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首页> 外文期刊>Current treatment options in gastroenterology >Endoscopic Biliary and Pancreatic Sphincterotomy.
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Endoscopic Biliary and Pancreatic Sphincterotomy.

机译：内镜胆囊和胰腺括约肌切开术。

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Endoscopic sphincterotomy is performed on the biliary and pancreatic sphincters for a variety of indications such as removal of stones, as part of treatment of strictures, to facilitate placement of stents, for closure of ductal leaks, and other indications. Pancreatic sphincterotomy has been increasingly performed for the treatment of papillary stenosis, sphincter of Oddi dysfunction, and for chronic and acute recurrent pancreatitis. Efficacy is clear for more traditional indications, but is not as well defined for some of the latter indications. Minor papillotomy is most often performed for acute recurrent pancreatitis associated with pancreas divisum, sometimes for chronic pancreatitis, and for other indications. Equipment, techniques, and safety of sphincterotomy have improved significantly over the past decades. Success rates are substantially higher when a sphincterotomy is performed by high-volume endoscopists. However, complications such as pancreatitis, bleeding, and perforation can still occur in up to 10% of cases and may occasionally be severe. Patients with the least clear indication or chance of benefit from sphincterotomy, such as those with suspected sphincter of Oddi dysfunction or suspected but absent bile duct stones, are at highest risk of complications. Complications are less frequent, but fully not eliminated, with an experienced endoscopist or an expert in the field. Risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) with biliary and/or pancreatic sphincterotomy can be substantially reduced by placement of a small-caliber pancreatic stent. Major challenges include defining the settings in which sphincterotomy is most likely to be effective, selection of appropriate patients for therapeutic ERCP by utilization of alternative imaging techniques such as magnetic resonance cholangiopancreatography and endoscopic ultrasound, and dissemination of newer techniques into practice to ensure optimal safety and efficacy for sphincterotomy.
机译：内镜括约肌切开术在胆管和胰括约肌上进行，以适应各种适应症，例如去除结石，作为狭窄治疗的一部分，以利于放置支架，闭合导管漏出和其他适应症。胰腺括约肌切开术已越来越多地用于治疗乳头状狭窄，Oddi括约肌功能障碍以及慢性和急性复发性胰腺炎。对于更传统的适应症，疗效是显而易见的，但对于后一种适应症的疗效尚不明确。较小的乳头切开术最常用于与胰腺分裂相关的急性复发性胰腺炎，有时用于慢性胰腺炎，以及其他适应症。在过去的几十年中，括约肌切开术的设备，技术和安全性得到了显着改善。当由大量内镜医师进行括约肌切开术时，成功率要高得多。但是，多达10％的病例仍会发生诸如胰腺炎，出血和穿孔等并发症，并且有时可能很严重。括约肌切开指征或机会最少的患者，例如疑似Oddi括约肌功能障碍或疑似但无胆管结石的患者，发生并发症的风险最高。由经验丰富的内镜医师或本领域专家来进行并发症的频率较低，但并未完全消除。内镜逆行胰胆管造影术（ERCP）合并胆管和/或胰括约肌切开术后发生胰腺炎的风险可通过放置小口径胰支架来大大降低。主要挑战包括确定最有可能进行括约肌切开术的设置，通过利用磁共振胆胰胰管成像和内窥镜超声等替代成像技术为治疗性ERCP选择合适的患者，以及将新技术推广到实践中以确保最佳的安全性。括约肌切开术的功效。

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