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Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?

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World Journal of Clinical Cases 2023年第29期11卷 6984-6994页

作者： Yung-Kuan Tsou Yi-Tse Su Cheng-Hui Lin nai-jen liu Department of Gastroenterology and Hepatology Chang Gung Memorial HospitalTaoyuan 333TaiwanChina

BACKGROUND Whether clinical outcomes of acute cholangitis(AC)vary by etiology is *** To compare outcomes in AC caused by malignant biliary obstruction(MBO)and common bile duct stones(CBDS).METHODS This retrospective study included 516 patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)due to AC caused by MBO(MBO group,n=56)and CBDS(CBDS group,n=460).Clinical and laboratory parameters were compared between the *** score matching(PSM)created 55 matched *** used in the PSM analysis were age,sex,time to ERCP,and technical success of *** primary outcome comparison was 30-d *** secondary outcome comparisons were intensive care unit(ICU)admission rate,length of hospital stay(LOHS),and 30-d readmission *** Compared with the CBDS group,the MBO group had significantly lower body temperature,percentage of abnormal white blood cell counts,and serum levels of aspartate aminotransferase,alanine aminotransferase,and *** temperature,percent abnormal white blood cell count,and serum aspartate aminotransferase levels remained significantly lower in the MBO group in the PSM *** count,prothrombin time/international normalized ratio,and serum levels of alkaline phosphatase and total bilirubin were significantly higher in the MBO *** MBO group had a significantly higher percentage of severe AC(33.9%vs 22.0%,P=0.045)and received ERCP later(median,92.5 h vs 47.4 h,P<0.001).However,the two differences were not found in the PSM *** 30-d mortality(5.4%vs 0.7%,P=0.019),ICU admission rates(12.5%vs 4.8%,P=0.028),30-d readmission rates(23.2%vs 8.0%,P<0.001),and LOHS(median,16.5 d vs 7.0 d,P<0.001)were significantly higher or longer in the MBO ***,only LOHS remained significant in the PSM *** analysis revealed that time to ERCP and multiple organ dysfunction were independent factors associated with 30-d *** MBO patients underwent ERC

关键词： Malignant biliary obstruction Common bile duct stones Endoscopic retrograde cholangiopancreatography Acute cholangitis Mortality Etiology

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Pancreatic stent improves the success rate of needle-knife papillotomy in patients with difficult biliary cannulation

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World Journal of Gastroenterology 2025年第1期31卷 58-67页

作者： Mu-Hsien Lee Cheng-Hui Lin Chi-Huan Wu Yung-Kuan Tsou Kai-Feng Sung Sheng-Fu Wang nai-jen liu Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuan 33305Taiwan School of Medicine Chang Gung UniversityTaoyuan 33305Taiwan

BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed ***,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of *** To explore whether PS placement improves the success rate of NKP in patients with difficult biliary *** This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary *** cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's *** primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event *** Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP *** the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.

关键词： Difficult biliary cannulation Endoscopic retrograde cholangiopancreatography Needle-knife papillotomy Pancreatic stent Selective biliary cannulation

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Predicting cholecystocholedochal fistulas in patients with Mirizzi syndrome undergoing endoscopic retrograde cholangiopancreatography

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World Journal of Gastroenterology 2020年第40期26卷 6241-6249页

作者： Chi-Huan Wu nai-jen liu Chun-Nan Yeh Shang-Yu Wang Yi-Yin Jan Department of Gastroenterology and Hepatology Linkou Medical CenterChang Gung Memorial HospitalChang Gung UniversityCollege of MedicineTaoyuan 333Taiwan Department of General Surgery Linkou Medical CenterChang Gung Memorial HospitalChang Gung UniversityCollege of MedicineTaoyuan 333Taiwan

BACKGROUND Mirizzi syndrome(MS) is defined as an extrinsic compression of the extrahepatic biliary system by an impacted stone in the gallbladder or the cystic duct leading to obstructive jaundice. Endoscopic retrograde cholangiopancreatography(ERCP) could serve diagnostic and therapeutic purposes in patients with MS in addition to revealing the relationships between the cystic duct, the gallbladder, and the common bile duct(CBD). Cholecystectomy is a challenging procedure for a laparoscopic surgeon in patients with MS, and the presence of a cholecystocholedochal fistula renders preoperative diagnosis important during *** To evaluate cholecystocholedochal fistulas in patients with MS during ERCP before *** From 2004 to 2018, all patients diagnosed with MS during ERCP were enrolled in this study. Patients with associated malignancy or those who had already undergone cholecystectomy before ERCP were excluded. In total, 117 patients with MS diagnosed by ERCP were enrolled in this study. Among them, 21 patients with MS had cholecystocholedochal fistulas. MS was further confirmed during cholecystectomy to check if cholecystocholedochal fistulas were present. The clinical data, cholangiography, and endoscopic findings during ERCP were recorded and *** Gallbladder opacification on cholangiography is more frequent in patients with MS complicated by cholecystocholedochal fistulas(P < 0.001). Pus in the CBD and stricture length of the CBD longer than 2 cm were two additional independent factors associated with MS, as demonstrated by multivariate analysis(odds ratio 5.82, P = 0.002;0.12, P = 0.008, respectively).CONCLUSION Gall bladder opacification is commonly seen in patients with MS with cholecystocholedochal fistulas during pre-operative ERCP. Additional findings such as pus in the CBD and stricture length of the CBD longer than 2 cm may aid the diagnosis of MS with cholecystocholedochal fistulas.

关键词： Cholecystectomy Cholecystocholedochal fistula Common bile duct Endoscopic retrograde cholangiopancreatography Mirizzi syndrome

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Treating delayed endoscopic sphincterotomy-induced bleeding:Epinephrine injection with or without thermotherapy

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World Journal of Gastroenterology 2009年第38期15卷 4823-4828页

作者： Yung-Kuan Tsou nai-jen liu Jui-Hsiang Tang Kai-Feng Sung Chi-Liang Cheng Ching-Song Lee Department of Hepato-Gastroenterology Division of Therapeutic EndoscopyChang Gung Memorial Hospital & Chang Gung University College of Medicine

AIM： To compare the hemostatic efficacy between epinephrine injection alone and epinephrine injection combined with thermotherapy for delayed postendoscopic sphincterotomy （ES） bleeding. METHODS： Cases with delayed post-ES bleeding undergoing epinephrine injection alone （epinephrine injection group, n = 26） or epinephrine combined with thermotherapy （combination therapy group, n = 33） in our institution between 1999 and 2007 were retrospectively investigated. The main outcome measurements were： initial endoscopic hemostasis, rebleeding, complications, requirement of angiographic embolization or surgery, requirement for blood transfusion, and mortality. RESULTS： The initial hemostatic efficacy was 96.2% for epinephrine injection alone and 100% for combination therapy （P = 0.44）. There were four patients with re-bleeding in each group （16.0% vs 12.1%, P = 0.72）. There was only one complication of pancreatitis from the combination therapy group. Three patients （11.5%） in the epinephrine injection group and one patient （3%） in the combination therapy group required angiographic embolization or surgery （P = 0.31）. The total number of blood transfusions was not significantly different between the two groups （3.5 ± 4.6 U vs 3.5 ± 4.5 U, P = 0.94）. There was no bleeding-related death in either group. CONCLUSION： Epinephrine injection alone is as effective as epinephrine injection combined with thermotherapy for the management of delayed post- ES bleeding.

关键词： Bleeding Endoscopic retrograde cholangiopancreatography Endoscopic sphincterotomy Epinephrine Thermotherapy

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Double balloon endoscopy increases the ERCP success rate in patients with a history of Billroth Ⅱ gastrectomy

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World Journal of Gastroenterology 2010年第36期16卷 4594-4598页

作者： Jui-Hsiang Tang Yung-Kuan Tsou Hao-Tsai Cheng Mu-Hsien Lee Ching-Song Lee nai-jen liu Division of Digestive Therapeutic Endoscopy Department of Gastroenterology and HepatologyChang Gung Memorial Hospital College of Medicine Chang Gung University

AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)***:From April 2006 to March 2007,32 patients with a BⅡgastrectomy underwent 34 ERCP *** all cases,the ERCP procedures were started using a *** intubation of the afferent loop or reaching the papilla failed,we changed to DBE for the ERCP procedure(DBE-ERCP).We assessed the success rate of afferent loop intubation,reaching the major papilla,selective cannulation,possibility of therapeutic approaches,procedure-related complications,and the overall success ***:Among the 32 patients with a history of BⅡgastrectomy,the duodenoscope was successfully passed up to the papilla in 22 patients(69%),and cannulation was successfully performed in 20 patients(63%).Six patients(2 with failure in afferent loop intubation and 4 with failure in reaching the papilla)underwent *** DBE reached the papilla in all the 6 patients(100%)and selective cannulation was successful in 5 patients(83%).Four patients(67%)who had common bile duct stones were successfully *** patient underwent diagnostic ERCP only and the other one,in whom selective cannulation failed,was diagnosed with papilla cancer proven by *** were no complications related to the *** overall ERCP success rate increased to 88%(28/32).CONCLUSION:The overall ERCP success rate increases with DBE in patients with a previous BⅡgastrectomy.

关键词： Double balloon endoscopy Endoscopic retrograde cholangiopancreatography BillrothⅡgastrectomy

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Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images

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World Journal of Gastroenterology 2014年第1期20卷 242-249页

作者： Chi-Liang Cheng Cheng-Hui Lin nai-jen liu Jui-Hsiang Tang Yen-Lin Kuo Yi-Ning Tsui Department of Gastroenterology Zhongli Evergreen Hospital Department of Digestive Therapeutic Endoscopy Chang Gung Hospital and Chang Gung University

AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).

关键词： Cervical esophagus Heterotopic gastric mucosa Endoscopic diagnosis Narrow-band imaging Conventional imaging

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Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography

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World Journal of Gastroenterology 2012年第19期18卷 2396-2401页

作者： Chi-Liang Cheng Yung-Kuan Tsou Cheng-Hui Lin Jui-Hsiang Tang hien-Fu Hung Kai-Feng Sung Ching-Song Lee nai-jen liu Division of Therapeutic Endoscopy Department of Gas-troenterology and Hepatology Chang Gung Memorial HospitalCollege of Medicine Chang Gung University Taoyuan 333Taiwan China Division of Radiology Department of Gastro-enterology and Hepatology College of Medicine Chang GungUniversity Taoyuan 333 Taiwan China

AIM： To describe characteristics of a poorly expandable （PE） common bile duct （CBD） with stones on en- doscopic retrograde cholangiography.METHODS： APE bile duct was characterized by a rigid and relatively narrowed distal CBD with retro- grade dilatation of the non-PE segment. Between 2003 and 2006, endoscopic retrograde cholangiography （ERC） images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Centerin Chang Gung Memoria acteristic PE bile duct on Hospital. Patients with char ERC were identified from the database. Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS： A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study. The median patient age was 45 years （range, 20 to 92 years）; 66.7% of the patients were men. The di ameters of the widest non-PE CBD segment, the PE segment, and the largest stone were 14.3 ± 4.9 mm, 5.8±1.6 mm, and 11.2±4.7 mm, respectively. The length of the PE segment was 39.7±15.4 mm （range, 12.3 mm to 70.9 mm）. To remove the CBD stone（s） completely, mechanical lithotripsy was required in 25 （83.3%） patients even though the stone size was not as large as were the difficult stones that have been described in the literature. The stone size and stone/ PE segment diameter ratio were associated with the need for lithotripsy. Post-ERC complications occurred in 4 cases： pancreatitis in 1, cholangitis in 2, and an im- pacted Dormia basket with cholangitis in 1. Two （6.7%） of the 28 patients developed recurrent CBD stones at follow-up （50±14 mo） and were successfully managed with therapeutic ERC.CONCLUSION： Patients with a PE duct frequently require mechanical lithotripsy for stones extraction, To retrieve stones successfully and avoid complications, these patients should be identified during ERC,

关键词： Common bile duct stone Difficult stone Endoscopic retrograde cholangiography Mechanicallithotripsy

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Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding

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World Journal of Gastroenterology 2016年第11期22卷 3196-3201页

作者： Mu-Hsien Lee Yung-Kuan Tsou Cheng-Hui Lin Ching-Song Lee nai-jen liu Kai-Feng Sung Hao-Tsai Cheng Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital and Chang Gung University College of Medicine

AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy(ES) ***: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, comorbidities, endoscopic diagnosis, presence of periampullary diverticulum, occurrence of immediate postES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic ***: A total of 35 patients(21.7%) had rebleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/d L, initial bleeding severity, and bleeding diathesis were significant predictors of rebleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/d L and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single(n = 23) or multiple(range, 2-7; n = 6) sessions in 29 of the 35 patients(82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from ***: Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/d L are predictors of re-bleeding.

关键词： Delayed bleeding Endoscopic hemostasis Endoscopic sphincterotomy Predictors Re-bleeding

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Timing of endoscopic retrograde cholangiopancreatography in the treatment of acute cholangitis of different severity

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World Journal of Gastroenterology 2022年第38期28卷 5602-5613页

作者： Yao-Chi Huang Chi-Huan Wu Mu Hsien Lee Sheng Fu Wang Yung-Kuan Tsou Cheng-Hui Lin Kai-Feng Sung nai-jen liu Department of Medicine College of MedicineChang Gung UniversityTaoyuan 333Taiwan Department of Gastroenterology and Hepatology Chang Gung Memorial HospitalTaoyuan 333Taiwan

BACKGROUND The optimal timing of endoscopic retrograde cholangiopancreatography(ERCP)in acute cholangitis(AC) is uncertain,especially in patients with AC of varying *** To report whether the timing of ERCP is associated with outcomes in AC patients with different *** According to the 2018 Tokyo guidelines,683 patients who met the definite diagnostic criteria for AC were retrospectively *** results were first compared between patients receiving ERCP ≤ 24 h and>24 h and then between patients receiving ERCP ≤ 48 h and>48 *** analyses were performed in patients with grade Ⅰ,Ⅱ or Ⅲ *** primary outcome was 30-d *** outcomes were intensive care unit(ICU) admission rate,length of hospital stay(LOHS) and 30-d readmission *** Taking 24 h as the critical value,compared with ERCP>24 h,malignant biliary obstruction as a cause of AC was significantly less common in the ERCP ≤ 24 h group(5.2% vs 11.5%).The proportion of cardiovascular dysfunction(11.2% vs 2.6%),respiratory dysfunction(14.2% vs 5.3%),and ICU admission(11.2% vs 4%)in the ERCP ≤ 24 h group was significantly higher,while the LOHS was significantly shorter(median,6 d vs 7 d).Stratified by the severity of AC,higher ICU admission was only observed in grade Ⅲ AC and shorter LOHS was only observed in grade Ⅰ and Ⅱ *** were no significant differences in 30-d mortality between groups,either in the overall population or in patients with grade Ⅰ,Ⅱ or Ⅲ *** 48 h as the critical value,compared with ERCP>48 h,the proportion of choledocholithiasis as the cause of AC was significantly higher in the ERCP ≤ 48 h group(81.5% vs 68.3%).The ERCP ≤ 48 h group had significantly lower 30-d mortality(0 vs 1.9%) and shorter LOHS(6 d vs 8 d).Stratified by AC severity,lower 30-d mortality(0 vs 6.1%) and higher ICU admission rates(22.2% vs 10.2%) were only observed in grade Ⅲ AC,and shorter LOHS was only observed in grade I and Ⅱ *** the multivariate analysis,cardi

关键词： Acute cholangitis Endoscopic retrograde cholangiopancreatography severity Timing Thirtyday mortality Length of hospital stay

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Enhancement of motor functional recovery in thoracic spinal cord injury: voluntary wheel running versus forced treadmill exercise

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Neural Regeneration Research 2025年第3期20卷 836-844页

作者： Do-Hun Lee Dan Cao Younghye Moon Chen Chen nai-Kui liu Xiao-Ming Xu Wei Wu Spinal Cord and Brain Injury Research Group Stark Neurosciences Research InstituteIndiana University School of MedicineIndianapolisINUSA Department of Neurological Surgery Indiana University School of MedicineIndianapolisINUSA Department of Neuroscience Baylor College of MedicineHoustonTXUSA

Spinal cord injury necessitates effective rehabilitation strategies, with exercise therapies showing promise in promoting recovery. This study investigated the impact of rehabilitation exercise on functional recovery and morphological changes following thoracic contusive spinal cord injury. After a 7-day recovery period after spinal cord injury, mice were assigned to either a trained group(10 weeks of voluntary running wheel or forced treadmill exercise) or an untrained group. Bi-weekly assessments revealed that the exercise-trained group, particularly the voluntary wheel exercise subgroup, displayed significantly improved locomotor recovery, more plasticity of dopaminergic and serotonin modulation compared with the untrained group. Additionally, exercise interventions led to gait pattern restoration and enhanced transcranial magnetic motor-evoked potentials. Despite consistent injury areas across groups, exercise training promoted terminal innervation of descending axons. In summary, voluntary wheel exercise shows promise for enhancing outcomes after thoracic contusive spinal cord injury, emphasizing the role of exercise modality in promoting recovery and morphological changes in spinal cord injuries. Our findings will influence future strategies for rehabilitation exercises, restoring functional movement after spinal cord injury.

关键词： behavioral assessment motor function neural plasticity running wheel exercise spinal cord injury treadmill exercise voluntary exercise

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