Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs

被引：143

作者：

Halttunen, Jorma ^{[1
]}

Meisner, Soren ^{[2
]}

Aabakken, Lars ^{[3
]}

Arnelo, Urban ^{[4
]}

Gronroos, Juha ^{[5
]}

Hauge, Truls ^{[6
]}

Kleveland, Per M. ^{[7
]}

Schmidt, Palle Nordblad ^{[8
]}

Saarela, Arto ^{[9
]}

Swahn, Fredrik ^{[4
]}

Toth, Ervin ^{[10
]}

Mustonen, Harri ^{[1
]}

Lohr, J. -Matthias ^{[4
]}

机构：

[1] Univ Helsinki, Cent Hosp, Dept Gastrointestinal & Gen Surg, Helsinki 00029, Hus, Finland

[2] Bispebjerg Hosp, DK-2400 Copenhagen, Denmark

[3] OUS Rikshosp, Oslo, Norway

[4] Karolinska Univ Sjukhuset, Gastroctr Kirurgi, Stockholm, Sweden

[5] Turku Univ Hosp, Div Digest Surg & Urol, FIN-20520 Turku, Finland

[6] Oslo Univ Hosp, Dept Gastroenterol, Oslo, Norway

[7] Reg Sykehuset, Med Avdelning, Trondheim, Norway

[8] Univ Copenhagen, Hvidovre Hosp, Dept Gastroenterol, DK-2650 Hvidovre, Denmark

[9] Oulu Univ Hosp, Dept Gastrointestinal Surg, Oulu, Finland

[10] Skane Univ Hosp, Endoscopy Unit, Malmo, Sweden

来源：

SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY | 2014年 / 49卷 / 06期

关键词：

cannulation; ERCP; needle knife; sphincterotomy; BILE-DUCT CANNULATION; WIRE-GUIDED CANNULATION; PROSPECTIVE RANDOMIZED-TRIAL; NEEDLE-KNIFE SPHINCTEROTOMY; BILIARY CANNULATION; PRECUT SPHINCTEROTOMY; RETROGRADE CHOLANGIOPANCREATOGRAPHY; SELECTIVE CANNULATION; PANCREATITIS; STANDARD;

D O I：

10.3109/00365521.2014.894120

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background. The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). Aims. To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. Patients and methods. Prospective consecutive recording of 907 cannulations in Scandinavian centers done by experienced endoscopists. Inclusion: indication for biliary access in patients with intact papilla. Exclusion: acute non-biliary and chronic pancreatitis at time of procedure. Results. The primary cannulation succeeded in 74.9%, with median values for time 0.88 min (53 s), with two attempts and with zero pancreatic passages or injections. The overall cannulation success was 97.4% and post-ERCP pancreatitis (PEP) rate was 5.3%. The median time for all successful cannulations was 1.55 min (range 0.02-94.2). If the primary cannulation succeeded, the pancreatitis rate was 2.8%; after secondary methods, it rose to 11.5%. Procedures lasting less than 5 min had a PEP rate of 2.6% versus 11.8% in those lasting longer. With one attempt, the PEP rate was 0.6%, with two 3.1%, with three to four 6.1%, and with five and more 11.9%. With one accidental pancreatic guide-wire passage, the risk of the PEP was 3.7%, and with two passages, it was 13.1%. Conclusions. If the increasing rate of PEP is taken as defining factor, the wire-guided cannulation of a native papilla can be considered difficult after 5 min, five attempts, and two pancreatic guide-wire passages when any of those limits is exceeded.

引用

页码：752 / 758

页数：7

共 32 条

[31] Transpancreatic precut sphincterotomy for cannulation of inaccessible common bile duct - A safe and successful technique [J].