Cholecystectomy rate following endoscopic biliary interventions

Introduction: Gallstones disease is a common disorder and symptomatic disease is usually managed with surgery while those with common bile duct stones are usually managed with endoscopic intervention before proceeding to surgery. This study was intended to assess the rate of cholecystectomy among patients who had undergone ERC interventions, the reasons for not proceeding to cholecystectomy and related complications. Materials and Methods: Patients who had intact gallbladder and had undergone ERC for stones related complications over a two year period were retrospectively identified from the Endoscopic Unit Registry. Detailed case note reviews were conducted. Results: The overall cholecystectomy rate post-ERC interventions was 36.9% (48/130). Cholecystectomy was offered to 59.2% (n=77) and the uptake was only 58.4% (n=45/77). Among those who agreed for cholecystectomy, 11.1% (n=5/45) failed to turn up for their scheduled surgery. Three patients (6.7%) had symptoms recurrence before their scheduled surgery: two subsequently underwent cholecystectomy without ERC intervention and one who was pregnant was managed conservatively with holecystectomy. Among the patients who had declined cholecystectomy, 18.8% (n=6/32) had symptoms recurrence. Four patients required repeat ERC interventions and eventually all had cholecystectomy subsequently. The most common reason for declining cholecystectomy was 'not keen' and already asymptomatic (46.9%, n=15/32). Among patients who were not offerred cholecystectomy (n=53/130), symptoms recurrence occurred in 15.2% (n=7/53). Four patients required repeat ERC interventions and three subsequently underwent cholecystectomy. Conclusions: The cholecystectomy rate remains low after ERC interventions. Recurrence of symptoms necessating re-interventions occurred in patients offerred and not offerred cholecystectomy. The uptake rate should be improved and delay to cholecystectomy should be reduced to avoid symptoms recurrence. Patients not undergoing interventions should be advised regarding symptoms recurrence and should be monitored.

Aberrant methylation of CpG island in 5′ promoter region of p16 gene and its role in diagnosis of pancreatic cancer / 第二军医大学学报

Objective: To investigate the aberrant methylation of CpG island in 5′ promoter region of p16 gene in the pancreatic juice and its value in diagnosis of patients with pancreatic cancer. Methods: Pure pancreatic juice(PPJ) was collected from the pancreatic duct by a nasopancreatic tube put under endoscopic retrograde cholangiopancreatography (ERCP). Cytological examination was performed by H-E staining in pure pancreatic juice. Aberrant p16 methylation was detected using the methylation-specific PCR (MSP) in the PPJ. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy cytological examination in diagnosis of pancreatic cancer were 40%, 100%, 100%, 45.4% and 60.0%, respectively. The DNA sequences were successfully extracted from the PPJ of 30 patients with pancreatic diseases and were subjected to MSP. Seven(35%) of the 20 cases with pancreatic cancer showed aberrant methylation of p16 gene. No aberrant methylation was detected in the pancreatic juice samples of patients with chronic pancreatitis and mucinous cystoadenocarcinoma of pancreas. When cytological examination combined with p16 methylation detection, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for diagnosis of pancreatic cancer were 55%, 100%, 100%, 52.6% and 70%, respectively. Conclusion: Pancreatic juice collected by nasopancreatic drainage during ERCP can be used for molecular analysis. Detection of aberrant methylation of p16 gene in pancreatic juice combined with cytological examination is a better method for diagnosis of pancreatic cancer.