Impact of a Novel Oblique-Tip Papillotome for Biliary Cannulation during ERCP: A Nonrandomized Coarsened Exact Matching Study.

Autor: Imazu H; Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.; Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan., Ho SH; Division of Gastroenterology, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia., Hino S; Department of Neuropsychiatry, Ishikawa Prefecture Takamatsu Hospital, Kahoku, Japan., Goh KL; Division of Gastroenterology, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia., Moriyama M; Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan., Sumiyama K; Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan., Tajiri H; Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo, Japan.
Jazyk: angličtina
Zdroj: Gastroenterology research and practice [Gastroenterol Res Pract] 2020 May 07; Vol. 2020, pp. 2417841. Date of Electronic Publication: 2020 May 07 (Print Publication: 2020).
DOI: 10.1155/2020/2417841
Abstrakt: Background: We developed a novel oblique-tip papillotome (OT-papillotome) to facilitate biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate the utility of the OT-papillotome for contrast-guided cannulation (CGC) and wire-guided cannulation (WGC) during ERCP, compared with standard cannulation by WGC using a standard-tip papillotome (ST-papillotome).
Methods: A prospective study was performed at two centers. CGC with the OT-papillotome (OT-CGC group) was performed at Jikei University Hospital, while WGC was done with the OT-papillotome and ST-papillotome (OT-WGC and ST-WGC groups, respectively) at the University of Malaya Medical Centre. The results of the OT-CGC and OT-WGC groups were compared with those of the ST-WGC group after performing coarsened exact matching (CEM) to reduce bias due to nonrandomized and center-based patient allocation.
Results: Eighty patients were enrolled in each of the OT-CGC, OT-WGC, and ST-WGC groups. After CEM, the successful biliary cannulation rate was significantly higher in the OT-CGC and OT-WGC groups than in the ST-WGC group, while rescue cannulation was reduced. The mean number of unintended pancreatic access events in the OT-WGC and OT-CGC groups was similar to the ST-WGC group. However, it was significantly lower in the OT-WGC group than in the OT-CGC group. Multivariate analysis revealed that the OT-papillotome was independently associated with less frequent rescue cannulation and a higher successful biliary cannulation rate.
Conclusions: Although use of the OT-papillotome in biliary cannulation did not reduce unintended pancreatic access events or PEP compared to the ST-papillotome, the OT-papillotome increased the successful biliary cannulation rate, while reducing the frequency of rescue cannulation procedures. Combining the OT-papillotome with WGC might be the best cannulation technique for minimizing unintended pancreatic access.
Competing Interests: The authors have no conflicts of interest and no financial or personal relationships that could influence or be perceived to influence the work presented in this article.
(Copyright © 2020 Hiroo Imazu et al.)
Databáze: MEDLINE
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