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The fundamental treatment for acute cholecystitis is surgical cholecystectomy, especially laparoscopic cholecystectomy. Some high-risk surgical patients need gallbladder drainage. The traditional drainage method is percutaneous transhepatic gallbladder drainage. However, in recent years, two endoscopic approaches, including endoscopic transpapillary gallbladder drainage and endoscopic ultrasound-guided gallbladder drainage, have developed rapidly and have advantages in long-term outcomes. In this article, the authors discuss the historical development, technical characteristics, comparison between methods , adverse events and long-term outcomes of the two endoscopic drainage methods through literature review.
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ObjectiveTo investigate the value of nasobiliary cholangiography in the diagnosis of residual common bile duct stones after endoscopic retrograde cholangiopancreatography (ERCP) and the risk factors for residual stones. MethodsA retrospective analysis was performed for the clinical data of the patients who underwent ERCP and nasobiliary cholangiography after endoscopic nasobiliary drainage in Peking University First Hospital from January 1, 2018 to December 31, 2019. The chi-square test was used for comparison of categorical data between groups, and a logistic regression analysis was used to investigate independent risk factors for residual stones. ResultsA total of 366 patients underwent ERCP and nasobiliary cholangiography and 27 patients were suspected to have residual stones, among whom 25 had residual stones confirmed by ERCP. The rate of residual stones after ERCP was 6.8% (25/366), and nasobiliary cholangiography had a positive predictive value of 92.6% (25/27) in predicting residual common bile duct stones. The univariate analysis showed that there were significant differences between the two groups in multiple stones, common bile duct diameter ≥1.5 cm, and mechanical lithotripsy (χ2=5014, 7.651, and 9.670, all P＜0.05). The multivariate logistic regression analysis showed that multiple stones (odds ratio ［OR］=2713, 95% confidence interval ［CI］: 1.002-7.345, P=0.049) and mechanical lithotripsy (OR=9.183, 95% CI: 2.347-35.925, P=0.001) were independent risk factors for residual stones. ConclusionPost-ERCP nasobiliary cholangiography is an effective method to detect residual common bile duct stones. Multiple stones and mechanical lithotripsy during ERCP are independent risk factors for residual stones.
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Objectiye To investigate the clinical application value of emergency therapeutic encoscopic retrograde cholangio-pancreatography (ERCP) on acute biliary-pancreatic diseases.Methods Duodenoscope was applied on the emergency treatment for 103 patients of acute biliary-pancreatic diseases from March 2007 to May 2010. According to patients' conditions, the examination of ERCP,endoscopic nasobiliary drainage (ENBD) and endoscopic sphincterotomy (EST) were carried out. The papilla sphincter was slivered by needle knife under the circumstances of the stone incarceration in the papilla,then calculus was removed by net basket. ENBD or endoscopic retrograde biliary drainage (ERBD)was placed according to the state of an illness. Statistical analysis was made by SPSS 13.0 software with a 2 × 2 table analysis, Comparison of ratio were determined with x2 test, a value less than 0. 05 was considered as significant. Results Of 103 cases, the success rate of endoscopic treatment was 97. 1% ( 100/103 ).Among 100 cases, 25cases (24. 3% ) were treated with ERCP and ENBD/ERBD; 12 cases (11.7%) were treated with ERCP, needle knife fenestration and ENBD; 67 cases (65. 1% ) were treated with ERCP,EST, calculus removal and ENBD; 8 cases (7. 8% ) were treated with ERCP, EST and ERBD. Of 100 cases one (1.0%) suffered from postoperative hemorrhage of duodenal papilla, which was cured by endoscopic hemostasis. Compared with selective cases those undergoing emergency ERCP often needed two stage procedures (P = 0. 010), but there are no statistical differences between two groups in success rate (P = 0. 122). Conclusions Emergency ERCP are safe and effective in acute biliary-pancreatic diseases.
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Objective To provide information and assistance for research of bile duct injury in OLT through endoscopic observation and treatment of biliary complications after liver transplantation.Methods After OLT, all the cases in normal group, bile duct injury group and hepatic artery injury group were observed, diagnosed and recorded respectively. Meanwhile, the biopsy was performed through the endoscopy for pathological examination. For those cases without T tube, the biopsy was conducted by choledochoscopy in combination with duodenoscopy. Results The exterior and interior bile duct anatomy of the 9 cases in the normal group was normal. They had no bile duct stenosis and scar, their bile duct mucous membrane looked good and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Fibrous tissue and small vascular proliferation happened under epithelium scattered with plasmocyte and lymphocyte. Various kinds of bile duct stones-simple, multiple and casting mould type, were found in 12 cases with bile duct injury. Bile duet mucous membrane injured in different degrees was repaired after stone removed and obstruction relieved by endoscope. Bile duct tree becoming normal was seen by pacification examination. Three cases in the hepatic injury group had bile duct ischemic necrosis, losing of normal structure without bile duct wall and mucous membrane. Conclusion Bile ducts are injured in different degrees in OLT. The choledochofibroscopy is of the first choice for diagnosis and treatment of complications after OLT.
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Objective To investigate methods and effects of percutaneous choledochoscopy via cholangio-jejunal anastomotic stoma in the treatment of recurrent intrahepatic biliary duct stones. Methods Eight cases of recurrent intrahepatic biliary duct stones after a Roux-en-Y cholangiojejunostomy from January 2000 to February 2005 were treated with percutaneous choledochoscopy. An enterostomy was made at the afferent jejunal loop. Then a choledochoscope was introduced into the intrahepatic biliary ducts by way of the cholangio-jejunal anastomotic stoma for stone removal and intrahepatic duct or anastomotic stoma dilatation. Results The intrahepatic stones were thoroughly removed in all the 8 cases. The biliary duct stenosis in 4 cases and the anastomotic stoma stenosis in 2 cases were relieved. Follow-up checkups in the 8 cases for 1~3 years revealed no recurrence of intrahepatic stones or stenosis. Conclusions Percutaneous choledochoscopy via cholangio-jejunal anastomotic stoma is minimally-invasive, safe, feasible, and effective in the treatment of recurrent intrahepatic biliary duct stones.
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Objective To discuss the etiology and treatment of extrahepatic biliary stenosis due to iatrogenic bile duct injuries. Methods A total of 12 cases of extrahepatic biliary stenosis after iatrogenic bile duct injuries(including 5 cases of open cholecystectomy and 7 cases of laparoscopic cholecystectomy) from January 1998 to January 2005 in this hospital was reviewed.After the establishment of a percutaneous transhepatic access,choledochoscopic stone removal,balloon dilatation,and drainage stent placement were performed for treating biliary stenosis.Results A F_(20) Gruntzig balloon catheter was employed for bile duct dilatation.The plastic drainage stent at 6~8 mm in diameter was successfully placed after 2 times of dilatation in 8 cases and after 3 times of dilatation in 4 cases,for 6~12 months of indwelling.Follow-up observations in the 12 cases for 2~3 years (mean,2.6 years) found no abdominal pain,fever,or jaundice.B-ultrasonography and MRCP findings showed no biliary stenosis and recurrent stones.Conclusions Choledochoscopic stone removal,balloon dilatation,and drainage stent placement are minimally invasive,safe,and effective in the treatment of extrahepatic biliary stenosis.