Clinical observation of Chaihu Qingdan decoction in treating acute severe cholangitis after endoscopic biliary drainage / 中国中西医结合急救杂志

Objective To observe the clinical effect of using Chaihu Qingdan decoction in the treatment of acute severe cholangitis (ACST) after endoscopic biliary drainage (ENBD). Methods One hundred and thirty two patients with ACST with ENBD admitted to Dongli District Hospital of Tianjin from October 2016 to October 2017, they were divided into a control group (42 cases) and a Chaihu Qingdan decoction group (90 cases) according to whether the patients accepted traditional Chinese medicine (TCM) treatment or not. The patients in the control group and the Chaihu Qingdan decoction group (combined group) were all treated with ENBD; the control group received routine anti-inflammatory treatment; the combined group, on the basis of conventional anti-inflammatory treatment, additionally was treated with Chaihu Qingdan decoction (composition: bupleurum chinense 18 g, capillary artemisia 30 g, astragalus root 20 g, radix paeoniae rubra 20 g, radix scutellariae 15 g, radix scutellariae 15 g, polygoni 15 g, rhododendron bungeanum 30 g, red cane 30 g, forsythia 20 g, bergamot15 g), 1 dose per day, 2 times daily, 10 days constituting a therapeutic course. After treatment, the difference of operation success rate, abdominal pain relief time, postoperative body temperature return to normal time, liver function, the incidence of postoperative complications, hospitalization time were observed. Results The success rate of operation in the combined group was higher than that in the control group [97.78% (88/90) vs. 95.24% (40/42)], but the difference was not statistically significant (P > 0.05); the relief time of abdominal pain in the combined group was significantly shorter than that of the control group (days: 6.1±1.1 vs. 7.4±1.5, P < 0.05), and the postoperative body temperature return to normal time in combined group was obviously shorter than that in the control group (days: 2.1±0.4 vs. 2.2±0.6, P > 0.05). With the prolongation of treatment, the levels of body temperature, white blood cell count (WBC), direct bilirubin (DBil), alanine aminotransferase (ALT) and aspartate transaminase (AST) were decreased gradually in both groups, reaching the lowest levels on 10 days after treatment, and the above indexes in the combined group were significantly lower than those in the control group [body temperature (℃):36.44±0.24 vs. 37.04±0.39, WBC (×109/L): 7.03±1.23 vs. 8.92±2.11, DBil (μmol/L): 12.03±4.53 vs. 20.32±6.12, ALT (U/L): 31.23±4.23 vs. 68.92±6.19, AST (U/L): 34.03±11.23 vs. 78.92±22.19, all P < 0.05]; after treatment, the total bilirubin (TBil) in both groups was lower than that before treatment, and the combined group was significantly lower than that in the control group after treatment (μmol/L: 61.59±11.64 vs. 82.33±12.05, P < 0.05); the incidence of complications in the combined group was significantly lower than that in the control group [3.33% (3/90) vs. 28.57% (12/42), P < 0.05], and the hospitalization time was shorter in the combined group than that in the control group (days:11.4±2.2 vs. 18.2±3.4, P < 0.05). Conclusion For patients with severe biliary tract inflammation, ENBD combined with Chaihu Qingdan decoction can reduce postoperative complications, reduce abdominal pain relief time, and accelerate liver function recovery.

Emergency endoscopic needle-knife precut papillotomy in acute severe cholangitis resulting from impacted common bile duct stones at duodenal papilla.

AIM: To evaluate the efficacy and safety of emergency endoscopic needle-knife precut papillotomy in acute severe cholangitis resulting from impacted common bile duct stones at duodenal papilla. METHODS: Between January 2010 and January 2015, 118 cases of acute severe cholangitis with impacted common bile duct stones at the native papilla underwent emergency endoscopic retrograde cholangiopancreatography (ERCP) and early needle-knife precut papillotomy in a tertiary referral center. Precut techniques were performed according to the different locations of stones in the duodenal papilla. Clinical data about therapy and recovery of the 118 patients were recorded and analyzed. RESULTS: One hundred and eighteen patients underwent emergency ERCP within 24 h after hospitalization, with a total success rate of 100%. The mean operating time was 6.4 ±â€¯4.1 min. Postoperative acute physiology and chronic health evaluation (APACHE) II scores, white blood cell count and liver function improved significantly. The complication rate was 4.2% (5/118); two with hemorrhage and three with acute pancreatitis. There was no procedure-related mortality. CONCLUSION: Emergency endoscopic needle-knife precut papillotomy is effective and safe for acute severe cholangitis resulting from impacted common bile duct stones at the duodenal papilla.

A retrospective study of emergency endoscopic needle-knife sphincterotomy for acute severe cholangitis resulting from impacted common bile duct stones at duodenal papilla / 中华消化内镜杂志

Objective To evaluate the application value of emergency endoscopic needle-knife sphincterotomy(NKS) on acute cholangitis of severe type (ACST) resulting from impacted common bile duct stones at duodenal papilla. Methods A retrospective study was performed on the data of 90 ACST cases with impacted common bile duct stones at the native papilla and undergoing emergency NKS between January 2011 and January 2017 in Tianjin Nankai Hospital. The completion of treatment, mean operating time, impacted stone clearance rate, changes of laboratory indexes before and after endoscopic procedure, and complications were analyzed. Results All the 90 patients underwent emergency NKS successfully, with a total success rate of 100. 0％. The mean operating time was 25. 2±11. 7 min. The impacted stone clearance rate was 95. 6％(86/90). The complication rate was 5. 6％(5/90), including 3 cases of hemorrhage and 2 cases of post-ERCP pancreatitis. There was no procedure-related mortality. The postoperative white blood cell count, serum procalcitonin, total bilirubin, direct bilirubin, and glutamic-pyruvic transaminase decreased significantly compared with pre-operation ( all P<0. 001) . Conclusion Emergency NKS is effective and safe for treatment of ACST resulting from impacted common bile duct stones at duodenal papilla with a relative high application value.