在63例患者中，16（27%）例患者属于早期预切开，47（73%）例属于晚期预切开。中位数时间（插管到开始切开时间）为28分钟（7-50）。两组之间的临床特点（年龄，性别，ERCP指征），预切开的方法和胰管支架置入率无统计学意义。有意义的是早期预切开组的（16/17; 94%）插管成功率高于晚期预切开组（32/46; 70%），（P<0.05）。并发现，有13例患者在40分钟后才开始预切开，插管的成功率低至53%（7/13），两组之间的ERCP术后并发症并无明显差异（5例胰腺炎患者，1例出血患者）。
Optimal timing for precutting in cases with difficult biliary cannulation
Yuichi Takano, Masatsugu Nagahama, Fumitaka Niiya, et al. Endoscopy International Open 2018; 06: E1015–E1019
Background and study aims
In endoscopic retrograde cholangiopancreatography (ERCP), precutting is widely used when achieving biliary cannulation is difficult. How-ever, no consensus has been reached with regard to the best time to initiate precutting.
Patients and methods
We retrospectively examined 63 patients who underwent precutting for naïve papilla with difficulty in biliary cannulation between 2009 and 2016. The outcomes of the early precut group (≤20min from cannulation until initiating precutting) and the late precut group (>20min) were compared.
Of the 63 patients, 17 (27%) were in the early precut group and 46 (73%) were in the late precut group; median time until the initiating precutting was 28 minutes (7–50). No significant difference was observed between
the two groups in terms of clinical features (age, sex, and indication for ERCP), precutting method, and rate of pancreatic duct stent placement. Significantly higher rates of successful biliary cannulation were observed in the early precut group (16/17; 94%) than in the late precut group
(32/46; 70%) (P<0.05). In 13 patients in whom precutting was commenced after 40 minutes, the rate of successful biliary cannulation was very low at 53% (7/13). No significant difference was found between the two groups in terms of incidence of complications (pancreatitis in 5 patients and bleeding in 1 patient).
In actual clinical practice, precutting is commenced approximately 30 minutes after cannulation; however, to successfully achieve biliary cannulation, precutting is recommended to be performed within 20 minutes. Precutting is effective when little inflammation and swelling of the ampulla of Vater is observed. This study was limited in that it was single-center, retrospective and had a small subject sample.
翻译：张卫 审校：张立超、侯森林 （Endoscopy International Open 2018）