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中华消化外科杂志 2024年第7期23卷 989-1000页

作者：赵进玉林延延岳平姚佳米宁宁李麻图付文康高龙 azumi suzuki Peng F Wong Kiyohito Tanaka Rungsun Rerknimitr Henrik H Junger Tan T Cheung Emmanuel Melloul Nicolas Demartines Joseph W Leung 袁金秋 Hans J Schlitt 孟文勃兰州大学第一临床医学院兰州730030 兰州大学第一医院普通外科兰州730030 浜松医学中心消化科日本浜松432-8002 詹姆斯库克大学医院血管外科英国米德尔斯堡TS43BW 京都第二红十字医院消化科日本京都602-8031 朱拉隆功国王纪念医院胃肠内镜卓越中心泰国曼谷10330 雷根斯堡大学医学中心外科德国雷根斯堡93053 香港大学外科学系中国香港999077 洛桑大学医院内脏外科瑞士洛桑CH-1015 加州大学戴维斯分校医学中心和萨克拉门托退伍军人医学中心胃肠肝病科美国萨克拉门托95817 中山大学附属第七医院临床研究中心深圳518107

胆道纤维化(BF)是病理性胆道损伤修复的结果,主要表现为胆管壁的增厚硬化和管腔的进行性狭窄,最终可能导致胆道梗阻、胆汁性肝硬化、肝衰竭、肝胆恶性肿瘤等严重不良结局。目前的研究将BF描述为某些胆管病的病理特征,对其病因、病理生... 详细信息

胆道纤维化(BF)是病理性胆道损伤修复的结果,主要表现为胆管壁的增厚硬化和管腔的进行性狭窄,最终可能导致胆道梗阻、胆汁性肝硬化、肝衰竭、肝胆恶性肿瘤等严重不良结局。目前的研究将BF描述为某些胆管病的病理特征,对其病因、病理生理、分子机制和治疗缺乏系统总结。BF是胆道系统普遍存在但容易被忽略的疾病状态,可能通过病理性胆道损伤后的异常修复机制促进肝胆疾病的发生和进展,笔者结合国内外最新研究进展,综述BF的概念、临床表现、病因、发病机制和治疗策略,为临床医师提供参考。

关键词：胆道疾病纤维化胆管反应病因信号通路治疗

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Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography:A single-blind,multicenter,randomized controlled trial

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Chinese Medical Journal 2024年第12期137卷 1437-1446页

作者： Wenbo Meng Joseph W.Leung Zhenyu Wang Qiyong Li Leida Zhang Kai Zhang Xuefeng Wang Meng Wang Qi Wang Yingmei Shao Jijun Zhang Ping Yue Lei Zhang Kexiang Zhu Xiaoliang Zhu Hui Zhang Senlin Hou Kailin Cai Hao Sun Ping Xue Wei Liu Haiping Wang Li Zhang Songming Ding Zhiqing Yang Ming Zhang Hao Weng QingyuanWu Bendong Chen Tiemin Jiang Yingkai Wang Lichao Zhang Ke Wu Xue Yang Zilong Wen Chun Liu LongMiao Zhengfeng Wang Jiajia Li Xiaowen Yan Fangzhao Wang Lingen Zhang Mingzhen Bai Ningning Mi XianzhuoZhang Wence Zhou Jinqiu Yuan azumi suzuki Kiyohito Tanaka Jiankang Liu Ula Nur Elisabete Weiderpass Xun Li Department of General Surgery The First Hospital of Lanzhou UniversityLanzhouGansu 730000China Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province LanzhouGansu 730000China Division of Gastroenterology and Hepatology UC Davis Medical CenterSacramentoCA 95816USA Department of Minimally Invasive Surgery Tianjin Nankai HospitalTianjin 300100China Division of Hepatobiliary and Pancreatic Surgery Department of SurgeryShulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren UniversityHangzhouZhejiang 310000China Department of Hepatobiliary Surgery Southwest HospitalArmy Medical UniversityChongqing 400000China Hepatobiliary Surgery Department Shandong Provincial Third HospitalJinanShandong 250000China Department of General Surgery Xinhua HospitalAffiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Laboratory of Biliary Tract Disease ResearchShanghai 200000China Department of Hepatobiliary and Pancreatic Surgery The First Hospital of Jilin UniversityChangchunJilin 130000China Department of Hepatobiliary Surgery The General Hospital of Ningxia Medical UniversityYinchuanNingxia 750000China Department of Hepatobiliary&Hydatid Digestive and Vascular Surgery CenterXinjiang Key Laboratory of Echinococcosis and Liver Surgery ResearchThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiang 830000China Department of Hepatobiliary and Pancreatic Surgery The First Hospital of Shanxi Medical UniversityTaiyuanShanxi 030000China Department of General Surgery The Second Hospital of Lanzhou UniversityLanzhouGansu 730000China Department of Biliopancreatic Endoscopic Surgery The Second Hospital of Hebei Medical UniversityShijiazhuangHebei 050000China Gastrointestinal Surgery Department Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430000China Department of Hepatobiliary Surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710000China Depart

Background:Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography(ERCP),the benefits and safety of high-carbohydrate fluid diet(CFD)intake 2 h before ERCP remain *** study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’***:This prospective,multicenter,randomized controlled trial involved 15 tertiary ERCP centers.A total of 1330 patients were randomized into CFD group(n=665)and fasting group(n=665).The CFD group received 400 mL of maltodextrin orally 2 h before ERCP,while the control group abstained from food/water overnight(>6 h)before *** ERCP procedures were performed using deep sedation with intravenous *** investigators were blinded but not the *** primary outcomes included postoperative fatigue and abdominal pain score,and the secondary outcomes included complications and changes in metabolic *** outcomes were analyzed according to a modified intention-to-treat ***:The post-ERCP fatigue scores were significantly lower at 4 h(4.1±2.6 vs.4.8±2.8,t=4.23,P<0.001)and 20 h(2.4±2.1 vs.3.4±2.4,t=7.94,P<0.001)in the CFD group,with least-squares mean differences of 0.48(95%confidence interval[CI]:0.26-0.71,P<0.001)and 0.76(95%CI:0.57-0.95,P<0.001),*** 4-h pain scores(2.1±1.7 vs.2.2±1.7,t=2.60,P=0.009,with a least-squares mean difference of 0.21[95%CI:0.05-0.37])and positive urine ketone levels(7.7%[39/509]vs.15.4%[82/533],χ^(2)=15.13,P<0.001)were lower in the CFD *** CFD group had significantly less cholangitis(2.1%[13/634]vs.4.0%[26/658],χ^(2)=3.99,P=0.046)but not pancreatitis(5.5%[35/634]vs.6.5%[43/658],χ^(2)=0.59,P=0.444).Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla(odds ratio[OR]:0.61,95%CI:0.39-0.95,P=0.028)in the multivariable ***:Ingesting 400 mL of CFD 2 h before ERCP is safe,with a reduction in post-ERCP fatigue,

关键词： Endoscopic retrograde cholangiopancreatography ERCP Carbohydrate Fasting Safety Complications Enhanced recovery after surgery Randomized controlled trial

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Choledocholithiasis characteristics with periampullary diverticulum and endoscopic retrograde cholangiopancreatography procedures:Comparison between two centers from Lanzhou and Kyoto

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World Journal of Gastrointestinal Surgery 2022年第2期14卷 132-142页

作者： Ke-Xiang Zhu Ping Yue Hai-Ping Wang Wen-Bo Meng Jian-Kang Liu Lei Zhang Xiao-Liang Zhu Hui Zhang Long Miao Zheng-Feng Wang Wen-Ce Zhou azumi suzuki Kiyohito Tanaka Xun Li Department of General Surgery The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina Cardiovascular Division Brigham and Women’s HospitalHarvard Medical SchoolBostonMA 02451United States Department of Gastroenterology Kyoto Second Red Cross HospitalKyoto 602-8026Japan

BACKGROUND Most of study regarding periampullary diverticulum(PAD)impact on endoscopic retrograde cholangiopancreatography(ERCP)therapy for choledocholithiasis based on data from one endoscopy center and lacked to compare the clinical characteristic of choledocholithiasis with PAD from different geographical *** To compare the choledocholithiasis clinical characteristics between two regional endoscopy centers and analyze impacts of clinical characteristics on ERCP methods for choledocholithiasis patients with *** Patients seen in two endoscopy centers(The First Hospital of Lanzhou University,Lanzhou,Gansu Province,China,and Kyoto Second Red Cross Hospital,Kyoto,Japan)underwent ERCP treatment for the first time between January 2012 and December *** characteristics of choledocholithiasis with PAD were compared between the two centers,and their ERCP procedures and therapeutic outcomes were *** A total of 829 out of 3608 patients in the Lanzhou center and 241 out of 1198 in the Kyoto center had choledocholithiasis with *** of clinical characteristics were significantly different between the two *** common bile duct(CBD)diameter was wider,choledocholithiasis size was lager and multiple CBD stones were more in the Lanzhou center patients than those in the Kyoto center patients(14.8±5.2 mm vs 11.6±4.2 mm,12.2±6.5 mm vs 8.2±5.3 mm,45.3%vs 20.3%,P<0.001 for all).In addition,concomitant diseases,such as acute cholangitis,gallbladder stones,obstructive jaundice,cholecystectomy,and acute pancreatitis,were significantly different between the two centers(P=0.03 to<0.001).In the Lanzhou center,CBD diameter and choledocholithiasis size were lower,and multiple CBD stones and acute cholangitis were less in non-PAD patients than those in PAD patients(13.4±5.1 mm vs 14.8±5.2 mm,10.3±5.4 mm vs 12.2±6.5,39%vs 45.3%,13.9%vs 18.5%,P=0.002 to<0.001).But all these characteristics were not significantly different in the Kyoto *** proporti

关键词： Clinical characteristics Periampullary diverticulum Endoscopic retrograde cholangiopancreatography Choledocholithisasis

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Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation

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World Journal of Gastroenterology 2020年第19期26卷 2403-2415页

作者： Ping Yue Ke-Xiang Zhu Hai-Ping Wang Wen-Bo Meng Jian-Kang Liu Lei Zhang Xiao-Liang Zhu Hui Zhang Long Miao Zheng-Feng Wang Wen-Ce Zhou azumi suzuki Kiyohito Tanaka Xun Li Department of Special Minimally Invasive Surgery The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina Key Laboratory of Biological Therapy and Regenerative Medicine Transformation of Gansu Province The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina Hepatopancreatobiliary Surgery Institute of Gansu Province Lanzhou 730000Gansu ProvinceChina The First Clinical Medical School of Lanzhou University Lanzhou 730000Gansu ProvinceChina The Second Department of General Surgery The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina Cardiovascular Division Brigham and Women's HospitalHarvard Medical SchoolBostonMA 02451United States The Fifth Department of General Surgery The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina Department of Gastroenterology Kyoto Second Red Cross HospitalKyoto 602-8026Japan

BACKGROUND Different types of periampullary diverticulum(PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography(ERCP) cannulation,but the clinical significance of the two current PAD classifications for cannulation is *** To verify the clinical value of our newly proposed PAD *** A new PAD classification(Li-Tanaka classification) was proposed at our *** PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were *** A total of 3564 patients with native papillae were enrolled, including 967(27.13%)PAD patients and 2597(72.87%) non-PAD patients. In the Li-Tanaka classification, type Ⅰ PAD patients exhibited the highest difficult cannulation rate(23.1%, P = 0.01), and type Ⅱ and Ⅳ patients had the highest cannulation success rates(99.4% in type Ⅱ and 99.3% in type Ⅳ, P < 0.001). In a multivariableadjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio(OR) = 1.87, 95% confidence interval(CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group,the difficulty of cannulation in the type Ⅰ PAD group according to the Li-Tanaka classification was greater(OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower(OR = 0.27, 95%CI: 0.11-0.66, P < 0.001),while it was higher in the type Ⅱ PAD group(OR = 4.44, 95%CI: 1.61-12.29, P <0.01).CONCLUSION Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.

关键词： Endoscopic retrograde cholangiopancreatography Periampullary diverticulum Classification Difficult cannulation Successful cannulation

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