ABSTRACT
Objective To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP)+SpyGlass system versus percutaneous transhepatic gallbladder drainage (PTGD)+ERCP in the treatment of acute cholecystitis secondary to choledocholithiasis. Methods A retrospective analysis was performed for the clinical data of the patients with acute cholecystitis secondary to choledocholithiasis who were treated in Department of Gastroenterology, Jilin City People's Hospital, from December 2019 to September 2021, among whom there were 23 patients in the ERCP+SpyGlass group and 19 patients in the PTGD+ERCP group. The two groups were compared in terms of the indicators such as surgical technical success, surgical operation time, surgical clinical success, postoperative recovery, length of hospital stay, and complications. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; the chi- square test or the Fisher's exact test was used for comparison of categorical data between groups. Results Compared with the PTGD+ERCP group, the ERCP+SpyGlass group had a significant reduction in C-reactive protein after surgery ( Z =2.999, P =0.003). There were no significant differences between the two groups in technical success rate ( χ 2 =1.735, P =0.188), clinical success rate ( χ 2 =0.846, P =0.358), total time of operation ( t =1.667, P = 0.113), white blood cell count on day 1 after surgery ( t =1.075, P = 0.289), length of postoperative hospital stay ( t =1.560, P =0.127), and incidence rate of complications (all P > 0.05). Conclusion In the treatment of acute cholecystitis secondary to choledocholithiasis, the ERCP+SpyGlass system has a comparable clinical effect to PTGD+ERCP and is safe and effective, without increasing surgery-related adverse events and risks, and it can also solve the problems of the biliary tract and the gallbladder at one time through natural orifices, with no scars on body surface and convenient postoperative nursing. Therefore, it holds promise for clinical application.
ABSTRACT
Objective To explore the value of SpyGlass (direct visualization system) guided laser lithotripsy for large bile duct stones in ERCP.Methods Thirty-three patients with large bile duct stones were randomly assigned to two groups: SpyGlass guided laser lithotripsy group (n =16) and mechanical lithotripsy group (n =17).All patients underwent ERCP procedures for stones extraction.The success rate of complete stone removal, the early complication rate related to the procedure and procedure time were compared between the two groups.Results The success rate of complete stone removal in SpyGlass guided laser lithotripsy group was higher than that of the mechanical lithotripsy group [75.0％ (12/16) VS 41.2％ (7/17) ,P ＜ 0.05].There were no significant differences between two groups in either procedure time [(51.6 ± 18.6) min VS (60.4 ± 12.3) min, P ＞ 0.05] or the early complication rate related to the procedure (18.8％ VS 5.9％ ,P ＞ 0.05).Conclusion SpyGlass guided laser lithotripsy is safe and effective for large bile duct stones.