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Objective To evaluate modified shortened scope for ERCP procedure in swine animal model.Methods A total of 17 male pigs were divided into the conventional endoscope group (shortened scope used on human,n =8) and the modified endoscope group (modified shortened scope,n =9).The success rates,time of access to the pylorus,biliary or pancreatic orifice,the cannulation time of biliary or pancreatic duct,the stenting time of biliary or pancreatic duct,the total time of procedure and the X-ray exposure time were compared between the two groups.Results The success rates were 2/8 and 9/9 in the conventional endoscope group and the modified endoscope group,respectively(P =0.002).There were significantly differences of the cannulation time of biliary duct(180.00 ± 37.89 s VS 55.22 ± 11.56 s,P =0.000),cannulation time of pancreatic duct(55.22 ± 11.56 s VS 56.56 ±29.19 s,P =0.015),the time of access to pancreatic orifice(21.50 ±7.33 min VS4.67 ±2.63 min,P =0.000) and the total time of procedure(55.13 ±5.64 min VS 31.67 ±8.25 min,P =0.000) between the two groups.There were no significant differences in the time of passing through the pylorus,the time of finding biliary orifice,the stenting time of biliary or pancreatic duct or the X-ray exposure time between the two groups.Conclusion The modified shortened scope can improve the success rate of short scope position,facilitate locating biliary or pancreatic orifice,improve the success rate of pancreatic duct cannulation and shorten the cannulation time of biliary or pancreatic duct and the total operation time.
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Objective To investigate the clinical value of KL-6 mucin in differential diagnosis of benign and malignant obstructive jaundice.Methods A total of 41 patients with malignant tumors and 15 with benign lesions were recruited in the study.KL-6 mucin levels of bile and serum were measured using enzyme-linked immunosorbent assay (ELISA).The serum alpha-fetoprotein (AFP),carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels were also measured using radioimmunoassay (RIA).All data were analyzed by Mann-Whitney U test and Receiver Operating Characteristics (ROC)curves.Results CEA,CA19-9,and KL-6 mucin in serum and KL-6 mucin in bile in patients with malignant tumors were significantly higher than those in patients with benign lesions (P ＜ 0.001).There were no significant differences in serum AFP between the two groups.An receiver operating characteristic (ROC)curves analysis revealed that the detection of KL-6 mucin in bile was reasonably accurate in differentiating malignant obstructive jaundice from benign (area under curve [AUC] 0.954).While the AUC of the ROC curves for serum AFP,CEA,CA19-9,KL-6 mucin and KL-6 in bile and 0.954 were 0.657,0.753,0.894,0.846 and 0.954 respectively.Using the ideal threshold as the cut-off point,the sensitivity and specificity of KL-6 mucin for differential diagnosis of benign and malignant obstructive jaundice was 90.24％and 93.33％.Conclusion As a tumor marker,KL-6 mucin in bile is valuable in differential diagnosis of benign and malignant obstructive jaundice.
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Objective To produce a kind of biliary stent with Mitomycin C-eliting and evaluate the availability and safety in biliary benign stricture model of rabbit.Methods 36 New Zealand rabbits were fulgurize choledochus to establish model of biliary benign stricture.Rabbits were randomly divided into Mitomycin C-eluting stent group 1 (n =12),polyurethane stent group 2 (n =12) and control group 3 (n =12) one month later.General conditions,survival of the animals and changes in liver function were observed after surgery.The histological changes of bile duct were observed after 30 days.The immunohistochemistry SP method was used to measure transforming growth factor-β1 (TGF-β1) and α-Smooth muscle actin (α-SMA) expression.Results Stricture was improved in the two stent groups.In Mitomycin C-Eluting stent group total bilirubin dropped from 5.56 μmol/l to 0.82 μmol/l,and in polyurethane stent group total bilirubin dropped from 6.72 μmol/1 to 0.87 μmol/l.The total bilirubin decreased in both two stent groups but no statistically significant between the two stent groups,and there were no improvement in control group.Diameter of the stricture bile duct in group 1 was expanded bigger than in group 2 according to histology observation.Inflammatory cell infiltration and collagen fibroplasia in the submucosal were obviously observed in control group.The immunohistochemistry results showed that the TGF-β1 and α-SMA strongly expressed in the stenosis bile duct of group 3.The expressions in group 2 were lower than group 3,but higher than in group 1.And there was significant difference between the two stent groups (P ＜ 0.05).Conclusion The new Mitomycin C-Eluting stent is safe and provides enhanced local drug delivery.It also can inhibit the form of Biliary scar to a certain degree.