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RESUMEN La colangiopancreatografía retrógrada endoscópica (CPRE) es un procedimiento invasivo para el diagnóstico y el tratamiento de la enfermedad biliopancreática. Entre sus complicaciones más infrecuentes se encuentra la migración proximal y distal de la endoprótesis biliar. Las escasas publicaciones sobre tal complicación motivaron la redacción de este artículo. Nuestro objetivo principal fue presentar dos casos clínicos de migración de endoprótesis biliar plástica, su manejo y resolución. Consideramos importante resaltar la necesidad del registro y seguimiento de los pacientes en quienes se colocaron endoprótesis biliares, para la prevención de su olvido más allá del tiempo recomendado de permanencia, y evitar así complicaciones tardías, ya que "la ignorancia no es la felicidad".
ABSTRACT Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure for the diagnosis and treatment of biliary tract and pancreatic duct diseases. Proximal and distal stent migration is a rare complication. The paucity of publications on this issue motivated this article. The main aim of this study was to describe two case reports of migration of biliary plastic stents, how they were managed and solved. We believe it is important to emphasize the need for recording and monitoring patients who have undergone biliary stent placement, to avoid leaving the stent in situ beyond the recommended time, and thus avoid late complications, since "ignorance is not bliss".
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Objective To evaluate the application efficacy of SpyGlass endoscopic direct visualization system in management of complex biliary complications after orthotopic liver transplantation. Methods Clinical data of 369 adult patients with biliary complications after orthotopic liver transplantation who received endoscopic retrograde cholangiopancreatography (ERCP) for the first time were retrospectively analyzed. Preoperative conditions, intraoperative manifestations, treatment outcomes and complications of patients treated with SpyGlass system were analyzed. Results Fifty-six patients were treated with SpyGlass system. The main preoperative symptoms included abdominal discomfort in 38 cases, fever in 8 cases, jaundice in 6 cases and skin itching in 4 cases. Ultrasound examination in 18 patients indicated common bile duct stenosis and significant intrahepatic bile duct dilatation. Preoperative magnetic resonance cholangiopancreatography (MRCP) of 56 patients revealed that 36 cases were diagnosed with common bile duct stenosis complicated with stones, 16 cases of common bile duct stenosis alone and 4 cases of suspected tumors. All patients had definite indications for SpyGlass system treatment. Among 56 patients treated with SpyGlass system, 34 cases were diagnosed with anastomotic stricture complicated with stones, 12 cases of anastomotic stricture alone, 1 case of biliary stone and 4 cases of tumors. Among 48 cases who were successfully treated, the levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, alkaline phosphatase and total bilirubin at postoperative 48 h were all significantly lower than preoperative levels (all P<0.05). No severe complications occurred in 56 patients treated with SpyGlass system. Conclusions Use of SpyGlass system may significantly increase success rate and guarantee surgical safety in the treatment of complex biliary complications after liver transplantation, which is worthy of promotion and application.
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Objective To preliminarily evaluate the application value of SpyGlass direct visualization system in the diagnosis and treatment of biliary stricture after liver transplantation. Methods Clinical data of 4 patients presenting with biliary stricture after liver transplantation who underwent SpyGlass direct visualization system examination were collected. The examination, treatment and prognosis of biliary stricture were analyzed. Results The examination results of color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in 4 patients suggested biliary anastomotic stricture with intrahepatic biliary dilatation, and 2 of them were complicated with intrahepatic biliary calculi. Repeated placement of biliary stent under ERCP yielded poor effect in 3 cases. SpyGlass direct visualization system examination hinted biliary anastomotic stricture in 4 patients, 3 cases of intrahepatic biliary dilatation, 3 cases of intrahepatic biliary calculi, 2 cases of purulent bile and 3 cases of floccules within the biliary tract, 1 case of congestion and edema of biliary tract wall and 2 cases of local epithelial necrosis and stiffness changes of intrahepatic biliary tract wall. The wire could not be inserted in 1 patient due to severe biliary anastomotic stricture. Four patients were treated with biliary stricture resection + biliary stone removal + biliary end-to-end anastomosis, biliary stricture resection + biliary-intestinal anastomosis, ERCP lithotomy + biliary metal stent implantation, and biliary metal stent implantation + percutaneous transhepatic bile duct lithotomy, respectively. Relevant symptoms were relieved without evident complications. All patients survived during the follow-up until the submission date. Conclusions Compared with traditional imaging examination, SpyGlass direct visualization system may more directly display the morphological characteristics of biliary tract wall and structural changes within biliary tract cavity, which is an effective examination tool for biliary stricture after liver transplantation. In addition, individualized treatment methods may be adopted for different biliary tract diseases, which is expected to improve clinical prognosis of patients.
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Objective To evaluate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP)-based comprehensive minimally invasive treatment for biliary anastomotic stenosis (BAS) after liver transplantation. Methods Clinical data of 60 BAS recipients after liver transplantation were retrospectively analyzed, 54 male and 6 female, aged (48±10) years. ERCP was initially carried out. If it succeeded, plastic or metallic stents were placed into the biliary tract. If it failed, percutaneous transhepatic cholangial drainage (PTCD) or single-operator cholangioscopy (SpyGlass) was adopted to pass through the stenosis. If all these procedures failed, magnetic anastomosis or other special methods were delivered. The incidence and treatment of BAS after liver transplantation were summarized. The efficacy, stent removal and recurrence were observed. Results The median time of incidence of BAS after liver transplantation was 8 (4, 13) months. Within postoperative 1 year, 1-2 years and over 2 years, 39, 16 and 5 recipients were diagnosed with BAS, respectively. All 60 BAS recipients after liver transplantation were successfully treated, including 56 cases initially receiving ERCP, and 41 completing BAS treatment, with a success rate of 73%. The failure of guide wire was the main cause of ERCP failure. The success rates of PTCD, SpyGlass and magnetic anastomosis were 5/9, 5/7 and 7/8, respectively. Two recipients were successfully treated by percutaneous choledochoscope-assisted blunt guide wire technique and stent placement in the biliary and duodenal fistula. After 3 (3, 4) cycles of ERCP and 13 (8, 18) months of stent indwelling, 38 recipients reached the stent removal criteria, including 25 plastic stents and 13 metallic stents. The indwelling time of plastic stents was longer than that of metallic stents (P < 0.05). Six cases suffered from stenosis recurrence at 12 (8, 33) months after stent removal, and the recurrence rate was 16%. Six patients were treated with ERCP, and 5 of them did not recur after the stents were successfully removed. Multivariate analysis showed that delayed diagnosis of stenosis and frequent ERCP before stent removal were the independent risk factors for BAS recurrence (both P < 0.05). Conclusions ERCP-based comprehensive minimally invasive treatment may improve the success rate of BAS treatment after liver transplantation and yield satisfactory long-term efficacy. Delayed diagnosis of BAS and high frequent ERCP required for stent removal are the independent risk factors for BAS recurrence.
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Liver transplantation has become an effective treatment for end-stage liver diseases. With rapid development of surgical techniques, donor selection, organ preservation and transportation, immunosuppressants and perioperative management, the overall incidence of complications after liver transplantation has been significantly decreased, whereas the incidence of biliary complications remains relatively high. At present, biliary complications after liver transplantation are still an important cause of graft failure. Nevertheless, the pathogenesis, diagnosis and treatment of biliary complications remain controversial, which are also research hotspots in the field of organ transplantation in recent years. In this article, new breakthrough and research progress upon biliary complications after orthotopic liver transplantation in adults were reviewed, aiming to provide theoretical basis for resolving biliary complications-related clinical issues.
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Background: Pancreaticoduodenectomy (PD) in the setting of preoperative post-ERCP acute pancreatitis (PAP) might pose significant challenges and leads to higher morbidity as compared to those without acute pancreatitis. The aim of the study was to study patients undergoing PD and compare intraoperative variables and postoperative outcomes in patients with and without preoperative PAP. Methods: We retrospectively analysed 20 patients who underwent PD from January 2015 to July 2017. Out of these, 2 patients had preoperative PAP following endoscopic biliary drainage for cholangitis.This group was compared with the rest 18 patients (control group) in terms of patient characteristics, operative variables and postoperative outcomes. Postoperative outcomes and overall complication rate, specifically hemorrhage, delayed gastric emptying and pancreatic fistula were noted. The postoperative complications in stented (n=9) and non-stented (n=11) patients were studied. Risk factors for pancreatic fistula were analysed in entire study population. (n=20). Results: PAP was found in 2 out of 20 patients (10%). The number of complications were higher in the PAP group (8/2) compared to control group (20/18). The ICU stay, delayed gastric emptying (DGE)and postoperative stay was higher in PAP group. There was one perioperative mortality due to grade C pancreatic fistula in the control group. Overall as well as infectious complications, were not statistically different in stented versus non-stented group. Soft pancreas(p=0.001) and non-dialted pancreatic duct (p=0.004) were significantly associated with pancreatic fistula. Conclusion: PD in the setting of PAP is feasible, albeit associated with more frequent complications, prolonged ICU and hospital stay.
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Objective To evaluate the clinical efficacy of early diagnosis by contrast-enhanced ultrasound (CEUS) combined with mesenchymal stem cell (MSC) therapy in the treatment of biliary ischemia after liver transplantation. Methods Clinical data of 9 recipients presenting with biliary ischemia detected by CEUS within 4 weeks after liver transplantation and diagnosed with non-anastomotic biliary stricture (NAS) within postoperative 1 year were retrospectively analyzed. In the conventional treatment group, 4 recipients were treated with conventional treatment including liver protection, cholagogic therapy and interventional therapy. In MSC treatment group, 5 recipients received intravenous infusion of MSC at 1, 2, 4, 8, 12 and 16 weeks after biliary ischemia detected by CEUS on the basis of conventional therapy. The interventional treatment and clinical prognosis within 1 year after liver transplantation were analyzed between two groups. Results Two recipients in the MSC treatment group required interventional therapy, which was initially given at 7-9 months after liver transplantation for 1-2 times. All recipients in the conventional treatment group required interventional therapy, which was initially delivered at postoperative 1-3 months for 2-6 times, earlier than that in the MSC treatment group. Within 1 year following liver transplantation, diffuse bile duct injury occurred in 2 recipients in MSC treatment group, and no graft dysfunction was observed. In the conventional treatment group, all recipients developed diffuse bile duct injury, and 2 recipients presented with graft dysfunction. Conclusions Early diagnosis of biliary ischemia after liver transplantation by CEUS combined with MSC therapy may delay and reduce the requirement of interventional therapy for NAS, and also improve clinical prognosis of the recipients.
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Resumen El tratamiento de la coledocolitiasis ha evolucionado de forma significativa desde que Robert Abbe realizó la primera coledocotomía y la exploración de las vías biliares en Nueva York, en 1889. La colangiopancreatografía retrógrada endoscópica (CPRE), que inicialmente fue un método diagnóstico, ahora solo tiene validez como método terapéutico. En la actualidad, los principales métodos diagnósticos son la colangioresonancia magnética (CRM) y la ultrasonografía endoscópica (USE). El tratamiento de la coledocolitiasis pasó de la técnica quirúrgica abierta -en la que, de forma rutinaria, se realizaba la coledocorrafia sobre un tubo de Kehr o tubo en T- a la endoscópica, mediante el uso de la CPRE, la esfinteroplastia y la instrumentación con balones y canastilla. Hoy en día se dispone de técnicas adicionales como la litotricia mecánica (LM) o extracorpórea, la dilatación con balón (DB) de gran tamaño y el Spyglass ® . La técnica laparoscópica se usa desde hace varios años, en diversas partes del mundo, para el tratamiento de la coledocolitiasis. Estudios recientes proponen incluso el cierre primario del colédoco o la coledocoduodenostomía, con lo cual no sería necesaria la utilización del tubo en T. Pero en muchos otros sitios, y por diversas razones, se continúa usando la exploración quirúrgica abierta y el tubo en T, que representa una importante opción en el tratamiento de algunos pacientes. Caso clínico: paciente masculino de 88 años, con coledocolitiasis recidivante, cálculo gigante de difícil manejo endoscópico y sepsis de origen biliar, que requirió drenaje quirúrgico abierto de urgencias. Se realizó una coledocotomía, y se dejó el tubo en T. Posteriormente, se efectuó un tratamiento exitoso conjunto, mediante instrumentación por el tubo en T, por parte de cirugía general, y CPRE, por gastroenterología.
Abstract The treatment of choledocholithiasis has evolved significantly since Robert Abbé performed the first bile duct exploration via choledochotomy in New York in 1889. Endoscopic retrograde cholangiopancreatography (ERCP), which was initially used for diagnosis, is now only valid as a therapeutic tool. Currently, the main diagnostic methods are magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS). The treatment of choledocholithiasis moved from the open surgery in which biliary stenting was routinely performed on a Kehr tube or T-tube, to the endoscopic technique using ERCP, sphincteroplasty and instrumentation with balloons and baskets. Additional techniques are now available such as mechanical or extra-corporeal lithotripsy, endoscopic papillary large balloon dilation and SpyGlass cholangioscopy. The laparoscopic technique has been used for several years in different parts of the world for the treatment of choledocholithiasis. Recent studies even propose performing the primary closure of the bile duct or choledochoduodenostomy, so that the T-tube is not necessary. However, in many other places, and for a variety of reasons, open exploratory surgery and the T-tube continue to be used, being an important option in the treatment of some patients. Case presentation: 88-year-old male patient with recurrent choledocholithiasis and a giant gallstone that was difficult to treat endoscopically, with sepsis of biliary origin, which required open surgical drainage at the emergency room. Choledocotomy was performed, and a T-tube was inserted at the site. Subsequently, a successful joint treatment was performed by the General Surgery Service and the Gastroenterology Service, using T-tube instrumentation and ERCP, respectively.
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Humans , Male , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis , General Surgery , Bile Ducts , Choledochostomy , MechanicsABSTRACT
Objective@#To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones.@*Methods@#Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group(38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE), and B group(49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). The curative effect of the two groups was observed.The operation time, the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery, and the complications of the two groups were recorded.@*Results@#In A group, the average diameter of common bile duct stones was (1.02±0.25)cm, the average diameter of common bile duct diameter was (1.15±0.25)cm.In B group, the mean diameter of common bile duct stones was (0.99±0.26)cm, and the average diameter of common bile duct was (1.13±0.26) cm.The differences between the two groups were not statistically significant (t=0.513, 0.437, 0.367, P=2.083, 1.533, 1.095). The successful operation rate of A group was 92.11%(35/38), which in B group was 91.84%(45/49), the difference was not statistically significant between the two groups(χ2=0.006, P=0.974). The incidence rate of complications in B group was 20.41%, which was significantly higher than that in A group, the difference was statistically significant(χ2=3.654, P=0.019). The hospitalization time, hospitalization expenses in A group were (10.6±2.6)d, (26 649.8±3 478.6)CNY, respectively, which were significantly better than those in B group (t=21.971, 17.168, all P<0.05).@*Conclusion@#The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery, and the safety of the former is higher than the latter.
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Objective To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones.Methods Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group (38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE),and B group (49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC).The curative effect of the two groups was observed.The operation time,the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery,and the complications of the two groups were recorded.Results In A group,the average diameter of common bile duct stones was (1.02 ± 0.25) cm,the average diameter of common bile duct diameter was (1.15 ± 0.25) cm.In B group,the mean diameter of common bile duct stones was (0.99 ± 0.26) cm,and the average diameter of common bile duct was (1.13 ± 0.26) cm.The differences between the two groups were not statistically significant (t =0.513,0.437,0.367,P =2.083,1.533,1.095).The successful operation rate of A group was 92.11％ (35/38),which in B group was 91.84％ (45/49),the difference was not statistically significant between the two groups (x2 =0.006,P =0.974).The incidence rate of complications in B group was 20.41％,which was significantly higher than that in A group,the difference was statistically significant(x2 =3.654,P =0.019).The hospitalization time,hospitalization expenses in A group were (10.6 ± 2.6) d,(26 649.8 ± 3 478.6) CNY,respectively,which were significantly better than those in B group (t =21.971,17.168,all P ＜ 0.05).Conclusion The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery,and the safety of the former is higher than the latter.
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Resumen La colangiopancreatografía retrógrada endoscópica (CPRE) es uno de los recursos terapéuticos más importantes para el manejo de las complicaciones biliares del trasplante hepático. Sin embargo, se pueden presentar varias complicaciones: pancreatitis aguda, hemorragia, perforaciones, infecciones y eventos adversos cardiopulmonares. La embolia aérea es una complicación muy infrecuente, severa y potencialmente fatal. Se reporta un caso de embolia aérea post-CPRE en una mujer de 55 años con antecedente de trasplante hepático y estenosis de la anastomosis biliar. Se discute la presentación clínica, el diagnóstico, el tratamiento y los posibles mecanismos involucrados en esta complicación.
Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most important therapeutic resources for management of biliary complications of liver transplantation. However, several complications including acute pancreatitis, hemorrhage, perforations, infections and cardiopulmonary adverse events can occur. Air embolisms occur very infrequently but are severe and potentially fatal complications. We report a case of post-ERCP embolism in a 55-year-old woman with a history of liver transplantation and stenosis of the biliary anastomosis. The clinical presentation, the diagnosis, the treatment and the possible mechanisms involved in this complication are discussed.
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Humans , Female , Middle Aged , Pulmonary Embolism , Cholangiopancreatography, Endoscopic Retrograde , Liver Transplantation , Patients , Hemorrhage , InfectionsABSTRACT
Objective To study the clinical efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) in the treatment of common bile duct (CBD) stones.Methods This retrospective study of EPLBD for CBD stoneswas conducted between May 2015 and March 2017 on 116 patients.The patients were divided into two groups based on the different methods of treatment:group A (the EPLBD group) and B(the EST + EPBD group).Results Treatment with EPLBD when compared with EST + EPBD produced similar outcomes with regard to the overall stone removal rates (96.2％ vs.93.5％,P ＞ 0.05) and complete ductal clearance in one session (92.6％ vs.92％,P ＞0.05).There were no significant differences in the rates of overall complication (22.2％ vs.22.2％,P ＞ 0.05),hemorrhage (7.4％ vs.11.3％,P ＞ 0.05),post-ERCP pancreatitis (9.3％ vs.6.6％,P ＞ 0.05) and acute cholangitis (5.6％ vs.8.1％,P ＞0.05).When compared with EST + EPBD,mechanical lithotripsy was performed less in the EPLBD group (16.6％ vs.27.4t％,p ＜ 0.05).Conclusions EPLBD was an effective and safe method to treat CBD stones.EPLBD reduced the use of mechanical lithotripsy when compared with EST + EPBD.
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Objective To investigate efficacy and safety of biliary metallic stent placement via endoscopic retrograde cholangiopancreatography (ERCP) for malignant extrahepatic biliary obstruction. Methods According to different methods, 40 patients with malignant biliary obstruction were divided into PTCD group and ERCP group. Patients in PTCD group received percutaneous puncture bile duct drainage (PTCD) treatment, patients in ERCP group received placement of metal stents under ERCP. Results The survival time of the two groups were significant difference (P < 0.05). Postoperative biliary patency time in ERCP group was significantly longer than that in PTCD group, the difference was statistically significant (P < 0.05). One week later, the index for liver function of ERCP group was significantly better than that in PTCD group (P < 0.05). Additionally, the incidence of complications of PTCD group amd ERCP group was 30.0% and 10.0%, respectively. The complication rate of ERCP group was significantly lower than PTCD group (P < 0.05). Conclusion The effect of ERCP stent implantation is similar to that of PTCD in the treatment of malignant biliary obstruction. However, after ERCP, the time of biliary tract patency is longer with less complications and the index of liver function is recovered quickier than that after PTCD. Therefore, for the patients with malignant extrahepatic biliary obstruction, ERCP holds better clinical efficacy and safety.
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Objective To explore the application of plastic pancreatic stents and/or nasal biliary drainage for choledocholithiasis patients having DSBC during Endoscopic Retrograde Cholangiopancreatography (ERCP).Methods Retrospective analysis on clinical data of 57 ERCP cases aiming at choledocholithiasis patients having DSBC from January 2010 to December 2015 has been carried out. According to the guide wire cannulation in an operation, patients are divided into three groups, i.e. plastic pancreatic stents group, nasal biliary drainage group, and plastic pancreatic stents + nasal biliary drainage group, so as to observe the success rate of operation and the occurrence rate of postoperative complications, such as pancreatitis or hyperamylasemia, as well as to compare the differences between the three groups.Results Out of the 57 patients receiving ERCP, 13 patients are in the plastic pancreatic stents group, with two successful operations (15.4%), one case of hyperamylasemia (7.7%), two cases of postoperative pancreatitis (15.4%), one case of fever (7.7%) and one case of hemorrhage (7.7%); 20 patients are in the nasal biliary drainage group, with 20 successful operations (100.0%), no occurrence of hyperamylasemia or postoperative pancreatitis or other complications including hemorrhage and fever; 24 patients are in the plastic pancreatic stents + nasal biliary drainage group, with 19 ERCP operations succeeded at the first attempt (79.2%) and 5 ERCP operations succeeded at the second try (20.8%), as well as 4 cases of hyperamylasemia (16.7%), 2 cases of hemorrhage (8.3%) , no occurrence of fever cases and postoperative pancreatitis. In comparison between the three groups, the occurrence of postoperative pancreatitis and successful rate of operation show a significant difference.Conclusion By adopting plastic pancreatic stents and/or nasal biliary drainage for patients having a dififcult selective biliary cannulation during ERCP, the success rate of operation can be improved, and the occurrence of pancreatitis can also be reduced.
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Objective To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic bile duct exploration lithotomy (LBDEL) in treatment of intra/extra-hepatic duct stones. Methods There were 110 patients whose intrahepatic stones located in Ⅰ , Ⅱ hepatic duct and 378 patients whose stones only located in the common bile duct. These patients respectively underwent LBDE combined with choledochoscope laser lithotripsy or ERCP combined with endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to remove the stones. Common bile ducts were performed primary suture or T tube placement in the LBDEL cases. The evaluation was carried out for perioperative complications and postoperative recovery of the surgical methods. Results The residual stone rate was 31.82% in 110 cases. The rate was higher in ERCP group (51.06%) than that in LBDEL group (17.46%) (P < 0.05). Postoperative recovery was better in LBDEL group than that in ERCP group. The residual stone rate was 8.20% in 378 cases. The rate was lower in ERCP group (3.68%) than that in LBDEL group(11.63%) (P < 0.05). Between the two groups, there had no statistical significance in postoperative recovery. The incidences of bile leakage and pulmonary infection were higher in LBDEL group than in ERCP group. The incidences of abdominal cavity infection, acute pancreatitis, digestive tract perforation and gastrointestinal bleeding were higher in ERCP group than that in LBDEL group. 2 of the 378 patients occurred death were happened digestive tract perforation which were induced during ERCP procedure. Conclusion LBDEL and ERCP demonstrated the same therapeutic effects in the treatment of common bile duct stones. However, ERCP has no large advantages in the treatment of hepatolithiasis, and shows higher complication rates. LBDEL has a significant curative effect for intra-and extrahepatic bile duct calculi and can maintain the integrity of Oddi sphincter. This technology is easy to spread to the basic-level hospital to benefit the majority of patients.
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A retrospective study was conducted based on the clinical data of 15 choledocholith patients after Billroth-Ⅱgastroenterestomy who were treated with endoscopic retrograde cholangio-pancreatography (ERCP) through colonoscopy or duodenoscopy.It showed that choledocholith removed by colonoscopy for patients with Billroth-Ⅱ gastroenterestomy can achieve comparable therapeutic effect,but this method can reduce the operation difficulty,shorten the operation time and significantly increase the success rate.
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Objective To study the efficacy and feasibility of the one-stage and two classification method to treat concomitant gallbladder stones and common bile duct stones.Methods 56 consecutive patients with concomitant gallbladder stones and common bile duct stones in Central Hospital of Huzhou were treated with the one-stage and two classification method from January 2013 to January 2017.According to the size and quantity,common bile duct stones were divided into difficult stones and non difficult stones.In plan A (n =35),endoscopic stone clearance and laparoscopic cholecystectomy were undertaken in a single operation to treat non difficult stones,In plan B (n =21),laparoscopic cholecystectomy and CBD exploration without T-tube insertion were undertaken in a single operation to treat difficult stones.The operation success rate,postoperative complications,hospitalization stay and follow-up outcomes were analyzed.Results Fifty-six patients were enrolled in the study.Fifty-one patients were treated by the one-stage and two classification method.Among them,thirty-two patients followed treatment plan A.Three patients were convened to plan B because of failure of bile duet intubation.Nineteen patients were treated by plan B.One patient was converted to laparotomy,and another underwent T-tube drainage.The incidence of complication was 7.1％.Post-ERCP pancreatitis happened in one patient.Post ERCP bleeding happened in another patient (1.6％).Bile leakage occurred in one patient,and incision infection occurred in one patient.There were no deaths.During a follow-up of 6-24 months,no stone recurrence and bile duct stenosis were observed.Conclusion The one-stage and two classification method was an effective and feasible alternative to manage concomitant gallbladder stones and common bile duct stones.
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Objective To discuss which drainage method is more efficient in treatment of choledocholithiasis with obstructive jaundice. Methods Compared the difference of serum total bilirubin,direct bilirubin, the variation of serum total bilirubin and direct bilirubin before and after drainage and daily biliary drainage by endoscopic nasobil-iary drainage (ENBD) and endoscopic nasobiliary drainage with continuous negative-pressure suction after three days. Results The daily biliary drainage about the patients by ENBD with continuous negative-pressure suction is much more effective than the patients by ENBD. The serum total bilirubin and direct bilirubin about the patients by ENBD with continuous negative-pressure suction is less than the patients by ENBD after three days. The variation of serum total bilirubin and direct bilirubin before and after drainage about the patients by ENBD with continuous neg-ative-pressure suction is more than the patients by ENBD. Conclusion The ENBD with continuous negative-pres-sure suction is more effective for choledocholithiasis with obstructive jaundice.
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The percutaneous transhepatic biliary drainage (PTBD) is an effective intervention as a palliative therapy for relieving a jaundice and cholangitis. It may be used in place of Endoscopic retrograde cholangiopancreatography (ERCP) in the obstructive biliary disease. Recently, by developing invasive procedures, the incidence of the complications such as bleeding and perforation has been increasing in the diagnosis and treatment of hepatobiliary disease. We report here on a case of remained drawstring after PTBD in a 85-year-old man. The patient was conducted PTBD for relieving a jaundice and cholangitis. And then the patient had complained of abdominal pain constantly. A few days later, we removed PTBD and attempted ERCP for removal of CBD stone. The ERCP showed remained drawstring around ampulla of vater and we removed it by IT knife. The drawstring was successfully removed.