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Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology

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Hepatobiliary & Pancreatic Diseases International 2019年第1期18卷 73-78页

作者： Jun Wen Tao Li Yi Lu Li-Ke Bie Biao Gong Digestive Endoscopy Center Department of Gastroenterology Ruijin Hospital Shanghai Jiaotong University School of Medicine Digestive Endoscopy Center The Sixth Affiliated Hospital of Sun Yat-sen University

Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.

关键词： Difficult biliary cannulation Endoscopic retrograde cholangiopancreatography Needle-knife fistulotomy Precut techniques Transpancreatic septotomy

Co-occurrence of IPMN and malignant IPNB complicated by a pancreatobiliary fistula: A case report and review of the literature

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World Journal of Clinical Cases 2019年第1期7卷 102-108页

作者： Xu Ren Chun-Lan Zhu Xu-Fu Qin Hong Jiang Tian Xia Yong-Ping Qu digestive Disease Hospital of Heilongjiang Provincial Hospital The Second digestive Department Digestive Disease Hospital of Heilongjiang Provincial Hospital Department of Pathology of Heilongjiang Provincial Hospital Digestive Endoscopy Center Digestive Disease Hospital of Heilongjiang Provincial Hospital

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.

关键词： Intraductal papillary mucinous neoplasm of the pancreas Intraductal papillary neoplasm of the bile duct Extrapancreatic malignancies Co-occurrence Pancreatobiliary fistula SpyGlass cholangiopancreatoscopy Endoscopic retrograde cholangiopancreatography Case report

Long-term outcomes of endoscopic papillary balloon dilation for removal of bile duct stones in Billroth Ⅱ gastrectomy patients

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Hepatobiliary & Pancreatic Diseases International 2018年第3期17卷 257-262页

作者： Tao Li Jun Wen Li-Ke Bie Yi Lu Biao Gong Department of Gastroenterology Digestive Endoscopy Center Ruijin Hospital Shanghai Jiao Tong University School of Medicine 197 Ruijin Er Road Shanghai 200025 China Digestive Endoscopy Center The Sixth Affiliated Hospital of Sun Yat-sen University Guangzhou 510655 China

Background： Endoscopic papillary balloon dilation （EPBD） for common bile duct （CBD） stones removal in Billroth II gastrectomy patients is feasible. However, the long-term outcomes of this technique are notclear. The aim of this study was to evaluate the procedural and long-term outcomes of EPBD for removal of CBD stones in Billroth II gastrectomy patients.

关键词： Endoscopic retrograde cholangiopancreatography Endoscopic papillary balloon dilation Common bile duct stonesBillroth II gastrectomy

Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: A review of the literature

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World Journal of Gastrointestinal Surgery 2019年第2期11卷 53-61页

作者： Benedetto Mangiavillano Mouen A Khashab Ilaria Tarantino Silvia Carrara Rossella Semeraro Francesco Auriemma Mario Bianchetti Leonardo Henry Eusebi Chen Yen-I Luca De Luca Mario Traina Alessandro Repici Gastrointestinal endoscopy Unit Humanitas-Mater Domini Humanitas Huniversity Division of Gastroenterology and Hepatology Johns Hopkins Hospital Gastroenterology and endoscopy Unit Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) digestive endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center IRCCS digestive endoscopy Unit Istituto Clinico Humanitas Research Hospital Unit of Gastroenterology Department of Medical and Surgical Sciences S. Orsola-Malpighi Hospital University of Bologna Gastroenterology and digestive endoscopy Unit Ospedali Riuniti Marche Nord digestive endoscopy Unit Division of Gastroenterology Humanitas Research Hospital

Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary, peri-ampullary, and pancreatic head neoplasia. Surgical bypass is no longer the gold-standard therapy for these patients, as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique, with a high technical success in expert hands. In recent years, endoscopic ultrasonography(EUS) has evolved from a diagnostic to a therapeutic procedure, and is now increasingly used to guide biliary drainage, especially in cases of failed endoscopic retrograde cholangiopancreatography(ERCP). The advent of lumen-apposing metal stents(LAMS) has expanded EUS therapeutic options, and changed the management of synchronous bilioduodenal stenosis. The most recent literature regarding endoscopic treatments for synchronous biliary and duodenal malignant stenosis has been reviewed to determine the best endoscopic approach, also considering the advent of an interventional EUS approach using LAMS.

关键词： Malignant biliary strictures Malignant duodenal stenosis Bilio-duodenal stenosis Biliary self-expandable metal stent Duodenal self-expandable metal stent Lumen-apposing metal stents Gastro-jejunostomy

Cannulation of the intradiverticular papilla using a duodenoscope:Is it a safe method?

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World Journal of Gastroenterology 2014年第29期20卷 10217-10218页

作者： Yun Qian Jin Huang Yin Zhang Zhi-Ning Fan Institute of digestive endoscopy Medical Center for Digestive Diseasesthe Second Affiliated Hospital of Nanjing Medical University

Endoscopic cannulation of the biliary tract is a challenging technique in cases of periampullary diverticula.Many new devices and new manipulations for successful biliary cannulation have been reported.endoscopy used to locate and cannulate a papilla hidden within a duodenal diverticulum is an effective method.However,the question of which endoscope should be chosen for this procedure,duodenoscope or gastroscope,waits to be answered.

关键词： Endoscopic retrograde cholangiopancreatography Int

Effects of exercise by type and duration on quality of life in patients with digestive system cancers:A systematic review and network meta-analysis

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Journal of Sport and Health Science 2023年第4期12卷 491-500,F0003页

作者： Chen-Qi Li Yuan-Chen Wang Shu-Qun Shen Yan-Li Zhang Jie-Qiong Zhao Wen-Bin Zou Rui-Liang Ge Department of Nutrition The Third Affiliated Hospital of Naval Medical UniversityShanghai 200438China National Clinical Research center for digestive Diseases Department of GastroenterologyDigestive Endoscopy CenterThe First Affiliated Hospital of Naval Medical UniversityShanghai 200433China Department of Outpatient The Third Affiliated Hospital of Naval Medical UniversityShanghai 200438China

Background:There is scant evidence regarding the effects of exercise type and duration on quality of life(QoL)in digestive system cancer(DSC)survivors.We aim to investigate the optimal type and duration of exercise to improve QoL for DSC survivors through a systematic review and network meta-analysis.Methods:A systematic literature search of PubMed,Embase,and Web of Science was performed.Eligibility for study inclusion was limited to studies that were randomized controlled trials involving all kinds of exercise in adult patients with DSCs,and the comparator was in standard care or other types of exercise.The primary outcome was QoL,including general health,physical health,mental health,and role function.Secondary outcomes included cancer-related symptoms such as fatigue,insomnia,depression,anxiety,and duration of hospital stay.The network meta-analyses were performed using a random-effect model.Results:The analysis included 32 eligible articles and a total of 2558 participants.Our primary outcome indicated that short-term aerobic exercise significantly enhanced general health(standardized mean difference(SMD)=0.66,95%credible intervals(Crls):0.05 to 1.30),and also contributed to a better mental health(SMD=0.38,95%CrI:-0.05 to 0.81)and role function(SMD=0.48,95%CrI:-0.27 to 1.20).Although without significant changes,short-term resistance exercise tended to increase the physical health of patients with DSCs(SM=0.69,95%CrI:-0.07 to 1.50)and effective in alleviating fatigue(SMD=-0.77,95%CrI:-1.50 to 0.01).Short-term aerobic exercise was related to a lower score of insomnia(SMD=-1.20,95%CrI:-2.40 to 0.06),depression(SMD=-0.51,95%CrI:-1.50 to 0.45),and anxiety(SMD=-0.45,95%CrI:-1.30 to 0.34).All types of exercise related to a trend of declined hospital stays(-0.87 to-5.00 day).Long-term resistance exercise,however,was negatively associated with general health(SMD=-0.33,95%CrI:-1.70 to 1.00),physical health(SMD=-0.18,95%CrI:-1.30to 0.90),and role function(SMD=-1.20,95%CrI:-2.50 to 0.11).Conclusion:This study suggests th

关键词： digestive system cancer Exercise Network meta-analysis Quality of life

PDCA nursing in improving quality management efficacy in endoscopic submucosal dissection

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World Journal of Clinical Cases 2022年第27期10卷 9611-9618页

作者： Yan-Hua He Fang Wang Digestive Endoscopy Center The First Affiliated Hospital of Soochow UniversitySuzhou 215006Jiangsu ProvinceChina

BACKGROUND Endoscopic submucosal dissection(ESD) is a common surgical strategy for the treatment of early gastrointestinal tumors and precancerous lesions.PDCA nursing can effectively prevent potential risks in the nursing process,protect patient privacy,and improve patient satisfaction,nursing integrity,and service quality.AIM To explore the effects of PDCA nursing model on the quality management of gastrointestinal ESD,the 36-item Shot-Form Health Survey(SF-36) score,and negative emotions.METHODS A total of 178 patients who underwent ESD between January 2020 and January 2021 were divided into two groups.The usual care mode was the control group,with 80 cases from January to July 2020;from July 2020 to January 2021,98 patients were enrolled in the PDCA care mode as the research group.The length of hospital stay and the costs of the two groups were statistically analyzed.The visual analog scale(VAS),SF-36 score,Zung self-rating scale for anxiety and depression,and postoperative complications were also assessed.RESULTS The length of hospitalization and cost in the research group were lower than in the control group(P < 0.05),and the VAS scores were lower than those before care(P < 0.05).Moreover,the VAS score of the research group was lower than that of the control group(P < 0.05).The SF-36 scores for physical function,role status,social function,pain,mental health,and physical strength were higher in the research group than in the control group(P < 0.05).Depression and anxiety scores of the research group were lower than those of the control group(P < 0.05).The postoperative complication rate in the research group(6.12%) was lower than in the control group(32.50%)(P < 0.05).CONCLUSION PDCA nursing can improve the quality of management of ESD surgery,shorten the length of hospital stay and cost,reduce the VAS and Zung scale scores to alleviate adverse emotions,improve the SF-36 score,and reduce postoperative complications.

关键词： PDCA care Endoscopic submucosal dissection 36-item Shot-Form Health Survey Zung scale score Postoperative complications

Gastrotracheal fistula:Treatment with a covered self-expanding Y-shaped metallic stent

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World Journal of Gastroenterology 2015年第3期21卷 1032-1035页

作者： Fei Wang Hong Yu Ming-Hui Zhu Quan-Peng Li Xian-Xiu Ge Jun-Jie Nie Lin Miao Institute of digestive endoscopy and Medical center for digestive Diseases Second Affiliated Hospital of Nanjing Medical University Department of Gastroenterology People’s Hospital of Jingjiang

A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously.After admission to our hospital,gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wallnear the carina and the upper residual stomach.We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy.A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus.Subsequently,the fistula was closed completely.The patient tolerated the stent well and had good palliation of his symptoms.

关键词： Gastrotracheal fistula Y-shaped metallic stent Eso

Antimicrobial prophylaxis in patients with colorectal lesions undergoing endoscopic resection

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World Journal of Gastroenterology 2015年第15期21卷 4715-4721页

作者： Qi-Sheng Zhang Bing Han Jian-Hua Xu Peng Gao Yu-Cui Shen Digestive Endoscopy Center Department of Gastroenterology and Hepatology Branch of Shanghai First People’s Hospital Jiaotong University

AIM: To investigate the effect of prophylaxis withantibiotics on clinical adverse events in patients who underwent endoscopic submucosal dissection(ESD) or endoscopic mucosal resection(EMR) for colorectal lesions.METHODS: From June 2011 to December 2013, a total of 428 patients were enrolled into the study, of which 214 patients admitted to hospital underwent EMR or ESD procedures. These patients were randomized to an antibiotic group, in which patients were given cefuroxime 1.5 g iv half an hour before and 6 h after surgery respectively, and a control group, in which patients were not given any antibiotic. A further 214 outpatients with small polyps treated by polypectomy were compared with controls that were matched by age and gender, and operations were performed as outpatient surgery. Recorded patient parameters were demographics, characteristics of lesions and treatment modality, and the size of the wound area. The primary outcome measures were clinical adverse events, including abdominal pain, diarrhea, hemotachezia, and fever. Secondary outcome measures were white blood cell count, C-reactive protein and blood culture. Additionlly, the relationship between the size of the wound area and clinical adverse events was analyzed. RESULTS: A total of 409 patients were enrolled in this study, with 107 patients in the control group, 107 patients in the antibiotic group, and another 195 cases in the follow-up outpatient group. The patients' demographic characteristics, including age, gender, characteristics of lesions, treatment modality, and the size of the wound area were similar between the 2 groups. The rates of adverse events in the antibiotic group were significantly lower than in the control group: abdominal pain(2.8% vs 14.9%, P < 0.01), diarrhea(2.0% vs 9.3%, P < 0.05), and fever(0.9% vs 8.4%, P < 0.05) respectively. The levels of inflammatory markers also decreased significantly in the antibiotic group compared with the control group: leukocytosis(2.0% vs 11.2%, P < 0.01), and C-reactiveprotein(2.0% vs 10.

关键词： Antibiotic prophylaxis Endoscopic mucosalresection Endoscopic submucosal dissection Adverseevents Cefuroxime