预切乳头切开术与内镜超声穿刺术治疗困难胆道插管:系统综述与元分析》。

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Research Pub Date : 2024-08-01 Epub Date: 2024-07-18 DOI:10.14740/gr1738
Amna Iqbal, Zohaib Ahmad, Muhammad Aziz, Abdulmajeed Alharbi, Hassam Ali, Ahmed Al-Chalabi, Manesh Kumar Gangwani, Dushyant Singh Dahiya, Wade Lee Smith, Shailendra Singh, Yaseen Alastal, Abdallah Kobeissy
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引用次数: 0

摘要

背景:在胆道入路困难的情况下,可采用各种内窥镜技术实现胆道插管。每种手术都有出血、感染、胰腺炎和胆管炎等风险。我们的荟萃分析旨在从技术成功率、术后胰腺炎和出血方面比较预切乳头切开术和内镜超声(EUS)-肾切除术:我们对比较预切乳头切开术和 EUS-环切术的研究进行了系统回顾和荟萃分析。主要结果是实现胆道插管的技术成功率。次要结果是术后胰腺炎和出血。采用随机效应模型计算风险比 (RR) 和置信区间 (CI)。P值小于0.05被认为具有统计学意义:我们的荟萃分析包括四项比较预切乳头切开术和 EUS-rendezvous 的研究。这些研究共纳入了13659例内镜逆行胰胆管造影(ERCP)手术,其中1004例患者因胆道插管困难而接受了备用胆道插管手术。研究对象的平均年龄为 49.5 岁,男性占总人数的 53.3%。两种手术的技术成功率相似(RR:0.95,95% CI (0.88,1.02))。术后胰腺炎(RR:1.82,95% CI(0.80,4.15))和术后出血(RR:2.80,95% CI(0.67,11.66))的发生率没有差异:结论:预切乳头切开术与 EUS-rendezvous技术在手术成功率或术后并发症(如胰腺炎和出血)方面没有差异。需要更多的随机对照试验(RCT)来比较两种手术技术和并发症发生率。不过,目前在经验丰富的内镜医师手中,这两种手术在困难胆道插管时同样有效和安全。
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Pre-Cut Papillotomy Versus Endoscopic Ultrasound-Rendezvous for Difficult Biliary Cannulation: A Systematic Review and Meta-Analysis.

Background: Various endoscopic techniques are employed to achieve biliary cannulation when confronted with difficult biliary access. Every procedure carries its own risk in terms of bleeding, infection, pancreatitis, and cholangitis. Our meta-analysis aimed to compare pre-cut papillotomy and endoscopic ultrasound (EUS)-rendezvous in terms of technical success rates, and post-procedure pancreatitis and bleeding.

Methods: We conducted a systematic review and meta-analysis of studies that compared pre-cut papillotomy and EUS-rendezvous. The primary outcome was technical success by achieving biliary cannulation. Secondary outcomes were postoperative pancreatitis and bleeding. A random-effects model was used to calculate the risk ratios (RRs) and confidence intervals (CIs). A P value < 0.05 was considered statistically significant.

Results: Our meta-analysis included four studies comparing pre-cut papillotomy and EUS-rendezvous. The studies included 13,659 total endoscopic retrograde cholangiopancreatography (ERCP) procedures, of whom 1,004 patients underwent alternate biliary cannulation procedures due to difficult biliary cannulation. The mean age of the study population was noted to be 49.5 years and males represented 53.3% of the total participants. Both procedures were similar in terms of technical success (RR: 0.95, 95% CI (0.88, 1.02)). No difference was found between rates of post procedure pancreatitis (RR: 1.82, 95% CI (0.80, 4.15)) and post procedure bleeding (RR: 2.80, 95% CI (0.67, 11.66)).

Conclusions: There was no difference in technical success of procedure or post-procedure complications such as pancreatitis and bleeding between pre-cut papillotomy and EUS-rendezvous technique. More randomized controlled trials (RCTs) are needed to compare both procedural techniques and complications rates. However, currently, both procedures are equally effective and safe during difficult biliary cannulation in the hands of experienced endoscopists.

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Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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