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Objective:To investigate the independent risk factors for fever after endoscopic radiofrequency ablation (RFA).Methods:From January 2016 to April 2021, 51 patients with early esophageal cancer, who were treated with RFA in the Department of Gastroenterology, Changhai Hospital and whose lesion range exceeded 3/4 of the circumference of esophagus, were included in the case-control study. Patients were divided into fever group ( n=15) and non-fever group ( n=36) according to whether they had fever after operation. The general condition of patients, family history of gastrointestinal tumors, lesion length, lesion range, ablation energy and ablation times were mainly collected for univariate analysis. The variables with P<0.1 were further included in multivariate logistic regression analysis to explore the independent risk factors for fever after RFA. Results:Univariate analysis showed that the lesion length ( t=-3.89, P<0.001), lesion range ( χ2=11.52, P=0.001) and ablation energy ( P=0.001) were significantly different between the two groups. Pearson correlation showed that there was a significant positive correlation between lesion length and lesion circumference ( r=0.71, P<0.001), and the lesion range was determined by the lesion circumference length. Therefore, the two variables of lesion length and ablation energy were finally included in the logistic regression analysis. Logistic regression analysis showed that the risk of fever after RFA was 1.21 times as high as that before when the length of esophageal lesions increased by 1 centimeter (95% CI: 1.01-1.43, P=0.037). The risk of fever after RFA using 12 J ablation energy was 0.43 times as high as that using 10 J ablation energy (95% CI: 0.22-0.85, P=0.015). Conclusion:Lesion length and ablation energy are independent risk factors for fever after esophageal RFA. Patients with long segment early esophageal cancer and using low ablation energy are more likely to have fever after RFA.
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Objective To evaluate the clinical value of endoscopic retrograde pancreatic drainage ( ERPD) in patients with pancreatic fistula. Methods Data of 42 patients with pancreatic fistula, who were treated with ERPD at Changhai Hospital and Henan Provincial People's Hospital from June 2013 to September 2018,were collected. The pancreatic fistula curative rate, healing duration of pancreatic fistula, and the incidence of complications were analyzed. Results Among 42 patients with pancreatic fistula,there were 30 males(71. 4％) and 12 females(28. 6％) with mean age of 41. 5±12. 8 years old. Pancreatic duct stents of 37 cases ( 88. 1％) went across the fistula. The overall curative rate was 90. 5％( 38/42 ) . The median healing duration of pancreatic fistula was 32. 0 d (8-183 d). The healing time of pancreatic fistula after injury(19. 0±9. 9 d,t=3. 50,P=0. 002) and of pancreatic fistula after surgery(20. 3±10. 7 d,t=3. 35, P=0. 003) were shorter than that of pancreatic fistula after acute severe pancreatitis (60. 0±48. 6 d). The healing time of pancreatic fistula with pancreatic pseudocysts was longer than that of pancreatic fistula without pancreatic pseudocysts (65. 3±55. 4 d VS 32. 6±23. 6 d, t=2. 21,P=0. 040). There were no significant differences in pancreatic fistula curative rate, pancreatic healing duration and times of ERCP in pancreatic fistula at different position. Postoperative stent-related complications occurred in 2 patients ( 4. 8％) , and 1 patient (2. 4％) developed mild pancreatitis. Conclusion ERPD is an important treating method with good therapeutic effect and low complications for pancreatic fistula.
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Objective To evaluate the efficacy and safety of endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) for gastroesophageal junction (GEJ)submucosal tumors (SMTs) originating from the muscularis propria(MP) layer.Methods Clinical data of sixty-one patients with GEJ SMTs originating from the MP layer who were treated with ESE(ESE group,n=39) or STER(STER group,n=22) between January 2013 and December 2015 in Changhai Hospital were retrospectively analyzed.Outcomes and complications in the two groups were compared.Results Single lesion in 61 patients were all resected by therapeutic endoscopy successfully.Operation time in the STER group was shorter than that of the ESE group(47.27±20.89 min VS 66.56±40.07 min,P＜0.05).There was no significant difference in number of hemostatic clips between the two groups[7.10±5.57 VS 8.00± 1.88,P＞0.05].Hospitalization time of STER group was shorter than that of the ESE group [3.0(1.25) d VS 4.0 (1.00) d,P＜0.05].One patient developed delayed hemorrhage in ESE group,while no other complications occurred in either group.The wound healed in both groups under gastroscopy,and no residual or recurrent tumors were detected during the follow-up period.Conclusion Both STER and ESE can be used for GEJ SMTs originating from the MP layer,but STER is more safe and efficient.
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Objective To investigate the therapeutic value of endoscopic papillectomy (EP) for duodenal papilla lesion.Methods Patients with duodenal papilla lesion treated with EP from June 2007 to December 2015 were enrolled.The clinical characteristics,EP technical features,complications,the treatment,postoperative recurrence were analyzed.Results A total of 43 patients were enrolled.The mean diameter of the lesion was 22.8±1.2 mm.Thirty-two patients (69.8％) received en bloc resection,and 11 (25.6％) received endoscopic piecemeal mucosal resection (EPMR).After the operation,duodenal papilla lesions recurred in 3 patients (7.0％),5 patients (11.6％) had delayed bleeding,4 (9.3％) had postoperative pancreatitis,6 (14.0％) had long-term bile duct stricture.Intraoperative pancreatic stenting (OR =0.000,95％ CI:0.000-) was the independent protective factor for postoperative pancreatitis.Pancreatic duct dilation (OR =13.500,95％ CI:1.400-130.191) was the independent risk factor for postoperative bile duct stenosis.Conclusion EP is minimally invasive with rapid recovery and less cost,and could be recommended for duodenal papilla lesions.
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Objective To evaluate the safety and effectiveness of a new hemostatic clip with sutures for ESD suspension method in animal models.Methods A total of 20 porcine stomachs were randomly divided into the experimental group (n=10) and the control group (n=10).ESD was done respectively in antrum greater curvature and antrum back wall of porcine stomach in vitro.All procedures were completed by the same endoscopist and nurse.The incidence of perforation,mucosa diameter,total operation time (T),dissection time (T1),the average number of submucosal injection,and one-time complete dissection rate were compared between two groups.Results Procedures were done successfully in antrum of 40 poccine in vitro and all mucosa were dissected completely in one procedure.No perforation occurred.Compared with the control group,the mucosa diameter difference was not statistically significant (P =0.368).The total operating time [(34.70± 1.06) min VS (37.1 0± 2.23) min,P =0.009],dissection time [(31.40± 2.00) min VS (34.80± 2.20) min,P=0.817] and the average number of submucosal injection[(7.60± 1.00) VS (10.60± 1.00),P＜0.001] in antral greater curvature ESD of the experimental group were significantly less than those of the control group.As for the antrum back wall,the mucosa diameter difference was not statistically significant.The total operation time [(37.00± 1.25) min VS (39.60± 1.65) min,P＜0.001],dissection time[(34.50± 1.35) min VS (37.00± 1.25) min,P＜0.001],the average number of submucosal injection [(7.60± 1.27) VS (11.40± 1.00),P＜0.001] were also significantly less than those of the control.Conclusion The new hemostatic clip with sutures for suspension can significantly shorten the operation time,reduce the number of submucosal injections and the difficulty in ESD.
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Objective To design a hemostatic clip and evaluate its efficacy and success rate of closure of stomach wall defect after full thickness resection (FTR).Methods A full thickness circular or linear resection (3 to 5 cm) was made on each model's antrum with needle knife and insulated-tip knife.The specimens were divided into 2 groups, using either an interrupted or continuous suturing method.Then the closure condition, suturing time, number of clips required and success rate of closure were compared.Results All 12 defects were successfully closed.The average closing time of interrupted and continuous suturing group were 13.33 ± 1.09 and 10.17 ±2.11 minutes, and the mean number of clips used were 4.67 ± 0.82 and 2.67 ± 0.82.The success rate was 100％.Conclusion This newly designed clip is a fast, reliable and convenient tool for stomach wall defect closure after FTR.
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Objective To investigate the dynamic changes in achalasia patients by using high resolution manometry (HRM).Methods Twenty-four achalasia patients were enrolled for HRM examination and typing.The esophageal pressure of patients with different subtypes was analyzed.Chi-square test was used for count data analysis.Two independent samples t-test was used for measurement data.Results Among twenty-four achalasia patients,five patients were type Ⅰ and maledominated,18 patients were type Ⅱ and female was more than male,and only one male patient was type Ⅲ.The frequency of weight loss in type Ⅰ was higher than that of type Ⅱ (x2 =6.97,P=0.008).The frequency of chest pain and food reflux in type Ⅰ was higher than that of type Ⅱ (both P＞0.05).The average distance from the nares to the upper edge of the lower esophageal sphincter (LES) with the electrode successfully inserted into the stomach was (44.9±3.3) cm and to the lower edge of the LES was (48.0±3.2) cm.The average LES length was (3.1 ±0.7) cm,average intraabdominal LES length was (2.1 ±0.5) cm.The average LES resting pressure was (34.6 ± 13.8) mm Hg (1 mm Hg =0.133 kPa) and the integrated relaxation pressure (IRP) was (31.1 ± 12.0) mm Hg.Conclusion Esophageal manometry is the golden standard for achalasia diagnosis,and HRM may be a simple,direct viewing and accurate method for accessing esophageal motor function.
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Objective To evaluate the safety and efficacy of therapeutic ERCP for patients above 90 years of age.Methods The data of 37 patients of above 90 years who underwent 42 ERCP procedures from January 2001 to December 2009 were studied retrospectively and compared with those of 152 matched patients ( 168 procedures) below 65 years old at a 1∶4 ratio for success rate and complications.Results The rate of complete success,partial success,and failure in observation group was 73.81％ (31/42),19.05％(8/42) and 2.38％ (1/42),respectively,which were similar (P ＞0.05) with those in control group,with complete success rate at 85.12％ ( 143/168),partial success rate at 12.50％ (21/168) and failure rate at 2.38％ (4/168).The rate of terminated operation in observation group (4.76％,2/42) was significantly higher than that of the control group (0.00％,0,P =0.039).The overall rate of complication in observation group was 7.14％ ( 3/42 ),slightly higher than that of the control group ( 6.55％,11/168,P ＞0.05 ).There was no significant difference between the two groups regarding the rates and severity of such complications as pancreatitis,hemorrhage and infection ( P ＞ 0.05 ).No perforation or death was observed.Conclusion Therapeutic ERCP for patients of 90 years or older is safe and effective.Adverse events related to chronic concomitant diseases need early detection and proper management.
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Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for digestive tract mucosal lesions,and risk factor of complications.Methods The data of 154 consecutive patients who underwent ESD for superficial digestive tract mucosal lesions were analyzed prospectively for therapeutic effect and rate of complications.Risk factors for bleeding was analyzed.Results The enbloc resection rate in 145 completed ESD procedures was 100.0％.Histologically,complete resection rate was 99.3％.ESD was not completed in 9 patients due to bleeding ( n =5) and perforation ( n =4).Acute massive bleeding occurred in 6 patients (6/154,3.9％),mild bleeding in 5 (3.2％),delayed bleeding in l (0.6％ ),perforation in 4 (2.6％ ) and post-ESD stenosis in 1 (0.6％ ).All complications were cured.The post-ESD ulcer-healing was achieved in 100％ at 8 weeks after treatment.During follow-up of 10.6months( ranged from 8 to 18 months),no residual or local recurrence was found.Statistic analysis showed independent risk factors for bleeding in ESD were lesion location (cardiac fundus),and lesion size.Conclusion ESD is an effective and safe procedure in treatment of digestive tract mucosal lesions.The complications of ESD are preventable and curable.Strictly controlling operation indications,individualized treatment and the proficient operation skills of physicians are the keys to success.
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Objective To evaluate the value of medical treatment in the management of SAP.Methods From January 2000 to December 2011,a total of 1064 cases out of 931 SAP patients were admitted and retrospectively analyzed.The etiologies,severity score,complication rates,therapies,effectiveness and costs of those SAP cases were summarized.Results There were 559 males and 372 females with a mean age of (51 ± 15)years old.The main cause was biliary tract disease (58.3％),followed by fat-rich diet (31.2％),hyperlipidemia (13.6％) and alcohol (7.1％).At the time of admission,95.5％ of SAP patients presented with level D disease according to Balthazar CT severity index,26.0％ had a Ranson score ≥3 and 30.1％ had an APACHE Ⅱ score ≥ 8.There were 42.7％ cases complicated with systemic inflammatory response syndrome (SIRS).Acute lung injury and acute respiratory distress syndrome (ARDS),acute kidney injury,shock or heart failure,acute liver dysfunction,and diffuse intravascular clotting (DIC)occurred in 24.0％,8.1％,5.4％,3.2％,and 1％ of all patients,respectively.Other complications of SAP included abdominal cavity bleeding (n =17),pseudocyst bleeding (n =9),pancreatic abscess (n =78) and gastrointestinal fistula (n =33).Totally 25 (2.3％) patients died in hospital and 36 (3.4％) patients were discharged against advice,with an overall treatment success rate of 94.3％.The mean hospital stay was (23.7 ± 19.2) d,and the average cost was 52.3 thousands of RMB.Conclusions A comprehensive treatment pathway relying on medical treatment,focusing on organ function support and assisted by miniinvasive intervention may improve the treatment success rate of SAP,which is worth of further application.
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Objective To evaluate the endoscopic papillectomy (EP) for ampullary adenoma (AA). Methods The resection rate, complications, local residual rate and local recurrence of EP for AA at endoscopy center of Changhai Hospital were retrospectively reviewed. Results From July 2005 to July 2009, a total of 19 patients with endoscopically diagnosed and pathologically confirmed AA underwent EP, in which 18 cases were scattered AA (94. 7%) including 1 case of multiple adenomas in duodenum, and 1 (5.3%) was familial adenomatous polyposis (FAP). The lesion was resected en bloc in 11 cases (57.9%) , and piecemeal in 8 (42. 1%). All patients were followed up at a mean period of 24. 5 months (range 7-48 months). The residual rate after first EP was 21. 1% (4/19), and the total success rate was 89.5% (17/19). Short-term complications after EP included 3 cases of bleeding, 3 cases of mild acute pancreatitis and 2 cases of acute cholangitis. Long-term complications were 1 case of stenosis of the common bile duct (CBD) orifice accompanied with acute cholangitis, 1 case of CBD stone and 1 case of acute cholangitis after stent placement. No such severe complications as perforation or procedure-related death was observed.Conclusion EP is a safe and effective modality for ampullary adenoma.
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Objective To investigate the changes of extraceUular regulated kinase 1/2 (ERK1/2) phosphorylation and assess the effects of blocking the ERK1/2 phosphorylation on rats with acute necrotizing pancreatitis (ANP). Methods The ANP model was induced by retrograde injection of 5% sodium tanrocholate into the biliary and pancreatic duct. 5 rats were treated as normal control. Other 75 Sprague-Dawley (SD) rots were randomly divided into sham operations(SO) group (n =25), ANP group (n =25) and PD98059 group (n =25). The rats were sacrificed at 15 min, 30 min, 1 h, 3 h and 6 h after ANP induction, the blood and pancreatic sample were taken. Pathological changes of pancreas were observed with light microscope and scored. The serum level of TNF-α and IL-1β was determined by ELISA. MPO activities in pancreas were measured by enzyme chemistry assay. Western blotting was performed to determine the phosphorylations of ERK1/2 in the pancreas homogenates. Results There was no significant pathologic changes in rats of SO group;but significant injuries occurred in ANP group, the pathologic score at 3 h was 9.9 ± 0.4;the extent of injuries attenuated in PD98059 group, the pathologic score at 3 h was 4.0 ± 0.4 (P < 0.05). The serum levels of TNF-α at 3 h in SO, ANP and PD98059 groups were (65.8 ± 20.5) pg/ml, (286.5 ± 50.3) pg/ml, (180.4±32.9)pg/ml, respectively;the serum levels of IL-1β at 3 h in SO, ANP and PD98059groups were (85.8 ± 25.5) pg/ml, (293.8 ± 46.3) pg/ml, (200. 5 ± 33.6) pg/ml, respectively;MPOactivities in pancreas were (0. 19 ± 0.02)U/g, (0.61±0.05)U/g, (0.52±0.03) U/g, and the values in ANP and PD98059 groups were significantly higher than those in SO group, while the values in PD98059 group were significantly lower than those in ANP group (P < 0.01). The expression of ERK1/2 phosphorylation in normal pancreas was 1100 ± 141, the expressions of ERK1/2 phosphorylation in ANP group at 15 min, 30 min were 5300 ± 486, 5621 ± 384, respectively;the expressions began to decrease 1 h later and returned the similar level as SO group at 6 h;the expressions of ERK1/2 phosphorylation in PD98059 group at 15 min, 30 rain were 4200 ± 370, 3600 ± 290, respectively;which were signifieanfly lower than those in ANP group (all P value < 0. 01). Conclusions The ERK1/2 signal transduetion pathway plays an important role in the pathogenesis of ANP. Inhibition of ERK1/2 phosphorylation by PD98059 may decrease the production of IL-1β, TNF-α and pancreatic MPO, attenuate the extent of pancreatic pathologic injuries.
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objective To investigate the rate and risk factors of early complications after endoscopic pancreatic sphincterotomy.Methods Data of patients,who underwent endoscopic pancreatic sphincterotomy from May 2006 to April 2007,were recorded before and during the procedure and prospectively studied.The Datients were followed up until discharge.Results A total of 165 patients underwent endoscopic pancreatic sphincterotomy,of which 25(15.2%)developed complications,including acute pancreatitis in 22(13.3%)(15 mild,6 moderate and 1 severe),hemorrhage in 1(0.6%),and acute cholangitis in 2(1.2%).There was no perforation or procedure-related mortality.Multivariate analysis indicated that risk factors of acute pancreatitis were female(OR:3.8,95%CI:1.4-10.8),recurrent pancreatitis(OR:3.1,95%CI:1.0-9.9),and parapapilla sphincterotomy(OR:5.9,95%CI:1.2-28.8).Conclusion Compared with routine ERCP,endoscopic pancreatic sphincterotomy may be associated with higher risk of acute pancreatitis,especiallv in women.patients with recurrent pancreatitis and those undergoing parapapilla sphincterotomy.
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Objective To investigate the changes of indications, degree of difficulty in procedure, complication and its severity in endoscopic retrograde cholangiopancreatography (ERCP) in Changhai hospital from 2001 to 2007. Methods The clinical data, including demographic data, indications, degree of difficulty in procedure, success rate, complication rate and severity of complication, of 2374 patients who underwent ERCP in 2001 and 2007 (966 in 2001 and 1408 in 2007), were retrospectively reviewed. Results Indications of ERCP changed at an interval of 5 years. Operations due to bile duct stone decreased (59.0% vs. 49.3%, P=0.000), while operations due to pancreas disease, especially chronic pancreatitis (6.6% vs. 18.5%, P=0.000) and recurrent pancreatitis (0.2% vs.1.6%, P=0.001), increased. Patients with biliary duct problems after liver transplantation appeared in 2007. The procedures of ERCP performed in 2007 were more difficult (P=0.000), with an increased percentage of Degree 5 procedure (7.3% vs. 33.3%, P=0.000). The number of diagnostic ERCP significantly decreased (Degree 1 + Degree 3, 30.5% +2.8% vs. 5.9% +3.1%, P=0.000). There was no significant difference in the success rate between the two years (P=0.084). The complication rate of ERCP in 2007 was significantly higher than that in 2001 (3.73% vs. 7.88%, P=0.000), but the severity of complication showed no significant difference (P=0.820). Conclusion Cases of diagnostic ERCP decreased in 2007. Indications of ERCP have changed, with a decrease in bile duct diseases and an increase in pancreatic diseases. The procedures are more complicated, but it does not lead to lower success rate. The increase in complication rate is possibly due to increase of therapeutic ERCP.
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Objective To explore the efficacy and safety of choledochoscopy combined with laser lithotripsy for refractory residual biliary calculi after operation. Methods Clinical data of 22 patients, who underwent choledochoseopy together with laser lithotripsy for refractory intra- and extra-hepatic calculi after operation from February 2007 to February 2009, were retrospectively studied. Results The success rate of stone removal was 95.5% (21/22) , with one session success rate of 86. 4% (19/22), and two sessions of 9. 1% (2/22). Stone removal could not be performed in one patient due to multiple intra-hepatic calculi, difficult calculi location at bile ducts of grade Ⅱ, and wide biliary angle with no access. No biliary duct hem-orrhage, perforation, or infection occurred. Conclusion Choledochoscopy combined with laser lithotripsy is an effective and safe procedure for refractory residual biliary calculi after operation.
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Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD)in treatment of patients with early gastric cancer(EGC).Methods A total of 4 3 consecutive patients with EGC were treated with ESD at Changhai Hospital from July 2007 to July 2008.The data referred to one-piece resection,histologically complete resection,operation time,complications,the post-ESD ulcer-healing and local recurrance were retrospectively analyzed.ResultsEn bloc resection was achieved in 97.7 0A(4 2/43)lesions in one-piece resection.The histologically complete resection rate was 95.3%(41/43).Only one patient had acute minor bleeding during the ESD procedure(2.3%,1/43)and one patient had delayed bleeding(2.3%,1/43).Post-ESD epigastric pain was found in 2 2 patients(51.2%).There was no complications such as acute major bleeding,perforation,requiring surgical treatment and death.The median operation time was 60.4 miutes.The post-ESD ulcer-healing was achieved in 100%(42/42)8 weeks after esomeprazole treatment.During follow-uP of 10.3 months(ranged from 8 to 1 8 months),no residual or local recurrence of EGC was seen.Conclusion ESD has the advantages of increasing one-piece resection and histologically curative resection rates.It is a safe and effective procedure in treatment of EGC.
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Objective To determine the efficacy of therapeutic endoscopic retrograde cholangio-pan-creatography (ERCP) in treatment of pain of chronic pancreatitis (CP). Methods The data of CP patients accompanying with pain, who received therapeutic ERCP from 1997 to 2006, were retrospectively analyzed.The diagnosis of CP was made based on the criteria from 2002 Asia-Pacific Consensus, and the effect of ther-apy was evaluated. Results Of 253 patients who received therapeutic ERCP, follow-up data were obtained from 214 patients ( 144 males and 70 females, ages ranging from 6.5 to 78.0 years, mean age 40. 5 years).The mean follow-up period was 41.9 months (12～131 months). Twenty-eight patients (13. 1% ) under-went surgery after ERCP. Relief rates of pain in patients who underwent ERCP with or without operation were 71.4% and 83.9% (P >0. 05 ) respectively. The overall relief rate of ERCP was 73%. The incidence of major complications related to the procedure was 14.9% (71/476) in terms of ERCP sessions, including post-ERCP pancreatitis in 12. 6%, mild cholangitis in 2. 1% and hemorrhage in 0. 2%. All complications sub-sided with conservative medical managements in 2 to 20 days. No perforation or death related to the procedure occurred. Conclusion Therapeutic ERCP is a mean of effective management of pain in patients with CP.
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ObjectiveEndoscopic suhmucosal dissection (ESD) is a new diagnostic and therapeutical technique for early gastric cancer (EGC).The aim of this study was to evaluate the efficacy and safety of ESD for EGG.MethodsThe data of patients who underwent ESD for EGCs from July 2007 to December 2007 were analyzed retrospectively.One-piece resection rate,histologically complete resection rate (the lateral and vertical margins were free of cancer),operation time,complications,post-ESD ulcer-healing rates and local recurrence were assessed.ResultsA total of 21 EGCs in 20 consecutive patients were treated with ESD.The median age was 56.4 years (range 37-75 years) and the male/female ratio was 1.9(13/7).Out of 21 lesions,20 (95.2%) were resected in one piece.The rate for one-piece resection with tumor-free margins was 90.5% (19/21).Acute minor bleeding during the ESD procedure occurred in 4.8% (1/21).Post-ESD epigastric pain rate was 76.2%(16/21).No acute major bleeding, delayed bleeding and perforation occurred.The median operation time was 50.4 min (range 45-200 min).The pest-ESD ulcer-healing rates was 100% after 8 weeks of oral esomeprazole.After a follow-up with median time of 9.2 months (range 8-12 months),none of the patients experienced residual/local recurrence of early gastric cancer.Conclusion ESD has the advantage of increasing one-piece resection rate and histologically curative resection rates.ESD is a safe and effective treatment for EGC.
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Objective To explore the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography ( ERCP) in teenagers with chronic pancreatitis. Methods Thirteen teenagers with chronic pancreatitis diagnosed and treated by consecutive ERCP procedures in our hospital from Feb 1997 to Feb 2002 were studied retrospectively. Results Of the 13 patients 12 had abdominal pain and 10 had history of acute/chronic pancreatitis. The ERCP findings were as follows: pancreatic duct stricture and/ or dilation 12, pancreatic duct stones 7, pancreatic pseudocysts 2, pancreas divisum 3, and cholecystolithia-sis 1. Therapeutic interventions included EST 7 , basket stone extraction 6, placement of pancreatic duct stent 5 , pancreatic duct stricture bougie or balloon dilation 4, accessory papillotomy 2 and endoscopic papillary dilation 1. In the 6 - 68 months follow - up, 11 (84. 6% ) never had recurrence of pancreatitis or abdominal pain ,2 patients had no abdominal pain after the second ERCP procedure. There were procedure -related complications of hyperamylasemia in 4 cases(30. 8% ) and pancreatitis in 3 cases(23. 1% ). Conclusion ERCP has significant value in diagnosing and treating chronic pancreatitis in teenagers, but has a rather high rate of complication . It suggested that the restrict selection of indication and safe application of the procedures in pediatric patients may be expected to decrease the adverse events of ERCP.
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AIM: To investigate the role of p38 mitogen-activated protein kinase (p38MAPK) signaling pathway in the Kupffer cells (KCs) production of pro-inflammatory cytokines, tumor necrosis factor-?(TNF-?) and interleukin-1?(IL-1?), in severe acute pancreatitis (SAP) rats. METHODS: Sprague-Dwaley rats were randomized into three groups: ①sham operation rats, ②SAP rats, ③SAP rats given the p38 MAPK inhibitor CNI-1493(10 mg/kg, iv). The SAP model was induced by the bili-pancreatic duct infusion with 5% sterile soduim taurocholate solution. Rats from each group were killed at 12 h after sham operation or SAP and Kupffer cells (KCs) were isolated. The mRNA expressions of TNF-? and IL-1? (by quantitative real-time RT-PCR) and p38 MAPK activity (by Western blot analysis) in KCs were examined. The levels of TNF-? and IL-1? in plasma were determined by ELISA. RESULTS: There was a significant acvitation of p38 MAPK in KCs harvested from SAP rats than those from sham operation rats. SAP also promoted the mRNA expressions of TNF-? and IL-1? in KCs and the plasma levels of TNF-? and IL-1?. These events were significantly inhibited by treatment with CNI-1493.CONCLUSIONS: p38 MAPK activation is one important aspect of the signaling events that may mediate the KCs production of pro-inflammatory cytokines, TNF-? and IL-1?, in SAP rats. The inhibition of the p38 MAPK may be a potential target in the prevention and treatment of SAP.