Transpancreatic Sphincterotomy Is Effective and Safe in Expert Hands on the Short Term.
Cholangiopancreatography, endoscopic retrograde/adverse effects
Cholangiopancreatography, endoscopic retrograde/methods
Postoperative hemorrhage/etiology
Sphincterotomy, endoscopic/adverse effects
Sphincterotomy, endoscopic/methods
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
11
11
2018
accepted:
23
04
2019
pubmed:
6
5
2019
medline:
24
3
2020
entrez:
6
5
2019
Statut:
ppublish
Résumé
In cases of difficult biliary cannulation, transpancreatic sphincterotomy (TPS) can be an alternative approach of biliary access. However, its success and safety profile have not been studied in detail. A systematic review and meta-analysis were performed to study the overall cannulation success and adverse events of TPS. These outcomes were also compared to other advanced cannulation methods. A systematic literature search was conducted to find all relevant articles containing data on TPS. Successful biliary cannulation and complications rates [post-ERCP pancreatitis (PEP), bleeding, and perforation rates] were compared in the pooled analyses of prospective comparative studies. The overall outcomes were calculated involving all studies on TPS. TPS was superior compared to needle-knife precut papillotomy (NKPP) and the double-guidewire method (DGW) regarding cannulation success (odds ratio [OR] 2.32; 95% confidence interval [CI] 1.37-3.93; and OR 2.72; 95% CI 1.30-5.69, respectively). The rate of PEP did not differ between TPS and NKPP or DGW; however, TPS (only retrospective studies were available for comparison) proved to be worse than needle-knife fistulotomy in this regard (OR 4.62; 95% CI 1.36-15.72). Bleeding and perforation rates were similar among these advanced techniques. There were no data about long-term consequences of TPS. The biliary cannulation rate of TPS is higher than that of the other advanced cannulation techniques, while the safety profile is similar to those. However, no long-term follow-up studies are available on the later consequences of TPS; therefore, such studies are strongly needed for its full evaluation.
Identifiants
pubmed: 31055720
doi: 10.1007/s10620-019-05640-4
pii: 10.1007/s10620-019-05640-4
pmc: PMC6704096
doi:
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2429-2444Commentaires et corrections
Type : CommentIn
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