Pancreatic duct stones are secondary to chronic pancreatitis while conventional medical treatment is always not effective. Due to the advantages of less trauma, simple operation, and fewer complications, since endoscopic retrograde cholangiopancreatography (ERCP) combined with extracorporeal shock wave lithotripsy (ESWL) was first used in the treatment of pancreatic duct stones in 1987, the treatment method has been continuously improved for more than 30 years, and has experienced the development process from being questioned to becoming the first-line treatment for pancreatic duct stones in multinational guidelines nowadays. However, with the rapid development of science and technology today, the method of ERCP combined with extracorporeal lithotripsy is also facing the challenges of many other treatment methods.
ObjectiveTo summarize the various treatment methods for reducing jaundice in the elderly patients with malignant obstructive jaundice (MOJ), and provide reference for the treatment of elderly MOJ.MethodUsing “malignant obstructive jaundice” as the Chinese keyword and the English keyword, a computer search of the literatures on the treatment of elderly MOJ patients was conducted and reviewed.ResultsThe treatment methods of reducing jaundice in elderly MOJ included radical surgery, cholangiojejunostomy, endoscopic ultrasound-guided biliary drainage, endoscopic biliary stent implantation, percutaneous transhepatic biliary drainage and stent implantation. Radical surgery was the most effective, but it was traumatic and had many complications for elderly patients. Cholangiojejunostomy was effective and suitable for elderly patients who cannot tolerate major surgery. Endoscopic ultrasound-guided biliary drainage was less traumatic to elderly patients, but technical difficulty. Endoscopic biliary stent implantation was currently the first-line choice for the treatment of elderly patients with advanced MOJ. Percutaneous transhepatic biliary drainage and stent implantation were suitable for elderly and frail patients with high obstruction.ConclusionThe treatment of elderly MOJ needs to be individualized and regionalized, and appropriate treatment methods should be selected according to the patient’s condition and the medical level of the medical center.
ObjectiveTo investigate the value of endoscopic sphincterotomy (EST) on treating sphincter of Oddi dysfunction (SOD). MethodsForty-two patients with SOD according to Rome Ⅱ diagnostic criteria were retrospectively summarized. Bile duct residual stone, tumor or biliopancreatic duct obstruction diseases were excluded by B ultrasound, CT, and MRCP examination. Total 42 patients underwent EST. ResultsEST was done successfully in 42 cases, success rate was 100%. Postoperative acute pancreatitis occurred in 5 patients (11.90%), which were cured by 3－7 d conservative treatment. There were no complications of severe acute pancreatitis, digestive tract perforation, hemorrhage, and cholangitis. Follow-up 12-45 months (mean 23.8 months), symptoms of abdominal pain in all cases were improved or relieved, the effective rate was 100%. There were 2 cases treated conservatively because of hyperlipemic pancreatitis. ConclusionEST has become the primary treatment procedure for SOD because of definite outcome, less suffering, safety, less complications, and reproducibility, which are concordant with the requirements of minimally invasive surgery.
How to effectively repair esophageal fistulas, caused by esophageal perforation, rupture and anastomotic leakage after esophagectomy has always been a key problem for the digestive surgeon. Although there are many clinical treatment methods, the therapeutic effect is still completely unsatisfactory, especially when severe mediastinal purulent cavity infection is associated with the esophageal fistula. In recent years, foreign centers have promoted a new minimally invasive endoscopic treatment technology to repair the esophageal fistula, endoscopic vacuum-assisted closure therapy, with significantly curative effect. In this article, we will review the specific operation, advantages and disadvantages, as well as the clinical efficacy of endoscopic vacuum-assisted closure therapy in treating the esophageal fistulas, to provide a new therapeutic technique for esophageal fistulas and expand the new field of minimally invasive endoscopic therapy.
Objective To explore the comprehensive treatment of synchronous double cancers of the esophagus and stomach. Methods The treatment procedures of 8 patients with synchronous double cancers of the esophagus andstomach admitted in the Department of Digestive Tumor Surgery of The Hospital of Traditional Chinese Medicine of Jiangsu Province between Oct. 2006 to Feb. 2013 were analyzed. Some experience of comprehensive treatment of synch-ronous double cancers of the esophagus and stomach was explored. Results Eight cases of synchronous double cancers of the esophagus and stomach were all diagnosed by endoscopic biopsy. According to the results of CT and endoscopic ultrasonography assessment， lesions which were staged earlier than T1a were cured by endoscopic mucosal resection（6 cases， including 4 cases of esophagus cancer and 2 cases of gastric cancer）， and resection operation （1 cases of esop-hagus cancer）. The lesions staged later than T2 were treated by preoperative neoadjuvant chemoradiation， surgery， and adjuvant chemoradiation after operation （8 cases， including 2 cases of esophagus cancer and 6 cases of gastric cancer）， and simple operation （1 case）. Eight patients had been followed-up for 10-76 months （averaged 41.3 months）. Six patients survived without recurrence and metastasis during the followed-up， 1 patient died in 7 months after operation， and 1 patient relapsed in 20 months after operation. Conclusions Individually designed comprehensive treatment using neo-chemotherapy， intervention chemotherapy， radio-chemotherapy， radical resction surgery， adjuvant chemotherapy， and endoscopic mucosal resection can treat synchronous double cancers of the esophagus and stomach effectively. Impr-actical pursuit for radical surgery will not result in good prognosis
Objective To analyze cause and therapy of perforation of choledocho-pancreatico-duodenal junction associated with endoscopic retrograde cholangiopancreatography (ERCP) and its related procedures. Method The clinical data of 11 patients diagnosed with the perforation of choledocho-pancreatico-duodenal junction associated with the ERCP from January 2010 to January 2017 were analyzed retrospectively. Results Of 11 patients, 5 were diagnosed within 24 h, 3 were diagnosed between 24 h and 48 h, 3 were diagnosed above 48 h. Seven patients who immediately operated were cured following definitive diagnosis, 2 died after undergoing the delayed operation, 2 died after receiving the conservative treatment. The results of the anatomical-pathological factors showed that 4 were the anomalous arrangement of pancreaticobiliary ducts, 2 were the periampullary diverticula, 3 were the exposure of common bile duct in the pancreas level, 2 had no bile duct abnormality. Conclusions Preoperative evaluation on anatomical-pathological factor of bile duct is importance to effectively predict risk of perforation of choledocho-pancreatico-duodenal junction associated with ERCP. Early precise diagnosis and actively surgical operation are essential for optimal outcome in patient with perforation of choledocho-pancreatico-duodenal junction associated with ERCP.
Objective To investigate therapeutic effect of endoscopic sphincterotomy with small incision (SES) combined with endoscopic papillary balloon dilation (EPBD) in treatment of larger common bile duct stones. Methods The clinical data of 80 patients with common bile duct stones treated in our hospital from February 2014 to October 2015 were retrospectively analyzed. These patients were divided into endoscopic sphincterotomy (EST) group (n = 40) and SES+EPBD group (n = 40) according to the therapeutic methods. The diameter of common bile duct stone was 10–20 mm. The operation status, recurrence rate and residual rate of common bile duct stone, and complications rate within 3 months after operation were compared between these two groups. Results The age and gender had no significant differences between these two groups (P>0.05). The operation time was shorter (P<0.05) and the intraoperative bleeding was less (P<0.05) in the SES+EPBD group as compared with the EST group. There were no significant differences in the hospital stay and recovery time of gastrointestinal function between these two groups (P>0.05). The levels of ALT, AST, DBIL, and TBIL in these two groups before treatment had no significant differences (P>0.05); after treatment, the above indicators of liver function in the SES+EPBD group were significantly lower than those in the EST group (P<0.05), and which were significantly decreased more in the same group (P<0.05). The residual stone, stone recurrence, and complications such as acute pancreatitis, acute cholangitis, bile leakage and postoperative hemorrhage were not found in the SES+EPBD group, the rates of these indicators in the SES+EPBD group were significantly lower than those in the EST group (P<0.05). Conclusion SES combined with EPBD has a good therapeutic effect on larger common bile duct stones (diameter of common bile duct stone is 10–20 mm) and recurrence rate is low.
Objective To compare effectiveness between laparoscopic Heller myotomy and peroral endoscopic myotomy (POEM) in treatment of achalasia of cardia (AC) in order to provide a basis for clinical choose. Method The literatures about the treatment of AC by laparoscopic Heller myotomy or POEM were retrieved from CNKI, Embase, PubMed databases, etc., and then the contents about curative effect and complications were summarized. Results The treatment models of AC included surgical treatment such as laparoscopic Heller myotomy and endoscopy such as POEM, but there was still lack of comparing data in these two treatment models, its selection remained controversial. There was a better short-term curative effect and slighter complications for POEM as compared with the laparoscopic Heller myotomy from the trend of published literatures. However, it’s long-term effects for these two treatment models were not clarified. Conclusions Both laparoscopic Heller myotomy and POEM are medicable for AC. POEM as a new treatment of AC shows some advantages of minimal invasion and exact efficacy, but it needs to be followed-up for a long-term. Treatment model for AC is chosen on basis of typing under endoscope, physical fitness, anatomy of easophagus, previous history, tolerance of surgery and other factors.