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首页> 外文期刊>BMC Gastroenterology >Influence of a novel classification of the papilla of Vater on the outcome of needle-knife fistulotomy for biliary cannulation
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Influence of a novel classification of the papilla of Vater on the outcome of needle-knife fistulotomy for biliary cannulation

机译：盆草Papilla分类对胆汁插管针刀瘘术的影响

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Existing proposed classification systems for the Papilla of Vater (PV) suboptimally account for all relevant, encountered PV appearances, are too complex or have not been assessed for intra- or interobserver variability. We proposed a novel endoscopic classification system for PV, determined its inter- and intraobserver rates and used the classification system to assess whether the success and complications of needle-knife fistulotomy (NKF) are influenced by the morphology of the PV. The classification system was developed by expert endoscopists. To evaluate the inter- and intraobserver agreement, an online questionnaire was sent to 20 endoscopists from several countries (10 experts and 10 nonexperts) that included 50 images of papillae of Vater divided among various categories. Four weeks later, a second survey, with the images from the first questionnaire randomly reordered, was sent to the same endoscopists. The inter- and intraobserver agreements among the experts and nonexperts was calculated. Using the proposed classification system, all 361 consecutive patients who underwent NKF for biliary access to a na?ve papilla were prospectively enrolled in the study. The novel classification system comprises 7 categories: type I, flat type, lacking an oral protrusion; type IIA, prominent tubular nonpleated type, with an oral protrusion and 2 transverse folds over the oral protrusion; type IIC: prominent bulging type, with an enlarged and bulging oral protrusion; type IIIA, diverticular-intradiverticular type, with a papillary orifice inside the diverticulum; type IIIB: diverticular-diverticular border type, with a papillary orifice less than 2?cm from the diverticular border; type IV: unclassified papilla, with no morphology classified in the other categories. The interobserver agreement between experts was substantial (K?=?0.611, 95% CI 0.498–0.709) and was higher than that between nonexperts (K?=?0.516; 95% CI 0.410–0.636). The intraobserver agreement was substantial among both experts (K?=?0,651; 95% CI 0.586–0.715) and nonexperts (K?=?0.646, 95% CI 0.615–0.677). In a multivariate model, type IIIA and IIIB were the only independent risk factors for difficult rescue NKF biliary cannulation (P?=?0.003 and P?=?0.019, respectively), and type I and type IIB were the only independent risk factors for a prolonged cannulation time using NKF (P??0.001 and P?=?0.005, respectively). The novel endoscopic classification system for PV is highly reproducible among experienced ERCPists according to the substantial level of agreement between experts. However, nonexperts require further training in its use. Using the novel classification system, we identified different types of papillae significantly associated with a lower efficacy of NKF and a prolonged time to obtain successful biliary cannulation using NKF.
机译：对于所有相关的VATAR（PV）百草乳头的现有拟议分类系统对所有相关的遇到的PV出场都过于复杂或者尚未被评估，或者尚未评估或interobserver变异性。我们提出了一种用于PV的新型内窥镜分类系统，确定其间和垄断速率，并使用分类系统来评估针刀瘘管切开术（NKF）的成功和并发症受到PV的形态的影响。分类系统是由专家内窥镜师开发的。为了评估和奥里替服务公司协议，在几个国家（10名专家和10名未生产）中送到20名内窥镜师的在线问卷，其中包括50个罂粟花草乳头分为各类。四周后，第二次调查，从第一个调查问卷随机重新排序的图像被发送到同一内窥镜师。计算专家和非专业人员之间的和奥里内书手协议。使用拟议的分类系统，所有361名接受NKF胆道访问NA的胆量的患者均前瞻性地注册了该研究。新型分类系统包括7类：I型，扁平型，缺乏口腔突出; IIA型，突出的管状非匹配型，具有口腔突起和2横向折叠在口腔突起上; IIC型：突出的凸出式，口腔突出凸起; IIIA型，憩室 - 颅内型，乳头内部乳头状孔; IIIB型：憩室 - 憩室边界型，乳头状孔口距离憩室边界小于2Ω厘米; IV型：未分类的乳头，没有归类在其他类别中的形态。专家之间的Interobserver协议很大（k？= 0.611,95％CI 0.498-0.709）并且高于非直植物（K？= 0.516; 95％CI 0.410-0.636）。在专家的同性（K？= 0.651; 95％CI 0.586-0.715）和非异常（K？= 0.646,95％CI 0.615-0.677）中，奥里宁机协定是大量的（K？= 0.651; 95％CI 0.586-0.715）。在多变量模型中，III型和IIIb是难度救援NKF胆汁插管的唯一独立风险因素（P？= 0.003和P？= 0.019），I型和III型是唯一的独立风险因素使用NKF的延长的挤压时间（p？＆ 0.001和p？0.005）。根据专家之间的大量协议，PV的新型内窥镜分类系统在经验丰富的ERCP师之间是高度可重复的。但是，非向量需要进一步培训。使用新颖的分类系统，我们确定了不同类型的乳头与NKF的效果显着相关，并且延长使用NKF获得成功的胆汁插管。

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