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Objective To investigate the risk factors of standard selectivity biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) for patints with choledocholithiasis,and the effect and safety of assistant cannulation methods.Methods The clinical data were retrospectively analyzed in 372 patients,who received ERCP for choledocholithiasis in the Yijishan Hospital of Wannan Medical College from January 2014 to December 2014.The risk factors of standard biliary cannulation were assessed by univariate and multivariate logistic regression analysis.The success rate of assistant biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) of standard biliary cannulation were compared with doubleguide wire technique (DGT) and precut sphincterotomy (PS),which were used when standard biliary cannulation failed.Results The univariate analysis showed that floppy and long duodenal papilla (P=0.000),angulated common bile duct(P=0.013) were related to failure of standard biliary cannulation.Multivariate analysis showed that floppy and long papilla (P=0.000,OR=0.131,95％CI:0.056-0.307),angulated common bile duct (P =0.003,OR =0.378,95 ％ CI:0.197-0.726) were independent risk factors for standard biliary cannulation.The success rate of standard biliary cannulation was 83.3％ (310/372),62 cases undergone DGT or PS after standard biliary cannulation failure,and the total success rate of cannulation was 99.7％ (371/372).There were 29 cases suffered from PEP in 371 successful cases of biliary cannulation,including 18 cases (5.8％,18/310) of standard biliary cannulation,8 cases (16.3％,8/49) of DGT,and 3 cases (25.0％,3/12) of PS.The incidence of PEP by DGT (x2 =5.532,P =0.019) and PS (x2 =6.994,P=0.008) was significantly higher than that of standard biliary cannulation,but there was no statistical difference on the incidence of PEP between DGT and PS (x2 =0.079,P =0.778).Conclusion Floppy and long duodenal papilla and angulated common bile duct could easily induce the failure of standard biliary cannulation in ERCP for patients with choledocholithiasis.DGT and PS are effective assistant cannulation methods when the standard cannulation fails.
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Objective To investigate the significance of H.pylori infection on upper gastrointestinal rebleeding in patients with long-term (≥ three months) aspirin and clopidogrel combination therapy.Methods From September 2007 to September 2011,at Yijishan Hospital of Wannan Medical College 78 patients with upper gastrointestinal bleeding and receiving long-term (≥ three months) aspirin and clopidogrel combined therapy were selected and treated with esomeprazole.The results of rapid urease test and gastric mucosal biopsy Giemsa staining of selected patients indicated 55 patients were H.pylori positive (positive group) and the other 23 cases were in negative group.The patients of positive group were randomly divided into intervention group (28 cases) and control group (22 cases) by the random allocation table method.The patients of intervention group received H.pylori eradiation treatment and the situation of H.pylori eradication was checked by 14C breath test.After treatment all patients were followed up for six months and clinical symptoms and the situation of rebleeding were observed.Categorical variables were expressed as percentage,intentional analysis and in accordance with protocol analysis were performed separately and analyzed by chi-square test.Results One patient in negative group with gastric cancer withdraw from the study.Two patients in intervention group lost.And one patient in control group lost.H.pylori of intervention group was all eradiated.In accordance with protocol analysis,the rebleeding rates of intervention group and control group were 7.69％ (2/26) and 34.62％ (9/26),respectively,and the difference was statistically significant (x2 =5.650,P=0.017).There was no significant difference between negative group (18.18％,4/22) and intervention group and no significant difference between negative group and control group (both P ＞ 0.05).In intentional analysis,the rebleeding rates of intervention group and control group were 7.14％ (2/28) and 33.33％ (9/27),respectively,and the difference was statistically significant (x2 =5.893,P =0.015).There was no significant difference between negative group (17.39 ％,4/23) and intervention group and no significant difference between negative group and control group (both P ＞ 0.05).Conclusion Eradication of H.pylori can reduce the rate of upper gastrointestinal rebleeding in patients with long-term aspirin and clopidogrel combination therapy.
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Objective To explore the effects of psychological disorders on qualityoflife of elderly patients with non-erosive reflux disease (NERD) under maintenance treatment of proton pump inhibitors (PPIs). Methods A total of 76 elderly patients with NERD treated by proton pump inhibitors (maintenance treatment of Esomeprazole over half a year) were enrolled. They were classified into symptom group aged (66.5±8.2) years (n=35) and symptom group aged(68.2+6.9)years (n=41)according to reflux symptoms,with 20 healthy people aged(65.4 ±8.8)years as control.The subjects completed the questioniaires on psychological status including self-rating anxiety scale (SAS) and self-rating depression scale (SDS) and their quality of life was evaluated by gastroesophageal heath related quality-of-life instrument(GERD -HRQL) and medical outcomes study short form(SF-36). Results Scores of SAS and SDS were significantly higher in symptom group (54.9±6.2,57.9±8.6) than in symptomless(37.9±8.7,42.7±7.9) and health control group (38.9± 7.2,43.1 ± 8.9),all (P＜0.05),but there was no difference between symptomless and health control group.The rates of anxiety and depression in symptom group (51.4％,57.1％) were increased as compared with symptomless (12.2％,9.8％)and health control group(0.0％,5.0％).Scores of GERD HRQL in symptom group were higher than in symptomlcss group (21.4± 5.0 vs.4.5±2.2,t=19.76,P＜0.01)while the indexes such as body pain,vitality,social function,affection,mental and whole health in score of SF-36 besides physiology function were lower in symptom group than in symptomless and control groups (P＜0.05 or P＜0.01 ).Only the significant differences in mental and whole health of SF-36 were found between symptomless and control groups (P＜0.01).Correlation analysis revealed that SAS and SDS scores were positively correlated with scores of GERD-HRQL in symptom group(P＜0.01) and negatively with all dimensions of SF-36 but physical function (P＜ 0.05). Conclusions Most of elderly symptomatic patients with NERD treated by PPI are in psychological disorders which results in lower quality of life.