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outcomes of preoperative endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage for malignant distal biliary obstruction prior to pancreaticoduodenectomy

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World Journal of Gastroenterology 2017年第29期23卷 5386-5394页

作者： guo-qiang zhang yong li yu-ping ren nan-tao fu hai-bing chen jun-wu yang wei-dong xiao Department of General Surgery the First Affiliated Hospital of Nanchang University

AIM to compare the outcomes of preoperative endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy (PD). METHODS Data from 153 consecutive patients who underwent preoperative endoscopic biliary drainage prior to PD between January 2009 and July 2016 were analyzed. We compared the clinical data, procedure-related complications of endoscopic biliary drainage (EBD) and postoperative complications of PD between the ENBD and ERBD groups. Univariate and multivariate analyses with odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to identify the risk factors for deep abdominal infection after PD. RESULTS One hundred and two (66.7%) patients underwent ENBD, and 51 (33.3%) patients underwent ERBD. endoscopic sphincterotomy was less frequently performed in the ENBD group than in the ERBD group (P = 0.039); the EBD duration in the ENBD group was shorter than that in the ERBD group (P = 0.036). After EBD, the levels of total bilirubin (TB) and alanine aminotransferase (ALT) were obviously decreased in both groups, and the decreases of TB and ALT in the ERBD group were greater than those in the ENBD group (P = 0.004 and P = 0.000, respectively). However, the rate of EBD procedure-related cholangitis was significantly higher in the ERBD group than in the ENBD group (P = 0.007). The postoperative complications of PD as graded by the Clavien-Dindo classification system were not significantly different between the two groups (P = 0.864). However, the incidence of deep abdominal infection after PD was significantly lower in the ENBD group than in the ERBD group (P = 0.019). Male gender (OR = 3.92; 95% CI: 1.63-9.47; P = 0.002), soft pancreas texture (OR = 3.60; 95% CI: 1.37-9.49; P = 0.009), length of biliary stricture (= 1.5 cm) (OR = 5.20; 95% CI: 2.23-12.16; P = 0.000) and ERBD method (OR = 4.08; 95% CI: 1.69-9.87; P = 0.002) were independent ri

关键词： preoperative endoscopic biliary drainage endoscopic nasobiliary drainage endoscopic retrograde biliary drainage pancreaticoduodenectomy malignant distal biliary obstruction

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Biliary spontaneous dislodgement spiral stent for patients who underwent mechanical lithotripsy

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World Journal of Gastroenterology 2020年第7期26卷 740-748页

作者： Lian-Song Ye Xiang-Lei Yuan Chun-Cheng Wu Wei Liu Jiang Du Ming-Hong Yao Qing-Hua Tan Bing Hu Department of Gastroenterology West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Epidemiology and Health Statistics West China School of Public HealthSichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND The incidence of post-endoscopic retrograde cholangiopancreatography(ERCP)cholangitis(PEC)in patients who underwent mechanical lithotripsy(ML)for large stone removal is high(up to 13.3%).One of the main causes is remaining small fragments or sludge that can impair normal biliary *** placement of a nasobiliary tube or a conventional plastic biliary stent has been commonly used under such conditions,but the patient may suffer from significant discomfort after the placement of a nasobiliary tube,while additional endoscopy is required for stent *** developed a biliary spontaneous dislodgement spiral stent(BSDSS)to overcome those *** To evaluate the feasibility,safety,and effectiveness of inserting a BSDSS for patients who underwent ML for large stone *** We conducted a single-center,retrospective,cohort study at West China Hospital,Sichuan University.A total of 91 consecutive patients with large biliary stones(≥10 mm)in the common bile duct who underwent ML between November 2017 and July 2018 were *** 49 eligible patients were divided into the BSDSS group and the nasobiliary tube *** success,post-ERCP adverse events(including PEC,post-ERCP pancreatitis,stone recurrence,BSDSS retention,self-extraction and dislocation of the nasobiliary tube),drainage time,and postoperative stay were measured and *** Twenty-one patients in the BSDSS group and 28 patients in the nasobiliary tube group were included in the *** baseline characteristics and clinical information were similar in the two *** of BSDSS and nasobiliary tube were technically successful in all 49 *** was no significant difference in the incidence of overall post-ERCP adverse events between the two groups(4.8%in the BSDSS group vs 17.9%in the nasobiliary tube group,P=0.219).The median duration of drainage time(3 d in the BSDSS group vs 4 d in the nasobiliary tube group)and length of postoperat

关键词： Cholangitis Choledocholithiasis drainage endoscopic nasobiliary drainage Mechanical lithotripsy Pancreatitis Spiral Stents

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Sequential therapy with combined trans-papillary endoscopic nasopancreatic and endoscopic retrograde pancreatic drainage for pancreatic pseudocysts

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World Journal of Clinical Cases 2021年第22期9卷 6254-6267页

作者： Yong-Gang He Jing Li Xue-Hui Peng Jing Wu Ming-Xun Xie Yi-Chen Tang Lu Zheng Xiao-Bing Huang Department of Hepatobiliary Surgery The Second Affiliated Hospital of Army Medical UniversityChongqing 400037China Department of Radiology The Second Affiliated Hospital of Army Medical UniversityChongqing 400037China

BACKGROUND endoscopic retrograde pancreatic drainage(ERPD)and stent implantation has become the major treatment method for pancreatic ***,it is associated with a high recurrence rate and *** To manage pancreatic pseudocysts by sequential therapy with endoscopic nasopancreatic drainage(ENPD)combined with ERPD and evaluate the treatment *** One hundred and sixty-two cases of pancreatic pseudocyst confirmed by endoscopic examination at our hospital between January 2014 and January 2020 were retrospectively *** were 152 cases of intubation via the duodenal papilla,of which 92 involved pancreatic duct stent implantation and 60 involved sequential therapy with combined ENPD and ERPD(two-step procedure).The success rate of the procedure,incidence of complications(infection,bleeding,etc.),recurrence,and length and cost of hospitalization were compared between the two *** The incidence of infection was significantly higher in the ERPD group(12 cases)than in the two-step procedure group(2 cases).Twelve patients developed infection in the ERPD group,and anti-infection therapy was effective in five cases but not in the remaining seven *** presented as fever and chills in the two-step procedure *** reoperation rate was significantly higher in the ERPD group with seven cases compared with zero cases in the two-step procedure group(P<0.05).Similarly,the recurrence rate was significantly higher in the ERPD group(19 cases)than in the two-step procedure group(0 cases).CONCLUSION Sequential therapy with combined ENPD and ERPD is safe and effective in patients with pancreatic pseudocysts.

关键词： Endoscopy endoscopic retrograde cholangiopancreatography endoscopic nasobiliary drainage endoscopic retrograde pancreatic drainage Pancreatic pseudocyst endoscopic ultrasonography trans-gastric puncture drainage of the pancreas

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Application of endoscopic nasobiliary cutting in the treatment of hilar cholangiocarcinoma

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Oncology and Translational Medicine 2021年第2期7卷 76-82页

作者： Shujuan Jiang Zhongyin Zhou Department of Gastroenterology Renmin Hospital of Wuhan UniversityWuhan 430060China

Objective The aim of the study was to study the clinical efficacy and prognosis of endoscopicallycutting the nasobiliary duct and leaving its residual segment as a biliary stent in the treatment of hilarcholangiocarcinoma (HC).Methods The clinical data of 55 patients with HC treated by endoscopic biliary drainage at theGastrointestinal Endoscopy Center of our hospital (Renmin Hospital of Wuhan University, China) fromAugust 2017 to August 2019 were retrospectively analyzed. According to different drainage schemes,patients were divided into the endoscopic nasobiliary cutting group (n = 26) and the endoscopic retrogradebiliary drainage (ERBD) group (n = 29). The postoperative liver function indexes, incidence of postoperativecomplications, median patency period of stents, and median survival time of patients were comparedbetween the two *** Liver function indexes (total bilirubin, direct bilirubin, alanine aminotransferase, aspartateaminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase) were significantly decreased in55 patients a week postoperaticely (P endoscopicnasobiliary cutting group were more significant than those in the ERBD group (P endoscopic nasobiliary cutting group was significantly lower than that in theERBD group (15.40% vs. 41.4%, P endoscopic nasobiliary cutting subgroups, there were 1and 3 cases of biliary tract infection in the gastric antrum cutting group (n = 21) and duodenal papilla cuttinggroup (n = 5), respectively, and 0 cases and 2 cases of displacement, respectively;there was a statisticallysignificant difference in terms of complications between the two subgroups (P nasobiliary duct cutting group were higherthan those (169 days and 202 days) in the ERBD group, but there was no significant difference (P

关键词： hilar cholangiocarcinoma(HC) endoscopic nasobiliary drainage endoscopic nasobiliary cutting endoscopic retrograde biliary drainage(ERBD) biliary stent

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