預切開容易掌握，可提高插管成功率；但上述兩種方法均有可能增加ERCP術后并發癥的發生。根據以上證據，結合內鏡醫生的經驗和患者及家屬的愿望，我們為該例患者實施了針狀刀預切開術，再行選擇性膽管插管獲得成功。
結論　當前證據顯示，預切開和胰管占據均可提高DSBC的插管成功率，但應用時要結合患者具體情況和內鏡醫生的經驗合理選擇。

引用本文： 陳鳳媛,陳世耀. 內鏡逆行胰膽管造影術中選擇性膽管插管困難的循證處理. 中國循證醫學雜志, 2010, 10(11): 1345-1349. doi: 10.7507/1672-2531.20100593 復制

1.	?9 Kaffes AJ, Sriram PV, Rao GV, et al. Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique. Gastrointest Endosc, 2005, 62(5): 669-674.
2.	McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg, 1968, 167(5): 752-756.
3.	Deng DH, Zuo HM, Wang JF, et al. New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation. World J Gastroenterol, 2007, 13(32): 4385-4390.
4.	Masci E, Mariani A, Curioni S, et al. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta analysis. Endoscopy, 2003, 35(10): 830-834.
5.	Tang SJ, Haber GB, Kortan P, et al. Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial. Endoscopy, 2005, 37(1): 58-65.
6.	Zhou PH, Yao LQ, Xu MD, et al. Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int, 2006, 5(4): 590-594.
7.	Maeda S, Hayashi H, Hosokawa O, et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy, 2003, 35(9): 721-724.
8.	魯臨, 曾憲忠, 陳健, 等. 兩種技術在ERCP選擇性膽管插管困難時的對照研究. 中華消化內鏡雜志, 2008, 25(2): 73-76.
9.	Catalano MF, Linder JD, Geenen JE. Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: Comparison with standard pre-cut papillotomy. Gastrointest Endosc, 2004, 60(4): 557-561.
10.	ASGE standards of practice committee. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy, 2005, 62(1): 1-8.
11.	ASGE standards of practice committee. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointestinal Endoscopy, 2010, 71(1): 1-9.
12.	Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis: a meta-analysis of controlled trials. Gastrointestinal Endoscopy, 2004, 60(4): 544-550.
13.	Das A, Singh P, Sivak MV, et al. Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis. Gastrointestinal Endoscopy, 2007, 65(7): 960-968.
14.	Laasch HU, Tringali A, Wilbraham L, et al. Comparison of standard and steerable catheters for bile duct cannulation in ERCP. Endoscopy, 2003, 35(8): 669-674.
15.	de Weerth A, Seitz U, Zhong Y, et al. Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy, 2006, 38(12): 1235-1240.
16.	Halttunen J, Keränen I, Udd M, et al. Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc, 2009, 23(4): 745-749.
17.	Mavrogiannis C, Liatsos C, Romanos A, et al. Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones. Gastrointest Endosc, 1999, 50(3): 334-339.
18.	Kim MH, Lee SK, Lee MH, et al. Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope. Endoscopy, 1997, 29(2): 82-85.
19.	Horiuchi A, Nakayama Y, Kajiyama M, et al. Effect of precut sphincterotomy on biliary cannulation based on the characteristics of the major duodenal papilla. Clin Gastroenterol Hepatol, 2007, 5(9): 1113-1118.
20.	Kei Ito, Naotaka Fujita, Yutaka Noda, et al. Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography. World J Gastroenterol, 2008, 14(36): 5595-5600.
21.	Fogel EL, Sherman S, Lehman GA. Increased selective biliary cannulation rates in the setting of periampullary diverticula: main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. Gastrointest Endosc, 1998, 47(5): 396-400.
22.	Goldberg E, Titus M, Haluszka O, et al. Pancreatic-duct stent placement facilitates difficult common bile duct cannulation. Gastrointest Endosc, 2005, 62(4): 592-596.
23.	Abu-Hamda EM, Baron TH, Simmons DT, et al. A retrospective comparison of outcomes using three different precut needle knife techniques for biliary cannulation. Clin Gastroenterol, 2005, 39(8): 717-721.
24.	Espinel DJ, Vivas AS, Munoz NF, et al. Needle-knife sphincterotomy for biliary access: a prospective study. Gastroenterol Hepatol, 2005, 28(7): 369-374.
25.	Baillie J. Needle knife sphincterotomy revisited. Gastrointest Endosc, 1997, 46(3): 282-284.
26.	Hashiba K, D’Assuncao MA, Armellini S, et al. Endoscopic suprapapillary blunt dissection of the distal common bile duct in cases of difficult cannulation: a pilot series. Endoscopy, 2004, 36(4): 317-321.
27.	Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointest Endosc, 1995, 41(5): 502-506.
28.	Slivka A. A new technique to assist in bile duct cannulation.Gastrointest Endosc, 1996, 44(5): 636.
29.	Dumonceau JM, Deviere J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy, 1998, 30(7): S80 .
30.	Christoforidis E, Goulimaris I, Kanellos I, et al. Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors. Endoscopy, 2002, 34(4): 286-292.

1. ?9 Kaffes AJ, Sriram PV, Rao GV, et al. Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique. Gastrointest Endosc, 2005, 62(5): 669-674.
2. McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg, 1968, 167(5): 752-756.
3. Deng DH, Zuo HM, Wang JF, et al. New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation. World J Gastroenterol, 2007, 13(32): 4385-4390.
4. Masci E, Mariani A, Curioni S, et al. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta analysis. Endoscopy, 2003, 35(10): 830-834.
5. Tang SJ, Haber GB, Kortan P, et al. Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial. Endoscopy, 2005, 37(1): 58-65.
6. Zhou PH, Yao LQ, Xu MD, et al. Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int, 2006, 5(4): 590-594.
7. Maeda S, Hayashi H, Hosokawa O, et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy, 2003, 35(9): 721-724.
8. 魯臨, 曾憲忠, 陳健, 等. 兩種技術在ERCP選擇性膽管插管困難時的對照研究. 中華消化內鏡雜志, 2008, 25(2): 73-76.
9. Catalano MF, Linder JD, Geenen JE. Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: Comparison with standard pre-cut papillotomy. Gastrointest Endosc, 2004, 60(4): 557-561.
10. ASGE standards of practice committee. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy, 2005, 62(1): 1-8.
11. ASGE standards of practice committee. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointestinal Endoscopy, 2010, 71(1): 1-9.
12. Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis: a meta-analysis of controlled trials. Gastrointestinal Endoscopy, 2004, 60(4): 544-550.
13. Das A, Singh P, Sivak MV, et al. Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis. Gastrointestinal Endoscopy, 2007, 65(7): 960-968.
14. Laasch HU, Tringali A, Wilbraham L, et al. Comparison of standard and steerable catheters for bile duct cannulation in ERCP. Endoscopy, 2003, 35(8): 669-674.
15. de Weerth A, Seitz U, Zhong Y, et al. Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy, 2006, 38(12): 1235-1240.
16. Halttunen J, Keränen I, Udd M, et al. Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc, 2009, 23(4): 745-749.
17. Mavrogiannis C, Liatsos C, Romanos A, et al. Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones. Gastrointest Endosc, 1999, 50(3): 334-339.
18. Kim MH, Lee SK, Lee MH, et al. Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope. Endoscopy, 1997, 29(2): 82-85.
19. Horiuchi A, Nakayama Y, Kajiyama M, et al. Effect of precut sphincterotomy on biliary cannulation based on the characteristics of the major duodenal papilla. Clin Gastroenterol Hepatol, 2007, 5(9): 1113-1118.
20. Kei Ito, Naotaka Fujita, Yutaka Noda, et al. Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography. World J Gastroenterol, 2008, 14(36): 5595-5600.
21. Fogel EL, Sherman S, Lehman GA. Increased selective biliary cannulation rates in the setting of periampullary diverticula: main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. Gastrointest Endosc, 1998, 47(5): 396-400.
22. Goldberg E, Titus M, Haluszka O, et al. Pancreatic-duct stent placement facilitates difficult common bile duct cannulation. Gastrointest Endosc, 2005, 62(4): 592-596.
23. Abu-Hamda EM, Baron TH, Simmons DT, et al. A retrospective comparison of outcomes using three different precut needle knife techniques for biliary cannulation. Clin Gastroenterol, 2005, 39(8): 717-721.
24. Espinel DJ, Vivas AS, Munoz NF, et al. Needle-knife sphincterotomy for biliary access: a prospective study. Gastroenterol Hepatol, 2005, 28(7): 369-374.
25. Baillie J. Needle knife sphincterotomy revisited. Gastrointest Endosc, 1997, 46(3): 282-284.
26. Hashiba K, D’Assuncao MA, Armellini S, et al. Endoscopic suprapapillary blunt dissection of the distal common bile duct in cases of difficult cannulation: a pilot series. Endoscopy, 2004, 36(4): 317-321.
27. Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointest Endosc, 1995, 41(5): 502-506.
28. Slivka A. A new technique to assist in bile duct cannulation.Gastrointest Endosc, 1996, 44(5): 636.
29. Dumonceau JM, Deviere J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy, 1998, 30(7): S80 .
30. Christoforidis E, Goulimaris I, Kanellos I, et al. Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors. Endoscopy, 2002, 34(4): 286-292.

《中國循證醫學雜志》

內鏡逆行胰膽管造影術中選擇性膽管插管困難的循證處理

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《中國循證醫學雜志》

內鏡逆行胰膽管造影術中選擇性膽管插管困難的循證處理

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