BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is associated with a variety of adverse events(AEs).One of the most important AEs is post-ERCP pancreatitis(PEP),which is most common in cases of difficul...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is associated with a variety of adverse events(AEs).One of the most important AEs is post-ERCP pancreatitis(PEP),which is most common in cases of difficult biliary cannulation.Although the precut technique has been reported as a PEP risk factor,recent studies indicate that early precut could reduce PEP,and that precut itself is not a risk factor.AIM To evaluate the safety of the precut technique,especially in terms of PEP.METHODS We conducted a retrospective study,spanning the period from November 2011 through December 2021.It included 1556 patients,aged≥20 years,who underwent their initial ERCP attempt for biliary disease with a naïve papilla at the Kawasaki University General Medical Center.We compared the PEP risk between the early precut and the delayed precut group.RESULTS The PEP incidence rate did not significantly differ between the precut and nonprecut groups.However,the PEP incidence was significantly lower in the early precut group than the delayed precut group(3.5%vs 10.5%;P=0.02).The PEP incidence in the delayed precut group without pancreatic stent insertion(17.3%)was significantly higher compared to other cases(P<0.01).CONCLUSION Our findings indicate that early precut may reduce PEP incidence.If the precut decision is delayed,a pancreatic stent should be inserted to prevent PEP.展开更多
AIM:To compare the outcomes between doubleguidewire technique(DGT) and transpancreatic precut sphincterotomy(TPS) in patients with difficult biliary cannulation.METHODS:This was a prospective,randomized study conducte...AIM:To compare the outcomes between doubleguidewire technique(DGT) and transpancreatic precut sphincterotomy(TPS) in patients with difficult biliary cannulation.METHODS:This was a prospective,randomized study conducted in single tertiary referral hospital in Korea.Between January 2005 and September 2010.A total of 71 patients,who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved,were randomized into DGT(n = 34) and TPS(n = 37) groups.DGT or TPS was done for selective biliary cannulation.We measured the technical success rates of biliary cannulation,median cannulation time,and procedure related complications.RESULTS:The distribution of patients after randomization was balanced,and both groups were comparable in baseline characteristics,except the higher percentage of endoscopic nasobiliary drainage in the DGT group(55.9% vs 13.5%,P < 0.001).Successful cannulation rate and mean cannulation times in DGT and TPS groups were 91.2% vs 91.9% and 14.1 ± 13.2 min vs 15.4 ± 17.9 min,P = 0.732,respectively.There was no significant difference between the two groups.The overall incidence of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis was 38.2% vs 10.8%,P < 0.011 in the DGT group and the TPS group;post-procedure pancreatitis was significantly higher in the DGT group.But the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups;DGT group vs TPS group:14.7% vs 16.2%,P < 1.0.CONCLUSION:When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved,DGT and TPS facilitated biliary cannulation and showed similar success rates.However,post-procedure pancreatitis was significantly higher in the DGT group.展开更多
Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access...Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access) sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% success- ful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when adminis- tered to the proper patient. Although precut sphincter- otomy ensures over 90% success of biliary cannula- tion, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also re- ported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilata- tion of their biliary tract. Nevertheless, precut sphinc- terotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, ef- ficacy and potential complications of precut sphincter- otomy.展开更多
AIM: To conduct a systemic review and meta-analysis to investigate the role of early precut technique. Multiple randomized controlled trails (RCTs) have reported conflicting results of the early precut sphincterotomy.
Static tensile test and tensile-tensile fatigue test of medium carbon steel sheet specimens with surface crack precut were performed on MTS810 hydraulic testing machine to clear the meaning of the point of Hp(y) value...Static tensile test and tensile-tensile fatigue test of medium carbon steel sheet specimens with surface crack precut were performed on MTS810 hydraulic testing machine to clear the meaning of the point of Hp(y) value zero. Magnetic memory signals were measured during the test process. The results show that only one point of Hp(y) zero value exists in all measured magnetic signal curves during the loading process, which should be a sign of intersection of positive-negative magnetic poles after magnetic ordered state appears and does not indicate the position of surface crack precut. The analysis shows that the surface crack precut can not interrupt the magnetic ordered state occurred during the test completely, hence its Hp(y) value is not zero. However, the crack extending to a penetrated defect at the instant of specimen′s fracture leads to the discontinuance of magnetic ordered state.展开更多
AIM： To determine the rates of success and complications of precut biliary sphincterotomy （PBS） based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy （E...AIM： To determine the rates of success and complications of precut biliary sphincterotomy （PBS） based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy （ES）. METHODS： A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center, The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcorne measures of the study were success and complications of PBS with a comparison to complications of ES.RESULTS： A total of 2939 endoscopic retrograde chola ngiopancreatographies （ERCPs） were performed during the study period, including 818 （28%） ES and 150 （5%） PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt （total 87%）. Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% （10/50） vs 5% （38/818）, P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopist＇s first attempt at precut （P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588）. CONCLUSION： Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.展开更多
AIM: To investigate the outcome of repeating endoscopic retrograde cholangiopancreaticography (ERCP) after initially failed precut sphincterotomy to achieve biliary cannulation.
BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR...BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;P<0.001).No significant difference was found in the proportion of patients with adverse events(EMR-P:9.1%;CEMR:6.4%;P=0.449).CONCLUSION In this study,EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasing adverse events.However,EMR-P required a relatively longer procedure time than CEMR.Considering its potential benefits for en bloc and R0 resection,EMR-P may be a promising technique in colorectal polyp resection.展开更多
We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified ...We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified some statistical deficiencies in this study.In addition,we believe that the differences between the treatments failed to achieve significance,and therefore,further analysis is required.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation,which is often challenging and associated with complications.In difficult cannulation cases,early precutting is freque...BACKGROUND Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation,which is often challenging and associated with complications.In difficult cannulation cases,early precutting is frequently used.However,its efficacy and optimal indications require further evaluation.AIM To evaluate the efficacy and safety of early precut(EP)in difficult bile duct cannulation.METHODS This retrospective analysis of endoscopic retrograde cholangiopancreatography procedures was performed for bile duct cannulation in patients with naive papillae who required advanced cannulation techniques(ACTs).These patients were admitted between April 2020 and March 2024 and were analyzed for risk factors,success rates,and complications.Outcomes were compared between the EP group and the conventional other ACTs group,with a focus on cases with oral protrusion large(oral protrusion-L).RESULTS The need for ACTs was identified as an independent risk factor for complications[odds ratio(OR)=5.4;95%confidence interval:1.887-15.53].Malignant biliary strictures(OR=2.58)and oral protrusion-L(OR=2.77)were also identified as independent risk factors for requiring ACTs.The EP group had a significantly higher second-line cannulation success rate(97.9%vs 73.2%,P=0.001)and lower complication rate(8.3%vs 39.0%,P=0.001)than the other ACTs group.Additionally,similar benefits were observed in the oral protrusion-L cases.CONCLUSION This study provides compelling evidence that EP is a viable alternative and a superior strategy in cases requiring ACTs,particularly oral protrusion-L.展开更多
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is associated with a variety of adverse events(AEs).One of the most important AEs is post-ERCP pancreatitis(PEP),which is most common in cases of difficult biliary cannulation.Although the precut technique has been reported as a PEP risk factor,recent studies indicate that early precut could reduce PEP,and that precut itself is not a risk factor.AIM To evaluate the safety of the precut technique,especially in terms of PEP.METHODS We conducted a retrospective study,spanning the period from November 2011 through December 2021.It included 1556 patients,aged≥20 years,who underwent their initial ERCP attempt for biliary disease with a naïve papilla at the Kawasaki University General Medical Center.We compared the PEP risk between the early precut and the delayed precut group.RESULTS The PEP incidence rate did not significantly differ between the precut and nonprecut groups.However,the PEP incidence was significantly lower in the early precut group than the delayed precut group(3.5%vs 10.5%;P=0.02).The PEP incidence in the delayed precut group without pancreatic stent insertion(17.3%)was significantly higher compared to other cases(P<0.01).CONCLUSION Our findings indicate that early precut may reduce PEP incidence.If the precut decision is delayed,a pancreatic stent should be inserted to prevent PEP.
文摘AIM:To compare the outcomes between doubleguidewire technique(DGT) and transpancreatic precut sphincterotomy(TPS) in patients with difficult biliary cannulation.METHODS:This was a prospective,randomized study conducted in single tertiary referral hospital in Korea.Between January 2005 and September 2010.A total of 71 patients,who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved,were randomized into DGT(n = 34) and TPS(n = 37) groups.DGT or TPS was done for selective biliary cannulation.We measured the technical success rates of biliary cannulation,median cannulation time,and procedure related complications.RESULTS:The distribution of patients after randomization was balanced,and both groups were comparable in baseline characteristics,except the higher percentage of endoscopic nasobiliary drainage in the DGT group(55.9% vs 13.5%,P < 0.001).Successful cannulation rate and mean cannulation times in DGT and TPS groups were 91.2% vs 91.9% and 14.1 ± 13.2 min vs 15.4 ± 17.9 min,P = 0.732,respectively.There was no significant difference between the two groups.The overall incidence of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis was 38.2% vs 10.8%,P < 0.011 in the DGT group and the TPS group;post-procedure pancreatitis was significantly higher in the DGT group.But the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups;DGT group vs TPS group:14.7% vs 16.2%,P < 1.0.CONCLUSION:When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved,DGT and TPS facilitated biliary cannulation and showed similar success rates.However,post-procedure pancreatitis was significantly higher in the DGT group.
文摘Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access) sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% success- ful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when adminis- tered to the proper patient. Although precut sphincter- otomy ensures over 90% success of biliary cannula- tion, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also re- ported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilata- tion of their biliary tract. Nevertheless, precut sphinc- terotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, ef- ficacy and potential complications of precut sphincter- otomy.
文摘AIM: To conduct a systemic review and meta-analysis to investigate the role of early precut technique. Multiple randomized controlled trails (RCTs) have reported conflicting results of the early precut sphincterotomy.
基金This work was financially supported by the National Natural Science Foundation of China (No.50235030, 50505052).
文摘Static tensile test and tensile-tensile fatigue test of medium carbon steel sheet specimens with surface crack precut were performed on MTS810 hydraulic testing machine to clear the meaning of the point of Hp(y) value zero. Magnetic memory signals were measured during the test process. The results show that only one point of Hp(y) zero value exists in all measured magnetic signal curves during the loading process, which should be a sign of intersection of positive-negative magnetic poles after magnetic ordered state appears and does not indicate the position of surface crack precut. The analysis shows that the surface crack precut can not interrupt the magnetic ordered state occurred during the test completely, hence its Hp(y) value is not zero. However, the crack extending to a penetrated defect at the instant of specimen′s fracture leads to the discontinuance of magnetic ordered state.
文摘AIM： To determine the rates of success and complications of precut biliary sphincterotomy （PBS） based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy （ES）. METHODS： A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center, The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcorne measures of the study were success and complications of PBS with a comparison to complications of ES.RESULTS： A total of 2939 endoscopic retrograde chola ngiopancreatographies （ERCPs） were performed during the study period, including 818 （28%） ES and 150 （5%） PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt （total 87%）. Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% （10/50） vs 5% （38/818）, P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopist＇s first attempt at precut （P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588）. CONCLUSION： Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.
文摘AIM: To investigate the outcome of repeating endoscopic retrograde cholangiopancreaticography (ERCP) after initially failed precut sphincterotomy to achieve biliary cannulation.
基金the Institutional Review Board of First Affiliated Hospital,School of Medicine,Zhejiang University(No.20191477)Ningbo First Hospital,Zhejiang(No.2020-R013)and other participating institutions.
文摘BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;P<0.001).No significant difference was found in the proportion of patients with adverse events(EMR-P:9.1%;CEMR:6.4%;P=0.449).CONCLUSION In this study,EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasing adverse events.However,EMR-P required a relatively longer procedure time than CEMR.Considering its potential benefits for en bloc and R0 resection,EMR-P may be a promising technique in colorectal polyp resection.
文摘We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified some statistical deficiencies in this study.In addition,we believe that the differences between the treatments failed to achieve significance,and therefore,further analysis is required.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation,which is often challenging and associated with complications.In difficult cannulation cases,early precutting is frequently used.However,its efficacy and optimal indications require further evaluation.AIM To evaluate the efficacy and safety of early precut(EP)in difficult bile duct cannulation.METHODS This retrospective analysis of endoscopic retrograde cholangiopancreatography procedures was performed for bile duct cannulation in patients with naive papillae who required advanced cannulation techniques(ACTs).These patients were admitted between April 2020 and March 2024 and were analyzed for risk factors,success rates,and complications.Outcomes were compared between the EP group and the conventional other ACTs group,with a focus on cases with oral protrusion large(oral protrusion-L).RESULTS The need for ACTs was identified as an independent risk factor for complications[odds ratio(OR)=5.4;95%confidence interval:1.887-15.53].Malignant biliary strictures(OR=2.58)and oral protrusion-L(OR=2.77)were also identified as independent risk factors for requiring ACTs.The EP group had a significantly higher second-line cannulation success rate(97.9%vs 73.2%,P=0.001)and lower complication rate(8.3%vs 39.0%,P=0.001)than the other ACTs group.Additionally,similar benefits were observed in the oral protrusion-L cases.CONCLUSION This study provides compelling evidence that EP is a viable alternative and a superior strategy in cases requiring ACTs,particularly oral protrusion-L.
