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Objective:To study the clinical value of endoscopic ultrasonography (EUS) before endoscopic retrograde cholangiopancreatography (ERCP) in patients with non-deterministic choledocholithiasis.Methods:Data of 132 patients with unconfirmed common bile duct calculi diagnosed in Tianjin Nankai Hospital from January 2017 to December 2019, whose clinical manifestations were not consistent with magnetic resonance cholangiopancreatography (MRCP) results, were retrospectively analyzed. Patients were divided into two groups: group A showed calculi under MRCP with no suspicious clinical manifestations, while group B showed no calculi under MRCP with suspected clinical manifestations. All patients underwent EUS. Necessity of ERCP was determined according to EUS results, and the diagnostic accuracy of EUS was analyzed compared with ERCP results and follow-up results as the gold standard.Results:Of the 132 patients, 87 were confirmed as choledocholithiasis, and 45 had no common bile duct calculi by the golden standard. Forty-four (33.3%) cases were negative in EUS and were confirmed free of calculi by follow-up. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS for choledocholithiasis were 95.40% (83/87), 97.78% (44/45), 96.21% (127/132), 98.81% (83/84) and 91.67% (44/48), respectively.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRCP for choledocholithiasis were 66.67% (58/87), 82.22% (37/45), 71.97% (95/132), 87.88% (58/66) and 56.06% (37/66), respectively. There were significant differences in the sensitivity, accuracy, positive predictive value or negative predictive value between EUS and ERCP (all P<0.05). There was significant consistency between the EUS results and the final diagnosis ( Kappa=0.917, P<0.001), and good consistency between MRCP results and the final diagnosis ( Kappa=0.439, P<0.001). The detection rate of false positive MRCP in group A was higher than that of false negative MRCP in group B [8/8 VS 89.66% (26/29), P<0.001] under EUS. Conclusion:EUS is superior to MRCP in the diagnosis of uncertain choledocholithiasis, and EUS prior to ERCP can reduce unnecessary ERCP operations and avoid missing stones.
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Objective To evaluate the efficacy and safety of interferon alpha (IFNα) combined with adefovir dipivoxil (ADV) for patients with chronic hepatitis B (CHB) non-responding to 24-week IFNα monotherapy.Methods Sixty CHB patients admitted to the First Affiliated Hospital of Xiamen University during 2009 and 2012 were enrolled in the study.All patients recieved IFNα monotherapy for 24 weeks and had no response.The patients were randomly divided into 3 groups by number table with 20 cases in each group.The experimental group was treated with IFNα combined with ADV,the control group 1 continued IFNα monotherapy,and the control group 2 shifted to ADV monotherapy.Virological,serological and biochemical responses were compared,and adverse reactions were observed.SPSS 19.0 software was used for data analysis.Results After 24 weeks of treatment,there was no statistical difference in HBV DNA loads,ALT levels and titers of HBeAg and HBsAg among three groups (F =0.985,0.717,0.985 and 0.717,P ＞ 0.05).And no HBeAg seroconversion was observed.After 48 weeks of treatment,the experimental group had higher HBV DNA negative conversion rate,ALT normalization rate and HBeAg conversion rate than control group 1 (x2 =10.00,3.956 and 4.800,P ＜ 0.05),but no statistically significant difference was found in HBeAg negative conversion rate (x2 =0.693,P ＞ 0.05).There was no significant difference in HBV DNA and HBeAg negative conversion rates between experimental group and the control group 2 (x2 =1.026,1.905 and 0.156,P ＞0.05),but the HBeAg conversion rate in experimental group was significantly higher than that in control group 2 (x2 =4.800,P ＜ 0.05).No HBsAg negative or serological conversion was observed,and there was no significant difference in titers of HBsAg among three groups (F =1.935,P ＞ 0.05).No adverse reaction was observed.Conclusion For patients nonresponding to IFNα monotherapy,combination of IFNα and ADV can achieve higher ALT normalization rate,HBeAg conversion rate and HBV DNA negative conversion rate,and improve the overall efficacy of CHB antiviral therapy.