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Objective@#To explore the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stones with periampullary diverticula (PAD).@*Methods@#Data of 2, 103 patients with common bile duct stones(CBD stones), who underwent therapeutic ERCP for the first time from April 2013 to March 2016, were prospectively analyzed. Patients were divided into two groups according to presence or absence of PAD (PAD group and non-PAD group). Success rate of ERCP, complete clearance rate of the CBD stones after the first attempt and difficult cannulation rate were compared between the two groups.@*Results@#The difficult CBD cannulation rate was 14.87%(117/787) in PAD group and 9.93% (123/1 239) in non-PAD group with significant difference (P=0.001). Successful CBD cannulation was achieved in 96.92% (787/812) patients in PAD group and 95.97% (1 239/1 291) in non-PAD group (P=0.156). The complete clearance rate of CBD stones after the first attempt was 85.39% (672/787) in PAD group and 87.09% (1 079/1 239)in non-PAD group (P=0.154). There was no significant difference between the two groups in the complication rate[26/812(3.20%) VS 33/1 291(2.56%), P=0.833].@*Conclusion@#Although PAD increases the difficulty of ERCP, ERCP is an effective and safe method for patients of CBD stones with PAD.
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Objective To analyze the effects of different size and type of periampullary diverticula ( PAD) on the incidence of biliary tract diseases. Methods The data of patients with PAD, who were first diagnosed by endoscopic examination in Tianjin Nankai Hospital from April 2013 to March 2016 were collected, and the age, gender, morbidity of biliary tract diseases, and the relationship between the size and type of PAD with biliary tract diseases were analyzed. Results A total of 1012 PAD patients were collected in the study. The rate of acute pancreatitis in patients with small PAD (18. 03％, 97/538) was higher than that of patients with large PAD ( 10. 78％, 11/102 ) and middle PAD ( 12. 90％, 48/372 ) , and the difference was statistically significant(P=0. 024). The rate of acute cholangitis in patients with large PAD (46. 08％, 47/102) was higher than that of patients with middle PAD (39. 52％,147/372) and small PAD ( 33. 46％, 180/538) , and the difference was statistically significant( P=0. 029) . No significant differences were observed in the morbidity of common bile duct stones, acute pancreatitis and acute cholangitis among the different types of PAD(P>0. 05). Conclusion The size of PAD is correlation with the incidence of biliary tract diseases, but the type of PAD has no significant impact for the incidence of biliary tract diseases.
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Objective To assess the safety and feasibility of hybrid trans-gastric endoscopic and laparoscopic cholecystectomy in a porcine model.Methods A total of 6 pigs underwent hybrid trans-gastric endoscopic and laparoscopic cholecystectomy from July to October,2010 under general anesthesia.The operation time and complications during the procedure were recorded,as well as post-operative changes of eating habits and weight.Animals underwent autopsies on post-operative days(POD)14 for evaluation of infection,abscesses and adhesion.Results All procedures were successfully performed and all dogs survived.There was no severe complication except for hemorrhage in one porcine,which was successfully managed under laparoscopy.The mean operation time was 87mins(ranging from 69-124 mins).After the operation,there was no change in eating habits or weight.At autopsy on POD 14,no abscess or hemorrhage was found.Sites of gastric closure were found to be completely healed.Conclusion The hybrid approach increases the safety of initial gastric puncture and gastric wall incision,simplifies peroral trans-gastric cholecystectomy,and decreases invasiveness of laparoscopic surgery.It is a bridge between laparoscopic and transluminal surgery.