Comparative analysis of endoscopic precut conventional and needle knife sphincterotomy  

作　　者：Andrzej Jamry 

机构地区：[1]2~(nd) Surgical Department,District Hospital Radomska

出　　处：《World Journal of Gastroenterology》2013年第14期2227-2233,共7页世界胃肠病学杂志（英文版）

摘　　要：AIM:To compare the efficacy,complications and postprocedural hyperamylasemia in endoscopic pre-cut conventional and needle knife sphincterotomie.METHODS:We performed a retrospective analysis of two pre-cut sphincterotomy(PS) techniques,pre-cut conventional sphincterotomy(PCS),and pre-cut needle knife(PNK).The study included 143 patients;the classic technique was used in 59 patients(41.3%),and the needle knife technique was used in 84 patients(58.7%).We analyzed the efficacy of bile duct access,the need for a two-step procedure,the rates of complications and hyperamylasemia 4 h after the procedure,"endoscopic bleeding" and the need for bleeding control.Furthermore,to assess whether the anatomy of the Vater's papilla,indications for the procedure or the need for additional procedures could inform the choice of the PS method,we evaluated the additive hyperamylasemia risk 4 h after the procedure with respect to the above mentioned variables.RESULTS:The bile duct access efficacy with PNK and PCS was 100% and 96.6%,respectively,and the difference between the two groups was not significant(P = 0.06).However,the needle knife technique required two-step access significantly more often,in 48.8% vs8.5% of cases(P < 0.0001).The only complication noted was post-ercp pancreatitis(PEP),which was observed in 4/84(4.8%) and 2/59(3.4%) patients submitted to PNK and PSC,respectively;the difference between the two procedures was not significant(P = 0.98).An analysis of other consequences of the techniques yielded the following results in the PNK and PCS groups:hyperamylasemia 4 h after the procedure > 80 U/L,41/84 vs 23/59(P = 0.32);hyperamylasemia 4 h after the procedure > 240 U/L,19/84 vs 11/59(P = 0.71);pancreatic pain,13/84 vs 7/59(P = 0.71);endoscopic bleeding,10/84 vs 8/59(P = 0.97);and the need for bleeding control,10/84 vs 7/59(P = 0.79).In the next part of the study,we analyzed the influence of the method chosen on the risk of hyperamylasemia with respect to an indication for endoscopic retrograde cholangiopancreatography,pAIM: To compare the efficacy, complications and post-procedural hyperamylasemia in endoscopic pre-cut conventional and needle knife sphincterotomie. METHODS: We performed a retrospective analysis of two pre-cut sphincterotomy (PS) techniques, pre-cut conventional sphincterotomy (PCS), and pre-cut needle knife (PNK). The study included 143 patients; the classic technique was used in 59 patients (41.3%), and the needle knife technique was used in 84 patients (58.7%). We analyzed the efficacy of bile duct access, the need for a two-step procedure, the rates of complications and hyperamylasemia 4 h after the procedure, “endoscopic bleeding” and the need for bleeding control. Furthermore, to assess whether the anatomy of the Vater’s papilla, indications for the procedure or the need for additional procedures could inform the choice of the PS method, we evaluated the additive hyperamylasemia risk 4 h after the procedure with respect to the above mentioned variables. RESULTS: The bile duct access efficacy with PNK and PCS was 100% and 96.6%, respectively, and the difference between the two groups was not significant (P = 0.06). However, the needle knife technique required two-step access significantly more often, in 48.8% vs 8.5% of cases (P < 0.0001). The only complication noted was post-ercp pancreatitis (PEP), which was observed in 4/84 (4.8%) and 2/59 (3.4%) patients submitted to PNK and PSC, respectively; the difference between the two procedures was not significant (P = 0.98). An analysis of other consequences of the techniques yielded the following results in the PNK and PCS groups: hyperamylasemia 4 h after the procedure > 80 U/L, 41/84 vs 23/59 (P = 0.32); hyperamylasemia 4 h after the procedure > 240 U/L, 19/84 vs 11/59 (P = 0.71); pancreatic pain, 13/84 vs 7/59 (P = 0.71); endoscopic bleeding, 10/84 vs 8/59 (P = 0.97); and the need for bleeding control, 10/84 vs 7/59 (P = 0.79). In the next part of the study, we analyzed the influence of the method chosen on the risk of hyperamylasemia with respect to

关 键 词：SPHINCTEROTOMY ENDOSCOPIC ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY Complications HYPERAMYLASEMIA 

分 类 号：R657.4[医药卫生—外科学]