Transpancreatic sphincterotomy combined with pancreatic duct stenting for difficult intubation of ERCP

doi:10.3877/cma.j.issn.2095-3232.2020.04.012

Abstract

Abstract:

Objective

To explore the application of transpancreatic sphincterotomy (TPS) combined with pancreatic stent occupation (PSO) in difficult intubation of endoscopic retrograde cholangiopancreatography (ERCP).

Methods

Clinical data of 224 patients with biliary tract disease who underwent ERCP from March 2015 to May 2019 at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were retrospectively analyzed. Among them, 114 were male and 110 female, with a mean age of (67±9) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients were assigned to TPS+PSO group (n=135) and control group (n=89) according to different intubation. The duration of intubation, intraoperative intubation success rate, incidence of postoperative complication and hospitalization costs of both groups of patients were recorded. Comparisons of length of hospital stay and cost between two groups were performed using t test and comparisons of rates were performed using Chi-square test.

Results

The success rate of biliary intubation in TPS+PSO group was 93% (125/135), which was significantly higher than 73% (65/89) in control group (χ²=15.938, P<0.05), and the duration of intubation was (25±10) min, which was significantly shorter than (37±14) min in control group (t=-3.927, P<0.05). The incidence of postoperative pancreatitis and bleeding in TPS+PSO group was 11% (15/135) and 1% (2/135), respectively, which were significantly lower than 25% (22/89) and 7%(6/89) in control group (χ²=7.203, 4.309; P<0.05). The hospitalization costs in TPS+PSO group and control group were (21±5) and (32±7) thousand Yuan, respectively, no significant difference was observed (t=-1.072, P>0.05).

Conclusions

TPS combined with PSO can improve the success rate in difficult intubation of ERCP and reduced the incidence of postoperative pancreatitis, with the advantages of shortened the operating time without increase of hospital cost, which is a safe, practical, and feasible endoscopic technique.

Key words: Cholangiopancreatography, endoscopic retrograde, Transpancreatic sphincterotomy, Pancreatic stent occupation

Fu Li, Xiwen Zhang, Rui Tang, Jinxin Huang, Jianmei Ji, Biao Gong, Jun Ding. Transpancreatic sphincterotomy combined with pancreatic duct stenting for difficult intubation of ERCP[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(04): 347-351.

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References 24

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组别	例数	性别（例）		年龄（岁，±s ）	ASA分级（例）		BMI （kg/m²，±s ）
组别	例数	男	女	年龄（岁，±s ）	Ⅰ、Ⅱ级	Ⅲ级以上	BMI （kg/m²，±s ）
TPS+PSO组	135	73	62	63±12	113	22	26±6
对照组	89	41	48	73±9	71	18	29±5
统计值	?	χ²=1.376		t=-1.632	χ²=0.564		t=-1.254
P值	?	>0.05		>0.05	>0.05		>0.05

组别	例数	性别（例）		年龄（岁，±s ）	ASA分级（例）		BMI （kg/m²，±s ）
组别	例数	男	女	年龄（岁，±s ）	Ⅰ、Ⅱ级	Ⅲ级以上	BMI （kg/m²，±s ）
TPS+PSO组	135	73	62	63±12	113	22	26±6
对照组	89	41	48	73±9	71	18	29±5
统计值	?	χ²=1.376		t=-1.632	χ²=0.564		t=-1.254
P值	?	>0.05		>0.05	>0.05		>0.05

组别	例数	插管时间（min）	CRP（mg/L）	IL-6（ng/L）	进食时间（h）	住院时间（d）	住院费用（万元）
TPS+PSO组	135	25±10	30±5	46±12	34±13	5.1±1.4	2.1±0.5
对照组	89	37±14	38±8	88±33	42±21	7.2±2.6	3.2±0.7
t值	?	-3.927	-1.562	-2.778	-1.039	-2.156	-1.072
P值	?	<0.05	>0.05	<0.05	>0.05	>0.05	>0.05

组别	例数	插管时间（min）	CRP（mg/L）	IL-6（ng/L）	进食时间（h）	住院时间（d）	住院费用（万元）
TPS+PSO组	135	25±10	30±5	46±12	34±13	5.1±1.4	2.1±0.5
对照组	89	37±14	38±8	88±33	42±21	7.2±2.6	3.2±0.7
t值	?	-3.927	-1.562	-2.778	-1.039	-2.156	-1.072
P值	?	<0.05	>0.05	<0.05	>0.05	>0.05	>0.05

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