内镜逆行胰胆管造影术中要重视十二指肠乳头的保护OA

Endoscopic retrograde cholangiopancreatography(ERCP)is one of the preferred options for treating common bile duct stones,bile duct stenosis,and bile leakage.Endoscopic sphincterotomy(EST)and endoscopic papillary balloon dilation(EPBD)can reduce the difficulty of stone removal and increase the stone clearance rate.However,EST and endoscopic papillary large balloon dilation(EPLBD)can also damage the Oddi sphincter and even cause long-term complications such as reflux cholangitis and stone recurrence.Therefore,it is necessary to protect the Oddi sphincter during ERCP.The Oddi sphincter is one of the main structures of duodenal papilla(DP).While endoscopists pay attention to protecting the Oddi sphincter,they often neglect the protection of other structures of the DP,such as the damage to the papillary folds caused by EST and EPLBD,and the damage to the DP mucosa caused by needle-knife.In addition,the DP has various diseases,such as duodenal papillitis,periampullary diverticula,and pancreaticobiliary maljunction.DP diseases not only affect the excretion of bile and pancreatic juice but also can lead to secondary inflammation,stones,and tumors in the biliary and pancreatic systems.This article will elaborate on three aspects:the structure and function of the DP,the damage to the DP caused by EST and EPBD,and how to protect the DP during ERCP.It is hoped that ERCP can leverage its advantages in treating biliary tract,pancreatic duct and DP diseases while minimizing damage to normal DP.