Seis meses de entrenamiento en Colangiografía Endoscópica Retrograda en centro formador de alto volumen ¿es suficiente? Experiencia inicial en un hospital de la Araucanía

Introducción: La colangiopancreatografía endoscópica retrógrada (CPRE) es un procedimiento terapéutico para diversas patologías biliopancreáticas. Existen diversos centros de formación con una variedad de tiempos de práctica para la realización de CPRE. Objetivo: Evaluar resultados iniciales post entrenamiento en endoscopia terapéutica en el Instituto Chileno-Japonés del Hospital San Borja Arriarán, analizando 150 CPRE consecutivas, describiendo aspectos técnicos, morbilidad y mortalidad, realizadas entre noviembre de 2017 a enero de 2019 por un único operador en un hospital de la Araucanía. Método: Análisis retrospectivo del registro prospectivo de los 150 primeros casos consecutivos de CPRE realizados en el hospital San José de Victoria (HSJV). Se midieron variables clínicas, técnicas y de laboratorio. Se utilizó estadística descriptiva con medidas de tendencia central, dispersión y tendencia extrema. Resultados: Serie de 150 pacientes sometidos a CPRE: Edad promedio 60,1 años, mediana de 65 y edades extremas 16-98 años. Sexo femenino 69,3%. Indicaciones CPRE: 67,3% coledocolitiasis sin colangitis, 16,7% colangitis aguda, 6% estenosis de vía biliar benigna, 3.3% tumor periampular. Todos apoyados por anestesista, 50,7% propofol y 49.3% anestesia general. Tasa de canulación biliar 96,7%. Precorte 19,3%. Complicaciones reportadas alcanzaron el 4,67%, sin mortalidad por el procedimiento en la serie. Conclusiones: Los resultados de esta serie muestran que la formación obtenida por el profesional logró los estándares sugeridos para un procedimiento efectivo y seguro, destacando una tasa de canulación del 96,7%, siendo superior a lo que las guías internacionales describen como exitosa. La morbilidad asociada a CPER es comparable a cifras nacionales e internacionales.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic procedure for various biliopancreatic pathologies. There are different training centers with a variety of practice times for performing ERCP. Objective: This study aims to evaluate the initial post-training results in therapeutic endoscopy at the Chilean-Japanese Institute of San Borja Arriarán Hospital, analyzing 150 consecutive ERCP procedures performed between November 2017 and January 2019 by a single operator at a hospital in La Araucanía, describing technical aspects, morbidity, and mortality. Method: Retrospective analysis of the prospective registry of the first 150 consecutive ERCP cases performed at the San José de Victoria Hospital (HSJV). Clinical, technical and laboratory variables were measured. Descriptive statistics were produced with measures of central tendency, dispersion and extreme tendency. Results: Series of 150 patients undergoing ERCP: mean age 60.1 years, median 65 and extreme ages 16-98 years. Female sex 69.3%. ERCP indications: 67.3% choledocholithiasis without cholangitis, 16.7% acute cholangitis, 6% benign bile duct stenosis, 3.3% periampullary tumor. All supported by an anesthetist, 50.7% propofol and 49.3% general anesthesia. Biliary cannulation rate 96.7%. Precut 19.3%. Reported complications reached 4.67%, with no mortality from the procedure in the series. Conclusions: The results of this series show that the training obtained by the professional improves the standards proposed for an effective and safe procedure, highlighting a cannulation rate of 96.7%, higher than what international guidelines describe as successful. The morbidity associated with ERCP in our series is comparable to national and international figures.

Duplicación del colédoco asociado a unión biliopancreática anómala: Reporte de caso / Common bile duct duplication associated with anomalous biliopancreatic junction: A case report

Introducción. La duplicación del colédoco es una anomalía congénita poco frecuente. En la mayoría de los casos este defecto se asocia a cálculos en la vía biliar, unión pancreatobiliar anómala, pancreatitis, cáncer gástrico o colangiocarcinoma. Por esta razón, el diagnóstico y el tratamiento temprano son importantes para evitar las complicaciones descritas a futuro. Métodos. Se presenta el caso de una paciente de 30 años, con antecedente de pancreatitis aguda, con cuadro de dolor abdominal crónico, a quien se le realizaron varios estudios imagenológicos sin claro diagnóstico. Fue llevada a manejo quirúrgico en donde se documentó duplicación del colédoco tipo II con unión pancreatobiliar anómala. Resultados. Se hizo reconstrucción de las vías biliares y hepatico-yeyunostomía, con adecuada evolución postoperatoria y reporte final de patología sin evidencia de tumor. Conclusión. El diagnóstico se hace mediante ecografía endoscópica biliopancreática, colangiorresonancia o colangiopancreatografía retrógrada endoscópica. El tratamiento depende de si está asociado o no a la presencia de unión biliopancreática anómala o cáncer. Si el paciente no presenta patología neoplásica, el tratamiento quirúrgico recomendado es la resección del conducto con reconstrucción de las vías biliares.

Introduction. Double common bile duct is an extremely rare congenital anomaly. This anomaly may be associated with bile duct stones, anomalous biliopancreatic junction, pancreatitis, bile duct cancer, or gastric cancers. Thus, early diagnosis and treatment is important to avoid complications. Clinical case. We report a rare case of double common bile duct associated with an anomalous biliopancreatic junction in a 30-year-old female, with prior history of acute pancreatitis, who presented with chronic abdominal pain. She underwent several imaging studies, without clear diagnosis. She was taken to surgical management where duplication of the type II common bile duct was documented with anomalous pancreatobiliary junction. Results. Reconstruction of the bile ducts and hepatico-jejunostomy were performed, with adequate postoperative evolution and final pathology report without evidence of tumor. Conclusion. Diagnosis is usually performed by an endoscopic ultrasound, magnetic resonance cholangiopancrea-tography, or endoscopic retrograde cholangiopancreatography. Treatment depends on the presence of anomalus biliopancreatic junction or concomitant cancer. In cases without associated malignancy, resection of bile duct and biliary reconstruction is the recommended surgical treatment.

Perforación colónica por endoprótesis biliar impactada / Colonic perforation due to impacted biliary stent

Introducción. La colocación de endoprótesis biliares es cada día más frecuente por ser actualmente una de las mejores opciones para el tratamiento de patologías de la vía biliar. La migración de las endoprótesis es una de las complicaciones que puede ocurrir en hasta un 10,8 % de los pacientes, pero en muy raras ocasiones llegan a causar una perforación intestinal. Caso clínico. Se trata de una paciente de 61 años, a quien cinco años atrás se le realizó una colangiopancreatografía retrógrada endoscópica por coledocolitiasis. Consultó por presentar dolor abdominal, y al examen físico se encontraron abdomen agudo y plastrón en fosa ilíaca izquierda a la palpación. La tomografía computarizada informó un cuerpo extraño a nivel del colon descendente, con perforación del mismo. Se realizó laparotomía exploratoria y colostomía por perforación del colon sigmoides secundaria a prótesis biliar migrada. Resultados. La paciente evolucionó favorablemente y a los seis meses se realizó el cierre de la colostomía, sin complicaciones. Conclusión. Los pacientes a quienes se les colocan prótesis biliares requieren un seguimiento adecuado para evitar complicaciones que, aunque raras, pueden ocurrir, como la migración intestinal con perforación. El tratamiento de dichas complicaciones se hace por vía endoscópica, laparoscópica o laparotomía en caso de complicación severa.

Introduction. Endoscopic placement of biliary stents is becoming more common every day, as it is currently one of the best options for the treatment of bile duct pathologies. One of the complications that can occur is the migration of the endoprostheses in up to 10.8% of patients, which in very rare cases can cause intestinal perforation. Clinical case. This is a 61-year-old female patient, who underwent endoscopic retrograde cholangiopancreatography five years ago for choledocholithiasis. She consulted due to abdominal pain, with a physical examination that upon palpation documented an acute abdomen and a palpable plastron in the left iliac fossa. The computed tomography revealed a foreign body at the level of the descending colon, with perforation. Exploratory laparotomy and colostomy were performed due to perforation of the sigmoid colon secondary to migrated biliary prosthesis. Results. The patient progressed favorably and six months later the colostomy was closed without complications. Conclusions. Patients who receive biliary stents require adequate follow-up to avoid complications that, although rare, may occur, such as intestinal migration with intestinal perforation. The treatment of these complications can be endoscopic, laparoscopic or laparotomy in case of severe complication.

Clinical Efficacy of Abdominal Ultrasound-guided Endoscopic Retrograde Appendicitis Therapy for Acute Uncomplicated Appendicitis / 昆明医科大学学报

Objective To compare the clinical efficacy of abdominal ultrasound-guided endoscopic retrograde appendicitis therapy(ERAT)with laparoscopic appendectomy(LA)for acute uncomplicated appendicitis using propensity score matching.Methods The clinical data of 441 patients with acute uncomplicated appendicitis admitted to the Third People's Hospital of Yunnan Province from March 2020 to April 2023 were collected.The cases were classified based on the differences in surgical method and divided into the ERAT group(n = 30)and LA group(n = 411).The clinical efficacy of patients was compared between the two groups after reducing confounding bias by propensity score matching(PSM).Results After PSM,a total of 30 pairs of patients in the two groups were successfully matched,and the baseline data of the two groups met the requirements for comparability.At 24 hours after the operation,the ERAT group exhibited lower white blood cells,neutrophil counts,and C-reactive protein levels compared to the LA group,and these differences were statistically significant(P<0.05).There was no significant difference in the operation time and total effective rate between the ERAT group and the LA group(P>0.05).However,the ERAT group had lower intraoperative blood loss and shorter pain relief time compared to the LA group,and these differences were statistically significant(P<0.05).Conclusion Abdominal ultrasound-guided endoscopic retrograde appendicitis treatment is an effective,safe,and feasible technique with good prospects for the treatment of acute uncomplicated appendicitis.

The effect of simple topical and intravenous general anesthesia on the occurrence of pancreatitis after ERCP surgery:a retrospective analysis / 临床外科杂志

Objective To investigate the effects of simple topical anesthesia and intravenous general anesthesia on the occurrence of pancreatitis after ERCP.Methods 400 Patients who underwent ERCP due to pancreaticobiliary duct disease in our hospital from January 2021 to March 2023 were selected and divided into two groups:Simple topical anesthesia group and intravenous general anesthesia group,200 cases in each group.The levels of venous pancreatic amylase and abdominal symptoms and signs were recorded in the two groups before operation and 3 h and 24 h after operation.The observation results were hyperamylaseemia and postoperative pancreatitis at 3 h and 24 h after operation.Results The incidence of postoperative pancreatitis after ERCP was higher in the superficial anesthesia group than in the intravenous general anesthesia group(7.5％and 2.0％,respectively;P＜0.05),there was statistical significance;The level of serum pancreatic amylase(198±216)U/L in intravenous general anesthesia group was significantly lower than that in superficial anesthesia group(379±327)U/L at 3h after surgery(P＜0.05).The level of serum pancreatic amylase(129±98)U/L in intravenous general anesthesia group was lower than that in superficial anesthesia group(187±156)at 24h after surgery(P＜0.05).The incidence of hyperamylasemia was 15.5％(31/200 cases)in the 3h postoperative intravenous general anesthesia group,lower than that in the simple surface anesthesia group(34.5％)(69/200 cases),and 5.5％(11/200 cases)in the 24h postoperative intravenous general anesthesia group,lower than that in the simple surface anesthesia group(19.0％)(38/200 cases)(P＜0.05).Conclusion Compared with simple surface anesthesia,intravenous general anesthesia can reduce the level of serum amylase after ERCP,and can reduce the occurrence of pancreatitis after ERCP.

Endoscopic retrograde cholangiopancreatography therapy of biliary and pancreatic diseases in children / 中国小儿急救医学

Endoscopic retrograde cholangiopancreatography（ERCP）is an important minimally invasive treatment method in adults with biliary and pancreatic diseases. With the development of endoscopic technology and the increasing understanding of pediatric biliary and pancreatic diseases，ERCP technology has gradually become an indispensable diagnostic and treatment method for pediatric patients with biliary and pancreatic diseases. This review mainly elaborated on the indications and surgical points of ERCP in pediatric biliary and pancreatic diseases，in order to promote the application and development of ERCP in children.

Prevention and treatment of post-endoscopic retrograde cholangiopancreatography complication in children / 中国小儿急救医学

Endoscopic retrograde cholangiopancreatography（ERCP）and related technologies are gradually being developed in pediatric biliary and pancreatic diseases.Clinicians should pay more attention to the prevention and treatment of postoperative complications.This review started with the operational methods of ERCP and its related technologies，elaborated on the possible complications，summarized the prevention and treatment methods，and aimed to provide reference for clinical doctors.

Standardize the management of ERCP complications and accelerate the widespread populari-zation of ERCP in China / 中华消化外科杂志

The process of endoscopic retrograde cholangiopancreatography (ERCP) is inva-sive, and its related treatments have a potential risk of complications, which poses certain obstacles to its safe promotion. Therefore, it is very important to standardize the management of ERCP compli-cations and promote the widespread development of ERCP in China. The authors interpret the back-ground, significance, and key issues that need to be paid attention to in the Guidelines for the management of complications of duodenal perforation associated with ERCP in China ( 2023 edition), in order to facilitate ERCP physicians to better grasp and apply the guidelines, provide guidance and reference for the standardized management of ERCP related complications of duodenal perforation, and promote the popularization and widespread development of ERCP in China.

Analysis of the risk factors for biliary infection after endoscopic retrograde cholangiopancreatography for malignant biliary obstruction / 中华肝胆外科杂志

Objective:To analyze the risk factors of biliary infection after endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant biliary obstruction.Methods:Clinical data of 160 patients with malignant biliary obstruction admitted to the Affiliated People's Hospital of Ningbo Univer-sity from June 2017 to June 2022 were retrospectively analyzed, including 89 males and 71 females, aged (65.1±8.0) (range, 41-78) years old. Patients were divided into two groups according to the occurrence of biliary infection within 30 days after ERCP: infected group ( n=30) and uninfected group ( n=130). Multivariate logistic regression was used to identify the risk factors of postoperative biliary infection. Results:The incidence of biliary infection after ERCP was 18.8% (30/160) in the patients with malignant biliary obstruction. A total of 43 strains of pathogenic bacteria were detected, including 34 Gram-negative strains and nine Gram-positive strains. The most common pathogenic bacterium was Escherichia coli. Multivariate analysis showed patients with diabetes mellitus ( OR=2.356, 95% CI: 1.587-5.441, P=0.001), sphincter dysfunction ( OR=2.651, 95% CI: 1.854-6.225, P=0.005), preoperative albumin <35 g/L ( OR=3.225, 95% CI: 2.041-5.689, P=0.002), preoperative hemoglobin <110 g/L ( OR=3.424, 95% CI: 2.115-6.333, P=0.003) suffered a higher risk of biliary infection after ERCP. Conclusion:Diabetes mellitus, sphincter dysfunction, lower levels of preoperative albumin and hemoglobin are independent risk factors for biliary infection after ERCP in patients with malignant biliary obstruction.

Comparative analysis of LC+ LCBDE and LC+ ERCP/EST for acute biliary pancreatitis / 中华肝胆外科杂志

Objective:To juxtapose laparoscopic cholecystectomy combined with common bile duct exploration and stone extraction (LC+ LCBDE) against endoscopic retrograde cholangiopancreatography/sphincterotomy with laparoscopic cholecystectomy (LC+ ERCP/EST) in the therapeutic context of acute biliary pancreatitis.Methods:The clinical data of patients with acute biliary pancreatitis in Department of Hepatobiliary Surgery, Datong Third People's Hospital from January 2017 to January 2021 were retrospectively analyzed. A total of 44 patients were inrolled, including 23 males and 21 females, with the age of (60.6±11.7) years. Based on different treatment approaches, the patients were divided into the LC+ LCBDE group ( n=33) and the LC+ ERCP group ( n=11, LC+ ERCP/EST). Total bilirubin, direct bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood amylase, operation time, postoperative hospitalization stays, total hospitalization cost, postoperative anal exhaust time, and postoperative complications (bile leakage, fever, bleeding) were compared between the two groups. Results:There were no significant differences in preoperative total bilirubin, direct bilirubin, ALT, AST, and blood amylase between LC+ ERCP group and LC+ LCBDE groups (all P>0.05). In LC+ LCBDE group, operation time was 110.0 (96.3, 147.5) min, postoperative hospitalization time was 9.0 (7.5, 11.0) d, postoperative exhaust time was 2.0 (1.0, 2.0) d, and in LC+ LCBDE group, operation time was 60.0 (32.0, 65.0) min, postoperative hospitalization time was 7.0 (4.0, 8.0) d, postoperative exhaust time was 1.0 (1.0, 1.0) d. Comparisons with LC+ LCBDE group, LC+ ERCP group had shorter postoperative hospitalization stay and earlier postoperative exhaust time, the total hospitalization cost of LC+ LCBDE group was 23 829.3 (21 779.6, 27 221.9) yuan, which was higher than 36 894.8 (31 963.5, 41 172.2) yuan in LC+ ERCP group, and the differences were statistically significant (all P<0.05). Comparison of postoperative total bilirubin, direct bilirubin, ALT and AST between LC+ ERCP group and LC+ LCBDE group, with no significant difference(all P>0.05). No postoperative complications such as bile leakage, residual stones, fever and bleeding occurred in both groups. Conclusion:Compared with LC+ ERCP/EST, LC+ LCBDE in the treatment of acute biliary pancreatitis, although the operation time and hospital stay are longer, but the total hospitalization cost is less, there is no need for multiple operations, and it can be used as the first choice for acute biliary pancreatitis.

Value of endoscopic retrograde cholangiopancreatography for the diagnosis and treatment of pediatric pancreaticobiliary maljunction / 中华消化内镜杂志

Objective:To investigate the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis and treatment of pediatric pancreaticobiliary maljunction (PBM).Methods:Data of 40 pediatric patients under 14 with PBM diagnosed and treated by ERCP at Department of Gastroenterology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from November 2012 to September 2022 were collected. PBM types, ERCP-related diagnosis and treatment, adverse events and prognosis were retrospectively analyzed.Results:Nineteen cases were P-B type (joining of common bile duct with pancreatic duct), 17 were B-P type (joining of pancreatic duct with common bile duct), and 4 were complex type. Forty children with PBM underwent 50 ERCP-related operations, among which 48 procedures succeeded. One case failed during cannulation of ERCP, replaced by rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP) afterwards. There were no serious postoperative adverse events such as bleeding, perforation or death. Thirty-four patients (85%) were followed up successfully, among which 14 underwent further surgery and 20 continued conservative treatment.Conclusion:ERCP is the golden standard to diagnose pediatric PBM, and it is also safe and effective treatment for PBM.

Progress in diagnosis and treatment of biliary anastomotic stricture after liver transplantation / 器官移植

In recent years, with the development of organ preservation, surgical techniques, perioperative management and immunosuppression regimens, the success rate of liver transplantation and survival rate of the recipients have been significantly enhanced. Liver transplantation has become the optimal treatment for patients with end-stage liver disease. However, biliary complications still commonly occur after liver transplantation, especially biliary anastomotic stricture. Severe biliary anastomotic stricture will not only increase the cost of treatment, but also lead to graft loss and even affect the survival rate of recipients. Therefore, timely diagnosis and treatment of biliary anastomotic stricture play a significant role in improving the survival rate of liver transplant recipients. In this article, the risk factors, clinical symptoms, diagnosis and treatment of biliary anastomotic stricture after liver transplantation were reviewed, aiming to provide novel ideas for the research, diagnosis and treatment of biliary anastomotic stricture after liver transplantation, and further enhance clinical efficacy of liver transplantation and the quality of life of recipients.

Advances in the differential diagnosis of malignant bile duct stenosis / 临床肝胆病杂志

There are various etiologies for extrahepatic bile duct stenosis， and pharmacotherapy and endoscopic intervention can achieve a good clinical effect in benign stenosis. Early diagnosis and timely surgical treatment of malignant stenosis may prolong the survival time of patients. However， there are still difficulties in the differential diagnosis of malignant bile duct stenosis. This article reviews the application of serology， radiology， endoscopic techniques， and artificial intelligence in the differential diagnosis of malignant bile duct stenosis， so as to provide strategies and references for formulating clinical diagnosis and treatment regimens.

Efficacy of endoscopic retrograde cholangiopancreatography combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in treatment of difficult choledocholithiasis / 临床肝胆病杂志

ObjectiveTo investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography （ERCP） combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in the treatment of difficult choledocholithiasis. MethodsA retrospective analysis was performed for the clinical data of 12 patients with difficult choledocholithiasis who underwent ERCP and electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in Department of Gastroenterology， Jilin People’s Hospital， from May to November 2022. The clinical effect of lithotripsy and lithotomy was observed， and postoperative complications and time of surgical operation were assessed. ResultsAmong the 12 patients， 11 （91.67%） were successfully treated by electrohydraulic lithotripsy under direct view， 9 （75.00%） achieved first-attempt success in lithotripsy， and 11 （91.67%） had complete removal of calculi； 1 patient was found to have stenosis of the bile ducts caused by multiple biliary tract surgeries， and grade Ⅱ intrahepatic bile duct stones above the sites of stenosis were removed under direct view， but there were still residues of grade Ⅲ intrahepatic bile duct stones， which led to the fact that complete calculus removal was not achieved. The mean time of ERCP operation was 91.3±26.2 minutes， including a time of 41.8±22.2 minutes for energy lithotripsy. There were 2 cases of postoperative biliary tract infection which were improved after anti-infective therapy， 2 cases of hyperamylasemia which were not given special treatment， and 3 cases of mild pancreatitis which were improved after symptomatic medication， and there were no complications such as bleeding and perforation. ConclusionERCP combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system is safe， effective， and feasible in the treatment of difficult choledocholithiasis.

Comparison of the effectiveness of different endoscopic retrograde cholangiopancreatography complexity scales in the training of endoscopists / 中国内镜杂志

Objective To explore the utility of different endoscopic retrograde cholangiopancreatography(ERCP)complexity scales in the training of endoscopists.Methods Clinical data of 237 patients treated by ERCP completed by trainee physicians at two hospitals in Eastern China from February 2022 to February 2023 were prospectively collected.All ERCP cases were classified using previously proposed complexity grading scales,including the American Society of Gastrointestinal Endoscopy(ASGE),Morriston and HOUSE grading scales,compared with the hepatopancreatic ampulla features classification.Successful intubation,successful surgical treatment and complication rates within 48 h were recorded.Results Within each grading,subgroups were divided according to severity,and the comparison of intubation success rates between subgroups in the 3 different grades showed statistically significant differences(P = 0.000).The treatment success rate and intubation success rate had similar findings(P = 0.000).There was no correlation between the complication rate and ASGE grading(P = 0.361),Morriston grading(P = 0.332),and HOUSE grading(P = 0.586).When only cases with primitive papillae were considered,the intubation success rate depended on the complexity grading after the newly added classification of hepatopancreatic ampulla features.In the ASGE group,the success rate of intubation was compared between different subgroups,and the difference was statistically significant(P = 0.004);in the Morriston group,the success rate of intubation was compared between different subgroups,and the success rate of intubation was statistically significant(P = 0.002);in the HOUSE group,the success rate of intubation was compared between different subgroups,and the difference was statistically significant(P = 0.000);In the hepatopancreatic ampulla characteristics group,the difference in intubation success rate was statistically significant when compared between different subgroups(P = 0.000).Similar findings were also found for treatment success rate and intubation success rate(P = 0.000).There was no correlation between the complication rate and ASGE group(P = 0.586),Morriston group(P = 0.443),HOUSE group(P = 0.306),and hepatopancreatic ampulla characteristics group(P = 0.350).Conclusion The use of hepatopancreatic ampulla features as a classification of biliary cannulation complexity is feasible and could be an alternative or additional means of predicting successful biliary cannulation and surgical treatment success and could be used in the future to assess endoscopist training and learning progress and technical standards.

Special application of stone extractor balloon catheter in ERCP for anastomotic biliary stenosis after liver transplantation / 中国内镜杂志

Objective To discuss the application effect of using a stone extractor balloon catheter to assist in crossing the anastomotic stenosis in treatment of anastomotic biliary stenosis after liver transplantation using endoscopic retrograde cholangiopancreatography(ERCP).Methods Clinical data of 48 patients who developed anastomotic biliary stenosis after liver transplantation and underwent ERCP treatment were collected.Upon unsuccessful use of a dilation catheter to cross the stricture,attempts were made to cross the anastomotic biliary stenosis by using a stone extractor balloon catheter.The success rate of the procedure was recorded,intraoperative conditions were observed,treatment outcomes and complications were analyzed.Results The main presenting symptoms in the 48 patients on admission were abdominal discomfort(32 patients),fever(7 patients),pruritus(4 patients),jaundice(3 patients),and no obvious symptoms(2 patients).Preoperative magnetic resonance cholangiopancreatography(MRCP)examination revealed isolated stricture of the anastomotic site in 35 cases,and stricture associated with stones in 13 cases.Using the stone extractor balloon catheter as a guide,guidewire crossing of the anastomotic stenosis was successful in 26 cases,resulting in a success rate of 54.17%(26/48).Through statistical analysis of the successful group and the failed group,there was a significant difference in whether the distal biliary dilatation between the two groups,and the difference was statistically significant(χ2 = 8.39,P = 0.004).In the 26 successfully treated cases,alanine transaminase(ALT),aspartate transaminase(AST),γ-glutamyl transpeptidase(γ-GT),alkaline phosphatase(ALP),and total bilirubin(TBiL)levels decreased significantly 48 hours after the procedure(P<0.05),and no serious complications occurred.Conclusion The use of a stone extractor balloon catheter significantly increases the success rate of crossing anastomotic stenosis in the treatment of anastomotic biliary stenosis after liver transplantation,especially in cases with distal dilatation of the common bile duct.This approach is safe and worth promoting.

Clinical application of intravenous dexmedetomidine combined with target-controlled remifentanil in anesthesia of ERCP surgery in older adult patients / 中国医科大学学报

Objective To explore the safety and feasibility of intravenous dexmedetomidine(Dex)combined with targeted infusion of remifentanil in endoscopic retrograde cholangiopancreatography(ERCP)anesthesia in older adult patients.Methods From January to August 2021,98 older adult patients(≥65 years old)undergoing ERCP were randomly divided into TRP and TRD groups.The TRP group was anesthetized with target-controlled infusion of propofol and remifentanil and the TRD group was treated with Dex combined with target-controlled infusion of remifentanil.mean arterial pressure(MAP),heart rate(HR),electrocardiogram(ECG),respiratory rate(RR),pulse oxygen saturation(SpO2),bispectral index(BIS)before anesthesia induction(T0),immediately after induction of anesthesia(T1),endoscopic introduction(T2),duodenal papilla intubation(T3),endoscopy withdrawal(T4)and postoperative awakening(T5)were observed.Arterial blood gas analysis at different time points(T0,every 15 min after anesthesia induction and T5),PaO2,and PaCO2,were recorded at the above mentioned time points;and the remifentanil concentration in target-controlled infusion,operation time,recovery time(from infusion of remifentanil to consciousness recovery),anesthesia recovery time(from consciousness recovery to leaving the operating room),intraoperative body movement,Aldrete scores out of the room,Visual Analogue Scale(VAS)at 60 min after surgery,occurrence of post-operative adverse reactions,as well as the satisfaction of anesthesiologists,endoscopists,and patients were recorded.Results Compared with the TRP group,MAP at T1 and T3,SpO2 and RR at T1,T2,T3,and T4,and BIS at T2,T3,T4,and T5 increased,whereas HR at T1,T2,T3,and T4 decreased;the number of mandibular rests,incidence of hypoxemia,Aldrete score,and satisfaction increased,whereas the VAS score at 60 min after surgery decreased in the TRD group(P<0.05).There were no statistically significant differences in postoperative adverse reactions,PaO2 and PaCO2,target-controlled infusion remifentanil concentration,operation time,recovery time,and anesthesia recovery time between the two groups.Conclusion Compared with the target-controlled infusion of propofol-remifentanil,intravenous infusion of Dex combined with target-controlled infusion of remifentanil can reduce the incidence of hypoxemia in older adult patients during ERCP surgery,and the anesthesia regimen can meet the anesthesia needs of ERCP surgery,which is safe and feasible.

Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography in a Patient with Gastric Bypass. Report of the First Local Case

We describe the first case in our environment of endoscopic ultrasound (EUS)-assisted transgastric endoscopic retrograde cholangiopancreatography in a patient with gastric bypass surgery. The procedure was performed with a side-viewing duodenoscope through a jejunogastrostomy using apposing stents, placed with EUS assistance, and a standard technique and instruments.

Se describe el primer caso en nuestro medio de colangiopancreatografía retrógrada endoscópica transgástrica asistida por endosonografía en una paciente con cirugía de baipás gástrico. El procedimiento se realizó con duodenoscopio de visión lateral a través de una yeyunogastrostomía por stent de aposición, emplazado con asistencia endosonográfica y con una técnica e instrumental estándar.

Colangiopancreatografía endoscópica asistida por laparoscopia para el tratamiento de coledocolitiasis en pacientes con Y de Roux / Laparoscopic-assisted endoscopic cholangiopancreatography for the treatment of choledocholithiasis in patients with Roux-en-Y

Introducción. Los pacientes con antecedente de baipás gástrico que presentan coledocolitiasis no pueden ser tratados con la técnica convencional de colangiopancreatografía retrógrada endoscópica. En estos casos, la vía transgástrica abierta o asistida por laparoscopia, se convierte en una excelente alternativa a la exploración abierta de la vía biliar. Métodos. Estudio retrospectivo que incluyó pacientes adultos con coledocolitiasis y antecedente de gastrectomía subtotal o baipás gástrico con Y de Roux, llevados a colangiopancreatografía endoscópica transgástrica laparo-asistida, entre enero de 2019 y diciembre de 2021, en la Clínica CES de Medellín, Colombia. Resultados. Se encontraron siete pacientes, todos con antecedente de baipás gástrico para el manejo de la obesidad. La tasa de identificación y canulación de la vía biliar y extracción de cálculos fue del 100 % mediante el abordaje transgástrico laparo-asistido. Conclusión. De acuerdo con varias revisiones sistemáticas, esta técnica es relativamente fácil de implementar y segura, presentando una tasa de complicaciones inferior a 5 %. Se propone una variante de esta técnica

Introduction. Patients with a history of gastric bypass who present with choledocholithiasis cannot be treated with the conventional technique of endoscopic retrograde cholangiopancreatography. In these cases, the open or laparoscopic-assisted transgastric approach becomes an excellent alternative to open bile duct gastric exploration. Methods. A retrospective review of patients with choledocholithiasis and a history of subtotal gastrectomy or gastric bypass with Roux-en-Y, who underwent laparo-assisted transgastric endoscopic cholangiopancreatography, was conducted between January 2019 and December 2021 at Clínica CES de Medellín, Colombia. Results. Seven patients were found, all with a history of gastric bypass secondary to obesity. The rate of bile duct identification and cannulation, and stone removal was 100% using the laparo-assisted transgastric approach. Conclusion. According to several systematic reviews, this technique is relatively easy to implement and safe, presenting a rate of complications less than 5%. A variant to this technique is proposed

Apendicitis aguda secundaria a obstrucción de orificio apendicular por migración de prótesis biliar / Acute appendicitis due to migration of a biliary prosthesis

La apendicitis aguda es la patología quirúrgica abdominal más común alrededor del mundo. Presentamos un caso de un paciente de 78 años que se presentó con un cuadro de apendicitis aguda en el servicio de urgencias. La tomografía computada de abdomen y pelvis mostró una apendicitis aguda secundaria a la obstrucción del orificio apendicular por una prótesis biliar migrada. Se realizó un manejo exitoso mediante el retiro de la prótesis por colonoscopía, permitiendo el alta hospitalaria del paciente 72 horas posteriores al ingreso.

Acute appendicitis is the most common surgical abdominal pathology worldwide that requires immediate intervention. We report a 78-year-old patient who presented with acute appendicitis. A computed tomography (CT) of the abdomen and pelvis showed acute appendicitis due to appendiceal orifice obstruction from a migrated biliary stent. The condition was successfully treated nonoperatively with endoscopic stent removal, allowing his discharge 72 hours after his admission.