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A duodenoscope is complex instrument with an elevator and an elevator wire channel which are difficult to access and not readily amenable to cleaning and disinfection. Lapses in endoscope reprocessing have been regarded as a major cause of duodenoscope-associated transmission of infection. However, recent outbreaks of carbapenem-resistant Enterobacteriaceae or other multidrug-resistant organisms have emerged in spite of proper adherence to the manufacturer's reprocessing instructions. It is the time to reestablish reprocessing protocol appropriate for duodenoscope and revise a new design of duodenoscope that makes reprocessing easier in order to prevent cross-transmission of infection by duodenoscope. This manuscript reviews current state of duodenoscope-associated infections, recent measures from the United States government agencies and its limitations, and future strategies to prevent duodenoscope-associated infections.
Subject(s)
Disease Outbreaks , Disinfection , Duodenoscopes , Elevators and Escalators , Endoscopes , Enterobacteriaceae , United States Government AgenciesABSTRACT
Objective To discuss the clinical effects of laparoscopic therapy and duodenoscopic therapy in the treatment of biliary severe acute pancreatitis.Methods A total of 140 patients with biliary severe acute pancreatitis(BSAP) in our hospital was assigned into laparoscopic therapy group(60 cases) and duodenoscopic therapy group(80 cases) according to the treatment plan,and indicators in both groups were compared,including acute physiology and chronic health evaluation(APACHE Ⅱ score),WBC,CRP,the operation time,intraoperative blood loss,hospitalization time,hospitalization fee,complication rate,cure rate,mortality rate,abdominal pain disappearing time,body temperature recovered to normal time,blood amylase recovered to normal time,amino acid transaminase(ALT) recovered to normal time,total bilirubin(TBIL) recovered to normal time,alkaline phosphatase(ALP) recovered to normal time.Results APACHE Ⅱ scores and the levels of WBC,TBIL,ALT and CRP in both groups were significantly decreased after surgery(P＜0.05),but there were no statistical differences between the two groups at the same time point after treatment(P＞0.05).The operative time and the intraoperative blood loss in the duodenoscopic therapy group were significantly less than those in laparoscopic therapy group(P＜0.05).There were no statistical differences between the two groups of hospitalization time,complication rate,cure rate,mortality rate,abdominal pain disappearing time,temperature returned to normal time,blood amylase recovered to normal time,ALT recovered to normal time,TBIL recovered to normal time,ALP recovered to normal time(P＞0.05).Conclusion In early stage,both laparoscopic therapy and duodenoscopic therapy can treat BSAP effectively,and their therapeutic effects are nearly similar.
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Objective: To analyze the clinical value of modified endoscopic nipple resection in duodenal papillary adenoma resection Methods: 40 patients with duodenal papillary adenoma were randomly divided into observation group (20 cases) and control group (20 cases)according to the random number table. The patients of control group were treated by conventional resection of papillary adenoma, while the patients of observation group were treated by modified endoscopic nipple resection. The resection rate and the implantation of stent between the two groups were compared. Besides, the occurrence rate of complication and postoperative follow-up between the two groups also were compared. Results: The complete resection rate of observation group (95.00%) was not significant difference with that of control group (90.00%), while en bloc resection rate of observation group (85.00%) significant higher than that of control group (55.00%) (x2=4.28, P0.05). In postoperative three months, the difference of recently complication between the two groups was significant (x2=6.14, P0.05) in more than postoperative three months. After the follow-up of one year, the recurrence rate of observation group (10.34%) was no significant with that of control group (14.29%)(x2=0.17, P>0.05). Conclusion: The modified endoscopic nipple resection can enhance the en bloc resection rate, and reduce the incidence of complications and the recurrence rate. Besides, it has many dominances including higher feasibility in clinical practices. Therefore, its promotion is worthy.
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Periampullary diverticulum is commonly found during endoscopy and can occur at any age although its prevalence increases with age. Periampullary diverticular bleeding is a rare and difficult to diagnose during clinical practice because of its unique appearance and location. This often can lead to massive bleeding and interfere with adequate bleeding control. Endoscopic management on duodenal diverticular bleeding is limited compared to colonic diverticular bleeding due to lack of experience. Herein, we report a case of active bleeding from a periampullary diverticulum during bile duct stone extraction diagnosed by side-viewing endoscope and successfully controlled using hemoclips without any complications.
Subject(s)
Aged , Humans , Male , Ampulla of Vater/surgery , Cholangiopancreatography, Endoscopic Retrograde , Diverticulum/diagnosis , Gastrointestinal Hemorrhage/etiology , Surgical Instruments , Tomography, X-Ray ComputedABSTRACT
Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancre-atography (ERCP)by using a duodenoscope in patients with prior Billroth Ⅱ gastrectomy.Methods Data of 98 patients(including 7 who underwent Billroth Ⅱand Braun)with prior Billroth Ⅱ gastrectomy who un-derwent ERCP from January 2008 to May 2014 at Endoscopy Center of Ruijin Hospital were retrospectively studied.Results A total of 98 patients accepted 111 ERCP procedures,the overall success rate was 75.7%(84 /111).The success rate of accessing Vater′s papilla was 82.0%(91 /111)and the selective can-nulations success rate was 92.3%(84 /91).In the cases of successful access,therapeutic procedures were achieved in 100.0%(84 /84)of all patients.The overall rate of complications was 4.5%(5 /111),with mild post-procedure pancreatitis occurring in 3 cases,cholangitis in 2 cases,respectively.Conclusion ERCP u-sing a duodenoscope can be safely and effectively performed in patients with prior Billroth Ⅱ gastrectomy with high cannulation and treatment success rates.
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Objective To evaluate the clinical utility of SpyGlass single-operator ERCP-guided cholangiopancreatoscopy system for the diagnosis and treatment of bile duct disorders.Methods A total of 9 patients with biliary diseases were treated with SpyGlass single-operator ERCP-guided cholangiopancreatoscopy system.Four patients with large bile duct stones accepted laser lithotripsy,and stones were removed by ERCP.Five patients with indeterminate bile duct stricture accepted cholangioscopy-guided sampling.All patients underwent ENBD,routine blood test,blood amylase test,oral food and water restriction,acid suppression and prophylactic antibiotics.Results SpyGlass was successful in all patients with a manipulating time of 21.2min and total procedure time of 46.2min.Complete stone clearance was achieved in all 4 patients with large biliary stones.Sample quality was adequate in all patients with bile duct stricture with 2 patients diagnosed as having malignant biliary tumor and 3 as inflammatory bile duct stenosis.Post-ERCP complications including mild pancreatitis in 2 patients,and the patients recovered gradually after corresponding treatment.Conclusion ERCP-guided cholangiopancreatoscopy with the SpyGlass system is technically feasible and can be successfully and safely performed in patients with biliary disorders.
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Objective A retrospective study to evaluate the feasibility of the sequential treatment of extrahepatic bile duct calculus and acute gallstone pancreatitis using the technique of combination of duodenoscope, laparoscope and choledochoscope in one anesthetic session. Methods 112 patients with extrahepatic bile duct calculus (including 23 patients associated with acute gallstone pancreatitis) were treated using this technique. The data were analyzed. Results The technique was successfully carried out in 102 patients but 10 patients had to be treated by conventional open operation.For the patients treated by this technique, 16 patients were treated by endoscopic sphincterotomy (EST) plus choledochotomy. The stones were removed through a choledochoscope, and the bile duct was drained by a T-tube (LCTD). 18 patients were treated by endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy (LC). The choledocholiths were removed by a choledochoscope through the cystic duct. 22 patients were treated by choledochotomy, and the calculus was removed through a choledochoscope and the bile duct was primarily sutured. 46 patients were treated by endoscopic nasobiliary drainage (ENBD) plus LC, choledochotomy. The calculi were through a choledochoscope and followed by primary suture of the bile duct. The mean time of endoscopic treatment, LC and postoperative hospital day were 35 min, 110 min and 6.5 d respectively. None of the 102 patients died after operation. 9 patients developed complications of ERCP or EST including acute pancreatitis (n=6), hemorrhage of papilla duodeni (n=2) and duodenal perforation (n= 1). 11 patients developed biliary fistula after primary suturing of the choledochus and they recovered with drainage; 2 patients developed residual or recurrent biliary fistula after the T tube was removed and they recovered after drainage via a [aparoscope. During follow-up for 1 to 3 years using ultrasonic or MRCP examinations, 3 cases of stones were found and they were removed by EST. There was no stenosis of common bile duct. Conclusions Our results suggested that the three-endoscope-combination in one anesthetic session for the treatment of extrahepatic bile duct calculi and acute gallstone pancreatitis was safe and efficacious. Moreover, this technique reduced the complications of EST. This technique increased the success rate using minimal invasive surgery.
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Objective Explore the feasibility of the laparoscopy, choledocho-fiberacopy, duodenoscopy for the extrahepatic bile duct stone patients and the scope of application. Methods Sixty-four patients with extract common bile duct stones received the multiple endoscopies. Results Satisfactory outcome was ob-tained, no conversion, residual stones, and other complications were observed. Conclusion With profi-ciency in endoscopic and laparoscopic techniques, and a good grasp of the indications for various methods, minimally invasive treatment for extrahepatic bile duct stones is safe and feasible.
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Objective To investigate the clinical value and therapeutic effect of biliary stent insertion(EMBE, ERBD)and ENBD via endoscopic retrograde cholangio-pancreatography(ERCP)on malignant obstructive jaundice.Methods A retrospective review was conducted of 51 patients with malignant obstructive jaundice receiving ERCP in our hospital from June 2002 to March 2009.Different biliary stents or ENBD were placed into their biliary duct to drain bile.Meanwhile, the efective power, incidence rate, unobstructive time, and live time were determined.Results ERCP was successfully performed in all these 51 cases and 31 of them were successfully embedded with self-expandable metal stents while 15 of them had plastic stents.The last 2 cases were only treated with ENBD.Eleven cases had complications, but none of them had sequela after prompt treatment.In 48 cases, the serum level of total bilirubin decreased from(279.6±143.7)μmol/L to(125.7±78.3)μmol/L after drainage(P＜0.01).The follow-up investigation in 39 cases indicated that the 3-and 6-month survival rates after the treatment were 91% and 74%, respectively.Conclusion Biliary stent insertion and ENBD via duodenoscopy is an effective and safe palliative treatment for malignant bile duct obstruction.
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Objective To discuss the clinical value and nursing of the three-endoscope in the treatment of eholedoeholithiasis. Methods 45 eases of choledocholithiasis patients who were treated with LCDE (three-endoscope) were named as the research group.56 patients who received traditional open ab-dominal surgery were set as the control group. The average hospitalization time and satisfaction degree with nursing were compared, t test and χ2 test were adopted. Results The average hospitalization time was shorter and satisfaction degree with nursing was higher in the research group than those in the control group. Conclusions The treatment of choledochohthiasis with three-endoscope is safe and feasible, es-pecially when combined with antibiotics lavage and stone dissolution through naso-biliary duct.The opera-tion can widen the surgical indication,reduce the risk of surgery with little damage,clear stones completely, reduce postoperative complicatioas,make patients recover faster, shorten the hospital stay and achieve the same or better treatment results when compared to the traditional open abdominal surgery.
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Objective To explore the clinical effect of treatment for cholecystolithiasis and calculus of com-mon bile with duodenoscope and laparoscope. Methods 48 cases of patients with cholecystolithiasis and calculus of common bile duct were analysed, of whom 30 cases were treated by traditional operation, and 18 cases were treated by duodenoscope and laparoscope. The operation time, stay-in-hospital time after operation, the gastrointestinal function recovery time after operation, the degree of pain were compared. Results The cost of duodenoscope and laparoscope was higher than that of traditional operation group, but the other parameters were better ( P < 0.05 ). Conclusion Treating cholecystolithiasis and calculus of common bile duct with duodenoscope and laparoscope is safe, less traumatic and the patients may recover faster than routine treatment.
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Objective To discuss the minimally invasive skills in the treatment of choledocholithiasis.Methods A retrospective analysis was made to sum up the minimally invasive methods in the treatment of choledocholithiasis,reinforcing sufficient cognition to the treatment of the disease.Results The minimally invasive methods in the treatment of choledocholithiasis included endoscopic sphincterotomy,endoscopic papillaryballoon dilation,fibercholedochoscopy,laparoscopic common bile dnctexploration and laparoscopy combined with endoscopy in treating choledocholithiasis.Conclusion The conception of the treatment of choledocholithiasis was renewed by djfferent minimally invasive skills.With the development of the medical apparatus and instruments,the minimally invasive skills will play an important role in the treatment of choledocholithiasis.
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Objective To investigate the efficacy of laparoscopic cholecystectomy(LC) followed by endoscopic retrograde cholangiopancreaticography(ERCP) for gallbladder and bile duct stones.Methods A total of 58 patients with both gallbladder and bile duct stones received endoscopic sphincterotomy(EST) in our hospital.After the stones were removed,LC was performed on the patients.Results Of the 58 patients,56 were successfully treated with EST and LC.Two cases were unsuccessful owing to difficulty in intubation during ERCP in one and failure to remove all the stones from the bile duct in the other.These two patients were then cured by LC combined with electronic choledochoscopy.Perioperative complications included bleeding during EST in 1,acute edematous pancreatitis in 2,and mild infection of the puncture site in 1.The overall complication rate was 7.1%(4/56).Retained common bile duct stone was observed in 1 patient,and was successfully removed by subsequent ERCP.Conclusions LC combined with ERCP is a safe and effective minimal invasive method for the treatment of concurrent gallstones and bile duct stones.
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Objective To explore the experience on using duodenoscope to treat hepatolithiasis through normal physiological ways.Methods ERCP,EST were used firstly,then removed calculus of the extrahepatic bile duct.Endoscopic papillary balloon dilatation was used if there was stenosis of bile duct.Removed calculus when it had been crushed in the hepatic duct.Injected decoction to dissolve calculus through endoscopic nasobiliary drainage,or inserted the endoscopic retrograde biliary drainage when the calculus was hard to removded.Results 101 cases of calculus in the extrahepatic bile duct were all removed.215 cases of hepatolithiasis were cleaned out at first time.9 cases were cured 1 week after dissolving calculus through endoscopic nasobiliary drainage.59 cases carried out ERBD,and 21 of them were cured 3 months later,37 patients were still in regular follow-up.33 cases with stenosis of bile duct were treated by endoscopic papillary balloon dilatation,19 of them were cured,the others were inserted with the endoscopic retrograde biliary drainage.19 cases of cholangitic abscess were cured by endoscopic nasobiliary drainage.Conclusion Using duodenoscope to treat hepatolithiasis through normal physiological ways is safe and effectic.
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Objective To discuss the feasibility and superiority of EST combined with LC in treating cholecystolithiasiswith common bile duct stones.Methods Patients underwent LC(laparoscopic cholecystectomy) preceded by EST(endoscopic sphincterotomy) and removal of common bile duct stones.ENBD(Endoscopic nasal biliary drainage tube)was placed if EST failure and then the patient underwent LC+laparoscopic biliary duct exploration(LCBDE),or open operative bile duct exploration.Results In 91 of the 99 cases,LC preceded by EST and stone removal was successful,while EST following LC was successful in 3 cases,and stone removal by EST was unsuccessful in 3 cases.Two cases less than 15 years of age underwentLC+LCBDE through the cystic duct and did not undergo EST.Three cases,who had EST failure,underwent LC+LCBDE with primary suture of the common bile duct or LCBDE with T-tube drainage of commonbile duct,or open bile duct exploration with primary suture of the common bile duct(ENBD was in place).All patients were discharged from hospital without serious complications.Conclusions EST combinedwith LC in treating cholecystolithiasis with common bile duct stones is a safe and effective method.Combination of endoscopic and laparoscopic procedures fully reflects the advantage of minimally invasive therapy.
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Objective To investigate the effectiveness of choledochoscopy and duodenoscopy in the treatment of residual calculus of the intrahepatic bile duct. Methods Clinical data of 573 cases of choledochoscopy and 36 cases of duodenoscopy from February 1985 to June 2004 were analyzed. Results Stones were completely removed under choledochoscope by way of T-tube sinus tract in 96.02% of patients (507/528) and by way of subcutaneous blind loop in 84.62% of patients (22/26). Percutaneous transhepatic choledochoscope placement was successfully conducted in 84.21% of patients (16/19) and stones were completely removed in 78.95% of the patients (15/19). The success rate of duodenoscopic cholangiography was 91.67% (33/36) and stones were completely removed under duodenoscope in 80.56% of patients (29/36). Conclusions Treatment of residual and recurrent calculus of the intrahepatic bile duct by choledochoscopy and duodenoscopy is effective and convenient.
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Objective To discuss the clinical effect of combined use of duodenoscopy and laparoscopy for treatment of cholecystolithiasis complicated by choledocholithiasis.Methods The clinical data of 106 cases of cholecystolithiasis with cholelcoholithiasis in our department during 7 years were analyzed.Endoscopic sphincteromy (EST) and endoscopic nasobiliary drainage (ENBD), followed by laparoscopic cholecystectomy(LC) was employed. Results In 101 cases(95.3 %) stones were removed by EST successfully. Complicated with postoperative pancreatitis in 11cases(10.4 %), bleeding in 1 case (0.9 %), and acute cholangitis in 2 cases (1.9 %). All of the patients recovered and discharged. Eighty-five cases were followed up for average 3.1 years. Of them, 5 cases had choledocholithiasis recurrence, 1 had papillary re-stenosis, 2 had bile duct carcinoma, and 2 died of other caused.Conclusions Combined use of EST and LC for treatment of calculus of extrahepatic bile duct is a safe and effective mini-intrusive operation.