Clinical value of a new direct visualization system of China-made peroral cholangiopancreatography (with video) / 中华消化内镜杂志

Objective:To investigate the efficacy and safety of a new China-made direct visualization system of peroral cholangiopancreatography in the diagnosis and treatment of biliopancreatic diseases.Methods:Clinical data of 37 patients who underwent endoscopic examination through the direct visualization system of peroral cholangiopancreatography at Digestive Endoscopy Center of Nanjing Drum Tower Hospital from April 2020 to June 2021 were retrospectively analyzed. Technical success rate and complications were analyzed.Results:The examination was completed in 37 patients through the system. The technical success rate was 100.0%. The nature of biliary stricture was confirmed in 24 cases, presenece or absence of bleeding or residual stones in the bile duct was confirmed in 6 cases, neoplasm or residual stones in the pancreatic duct was determined in 2 cases, biliary stricture was passed assisted with visualized guidewire in 2 cases, and lithotripsy was performed assisted with biliary laser in 3 cases. Nine patients were pathologically diagnosed as having malignant biliary stricture, and 8 of them were confirmed malignant by the system. Drainage was performed in 34 cases after the examination. There were 3 cases of cholangitis, 4 cases of bacteremia and 2 cases of postoperative pancreatitis after the operation, which were relieved in a short time after conservative treatment. Bleeding occurred in 1 case which was improved after two times of endoscopic hemostasis.Conclusion:The new direct visualization system of peroral cholangiopancreatography is safe and effective in the diagnosis and treatment of biliopancreatic diseases.

Comparative effectiveness research on small IT knife pre-cut and conventional guidewire cannulation on selective biliary intubation (with video) / 中华消化内镜杂志

Objective:To evaluate the application value of small IT knife pre-cut in assistance to duodenal papillary cannulation compared with conventional guidewire cannulation.Methods:A retrospective analysis was performed on the data of 90 patients with choledocholithiasis including 52 patients with small IT knife pre-cut assisted intubation (small IT knife group) and 38 patients with conventional guidewire intubation (conventional group) in endoscopic retrograde cholangiopancreatography (ERCP) from May 2016 to July 2019 in the digestive endoscopy center of Nanjing Drum Tower Hospital. The basic data, curative effect and complications of the two groups were collected and compared.Results:There was statistically significant difference in gender composition between the small IT knife group and the conventional group ( χ2=5.679, P=0.017), but no significant difference in other baseline data between the two groups (all P>0.05). The median intubation time of the small IT knife group was significantly shorter than that of the conventional group (141.5 s VS 270.0 s, Z=1 268.0, P=0.022). There were no significant differences in the success rate of intubation [98.1% (51/52) VS 94.7% (36/38), χ2=0.760, P=0.571], the incidence of intraoperative bleeding [15.4% (8/52) VS 7.9% (3/38), χ2=1.148, P=0.345], postoperative pancreatitis [5.8% (3/52) VS 7.9% (3/38), χ2=0.159, P=0.694], and postoperative cholangitis [1.9% (1/52) VS 5.3% (2/38), χ2=0.760, P=0.571] between the two groups. No perforation occurred in the two groups. After stratifying according to the operator′s proficiency, the median intubation time was significantly different between the small IT knife expert group and the conventional expert group (116.0 s VS 258.0 s, Z=276.0, P=0.038), while there was no significant difference in the intubation time among other groups (all P>0.05). Conclusion:The small IT knife is safe and effective to pre-cut and assist intubation in ERCP, and it may shorten the intubation time.

Analysis of endoscopic submucosal dissection training system construction / 中华消化内镜杂志

Objective:To investigate the prerequisites for endoscopists, who were chosen to receive endoscopic submucosal dissection (ESD) training.Methods:A total of 41 trainees, who attended ESD training in the endoscopic center of Nanjing Drum Tower Hospital from January 2017 to June 2018 were enrolled in the study. The general information of the subjects were collected, including name, age, gender, the number of gastroscopy and colonoscopy independently performed before training, the independent usage of narrow band image (NBI), magnifying endoscopy (ME), endoscopic mucosal resection (EMR), ESD, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) before training. And then every trainee independently finished four in vitro experiments of pig esophagus ESD. The specimen area and operating time were recorded, and the operating speed was calculated. Linear regression analysis was used to analyze the affecting factors of operating speed of ESD.Results:Among the 41 trainees, 26 were male and 15 were female, with age of 36.07±4.44 years. The specimen area, operating time and operating speed of pig esophagus ESD was 4.67±1.61 cm 2, 24.54±5.97 min, and 0.19±0.05 cm 2/min, respectively. Univariate linear regression analysis showed that the number of gastroscopy (n>5 000, P=0.001 8) and colonoscopy (n>3 000, P=0.000 1), the detect number of early cancer in upper digestive tract (n>30, P=0.000 3) and lower digestive tract (n>10, P=0.019 7), and the usage of ME ( P=0.047 8), EMR ( P=0.019 6) and ESD ( P=0.000 3) before training were statistically correlated with the operating speed of ESD. Carrying out NBI ( P=0.532 9), ERCP ( P=0.500 7) and EUS ( P=0.766 8) before training were not statistically correlated with the operating speed of ESD. The operating speed of ESD was negatively correlated with the perforation rate of ESD ( P<0.000 1). According to multivariable linear regression model, the usage of EMR ( P=0.029) and ESD ( P=0.034) were statistically correlated with the operating speed of ESD. Conclusion:ESD trainees, who have the number of gastroscopy more than 5 000, the number of colonoscopy more than 3 000, the detect number of early cancer more than 30 in upper digestive tract and 10 in lower digestive tract, and the usage of ME, EMR and ESD before training, can get a better training effect. The study provides a theoretical basis for selecting appropriate ESD trainees.

Analysis of endoscopic submucosal dissection training system construction / 中华消化内镜杂志

Objective@#To investigate the prerequisites for endoscopists, who were chosen to receive endoscopic submucosal dissection (ESD) training.@*Methods@#A total of 41 trainees, who attended ESD training in the endoscopic center of Nanjing Drum Tower Hospital from January 2017 to June 2018 were enrolled in the study. The general information of the subjects were collected, including name, age, gender, the number of gastroscopy and colonoscopy independently performed before training, the independent usage of narrow band image (NBI), magnifying endoscopy (ME), endoscopic mucosal resection (EMR), ESD, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) before training. And then every trainee independently finished four in vitro experiments of pig esophagus ESD. The specimen area and operating time were recorded, and the operating speed was calculated. Linear regression analysis was used to analyze the affecting factors of operating speed of ESD.@*Results@#Among the 41 trainees, 26 were male and 15 were female, with age of 36.07±4.44 years. The specimen area, operating time and operating speed of pig esophagus ESD was 4.67±1.61 cm2, 24.54±5.97 min, and 0.19±0.05 cm2/min, respectively. Univariate linear regression analysis showed that the number of gastroscopy (n>5 000, P=0.001 8) and colonoscopy (n>3 000, P=0.000 1), the detect number of early cancer in upper digestive tract (n>30, P=0.000 3) and lower digestive tract (n>10, P=0.019 7), and the usage of ME (P=0.047 8), EMR (P=0.019 6) and ESD (P=0.000 3) before training were statistically correlated with the operating speed of ESD. Carrying out NBI (P=0.532 9), ERCP (P=0.500 7) and EUS (P=0.766 8) before training were not statistically correlated with the operating speed of ESD. The operating speed of ESD was negatively correlated with the perforation rate of ESD (P<0.000 1). According to multivariable linear regression model, the usage of EMR (P=0.029) and ESD (P=0.034) were statistically correlated with the operating speed of ESD.@*Conclusion@#ESD trainees, who have the number of gastroscopy more than 5 000, the number of colonoscopy more than 3 000, the detect number of early cancer more than 30 in upper digestive tract and 10 in lower digestive tract, and the usage of ME, EMR and ESD before training, can get a better training effect. The study provides a theoretical basis for selecting appropriate ESD trainees.

Efficacy and safety of endoscopic ultrasound-guided biliary drainage on obstructive jaundice patients who had failed in the endoscopic retrograde cholangiography ( with video) / 中华消化内镜杂志

Objective To investigate the efficacy and safety of endoscopic ultrasound-guided biliary drainage ( EUS-BD ) on obstructive jaundice patients who had failed in the endoscopic retrograde cholangiography ( ERC ) . Methods Seventeen obstructive jaundice patients who underwent EUS-BD at Nanjing Drum Tower Hospital from October 2015 to July 2017 were enrolled in the study. The types of biliary drainage, technical success rate, clinical efficacy, post-procedure adverse events, and follow-up were analyzed. Results EUS-BD was successfully performed in 16 out of 17 patients, with technical success rate of 94. 1％. Operation pathway included 12 EUS-guided hepaticogastrostomy, 2 EUS-guided antegrade stenting, 1 EUS-guided rendezvous, and 1 EUS-guided choledochoduodenostomy. All the 16 patients′bilirubin decreased at different levels after operation, and the clinical success rate was 94. 1％ (16/17). Post-operation complications included 5 cases of cholangitis, 2 of bile leakage, and 1 of pneumoperitoneum and duodenal perforation. The patients were followed up for 14-390 days after procedures. Two patients died of underlying disease one month after operation. Jaundice in another 2 patients worsened during follow-up and were improved after replacement of previous stent. Conclusion EUS-BD has a relatively high technical success rate, and can be considered as an alternative choice for patients with obstructive jaundice after failure of ERC. Operation pathway should be decided according to patient′s condition.

Efficacy and safety of endoscopic retrograde cholangiopancreatography for children with pancreaticobiliary diseases / 中华消化内镜杂志

Objective To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for children with pancreaticobiliary diseases. Methods Data of children under 14 years old who have underwent ERCP in Nanjing Drum Tower Hospital between September 2007 and August 2016 were reviewed for completion, complications and therapeutic methods. Results A total of 41 children underwent 68 ERCP, including 6(8. 8%) diagnostic and 62(91. 2%) therapeutic procedures. All procedures were performed under deep sedation. Cannulation failed in only 1 child with anomalous junction of pancreaticobiliary duct. The procedure success rate was 98. 5%( 67/68 ) . There were 8 adverse events, including 7 mild post?ERCP pancreatitis and 1 fever. Incidence of adverse event was 11. 8%( 8/68) . There was no such severe adverse event as bleeding, perforation, death, or other anesthesia related adverse event. Thirty?two children ( 78. 0%) had follow?up, ranging from 2 month to 6 years. Children followed lived well with no long?term adverse event. Conclusion ERCP is an effective and safe procedure for the diagnosis and treatment of pancreaticobiliary diseases in children.

Diagnostic value of intraductal ultrasonography and brush cytology on differentiating malignant and benign biliary stricture / 中华消化内镜杂志

Objective To investigate the diagnostic value of intraductal ultrasonography ( IDUS ) with or without brush cytology on distinguishing malignant from benign biliary stricture. Methods The data of patients with biliary stricture, who underwent endoscopic retrograde cholangiography( ERC) and IDUS in Drum Tower Hospital from September 2007 to October 2015 were retrospectively analyzed. Features of IDUS images and results of brush cytology were compared with postoperative histological results to evaluate the diagnostic yield of IDUS and brush cytology on differential diagnosis of malignant biliary stricture. Results A total of 230 patients with biliary stricture underwent ERC and IDUS, and 206 patients meanwhile received brush cytology, including 84 cases of malignant biliary stricture. Of the 230 patients, 87 cases underwent surgery, and 75 revealed malignant results, including 65 cases of cholangiocarcinoma, 8 cases of pancreatic adenocarcinoma, and 2 cases of periampullary adenocarcinoma. Using postoperative pathologic results as the gold standard, 72 malignant and 9 benign biliary strictures were correctly diagnosed by IDUS. The sensitivity, specificity, positive predictive value, and negative predictive value of IDUS for diagnosis of malignant biliary stricture was 96. 0％, 75. 0％, 96. 0％, and 75. 0％, respectively. Sixty-five patients underwent IDUS with brush cytology during ERC before surgery, and 56 out of 65 showed malignant results. Thirty-one malignant and 9 benign biliary stricture were correctly diagnosed by brush cytology. The sensitivity, specificity, positive predict value, and negative predict value of brush cytology for diagnosis of malignant biliary stricture was 55. 4％, 100％, 100％, and 26. 5％, respectively. If brush cytology combined with IDUS to diagnose malignant biliary stricture, the sensitivity rose up to 94. 6％, while the specificity went down to 77. 8％, and the positive and negative predictive value was 96. 4％ and 70. 0％, respectively. Conclusion IDUS exhibited excellent sensitivity and specificity, while brush cytology revealed perfect specificity and positive predictive value on diagnosis of malignant biliary stricture. If IDUS combined with brush cytology, the sensitivity and negative predictive value could rise significantly, while the specificity and positive predictive value mildly went down, which suggested that IDUS remained a certain degree of over judgment and false positive rate.

Value of pancreatic stent placement for endoscopic resection of duodenal papilla adenoma / 中华消化内镜杂志

Objective To assess the application value of pancreatic stent placement for endoscopic resection of duodenal major papilla adenoma.Methods A total of 67 cases of duodenal major papilla adenoma that were confirmed by biopsy and underwent endoscopic papillectomy from August 2007 to July 2016 in endoscopy center of Drum Tower Hospital of Nanjing were analyzed retrospectively.There were 50 patients treated with pancreatic stent placement and 17 patients without as the control group.The general information, efficacy and complications of two groups were collected at the same time.Results There were no significant differences in gender(P=0.070), age(P=0.151) or tumor size(P=0.136) between pancreatic stent placement group and the control group.There were no statistical differences in en bloc resection rates or complete resection rates between the two groups.And there were no significant differences in short-term complications of bleeding(P=0.428), pancreatitis(P=0.982), cholangitis(P=1.000), perforation(P=1.000)or long-term complications of distal common pancreatic duct stricture between the two groups.Conclusion Pancreatic stent should not be routinely placed in endoscopic papillectomy, and should be considered for specific cases.

Modified endoscopic resection of duodenal major papillary adenoma / 中华消化内镜杂志

Objective To assess feasibility and advantages of the improved endoscopic resection of duodenal major papillary.Methods A total of 56 cases were collected in Drum Tower Hospital from October 2007 to December 2012, which were diagnosed as duodenal major papillary adenoma or carcinoma in situ, where tumor didn't extend to the biliary or pancreatic duct by the endoscopic ultrasonography, intraductal ultrasonography or histology of biopsy specimens.The diameters of these adenoma ranged from 0.3 cm to 5.0 cm.Twenty-four lesions were resected by routine endoscopic method and 32 lesions were removed by modified endoscopic method.All patients underwent ERCP and biliary and/or pancreatic stents were placed.Results En bloc resection rate was significantly higher in modified group(87.5％ ,28/32) than that in routine group (60.9％, 14/23, P ＜ 0.05).There were no significant differences in complete resection rates (93.8％ ,30/32 VS 87.0％, 20/23;P ＞0.05), or in the amount and difficulty of pancreaticobiliary stenting(P ＞ 0.05)between modified group and routine group.Short-term complication occurrence in modified group was lower than that of the routine group(15.6％ ,5/32 VS 41.6％, 10/24, P ＜ 0.05), but long-term complication occurrence showed no significant difference.There was no significant difference in recurrence rate between two groups[7.1％ (2/28) VS 15.0％ (3/20) ,P ＞0.05].Conclusion Endoscopic resection of duodenal major papillary adenoma with a modified method shows more therapeutic effect.

A prospective study of pancreatic duct stent in preventing post-ERCP pancreatitis of difficult bile duct cannulation / 中华消化内镜杂志

Objective To investigate the efficacy of pancreatic duct stent in preventing post-ERCP pancreatitis (PEP) of difficult bile duct cannulation.Methods A total of 120 patients who underwent difficult bile duct cannulation during routine ERCP were randomized to receive pancreatic duct stent placement (S group) or not (NS group),and the incidence of PEP,hyperamylasemia and scores of abdominal pain were analyzed.Results There were 15 cases of hyperamylasemia and 5 cases of PEP occurred in S group,but no severe PEP was observed.The score of abdominal pain was (3.82 ± 1.48) in S group.There were 18cases of hyperamylasemia and 14 cases of PEP occurred,including 2 severe PEP in NS group.The score of abdominal pain was (7.48 ± 1.93) in NS group.There was no significant difference in the incidence of hyperamylasemia between the two groups (P ＞ 0.05).The incidence of PEP,severe PEP and the scores of abdominal pain were lower in the S group (P ＜ 0.05).Conclusion Placement of pancreatic duct stent can reduce the PEP rate of difficult bile duct cannulation and relieve the abdominal pain.

Analysis of risk factors for post-ERCP pancreatitis / 中华消化内镜杂志

Objective To investigate the risk factors of post-ERCP pancreatitis( PEP). Methods Data of 4,234 patients who underwent ERCP in Nanjing Drum Tower Hospital were retrospectively analysed. Information of patients and operations,including age,gender,operation history,major disease history,labora-tory examination before operation,abdominal ultrasound,CT,MRCP,detailed ERCP operation process,com-plications and treatment were carefully recorded. Then Chi-square test was used for univariate analysis,and stepwise multivariate Logistic regression for variate analysis. Linear correlations between risk factors were de-tected. Results There were totally 226 PEPs,with 5. 3% incidence rate. Univariate analysis showed that the female(χ2 =9. 715,P=0. 002),young( <60 years)(χ2 =6. 108,P=0. 013),chronic pancreatitis(χ2 =14. 703,P=0. 001),initial ERCP(χ2 =14. 899,P=0. 000),hypertension(χ2 =4. 489,P=0. 034),nor-mal bilirubin levels before operation(χ2 =19. 159,P =0. 000 ),difficult cannulation(χ2 =45. 824,P =0. 000),pancreatic guide wire(χ2 =30. 223,P=0. 000),papillary pre cut(χ2 =45. 928,P=0. 000),pan-creatography(χ2 =20. 170,P=0. 000)may be risk factors for PEP. Non conditional Logistic regression analy-sis showed that female(OR=1. 449,P=0. 011),initial ERCP(OR=1. 745,P=0. 003),normal bilirubin levels before operation(OR=1. 917,P=0. 000),difficult cannulation(OR=3. 317,P=0. 000)and pancre-atography(OR=1. 823,P=0. 004)were independent risk factors for PEP. Linear correlation analysis sugges-ted that pancreatic duct guide wire and papillary precut were related to the difficult cannulation,and the corre-lation coefficients were -0. 788 and -0. 699. Conclusion Female,young(<60 years),chronic pancreati-tis,initial ERCP,hypertension,normal bilirubin levels,difficult cannulation,pancreatic duct guide wire,pa-pillary precut,pancreatography may induce PEP. Female,normal bilirubin levels before operation,initial ER-CP,difficult cannulation and pancreatography are independent risk factors for PEP,while pancreatic duct guide wire,papillary precut are not,as they were linear correlated to difficult cannulation.

Diagnostic value of single balloon enteroscopy for obscure gastrointestinal bleeding / 中华消化内镜杂志

ObjectiveTo investigate the diagnostic value of single balloon enteroscopy (SBE) for obscure gastrointestinal bleeding.MethodsA total of 78 SBE procedures was conducted on 72 patients with obscure gastrointestinal bleeding,with 40 via oral route and 38 via anal route.The procedure time,insertion depth and rate of positive finding were recorded.ResultsFor 40 SBE procedures performed via oral route,the mean procedure time was 60 minutes ( 15-110 minutes),and the mean insertion depth was 195 cm at the distal end of Trentz ligament (30-240 cm).For 38 SBE procedures performed via anus,the mean procedure time was 75 minuets (30-120 minutes),and the mean insertion depth was 160 cm at the proximal end of ileocecal valve (50-200 cm ).The whole diagnostic yield of obscure gastrointestinal bleeding was 62.5％.ConclusionSBE is a safe and useful tool for the diagnosis of obscure gastrointestinal bleeding.

Diagnostic value of intraductal ultrasonography for biliary stricture / 中华消化内镜杂志

Objective To investigate the diagnostic value of intraductal ultrasonography for the quality of biliary stricture.Methods Data of the patients who had received operation because of biliary stricture after IDUS examination from 2006 to 2010 were collected.IDUS results were compared with those of operation.Results There were 43 cases of malignant strictures and 6 benign strictures in total.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of intraductal uhrasonography for the quality of biliary stricture were 97.7％ ( 42/43 ),83.3％ ( 5/6 ),97.7％ ( 42/43 ),83.3％ (5/6) and 95.9％ (47/49),respectively,which were significantly higher than conventional imaging like ultrasound B,CT and MRCP.Twenty one cases in 32 were diagnosed as malignant biliary stricture with cytological brushing,with the diagnostic accuracy of 65.6％.All cases had been diagnosed by IDUS.Conclusion Intraductal ultrasonography is of high diagnostic value for biliary stricture.However,cytological brushing based on IDUS is of limited diagnostic value for malignant biliary stricture.

Endoscopic retrograde cholangiopancreatography combined with tumor marker measurement in biliary juice in differential diagnosis of biliary-pancreatic diseases / 中华消化内镜杂志

Objective To investigate the diagnostic value of tumor marker measurement in biliary juice obtained during endoscopic retrograde cholangiopancreatography (ERCP) in differential diagnosis of suspected biliary-pancrentic diseases.Methods ERCP was performed in patients with suspected biliarypancreatic lesions that could not be diagnosed by routine methods including ultrasonography,MRCP,blood biochemistry and serum tumor marker test,and biliary juice was obtained to measure tumor markers including CEA and CA199.A total of 29 patients with definitive diagnosis were recruited and divided into benign and malignant groups.Serum biochemical findings and tumor markers were compared between 2 groups.The diagnostic value of uhrasonography,EUS,MRCP,ERCP and ERCP combined with biliary tumor markers were also compared.Results There was no significant difference in serum biochemical findings,serum CEA,serum CA19-9 or biliary CA19-9 between 2 groups,while the average biliary CEA in malignant group was significandy higher than that in benign group (P＜0.001).The accuracy of ERCP combined with biliary tumor markers in diagnosing suspected biliary-pancreatic diseases was 69.0%,which was higher than that of ultrasonography (6.9%),MRCP (37.9%) and ERCP (41.4%),respectively.Conclusion The diagnostic accuracy of suspected biliary-pancreatic diseases can be improved through ERCP combined with biliary CEA test,which is helpful in differential diagnosis between benign and malignant lesions.

Therapeutic endoscopic retrograde cholangiopancreatography in patients aging over 85 / 中华消化内镜杂志

Objective To evaluate the safely and efficacy of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and its related procedures in patients older than 85 years.Methods Data of patients older than 85 who underwent ERCP between 2004 and 2009 (group A, n =52) were reviewed and compared with those of patients aging 70-84 years (group B, n = 329).Results The rate of patients with underlying disorders of other systems in group A was significantly greater than that of group B (100.0% vs.77.5% , P < 0.05) , as well as the rate of multiple procedures to achieve stone clearance (42.3% vs.28.8% , P <0.05).There were no significant differences between 2 groups regarding the rates of complication (7.7% vs.4.9% ) and post-procedure mortality (1.9% vs.0.6% ).Conclusion Therapeutic ERCP and related procedures are safe and effective in patients aging over 85, and advanced age should not be regarded as the contraindication of the procedure.

A Study on the Relationship of Time Management Disposition and Coping Style, Personality Characteristics of College Students / 中国临床心理学杂志

Objective: To study the relation between college students' time management disposition and their coping styles and personality characteristics.Methods: 282 college students were investigated with Time Management Disposition Scale,The Simplified Coping Style Questionnaire and Y-G Personality Test.Results: ①Time management disposition of college students was obviously correlated with their coping style.It was positively correlated with positive coping style in totality and each dimension,and was negatively correlated with negative coping style in totality and sense of time control,and sense of time efficiency.②Some factors of time management disposition had significant correlations with some traits of Y-G Personality Test.Conclusion: Time manage disposition was obviously correlated with coping styles and personality characteristics.