Difficult biliary cannulation in ERCP procedures with or without trainee involvement: a comparative study
Difficult biliary cannulation in ERCP procedures with or without trainee involvement: a comparative study
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DOI：
10.1055/a-1523-0780
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发表时间：
2021-06
期刊：
影响因子：
9.3
通讯作者：
Xu Wang;Hui Luo;Qin Tao;Gui Ren;Xiangping Wang;Shuhui Liang;Linhui Zhang;Long Chen;Xin Shi;Xuegang Guo;Yanglin Pan
中科院分区：
文献类型：
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作者：
Xu Wang;Hui Luo;Qin Tao;Gui Ren;Xiangping Wang;Shuhui Liang;Linhui Zhang;Long Chen;Xin Shi;Xuegang Guo;Yanglin Pan
摘要背景欧洲胃肠内镜学会提出了5-5-1标准（> 5分钟- 5次插管尝试- 1次意外胰管插管）来定义困难的胆管插管。然而，该标准可能不适用于受训者参与的手术。我们制定了受训者参与的手术中插管困难的标准。方法选择有或无实习医生参与的胆管插管患者。可能太简单的程序（e）。G.或太难（E。G.改变的解剖结构）被排除。主要结局是插管困难，定义为插管时间、尝试次数或意外胰管（PD）插管超过每个变量的75%百分位数。使用倾向评分匹配（PSM）分析。结果两组共1596例患者经PSM治疗后，与无受训者参与的手术相比，受训者参与的手术的中位（四分位距[IQR]）插管时间更长（7.5 [2.2-15.3] vs. 2.0 [0.6-5.2]分钟），尝试次数更多（5 [2-10] vs. 2 [1-4]），意外腹膜透析插管次数更多（0 [0-2] vs. 0 [0-1]）（均P < 0.001）。对于受训者参与的插管，提出了困难插管的15-10-2标准，对于没有受训者参与的插管，几乎证实了5-5-1标准。使用这些相应标准的插管困难比例分别为35.5%（95%置信区间[CI] 33.2%-37.9%）和31.8%（95% CI 29.5%-34.2%）（比值比1.18 [95% CI 1.02-1.37]）。插管困难后ERCP后胰腺炎的发生率相当（分别为7.8%[95% CI 5.7%-10.3%] vs. 9.8%[95% CI 7.4%-12.8%]）。结论以75%的误操作率作为临界值，建议的15-10-2插管困难标准适用于受训者参与的操作。
Abstract Background The 5–5–1 criteria (> 5 minutes – 5 cannulation attempts – 1 unintended pancreas duct cannulation) were proposed by the European Society of Gastrointestinal Endoscopy to define difficult biliary cannulation. However, the criteria may be inappropriate for trainee-involved procedures. We developed criteria for difficult cannulation in trainee-involved procedures. Methods Patients undergoing biliary cannulation with or without trainee involvement were eligible. Procedures that might be too easy (e. g. fistula) or too difficult (e. g. altered anatomy) were excluded. The primary outcome was difficult cannulation, defined as cannulation time, attempts, or inadvertent pancreatic duct (PD) cannulation exceeding the 75 % percentile of each variable. Propensity score matching (PSM) analysis was used. Results After PSM, there were 1596 patients in each group. Trainee-involved procedures had longer median (interquartile range [IQR]) cannulation time (7.5 [2.2–15.3] vs. 2.0 [0.6–5.2] minutes), and more attempts (5 [2–10] vs. 2 [1–4]) and inadvertent PD cannulation (0 [0–2] vs. 0 [0–1]) vs. procedures without trainee involvement (all P < 0.001). The 15–10–2 criteria for difficult cannulation were proposed for trainee-involved cannulation and the 5–5-1 criteria were nearly confirmed for cannulation without trainee involvement. The proportions of difficult cannulation using these respective criteria were 35.5 % (95 % confidence interval [CI] 33.2 %–37.9 %) and 31.8 % (95 %CI 29.5 %–34.2 %), respectively (odds ratio 1.18 [95 %CI 1.02–1.37]). Incidences of post-ERCP pancreatitis following difficult cannulation were comparable (7.8 % [95 %CI 5.7 %–10.3 %] vs. 9.8 % [95 %CI 7.4 %–12.8 %], respectively). Conclusion By using the 75 % percentiles as cutoffs, the proposed 15–10–2 criteria for difficult cannulation could be appropriate in trainee-involved procedures.