胆管挿管困難例に対する対策 Needle knifeを用いたprecut法を中心に
経乳頭的胆管深部挿管困難な症例に対し，needle knifeを用いたprecut法は挿管率の向上に有効である一方で，技術的な難易度が高く，さらに膵炎や出血，穿孔といった偶発症の可能性もあり，熟練者が行うべき処置とされ普及していない。われわれが行っているfreehandによるneedle knifeを用いたprecut法は，口側隆起の粘膜を長めに切開し，粘膜下の白色索状物である括約筋を視認したうえで胆管側の括約筋を切開し，胆管口を露出させる手技である。乳頭の基本的な構造を理解し，needle knifeによる切開の方向，長さ，深度を見極めることで高い確率で胆管口を露出でき挿管が可能となる。その...
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| Published in | 日本腹部救急医学会雑誌 Vol. 36; no. 1; pp. 53 - 62 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
31.01.2016
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.36.53 |
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| Abstract | 経乳頭的胆管深部挿管困難な症例に対し，needle knifeを用いたprecut法は挿管率の向上に有効である一方で，技術的な難易度が高く，さらに膵炎や出血，穿孔といった偶発症の可能性もあり，熟練者が行うべき処置とされ普及していない。われわれが行っているfreehandによるneedle knifeを用いたprecut法は，口側隆起の粘膜を長めに切開し，粘膜下の白色索状物である括約筋を視認したうえで胆管側の括約筋を切開し，胆管口を露出させる手技である。乳頭の基本的な構造を理解し，needle knifeによる切開の方向，長さ，深度を見極めることで高い確率で胆管口を露出でき挿管が可能となる。そのため，胆道内視鏡治療に習熟するためには是非ともマスターすべき手技と考え，本稿ではわれわれの行っているprecut法とその有用性を概説する。 |
|---|---|
| AbstractList | 経乳頭的胆管深部挿管困難な症例に対し，needle knifeを用いたprecut法は挿管率の向上に有効である一方で，技術的な難易度が高く，さらに膵炎や出血，穿孔といった偶発症の可能性もあり，熟練者が行うべき処置とされ普及していない。われわれが行っているfreehandによるneedle knifeを用いたprecut法は，口側隆起の粘膜を長めに切開し，粘膜下の白色索状物である括約筋を視認したうえで胆管側の括約筋を切開し，胆管口を露出させる手技である。乳頭の基本的な構造を理解し，needle knifeによる切開の方向，長さ，深度を見極めることで高い確率で胆管口を露出でき挿管が可能となる。そのため，胆道内視鏡治療に習熟するためには是非ともマスターすべき手技と考え，本稿ではわれわれの行っているprecut法とその有用性を概説する。 |
| Author | 河本, 博文 後藤, 大輔 |
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| Copyright | 2014, Japanese Society for Abdominal Emargency Medicine |
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| References | 6) 大井 至：十二指腸内視鏡検査と内視鏡的膵胆管造影．Gastroenterol Endosc 1986；28：2881-2883 20) Katsinelos P, Gkagkalis S, Chatzimavroudis G, et al: Comparison of three types of precut technique to achieve common bile duct cannulation: a retrospective analysis of 274 cases. Dig Dis Sci 2012; 57: 3286-3292. 4) Khashab MA, Valeshabad AK, Modayil R, et al: EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). Gastrointest Endosc 2013; 78: 734-741. 5) Park do H, Jeong SU, Lee BU, et al: Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP（with video）. Gastrointest Endosc 2013; 78: 91-101. 11) Lin LF: Transpancreatic precut sphincterotomy for biliary access: the relation of sphincterotomy size to immediate success rate of biliary cannulation. Diagn Ther Endosc Publication Date：10 Mar 2014; DOI: 10. 1155/2014/864082. 2) 河本博文，後藤大輔，加藤博也：プレカットはどれくらい経験したら行ってよいのですか？ 消化器内視鏡レクチャー 2013；1：505-512 10) Saritas U, Ustundag Y, Harmander F: Precut sphincterotomy: A reliable salvage for difficult biliary cannulation. World J Gastroenterol 2013; 19: 1-7. 13) Freeman ML, Guda NM: ERCP cannulation: a review of reported techniques. Gastrointest Endosc 2005; 61: 112-125. 23) Choudhary A, Winn J, Siddique S, et al: Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. World J Gastroenterol 2014; 20: 4093-4101. 9) Kubota K, Sato T, Kato S, et al: Needle - knife precut papillotomy with a small incision over a pancreatic stent improves the success rate and reduces the complication rate in difficult biliary cannulations. J Hepatobiliary Pancreat Sci 2013; 20: 382-388. 3) Dhir V, Bhandari S, Bapat M, et al: Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access（with videos）. Gastrointest Endosc. 2012; 75: 354-359. 12) Lee TH, Hwang SO, Choi HJ, et al: Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study. BMC Gastroenterol 2014; 14: 30. 30) Bailey AA, Bourke MJ, Kaffes AJ, et al: Needle-knife sphincterotomy: facters predicting its use and the relationship with post-ERCP pancreatitis (with video). Gastrointest Endosc 2010; 71: 266-271. 28) Williams EJ, Taylor S, Fairclough P, et al: Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007; 39: 793-801. 7) Fukatsu H, Kawamoto H, Kato H, et al: Evaluation of needle-knife precut pappilotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors. Surg Endosc 2008; 22: 717-723. 17) Wang P, Zhang W, Liu F, et al: Success and complication rates of two precut techniques, transpancreatic sphincterotomy and needle-knife sphincterotomy for bile duct cannulation. J Gastrointest Surg 2010; 14: 697-704. 27) Cheng CL, Sherman S, Watkins JL, et al: Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol 2006; 101: 139-147. 31) Davee T, Garcia JA, Baron TH: Precut sphincterotomy for selective biliary duct cannulation during endoscopic retrograde cholangiopancreatography. Ann Gastroenterol 2012; 25: 291-302. 26) Freeman ML: Adverse outcomes of ERCP. Gastrointest Endosc 2002; 56（6 Suppl）: S273-282. 25) Jamry A: Comparative analysis of endoscopic precut conventional and needle knife sphincterotomy.World J Gastroenterol 2013; 19: 2227-2233. 21) 明石隆吉：通常型パピロトームによるシンプルプレカッティング─膵管括約筋切開術（PSP）．消内視鏡 2011；23：402-406 18) Lee YJ, Park YK, Lee MJ, et al: Different Strategies for Transpancreatic Septotomy and Needle Knife Infundibulotomy Due to the Presence of Unintended Pancreatic Cannulation in Difficult Biliary Cannulation. Gut Liver 2015; 9: 534-539. 32) Gong B, Hao L, Bie L, et al: Does precut technique improve selective bile duct cannulation or increase post-ERCP pancreatitis rate? A meta-analysis of randomized controlled trials. Surg Endosc 2010; 24: 2670-2680. 8) Binmoeller KF, Seifert H, Gerke H, et al: Papillary roof incision using the Erlangen - type pre - cut papillotome to achieve selective bile duct cannulation. Gastrointest Endosc 1996; 44: 689-695. 22) Cennamo V, Fuccio L, Zagari RM, et al: Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials. Endoscopy 2010; 42: 381-388. 29) Cotton PB, Garrow DA, Gallagher J, et al: Risk factors for complications after ERCP: a multivariate analysis of 11, 497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-88. 14) Yoo YW, Cha W, Lee WC, et al: Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation. World J Gastroenterol 2013; 19: 108-114. 19) Abu-Hamda EM, Baron TH, Simmons DT, et al: A retrospective comparison of outcomes using three different precut needle knife techniques for biliary cannulation. J Clin Gastroenterol 2005；39：717-721. 16) Lawrence C, Romagnuolo J, Cotton PB, et al: Post-ERCP pancreatitis rates do not differ between needle-knife and pull-type pancreatic sphincterotomy techniques: a multiendoscopist 13-year experience. Gastrointest Endosc 2009; 69: 1271-1275. 33) Cha SW, Leung WD, Lehman GA, et al: Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy-associated pancreatitis? A randomzed, prospective study. Gastrointest Endosc 2013; 77: 209-216. 24) Akaraviputh T, Lohsiriwat V, Swangsri J, et al: The learning curve for safety and success of precut sphincterotomy for therapeutic ERCP: a single endoscopist’s experience. Endoscopy 2008; 40: 513-516. 1) 河本博文，後藤大輔：Needle knifeによるPrecut．消内視鏡2014；26：241-250 15) Halttunen J, Keranen I, Udd M, et al: Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc 2009; 23: 745-749. |
| References_xml | – reference: 13) Freeman ML, Guda NM: ERCP cannulation: a review of reported techniques. Gastrointest Endosc 2005; 61: 112-125. – reference: 23) Choudhary A, Winn J, Siddique S, et al: Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. World J Gastroenterol 2014; 20: 4093-4101. – reference: 10) Saritas U, Ustundag Y, Harmander F: Precut sphincterotomy: A reliable salvage for difficult biliary cannulation. World J Gastroenterol 2013; 19: 1-7. – reference: 20) Katsinelos P, Gkagkalis S, Chatzimavroudis G, et al: Comparison of three types of precut technique to achieve common bile duct cannulation: a retrospective analysis of 274 cases. Dig Dis Sci 2012; 57: 3286-3292. – reference: 9) Kubota K, Sato T, Kato S, et al: Needle - knife precut papillotomy with a small incision over a pancreatic stent improves the success rate and reduces the complication rate in difficult biliary cannulations. J Hepatobiliary Pancreat Sci 2013; 20: 382-388. – reference: 15) Halttunen J, Keranen I, Udd M, et al: Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc 2009; 23: 745-749. – reference: 2) 河本博文，後藤大輔，加藤博也：プレカットはどれくらい経験したら行ってよいのですか？ 消化器内視鏡レクチャー 2013；1：505-512． – reference: 24) Akaraviputh T, Lohsiriwat V, Swangsri J, et al: The learning curve for safety and success of precut sphincterotomy for therapeutic ERCP: a single endoscopist’s experience. Endoscopy 2008; 40: 513-516. – reference: 19) Abu-Hamda EM, Baron TH, Simmons DT, et al: A retrospective comparison of outcomes using three different precut needle knife techniques for biliary cannulation. J Clin Gastroenterol 2005；39：717-721. – reference: 28) Williams EJ, Taylor S, Fairclough P, et al: Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007; 39: 793-801. – reference: 6) 大井 至：十二指腸内視鏡検査と内視鏡的膵胆管造影．Gastroenterol Endosc 1986；28：2881-2883． – reference: 25) Jamry A: Comparative analysis of endoscopic precut conventional and needle knife sphincterotomy.World J Gastroenterol 2013; 19: 2227-2233. – reference: 17) Wang P, Zhang W, Liu F, et al: Success and complication rates of two precut techniques, transpancreatic sphincterotomy and needle-knife sphincterotomy for bile duct cannulation. J Gastrointest Surg 2010; 14: 697-704. – reference: 31) Davee T, Garcia JA, Baron TH: Precut sphincterotomy for selective biliary duct cannulation during endoscopic retrograde cholangiopancreatography. Ann Gastroenterol 2012; 25: 291-302. – reference: 7) Fukatsu H, Kawamoto H, Kato H, et al: Evaluation of needle-knife precut pappilotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors. Surg Endosc 2008; 22: 717-723. – reference: 22) Cennamo V, Fuccio L, Zagari RM, et al: Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials. Endoscopy 2010; 42: 381-388. – reference: 5) Park do H, Jeong SU, Lee BU, et al: Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP（with video）. Gastrointest Endosc 2013; 78: 91-101. – reference: 12) Lee TH, Hwang SO, Choi HJ, et al: Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study. BMC Gastroenterol 2014; 14: 30. – reference: 18) Lee YJ, Park YK, Lee MJ, et al: Different Strategies for Transpancreatic Septotomy and Needle Knife Infundibulotomy Due to the Presence of Unintended Pancreatic Cannulation in Difficult Biliary Cannulation. Gut Liver 2015; 9: 534-539. – reference: 26) Freeman ML: Adverse outcomes of ERCP. Gastrointest Endosc 2002; 56（6 Suppl）: S273-282. – reference: 30) Bailey AA, Bourke MJ, Kaffes AJ, et al: Needle-knife sphincterotomy: facters predicting its use and the relationship with post-ERCP pancreatitis (with video). Gastrointest Endosc 2010; 71: 266-271. – reference: 27) Cheng CL, Sherman S, Watkins JL, et al: Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol 2006; 101: 139-147. – reference: 1) 河本博文，後藤大輔：Needle knifeによるPrecut．消内視鏡2014；26：241-250． – reference: 33) Cha SW, Leung WD, Lehman GA, et al: Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy-associated pancreatitis? A randomzed, prospective study. Gastrointest Endosc 2013; 77: 209-216. – reference: 8) Binmoeller KF, Seifert H, Gerke H, et al: Papillary roof incision using the Erlangen - type pre - cut papillotome to achieve selective bile duct cannulation. Gastrointest Endosc 1996; 44: 689-695. – reference: 29) Cotton PB, Garrow DA, Gallagher J, et al: Risk factors for complications after ERCP: a multivariate analysis of 11, 497 procedures over 12 years. Gastrointest Endosc 2009; 70: 80-88. – reference: 11) Lin LF: Transpancreatic precut sphincterotomy for biliary access: the relation of sphincterotomy size to immediate success rate of biliary cannulation. Diagn Ther Endosc Publication Date：10 Mar 2014; DOI: 10. 1155/2014/864082. – reference: 14) Yoo YW, Cha W, Lee WC, et al: Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation. World J Gastroenterol 2013; 19: 108-114. – reference: 4) Khashab MA, Valeshabad AK, Modayil R, et al: EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). Gastrointest Endosc 2013; 78: 734-741. – reference: 21) 明石隆吉：通常型パピロトームによるシンプルプレカッティング─膵管括約筋切開術（PSP）．消内視鏡 2011；23：402-406． – reference: 32) Gong B, Hao L, Bie L, et al: Does precut technique improve selective bile duct cannulation or increase post-ERCP pancreatitis rate? A meta-analysis of randomized controlled trials. Surg Endosc 2010; 24: 2670-2680. – reference: 3) Dhir V, Bhandari S, Bapat M, et al: Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access（with videos）. Gastrointest Endosc. 2012; 75: 354-359. – reference: 16) Lawrence C, Romagnuolo J, Cotton PB, et al: Post-ERCP pancreatitis rates do not differ between needle-knife and pull-type pancreatic sphincterotomy techniques: a multiendoscopist 13-year experience. Gastrointest Endosc 2009; 69: 1271-1275. |
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| Snippet | 経乳頭的胆管深部挿管困難な症例に対し，needle knifeを用いたprecut法は挿管率の向上に有効である一方で，技術的な難易度が高く，さらに膵炎や出血，穿孔といった偶発... |
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| SubjectTerms | needle knife precut 挿管困難 |
| Subtitle | Needle knifeを用いたprecut法を中心に |
| Title | 胆管挿管困難例に対する対策 |
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