目的 观察内镜治疗急性胆源性胰腺炎（ABP）的疗效及其并发症。方法 30例ABP患者在抗炎、抑酶等综合治疗基础上，经内镜（1～3 d 内）逆行胰胆管造影（ERCP）及经内镜十二指肠乳头括约肌切开（EST）或鼻胆管引流（ENBD）等治疗。结果 内镜治疗后22 例（73.3%）轻症急性胆源性胰腺炎（MABP）患者3～5 d 体温恢复正常； 8例（26.7%） 重症急性胆源性胰腺炎（SABP）患者3～8 d 腹部体征好转，血常规、淀粉酶及血生化1~2周内基本恢复，平均住院18.7 d，3例死亡（10.0%）。内镜治疗过程中5例出现十二指肠乳头括约肌切口少量出血，经简单治疗止血，未再出现其他并发症。与同期开腹手术治疗相比较，症状体征缓解、血常规、淀粉酶、血生化恢复正常及住院的时间更短，死亡率无明显差异。结论 ABP早期ERCP 及内镜治疗安全有效。
Endoscopic retrograde cholangiopancreatography is one of the main methods for the diagnosis and treatment of biliary tract and pancreatic diseases. Compared with other digestive endoscopes, duodenoscopy has a special structure. Since the outbreaks of nosocomial infections caused by the transmission of multidrug-resistant organism through duodenoscopy in 2010, the reprocessing and design of digestive endoscopes represented by duodenoscopy have faced new challenges. This article reviews the international advances in duodenoscopy reprocessing in the past 10 years including the structural characteristics of duodenoscope, related infection outbreak cases, outbreak control measures, and the use of disposable duodenoscopy, so as to provide guidance and reference for the duodenoscopy reprocessing and related nosocomial infections prevention and control work in China.
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 discuss the value of biliary stent in treatment of malignant biliary obstruction with different pathways of bile duct stent insertion. Methods Fourty-two cases of malignant biliary obstruction whose biliary stent insertions were through operation (n=18), PTCD (n=17) and ERCP (n=7) respectively were reviewed retrospectively. Results The bile duct stents were successfully inserted in all patients through the malignant obstruction and achieved internal biliary drainage. Compared with the level of the bilirubin before operation, it decreased about 100 μmol/L one week after the stent insertion in all patients. Compared with the levels of glutamic oxalacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and glutamyltranspeptidase before operation, they decreased 1 week after the stent insertion （Plt;0.05). The median survival time was 22 weeks. The average survival time was (32.89±33.87) weeks. Two patients died in hospital after PTCD, and the mortality was 4.76%. Complications included 8 cases of cholangitis, 3 cases of bile duct hemorrhage and 2 cases of hepatic failure. Conclusion The bile duct stent insertions through operation, PTCD and ERCP are all effective in relieving the bile duct construction with malignant biliary obstruction. Each method should be chosed according to the systemic and local condition for every patient so as to improve the safety and efficiency, and to decrease the occurrence of complications.
Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.
ObjectiveTo investigate the etiology of pediatric pancreatitis and the effect of endoscopic retrograde cholangiopancreatography (ERCP) in it. MethodsPatients hospitalized for pancreatitis in West China Hospital of Sichuan University from Jan. 2008 to Jun. 2023 were included according to the inclusion and exclusion criteria. Totally, 241 cases (207 cases with acute pancreatitis and 34 with chronic pancreatitis) were included. Patients were divided into primary group (n=168) and recurrent group (n=73) according to their previous medical history. ResultsThe duration of hospitalization in the primary group was longer than that in the recurrent group [10.0 (7.0, 16.0) d vs. 7.5 (6.0, 11.8) d, P=0.012]. The proportion of acute pancreatitis in primary group (163/168, 97.0%) was higher than that in the recurrent group (44/73, 60.3%), P<0.001. There was no significant difference in the etiological component ratio between the primary and recurrent groups (χ2=7.504, P=0.347). However, in the primary group, the first etiology was biliary factors (38/163, 23.3%), and the second was biliary pancreatic anatomic abnormality (22/163, 13.5%). In the recurrence group, biliary pancreatic anatomic abnormality (13/44, 29.5%) was the first cause, and biliary factor (7/44, 15.9%) was the second cause. Among 207 cases with acute pancreatitis, there were 114 cases (55.1%) with clear etiology, including 45 cases (21.7%) of biliary factors, 35 cases (16.9%) of abnormal biliary pancreatic structure, 12 cases (5.8%) of traumatic factors, and 10 cases (4.8%) of drug-induced factors. In this study, 66 cases were treated with ERCP for pancreatitis, and a total of 103 ERCP operations were performed with cannulation success rate of 100%. Twenty-three cases (23/37, 62.2%) of acute pancreatitis resulted from biliary and biliary pancreatic structure abnormalities received ERCP. In biliary acute pancreatitis, the removal rate of choledocholithiasis in single ERCP operation was 80.0% (8/10). The clinical symptoms (abdominal pain, jaundice, and fever) of all cases were significantly improved after surgery, and no complications such as cholangitis, bleeding and perforation occurred. ConclusionsBiliary, congenital pancreatic anatomical abnormalities, drugs and trauma are the common causes of acute pancreatitis in children. ERCP is a safe and effective treatment for children with biliary pancreatitis, pancreatic anatomical abnormalities, and chronic pancreatitis.
Objective To study the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) and early endoscopic management for acute biliary pancreatitis. Methods Ninety-one patients with acute biliary pancreatitis were divided into ERCP group (46 cases) and control group (45 cases) according to the therapy methods. All patients were given positive conventional treatment, the patients of the ERCP group accepted endoscopic therapy within 48 h after hospitalization. The curative effects of two groups were observed, and the related indexes, such as time of abdominal pain relief, temperature to normal, leukocytes to normal, liver function to normal, average time in hospital, and mortality were compared between two groups. Results Among 46 patients by ERCP diagnosis, there were 27 cases of common duct stone (CDS), 6 cases of cholecystolithiasis, 3 cases of great diverticulum at duodenal papilla side, 4 cases of suppurative cholangitis, 3 cases of stenosis in bile common duct inferior segment and 3 cases of no abnormality. Among 27 cases of CDS, 20 patients had endoscopic sphincterotomy (EST), 4 had duodenal papilla artifistulation, 20 had calculus removed by once basket and aerocyst, and 7 patients with suppurative cholangitis and great stone saccepted EST or macadam after stabilization. The cases of great diverticulum at duodenal papilla side and cases of stenosis in bile common duct inferior segment accepted EST, the cases of suppurative cholangitis accepted endoscopic nasobiliary drainage (ENBD), and all accepted ENBD. The time of abdominal pain relief, temperature to normal, leukocytes to normal, liver function to normal, and the average time in hospital in the ERCP group were significantly shorter than those in the control group (Plt;0.05). The blood amylase to normal time and mortality had no significant differences between two groups (Pgt;0.05). Conclusion The early endoscopic management for patients with acute biliary pancreatitis can clear etiology, reduce the time in hospital and be minimally invasive, safe, and effective.
Objective To explore the value of endoscopic retrograde cholangiopancreatograph (ERCP) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of pancreatic duct stones. Methods A retrospective collection of 28 patients with chronic pancreatitis and pancreatic duct stones admitted to the Department of Gastroenterology from January 2010 to August 2021 was performed. According to the treatment of patients, they were divided into ERCP direct stone extraction group and ESWL combined ERCP stone extraction group. We compared the treatment effects of the two groups of patients, including the success rate of stone extraction, postoperative complications of ERCP, postoperative symptom improvement, and so on. Results Among the 28 patients, 19 cases underwent ERCP direct stone extraction, and 9 cases underwent ESWL combined with ERCP stone extraction. In the ERCP direct stone extraction group, 7 cases (36.84%) were completely extracted, 1 case was partially extracted (5.26%), and 11 cases (57.89%) failed to extract and only placed stents and drained; 5 cases (26.32%) had elevated white blood cells at 6 hours postoperatively, C-reactive protein increased in 4 cases (21.05%), 3 cases (15.79%) were diagnosed as ERCP-related pancreatitis, and 2 cases (10.53%) were diagnosed as hyperamylaseemia. The abdominal pain symptoms were completely relieved in 14 cases (73.68%) during a follow-up period of 3 to 6 months. The body mass of 17 cases (89.47%) increased in the 6 months after stone extraction. ESWL combined with ERCP had complete stone extraction in 5 cases (55.56%), partial stone extraction in 3 cases (33.33%), and failure in stone extraction and only stent drainage in 1 case (11.11%). One case (11.11%) had elevated white blood cells at 6 hours postoperatively, and 1 case (11.11%) had elevated C-reactive protein . One case (11.11%) was diagnosed with ERCP-related pancreatitis. One case (11.11%) got abdominal pain and transient hematuria during ESWL, which resolved spontaneously 3 days later. After 3 to 6 months of follow-up, 9 patients (100%) had complete relief of abdominal pain symptoms, and the body mass of 9 patients (100%) increased in the 6 months after stone extraction. The stone clearance rate of the ESWL combined with ERCP stone extraction group was higher than that of the ERCP direct stone extraction group (P=0.033), but there was no statistically significant difference between the two groups in terms of ERCP-related complications, relief of abdominal pain, and weight gain (P>0.05). Conclusion ESWL combined with ERCP in the treatment of chronic pancreatitis complicated with pancreatic duct stone extraction is more effective than ERCP direct stone extraction.