{"title":"预切括约肌切开术的最佳时机预防内镜后逆行胆管造影胰腺炎:一项回顾性研究","authors":"Tomohiro Tanikawa, Keisuke Miyake, Mayuko Kawada, Katsunori Ishii, Takashi Fushimi, Noriyo Urata, Nozomu Wada, Ken Nishino, Mitsuhiko Suehiro, Miwa Kawanaka, Hidenori Shiraha, Ken Haruma, Hirofumi Kawamoto","doi":"10.1002/deo2.70138","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>Precut sphincterotomy is often performed when bile duct cannulation is difficult; however, the former has a higher risk of complications than conventional methods. Early precut reduces the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). This study aimed to determine the appropriate timing for precut sphincterotomy to minimize the incidence of PEP.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective study analyzed 320 patients who underwent precut sphincterotomy during their first endoscopic retrograde cholangiopancreatography at a single center. The optimal precut timing was identified using receiver operating characteristic analysis. Patients were divided into an optimized precut group (≤12 min, <i>n</i> = 198) and a delayed group (>12 min, <i>n</i> = 122). The incidence and risk factors of PEP were evaluated using multivariate analyses.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Receiver operating characteristic analysis identified 12.5 min as the optimal cutoff for transitioning to precut sphincterotomy (area under the curve, 0.613; sensitivity, 61.5%; specificity, 63.9%). The incidence of PEP was significantly lower in the optimized precut group than in the delayed precut group (5.1% vs. 13.1%, <i>p</i> = 0.02). Multivariate analysis identified delayed precut timing (odds ratio [OR], 3.134; <i>p</i> = 0.04) and the absence of endoscopic pancreatic stenting (OR, 0.284; <i>p</i> = 0.01) as independent risk factors for PEP.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Precut sphincterotomy within 12.5 min of a cannulation attempt reduces the risk of PEP while maintaining procedural safety. Additionally, endoscopic pancreatic stenting can reduce PEP, even in precut scenarios.</p>\n </section>\n </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70138","citationCount":"0","resultStr":"{\"title\":\"Optimal timing of precut sphincterotomy to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis in difficult biliary cannulation: A retrospective study\",\"authors\":\"Tomohiro Tanikawa, Keisuke Miyake, Mayuko Kawada, Katsunori Ishii, Takashi Fushimi, Noriyo Urata, Nozomu Wada, Ken Nishino, Mitsuhiko Suehiro, Miwa Kawanaka, Hidenori Shiraha, Ken Haruma, Hirofumi Kawamoto\",\"doi\":\"10.1002/deo2.70138\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>Precut sphincterotomy is often performed when bile duct cannulation is difficult; however, the former has a higher risk of complications than conventional methods. Early precut reduces the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). This study aimed to determine the appropriate timing for precut sphincterotomy to minimize the incidence of PEP.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This retrospective study analyzed 320 patients who underwent precut sphincterotomy during their first endoscopic retrograde cholangiopancreatography at a single center. The optimal precut timing was identified using receiver operating characteristic analysis. Patients were divided into an optimized precut group (≤12 min, <i>n</i> = 198) and a delayed group (>12 min, <i>n</i> = 122). The incidence and risk factors of PEP were evaluated using multivariate analyses.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Receiver operating characteristic analysis identified 12.5 min as the optimal cutoff for transitioning to precut sphincterotomy (area under the curve, 0.613; sensitivity, 61.5%; specificity, 63.9%). The incidence of PEP was significantly lower in the optimized precut group than in the delayed precut group (5.1% vs. 13.1%, <i>p</i> = 0.02). Multivariate analysis identified delayed precut timing (odds ratio [OR], 3.134; <i>p</i> = 0.04) and the absence of endoscopic pancreatic stenting (OR, 0.284; <i>p</i> = 0.01) as independent risk factors for PEP.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Precut sphincterotomy within 12.5 min of a cannulation attempt reduces the risk of PEP while maintaining procedural safety. 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引用次数: 0
摘要
目的胆管插管困难时,常采用预切括约肌切开术;然而,前者比传统方法有更高的并发症风险。早期预切可降低内镜后逆行胆管胰腺炎(PEP)的风险。本研究旨在确定预切括约肌切开术的合适时机,以尽量减少PEP的发生率。方法回顾性分析320例在单中心进行第一次内窥镜逆行胆管造影时行预切括约肌切开术的患者。通过对接收机工作特性的分析,确定了最优预切时序。患者分为优化预切组(≤12 min, n = 198)和延迟组(>12 min, n = 122)。采用多因素分析评价PEP的发生率和危险因素。结果经受试者工作特征分析,12.5 min为预切括约肌切开术的最佳过渡时间(曲线下面积,0.613;敏感性,61.5%;特异性,63.9%)。优化预切组PEP发生率显著低于延迟预切组(5.1%比13.1%,p = 0.02)。多因素分析发现预切时间延迟(优势比[OR], 3.134;p = 0.04)和未行胰内窥镜支架植入术(OR, 0.284;p = 0.01)为PEP的独立危险因素。结论在插管12.5 min内进行预切括约肌切开术可降低PEP的风险,同时保证手术安全。此外,内窥镜胰腺支架植入术可以降低PEP,即使在预切情况下也是如此。
Optimal timing of precut sphincterotomy to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis in difficult biliary cannulation: A retrospective study
Objectives
Precut sphincterotomy is often performed when bile duct cannulation is difficult; however, the former has a higher risk of complications than conventional methods. Early precut reduces the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). This study aimed to determine the appropriate timing for precut sphincterotomy to minimize the incidence of PEP.
Methods
This retrospective study analyzed 320 patients who underwent precut sphincterotomy during their first endoscopic retrograde cholangiopancreatography at a single center. The optimal precut timing was identified using receiver operating characteristic analysis. Patients were divided into an optimized precut group (≤12 min, n = 198) and a delayed group (>12 min, n = 122). The incidence and risk factors of PEP were evaluated using multivariate analyses.
Results
Receiver operating characteristic analysis identified 12.5 min as the optimal cutoff for transitioning to precut sphincterotomy (area under the curve, 0.613; sensitivity, 61.5%; specificity, 63.9%). The incidence of PEP was significantly lower in the optimized precut group than in the delayed precut group (5.1% vs. 13.1%, p = 0.02). Multivariate analysis identified delayed precut timing (odds ratio [OR], 3.134; p = 0.04) and the absence of endoscopic pancreatic stenting (OR, 0.284; p = 0.01) as independent risk factors for PEP.
Conclusion
Precut sphincterotomy within 12.5 min of a cannulation attempt reduces the risk of PEP while maintaining procedural safety. Additionally, endoscopic pancreatic stenting can reduce PEP, even in precut scenarios.