Clinical effect of different methods for endoscopic precut sphincterotomy in difficult intubation during endoscopic retrograde cholangiopancreatography: A comparative analysis

Objective To investigate the clinical characteristics of different methods for endoscopic precut sphincterotomy in difficult intubation during endoscopic retrograde cholangiopancreatography (ERCP) . Methods A retrospective analysis was performed for the clinical data of 185 patients who underwent ERCP and precut sphincterotomy in The Second Affiliated Hospital of Kunming Medical University from May2015 to December 2018. According to the method for endoscopic precut sphincterotomy, these patients were divided into needle-knife precut sphincterotomy (NKP) group with 73 patients, needle-knife fenestration (NKF) group with 24 patients, transpancreatic precut sphincterotomy (TPS) group with 30 patients, and arch-knife precut sphincterotomy group (Erlangen group) with 58 patients. These four precut methods were analyzed in terms of advantages and disadvantages, influence on the success rate of intubation, and increase or reduction in complications. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for comparison within each group; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Nemenyi method was used for further comparison between two groups.The chi-square test was used for comparison of categorical data between multiple groups, and a logistic regression analysis was used to determine risk factors and perform a multivariate analysis. Results The NKF and TPS groups had a significantly higher success rate of intubation than the NKP group (both P < 0. 05) . The TPS group had a significantly lower incidence rate of complications than the NKF group, and the NKF group had a significantly higher incidence rate of complications than the NKP group (both P < 0. 05) . The Erlangen group had asignificantly higher incidence rate of complications than the NKP and TPS groups (both P < 0. 05) . NKF (odds ratio [OR]= 2. 420, 95%confidence interval [CI]: 0. 235-0. 828, P = 0. 036) and TPS (OR = 1. 752, 95% CI: 0. 238-0. 594, P = 0. 029) were influencing factors for successful intubation. Age > 57 years (OR = 0. 094, 95% CI: 0. 028-0. 316, P < 0. 001) and total time of operation (OR =1. 029, 95% CI: 1. 002-1. 057, P = 0. 036) were influencing factors for post-ERCP pancreatitis (PEP) , and further multivariate logistic regression analysis showed that age > 57 years (OR = 0. 065, 95% CI: 0. 017-0. 256, P < 0. 001) was an independent protective factor against the risk of PEP, while total time of operation (OR = 1. 040, 95% CI: 1. 007-1. 074, P = 0. 016) was an independent risk factor for PEP. Conclusion TPS may be safer and more effective than NKP and Erlangen under certain conditions. Age and total time of operation may influence the incidence rate of complications.