壶腹周围憩室对ERCP操作的影响:一项病例对照研究(译)

时间:2018-09-06 作者:翻译:张卫 审校:张 点击:821次

壶腹周围憩室对ERCP操作的影响:一项病例对照研究(译)

背景/目的:壶腹周围憩室在ERCP术中是经常被发现的,被认为与胆总管结石形成有关系。壶腹周围憩室对ERCP操作的影响是备受质疑的。我们的目的是比较壶腹周围憩室的患者与对照组之间成功行治疗性ERCP的差异。
方法:我们在国家数据库收集了所有行ERCP并术中发现壶腹周围憩室的患者(n=1089)并且与对照组(n=3267)之间以1:3的比例比较了他们之间的年龄和性别。同时比较两组之间的人口特点、内镜下所见、主要结构的显影和治疗性ERCP的成功率。并对患有胆结石的PAD患者与对照组进行二次分析。
结果:队列平均年龄为68.4±14.3岁,55.1%为女性。两组之间ERCP的成功率相仿。多因素分析组内之间的数据并无统计学意义。壶腹周围憩室的存在并没有影响到Oddis括约肌切开和主要胆管结构的显影的成功率。二次分析显示,对患有胆结石的PAD患者与对照组之间比较,取石的成功率也是相似的。
结论:壶腹周围憩室也许不能被认为是成功实施ERCP的一个阻碍因素。期待更深入的研究找到最合适的插管方法和内镜下治疗对不同类型PAD的患者。

Impact of Periampullary Diverticulum on ERCP Performance:A Matched Case-Control Study
Impact of Periampullary Diverticulum on ERCP Performance:A Matched Case-Control Study

Juan E. Corral, Omar Y. Mousa, Paul T. Kröner, Victoria Gomez and Frank J. Lukens Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

Background/Aims: Periampullary diverticulum (PAD) is frequently encountered during endoscopic retrogradecholangiopancreatography (ERCP) and has been associated with stone formation in the bile duct. The effects of PAD on the ERCP procedure have been often debated. We aimed to compare the therapeutic success of ERCP between patients with PAD and matched controls.
Methods: We reviewed all ERCPs with findings of PAD in a national database (n=1,089) and compared them with age and gender matched controls in a 1:3 fashion (n=3,267). Demographics, endoscopic findings, visualization of main structures, and therapeutic success rates were compared between groups. Secondary analysis compared PAD cases and controls who had gallstone disease.
Results: The average cohort age was 68.4±14.3 years and 55.1% were male. ERCP success was similar in both groups, and no significant inter-group differences were found in the multivariate analysis. The presence of PAD did not affect the rates of sphincterotomy or visualization of main biliary structures. Secondary analysis showed similar success rates for gallstone removal between patients with PAD and controls.
Conclusions: PAD may not be considered a hinderance to ERCP success. Further research is needed to determine the best approach to cannulate the ampulla and provide endoscopic therapy for different subtypes of PAD.

翻译:张卫  审校:张立超 侯森林