《2025年世界内镜组织指南:内镜逆行胰胆管造影术中胆道插管及括约肌切开术技术》摘译
DOI: 10.12449/JCH251009
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:林俊龙负责文章翻译;华赟鹏负责文章审校。
An excerpt of World Endoscopy Organization guidelines on endoscopic retrograde cholangiopancreatography biliary cannulation and sphincterotomy techniques (2025 edition)
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摘要: 关于胆道插管的最新指南仍无进展。该指南是世界内镜组织(WEO)的一项倡议,由来自亚洲、欧洲和美洲的专家小组制定。该指南针对内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)的预防、胆管插管技术、括约肌切开术/乳头球囊扩张术以及特殊情况下胆管插管4个关键领域的相关临床问题,通过系统文献回顾并采用推荐分级的评估、制定与评价方法进行了解答。成功的胆管插管和括约肌切开术是ERCP的基础,对几乎所有治疗性和高级诊断性操作均不可或缺。然而,不良事件,尤其是PEP,可能频繁发生并影响患者预后。高胆管插管成功率和低PEP发生率是ERCP完成质量的指标,应成为所有内镜医师的目标。本指南旨在提供适用于全球的临床实践建议,不受资源和专业知识限制。主要内容涵盖ERCP的术前、术中和术后管理,包括降低PEP风险的措施、初次胆道插管技术、胆道插管困难时的处理方案、ERCP失败时的替代方案(经皮和超声内镜引导)、解剖结构改变(如壶腹周围憩室和术后解剖结构)以及十二指肠狭窄时的胆道插管方法。
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关键词:
- 胰胆管造影术, 内窥镜逆行 /
- 括约肌切开术 /
- 诊疗准则
Abstract: There is still a lack of guidelines on biliary cannulation in recent years. The guidelines are an initiative of the World Endoscopy Organization (WEO) formulated by a panel of experts from Asia, Europe, and America. Through a systematic literature review and the application of the Grading of Recommendations Assessment, Development, and Evaluation methodology, the guidelines address clinical questions pertaining to four key domains, i.e., prevention of post-ERCP pancreatitis (PEP), bile duct cannulation techniques, sphincterotomy/papillary balloon dilation, and bile duct cannulation under special circumstances. Successful biliary cannulation and sphincterotomy are cornerstones of ERCP and are indispensable for almost all therapeutic and advanced diagnostic procedures; however, adverse events, especially PEP, may occur frequently and affect the prognosis of patients. A high success rate of bile duct cannulation and a low incidence rate of PEP are quality indicators for ERCP and should be the goal of all endoscopists. The guidelines aim to provide clinical practice recommendations applicable worldwide, regardless of resources and expertise. The guidelines cover the preoperative, intraoperative, and postoperative management of ERCP, including the measures to reduce the risk of PEP, the technique for an initial biliary cannulation attempt, options for cannulation in case of difficult biliary access, alternatives to ERCP in case of failure (under the guidance of percutaneous and endoscopic ultrasound), and biliary access in altered anatomy (periampullary diverticulum and postsurgical anatomy) and in the presence of duodenal stenosis. -
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[1] CRINÒ SF, AABAKKEN L, BAPAYE A, et al. World Endoscopy Organization guidelines on endoscopic retrograde cholangiopancreatography biliary cannulation and sphincterotomy techniques[J]. Dig Endosc, 2025. DOI: 10.1111/den.15060.[ Epub ahead of print] -

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