Clinical application value of endoscopic ultrasound in the etiological diagnosis of idiopathic acute pancreatitis / 中华胰腺病杂志

Objective:To evaluate the clinical application value of endoscopic ultrasonography (EUS) in the etiological diagnosis of patients initially diagnosed with idiopathic acute pancreatitis (IAP).Methods:Clinical data of 128 patients who underwent further EUS and magnetic resonance cholangiopancreatography (MRCP) after initial diagnosis of IAP at the Gastrointestinal Endoscopy Center of the First Affiliated Hospital of Naval Medical University between January 2015 and February 2022 were collected and divided into a single-episode group (single-episode group, 51 cases) and a multiple-episode group (recurrent group, 77 cases) based on the number of AP episodes. The data and the diagnosis of the etiology of IAP in the two groups by EUS were analyzed and compared with the etiological diagnosis results of MRCP.Results:The differences on basic information such as gender, age, history of smoking, history of alcohol consumption, family history of pancreatic disease, history of cholecystectomy, abnormality of liver function, and severity of pancreatitis between the single-episode group and recurrent group of IAP patients were not statistically significant. The etiology was clarified in 79 (62%) IAP patients after EUS examination, of which 55 (43%) cases had biliary disease (gallstones, microlithiasis, biliary sludge) and 24 (19%) cases had pancreatic disease (chronic pancreatitis, pancreatic divisum, pancreatic interstitial or pancreatic ductal changes). The percentage of patients with biliary disease as the cause of IAP was significantly higher in the single-episode group than in the recurrent group (59% vs 32%), while the percentage of patients with pancreatic disease as the cause of IAP was higher in the recurrent group than in the single-episode group (25% vs 10%), with statistically significant differences ( P values=0.004 and 0.035, respectively). The performance of EUS in diagnosing the etiology of IAP was significantly higher than that of MRCP (62% vs 19%, P=0.032), where EUS was more accurate in detecting biliary microlithiasis or biliary sludge (43% vs 9%, P<0.01). EUS was also superior to MRCP in identifying subtle changes in chronic pancreatitis lesions (small pancreatic nodules, patchy hyperechogenicity, etc.) and intraductal papillary mucinous neoplasms(17% vs 7%, P<0.05), but was inferior to MRCP in identifying pancreatic divisum (2 cases vs 4 cases). Conclusions:In view of high diagnostic accuracy and safety of EUS in diagnosing biliary diseases, and based on the fact that most IAPs in China are due to biliary diseases, EUS based management strategy can be considered to be a reasonable approach for evaluation of IAP patients. The MRCP can be used as a supplement to the EUS to identify a controversial etiology.

Research Progress of Antibacterial Biliary Stent / 中国医疗器械杂志

Biliary stent has been widely used in the treatment of biliary stricture and obstruction, it can relieve the pain of patients effectively, but bacterial infection and stent obstruction are still troublesome after surgery. We introduce the mechanism of infection and stent blockage caused by bacterial invasion after biliary stent implantation, and expound the formation mechanism of bacterial biofilm and bile sludge in this review. Antibacterial biliary stent is an effective way to inhibit biliary tract infection, the literatures on antibacterial modification of biliary stent with different antibacterial methods in domestic and abroad are reviewed, and the research prospect of antibacterial biliary stent is summarized and prospected.

Ceftriaxone-Induced Acute Pancreatitis in Patient with Liver Abscess / 대한췌담도학회지

Acute pancreatitis is a rare complication in patients treated with ceftriaxone. Precipitation of ceftriaxone in the bile causes the formation of biliary sludge leading to the development of cholangitis, cholecystitis, or pancreatitis. We treated a patient with acute pancreatitis who developed this condition after the administration of ceftriaxone. A 70-year-old man presented in a drowsy state with fever. He was diagnosed with a liver abscess and treated with intravenously administrated ceftriaxone and metronidazole. He complained of dyspepsia and epigastric pain on the 25th day of ceftriaxone administration. Laboratory examination and abdominal computed tomography revealed biliary pancreatitis. Ceftriaxone-induced acute pancreatitis was suspected, and ceftriaxone administration was immediately discontinued. Two days later, serum amylase and lipase levels recovered to within reference range, and he showed rapid resolution of symptoms. We concluded that ceftriaxone results in the formation of biliary sludge and causes serious adverse events such as cholecystitis, cholangitis and biliary pancreatitis.

Preliminary discussion of ultrasonograms of biliary sludge and its relationship with the prognosis of patients after liver transplantation / 器官移植

Objective To investigate the ultrasonograms of biliary sludge and its relationship with the prognosis of patients after liver transplantation.Methods Ultrasonograms of 36 patients with biliary sludge after liver transplantation were retrospectively analyzed.These patients were divided into two groups according to the different treatment outcomes:poor prognosis group and favorable prognosis group.The characteristics of initial ultrasonograms of biliary sludge when they were found at first time compared between two groups .Results Biliary sludge combined with ischemic-type biliary lesions accounted for 95% ( 19/20 ) in poor prognosis group while 13%(2/16)in favorable prognosis group.There was significant difference between two groups (P<0.05).In favorable prognosis group , biliary sludge was found locating in hepatic hilar region in all 16 cases (16/16) and the sludge had clear boundaries dissociated with bile duct walls were observed in 14 cases (14/16).There was no incrassation of bile duct walls in hepatic hilar region , nor dilation of intrahepatic bile ducts observed in 14 cases ( 14/16 ).In poor prognosis group , biliary sludge was observed widespread not only in hepatic hilar region but also in intrahepatic biliary ducts in 10 cases ( 10/20 ) , and the boundaries between sludge and bile duct walls were vague in 15 cases (15/20).Obvious incrassation of bile duct walls in hepatic hilar region was observed in 16 cases (16/20), and dilation of intrahepatic bile ducts was observed in 19 cases (19/20).There were significant differences in the above 4 ultrasound features between two groups (all in P<0.05).Conclusions There are differences in the ultrasonograms of biliary sludge between different prognosis groups.Biliary sludge combined with ischemic-type biliary lesions suggests a poor prognosis , which may need more active interventional treatments.

Unusual Presentation of Cystic Lymphangioma of the Gallbladder

Cystic lymphangioma of the gallbladder is quite a rare tumor with only a few cases having been reported in the literature. We describe here a rare case of cystic lymphangioma of the gallbladder, which was unusual in that the patient presented with biliary pain and an abnormal liver test. Ultrasonography and computed tomography of the abdomen showed a multi-septated cystic mass in the gallbladder fossa and an adjacent compressed gallbladder. Endoscopic retrograde cholangiography showed there was no communication between the bile tract and the lesion, and there were no other abnormal findings with the exception of a laterally compressed gallbladder. After performing endoscopic sphincterotomy, a small amount of sludge was released from the bile duct. The histological findings were consistent with a cystic lymphangioma originating from the subserosal layer of the gallbladder. This unusual clinical presentation of a gallbladder cystic lymphangioma was attributed to biliary sludge, and this was induced by gallbladder dysfunction that was possibly from compression of the gallbladder due to the mass.

To evaluate the effectiveness of the granulated medicine TSM in the treatment of cholecystolithiasis and biliary sludge

Background: Gallstone is a common disease not only in Vietnam but worldwide. A method of treatment for gallstone has not been discovered. Cholecystectomy is the main method for cholecystolithiasis. This solution has some advantage but the weak point is it can result in injury to the bile duct, high cost and cholecystectomy is not able to be carried out in every hospital. The particular traits of the Vietnamese gallstone patients are mixed crystals. Modern Medicine has some drugs for cholesterol stone so it has little affect. In addition, it gives undesirable side effects. Objective: To evaluate the effectiveness of the granulated medicine TSM in the treatment of cholecystolithiasis and biliary sludge. Subject and Method: The study was carried out in 47 cases (35 cholecystolithiasis, 12 biliary sludge) that used granulated TSM. Result: Granulated TSM reduce some clinical symptoms in gallstone patients with p<0.01. In general, the granulated TSM did not cause side effects and did not affect the liver and kidney functions. Conclusion: Granulated TSM has an advantage for gallstone patients. Gallstones were eliminated and completely in some cases.