The clinical analysis of endoscopic pancreaticobiliary separation in the treatment of occult pancreaticobiliary reflux

2020 ◽  
Author(s):  
Zhao Gang ◽  
Zhang Cheng ◽  
Cai Hao ◽  
Xu An An ◽  
Li Hai Dong ◽  
...  
Keyword(s):  
Bile Duct ◽  
Recurrence Rate ◽  
Endoscopic Sphincterotomy ◽  
Clinical Analysis ◽  
Endoscopic Retrograde ◽  
Curative Effect ◽  
Papillary Tumour ◽  
Significant Difference ◽  
The Difference ◽  
Pancreatic Reflux

Abstract Objective To investigate the aetiology of occult pancreaticobiliary reflux (OPBR) and the curative effect of EST in patients with cholecystolithiasis. Methods The clinical data of 47 OPBR patients with cholecystolithiasis from October 2013 to October 2016 were analyzed retrospectively.Results The average gallbladder bile amylase (GBA) of 47 patients was 864 ± 575 U/L. Forty patients underwent endoscopic retrograde cholangiopancreatography (ERCP), among which 26 patients were diagnosed with papillitis, 16 patients with peripapillary diverticulum, 14 patients with nipple overlength, five patients with nipple atrophy, three patients with ampullary calculi and two patients with papillary tumour. Thirty-three patients underwent endoscopic sphincterotomy (EST), after the operation, 16 patients reexamined GBA, in which 15 patients had normal GBA, and the difference of GBA was statistically significant (1161 ± 764 U/L vs 47 ± 17 U/L, t=5.641, P<0.05). After following up of 1 to 4 years, 27 patients without cholecystectomy who underwent EST had no recurrence of calculus, and in 9 patients who did not undergo EST, two patients had a recurrence of calculus. There was a significant difference in the recurrence rate of calculus (χ2=21.340, P<0.05). Conclusion Pancreaticobiliary junction disease is an essential cause of OPBR and cholecystolithiasis formation. EST can reduce the retention of pancreatic reflux juice both in gallbladder and bile duct and can reduce the recurrence rate of cholecystolithiasis after choledochoscopic lithotomy.

scholarly journals Risk Factors for Success, Complications, and Death after Endoscopic Sphincterotomy for Bile Duct Stones: A 17-Year Experience with 2,137 Cases

2020 ◽  
Vol 38 (6) ◽  
pp. 534-541 ◽  
Author(s):  
Júlio Carlos Pereira Lima ◽  
Ivan David Arciniegas Sanmartin ◽  
Bruna Latrônico Palma ◽  
Carlos Eduardo Oliveira dos Santos
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Sphincterotomy ◽  
Older Patients ◽  
Bile Duct Stones ◽  
Related Complication ◽  
Endoscopic Retrograde ◽  
Stone Removal

<b><i>Background:</i></b> Risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) complications are well-studied. However, risk factors for complications and success after endoscopic sphincterotomy (EST) for duct stones are poorly determined. This study aimed to verify risk factors for mortality, complications, and success after EST. <b><i>Methods:</i></b> A multivariate analysis was carried out in a dataset of ERCPs performed during 17 years. <b><i>Results:</i></b> A total of5,226 ERCPs were performed, of which 2,137 were in patients with bile duct stones (1,458 women and 679 men; mean age = 57 years) who underwent EST with attempted stone removal. There were 171 (8%) complications, with pancreatitis in 87 (4.1%), bleeding in 48 (2.2%), other complications in 36 (1.8%), and mortality of 0.6%. Successful stone(s) removal was obtained in 2,028 cases (94.9%). On multivariate analysis, mortality was associated with age &#x3e;60 years (1 vs. 0.2%), cholangitis (4.3 vs. 0.3%), and EST-related complications (5.8 vs. 0.2%). Complications were associated with unsuccessful stone removal (13.4 vs. 7.5%) and difficult cannulation (13.9 vs. 5.4%). An unsuccessful EST was independently related to difficult cannulation (86.2 vs. 98.7%), precutting (79.4 vs. 96.4%), and complications (86.5 vs. 95.6%). <b><i>Conclusions:</i></b> Risk factors for complications after EST for stones are delayed bile duct cannulation and failed stone retrieval. Mortality is higher in older patients, those who presented with an EST-related complication, or those who presented initially with cholangitis. Difficult cannulation, EST-related complications, and precutting were associated with an unsuccessful procedure. In this series, outpatient EST with attempted stone retrieval was found to be as safe as performing the procedure in hospitalized patients.

scholarly journals Cholecystectomy outcomes after endoscopic sphincterotomy in patients with choledocholithiasis: A meta-analysis

2020 ◽  
Author(s):  
Jie Xu ◽  
Chuang Yang
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Recurrent Pancreatitis ◽  
Significant Difference ◽  
Risk Patients ◽  
Gallbladder In Situ

Abstract Background Endoscopic sphincterotomy is the standard treatment for common bile duct stones.There is different evidence considering complications specifically biliary pancreatitis and cholangitis with the use of cholecystectomy after endoscopic sphincterotomy.The purpose of this article is to compare the positive cholecystectomy after endoscopic treatment of common bile duct stones, whether the incidence of recurrent pancreatitis cholangitis is reduced, especially in high-risk patients. Methods We searched Pubmed(1990-2019)、Embase(1990-2019)和 Cochrane(1990-2019)database for trials comparing the 2 strategies for gallstones after ES.A related article on the removal of gallbladder after endoscopic sphincterotomy was collected,followed by analysis of each group using RevMan. Results We have adopted a total of 8 studies, including 7 randomized controlled trials and 1 retrospective study. A total of 12718 patients were included in the study, 4922 in the early cholecystectomy group, and 7795 in the gallbladder in situ group.During the follow-up period, 41 patients had pancreatitis after endoscopic sphincterotomy in the cholecystectomy group, and 177 patients in the wait-and-see group. The incidence of pancreatitis in the gallbladder in situ group was significantly reduced(RR 0.38, 95%CI 0.27 to 0.53, P < 0.00001,I 2 =0%).The incidence of cholangitis and jaundice in the removal of the gallbladder group was also less than that in the preserved gallbladder group(RR 0.31, 95%CI 0.26 to 0.38, P < 0.00001,I 2 =0%).There was no significant difference in mortality between the two groups(RR 0.73, 95%CI 0.52 to 1.02, P =0.07,I 2 =14%).There is a significant difference in cholecystitis or biliary colic(RR 0.25, 95% CI 0.21 to 0.29, P < 0.00001,I 2 =28%). Conclusions Early endoscopic cholecystectomy after removal of common bile duct stones can effectively reduce biliary complications such as recurrent pancreatitis, cholangitis and cholecystitis. This is still true for high-risk patients, and has no significant effect on the mortality of patients. After ES,laparoscopic cholecystectomy should be recommended.

scholarly journals Clinical Statistical Analysis with Comparison between Pelvic and Non-pelvic Chondrosarcoma

2021 ◽  
Vol 36 (3) ◽  
pp. e271-e271
Author(s):  
Sayed Abdulla Jami1, ◽  
Shi Jiandang ◽  
Brotendu Shekhar Roy ◽  
Zhanwen Zhou ◽  
Liu Chang Hao
Keyword(s):  
Prognostic Factors ◽  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Survival Rates ◽  
Significant Difference ◽  
Grade Ii ◽  
The Difference ◽  
Early Local Recurrence ◽  
Male To Female

Objectives: Chondrosarcomas are rare tumors with a variable biological characteristic. Their treatment clinically and surgically is controversial. Analysis of the clinical statistics and prognostic factors of pelvic chondrosarcoma provides a reference for clinical diagnosis and treatment. Methods: A total of 73 cases of chondrosarcoma were collected, including 24 pelvic samples, from 2008 to 2017 from the hospital database and divided into two groups: pelvic chondrosarcoma and non-pelvic chondrosarcoma. The clinical characteristics and prognostic factors of pelvic chondrosarcoma were analyzed using different statistical methods. Results: Among the 24 pelvic chondrosarcoma patients, the ratio of male to female was 1.4:1, and the median age was 43.5 years. According to the classification proposed by Enneking, there were five grade I, 14 grade II, and five grade III. Histological grading of chondrosarcoma was grade I in one case, II in 15 cases, and III in eight cases. The histological type was 17 conventional, three dedifferentiated, two secondary, one myxoid, and one mesenchymal. The overall survival rates for 24 cases at three, five, and 10 years were 82.2±8.1%, 77.3±8.9%, and 52.4±12.1%, respectively. The local recurrence rate of pelvic chondrosarcoma after surgical resection (83.3%) was significantly higher than that of other sites (34.7%), and the difference was statistically significant (p < 0.001). The final proportion of amputation rate (50.0%) was also higher than other parts (20.4%), with a statistically significant difference (p =0.010). The total survival of the two groups was not significantly different (p =0.216). Conclusions: Chondrosarcoma of bone generally has an excellent prognosis when optimally diagnosed and treated by an experienced team of specialists. Pelvic chondrosarcoma has a higher local recurrence rate than the other sites and tends to result in amputation. Early local recurrence after surgery indicates a poor prognosis.

scholarly journals Clinical efficacy, timing, and outcomes of ERCP for management of bile duct leaks: a nationwide cohort study

2021 ◽  
Vol 09 (02) ◽  
pp. E247-E252
Author(s):  
Aakash Desai ◽  
Patrick Twohig ◽  
Sophie Trujillo ◽  
Shaman Dalal ◽  
Gursimran S. Kochhar ◽  
...  
Keyword(s):  
Bile Duct ◽  
Combination Therapy ◽  
The United States ◽  
Biliary Stent ◽  
Duodenal Perforation ◽  
Effective Management ◽  
Clinical Database ◽  
Endoscopic Retrograde ◽  
Significant Difference ◽  
Ascending Cholangitis

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) can safely and effectively manage postsurgical or traumatic bile duct leaks (BDLs). Standardized guidelines are lacking regarding effective management of BDLs. Our aim was to evaluate the efficacy, clinical outcomes, and complications of different ERCP techniques and intervention timing using a nationwide database. Patients and methods We performed a retrospective analysis of the IBM Explorys database (1999–2019), a pooled, national, de-identified clinical database of over 64 million unique patients across the United States. ERCP timing after BDL was classified as emergent (< 1 day), urgent (1–3 days) or expectant (> 3 days). ERCP technique was classified into sphincterotomy, stent or combination therapy. ERCP complications were defined as pancreatitis, duodenal perforation, duodenal hemorrhage, and ascending cholangitis within 7 days of the procedure. Results Expectant ERCP had a decreased risk of adverse events (AEs) compared to emergent and urgent ERCP (P = 0.004). Rehospitalization rates also were lower in expectant ERCP (P < 0.001). Patients with COPD were more likely to have an AE if the ERCP was performed emergently compared to expectantly (P = 0.002). Combination therapy had a lower rate of ERCP failure compared to placement of a biliary stent (P = 0.02). There was no statistically significant difference in rates of ERCP failure between biliary stent and sphincterotomy (P = 0.06) or sphincterotomy and combination therapy (P = 0.74). Conclusion Our study suggests that ERCP does not need to be performed emergently or urgently for management of BDLs. Combination therapy is superior to stenting but not sphincterotomy; however, future prospective studies are needed to validate these findings.

scholarly journals Is Cholecystectomy a cause of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography?

2021 ◽  
Vol 84 (4) ◽  
Author(s):  
R.E. Cankurtaran ◽  
R Atalay ◽  
Y.H. Polat ◽  
F Kivrakoglu ◽  
M Tahtacı ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Common Bile Duct Stones ◽  
Study Patient ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Significant Difference ◽  
Difficult Biliary Cannulation

Background and study aim: In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of naive papillae is defined as difficult in the presence of more than 5 papilla contacts, more than 5min cannulation time or more than one unintended pancreatic duct cannulation or opacification. It is not known whether cholecystectomy is a cause of difficult biliary cannulation. This study aimed to investigate whether cholecystectomy (CCY) is a cause of difficult biliary cannulation in patients who have undergone Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis. Patients and methods: Adult patients with naive papillae and those who underwent ERCP for common bile duct stones and/or sludge were included in this retrospective study. Patient demographics, clinical presentation (acute cholangitis, biliary pancreatitis or biliary colic), periprocedural data including laboratory and radiological findings and ERCP results were compared between no-CCY and post-CCY groups. Results: 438 patients were included in the present study and 347 of these patients were in the no-CCY group and 91 patients were in post-CCY group. A statistically significant difference was found in the number of patients with difficult cannulation in the post-CCY group (n=30, 33.0%) patients compared to the no- CCY group (n=67, 19.3%) (p=0.011). According the multivariate analyses results, presence of history of cholecystectomy was found an independent risk factor of difficult cannulation (Odds ratio: 2.014; 95 % Cl 1.205-3.366; p=0.008). Conclusions: The results showed that biliary cannulation was significantly more difficult in patients with cholecystectomy who underwent ERCP for common bile duct stones.

scholarly journals Clinical Characteristics of Paediatric Pancreatitis Caused by Pancreaticobiliary Malformation: A Single-Centre Retrospective Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Jing Guo ◽  
Qian-ru Jia ◽  
Mei Sun
Keyword(s):  
Recurrence Rate ◽  
Age Of Onset ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Abdominal Ultrasound ◽  
Endoscopic Retrograde ◽  
Number Of Patients ◽  
Initial Onset ◽  
Clinical Profiles ◽  
The Difference ◽  
Enhanced Computed Tomography

Background/Aims: To investigate the clinical profiles of children with pancreatitis caused by pancreaticobiliary malformation.Methods: We retrospectively analysed the clinical data of children diagnosed with pancreatitis at our institute from June 2017 to January 2021.Results: A total of 195 patients and 169 control subjects were included in this study. Twenty-six (13.3%) patients had pancreaticobiliary malformation-related pancreatitis. The average age of onset in the pancreaticobiliary malformation pancreatitis (PMP) group was lower than that in the non-PMP group, and the difference was statistically significant. The number of patients in the PMP group that had jaundice was significantly higher than that of the non-PMP group (P &lt; 0.05). Logistic regression analysis showed that total bilirubin (TB) and γ-glutamyltransferase (GGT) (odds ratio = 1.096, P &lt; 0.01) were independent predictors of pancreaticobiliary malformation-related pancreatitis in children. The positive detection rate of pancreaticobiliary malformation was 68% for abdominal ultrasound, 38.4% for abdominal enhanced computed tomography, and 91.3% for magnetic resonance cholangiopancreatography (MRCP). The recurrence rate (34.6%) in the PMP group was higher than that in the non-PMP group (15.4%, P &lt; 0.05); surgical therapy had the lowest recurrence rate. Age at initial onset of pancreatitis was younger and the period to recurrence was shorter in the PMP group than in the non-PMP group (P &lt; 0.05).Conclusion: Pancreaticobiliary malformation is one of the major causes of paediatric pancreatitis. Elevated TB and GGT in patients with pancreatitis may be suggestive for underlying pancreaticobiliary malformation not solely to pancreatitis. MRCP should be used when pancreatitis due to pancreaticobiliary malformation is suspected. Surgery or endoscopic retrograde cholangiopancreatography-guided intervention may be helpful but further study is needed.

scholarly journals Cholecystectomy outcomes after endoscopic sphincterotomy in patients with choledocholithiasis: A meta-analysis

2020 ◽  
Author(s):  
Jie Xu ◽  
Chuang Yang
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Recurrent Pancreatitis ◽  
Significant Difference ◽  
Risk Patients ◽  
Gallbladder In Situ

Abstract Background Endoscopic sphincterotomy is the standard treatment for common bile duct stones.There is different evidence considering complications specifically biliary pancreatitis and cholangitis with the use of cholecystectomy after endoscopic sphincterotomy.The purpose of this article is to compare the positive cholecystectomy after endoscopic treatment of common bile duct stones, whether the incidence of recurrent pancreatitis cholangitis is reduced, especially in high-risk patients. Methods We searched Pubmed(1990-2019)、Embase(1990-2019)和 Cochrane(1990-2019)database for trials comparing the 2 strategies for gallstones after ES.A related article on the removal of gallbladder after endoscopic sphincterotomy was collected,followed by analysis of each group using RevMan. Results We have adopted a total of 8 studies, including 7 randomized controlled trials and 1 retrospective study. A total of 12718 patients were included in the study, 4922 in the early cholecystectomy group, and 7795 in the gallbladder in situ group.During the follow-up period, 41 patients had pancreatitis after endoscopic sphincterotomy in the cholecystectomy group, and 177 patients in the wait-and-see group. The incidence of pancreatitis in the gallbladder in situ group was significantly reduced(RR 0.38, 95%CI 0.27 to 0.53, P < 0.00001,I 2 =0%).The incidence of cholangitis and jaundice in the removal of the gallbladder group was also less than that in the preserved gallbladder group(RR 0.31, 95%CI 0.26 to 0.38, P < 0.00001,I 2 =0%).There was no significant difference in mortality between the two groups(RR 0.73, 95%CI 0.52 to 1.02, P =0.07,I 2 =14%).There is a significant difference in cholecystitis or biliary colic(RR 0.25, 95% CI 0.21 to 0.29, P < 0.00001,I 2 =28%). Conclusions Early endoscopic cholecystectomy after removal of common bile duct stones can effectively reduce biliary complications such as recurrent pancreatitis, cholangitis and cholecystitis. This is still true for high-risk patients, and has no significant effect on the mortality of patients. After ES,laparoscopic cholecystectomy should be recommended.

scholarly journals Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis

2021 ◽  
pp. 53-61
Author(s):  
Taro Fukui ◽  
Takeshi Chochi ◽  
Toru Maeda ◽  
Chunyong Lee ◽  
Yohnosuke Wada ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Sphincterotomy ◽  
Fluid Collection ◽  
Rare Condition ◽  
Common Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Bile Duct Wall ◽  
Biliary Peritonitis

Spontaneous bile duct rupture is a rare condition in adults, with only 70 cases reported. Increased bile duct wall pressure may lead to rupture and biliary peritonitis. In this patient, the bile duct ruptured in the hepatic left triangular ligament. A 91-year-old man underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and endoscopic retrograde biliary drainage (ERBD) placement. One week later, removal of the ERBD and common bile duct stones and an endoscopic sphincterotomy (EST) were performed. Four days later, the patient had abdominal pain, increased inflammatory reaction, and jaundice. Abdominal computed tomography showed ascites, bile duct dilatation and fluid collection under the liver (10 cm in diameter). Emergency surgery was performed to drain the fluid. On laparotomy, encapsulated biliary ascites was seen. To search for the site of the leak, after cholecystectomy, a tube (C-tube) was inserted into the common bile duct via cystic duct stump. Because of uncontrollable bleeding, after packing with surgical gauze, the operation was temporarily stopped. The next day, reoperation was performed. Intraoperative cholangiography with contrast dye revealed the perforation site in the left triangular ligament and a partial resection was performed. Bile excretion from the C-tube was subsequently observed, but the patient’s jaundice did not improve. Although endoscopic retrograde cholangiopancreatography revealed that the EST site was normal, ERBD was placed again, and the jaundice gradually improved. Although EST was performed in this case, biliary peritonitis resulting from spontaneous bile duct rupture occurred. This case was very informative because biliary perforation may occur even after EST.

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