Objective To evaluate the use of fast track surgery （FTS） in the treatment for cholecystolithiasis combined with calculus of common bile duct （CBD） by combination of laparoscope and duodenoscope. Methods One hundred and twenty patients with cholecystolithiasis combined with calculus of CBD underwent laparoscopic cholecyst-ectomy （LC） and endoscopic retrograde cholangiopancreatography （ERCP） were divided into FTS group （n=55） and conventional group （n=65），which were accepted the perioperative therapy of FTS or conventional therapy，respectively. After operation，the incision pain，nausea and vomiting，infusion time，loss of body weight，out-of-bed time，dieting time，postoperative hospitalization，hospital costs，and complications were compared in two groups. Results Compared with the conventional group，the postoperative infusion time，dieting time，out-of-bed time，and postoperative hospitali-zation were shorter，the incidence rates of pulmonary infection，and urinary systems infection，pancreatitis，nausea and vomiting， and incision pain were lower，the loss of body weight was lower in the FTS group （P＜0.05），but the differences of WBC and serum amylase at 24 h after operation were not significant between the FTS group and conventional group（P＞0.05）. Conclusion The FTS is safe，economic，and effective in the treatment for cholecystolithiasis combined with calculus of CBD by combination of laparoscope and duodenoscope.
Objective To discuss the therapeutic effect and safety of laparoscopic cholecystectomy plus laparoscopiccommon bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincte-rotomy plus LC （ERCP/EST＋LC） for cholecystolithiasis with choledocholithiasis patients with obstructive jaundice. Methods The clinical data of cholecystolithiasis with choledocholithiasis patients with obstructive jaundice from January2011 to June 2012 were analyzed retrospectively. During this period， 48 patients were treated by LC＋LCBDE （LC＋LCBDE group）， and 76 patients by ERCP/EST＋LC （ERCP/EST＋LC group）. Results ①There were no statistical significances in the age， gender， preoperative total bilirubin， alanine aminotransferase， number and maximum diameter of common bile duct stone， and internal diameter of common bile duct in two groups （P＞0.05）. ②No perioperative mortality occurred and no significant differences were observed in terms of stone clearance from the common bile duct， postoperative morbidity， and conversion to open surgery in two groups （P＞0.05）. However， the operative time and post-operative hospital stay in the LC＋LCBDE group were shorter than those in the ERCP/EST＋LC group （P＜0.05）. In addi-tion， the costs of surgical procedure and hospitalization charges in the LC＋LCBDE group were less than those in the ERCP/EST＋LC group （P＜0.05）. Conclusions Both LC＋LCBDE and ERCP/EST＋LC are safe and effective therapies forcholecystolithiasis with choledocholithiasis patients with obstructive jaundice. However， LC＋LCBDE is better for pati-ents’ recovery and cost effective. Especially for patients with common bile duct＞1.0cm in diameter or with multiple common bile duct stones， LC＋LCBDE is the best choice. To sum up， the choice of minimally invasive treatment must be individualized according to the patient’s condition and the availability of local resources.
Objective To find the most effective treatment for a patient with difficult selective biliary cannulation (DSBC) during endoscopic retrograde cholangiopancreatography (ERCP) by EBM practice. Methods Evidence was retrieved from The Cochrane Library (Issue 1, 2010), ACP online, NGC (1998 to June 2010), PubMed (1950 to June 2010), and CBM (1994 to June 2010). The collected evidence was then graded. Results After preliminary research, we identified 18 relevant articles. The evidence showed that pre-cutting technique could increase cannulation success rates in DSBC and was safe, effective, and time-saving for an experienced endoscopist. Pancreatic duct occupation was easier to perform than pre-cutting technique and could also increase selective cannulation success rates in DSBC. According to the evidence, together with endoscopist’s experience and the preference of the patient and his family, needle-knife precut papillotomy was performed. Successful selective biliary cannulation was accomplished after pre-cutting. Conclusion The current evidence suggests that pre-cutting technique and pancreatic duct occupation could increase selective cannulation success rates in DSBC. Patients’ condition and endoscopist’s experience should be considered properly before the operation.
Objective To evaluate the safety and effect of early therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and interventional treatment for acute biliary pancreatitis. Methods Eighty-seven hospitalized patients with acute biliary pancreatitis were divided into endoscopic therapy group and conservative therapy group according to the treatment methods. ERCP examination and treatment were used in the endoscopic therapy group, medical conservative treatments were used in the conservative therapy group. The efficacy such as blood amylase recovery time, abdominal pain relief time, blood white blood cell recovery time, liver function recovery time, hospital stay, and complications were observed. Results Blood amylase recovery time, abdominal pain relief time, blood white blood cell recovery time, liver function recovery time, and hospital stay in the endoscopic therapy group were significantly shorter than those in the conservative therapy group (Plt;0.05). There were no ERCP related severe complications or aggrevated symptoms. Conclusion Early endoscopic therapy is a safe and effective method for acute biliary pancreatitis and can prevent further progression to severe status.
Objective To evaluate the clinical effectiveness of laparoscopic cholecystectomy and laparoscopic common bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincterectomy with LC（ERCP/EST＋LC） in treatment for cholecystolithiasis with choledocholithiasis. Methods From January 2008 to July 2011， 127 patients suffered from cholecystolithiasis with choledocholithiasis underwent either LC＋LCBDE（85 cases， LC＋LCBDE group） or ERCP/EST＋LC（42 cases， ERCP/EST＋LC group） were collected retrospectively. The clearance rate of calculus， hospital stay， hospitalization expenses， and the rate of postoperative complications were compared between two groups. Results Eighty-five patients were performed successfully in the LC＋LCBDE group， out of which 54 patients had primary closure of common bile duct （LC＋LCBDE primary closure group）， whereas in 28 patients common bile ducts were closed over T tube （LC＋LCBDE＋T tube group）. Forty-two patients were performed successfully in the ERCP/EST＋LC group. There were no differences in the clearance rate of calculus〔100%（82/82） versus 97.37%（37/38）， P=0.317〕 and postoperative complications rate 〔（4.71% （4/85） versus 4.76%（2/42）， P=1.000〕 between the LC＋LCBDE group and ERCP/EST＋LC group. The median （quartile） hospital stay in the LC＋LCBDE group was shorter than that in the ERCP/EST＋LC group 〔12 （6） d versus 17（9） d， P＜0.001〕. In the LC＋LCBDE primary closure group， both median （quartile）?hospital stay and median（quartile） hospitalization expenses were less than those of ERCP/EST＋LC〔hospital stay：11（5） d versus 17（9） d， P＜0.001；hospitalization expenses：27 054（8 452） yuan versus 31 595（11 743） yuan， P=0.005〕 . Conclusions In the management of patients suffered from cholecystolithiasis with choledocholithiasis， both LC＋LCBDE and ERCP/EST＋LC are safe and effective. LC＋LCBDE， especially primary closure after LCBDE， is associated with significantly less costs as compared with ERCP/EST＋LC. Moreover， patients can be cured by LC＋LCBDE through one-stage treatment with the protection of the papilla function and no limits to the amount or size of the choledocholithiasis. The LC＋LCBDE is a preferable choice for the appropriate cases of cholecystolithiasis with choledocholithiasis.
ObjectiveTo investigate the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice of elderly patients. MethodsTotally 338 patients with obstructive jaundice underwent ERCP were divided into elderly group (age ≥60 years old) and nonelderly group (age lt;60 years old) based on age. The levels of serum amylase (AMY), ALT, and TBIL in 6, 24, and 48 h after ERCP were detected. The success rate of cholangiopancreatography, accuracy rate of diagnosis, and incidence of complications after ERCP in two groups were analyzed. ResultsThe difference of serum AMY, ALT, and TBIL levels of patients in 6, 24, and 48 h after ERCP were not significant between two groups (Pgt;0.05). The success rate of cholangiopancreatography in nonelderly group was 96.3% (130/135) and in elderly group was 96.1% (195/203), and no difference was found (Pgt;0.05). However, the accuracy rate of diagnosis of ERCP in nonelderly group (84.6%, 110/130) was significantly lower than that in elderly group (98.5%, 192/195), Plt;0.05. The difference of the incidence of complications was not significant between two groups 〔14.8% (20/135) vs. 17.2% (35/203)〕, Pgt;0.05. There was no mortality in two groups patients. ConclusionERCP is a safe, effective, and accurate method, which is of importance to the diagnosis of obstructive jaundice in elderly patients.
Objective To evaluate the role of endoscopic retrograde cholangio-pancreatography(ERCP)in diagnosis of anomalous converge of the cystic duct and prevention of bile duct injuries during laparoscopic cholecystectomy(LC). Methods From July, 1992 to June, 1999, LCs were performed in 4 500 patients with gallbladder stone or cholecystitis at our center. Preoperative ERCPs were performed in 780 of all patients (14.50%). Anomalous junctions of the cystic duct with common hepatic duct were investigated and the length and caliber of these cystic duct were measured and compared with 100 control cases. Results An overall anomalous converges of the cystic duct were found in 125(16.03%) of the 780 patients undergoing ERCP. Of 780 patients undergoing LC, 35 cases were converted to open cholecystectomy(4.5%), and various complications occurred in 6 cases (0.77%), but no death and biliary duct injuries occurred. Conclusion Various types of anomalous junctions of the cystic duct could be diagnosed precisely by ERCP before LC and the preoperative examination of ERCP may be helpful in prevention of bile duct injuries and other biliary complications in the laparoscopic time.
Objective To study the clinical diagnosis and treatment of juxtapapillary duodenal diverticula with biliary deseases.Methods Eighteen duodenal diverticulum treated in our department in recent 5 years were retrospectivly analyzed, especially investigated the postcholecystectomy cases whose symptoms were continuing existence after operatoins. Articles about the surgical treatment were reviewed. Results The total of 18 duodenal diverticulum with 17 cases of juxtapapillary duodenal diverticulum were included in this study. The ages of 12 cases were over 50 years old. Sixteen cases(88.89%) presented biliary stones. Seven cases once had performed cholecystectomy or cholecystectomy plus choledochotomy,but symptoms persisted after operations. The duodenal diverticulum were found by endoscopic retrograde cholangiopancreatography (ERCP) and hypotonic duodenography. Sixteen patients underwent surgical treatment with good effect. Conclusion The juxtapapillary duodenal diveticula has the close relationship with biliary stones. ERCP and hypotonic duodenogrphy are the most reliable methods to get the correct diagnosis. In case of recurrent common bile duct stones after operations or persisting billiary symptoms after cholecystectomy, the coexistence of juxtapapillary duodenal diverticulum should be ruled out. The surgical treatment is only considered for the duodenal diverticulum with complication.
Objective To investigate whether intraductal electrocautery incision （IEI） could decrease the recurrence of post-liver transplant anastomotic strictures （PTAS） after conventional endoscopic intervention of balloon dilatation （BD） and plastic stenting （PS）. Methods The clinical data of 27 patients with PTAS who were given endoscopic treatment of BD＋PS or IEI＋BD＋PS in our hospital from January 2007 to October 2011 were reviewed retrospectively. Results The treatment of BD＋PS was initially successful in 9 of 11 （81.8%） cases， but showed recurrence in 5 of 9 （55.6%）. The treatment of IEI＋BD＋PS was initially successful in 14 of 16 （87.5%） cases, and the recurrence was observed only in 3 of 14 （21.4%）. The total diameter of inserted plastic stents in IEI＋BD＋PS group was significantly greater than that in BD＋PS group 〔（12±3.2） Fr vs. （8±1.3） Fr，P=0.039〕. All recurrences were successfully retreated by IEI＋BD＋PS. Procedure-related complications included pancreatitis in 5 cases （18.5%）, cholangitis in 8 cases （29.6%）, bleeding after EST in 1 cases （3.7%）, which were all cured with medical treatment. No complications related to intraductal endocautery incision procedure such as bleeding and perforation were observed. Median follow-up after completion of endoscopic therapy was 22 months （range 1-49 months）. Conclusions Intraductal electrocautery incision is an effective and safe supplement to balloon dilatation and plastic stenting treatment of PTAS, which can decrease the recurrence of anastomotic strictures in conventional endoscopic intervention.
Objective To analyze the clinical characteristics associated with hospital infections in patients with common bile duct stones treated by endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE), thereby providing a basis for selecting treatment strategies and formulating hospital infection prevention measures for such patients. Methods Patients with common bile duct stones at Jiangsu Provincial People’s Hospital between January 2020 and July 2023 were retrospectively selected and divided into ERCP and LCBDE groups according to their surgical methods. Basic patient data, length of hospital stay, hospitalization costs, perioperative infection-related indicators, and occurance of hospital infections were compared between groups. Results A total of 402 patients were enrolled, with 242 in the ERCP group and 160 in the LCBDE group. Significant differences were noted in smoking, alcohol consumption, history of lung diseases, history of heart diseases, history of cholecystectomy/biliary surgery, presence of cholecystitis, presence of cholecystolithiasis, number of stones, maximum stone diameter, common bile duct diameter, total hospital stay, and total expenses (P<0.05). Twenty-four hours before surgery, except for the neutrophil count, which was slightly higher in the ERCP group than that in the LCBDE group (P=0.043), the infection-related indicators did not differ significantly between the two groups (P>0.05). Twenty-four hours after surgery, the levels of serum white blood cell, neutrophil, and aspartate aminotransferase in the ERCP group were lower than those in the LCBDE group (P<0.05), and the levels of alkaline phosphatase and gamma-glutamyl transferase in the ERCP group were higher than those in the LCBDE group (P<0.05). A total of 179 bile samples were collected and tested, identifying 137 strains of pathogenic bacteria (78 in the ERCP group and 59 in the LCBDE group). In the ERCP group, 42 strains (53.85%) were Gram-negative bacteria, 34 strains (45.59%) were Gram-positive bacteria, and 2 strains (2.56%) were fungi; in the LCBDE group, 33 strains (55.93%) were Gram-negative bacteria and 26 strains (44.07%) were Gram-positive bacteria. No significant difference was observed in the composition of pathogenic bacteria between the two groups (χ2=1.174, P=0.695). Among the 402 patients, 38 cases of hospital infection occurred postoperatively, with an infection rate of 9.45%. The difference in the infection rate between the ERCP group and the LCBDE group were statistically significant (11.98% vs. 5.63%; χ2=4.550, P=0.033). The main sites of infection were bloodstream, lungs, and abdominal-pelvic cavity. Conclusions The predominant pathogens isolated after both ERCP and LCBDE are Gram-negative bacteria. Compared with LCBDE, ERCP has less impact on inflammatory markers, hospital stay, and costs, but has a higher incidence of hospital infections.