Needle-Knife Fistulotomy Versus Needle-Knife Papillotomy in Difficult Biliary Cannulation: A Systematic Review and Meta-Analysis.

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Research Pub Date : 2024-06-01 Epub Date: 2024-06-29 DOI:10.14740/gr1726
Saqr Alsakarneh, Tim Brotherton, Fouad Jaber, Mahmoud Y Madi, Laith Numan, Mohamed Ahmed, Yazan Sallam, Mohammad Adam, Dushyant Singh Dahiya, Pearl Aggarwal, Fazel Dinary
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引用次数: 0

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential endoscopic therapeutic modality for biliary and pancreatic diseases. Needle-knife fistulotomy (NKF) and papillotomy (NKP) are the two most commonly used rescue techniques for patients with difficult biliary cannulation. However, there remains a need for comparative studies on these approaches to inform clinical decision-making. This meta-analysis aimed to evaluate the efficacy and safety of NKF compared to NKP as a rescue technique in difficult biliary cannulation after failed conventional ERCP.

Methods: We searched PubMed, Scopus, Embase, and Web of Science databases through November 2023 to include all studies that directly compared the outcomes of NKF with NKP in difficult biliary cannulation. Single-arm studies were excluded. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous data related to clinical events were calculated using the Mantel-Haenszel method within a random-effect model. The primary outcome was the biliary cannulation success rate.

Results: Four studies with 823 patients (n = 376 NKF vs. n = 447 NKP) were included in our analysis. There was no significant difference between the two groups in biliary cannulation success rate (91.7% vs. 86.9%, respectively; OR = 1.54, 95% CI: 0.21 - 2.49, P = 0.14; I2 = 0%). However, the overall rate of adverse events was significantly lower in the NKF group than in the NKP group (OR = 0.46, 95% CI: 0.25 - 0.84, P = 0.01). Pancreatitis (OR = 0.23, 95% CI: 0.05 - 1.11, P = 0.07) and bleeding (OR = 1.43, 95% CI: 0.59 - 3.46, P = 0.42) were similar between the two groups. No significant differences in cholangitis, cholecystitis, perforation, or mortality were observed.

Conclusions: Our meta-analysis indicates comparable success rates in comparing NKF and NKP techniques for difficult biliary cannulation after failed conventional ERCP cannulation. Notably, the NKF technique significantly reduces overall adverse events compared to NKP, suggesting that NKF may be preferable due to its favorable safety profile. Additional randomized controlled trials (RCTs) are warranted to evaluate the interval benefit of an NKF technique.

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针刀瘘管切开术与针刀乳头切开术在困难胆道插管中的应用:系统综述与元分析》。
背景:内镜逆行胰胆管造影术(ERCP)是胆道和胰腺疾病的重要内镜治疗方式。针刀瘘管切开术(NKF)和乳头切开术(NKP)是胆道插管困难患者最常用的两种抢救技术。然而,仍然需要对这些方法进行比较研究,以便为临床决策提供依据。本荟萃分析旨在评估 NKF 与 NKP 作为常规 ERCP 失败后困难胆道插管抢救技术的有效性和安全性:我们检索了截至 2023 年 11 月的 PubMed、Scopus、Embase 和 Web of Science 数据库,以纳入所有直接比较 NKF 与 NKP 在困难胆道插管中的疗效的研究。排除了单臂研究。采用随机效应模型中的 Mantel-Haenszel 法计算了与临床事件相关的二分法数据的汇总几率比 (OR) 和 95% 置信区间 (CI)。主要结果为胆道插管成功率:四项研究共纳入了 823 名患者(n = 376 NKF vs. n = 447 NKP)。两组胆道插管成功率无明显差异(分别为 91.7% 对 86.9%;OR = 1.54,95% CI:0.21 - 2.49,P = 0.14;I2 = 0%)。然而,NKF 组的不良事件总发生率明显低于 NKP 组(OR = 0.46,95% CI:0.25 - 0.84,P = 0.01)。胰腺炎(OR = 0.23,95% CI:0.05 - 1.11,P = 0.07)和出血(OR = 1.43,95% CI:0.59 - 3.46,P = 0.42)在两组之间相似。在胆管炎、胆囊炎、穿孔或死亡率方面没有观察到明显差异:我们的荟萃分析表明,比较 NKF 和 NKP 技术在常规 ERCP 插管失败后进行困难胆道插管的成功率不相上下。值得注意的是,与 NKP 相比,NKF 技术大大降低了总体不良事件,这表明 NKF 因其良好的安全性而更受欢迎。有必要进行更多的随机对照试验 (RCT),以评估 NKF 技术的间隔效益。
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Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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