Supplementary Material for: Comparison between transpancreatic sphincterotomy and needle-knife precut in difficult cannulation of endoscopic retrograde cholangiopancreatography: an up-to-date meta-analysis and systematic review

Background Selective cannulation, which is essential for endoscopic retrograde cholangiopancreatography (ERCP), may be difficult. The aim of this study was to compare transpancreatic sphincterotomy (TPS) and needle-knife precut (NKP) in difficult cannulation during ERCP. Methods PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched for relevant studies from January 1990 to April 2022. A meta-analysis focusing on cannulation success and post-ERCP complications was performed by Review Manager. Results Seventeen eligible studies involving 2340 patients were included. Our results showed that the TPS group had a higher cannulation success rate (odds ratio (OR) 0.48, 95% confidence interval (CI) 0.27–0.87, p = 0.02) and less bleeding (OR 1.94, 95% CI 1.09–3.47, p = 0.03) compared with the NKP group. There was no significant difference between NKP and TPS in the rates of post-ERCP pancreatitis (OR 0.83, 95% CI 0.59–1.18, p = 0.30), perforation (OR 2.04, 95% CI 0.69–6.03, p = 0.20), and adverse events (OR 1.29, 95% CI 0.94–1.77, p = 0.12). Conclusion TPS appears to be associated with a higher cannulation success rate and less bleeding than those with NKP, with equal post-ERCP pancreatitis, perforation, and adverse events rates between TPS and NKP. Further large-scale trials are warranted to support our findings.背景：选择性插管（selective cannulation）是内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）的核心操作环节，但往往颇具难度。本研究旨在对比ERCP术中困难插管场景下，胰管括约肌切开术（transpancreatic sphincterotomy, TPS）与针状刀预切开术（needle-knife precut, NKP）的临床效果。方法：本研究检索了1990年1月至2022年4月期间PubMed、Embase、Web of Science、Cochrane对照试验中心注册库（Cochrane Central Register of Controlled Trials）以及ClinicalTrials.gov数据库中的相关研究。采用Review Manager软件针对插管成功率及ERCP术后并发症开展荟萃分析。结果：最终纳入17项符合纳入标准的研究，共涉及2340例患者。结果显示，与NKP组相比，TPS组的插管成功率更高（优势比（odds ratio, OR）=0.48，95%置信区间（confidence interval, CI）：0.27–0.87，P=0.02），且术后出血风险更低（OR=1.94，95%CI：1.09–3.47，P=0.03）。两组在ERCP术后胰腺炎（OR=0.83，95%CI：0.59–1.18，P=0.30）、穿孔（OR=2.04，95%CI：0.69–6.03，P=0.20）及不良事件发生率方面均无显著差异（OR=1.29，95%CI：0.94–1.77，P=0.12）。结论：综上，相较于NKP，TPS可获得更高的插管成功率且术后出血风险更低，两组在ERCP术后胰腺炎、穿孔及不良事件发生率上无显著差异。未来仍需开展大规模临床试验以验证本研究结论。