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Papillary fistulotomy vs conventional cannulation for endoscopic biliary access:A prospective randomized trial

World Journal of Gastroenterology 2018年第16期24卷 1803-1811页

作者： Carlos Kiyoshi Furuya Paulo Sakai Fabio Ramalho Tavares Marinho Jose Pinhata Otoch Spencer Cheng lívia lemes prudencio Eduardo Guimaraes Hourneaux de Moura Everson luiz de Almeida Artifon Department of Gastrointestinal Endoscopy Unit University of Sao PauloSao Paulo 05409001Brazil Department of Surgery University of Sao PauloSao Paulo 05403000Brazil Department of Gastroenterology and Radiology University of Sao PauloSao Paulo 04107-030Brazil

AIM To compare the cannulation success, biochemical profile, and complications of the papillary fistulotomy technique vs catheter and guidewire standard *** From July 2010 to May 2017, patients were prospectively randomized into two groups: Cannulation with a catheter and guidewire(Group Ⅰ) and papillary fistulotomy(Group Ⅱ). Amylase, lipase and C-reactive protein at T0, as well as 12 h and 24 h after endoscopic retrograde cholangiopancreatography, and complications(pancreatitis, bleeding, perforation) were *** We included 102 patients(66 females and 36 males, mean age 59.11 ± 18.7 years). Group Ⅰ and Group Ⅱ had 51 patients each. The successful cannulation rates were 76.5% and 100%, respectively(P = 0.0002). Twelve patients(23.5%) in Group Ⅰ had a difficult cannulation and underwent fistulotomy, which led to successful secondary biliary access(Failure Group). The complication rate was 13.7%(2 perforations and 5 mild pancreatitis) vs 2.0%(1 patient with perforation and pancreatitis) in Groups Ⅰ and Ⅱ, respectively(P = 0.0597). CONClUSION Papillary fistulotomy was more effective than guidewire cannulation, and it was associated with a lower profile of amylase and lipase. Complications were similar in both groups.

关键词： Catheterization Complications Endoscopic retrograde cholangiopancreatography Therapeutic use Common bile duct

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