ABSTRACT
Objective To investigate the efficacy of holmium laser coagulation under choledochoscope for the treatment of intrahepatic hemobilia.Methods The clinical data of 55 patients with intrahepatic hemobilia who received holmium laser coagulation under choledochoscope at the General Hospital of Chengdu Military Area from June 2003 to August 2011 were retrospectively analyzed.After the hemobilia was confirmed with choledochoscopy,an optical fiber of holmium laser was inserted into the intrahepatic bile duct from the hole of choledochoscope.The top of the optical fiber was posed close to the bleeding region,and then the laser was stimulated for coagulation under direct vision.If the observation of the bleeding area was influenced by the bleeding,the porta hepatis was temporarily occluded with a rubber hose combined with pressurized liquid injection bag.For patients with distal bile duct stenosis and bleeding,the narrow area was first expanded by biliary balloon or laser,then hemostasis was completed after the flow of bile duct was restored.Results The hemorrhage of the 55 patients was controlled,with an average time of 5.5 minutes (range,2-15 minutes).Temporary hepatic portal clamping was applied for 16 patients (27 times),and the average blocking time was 2.2 minutes (range,1-4 minutes).Biliary rehaemorrahagia occurred after operation in 2 patients,and they were cured by non-surgical treatment.All patients were discharged after successful hemostasis.The time of follow-up was 35-49 days.The epithelium of the bile duct coagulated by intraoperative holmium laser restored flat in 41 patients,and new biliary stricture was not found in the other 14 patients.Conclusion Holmium laser coagulation under choledochoscope for intrahepatic hemobilia is simple and effective.
ABSTRACT
Objective To evaluate intra-biliary tunnel electro-resection and aspiration approach during ERCP for severe biliary stricture.MethodsA total of 14 patients with severe benign or malignant biliary stricture,which failed in previous ERCP,were recruited. First the guide wire was passed gently through the narrow segment under fluoroscopy,then the double-lumen needle knife was placed near the stricture and wire cutter was protruded.The tunnel electro-resection and aspiration was performed along the guide wire until the narrow segment could be passed through under fluoroscopy by the expanding balloon dilator for the following procedures.ResultsOf 14 patients with severe biliary strictnres,electro-resection and aspiration procedure were successful in 12 (85.7％).Metal stents were implanted in all 7 patients with malignant biliary strictures.Plastic stents were placed after balloon dilatation in 5 patients with benign stenosis.Three out of 5 patients received double plastic stents,while the two others only needed a single plastic stent.The procedure was failed in 2 patients ( 14.3％ ) with malignant biliary strictures as hilar cholangiocarcinoma invaded the left and right hepatic duct,forming a right angle in biliary stenosis,so that needle knife could not go through,and the following procedure was aborted.There were no severe complications like massive bleeding,perforation or death observed.ConclusionThe intra-biliary tunnel electro-resection and aspiration approach can significantly increase the success rate of ERCP in severe biliary strictures.