ObjectiveTo understand advances in the timing and surgical mode selection of gastrointestinal endoscopy and surgical intervention for acute biliary pancreatitis (ABP).MethodThe recent literatures on the timing and choice of gastrointestinal endoscopy and surgical treatments aimed at ABP were reviewed.ResultsFor ABP patients with early cholangitis or biliary obstruction, no matter how serious, endoscopic treatment should be used to relieve obstruction and relieve symptoms. For patients only with ABP, if non-surgical treatment was not effective and patients showed symptoms such as biliary obstruction or biliary tract infection, endoscopic intervention should be considered. Most ABP patients had milder symptoms and could undergo cholecystectomy during the same hospitalization to prevent ABP recurrence after symptoms relief. Patients with severe ABP could be treated with cholecystectomy along with pancreatic necrotic tissue removal, and surgery should be performed after the disease was controlled. If the preoperative imaging examination highly suspected that there were stones in the biliary tract, biliary exploration should be performed at the same time. Laparoscopic surgery should be selected as far as possible to facilitate the postoperative recovery of the patient.ConclusionsFor patients with ABP, whether endoscopic or surgical treatment, the timing and surgical mode selection should follow the specific clinical situation with the “individualization” principle of the treatment. We should make the reasonable and effective policy at diagnosis and treatment according to different conditions.
Objective To investigate whether intraductal electrocautery incision （IEI） could decrease the recurrence of post-liver transplant anastomotic strictures （PTAS） after conventional endoscopic intervention of balloon dilatation （BD） and plastic stenting （PS）. Methods The clinical data of 27 patients with PTAS who were given endoscopic treatment of BD＋PS or IEI＋BD＋PS in our hospital from January 2007 to October 2011 were reviewed retrospectively. Results The treatment of BD＋PS was initially successful in 9 of 11 （81.8%） cases， but showed recurrence in 5 of 9 （55.6%）. The treatment of IEI＋BD＋PS was initially successful in 14 of 16 （87.5%） cases, and the recurrence was observed only in 3 of 14 （21.4%）. The total diameter of inserted plastic stents in IEI＋BD＋PS group was significantly greater than that in BD＋PS group 〔（12±3.2） Fr vs. （8±1.3） Fr，P=0.039〕. All recurrences were successfully retreated by IEI＋BD＋PS. Procedure-related complications included pancreatitis in 5 cases （18.5%）, cholangitis in 8 cases （29.6%）, bleeding after EST in 1 cases （3.7%）, which were all cured with medical treatment. No complications related to intraductal endocautery incision procedure such as bleeding and perforation were observed. Median follow-up after completion of endoscopic therapy was 22 months （range 1-49 months）. Conclusions Intraductal electrocautery incision is an effective and safe supplement to balloon dilatation and plastic stenting treatment of PTAS, which can decrease the recurrence of anastomotic strictures in conventional endoscopic intervention.
目的探讨肝移植术后胆道并发症的病因及内镜在肝移植并发症中的治疗。 方法笔者所在单位1995年9月至2010年3月期间共施行尸体肝移植516例，将其分为2个阶段，即1995～2001年的技术摸索阶段和2001～2010年的技术成熟阶段。第1阶段125例，有17例（13.60%）发生胆道并发症；第2阶段391例，有15例（3.84%）发生胆道并发症。对这32例患者行内镜诊治的相关临床资料进行回顾性分析。 结果32例中单纯胆瘘5例，单纯胆管结石2例，单纯胆管狭窄11例，胆管狭窄伴结石9例，胆管狭窄合并胆瘘2例，胆管扭曲2例，十二指肠乳头狭窄1例。针对不同的胆道并发症，采取了胆管扩张、乳头切开取石、胆道支架置放、鼻胆管引流等不同的治疗方式，32例患者共行内镜治疗56例次，治疗成功27例（84.38%）；发生内镜相关并发症4例（12.50%）。 结论内镜治疗肝移植术后胆道并发症的疗效是值得肯定的。
Radiation proctopathy, which can be categorized as acute and chronic, is defined as the radiation damage to the rectum caused by radiation therapy in patients with pelvic malignancies. Chronic radiation proctopathy can cause complications such as rectal bleeding, which severely affects patients’ quality of life. At present, endoscopic therapy has become the primary method for diagnosis and treatment of bleeding from chronic radiation proctopathy. In October 2019, the American Society for Gastrointestinal Endoscopy (ASGE) published "ASGE guideline on the role of endoscopy for bleeding from chronic radiation". The guideline described the effectiveness and safety of different endoscopic therapies such as argon plasma coagulation, bipolar electrocoagulation, heater probe, radiofrequency ablation, cryoablation, etc. in the treatment of bleeding from chronic radiation. This paper interprets it to provide references for clinicians in the treatment of bleeding from chronic radiation.
Objective To compare the therapy effect between surgical therapy and endoscopic therapy for chronic pancreatitis (CP) combined with pancreatic ductal stones (PDS). Methods Clinical data of 113 cases of CP combined with PDS who got treatment in Southwest Hospital of The Third Military Medical University between January 2010 and December 2015 were analyzed retrospectively, 84 of them underwent surgery (surgery group), and 29 of them got endoscopic therapy (endoscopy group). Results The operative time, intraoperative bleeding volume, postoperative hospital stay, and days in hospital, mortality, incidence of complication (pancreatic fistula, delayed gastric emptying, diabetes mellitus, and acute pancreatitis) of the surgery group were all higher than those of endoscopy group (P ＜0.05), but the ratios of the two-stage surgery and recurrence of PDS were all lower (P ＜00.05). The differences between symptom remission rate and residual stones rate were not statistically significant (P>0.05). Conclusions For cases of CP combined with PDS, the clinical therapy effect in symptom remission and residual stones between surgical and endoscopic therapy is similar, but compared with the endoscopic therapy, the operative time, intraoperative bleeding volume, postoperative hospital stay, and days in hospital of the surgical therapy are both longer. However, the ratios of the two-stage surgery and recurrence of PDS in the endoscopy group is significantly higher than those of surgery group.
ObjectiveTo explore the safety and effectiveness of endoscopic treatment for biliary tract complications after liver transplantation.MethodsPatients who underwent endoscopic treatment for biliary tract complications after liver transplantation from January 2009 to December 2018 in West China Hospital were enrolled. Characteristics of patients, types of biliary tract complications, effectiveness of endoscopic treatment and endoscopic related complications were collected and analyzed.ResultsAmong the 57 patients with biliary tract complications, 37 patients had biliary stricture alone, 4 patients had bile leak alone, 15 patients had biliary stricture plus biliary stones or sludge, and 1 patient had biliary stricture combined with biliary leakage. A total of 112 treatments of endoscopic retrograde cholangiopancreatography (ERCP) were performed, among which 100 treatments were accomplished successfully (89.3%), including the improvement of bile duct stenosis, the cure of bile leak and the successful removal of common bile duct stones. The number of total ERCP related complications was 15 (13.4%), among which post ERCP pancreatitis was the most common (9.8%).ConclusionEndoscopic therapy can be considered as an initial treatment for biliary tract complications after liver transplantation as its safety and effectiveness.
目的总结急性胆源性胰腺炎(ABP)的治疗经验。方法我院2005年2月至2009年10月期间收治89例ABP患者，梗阻型ABP 29例，其中2例胆总管下端结石梗阻致坏死型胰腺炎患者，24 h内行开腹或腹腔镜胆囊切除（LC）、胆总管切开取石、T管引流、胰腺被膜切开减压、胰腺坏死组织清除; 8例肝外胆管结石患者急诊(24～48 h)行内镜逆行胰胆管造影术(ERCP)+内镜下括约肌切开术(EST)+内镜下鼻胆管引流(ENBD); 17例胆囊结石伴胆总管结石及2例胆总管下端占位患者先行内科保守治疗病情得到控制，7 d后行CT、EST或ENBD，择期行LC、胆总管切开取石术、限期内镜胆管内支架放置术或开放根治术。非梗阻型ABP 60例，均为胆囊结石、胆囊炎所致，在入院后3～14 d急性胰腺炎控制后42例行胆囊切除术，18例行保守治疗。结果29例梗阻型ABP在及时或限时行胆道引流解除梗阻后均使胰腺炎得到控制，病情稳定后行手术治疗，均治愈出院; 60例非梗阻型ABP患者中，42例住院行一期胆囊切除术，治愈率达100%，18例保守治疗患者，1个月至1年胰腺炎复发9例，均再次入院，3例保守治疗好转后出院； 6例行胆囊切除术，其中LC 4例，开腹胆囊切除术2例，其中5例治愈，1例出现急性呼吸窘迫综合征抢救无效死亡。结论ABP应根据胆管有无梗阻分型治疗，梗阻型应尽早引流解除胆管梗阻，EST+ENBD能有效解除胆管梗阻控制胰腺炎症； 非梗阻型宜积极保守治疗，病情缓解后手术治疗，能有效降低并发症发生率和病死率。