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Objective:To investigate the influence of liver drainage volume on overall survival time in patients with unresectable malignant hilar bile duct obstruction.Methods:Data of 633 patients with unresectable malignant hilar bile duct obstruction (BismuthⅡ-Ⅳ) who underwent endoscopic stent drainage in 3 endoscopy centers from January 2002 to May 2019 were retrospectively analyzed. Main observation indicators included clinical success rate, stent patency, overall survival, the effective liver drainage volume, and complication incidence.Results:The clinical success rates of patients with liver drainage volume <30%, 30%-50%, and >50% were 56.8% (25/44), 77.3% (201/260) and 84.2% (277/329) respectively. The incidences of early cholangitis were 31.8% (14/44), 18.8% (49/260) and 16.1% (53/329). The median stent patency time was 4.5 (95% CI: 1.8-7.2) months, 5.6 (95% CI: 5.0-6.2) months and 6.6 (95% CI: 5.2-8.0) months. The overall survival time was 2.4 (95% CI: 1.8-3.0) months, 4.0 (95% CI: 3.4-4.6) months and 4.9 (95% CI:4.4-5.4) months, respectively. The clinical success rate ( χ 2=8.28, P=0.012), median stent patency period ( χ 2=18.87, P=0.015) and overall survival time ( χ 2=6.93, P=0.024) of 30%-50% liver drainage volume group were significantly higher than those of <30% group. Further multivariate cox regression analysis showed that the disease type (hepatocellular carcinoma VS hilar cholangiocarcinoma: HR=1.50, 95% CI:1.18-1.91, P=0.001; gallbladder carcinoma VS hilar cholangiocarcinoma: HR=1.45, 95% CI:1.14-1.85, P=0.002; metastatic cholangiocarcinoma VS hilar cholangiocarcinoma: HR=1.48, 95% CI:1.08-2.04, P=0.015), bilirubin level >200 μmol/L ( HR=1.35, 95% CI:1.14-1.60, P<0.001),metal stents ( HR=0.67, 95% CI:0.56-0.79, P<0.001), liver drainage volume (volume 30%-50% VS <30%: HR=0.64, 95% CI: 0.45-0.90, P=0.010; volume>50% VS <30%: HR=0.58, 95% CI:0.41-0.81, P=0.002) and anti-tumor therapy ( HR=0.51, 95% CI:0.42-0.61, P<0.001) were independent predictors for overall survival time of patients with unresectable malignant hilar bile duct obstruction. Conclusion:When endoscopic stent drainage is performed for patients with unresectable malignant hilar bile duct obstruction, at least 30% liver volume is required for better overall survival. In addition, the use of metal stent drainage and anti-tumor therapy may increase survival benefits.
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Objective:To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) after pancreaticoduodenectomy and endoscopic selection strategies.Methods:Clinical data of 34 patients treated with ERCP after pancreaticoduodenectomy at the Endoscopic Center of the First Affiliated Hospital of Air Force Medical University from January 2013 to December 2021 were retrospectively analyzed. The success rates of endoscopic insertion, diagnosis, treatment and ERCP, and the incidence of adverse events were analyzed.Results:Fifty ERCP treatments were performed in 34 patients. The success rates of endoscopic insertion, diagnosis, treatment, and ERCP after pancreaticoduodenectomy were 92.0% (46/50), 93.5% (43/46), 88.4% (38/43) and 76.0% (38/50), respectively. The success rates of ERCP assisted with colonoscope and balloon-assisted enterosocpe were 76.0% (19/25) and 75.0% (18/24), respectively. There were 3 adverse events, including 1 case of anastomotic mucosa tear during surgery, 1 case of cardiopulmonary arrest and 1 case of postoperative cholangitis.Conclusion:ERCP is effective and safe after pancreaticoduodenectomy in general. ERCP assisted with colonoscope and balloon-assisted colonoscope shows similar success rate after pancreaticoduodenectomy.
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Objective:To investigate the outcome and prognostic factors associated with endoscopic retrograde cholangiopancreatography (ERCP) in patients with primary sclerosing cholangitis (PSC).Methods:PSC patients admitted to Xijing Hospital from May 2009 to May 2020 were included. Data of demographics, clinical symptoms, laboratory and imaging tests, and ERCP consultations were collected to explore the population characteristics and clinical efficacy of ERCP treatment, and to follow up disease progression, transplant-free survival, and overall survival .Results:A total of 74 patients with PSC were included in this study, with a median age of 53 years, 54.1% (40/74) male. Patients combined with bile duct dominant stenosis, inflammatory bowel disease (IBD), and another autoimmune liver disease were 32.4% (24/74), 18.9% (14/74), and 17.6% (13/74), respectively, and those undergoing ERCP were 36.5% (27/74). Logistic regression analysis showed that high total bilirubin ( OR=12.33, 95% CI: 1.24-122.63, P=0.032) and bile duct dominant stenosis ( OR=24.67, 95% CI: 3.40-178.88, P=0.002) were independent high-risk factors for ERCP consultation. The operation and clinical success rates of ERCP were both 96.3% (26/27). As of the last follow-up, the proportions of patients progressing to cirrhosis, bile duct cancer, liver transplantation and death were 9.5% (7/74), 4.1% (3/74), 5.4% (4/74) and 18.9% (14/74), respectively. The five-year survival rate of the follow-up patients ( n=54) was 83.3%. The differences in transplant-free survival ( P=0.933) and overall survival ( P=0.608) between ERCP patients and non-ERCP patients were not statistically significant. Transplant-free survival of those who were companied with pruritus ( HR=5.30, 95% CI: 1.50-18.90, P=0.010) was shorter. Conclusion:PSC patients have higher proportion of IBD and less autoimmune liver disease. Higher proportion of patients with higher total bilirubin or bile duct dominant stenosis receive ERCP. While the short-term efficacy of ERCP is satisfactory, the long-term prognosis is still suboptimal. Patients with pruritus have a shorter transplant-free survival.
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Objective:To investigate the application value of different metal stents place-ment position in endoscopic drainage of malignant hilar bile duct obstruction.Methods:The retro-spective cohort study was conducted. The clinicopathological data of 300 patients with malignant hilar bile duct obstruction who were admitted to 3 medical centers, including 216 patients in the Third Affiliated Hospital of Naval Medical University, 48 patients in the Xijing Hospital of Air Force Medical University, 36 patients in the First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, from January 2012 to January 2019 were collected. There were 164 males and 136 females, aged (67±12)years. All patients were determined to be unresectable by multidisciplinary consultation and underwent endoscopic retrograde cholangiopancreatography. Observation indicators: (1) clinicopathological features of patients; (2) follow-up; (3) analysis of influencing factors for patency time of metal biliary stents and overall survival time of patients. Follow-up was conducted using outpatient examination and telephone interview to detect patency of metal biliary stents and survival of patients up to July 2019 or death of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used to conduct survival analysis. COX regression model was used for univariate and multivariate analyses. Factors with P<0.1 in univariate analysis were included in multivariate analysis. Results:(1) Clinicopathological features of patients. Of the 300 patients, 163 cases underwent endoscopic drainage with at least one metal biliary stent' distal portion crossing the duodenal main papilla (hereinafter referred to as crossing papilla), and 137 cases underwent endoscopic drainage with no metal biliary stent' distal portion crossing the duodenal main papilla (hereinafter referred to as no crossing papilla). Age, disease type (hilar cholangiocarcinoma, hepatocellular carcinoma, intrahepatic cholangio-carcinoma, gallbladder carcinoma, metastatic cholangiocarcinoma), metal biliary stents type (unilateral metal biliary stent, bilateral metal biliary stents) of patients with crossing papilla were (68±13)years, 95, 8, 11, 31, 18, 63, 100, respectively. The above indicators of patients with no crossing papilla were (64±12)years, 63, 22, 20, 23, 9, 126, 11, respectively. There were significant differences in the above indicators between patients with crossing papilla and patients with no crossing papilla ( t=2.70, χ2=17.69, 90.79, P<0.05). (2) Follow-up. All the 300 patients were followed up for 5.4(3.1,9.3)months. The patency time of metal biliary stents was 9.0(8.2,9.8)months and 6.4(4.8,8.0)months of patients with crossing papilla and patients with no crossing papilla, showing a significant difference between them ( χ2=8.23, P<0.05). The overall survival time was 5.5(4.2,6.8)months and 5.5(4.3,6.8)months of patients with crossing papilla and patients with no crossing papilla, showing no significant difference between them ( χ2=0.28, P>0.05). (3) Analysis of influencing factors for patency time of metal biliary stents and overall survival time of patients. Results of univariate analysis showed that type of metal biliary stents and the placement position of metal biliary stents were related factors affecting the patency time of metal biliary stents [ hazard ratio( HR)=0.44, 0.60, 95% confidence intervals as 0.30?0.64, 0.42?0.85, P<0.05]. Results of multi-variate analysis showed that bilateral metal biliary stents was an independent protective factor for the patency time of metal biliary stents ( HR=0.46, 95% confidence interval as 0.29?0.72, P<0.05). Results of univariate analysis showed that disease type (intrahepatic cholangiocarcinoma versus hilar cholangiocarcinoma), preoperative serum total bilirubin, type of metal biliary stents, anti-tumor therapy were related factors affecting the overall survival time of patients ( HR=1.05, 1.43, 0.72, 0.61, 95% confidence intervals as 0.70?1.57, 1.12?1.83, 0.55?0.92, 0.47?0.81, P<0.05). Results of multi-variate analysis showed that age >60 years, disease type as hepatocellular carcinoma, preoperative serum total bilirubin >200 μmol/L were independent risk factors for the overall survival time of patients ( HR=1.35, 1.98, 1.46, 95% confidence intervals as 1.02?1.79, 1.40?2.80, 1.13?1.89, P<0.05), and bilateral metal biliary stents, anti-tumor therapy were independent protective factors for the overall survival time of patients ( HR=0.68, 0.60, 95% confidence intervals as 0.53?0.89, 0.45?0.80, P<0.05). Conclusions:Endoscopic drainage with or without metal biliary stents' distal portion crossing the duodenal main papilla is safe and feasible for patients with malignant hilar bile duct obstruction. Bilateral metal biliary stents is an independent protective factor for the patency time of metal biliary stents. Age >60 years, disease type as hepatocellular carcinoma, preoperative serum total bilirubin >200 μmol/L are independent risk factors for the overall survival time of patients, and bilateral metal biliary stents, anti-tumor therapy are independent protective factors for the overall survival time of patients.
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Objective:To compare the bile bacterial diversity in patients with different types of common bile duct stones (CBDS).Methods:A total of 45 patients with CBDS diagnosed by abdominal ultrasound, abdominal CT and (or) magnetic resonance cholangiopancreatography (MRCP) and treated by endoscopic retrograde cholangiopancreatography (ERCP) in the First Affiliated Hospital of Air Force Medical University from August 2017 to January 2018 were divided into the non-stone (NS) group, the primary cholesterol stone (PCS) group, the primary pigment stone (PPS) group, and the recurrent stone (RS) group. 16S rRNA sequencing was used to analyze the microbile community structure and diversity in bile which was collected before contrast medium injection.Results:Thirty-three patients were in the non-RS group (8 in the NS group, 8 in the PCS group, and 17 in the PPS group) and 12 were in the RS group. The proportion of patients with intra-diverticular papilla [41.67% (5/12) VS 3.03% (1/33), χ2=8.27, P=0.004], loose stones [91.67% (11/12) VS 36.36% (12/33), χ2=10.77, P=0.001] and pigmental stones [100.00% (12/12) VS 51.52% (17/33), χ2=7.04, P=0.008] were significantly higher in the RS group than those in the non-RS group. There was no significant difference in other baseline data ( P>0.05). At the phylum and genus level, the bacterial abundance was similar in the RS and PPS group. Alpha and Beta diversity analysis showed that the microbial diversity was similar between the RS and PPS group, both of which were lower than those in the NS and PCS group ( P<0.05). MetaStat analysis revealed that Helicobacter pylori was the dominant bacteria in the RS group, and Proteobacteria and Escherichia coli were the dominant bacteria in both RS and PPS groups. Conclusion:Bacterial abundance of bile in the RS group is similar to that of the PPS group, but the diversity of biliary bacteria flora in the RS group and PPS group are significantly lower than those in the PCS group and NS group. Helicobacter pylori is the dominant biliary bacteria in the RS group.
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Objective:To investigate the risk factors for moderate to severe pancreatitis (PEP) after endoscopic retrograde cholangiopancreatography (ERCP) .Methods:Data of 6 731 patients diagnosed as having biliary and pancreatic diseases with initial papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) from June 2010 to June 2020 in the First Affiliated Hospital of Air Force Medical University were retrospectively analyzed. Parameters related to intubation and postoperative complications were prospectively collected. The main end point was moderate to severe PEP. Logistic regression analysis was used to explore the risk factors for moderate to severe PEP.Results:The incidence of overall PEP and moderate to severe PEP in 6 731 ERCP patients with initial papilla were 5.3% ( n=359) and 1.0% ( n=68) respectively. Univariate analysis showed that female, indications of ERCP, cannulation method, cannulation time, cannulation attempts, times of inadvertent pancreatic duct cannulation and cannulation with or without trainee involvement were all associated with moderate to severe PEP ( P<0.10). Multivariate analysis showed that female ( OR=2.32, 95% CI:1.28-4.21, P=0.006), non-common bile duct stones indication ( OR=2.04, 95% CI:1.16-3.59, P=0.014), cannulation time ≥5 min ( OR=2.23, 95% CI: 1.20-4.13, P=0.011), inadvertent pancreatic duct cannulation time ≥1 ( OR=1.88, 95% CI: 1.03-3.44, P=0.040) and non-trainee involvement cannulation ( OR=1.81, 95% CI: 1.02-3.22, P=0.043) were independent risk factors for moderate to severe PEP. Conclusion:The independent risk factors for moderate to severe PEP include female, non-common bile duct stones indication, non-trainee involvement cannulation and difficult cannulation. Great importance should be attached to these factors above during the whole perioperative period of ERCP.
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Objective:To explore the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) biliary stent implantation in patients with unresectable malignant biliary stricture (MBS) and the influencing factors of overall survival.Methods:The clinical data of 346 patients who underwent ERCP biliary stent implantation due to MBS from May 2013 to October 2016 in Xijing Digestive Disease Hospital of Air Force Military Medical University, Shanxi Bethune Hospital and Mengchao Hepatobiliary Hospital of Fujian Medical University were retrospectively analyzed, and the efficacy, complications and risk factors affecting overall survival were also analyzed.Results:After ERCP biliary stent implantation, the levels of total bilirubin, γ-glutamyl transpeptidase, alkaline phosphatase and alanine aminotransferase were lower than those before surgery (all P < 0.01). The incidence of infection after operation was 14.7% (51/346), and the incidence of biliary infection was 13.0% (45/346). The incidence of post-ERCP pancreatitis (PEP) was 4.6% (16/346). The median survival time after ERCP was 131.0 d (70.3 d, 246.5 d). Multivariate Cox regression analysis showed that the independent risk factors affecting the overall survival patients included the hilar bile duct stenosis ( HR = 1.85, 95% CI 1.44-2.38, P < 0.01), preoperative bilirubin level exceeding the upper limit of normal level by 5 times ( HR = 1.75, 95% CI 1.30-2.36, P < 0.01), carbohydrate antigen 199 level exceeding the upper limit of normal level by 10 times ( HR = 1.27, 95% CI 1.00-1.61, P = 0.050), vascular and organ metastasis ( HR = 1.32, 95% CI 1.04-1.69, P = 0.023), and the poor jaundice decreasing level ( HR = 1.37, 95% CI 1.02-1.85, P = 0.037) . Conclusions:The ERCP biliary stent implantation is a safe and effective therapy for MBS. ERCP biliary stent implantation MBS patients with hilar bile duct stenosis, preoperative bilirubin levels more than 5 times of the upper limit of normal level, carbohydrate antigen 199 levels more than 10 times of the upper limit of normal level, vascular and organ metastasis, and poor jaundice decreasing level may have poor overall survival.
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Objective:To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for patients with liver cirrhosis combined with biliopancreatic diseases.Methods:Data of 99 patients with liver cirrhosis combined with biliopancreatic diseases who received ERCP at Xijing Digestive Hospital from November 2008 to December 2017 for the first time were retrospectively studied. Success rate of ERCP and incidence of complications were analyzed.Results:The 99 cases of liver cirrhosis were mainly caused by hepatitis B virus infection (40.4%, 40/99) and unknown reasons (30.3%, 30/99), and the mean model for end-stage liver disease score was 15.4±5.3. The common bile duct stones and bile duct stricture were the most common biliopancreatic diseases, accounting for 49.5% (49/99) and 33.3% (33/99), respectively. The success rate of ERCP was 100.0%(99/99). The total postoperative complication incidence was 14.1% (14/99), among which liver cirrhosis-related complications was 3.0% (3/99); ERCP-related complications was 11.1% (11/99), including 9.1% (9/99) biliary tract infection, and 2.0% (2/99) delayed bleeding. No post-ERCP pancreatitis, perforation or death occurred.Conclusion:ERCP is safe and effective for liver cirrhosis combined with biliopancreatic diseases.
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Objective@#To investigate the history, risk factors for prognosis of malignant biliary stricture (MBS) patients receiving conservative therapy after endoscopic retrograde cholangiopancreatography(ERCP) and to set up a predictive model for overall survival (OS).@*Methods@#MBS patients who underwent ERCP and conservative therapy in Xijing Hospital and PLA No.451 Hospital from January 2009 to December 2013 were enrolled to the present study. Predictive factors associated with OS were identified in the training cohort by stepwise multivariate Cox regression analysis. A predictive model was then developed and externally validated in the validation cohort.@*Results@#Between January 2009 and December 2013, 152 and 149 patients were eligible to the training and validation cohort respectively. In the training cohort, tumors were mainly originated from bile duct (33.6%), pancreas (23.5%) or ampulla (20.4%). 76.3% (116/152) patients died during the observation period. The median OS for the training population was 5.0 months (3.9-6.2 months). CA19-9≥1 000 U/mL, non-ampulla tumor, metastasis, pre-ERCP total bilirubin≥7 mg/dL and hilar stricture were identified as independent predictive factors of poor OS (all P<0.05). Based on these factors, the COMTH predictive model was developed. The median OS of patients with COMTH>8 in the training and validation cohorts were both 3.0 months, which were significantly shorter than those with COMTH≤8 (10.0 and 6.9 months in the training and validation cohorts respectively, both P<0.001).@*Conclusion@#The prognosis of MBS patients undergoing ERCP is poor. The survival chance of patients with COMTH>8 is even more dismal.
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Endoscopic retrograde cholangiopancreatography(ERCP)is a well-established advanced endoscopic technique for the diagnosis and treatment of pancreatobiliary diseases. New advances have been made in the treatment concept and techniques of ERCP in recent years. This article elaborates on the recent advances in ERCP,including the application of pancreatic duct stent,non-steroidal anti-inflammatory drugs,and aggressive hydration to prevent postoperative pancreatitis,covered metal stent for the treatment of benign bile duct stenosis,in-traluminal radiofrequency ablation for malignant bile duct stenosis,extracorporeal shockwave lithotripsy and covered metal stent for the treat-ment of chronic pancreatitis,peroral choledochoscopy for qualitative diagnosis of bile duct stenosis and huge refractory stones,definition of difficult intubation,timing of pre-cut technique,and ERCP after gastrointestinal reconstruction.
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Objective To investigate the clinical outcome of pancreatic pseudocyst(PPC)treated with non-surgical methods,and to compare the efficacy and safety between percutaneous drainage and endoscopic drainage in the management of PPC.Methods From February 2010 to July 2017,clinical data of patients with PPC,who received percutaneous drainage or endoscopic drainage,were retrospectively analyzed.The symptom relief rate,short-term and long-term radiologic remission rate,complication rate, recurrence rate and length of hospital stay were compared between patients treated by ultrasound guided percutaneous drainage(percutaneous group),by endoscopic ultrasonography-guided drainage(EUS group)and by endoscopic retrograde pancreatography guided transpapillary drainage(ERP group).Two independent samples t test,one-way analysis of variance,non-parametric test and Fisher′s exact test were performed for statistical analysis.Results A total of 153 patients were treated and the operation was successfully conducted in 148 patients(96.7%),of whom 39 were in percutaneous group,73 in EUS group and 36 in ERP group.The median follow-up time was 26 weeks(two weeks to 358 weeks).The symptom relief rate,long-term radiographic remission rate,complication rate,recurrence rate and retreatment rate of percutaneous group,EUS group and ERP group were 87.2%(34/39),79.5%(58/73),80.6%(29/36);81.5%(22/27),88.6%(39/44),66.7%(16/24);17.9%(7/39),28.8%(21/73),16.7%(6/36);15.0%(3/20),13.8%(8/58),10.0%(2/20);and 10.3%(4/39),8.2%(6/73),2.8%(1/36),respectively.There was no statistically significant difference among three groups (all P> 0.05).The short-term radiographic remission rate of ERP group was significantly lower than those of percutaneous group and EUS group(46.7%,14/30 vs 77.1%,27/35 and 87.7%,64/73),and the differences were statistically significant(χ2 =6.442 and 19.450,both P<0.01).The median hospital stay of percutaneous group was longer than those of EUS group and ERP group(14.0 days vs 9.0 days and 8.0 days),and the differences were statistically significant(Z= -3.687 and -2.630,both P<0.01).Conclusions The efficacies of percutaneous drainage and EUS-guided drainage are both better than ERP,and they are effective and safe methods especially for the patients with complication of pseudocysts and necrosis debris in pseudocysts.However,the hospitalization time of percutaneous drainage is longer. In addition,percutaneous drainage can be an alternative method after failed endoscopic drainage.
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Objective To analyze the risk factors of post-ERCP pancreatitis (PEP) and to evaluate the relationship between cannulation time and PEP.Methods The data of cannulation time in 1 625 patients who underwent ERCP from 2010 to 2012 were retrospectively studied.The risk factors associated with PEP were analyzed by univariate and multivariate Logistic regression analysis.The effect of different cannulation time on PEP was evaluated.Results The incidence of overall PEP was 4.6％ (75/1 625) including 4.1％ (67/1 625)of mild and 0.5％ (8/1 625)of moderate-to-severe.Univariate analysis revealed that diabetes mellitus (P =0.02),choledocholithiasis (P =0.02),malignant biliary stenosis (P =0.007),duodenal stenosis (P =0.029),precut (P＜0.01),cannulation time ≥ 8 min (P＜0.01),blood platelet count ≥ 180× 109/L(P =0.089),alkaline phosphatase ≥ 120 U/L (P =0.083) and total bilirubin ≥ 17.1 μmol/L (P =0.094)were associated with PEP.Multivariate analysis revealed that precut (OR=1.93,95％CI:1.10-3.39,P=0.022),cannulation time ≥8 min (OR =3.50,95％CI:2.00-6.13,P＜0.01) and duodenum stenosis (OR=2.92,95％CI:1.08-7.86,P=0.034) were independent risk factors of PEP.Within 30 min of cannulation,longer cannulation time was accompanied with higher PEP rate.Conclusion The cannulation time is an independent risk factor of PEP.Overall PEP is increased when cannulation time is more than 8 min.
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Objective To investigate risk factors decreasing cannulation success rate of trainees receiving hands-on ERCP training and to improve thelevel of ERCP training.Methods Clinical data of 1 193 ERCP cases involved in training in Xijing Hospital of Digestive Disease from December 2012 to December 2014 were retrospectively analyzed.Multivariate logistic regression analysis was performed to investigate the risk factors influencing cannulation success rate of trainees.Results There were 1 165 and 28 patients undergoing common biliary duct (CBD) cannulation and pancreatic duct(PD) cannulation respectively.The success rate of CBD cannulation by trainees was 58.5％(681/1 165)and the overall success rate was 97.9％(1 140/1 165).PD cannulation success rate by trainees was 39.3％ (11/28) and the overall success rate was 89.3％ (25/28).The overall complication incidence was 8.0％ (96/1 193)and the incidence of post-ERCP pancreatitis was 4.4％(53/1 193).Multivariate logistic regression analysis showed that the selective cannulation by trainees was more likely to fail in patients with malignant biliary stricture(OR =0.44,95％CI:0.28-0.67,P＜0.01),benign or undetermined biliary stricture(OR =0.32,95％ CI:0.17-0.60,P＜ 0.01),suspected sphincter of Oddi dysfunction(SOD) (OR =0.28,95％ CI:0.16-0.47,P＜ 0.01),coexisting hypertension (OR =0.65,95 ％ CI:0.44-0.96,P＜0.05),RDW ≥ 48 fL (OR =0.69,95％ CI:0.51-0.92,P＜ 0.05),PLT＜ 100 × 109/L (OR=1.68,95％CI:1.05-2.71,P＜0.05).Conclusion Biliary stricture,suspected sphincter of Oddi dysfunction,coexisting hypertension,abnormal RDW and PLT were independent risk factors influencing cannulation success rate by trainees during hands-on ERCP training.
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Objective To explore the success rate and failure risk factors of biliary stenting on the patients with type Ⅰor Ⅱ duodenal malignant stricture treated by self-expandable metallic stent (SEMS). Methods A total of 36 patients with unresectable duodenal stricture after endoscopic SEMS placement be-tween February 2010 and February 2014 at Xijing Digestive Disease Hospital were enrolled.These patients underwent ERCP biliary metal stenting subsequently due to the malignant biliary stenosis.The clinical and imaging features of these patients were retrospectively analyzed.Results ERCP biliary stenting was suc-cessfully completed in 66.7% of patients with previous duodenal SEMS treatment.The success rates of pa-tients with type Ⅰ and Ⅱ duodenal stricture were 88.0% and 18.2% respectively(P <0.001).The suc-cess rates of patients with different lengths of duodenal stenosis were 88.9% for <3.5 cm and 44.4% for ≥3.5 cm (P =0.005).Compared with 80 or 90 mm duodenal stent,patients with 60 mm stent had a higher completion rate for ERCP biliary stent (88.0% VS 18.2%,P <0.001).Multivariate logistic regression a-nalysis revealed that length of duodenal stenosis ≥3.5 cm and 80 or 90 mm duodenal stent were independent factors for failure of ERCP in patients with previous SEMS placement.Conclusion For unresectable DMS patients with SEMS placement,subsequently ERCP biliary metal stenting is safe and effective.The length of duodenal malignant stenosis and longer duodenal stent are high-risk factors for the failure of ERCP biliary stenting.
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Objective To investigate the role of endoscopic retrograde cholangiopancreatography (ERCP) management in the diagnosis and treatment and illustrate clinical features of non-iatrogenic hemobi lia.Methods A total of 35 patients diagnosed as hemobilia via endoscope from August 2009 to September 2012 were reviewed retrospectively.Patients with iatrogenic causes of hemobilia were excluded in this study.Results The clinical features of hemobilia mainly included jaundice (77.1％),abdominal pain (62.9％),hematemesis (5.7％),melena (2.9％) and hematochezia (2.9％).Quincke triad was found in 4 patients with hemobilia.Hemobilia were caused by hepatobiliary malignancies in 29 patients and benign biliary tract diseases in the other six.Biliary obstruction caused by hemobilia was successfully ameliorated by ERCP in 34 patients.Postoperative pancreatitis ocurred in 1 patient.Conclusion The common noniatrogenic causes of hemobilia were hepatobiliary and pancreatic malignancies.ERCP is recommended as the initial management to confirm the hemobilia and solve biliary obstruction.
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Objective To assess the feasibility and safety of adjustable loop-based purse-string technique in gastrotomy closure of natural orifice translumenal endoscopic surgery (NOTES).Methods Ten healthy female dogs were used in this study.Transgastric NOTES peritoneal exploration was performed in 5 groups (2 dogs in each) via various sites of the stomach ( greater curvature of the antrum; greater and lesser curvature of the body; anterior and posterior wall of the body).The gastric incision was then closed by using loop-based purse-string technique.Healing of the incision and intra-peritoneal infection were checked by endoscopy,necropsy,bacterial culture and histological examination 2 weeks later.Results The performance of NOTES peritoneal exploration and closure with purse-string technique was successful in ten dogs without significant complications.The mean operation time of closure was 7.3 ± 1.8 min.Minor bleeding occurred in 2 dogs (20％) during the incision of greater curvature of the antrum and body,which was controlled by electrocoagulation.Culture of the ascitic fluid and necropsy revealed no sign of abdominal infection or other complications except for adhesion in 1 dog ( 10％ ).The intact incision was confirmed by endoscopic,postmortem and histological examination,which suggested complete healing of the incision.Conclusion It is easy and safe to use loop-based purse-string technique for closure of multi-regional NOTES gastrotomy.This technology may be used for the repair of gastric ulcer perforation theoretically.
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Objective To evaluate the technical feasibility and safety of transvaginal appendectomy by endoscopy in canine models.Methods Six female dogs weighing between 12-15 kg underwent transvaginal appendectomy by endoscopy.A small incision at posterior fornix of the vagina was made endoscopically by a needle knife and then dilated by a balloon dilator.After the endoscope entered the peritoneal cavity,the appendicular artery was clipped and the appendix was dissociated,and then the free appendix was ligated by an endoloop near root and removed by snare cutting.The appendix was then removed through the vaginal port.Finally,the vaginal incision was closed by clipping and endolooping.Two weeks after the procedure,the animals were sacrificed for anatomic investigation.Results Endoscopic transvaginal appendectomy was successfully performed in all animals with a mean operating time of (94.2±41.8) min.Complicated bleeding occurred in 1 dog and rectal burn in another during the operation.All the experimental animals survived the post operative period for 2 weeks without any complications.Post mortem examination revealed that the wound and vaginal incision healed well.Conclusion Transvaginal appendectomy by endoscopy is safe and feasible in a canine model,while further study and progression of appropriate accessories are needed for future clinical use.
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Objective To investigate the efficacy and complications of therapeutic ERCP for patients over 80 years. Methods Data of 80 patients aging over 80 years, who tnderwent therapeutic ERCP from August 2007 to August 2009 were retrospectively studied. The etiology, complications and therapeutic effects were evaluated. Results A total of 51 patients (63. 8% ) were accompanied by cardiovascular diseases, and 43 patients were diagnosed as having malignant bile duct stricture (53. 8% ). The overail therapeutic efficacy was 96. 3%. The incidence of post-operative complications was 12. 5% (10/80). Occurrence of complications in patients with malignant tumors ( 18. 6% ) was significantly higher than that in patients with bile duct stones (5.6% ,P ＜0. 05). Incidence of complications in those with cardiopulmonary diseases was similar with that in patients without (11.8% vs. 13.8%,P＞0.05). Conclusion Age more than 80should not be considered as contraindication of ERCP. Therapeutic ERCP is effective in senior patients. Patients with advanced ages shows a relatively high incidence of complication after ERCP, which may not be related to other accompanying diseases.
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The amino acid sequence (1-301aa) coding the human PTP1B catalytic domain (PTP1Bc) was obtained from the GenBank. The PTP1Bc gene was constructed by overlapping PCR, then was inserted into vector pET-22b(+) and expressed efficiently in E. coli BL21(DE3) under optimum condition after IPTG induction. The proteins were expressed mainly as inclusion bodies with the yield of more than 30% of total bacterial proteins. The expressed products were purified through Ni(2+)-affinity chromatographic column. After purification, the purity of the proteins was more than 95%. Western blotting analysis suggested that the purified proteins could specially combine with anti-PTP1B antibody. Enzyme activity assay showed that the protein has phosphatase activities.