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Objective To evaluate the diagnostic value of endoscopic ultrasonography(EUS)for common bile duct(CBD)stones before endoscopic retrograde cholangiopancreatography(ERCP). Methods Data of patients with suspected CBD stones admitted to The First People′s Hospital of Hangzhou from July 2012 to July 2013 were reviewed. Diagnostic efficiency and rates of complications were analyzed between patients undergoing EUS(EUS group)and MRCP(MRCP group)before ERCP, and between patients who underwent EUS and ERCP in different sessions(non-one-session group)with those in one session(one-session group). Results A total of 657 patients were included. With ERCP and follow-up results as the gold standard, the sensitivity(97.5% VS 88.4%), accuracy(96.3% VS 88.0%)and negative predictive value(88.9% VS 60.0%)of EUS in the diagnosis of CBD stones were significantly higher than those of MRCP(P<0.05). There were no significant differences between one-session group and non-one-session group in the sensitivity(97.5% VS 97.4%), specificity(91.7% VS 90.0%), positive predictive value(98.3% VS 97.4%), negative predictive value(88.0% VS 90.0%), and accuracy (96.6% VS 95.9%)in diagnosis of CBD stones(P>0.05). There were no significant differences in incidence of postoperative complications of ERCP between EUS and MRCP group[5.4%(13/242)VS 5.1%(21/415),P>0.05],and between one-session group and non-one-session group[5.5%(8/145)VS 5.2%(5/97),P>0.05].Conclusion Preoperative EUS before ERCP could increase diagnostic sensitivity and negative pridictive value of CBD stones without increasing the incidence of complications.
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Objective To evaluate the clinical efficiency of endoscopic ultrasound-guided celiac plexus neurolysis(EUS-CPN)for pain associated with advanced pancreatic carcinoma.Methods EUS-CPN was performed in 29 patients with advanced pancreatic carcinoma in Hangzhou First People′s Hospital from May 2010 to April 2015. The pain status before and after treatment was measured by visual analogue scale (VAS),and the clinical efficacy was assessed by pain anesis rate(PAR). Results All the 29 patients successfully completed EUS-CPN. The mean VAS value of the first day after treatment(3.6±1.5)was lower than that of preoperative(8.2±2.3,P=0.00). The mean VAS value of 1 month after treatment(2.0±0.6) was statistically different compared with the value of the first day after treatment(P=0.00). There were 10, 9,4,and 3 patients who had complete,obvious,moderate and mild relief,respectively. Three patients had no pain relief. The overall efficiency rate was 79.3%(23/29). Conclusion EUS-CPN is a safe and effective method for relieving pain in pancreatic carcinoma.
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Objective To study the therapeutic effect of EUS-guided rendezvous (EUS-RV) when ERCP failed in patients with malignant obstructive jaundice. Methods 12 cases of malignant obstructive jaundice patients were underwent EUS-RV after unsuccessful ERCP. The operation success rate, liver function recovery 1 week and 1 month after operation, complication rates, hospital stay and patient survival were observed. Results All 12 patients were successfully operated and placed stents by endoscopic ultrasound puncture following by ERCP: 8 patients by the stomach, 4 patients by duodenum, the operation success rate was 100.00%; There were significant difference between the liver function recovery of preoperative and postoperative one week or postoperative one week and postoperative one month (P < 0.05). 1 bleeding occurred and were improved after conservative treatment, the complications rate was 8.33%; the hospital stay was (20.68 ± 5.76) d; the average survival time of patients was 224 d. Conclusion EUS-guided rendezvous may be the alternative treatment due to the diminutive trauma and good effect when ERCP failed in patients with malignant obstructive jaundice.
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Objective To study the therapeutic effect of EUS-guided biliary drainage (EUS-BD) on patients with malignant obstructive jaundice when ERCP failed.Methods From January 2014 to January 2016,all patients with malignant obstructive jaundice during hospitalization underwent EUS-guided biliary drainage (group A,36 cases) or PTCD treatment (group B,30 cases) by draw after failed ERCP.Operation success rate,liver function recovery time,complication rates,length of hospital stay and hospital costs were observed and compared.Results There was no significant difference in the operation success rates between two groups [94.44％ (34/36) VS 86.67％ (26/30),P＞0 05)].And there were significant differences in liver function recovery time (25.79± 6.48 d VS 30.24 ± 8.49 d),incidence of complications [5.56％ (2/36) VS 23.33％ (7/30)],length of hospital stay (21.54±4.73 d VS 25.68 ± 8.56 d) and hospitalization costs (23.5±8.4 thousand yuan VS 32.8±6.5 thousand yuan,P＜0.05).Conclusion EUS-guided biliary drainage could be the first option for its noninvasiveness and efficacy,when ERCP failed in patients with malignant obstructive jaundice.
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Objective To evaluate the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guid﹣ed fine-needle aspiration in patients with pancreatic cancer. Methods 256 patients with pancreatic cancer from Jan﹣uary 2010 to December 2014, 82 were considered resectable on the basis of cross-sectional imaging findings. Of these patients, 54 underwent EUS-FNA before surgery (FNA+group) and 28 underwent surgery without preoperative EUS-FNA (FNA- group), the diagnosis result of EUS-FNA and the survival time of the two groups were observed. Results All 54 lesions were visible on EUS, and all 54 attempts at FNA were technically successful. The diagnostic accuracy according to cytology and histology findings was 94.44 % (51/54) and 88.89% (48/54), respectively, and the total accuracy was 94.44 % (51/54). Two patients developed mild pancreatitis and two hemorrhage after EUS-FNA but were successfully treated by conservative therapy. No severe complications occurred after EUS-FNA. In the FNA+and FNA- groups, the median relapse-free survival (RFS) was 282 and 265 d, respectively (P>0.05), and the median overall survival (OS) was 568 and 557 d, respectively (P>0.05). RFS and OS were therefore not inferior in the FNA+group. These data indicate that the usage of EUS-FNA did not influence RFS or OS, nor did it increase the risk of other complications. Conclusions Preoperative EUS-FNA is a safe and accurate diagnostic method.
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Objective To investigate clinical effect of pinaverium bromide combined with probiotics in the treatment of patients with irritable bowel syndrome (IBS).Methods 156 patients with IBS were randomly divided into observation group and control group.Cases in control group received pinaverium bromide tablets,and cases in observation group received bifid triple viable capsule plus pinaverium bromide tablets.Duration of treatment was 4 weeks in both groups.Clinical efficacy was evaluated after treatment.Results Total effective rates of observation group and control group were respectively 85.9％ and 70.5％.Total effective rate of observation group was significantly better than that of control group(x2 =8.557,P ＜ 0.05).The systolic pressure of anorectum was significantly lower than that of control group after treatment(t =4.432,P ＜ 0.01),but resting pressure and diastolic pressure were not significantly different after treatment(t =0.812,0.142,all P ＞ 0.05).First sensation volume,defecating sensation volume and pain volume in observation group were significantly lower than those in control group (t =3.440,4.671,3.697,all P ＜ 0.01).Conclusion Treatment of IBS with pinaverium bromide combined with probiotics is effective,and it can improve the anorectal dynamic and isceral sensitivity in patients with IBS.
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Objective To study the predetermination value of multi-slice spiral CT for showing the major blood vessels,bile and pancreatic ducts around normal duodenal papilla before EST.Methods A 16-slice spiral CT was used to perform 28s and 68s enhanced scan for normal structures surrounding duodenal papilla in 30 subjects.Post-processing was done to the raw data with thin-slice maximum intensity projection (TSMIP) and thin-slice average intensity projection (TSAIP),and then the structure of bile and pancreatic ducts,duodenal artery and pancreatic-duodenal conjunction were reconstructed.The reconstructed images were double-blind evaluated.Distances between papilla and upper,front,and behind edge of the pancreatic-duodenal conjunction,situation of the duodenal papilla artery and the distance from the papilla artery end to the papilla were recorded.Results After dual-phase enhanced scan,the post-processing results for the images of the surrounding structure of pancreatic and duodenal papilla were stable and the results of double-blind evaluation were consistent.Image scores of the arteries surrounding duodenal papilla and pancreatic duct at 28th second were significantly higher than those of 68th second,whereas bile duct and the ampulla structure image scores of 68th second were higher.TSMIP of local vascular structure could display anterior-superior pancreatic-duodenal artery (ASPDA) in 93.3％ of the subjects,posterior-superior pancreatic-duodenal artery (PSPDA) in 73.3％,inferior pancreatic-duodenal artery (IPDA) in 73.3％,duodenal-papillary artery (DPA) in 56.7％,bile duct in 96.7％,pancreatic duct in 90.0％ aud pancreatic and duodenal parenchima in 100.0％.The DPAs all started from PSPDA origin and down to papilla,with only 2 cases of 30 (6.7％) reached the upper edge of the duodenal papilla.Others showed arteries turned thin obviously at 12 mm above the papilla; the normal common bile duct can be tracked to the opening of the papilla.The Coronal Oblique TSAIP imaging showed the distance from the duodenal papilla-bile duct ending to the lower edge of the pancreatic-duodeual upper conjunction was 15.7±1.9 mm.Distance from papilla to the front edge of pancreatic-duodenal conjunction was 16.6±3.2 mm and to the behind edge was 1.7±0.4 mm.Distance (depth) from the inner edge of the papilla to the bile-pancreatic conjunction was 8.0±1.7 mm.Conclusion The 3D reconstruction of the Multi-slice spiral enhancement CT Imaging can providc high quality images of relative vascular,bile-pancreatic and obvious surrounding structures to the forthcoming operation.Massive hemorrhage and perforation risks of EST can be evaluated based on the vascular distribution and directions around duodenum and pancreas and the bile duct imaging.
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Objective To explore the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute cholangitis during pregnancy. Methods The clinical data of 16 pregnant patients with acute cholangitis who underwent ERCP and/or endoscopic sphincterotomy (EST) from August 2001 to February 2009 were retrospectively analyzed. Results Two patients were in the first trimester, 8 in the second trimester and 6 in the third trimester of pregnancy. Two patients had endoscopic placement of a plastic biliary stent in the first trimester. EST was then used to remove the stones successfully 4 and 5 months later. ERCP was performed in 8 women in the second trimester and 6 in their third trimester. Successful clearance of biliary stones at the time of ERCP was achieved in 14 pregnant women. Two patients who had multiple biliary stones underwent placement of a plastic biliary stent to limit the total fluoroscopy time. A second ERCP was carried out on the 2 patients to remove the stones after delivery. Post-ERCP mild pancreatitis developed in 1 patient in the third trimester. There was no spontaneous fetal loss, premature births, intrauterine fetal distress, fetal growth retardation/mental retardation/fetal malformation. Conclusion Short-term follow-up of all neonates whose mothers received ERCP during their pregnancies supported the efficacy and safety of its use. However, the long-term fetal complications of radiation exposure have not been investigated.
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Objective To compare the therapeutic efficacy and procedure related complications between endoscopic sphincterotomy (EST) and surgery in treatment for choledocholithiasis concomitant with liver cirrhosis. Methods The data of patients with choledocholithiasis concomitant with cirrhosis who underwent EST (n = 139 ) or surgery (n =98 ) for stone clearance from August 1985 to May 2008,were retrospectively analyzed and compared. Results The success rates of complete stone clearance in EST and surgery groups were 95% and 100%,respectively. There was a significant difference in the rate of procedure-related complications between EST and surgery groups ( 16. 5% vs. 62. 2%,P ＜ 0. 01 ),as well as the mortality rate (5.0% vs. 24. 5% ). When patients were further grouped according to Child-Pugh liver function classification,a significant difference in rate of procedure-related complications was detected between 2 groups in patients of Child-Pugh B and C,as well as the mortality rate in patients of Child-Pugh C. Conclusion For patients with choledocholithiasis concomitant with liver cirrhosis,EST,with a stone clearance rate at 95%,is superior to surgery with a significant reduction in risk of procedure-related complication and mortality rate.
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Objective To explore the therapeutic effect and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute severe cholangitis (ASC) in patients older than eighty. Methods The clinical data of 106 patients aged 80 years and over with ASC who underwent ERCP were reviewed. Results Among 106 cases, there were 95 patients with common bile duct (CBD) stones, and 11 patients with biliary tract neoplasms. The 11 cases with biliary tract neoplasms underwent endoscopic nasobiliary drainage (ENBD) to correct critical situation. After stabilization, surgical treatment or stent placement was performed. The 61 of 95 cases with CBD stones underwent ENBD in critical phase and endoscopic sphincterotomy (EST) plus stone removal for subsequent treatment after stabilization. The 34 of 95 cases with CBD stones underwent EST to remove stones. Procedure-related complications were found in 5 patients. At 24 and 72 hours postoperation, the values of white blood cell count, serum total bilirubin, body temperature, and occurrence rate of patients with shock and mental symptoms were decreased in the other 101 patients.Conclusions For patients aged 80 years and over with ASC, ERCP is a safe and effective procedure.