内镜逆行胰胆管造影是治疗胰胆管疾病的重要技术。然而,治疗性ERCP仍与各种并发症有关,如ERCP术后胰腺炎、胆管炎、出血、胆囊炎和穿孔。此外,为了安全、成功地进行ERCP手术,最初选择性的胆管或胰腺插管是必要的,以减少潜在的并发症。选择性胆道插管仍有5%至10%的患者失败,尽管有多种内镜技术可用。为了克服插管困难,在不增加并发症发生率的情况下,设计了各种插管技术和设备。这篇文章就不同操作技术对于术后并发症的发生进行全面概述。
Endoscopic retrograde cholangiopancreatography (ERCP) is an important technique for the treat-ment of pancreaticobiliary diseases. However, therapeutic ERCP is still associated with various complications, such as post-ERCP pancreatitis, cholangitis, hemorrhage, cholecystitis, and perfora-tion. In addition, for a safe and successful ERCP procedure, initial selective bile duct or pancreatic cannulation is necessary to reduce potential complications. Selective biliary cannulation still fails in 5% to 10% of patients despite the availability of multiple endoscopic techniques. To overcome the difficulty of intubation, a variety of intubation techniques and devices have been designed without increasing the incidence of complications. This article provides a comprehensive overview of dif-ferent surgical techniques for the occurrence of postoperative complications.
Endoscopic retrograde cholangiopancreatography (ERCP) is an important technique for the treatment of pancreaticobiliary diseases. However, therapeutic ERCP is still associated with various complications, such as post-ERCP pancreatitis, cholangitis, hemorrhage, cholecystitis, and perforation. In addition, for a safe and successful ERCP procedure, initial selective bile duct or pancreatic cannulation is necessary to reduce potential complications. Selective biliary cannulation still fails in 5% to 10% of patients despite the availability of multiple endoscopic techniques. To overcome the difficulty of intubation, a variety of intubation techniques and devices have been designed without increasing the incidence of complications. This article provides a comprehensive overview of different surgical techniques for the occurrence of postoperative complications.
张永烜,任 利. 预防ERCP术后胰腺炎:不同操作技术的进展Prevention of Post-ERCP Pancreatitis: Pro-gress in Different Procedural Techniques[J]. 临床医学进展, 2022, 12(11): 10124-10129. https://doi.org/10.12677/ACM.2022.12111460
参考文献ReferencesMorales, S.J., Sampath, K. and Gardner, T.B. (2018) A Review of Prevention of Post-ERCP Pancreatitis. Gastroenterology & Hepatology (NY), 14, 286-292.Inamdar, S., Han, D., Passi, M., Sejpal, D.V. and Trindade, A.J. (2017) Rectal Indomethacin Is Protective against Post-ERCP Pancreatitis in High-Risk Patients but Not Aver-age-Risk Patients: A Systematic Review and Meta-Analysis. Gastrointestinal Endoscopy, 85, 67-75. <br>https://doi.org/10.1016/j.gie.2016.08.034Matsushita, M., Koyabu, M., Nishio, A., Seki, T. and Okazaki, K. (2017) Techniques of ERCP with a Conventional Endoscope in Pancreatoduodenectomy Anatomy. Gastrointestinal En-doscopy, 86, 747-748.
<br>https://doi.org/10.1016/j.gie.2017.05.007Li, D.P., Zhang, Q.Y., Cheng, J., Li, J.Z. and Wang, L. (2017) The Effect of Somatostatin Retained Enema in the Treatment of Pancreatic Ileus. European Review for Medical and Pharma-cological Sciences, 21, 3476-3481.Tierney, J., Bhutiani, N., Stamp, B., Richey, J.S., Bahr, M.H. and Vitale, G.C. (2018) Predictive Risk Factors Associated with Cholangitis Following ERCP. Surgical Endoscopy, 32, 799-804.
<br>https://doi.org/10.1007/s00464-017-5746-zRodrigues-Pinto, E., Macedo, G. and Baron, T.H. (2017) ERCP Competence Assessment: Miles to Go before Standardization. Endoscopy International Open, 5, E718-E721. <br>https://doi.org/10.1055/s-0043-107780Guda, N.M. and Freeman, M.L. (2015) Overview of ERCP Complica-tions: Prevention and Management. In: Lee, L.S., Ed., ERCP and EUS: A Case-Based Approach, Springer, New York, 37-56.
<br>https://doi.org/10.1007/978-1-4939-2320-5_3Freeman, M.L., Nelson, D.B., Sherman, S., Haber, G.B., Her-man, M.E., Dorsher, P.J., Moore, J.P., Fennerty, M.B., Ryan, M.E., Shaw, M.J., Lande, J.D. and Pheley, A.M. (1996) Complications of Endoscopic Biliary Sphincterotomy. The New England Journal of Medicine, 335, 909-918. <br>https://doi.org/10.1056/NEJM199609263351301Kahaleh, M. and Freeman, M. (2012) Prevention and Man-agement of Post-Endoscopic Retrograde Cholangiopancreatography Complications. Clinical Endoscopy, 45, 305-312. <br>https://doi.org/10.5946/ce.2012.45.3.305Zimmon, D.S., Falkenstein, D.B., Riccobono, C. and Aaron, B. (1975) Complications of Endoscopic Retrograde Cholangiopancreatography. Analysis of 300 Consecutive Cases. Gas-troenterology, 69, 303-309.
<br>https://doi.org/10.1016/S0016-5085(19)32569-7Bilbao, M.K., Dotter, C.T., Lee, T.G. and Katon, R.M. (1976) Complications of Endoscopic Retrograde Cholangiopancreatography (ERCP). A Study of 10,000 Cases. Gastroenterol-ogy, 70, 314-320.
<br>https://doi.org/10.1016/S0016-5085(76)80139-4Mine, T., Morizane, T., Kawaguchi, Y., Akashi, R., Hanada, K., et al. (2017) Clinical Practice Guideline for Post-ERCP Pancreatitis. Journal of Gastroenterology, 52, 1013-1022. <br>https://doi.org/10.1007/s00535-017-1359-5Wang, A.Y. (2017) Medications and Methods for the Prevention of Post-ERCP Pancreatitis. Gastroenterology & Hepatology (NY), 13, 188-191.Testoni, P.A., Mariani, A., Aabakken, L., et al. (2016) Papillary Cannulation and Sphincterotomy Techniques at ERCP: European Society of Gas-trointestinal Endoscopy (ESGE). Clinical Guideline. Endoscopy, 48, 657-683.
<br>https://doi.org/10.1055/s-0042-108641Andriulli, A., Loperfido, S., Napolitano, G., et al. (2007) Incidence Rates of Post-ERCP Complications: A Systematic Survey of Prospective Studies. American Journal of Gastroenterology, 102, 1781-1788.
<br>https://doi.org/10.1111/j.1572-0241.2007.01279.xKapral, C., Mühlberger, A., Wewalka, F., et al. (2012) Quality Assessment of Endoscopic Retrograde Cholangiopancreatography: Results of a Running Nationwide Austrian Benchmarking Project after 5 Years of Implementation. European Journal of Gastroenterology and Hepatology, 24, 1447-1454. <br>https://doi.org/10.1097/MEG.0b013e3283583c6fKochar, B., Akshintala, V.S., Afghani, E., et al. (2015) Incidence, Severity, and Mortality of Post-ERCP Pancreatitis: A Systematic Review by Using Randomized, Con-trolled Trials. Gastrointestinal Endoscopy, 81, 143-149.e9.
<br>https://doi.org/10.1016/j.gie.2014.06.045Silviera, M.L., Seamon, M.J., Porshinsky, B., et al. (2009) Compli-cations Related to Endoscopic Retrograde Cholangiopancreatography: A Comprehensive Clinical Review. Journal of Gastrointestinal and Liver Diseases, 18, 73-82.Wang, P., Li, Z.S., Liu, F., et al. (2009) Risk Factors for ERCP-Related Complications: A Prospective Multicenter Study. American Journal of Gastroenterology, 104, 31-40. <br>https://doi.org/10.1038/ajg.2008.5Omar, M., Ahmed, A., Said, O. and El-Amin, H. (2015) Risk Factors for Post-ERCP Pancreatitis: A Prospectivemulticenter Study in Upper Egypt. The Egyptian Journal of Surgery, 34, 1-10. <br>https://doi.org/10.4103/1110-1121.153364DiMagno, M.J., Spaete, J.P., Ballard, D.D., Wamsteker, E.J. and Saini, S.D. (2013) Risk Models for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis (PEP): Smoking and Chronic Liver Disease Are Predictors of Protection against PEP. Pancreas, 42, 996-1003. <br>https://doi.org/10.1097/MPA.0b013e31827e95e9Testoni, P.A., Mariani, A., Giussani, A., et al. (2010) Risk Factors for Post-ERCP Pancreatitis in High- and Low-Volume Centers and among Expert and Non-Expert Operators: A Prospective Multicenter Study. American Journal of Gastroenterology, 105, 1753-1761. <br>https://doi.org/10.1038/ajg.2010.136Srinivasan, I., Freeman, M.L., Baron, T.H., Kozarek, R.A. and Carr-Locke, D.L. (2019) Adverse Events of ERCP: Prediction, Prevention, and Management. In: Baron, T.H., Kozarek, R.A. and Carr-Locke, D.L., Eds., ERCP, Elsevier, Amsterdam, 59-67.Cotton, P.B., Yaghoobi, M., Cotton, P.B. and Leung, J. (2015) Adverse Events: Definitions, Avoidance, and Management. In: Cotton, P.B. and Leung, J., Eds., ERCP: The Fundamentals, John Wiley Sons, Oxford, 371-396.
<br>https://doi.org/10.1002/9781118769409.ch24Elmunzer, B.J. (2017) Reducing the Risk of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. Digestive Endoscopy, 29, 749-757. <br>https://doi.org/10.1111/den.12908Cheng, C.L., Sherman, S., Watkins, J.L., et al. (2006) Risk Factors for Post-ERCP Pancreatitis: A Prospective Multicenter Study. American Journal of Gastroenterology, 101, 139-147. <br>https://doi.org/10.1111/j.1572-0241.2006.00380.xCotton, P.B., Garrow, D.A., Gallagher, J. and Romagnuolo, J. (2009) Risk Factors for Complications after ERCP: A Multivariate Analysis of 11,497 Procedures over 12 Years. Gastrointestinal Endoscopy, 70, 80-88.
<br>https://doi.org/10.1016/j.gie.2008.10.039Christoforidis, E., Goulimaris, I., Kanellos, I., Tsalis, K., Demetri-ades, C. and Betsis, D. (2002) Post-ERCP Pancreatitis and Hyperamylasemia: Patient-Related and Operative Risk Factors. Endoscopy, 34, 286-292.
<br>https://doi.org/10.1055/s-2002-23630Freeman, M.L., DiSario, J.A., Nelson, D.B., Fennerty, M.B., et al. (2001) Risk Factors for Post-ERCP Pancreatitis: A Prospective, Multicenter Study. Gastrointestinal Endoscopy, 54, 425-434. <br>https://doi.org/10.1067/mge.2001.117550Lee, T.H., Jung, Y.K. and Park, S.H. (2014) Preparation of High-Risk Patients and the Choice of Guidewire for a Successful Endoscopic Retrograde Cholangiopancreatography Procedure. Clinical Endoscopy, 47, 334-340.
<br>https://doi.org/10.5946/ce.2014.47.4.334Lee, T.H. and Park, D.H. (2014) Endoscopic Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. World Journal of Gastroenterology, 20, 16582-16595. <br>https://doi.org/10.3748/wjg.v20.i44.16582Tse, F., Yuan, Y., Moayyedi, P. and Leontiadis, G.I. (2012) Guidewire-Assisted Cannulation of the Common Bile Duct for the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis. Cochrane Database of Systematic Reviews, 12, CD009662. <br>https://doi.org/10.1002/14651858.CD009662Mariani, A., Giussani, A., Di Leo, M., Testoni, S. and Testoni, P.A. (2012) Guidewire Biliary Cannulation Does Not Reduce Post-ERCP Pancreatitis Compared with the Contrast Injec-tion Technique in Low-Risk and High-Risk Patients. Gastrointestinal Endoscopy, 75, 339-346. <br>https://doi.org/10.1016/j.gie.2011.09.002Kobayashi, G., Fujita, N., Imaizumi, K., et al. (2013) Wire-Guided Biliary Cannulation Technique Does Not Reduce the Risk of Post-ERCP Pancreatitis: Multicenter Randomized Con-trolled Trial. Digestive Endoscopy, 25, 295-302.
<br>https://doi.org/10.1111/j.1443-1661.2012.01372.xLee, T.H., Park, D.H., Park, J.Y., et al. (2009) Can Wire-Guided Cannulation Prevent Post-ERCP Pancreatitis? A Prospective Randomized Trial. Gastrointestinal Endosco-py, 69, 444-449. <br>https://doi.org/10.1016/j.gie.2008.04.064Bassan, M.S., Sundaralingam, P., Fanning, S.B., et al. (2018) The Impact of Wire Caliber on ERCP Outcomes: A Multicenter Randomized Controlled Trial of 0.025-Inch and 0.035-Inch Guidewires. Gastrointestinal Endoscopy, 87, 1454-1460. <br>https://doi.org/10.1016/j.gie.2017.11.037Wang, X., Luo, H., Luo, B., et al. (2021) Combination Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Patients Undergoing Double-Guidewire Assisted Biliary Cannulation: A Case-Control Study with Propensity Score Matching. Journal of Gastroenterology and Hepatol-ogy, 36, 1905-1912.
<br>https://doi.org/10.1111/jgh.15402Guzmán-Calderón, E., Martinez-Moreno, B., Casellas, J.A. and Aparicio, J.R. (2021) Transpancreatic Precut Papillotomy versus Double-Guidewire Technique in Difficult Biliary Cannulation: A Systematic Review and Meta-Analysis. Endoscopy International Open, 9, E1758-E1767. <br>https://doi.org/10.1055/a-1534-2388Swan, M.P., Alexander, S., Moss, A., et al. (2013) Needle Knife Sphincterotomy Does Not Increase the Risk of Pancreatitis in Patients with Difficult Biliary Cannulation. Clinical Gas-troenterology and Hepatology, 11, 430-436.e1.
<br>https://doi.org/10.1016/j.cgh.2012.12.017Sofuni, A., Maguchi, H., Mukai, T., et al. (2011) Endoscopic Pan-creatic Duct Stents Reduce the Incidence of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in High-Risk Patients. Clinical Gastroenterology and Hepatology, 9, 851-858. <br>https://doi.org/10.1016/j.cgh.2011.06.033Fujisawa, T., Kagawa, K., Ochiai, K., et al. (2016) Prophylactic Ef-ficacy of 3- or 5-cm Pancreatic Stents for Preventing Post-ERCP Pancreatitis: A Prospective, Randomized Trial. Journal of Clinical Gastroenterology, 50, e30-e34.
<br>https://doi.org/10.1097/MCG.0000000000000397Enns, R., Eloubeidi, M.A., Mergener, K., et al. (2002) ERCP-Related Perforations: Risk Factors and Management. Endoscopy, 34, 293-298. <br>https://doi.org/10.1055/s-2002-23650Martin, D.F. and Tweedle, D.E. (1990) Retroperitoneal Perforation during ERCP and Endoscopic Sphincterotomy: Causes, Clinical Features and Management. Endoscopy, 22, 174-175. <br>https://doi.org/10.1055/s-2007-1012833