Effect of early precut sphincterotomy on incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP) in patients with difficult biliary access

YANG Hongqi; GUO Yanfang; PENG Hui; HONG Lili; SHI Junchao; CAO Jifan; ZHOU Tingting

PDF(544 KB)

Medical Journal of the Chinese People Armed Police Forces ›› 2021, Vol. 32 ›› Issue (2) : 105-107.

Effect of early precut sphincterotomy on incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP) in patients with difficult biliary access

YANG Hongqi, GUO Yanfang, PENG Hui, HONG Lili, SHI Junchao, CAO Jifan, ZHOU Tingting

Author information +

History +

Abstract

Objective To investigate the effect of early precut sphincterotomy on the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP) in patients with difficult biliary access.Methods According to the precut time, 187 patients who were referred to Anhui Provincial Corps Hospital of Chinese People's Armed Police Force for ERCP due to difficult biliary cannulation between March 2014 and November 2019 were divided into the early precut group (group A,n=85) and the delayed precut group (Group B,n=102). The success rate of cannulation and the incidence of PEP were compared between the two groups. No rectal indomethacin or pancreatic stent was used for prevention of PEP.Results The incidence of PEP was 4.71%(4/85)in group A and 14.71%(15/102)in group B, so the difference was statistically significant (P<0.05). One of the 15 cases of PEP was severe in group B. There was no significant difference in the incidence of postoperative bleeding, perforation, cholangitis or other complications between the two groups. There was no mortality in either group.Conclusions In patients with difficult biliary cannulation, early precut sphincterotomy is an effective approach and can significantly reduce the incidence of PEP.

Key words

early precut sphincterotomy / difficult biliary access / post-endoscopic retrograde cholangiopancreatography pancreatitis

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

YANG Hongqi, GUO Yanfang, PENG Hui, HONG Lili, SHI Junchao, CAO Jifan, ZHOU Tingting. Effect of early precut sphincterotomy on incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP) in patients with difficult biliary access[J]. Medical Journal of the Chinese People Armed Police Forces. 2021, 32(2): 105-107

References

[1] Wu D, Lu B, Xue H D, et al. Validation of modified determinant-based classification of severity for acute pancreatitis in a tertiary teaching hospital[J].Pancreatology,2019,19(2):217-223.
[2] Tenner S, Baillie J,Witt J, et al. American College of Gastroenterology Guideline: management of acute pancreatitis [J].AMJ Gastroenterol,2013,108:14100-14115.
[3] Mine T, Morizane T, Kawaguchi Y, et al. Clinical practice guideline for post-ERCP pancreatitis[J]. J Gastroenterol, 2017, 52(9):1013-1022.
[4] Dumonceau J M, Andriulli A, Elmunzer B J, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy(ESGE) Guideline-updated June 2014[J].Endoscopy,2014,46:799-815.
[5] Swan M P, Alexander S, Moss A, et al. Needle knife sphincterotomy does not increase the risk of pancreatitis in patients with diffcult biliary cannulation[J]. Clin Gastroenterol Hepatol,2013,11: 430-436.
[6] Testoni P A, Giussani A, Vailati C, et al. Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease[J]. Dig Liver Dis, 2011, 43:792-796.
[7] Cennamo V, Fuccio L, Zagari R M, et al. Can early precut implementa-tion reduce endoscopic retrograde cholangiopancreatography related complication risk? Meta-analysis of randomized controlled trials [J]. Endoscopy, 2010, 42(5):381-388.
[8] Hiroshi K,Yoshimasa K,Shuhei K, et al. Transpapillary selective bile duct cannulation technique:review of Japanese randomized controlled trials since 2010 and an overview of clinical results in precut sphincterotomy since 2004[J]. Dig Endosc,2016, 28: 77-95.
[9] Manes G, DiGiorgio P, Repici A, et al. An analysis of the factors associated with the development of complications in patients undergoing precut sphincterotomy: a prospective, control, randomized, multicenterstudy[J]. AMJ Gastroenterol, 2009, 104: 2412-2417.
[10] Yildirim A E, Kadayifci A. Repeated cannulation attempts or late precut : which is more risky for post-ERCP pancreatitis? [J].Endoscopy, 2016, 48: 955.
[11] Sundaralingam P, Masson P, Bourke M J. Early precut Sphincterotomy does not increase risk during endoscopic retrogradecholangiopancreatography in patients with difficult biliary access: a meta-analysis of randomized controlled trials[J]. Clin Gastroenterol Hepatol, 2015, 13:1722-1729.
[12] Lopes L, Dinis-Ribeiro M, Rolanda C. Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”? [J].GIE, 2014, 80: 634-641.