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Objective:To evaluate endoscopic nasobiliary drainage (ENBD) combined with nasojejunal tube feeding for elderly patients with severe acute cholangitis.Methods:Data of 43 elderly patients with severe acute cholangitis, who received ENBD combined with nasojejunal tube feeding from January 1, 2016 to May 31, 2018 at Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine were retrospectively analyzed and were included in the observation group, and 43 other patients who received ENBD combined with conventional therapy in the same period were included in the control group with the matching principle of 1∶1. Liver function indices (ALT and AST), nutritional status (Hb, TP and ALB) and inflammation indices (WBC, NEU% and CRP) of the two groups before the operation, 3 days and 7 days of nutritional support after the operation were compared. Adverse reactions (abdominal distention and diarrhea), mortality, hospitalization time and expenses of the two groups were also compared.Results:There were no significant differences in gender composition, mean age, preoperative APACHE-Ⅱ score, NRS2002 score, liver function index, nutritional index, or inflammatory index between the observation group and the control group ( P>0.05). The baseline data of the two groups were comparable. After 3 days of nutritional support, ALT, AST, TP were 21.0 (15.0, 35.5) U/L, 26.0 (21.0, 36.5) U/L, and 64.2±5.2 g/L, respectively in the observation group, and 47.0 (29.5, 82.5) U/L ( P<0.05), 47.0 (29.0, 75.0) U/L ( P<0.05), and 60.5±6.4 g/L ( P<0.05), respectively in the control group. The levels of other indicators were not statistically different at this time point ( P>0.05). At 7 days postoperative nutritional support, ALT, AST, TP, ALB and CRP of the observation group were 22.0 (14.0, 31.5) U/L, 26.0 (20.5, 38.5) U/L, 67.6±5.4 g/L, 34.6±3.7 g/L, and 28.0 (18.5, 35.5) mg/L, respectively, and 43.0 (18.0, 59.5) U/L ( P<0.01), 34.0 (24.0, 60.5) U/L ( P=0.02), 64.5±5.7 g/L ( P=0.01), 31.5±7.0 g/L ( P=0.02), and 34.0 (24.0, 66.5) mg/L ( P<0.05) in the control group. There were no significant differences in the levels of other indicators between the two groups at this time point ( P>0.05). In the observation group, the incidence of diarrhea, abdominal distension, mortality, hospitalization time and hospitalization expenses were 32.6% (14/43), 30.2% (13/43), 9.3% (4/43), 16.0±7.0 days and 40±10 thousand yuan, respectively, and in the control group, the above indicators were 4.7% (2/43) ( P<0.05), 7.0% (3/43) ( P<0.05), 11.6% (5/43) ( P=0.72), 19.3±3.7 days ( P<0.05)) and 53±23 thousand yuan ( P<0.05), respectively. Conclusion:For elderly patients with severe acute cholangitis, enteral nutrition with ENBD can effectively improve the nutritional status, reduce inflammatory reaction, the impact on liver function, and hospital costs, and shorten the hospitalization time, which is suitable for further clinical application.
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Objective:To investigate the clinical efficacy and safety of entecavir combined with triple viable bifidobacterium capsules in the treatment of patients with cirrhosis induced by chronic hepatitis B.Methods:Totally 86 chronic hepatitis B patients with cirrhosis were randomly divided into the observation group and the control group with 43 ones in each.The control group was given entecavir treatment,and the observation group was treated with triple viable bifidobacterium capsules additionally.The treatment course was three months.The effect of treatment,changes of liver function(TBiL,AST,ALT,etc.),liver fibrosis level (HA,PCⅢ,LN,etc.)and adverse events were compared between the groups before and after the treatment.Results:The total effective rate of the observation group was higher than that of the control group (P<0.05);the levels of TBiL,AST and ALT decreased in both groups after the treatment (P<0.05),and those in the observation group were lower than those in the control group (P<0.05);the levels of HA,PC III and LN decreased in the two groups after the treatment (P<0.05),and those in the observation group were lower than those in the control group (P<0.05);there were no significant adverse drug reactions in both groups during the treatment course.Conclusion:Entecavir combined with triple viable bifidobacterium capsules in the treatment of patients with cirrhosis induced by chronic hepatitis B exhibits significant clinical efficacy,which can improve liver function and liver fibrosis with promising safety and without significant adverse reactions.
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Objective To evaluate endoscopic management of bile duct benign and malignant stenosis after cholecystectomy.Methods A retrospective analysis was made on 120 bile duct benign and malignant stenosis developed after cholecystectomy, ERCP diagnosis and treatment was evaluated.Results Of the 120 cases, there was bile duct stenosis in 79 cases (including 61 cases with common bile duct stones), papillary inflamnatory stenosis in 15 cases, diverticulum associated duodenal papillitis in 8 cases, malignant biliary stricture in 8 cases.Among these 120 cases there were hilar benign stenosis in 3 cases, 3 cases with hilar malignant tumor, 4 cases of chronic pancreatitis.Benign bile duct stricture was treated with plastic stent drainage, concomitant calculi by endoscopic stone extraction.Papillary stenosis and papillitis were managed by EST or EPBD, inoperable malignant biliary stenosis by mental stent placement.Conclusions After cholecystectomy biliary stenosis treated by ERCP and endoscopic therapy is miniinvasive helping control biliary infection when the diagnosis of benign stenosis of bile duct is established.
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Objective To evaluate the feasibility and safety of performing endoscopic retrograde cholangiopancreatography (ERCP) assisted by single-balloon enteroscopy (SBE) in patients with biliary obstruction after gastrointestinal reconstruction.Methods Clinical data about 7 cases of single-balloon enteroscopy assisted-ERCP (SBE-ERCP) were summarized including the completion of treatment,operation time,and complications for retrospective study.Results The papilla or anastomotic site was reached and therapeutic ERCP were performed successfully in 6 patients.The overall success rate was 85.7％ (6/7),and the mean operation time of SBE-ERCP was 42 min (ranging from 28 to 72 min).The afferent loop and papilla were failed to be confirmed in 1 patient.No complication such as perforation,pancreatitis or bleeding ocurred in all the 7 patients.Conclusion Single-balloon enteroscopy assisted-ERCP (SBE-ERCP) is feasible and relatively safe in postsurgical patients with gastrointestinal reconstruction.