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Objective To evaluate the effectiveness of mouth care combined with intestinal and endoscopic working channel flushing for ERCP related cholangitis and to investigate the mechanisms.Methods A total of 284 patients who underwent ERCP were divided into the amikacin group (n =96),the saline group (n =95) and the control group (n =93).Specimens were collected before cannulation (Sample 1),the first access to the bile duct (Sample 2) and at the end of ERCP (Sample 3).All the samples underwent bacterial culture and colony counting.Incidence of ERCP related cholangitis and bacterial results were recorded.Results The incidences of ERCP related cholangitis were 7.3％ (7/96),8.4％ (8/95)and 18.3％ (17/93)in amikacin group,saline group and control group respectively,with significant differences among three groups (x2 =6.861,P =0.032).The positive rate of bacterial culture of Sample 1 in the amikacin group,saline group and control group were 6.3％ (6/96),25.3％ (24/95) and 28.0％ (26/93) (x2 =16.833,P =0.000),respectively.The positive rate of bacterial culture of Sample 2 in amikacin group,saline group and control group were 6.3％ (6/96),16.8％ (16/95) and 24.7％ (23/93)(x2 =12.206,P =0.002),respectively.The positive rate of bacterial culture of Sample 3 in amikacin group,saline group and control group were 7.3％ (7/96),17.9％ (17/95) and 33.3％ (31/93) (x2 =20.713,P =0.000),respectively.Conclusion The procedure of ERCP can bring the intestinal bacteria into the bile duct,which could be reduced by mouth care combined with intestinal and endoscopic working channel flushing.And the incidence of ERCP related cholangitis can be effectively reduced.
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Objective To determine the safety and clinical value of secondary ERCP to a failed intubation procedure.Methods A total of 212 patients with difficult intubation during ERCP procedures were enrolled.Patients with failed conventional intubation accepted precut sphincterotomy.The operation stopped after one hour of effort.A secondary selective ERCP was performed at a appropriate time.The operation success rate and complication rate of first ERCP and secondary ERCP were compared.Results The success rate of first ERCP was 67.0％ (142/212),and the total success rate was 90.6％ (192/212).The total success rate is significantly higher than that of first ERCP operation(x2 =35.263,P ＜0.05).The complication rate of first ERCP,secondary ERCP and total complication rate was 8.96％ (19/212),4.29％ (3/70),10.38％ (22/212),respectively.Complication rates of total ERCP and secondary ERCP were not significantly different from the first ERCP (P ＞ 0.05).Conclusion It is safe and effective for patients with failed ERCP intubations after precut to receive a secondary ERCP at a appropriate time.
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Objective To evaluate the effectiveness of mouth care combined with intestinal and endoscopic working channel washing for ERCP related cholangitis.Methods A total of 573 patients diagnosed as having obstructive jaundice were randomized into three groups,190 cases in the control group,192 in the saline group and 191 in the amikacin group.Clinical and laboratory data were collected before ERCP and ERCP related cholangitis were recorded.Results There were no significant differences among the three groups in sex,age,the level of obstruction,the category of obstruction,total bilirubin or WBC counting.The incidences of ERCP related cholangitis were 21.1％ (40/190),13.5％ (26/192) and 4.7％ (9/191)in control group,saline group and amikacin group respectively,which was significantly different (x2 =22.409,P =0.000 ).The incidences of ERCP related cholangitis were 19.5％ ( 65/333 ) and 4.2％(10/240) in patients diagnosed as having hilar duct obstruction and low positioned biliary obstruction respectively (x2 =27.175,P =0.000).There was no significant difference in ERCP related cholangitis between benign and malignant biliary obstruction.Subgroup of hilar duct obstruction showed the incidences of ERCP related cholangitis were 29.7％ (33/111 ),20.5％ (24/117)and 7.6％ (8/105)in the control group,the saline group and the amikacin group,respectively (x2 =16.905,P =0.000).Conclusion The incidence of ERCP related cholangitis is relatively higher in patients with hilar duct obstruction.Mouth care combined with intestinal and endoscopic working channel washing can effectively reduce the incidence of ERCP related cholangitis,especially in the amikacin group.
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Objective To evaluate endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management of biliary cast syndrome after orthotropic liver transplantation. Methods A total of 71 consecutive patients with abnormal liver function and MRCP findings after liver transplantation underwent ERCP for diagnosis and management. Their data were retrospectively reviewed. Results A total of 188 sessions of ERCP were carried out on the 71 patients, most of whom were found to have stenosis of anastomotic stoma and/or bile duct. Bile sludge was found and removed in all patients diagnosed within 3 months after liver transplantation, while pigmentoid stones were found and removed in patients diagnosed within 3-6 months and biliary casts in patients diagnosed at more than 6 months. Each patient underwent 2.6 sessions averagely. Biliary casts were formed at an average time of 22. 7 ± 15.6 months after transplantation. PostERCP complications included 2 cases of pancreatitis and 3 cholangitis, with an occurrence rate of 2. 6%(5/188), which were all controlled with conservative treatment. The follow-up data was available in 56 patients showing improvement in liver function after ERCP, among who 42 met the endoscopic criteria of cure,1 0 received second liver transplantation because of progressive sclerosing cholangitis and 4 died from diseases other than liver transplantation. Conclusion Therapeutic ERCP for the biliary cast syndrome after liver transplantation is feasible, safe and effective, and can be performed repeatedly with good short-term effect.