Efficacy of percutaneous jejunal drainage in treatment of hepatolithiasis after choledochojejunostomy / 中华肝胆外科杂志

Objective:To study the feasibility and safety of percutaneous jejunal drainage in treatment of hepatolithiasis after choledochojejunostomy.Methods:The clinical data of 24 patients with hepatolithiasis after choledochojejunostomy treated by percutaneous jejunal drainage at the Cholelithiasis Center, Shanghai East Hospital Affiliated to Tongji University from May 2021 to May 2022 were retrospectively analyzed. There were 16 males and 8 females, aged (50.46±10.89) years old. Ultrasound and X ray guided percutaneous jejunography was performed under local anesthesia for patients with hepatolithiasis after choledochojejunostomy. Then the fistula was directly dilated to 16.0Fr, and percutaneous jejunal choledochoscopy was performed 3 days later. The success rate, complication rate and stone removal rate were analysed.Results:Twenty-four patients were treated with percutaneous jejunography, with a success rate of 79.2%(19/24), including 19 patients after anterior colonic cholangiojejunostomy with a success rate of 94.7%(18/19), and 5 patients after retrocolonic cholangiojejunostomy with a success rate of 20.0%(1/5). There was no complication including bleeding, intestinal leakage and bile leakage. In 19 patients with successful percutaneous jejunography, the success rate of fistula dilation was 100%(19/19), and there was no complication. Five patients with failed percutaneous jejunography underwent open choledocholithotomy through the jejunal output-loop, and bile leakage occurred in one patient. Thirteen patients with anastomotic stenosis, 5 with intrahepatic biliary strictures, and 6 with anastomotic and intrahepatic biliary strictures were diagnosed by choledochoscopy and selective cholangiography in these 24 patients. After choledochoscopic electrotomy, cylindrical balloon dilation, stone removal, stenting and other treatments, the stenosis relief rate was 100%(24/24), and the clearance rate of intrahepatic bile duct stones was 91.7%(22/24).Conclusion:Percutaneous jejunal drainage was a feasible, safe and minimally invasive method for treatment of hepatolithiasis after choledochojejunostomy. The procedure was especially suitable for patients with anterior colonic cholangiojejunostomy.

Electrohydraulic Lithotripsy for Difficult Bile Duct Stones under Endoscopic Retrograde Cholangiopancreatography and Peroral Transluminal Cholangioscopy Guidance

BACKGROUND/AIMS: Electrohydraulic lithotripsy (EHL) under endoscopic retrograde cholangiopancreatography (ERCP) guidance can be an option to treat difficult stones. Recently, a digital, single-operator cholangioscope (SPY-DS) has become available. Peroral transluminal cholangioscopy (PTLC) using SPY-DS has also been reported. In this retrospective study, the technical feasibility and clinical effectiveness of EHL for difficult bile duct stones under ERCP guidance and under PTLC guidance was examined. METHODS: In this pilot study, patients with difficult bile duct stones between July 2016 and July 2017 were retrospectively enrolled. RESULTS: Forty-two consecutive patients underwent EHL using a SPY-DS; 34 patients underwent EHL under ERCP guidance, and the other 8 patients underwent EHL under PTLC guidance. Median procedure time was 31 minutes (range, 19 to 66 minutes). The median number of EHL sessions was 1 (range, 1 to 2), and that of ERCP sessions was also 1 (range, 1 to 3). The rate of complete stone clearance was 98% (41/42). Adverse events such as cholangitis and acute pancreatitis were seen in 14% (6/42), which could be treated conservatively. CONCLUSIONS: EHL using SPY-DS was technically feasible, not only under ERCP guidance, but also PTLC guidance. A prospective clinical study of EHL using SPY-DS is needed.

Treatment of parapancreatic abscess with debridement by choledochoscope in combination with percutancous puncture drainage under ultrasound guidance: an analysis of 36 cases / 中华肝胆外科杂志

Objective To explore a new method of parapancreatic abscess treatment and establish an idea of minimally invasive technologies for parapancreatic abscess to improve the recovery rate of acute pancreatitis. Methods The patients had experienced percutaneous puncture and placed drainage tube under the ultrasound guidance first, then the sinus tract was expanded gradually to 24F perimeter by Cook's fascia expender. Finally, the necrotic tissue and pyogenic membrane was removed and repeatedly washed under guidance of choledochoscopy. Results The recovery rate was 91.1 %(33/36). The complication incidence was 10.7% (hemorrage:2 cases, external intestinal fistula:3 cases, and fatal MOF: 1 case). Conclusions The viewpoint which parapancreatic abscess only can be cured by drainage operation can be changed by associating debridement by choledochoscope with percutaneous puncture drainage under the ultrasound guidance. It is a simple, safe and effective method. It can be used to reduce the patients' damage, complication and mortality and accomplish the idea of damage control by minimally invasive technologies.