Primary needle-knife fistulotomy for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis:Importance of the endoscopist’s expertise level  

作　　者：Sung Yong Han Dong Hoon Baek Dong Uk Kim Chang Joon Park Young Joo Park Moon Won Lee Geun Am Song 

机构地区：[1]Division of Gastroenterology and Hepatology,Internal Medicine and Biomedical Research Institute,Pusan National University Hospital,Busan 49241,South Korea

出　　处：《World Journal of Clinical Cases》2021年第17期4166-4177,共12页世界临床病例杂志

基　　金：Korea Medical Device Development Fund Grant Funded by the Korea Government the Ministry of Trade,Industry and Energy(Project Number:9991007196),No.KMDF_PR_20200901_0066.

摘　　要：BACKGROUND Needle-knife fistulotomy(NKF)is used as a rescue technique for difficult cannulation.However,the data are limited regarding the use of NKF for primary biliary cannulation,especially when performed by beginners.AIM To assess the effectiveness and safety of primary NKF for biliary cannulation,and the role of the endoscopist’s expertise level(beginner vs expert).METHODS We retrospectively evaluated the records of 542 patients with naïve prominent bulging papilla and no history of pancreatitis,who underwent bile duct cannulation at a tertiary referral center.The patients were categorized according to the endoscopist’s expertise level and the technique used for bile duct cannulation.We assessed the rates of successful cannulation and adverse events.RESULTS The baseline characteristics did not differ between the experienced and lessexperienced endoscopists.The incidence rate of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)was significantly affected by the endoscopist’s expertise level in patients who received conventional cannulation with sphincterotomy(8.9%vs 3.4%for beginner vs expert,P=0.039),but not in those who received NKF.In the multivariable analysis,a lower expertise level of the biliary endoscopist(P=0.037)and longer total procedure time(P=0.026)were significant risk factor of PEP in patients who received conventional cannulation with sphincterotomy but only total procedure time(P=0.004)was significant risk factor of PEP in those who received NKF.CONCLUSION Primary NKF was effective and safe in patients with prominent and bulging ampulla,even when performed by less-experienced endoscopist.We need to confirm which level of endoscopist’s experience is needed for primary NKF through prospective randomized study.

关 键 词：Needle-knife fistulotomy Primary biliary cannulation Endoscopic retrograde cholangiopancreatography Expertise levels PANCREATITIS 

分 类 号：R657.4[医药卫生—外科学] R657.5[医药卫生—临床医学]