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

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World Journal of Clinical Cases 2021年第17期9卷 4166-4177页

作者： Sung Yong Han Dong Hoon Baek Dong Uk Kim Chang Joon Park Young Joo Park Moon Won Lee Geun Am Song Division of Gastroenterology and Hepatology Internal Medicine and Biomedical Research InstitutePusan National University HospitalBusan 49241South Korea

BACKGROUND Needle-knife fistulotomy(NKF)is used as a rescue technique for difficult ***,the data are limited regarding the use of NKF for primary biliary cannulation,especially when performed by *** 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 *** patients were categorized according to the endoscopist’s expertise level and the technique used for bile duct *** assessed the rates of successful cannulation and adverse *** The baseline characteristics did not differ between the experienced and lessexperienced *** 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 *** 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 *** primary NKF was effective and safe in patients with prominent and bulging ampulla,even when performed by less-experienced *** 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

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