Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1726-1733
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1726
Effect of endoscopic sphincterotomy and endoscopic papillary balloon dilation endoscopic retrograde cholangiopancreatographies on the sphincter of Oddi
Kai Fu, Ying-Ying Yang, Hui Chen, Guang-Xin Zhang, Yan Wang, Zhi Yin
Kai Fu, Ying-Ying Yang, Hui Chen, Guang-Xin Zhang, Yan Wang, Department of Gastroenterology, Yixing Hospital of Traditional Chinese Medicine, Wuxi 214200, Jiangsu Province, China
Zhi Yin, Endoscopy Center, Yixing Hospital of Traditional Chinese Medicine, Wuxi 214200, Jiangsu Province, China
Co-first authors: Kai Fu and Ying-Ying Yang.
Co-corresponding authors: Yan Wang and Zhi Yin.
Author contributions: Fu K and Yang YY designed and performed the research and wrote the paper; Wang Y and Yin Z designed the research and supervised the report; Chen H designed the research and contributed to the analysis; Zhang GX and Chen H provided clinical advice; Wang Y and Yin Z supervised the report.
Institutional review board statement: The study was reviewed and approved by Yixing Hospital of Traditional Chinese Medicine (Approved No. 2022-052).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at wy_wangyan_yx@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Wang, MM, Chief Physician, Department of Gastroenterology, Yixing Hospital of Traditional Chinese Medicine, No. 128 Yangquan East Road, Yicheng Street, Wuxi 214200, Jiangsu Province, China. wy_wangyan_yx@163.com
Received: March 9, 2024
Revised: April 29, 2024
Accepted: May 17, 2024
Published online: June 27, 2024
Processing time: 112 Days and 20.1 Hours
Abstract
BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP), with its clinical ad-vantages of less trauma and faster recovery, has become the primary treatment for choledocholithiasis.

AIM

To investigate the effects of different ERCP procedures on the sphincter of Oddi.

METHODS

The clinical data of 91 patients who underwent ERCP at Yixing Hospital of Traditional Chinese Medicine between February 2018 and February 2021 were analyzed retrospectively. The patients were divided into endoscopic sphincterotomy (EST, n = 24) and endoscopic papillary balloon dilation (EPBD, n = 67) groups. The duration of operation, pancreatic development, pancreatic sphincterotomy, intubation difficulties, stone recurrence, and incidence of reflux cholangitis and cholecystitis were statistically analyzed in patients with a history of choledocholithiasis, pancreatitis, and Oddi sphincter dysfunction in the EST and EPBD groups.

RESULTS

Differences in hypertension, diabetes, increased bilirubin, small diameter of the common bile duct, or ampullary diverticulum between the two groups were not significant. Statistically significant differences were observed between the two groups concerning sex and age (< 60 years). Patients with a history of choledocholithiasis, pancreatitis, and Oddi sphincter dysfunction were higher in the EST group than in the EPBD group. The number of cases of pancreatic development, pancreatic duct sphincterotomy, and difficult intubation were higher in the EST group than in the EPBD group. The number of Oddi’s sphincter manometries, ERCP surgical outcomes, and guidewires entering the pancreatic duct several times in EST group were lower than those in the EPBD group. The numbers of stone recurrences, reflux cholangitis, and cholecystitis were higher in the EST group than in the EPBD group.

CONCLUSION

In summary, common bile duct stones, pancreatitis history, and multiple guided wire introductions into the pancreatic duct are independent risk factors for EST and EPBD. Based on this evidence, this study can provide actionable insights for clinicians and researchers.

Keywords: Oddi; Cholangiopancreatography; Endoscopic retrograde; Risk factors; Endoscopic sphincterotomy; Endoscopic papillary balloon dilation

Core Tip: This study suggests that the number of cases of pancreatic development, sphincterotomy of pancreatic duct, difficulty intubation, recurrence of calculus, reflux cholangitis and cholecystitis in endoscopic sphincterotomy (EST) group were higher than those in endoscopic papillary balloon dilation (EPBD) group. Moreover, choledocholithiasis, history of pancreatitis, and multiple guides leads into the pancreatic duct are independent risk factors for EST and EPBD. Clinical re-identification of Oddi sphincter function will ensure rational and standardized patient treatment.