Analysis of clinical effificacy of the pancreatic duct stent for treatment of acute biliary pancreatitis / 国际外科学杂志

Objective:This study was conducted to further investigate the clinical value of ERCP plus EST and pancreatic duct (PD) stent placement in treatment of ABP.Methods:The data of 115 patients with ABP in People′s Hospital of Chongqing Banan District between February 2018 to October 2020 were retrospectively analyzed. Of the patients, 46 cases received ERCP plus EST and PD stent placement(PD stent group), and other 69 cases only received ERCP plus EST(control group), all patients received surgery within 72 h. Outcome measures: preoperative complications, APACHE II score, Glasgow score, preoperative and postoperative laboratory indicators (white blood cell, C-reactive protein, serum amylase, total bilirubin, alanine aminotransferase), postoperative complications, hospitalization time, hospitalization cost. All patients received outpatient or telephone follow-up after discharge, patients were followed up for recurrence of pancreatitis and complications, follow-up ended in June 2021. Continuous data were represented as ( ± s), and comparisons between the two groups were performed using Student′s t tests for normally distributed data with homogeneity of variance. The Mann-Whitney U test was used for nonnormally distributed data. Categorical data are expressed as rates values and were analyzed with the chi-square test or Fisher′s exact test. Results:There were no significant differences between two groups in age, complications, APACHEII score, Glasgow score, preoperative laboratory examination, postoperative CRP, total bilirubin and ALT ( P>0.05). Postoperative WBC[8.5(7.6, 10.3)]×10 9/L, serum amylase [197.5(143.0, 256.0) U/L] in the PD stent group were significantly lower than control group[9.9(8.2, 12.8) 10 9/L, 270.0(168.0, 419.0) U/L]( P<0.05). The overall incidence of complications in the PD stent group (6.5%) was significantly lower than the control group (20.3%), there were statistical differences between groups( P<0.05). Hospitalization time and hospitalization cost were not significantly different between the two groups ( P> 0.05). All patients were followed up, with an average follow-up of 16 months, all recovered well postoperatively in patients with stent group, but a patient who suffered from peripancreatic abscess with severe infection needed hospitalization again in control group, another two patients with pancreatic pseudocyst, 1 case were followed up for 3 months to gradually absorbed, and 1 case underwent another surgical treatment. Conclusion:The placement of temporary pancreatic duct stent provided adequate drainage of pancreatic fluid to reverse the course of ABP, and the complication rate was significantly lower than that of the control group, with superior clinical outcome to ABP patients treated with ERCP+ EST alone.

Effects of early endoscopic therapy on inflammatory factors and efficacy in elderly patients with acute biliary pancreatitis / 中华内分泌外科杂志

Objective:To evaluate the inflammatory factors effects of early endoscopic therapy for elderly patients with acute biliary pancreatitis (ABP) and its clinical efficacys.Methods:206 elderly patients with ABP admitted from Jan. 2010 to Dec. 2019 were divided into observation group (102 cases) and the control group (104 cases) according to treatment method. The observation group received endoscopic retrograde cholangiopancreatography (ERCP) , endoscopic sphincterotomy (EST) and endoscopic naso-biliary drainage (ENBD) , while the control group received conventional treatment. Clinical symptoms, changes of inflammatory factors, complications and prognosis were observed in each group.Results:CRP, SAA, IL-6, IL-8 and TNF-a after treatment were significantly lowered than those before treatment ( P<0.05) . In addition, the levels of CRP, SAA, IL-6, IL-8 and TNF-a in the observation group were significantly lower than those in the control group ( P<0.05) . The time to abdominal pain extinction, time to fever cessation, hospital stay in observation group were (3.92±1.54) , (3.63±1.41) , and (14.35±2.46) d, significantly less than those in the control group [ (5.81±1.72) , (5.45±2.13) , (19.37±3.12) d, P<0.05]. APACHE Ⅱ score of the observation group was (10.02±2.67) point after treatment, significantly lower than that in the control group [ (12.35±3.62) point, t=4.42, P<0.05]. The incidence of complications in the observation group was 10.78% after treatment, significantly lower than that in the control group [ (24.03%) , χ2=6.27, P< 0.05]. The mortality in the observation group was 1.96%, lower than 4.81% in the control group, with no statistical significance. Conclusion:Early endoscopic therapy is safe and highly effective for elderly patients with ABP, with the advantages of shorter hospital stay, quicker subsided inflammation, and lower incidence of complications.

Cholecystectomy in mild to moderate acute biliary pancreatitis when to intervene: early versus delayed

Background: Objective of the study was to compare the outcomes of early versus late cholecystectomy in mild to moderate acute biliary pancreatitis.Methods: This comparative prospective study was conducted at Surgical Department of Qazi Hussain Ahmed Medical Complex, Nowshera from 1st January 2018 to 31st March 2020. Patients with mild to moderate acute biliary pancreatitis (ABP) were included in the study. Patients were divided into two groups. Group 1 having patients undergoing early (operated in 7 days) and Group 2 having patients with delayed (operated after 6 weeks) laparoscopic cholecystectomy. The outcomes like hospital stay, peri and post-operative complications, recurrent cholecystitis and pancreatitis were compared. P<0.05 was considered significant.Results: A total of 300 patients were included with 150 in each group. There were 70 (46.66%) males in group 1 while group 2 consisted of 68 (45.33%) males. The median time interval of operation to the laparoscopic surgery was 5 days in group1 and 42 days in group 2. Peri operative outcomes were not significant between two groups (p=0.6). About 14 (09.63%) patients were converted to open surgery in group1 and 17 (10.53%) in group 2. Postoperative complications were also not significant between two groups (p=1.0). Group 1 had small total length of stay as compared to group 2 (p=0.006). Recurrent biliary events occurred in 63 (42.12%) patients in total with no event in group 1.Conclusions: Patients with mild to moderate ABP having early laparoscopic cholecystectomy present with reduced recurrent biliary events and the total length of hospital.

The timing and mechanism of endoscopic retrograde cholangiopancreatography in the treatment of acute biliary pancreatitis / 解放军医学杂志

Objective: To study the timing and mechanism of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute biliary pancreatitis (ABP). Methods: The data of 101 patients with ABP in General Hospital of Western Theater Command between January 2012 to June 2018 were retrospectively analyzed. Receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off time of ERCP in the treatment of ABP. The patients were divided into early ERCP group (within 66 hours after onset) and late ERCP group (over 66 hours after onset), and the patients in the early ERCP groups were subdivided into 3 subgroups according to the result of the ROC curve: 0-24 h group (n=10), 24-48 h group (n=27) and 48-66 h group (n=18). Primary endpoints (main outcome measures or main observation indexes) were exacerbation rate, incidence of new onset of organ failure (NOF) and mortality. Secondary endpoints were infection rate, severity scores (APACHE II, RANSON, Marshall, GCSI), serological variables (C-reactive protein, IL-6, IL-10, TNF-α, triglyceride) and incidence of ERCPrelated complications. Logistic regression was used to explore the risk factors for the exacerbation of ABP. Results: The ROC curve analysis showed that 66 hours after the onset of ABP was the best cut-off time of ERCP. Exacerbation rate, incidence of NOF and infection rate were significantly lower in the early ERCP group than in the late ERCP group (P0.05). There was no significant difference between the early ERCP subgroups in primary and secondary (P>0.05). Logistic regression showed that elevated serum triglyceride and GCSI scores were risk factors for the exacerbation of ABP, while early ERCP treatment was a protective factor. Conclusions: Early ERCP treatment (within 66 hours after the onset) could reduce the risk of exacerbation, and improve the prognosis of patients with ABP. The potential mechanism is to improve the gastrointestinal function and reduce serum triglyceride.

Analysis of major pathogens, sensitive antibiotics, and related factors in bile from patients with acute biliary pancreatitis / 国际检验医学杂志

Objective To explore the main pathogenic bacteria and sensitive antibiotics and related factors in bile in patients with acute biliary pancreatitis (ABP).Methods 176 patients with ABP from September2015 to September 2017 were selected as the study subjects.Bile was collected for bacterial culture and antibiotic susceptibility testing.The relationship between different obstruction sites and total bilirubin levels and bacterial detection rates was compared.Results The positive rate of bacterial culture was 68.18％.There were 155 aerobic bacteria and 25 anaerobic bacteria.Among the G-bacteria, E.coli (62.85％) accounted for the largest proportion, Enterococcus (12.26％) accounted for the highest proportion of G+ bacteria, and Bacteroides fragilis (52.00％) accounted for the majority of anaerobes..The sensitivity of G-bacteria to meropenem, cefepime and ciprofloxacin was greater than 80％, which was 96.77％, 91.13％ and 84.68％, respectively.The sensitivity rate of G+ to vancomycin was 100％, and the sensitivity rate to meropenem, tetracycline, and azithromycin was higher than 80％.The positive rate of bacterial culture in high obstruction was significantly higher than that in middle-low obstruction (P＜0.05).The low-level group was significantly higher than the middle-level group and the high-level group (P＜0.05), and the middle-level group was significantly higher than the high-level group (P＜0.05).Conclusion For the early anti-infection treatment of ABP patients, aminoglycosides+third-generation cefquinolones+ metronidazole can be used for treatment.Patients with high obstruction and low TB levels need to strengthen anti-infection treatment.

Feasibility of Temporary Pancreatic Stenting after Early Endoscopic Retrograde Cholangiopancreatography in Patients with Acute Biliary Pancreatitis / 대한소화기학회지

BACKGROUND/AIMS: To assess the safety and effectiveness of temporary pancreatic stenting after early endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute biliary pancreatitis regardless of the severity or concomitant cholangitis. METHODS: Temporary pancreatic stenting was performed in 79 patients with visualized pancreatic duct during ERCP. The outcomes of 64 patients with adequate pancreatic stenting (PS) and 15 patients with inadequate pancreatic stenting (no PS) were compared in this prospective, observational trial. RESULTS: The baseline characteristics were similar. Development of systemic inflammatory response syndrome (7.8% for PS vs. 13.3% for no PS; p=0.50) and mortality (none for both groups; p=0.99) did not differ. However, fewer local complications occurred in PS than in no PS (4.7% for PS vs. 20.0% for no PS; p=0.04) and the difference was most outstanding in necrosis (1.6% for PS vs. 13.3% for no PS; p=0.03). CONCLUSIONS: Temporary pancreatic stenting after early ERCP should be considered safe, as complications did not increase even in cases of inadequate stenting. However, if successful, there appears to be a reduction in local complications.

Early endoscopic pancreatic and (or) biliary stents combined with Qingyi granules in treatment of acute biliary pancreatitis / 中华内分泌外科杂志

Objective To investigate the early (within 72 hours) application and effect of endoscopic pancreatic and (or) biliary stents combined with Qingyi granules in treatment of acute biliary pancreatitis (ABP) patients.Methods A retrospective analysis was done to the 245 patients admitted for ABP from Jan.2012 to Jan.2016 in the First Hospital of Lanzhou University.133 patients (group A) were treated within 72 hours by endoscopic pancreatic and (or) biliary stents combined with Qingyi granules through feeding tube.112 patients (group B) were treated by endoscopic pancreatic and (or) biliary stents and feeding tube without Qingyi granules.Then the study was done to compare the difference of recover days of abdominal distension,abdominal pain,normalization time of amylase and WBC,length of stay,decrease level of PCT,and the incidence of ABP complications.Results Group A was superior to group B in terms of the recover days of abdominal distension (3.8±3.2)d vs (5.2± 2.4)d,abdominal pain (2.6±2.1)d vs (4.9±2.7)d,normalization time of amylase(2.8±1.6)d vs (4.4±3.7)d,WBC (2.6±1.3)d vs (4.1± 2.7)d,length of stay(9.4±2.1)d vs (12.6±3.3)d and postoperative PCT level(2.59±2.33)ng/ml vs (3.98±3.03)ng/ml,and the difference had statistical significance (P＜0.05),while there was no significant difference between the two groups in the incidence of ABP complications.Conclusions For ABP patients,early placement of endoscopic pancreatic and (or) biliary duct stents combined with Qingyi granules through feeding tube can remove the etiology,and block the disease from further progress.Early enteral nutrition can contribute to the recovery of intestinal mucosa and the maintenance of internal environment.Combined with Qingyi granules,it can relief the symptoms,decrease the laboratory index and shorten the hospitalization time.

Endoscopic ultrasonography applied in the management of suspected obstructive jaundice in acute biliary pancreatitis / 中国内镜杂志

Objective To explore the application value of endoscopic ultrasonography (EUS) in the diagnosis of suspected obstructive jaundice in acute biliary pancreatitis and its effect on treatment outcomes. Methods Clinical data were retrospectively collected in 96 patients with acute biliary pancreatitis (ABP) who were suspected obstructive jaundice. Patients were divided into early EUS scanning group (EES) and delay EUS scanning group (DES). Clinical treatment results and test results were compared between the two groups. Results The diagnosis sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS were 96.43 %, 82.5 %, 90.63 %, 88.52 % and 96.29 %. Early EUS scan with 72 h could identify the etiology of ABP and subsequent treatment based on the EUS can easily decrease the white blood cell count, percentage of neutrophils, total bilirubin and serum amylase (P < 0.05). The pain relief rate in EEI group after 1 week treatment was significantly higher than that in the DES group (87.50 % vs 66.67 %, P = 0.027) and average length of hospitalization was shorter [(12.70 ±2.10) d vs (14.10 ± 3.00) d, P = 0.006]. Delay EUS scan were likely to have higher white blood cell count and total bilirubin, meanwhile seemed to increase the organ failure rate and necrotic infection of the pancreas. Conclusion ABP with suspected obstructive jaundice should be considered to have endoscopy intervention. Results of EUS are the basis for treatment decision, which can avoid the unnecessary endoscopy treatment.

Analysis of 32 cases of acute biliary pancreatitis with pancreaticobiliary maljunction / 国际外科学杂志

Objective To investigate the relationship between acute biliary pancreatitis and pancreaticobiliary maljunction and the role of magnetic resonance cholangiopancreatography(MRCP) in evaluation of pancreatico biliary maljunction.Methods To compare the liver function indicators of different groups of acute biliary pancreatitis patients(153 cases) associated with pancreatico biliary maljunction and without pancreatico biliary maljunction before and after the conservative treatment.Results The 32 acute biliary pancreatitis patients with pancreatico biliary maljunction detected by MRCP were compared with the 121 cases without pancreatico biliary maljunction.The ALT,AST,GGT after conservative treatment in both group of pancreatico biliary maljunction and Npancreatico biliary maljunction were significantly decreased (P ＜ 0.05).ALT,AST and GGT of pancreatico biliary maljunction group were higher than that of Npancreatico biliary maljunction group with statistical significance (P ＜ 0.05).Conclusions MRCP as a noninvasive cholangiopancreatography study of pancreatico biliary maljunction is a safe and reliable examination method,pancreatico biliary maljunction is one of the important causes of acute biliary pancreatitis.

Does Endoscopic Sphincterotomy and/or Cholecystectomy Reduce Recurrence Rate of Acute Biliary Pancreatitis? / 대한소화기학회지

BACKGROUND/AIMS: Practice guidelines from international societies have recommended cholecystectomy during the same hospitalization for acute biliary pancreatitis (ABP). The aim of this study is to investigate the question of whether endoscopic sphincterotomy (EST) and/or cholecystectomy during the same hospitalization can reduce the recurrence rate of ABP. METHODS: A total of 119 patients with ABP admitted to our institution between May 2005 and May 2010 who had complete follow-up data until May 2012 were enrolled. RESULTS: No significant differences in initial CT severity index and Charlson comorbidity index were observed between EST (n=64) and non-EST group (n=55) and among subgroups classified according to interventions performed. In Kaplan-Meier analyses, significantly higher recurrence rates of ABP were observed in the non-EST group compared to the EST group (p<0.01), and in the conservative treatment group compared to other intervention groups (p<0.01). The frequency of complications from ABP was significantly higher in the conservative treatment group (35.7%) and lowest in the EST plus cholecystectomy group (5.0%, p=0.008). In multivariate analysis, conservative treatment without EST and/or cholecystectomy, and non-EST group were independent risk factors for recurrence after the initial attack of ABP. CONCLUSIONS: ERCP with EST and cholecystectomy during the index admission is associated with reduced recurrence rates of ABP.

Acute Biliary Pancreatitis: A Case Report.

Acute biliary pancreatitis (ABP) a condition caused by gallstones; can be a life-threatening condition if not treated early (mortality ~2-7%). Complications and symptoms of ABP can be ranging from mild (nausea, vomiting, and fever) to severe (necrosis, infections, hemorrhage, abscesses, renal failure, and adult respiratory distress syndrome). Th is paper presents a specifi c case of a middle-aged male diagnosed with ABP to illustrate the disease in a clinical setting, mainly looking at its presentation, diagnosis and focusing more on treatment and management. Clinical examinations and radiological investigations are crucial to recognize the diagnosis and foresee the prognosis of this condition. Th e medications that are administered to patients suff ering from this condition include analgesics (like morphine), intravenous fl uids, and antibiotics (e.g. ciprofl oxacin). Th e limitations and lack of knowledge described above are immense concerns. It is highly encouraged that future research opportunities will compensate for the present gap in knowledge, contributing to current literature, as well as having practical implications for treatment and management of ABP.

Colangiopancreatografía retrograda endoscópica (CPRE) precoz y pancreatitis aguda biliar (PAB) / Early endoscopic retrograde cholangiopancreatography (ERCP) and acute biliary pancreatitis (ABP)

For over 20 years we have discussed the indication of early endoscopic retrograde cholangiopancreatography (ERCP) (72 h before the onset of symptoms) in acute biliary pancreatitis (ABP), seeking to stop the inflammatory process, reducing complications and mortality, taking into account that ERCP can cause pancreatitis and other complications such as perforation and hemorrhage. To elucidate this problem, there have been multiple meta-analyses based on the same 3 or 5 randomized controlled trials of early ERCP versus conventional treatment (including elective ERCP) in ABP, which have produced conflicting results. There is agreement regarding that it is not indicated in mild ABP, and it is indicated in ABP associated with cholangitis and persistent obstruction of the ampulla of Vater. There is controversy in severe presentation of ABP, since current evidence does not definitely show the usefulness of early ERCP. No more complications related to ERCP have been reported in this situation.

Desde hace más de 20 años se discute la indicación de la colangiopancreatografía retrógrada endoscópica (CPRE) precoz (antes de 72 h del inicio de los síntomas) en la pancreatitis aguda biliar (PAB), buscando detener el proceso inflamatorio, disminuyendo sus complicaciones y su mortalidad, tomando en cuenta que la CPRE puede ser causa de pancreatitis y otras complicaciones como perforación y hemorragia. Para dilucidar este problema se han realizado múltiples meta-análisis basados en los mismos 3 ó 5 estudios aleatorizados y controlados de CPRE precoz versus el tratamiento convencional (que incluye CPRE electiva) en PAB, los cuales han dado resultados discordantes. En lo que hay acuerdo es en que no está indicada en la PAB leve y sí está indicada en la PAB asociada a colangitis y a obstrucción persistente de la ampolla de Vater. En la PAB de presentación grave hay controversia; la evidencia actual no demuestra en forma definitiva la utilidad de una CPRE precoz. No se ha reportado mayor número de complicaciones relacionadas a la CPRE en esta situación.

Efficacy analysis on combination use of endoscopy and enteral nutrition in the treatment of acute biliary pancreatitis in elderly patients / 中华胰腺病杂志

Objective To investigate the effectiveness of endoscopy and enteral nutrition (EN) in the treatment of acute biliary pancreatitis (ABP) in elderly patients and its impact on prognosis.Methods Eighty-four elderly patients with ABP were randomly divided into two groups,including 42 cases of combination treatment group,42 cases of routine treatment group.The routine treatment group was managed with normal comprehensive treatment,and in combination treatment group,patients were treated with additional endoscopic retrograde cholangiopancreatography (ERCP),endoscopic sphincterotomy (EST) and endoscopic naso-biliary (ENBD) drainage and EN.The clinical symptoms,serum inflammatory cytokines,complications and prognosis were compared.Results The CRP,TNF-α,IL-2,and serum amylase,glucose,AST after treatment were significantly lowered than those before treatment (P ＜ 0.05).In addition,the levels of CRP,TNF-α,IL-2,and serum amylase,glucose,AST,ALB in combination treatment group were significantly lower than those in routine treatment group (P ＜ 0.05).The time to abdominal pain cessation,time to fever cessation,hospital stay in combination treatment group were (4.6± 1.3),(3.7± 1.3),(13.5± 2.7) d,which were significantly lower than those in routine treatment group [(6.1 ± 1.3),(5.5 ± 2.1),(18.1 ± 3.8) d,P ＜ 0.05].The APACHE Ⅱ score of combination group after treatment was (7.l ± 1.8) point,which was significantly lower than that in routine treatment group [(9.2 ± 2.6) point,t =3.41,P ＜ 0.05)].The incidence rates of ARF,ARDS,peri-pancreatic infection and abdominal hemorrhage,in combination group were 7.1％,4.8％,4.8％,4.8％,respectively,which were significantly lower than those in routine treatment group (23.8％,19.1％,21.4 ％,19.1％,P＜0.05).The mortality in combiration group was 4.8％,which was lower than 16.7％ in routine treatment group with no statistical significant.Conclusions It is a safe and effective to treat elderly ABP patients with endoscopy combined with EN,which can significantly reduce complications and mortality.

Management and opportunity of operation in obstructive acute biliary pancreatitis / 国际外科学杂志

Objective To investigate the management and timing of operation in obstructive acute biliary pancreatifis.Methods A etrospective review was performed of seventy-six consecutive patients who presented to a single tertiary care institution from 2000 to 2010 with obstructive acute biliary pancreatitis.Results Of the seventy-six patients,thirty-six patients underwent operations,with early(after onset within 2 weeks)operations in twenty cases,delayed operationsin sixteen cases and one case dead,no one experienced recurrent pancreatitis during follow-up.Fifteen patients were treated by endoscopy,ERCP/EST in eleven cases,ERCP/ENBD in one case and ERCP only in three case.All patients were cured,only one patient experienced recurrent pancreatitis.Twenty-five patients received conservative treatment,one patient died,six patients experienced recurrent panereatitis.Conclusions Surgery is essential in the management of acute biliary pancreatitis.In cases of obstructive acute biliary pancreatitis,early operation or endoscopic therapy should be performed to remove biliopancreatic obstruction after aggressive conservative treatment.

Management of patients with acute billiary pancreatitis / 国际外科学杂志

Objective To investigate the treatment options of acute biliary pancreatitis.Methods A retrospective review was performed in 134 consecutive patients who presented to a single tertiary care institution from 2000 to 2010 with acute biliary pancreatitis.Results Of the 134 patients,30 had a persistent (commonbile duct,CBD)stone.Following multivariate analysis,at admission CBD size on ultrasound,alkaline phosphatase(ALP),total bilirubin(TB),significantly correlated with persistent CBD stone.Receiver operator curve analysis and linear regression were applied to obtain optimal and equitable predictive values,and variables combined.Optimal values were.,CBD≥10 mm;AP≥150 U/L;and TB≥51.3μmol/L.Presence of three variables had an associated odds ratio(OR)of29.5(P<0.001)for presence of persistent CBD stone.Zero variables conferred asignificantly decreased probability of CBD stone,OR 0.07(P<0.001).Conclusions Presence of three variables significantly correlated with persistent CBD stone.Biliary evaluation by endoscopic retrograde cholangiopancreatography(ERCP)is suggested.In the absence of any positive predictive variables,cholecystectomy may be sufficient.Decisions regarding patients with one to two be made vailables should occur on a case-to-case basis.

Diagnosis and treatment of 126 cases of acute biliary pancreatitis / 中华内分泌外科杂志

Objective To explore the diagnosis and treatment of acute biliary pancreatitis (ABP) and when to operate. Methods 126 cases of ABP from Jan. 2005 to Dec. 2009 in our hospital were analyzed retrospectively. Results The cases number of the mild non-obstructive type, mild obstructive type, severe non-obstructive type, and severe obstructive type was 54, 33, 15, 24 respectively. 43 patients underwent early operation, 80 patients underwent postponed operation and three patients died preoperatively as a consequence of fulminat severe pancreatitis. 117 cases ( 92.86% ) were cured and 9 cases ( 7. 14% ) with severe acute pancreatitis died. Conclusion ABP should be treated according to its type. The key to reduce the complications and increase the cure rate is to determine the proper operation time according to the condition of individual patient.

Association of common bile duct stone with acute biliary pancreatitis / 中华消化杂志

Objective To investigate the factors that related to acute biliary pancreatitis including size and the location of the common bile duct stone. Methods Clinical data from 3497 patients with common bile duct stone admitted to the hospital between Jan. 2002 and Dec. 2008 were retrospective analyzed. All patients were grouped according to the size and the location of the bile duct stones. The incidence of acute pancreatitis was compared among groups. Results In patients with common bile duct stone accompanying the acute pancreatitis,common symptoms were fever, bellyache and jaundice, as well as elevated serum amylase. There was a negative correlation between size of the common bile duct stone and the severity of acute hiliary pancreatitis, which was easily induced by the stone in the Vater's ampullar or distal common bile duct. Conclusion Early endoscopic treatment should be carried out in patients with microlith located in the Vater's ampullar or distal common bile duct in order to prevent the acute biliary pancreatitis.

Strangulation of Umbilical Hernia after Therapeutic Endoscopic Retrograde Cholangiopancreatography of Acute Biliary Pancreatitis / 대한소화기내시경학회지

Endoscopic retrograde cholangiopancreatography (ERCP) is a safe procedure with life-threatening complications rarely occurring after the procedure. There are several reports of complications with ERCP, including bleeding, perforation, pancreatitis, cholangitis and cholecystitis. In our case, an umbilical hernia was strangulated after therapeutic ERCP had been performed in a patient with acute pancreatitis by a biliary stone, which required a surgical resection. To the best of our knowledge, this is the first report of such a case in Korea. This case highlights the need for close and careful observations for the early detection of possible complications after ERCP.

Laparoscopic Surgery for the Treatment of Acute Biliary Pancreatitis at Early Stage:Report of 18 Cases / 中国微创外科杂志

Objective To explore the feasibility and efficiency of laparoscopic surgery for the treatment of acute biliary pancreatitis (ABP) at early stage. Methods From January 2003 to June 2006, 18 patients with ABP received laparoscopic surgeries, including laparoscopic cholecystectomy (LC) in 3, LC combined with laparoscopic common bile duct exploration (LCBDE) in 9, LC combined with opening of the pancreatic capsule for drainage in 5, and LC combined with LCBDE and opening of the pancreatic capsule for drainage in 1. Results In all the patients, the laparoscopic operations were completed successfully without conversion to open surgery. The operation time was 100-150 min with a mean of (115.3?15.2) min. The stones in the bile duct were removed completely by LCBDE in 10 patients. No subcutaneous emphysema, hemorrhage, abdominal abscess or stenosis of the bile duct occurred in this series. The 18 patients were followed up for 4-40 months (mean, 28.5 months), during which 2 patients developed pancreatic pseudocyst. One of the patients was cured by internal drainage. In the other patient, the pseudocyst was absorbed spontaneously. No recurrence of pancreatitis or common bile duct stones was found. Conclusions Laparoscopic surgery is minimally invasive and effective for the treatment of ABP at early stage.

Endoscopic Treatment for Severe Acute Biliary Pancreatitis / 中国微创外科杂志

Objective To evaluate the value of endoscopic treatment for severe acute biliary pancreatitis (SABP). Methods A total of 36 patients with SABP, who received emergency operation were enrolled into this study. Among the patients, 16 received endoscopic naso-biliary drainage (ENBD) because of acute cholecystitis or cholecystolithiasis; 11 underwent endoscopic sphincterotomy (EST) and ENBD due to stenotic papillitis or choledocholithiasis; 4 were treated with EST using needle knife and ENBD due to difficulties in inserting bow knife and cannula catheter into the common bile duct; and 2 experienced the guide wire entering into the wirsung’s duct for over 3 times, when the cannula catheter was inserted into the common bile duct. Thus, the sphincter of Oddi was incised by bow knife to expose the opening of the cystic duct, and then ENBD was performed. Open surgery was performed in 3 cases because of failure of ENBD. In all the patients, systemic medical treatment was carried out after the operations.Results ENBD was completed in 33 cases, among which 29 (81%) patients were cured and 4 (11%) patients died. The operation failed in 3 cases. After the operation, 3 patients developed peripancreatic infection. No hemorrhage of the duodenum papilla, duodenal perforation, or cholangitis occurred in this series. The mean hospital stay was 22 d (15-75 d). 26 of the cured patients were followed up for 12-36 months (mean, 18 months), no recurrence of the symptoms of pancreatitis was found. Conclusions Endoscopic treatment combined with systemic medical therapy may reduce the course of disease and increase the cure rate for patients with SABP.