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Cozma MA, Angelescu C, Haidar A, Mateescu RB, Diaconu CC. Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital. Biomedicines 2025; 13:727. [PMID: 40149703 PMCID: PMC11940217 DOI: 10.3390/biomedicines13030727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 03/02/2025] [Accepted: 03/11/2025] [Indexed: 03/29/2025] Open
Abstract
Background/Objectives: Pancreatitis is the most frequent and serious complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence between 2 and 10% and a mortality rate of 1 in 500 patients. Etiopathogenesis remains poorly understood. The aim of this study was to analyze the incidence of post-ERCP pancreatitis (PEP) and to identify potential patient- and procedure-related risk factors (RF) in a cohort of patients from a tertiary referral center in Romania. Methods: We conducted a retrospective, observational, single-center study in which we analyzed ERCP procedures performed in the Gastroenterology Department of Colentina Clinical Hospital, Bucharest, Romania, between January 2019 and September 2024. All patients received intrarectal diclofenac before the ERCP and were hydrated with at least 1500 mL of Ringer's solution after the procedure in the absence of contraindications, according to the latest international recommendations. Results: In total, 2743 ERCPs were performed in the given time period, while 2350 procedures were analyzed in the study. PEP occurred in 350 cases (14.9%). Of these, 191 (54.6%) occurred in males with a mean age of 66.5 years. Procedural RF with adjusted odds ratios (OR) were as follows: difficult cannulation of the common bile duct, OR = 3.734, p < 0.001, main pancreatic duct catheterization, OR = 1.454, p = 0.022, and endoscopic papillary balloon dilatation, with an OR of 3.258, p < 0.001. Pancreatic duct stent placement was shown to prevent PEP in this study group (p < 0.001). Conclusions: PEP remains a serious complication of ERCP, associated with significant morbidity and occasional mortality. While some proven risk factors, such as age, gender, or comorbidities, are unmodifiable, avoiding Wirsung duct cannulation and pancreatography, or prophylactic pancreatic duct stent placement, could play a significant role in PEP prevention.
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Affiliation(s)
- Matei-Alexandru Cozma
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Cristina Angelescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Andrei Haidar
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Radu Bogdan Mateescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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Ho Yin Henry L, Wai Yin Angus C, Chi Chuen Clarence M, Yiu Fung AY, Ning F, Ka Wing Keith L, Wai Lun T. Large balloon sphincteroplasty for CBD stone removal during acute cholangitis. Single center propensity-score matched cohort study. Surg Endosc 2025; 39:1077-1085. [PMID: 39690334 DOI: 10.1007/s00464-024-11402-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 11/03/2024] [Indexed: 12/19/2024]
Abstract
BACKGROUND Endoscopic biliary drainage is the mainstay of treatment for acute cholangitis. CBD stone removal can be performed in same session with biliary drainage. Our team incorporated the use of endoscopic large balloon sphincteroplasty as an alternative for conventional papillotomy for biliary access. This study aims to identify tips and pitfalls of EPLBD usage during acute cholangitis. METHOD From the period October 2016 to April 2021, Yan Chai Hospital has 209 patients presented with acute cholangitis had ERCP for CBD stone removal performed. Among which, 50 patients had limited papillotomy followed by endoscopic large balloon papillary dilatation for biliary access (EPLBD), while 159 patients had conventional sphincterotomy (EST) done. Propensity score matching analysis was performed in a 1:1 ratio. Primary outcome was complete CBD stone removal as defined by clearance of occlusive cholangiogram. Secondary outcomes are post-ERCP pancreatitis, minor bleeding and major bleeding, flare up of sepsis. Logistic regression analysis was performed to identify risk factors associated with one year recurrence rate. Kaplan Meier analysis was utilized for long-term recurrence rate after ERCP. RESULT In overall cohort, presence of large CBD stone & parapapillary diverticulum was more frequent in EPLBD group (26.0 ≤ 6.2% vs 9.4 ± 2.3%, p = 0.003) & (52.0 ± 7.1% vs 24.5 ± 3.4%, p < 0.001); they were balanced in PSM cohort. The complete CBD stone removal rate were higher in EPLBD group than EST group with statistical significance (80.0 ± 5.7% vs 54.0 ± 7.0%, p = 0.006). Major bleeding requiring reintervention was observed in 2.0 ± 2.0% vs 8.0 ± 3.8%, p = 0.169. Post ERCP pancreatitis were observed in 2.3 ± 2.2% vs 2.4 ± 2.4%, p = 0.960. 1 year recurrence rate was 14.0 ± 4.9% vs 2.0 ± 2.0 % , p = 0.027 . CONCLUSION Deployment of EPLBD during acute cholangitis demonstrated clinical efficacy in CBD stone clearance when compared with conventional sphincterotomy with a non-inferior safety profile. However, long term recurrence rate of acute cholangitis was observed to be higher.
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Affiliation(s)
- Lee Ho Yin Henry
- Department of Surgery, Yan Chai Hospital, HKSAR, Tsuen Wan, China.
| | | | | | | | - Fan Ning
- Department of Surgery, Yan Chai Hospital, HKSAR, Tsuen Wan, China
| | | | - Tao Wai Lun
- Department of Medicine, Yan Chai Hospital, Tsuen Wan, China
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Chen ZL, Fu H. Endoscopic retrograde cholangiopancreatography, endoscopic papillary balloon dilation, and laparoscopic hepatectomy for intra- and extrahepatic bile duct stones. World J Gastrointest Surg 2025; 17:100544. [PMID: 39872759 PMCID: PMC11757201 DOI: 10.4240/wjgs.v17.i1.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 11/12/2024] [Accepted: 11/29/2024] [Indexed: 12/27/2024] Open
Abstract
BACKGROUND Intrahepatic and extrahepatic bile duct stones (BDSs) have a high rate of residual stones, a high risk of recurrence, and a high rate of reoperation. It is very important to take timely and effective surgical intervention for patients. AIM To analyze the efficacy, postoperative rehabilitation, and quality of life (QoL) of patients with intra- and extrahepatic BDSs treated with endoscopic retrograde cholangiopancreatography (ERCP) + endoscopic papillary balloon dilation (EPBD) + laparoscopic hepatectomy (LH). METHODS This study selected 114 cases of intra- and extrahepatic BDSs from April 2021 to April 2024, consisting of 55 cases in the control group receiving laparoscopic common bile duct exploration and LH and 59 cases in the observation group treated with ERCP + EPBD + LH. Efficacy, surgical indicators [operation time (OT) and intraoperative blood loss (IBL)], postoperative rehabilitation (time for body temperature to return to normal, time for pain relief, and time for drainage to reduce jaundice), hospital stay, medical expenses, and QoL [Gastrointestinal Quality of Life Index (GIQLI)] were comparatively analyzed. Further, Logistic regression analysis was conducted to analyze factors influencing the QoL of patients with intra- and extrahepatic BDSs. RESULTS The data demonstrated a higher overall effective rate in the observation group compared to the control group (P = 0.011), together with notably reduced OT, less IBL, shorter body temperature recovery time, pain relief time, time for drainage to reduce jaundice, and hospital stay (all P < 0.05). The postoperative GIQLI of the observation group was more significantly increased compared to the control group (P < 0.05). The two groups demonstrated no marked difference in medical expenses (P > 0.05). CONCLUSION The above indicates that ERCP + EPBD + LH is effective in treating patients with intra- and extrahepatic BDSs, which is conducive to postoperative rehabilitation and QoL improvement, with promising prospects for clinical promotion.
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Affiliation(s)
- Zhi-Liang Chen
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital, Shaoxing 312000, Zhejiang Province, China
| | - Hong Fu
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital, Shaoxing 312000, Zhejiang Province, China
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Kouchi K, Takenouchi A, Matsuoka A, Yabe K, Yoshizawa H, Nakata C, Fujishiro J, Sugiyama H. Case Series of Endoscopic Papillary Balloon Dilation for Children with Common Bile Duct Stones and a Review of the Literature. J Clin Med 2024; 13:2251. [PMID: 38673524 PMCID: PMC11050672 DOI: 10.3390/jcm13082251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Endoscopic sphincterotomy (EST) has been employed for the endoscopic treatment of common bile duct stones (CBDSs) and has been reported to have a high success rate for stone removal. However, EST is associated with a risk of bleeding, perforation, and sphincter of Oddi function disruption. To avoid these risks, endoscopic papillary balloon dilation (EPBD) is an option for CBDS. Sphincter of Oddi function preservation decreases long-term biliary infection and gallstone recurrence. EPBD may have advantages in children who require a long follow up. However, there have been few reports on pediatric cases, particularly in infants. Methods: From September 2017 to December 2023, we performed EPBD for four pediatric CBDSs. The patients were aged from 5 months to 8 years, including two infants aged 5 and 6 months. Furthermore, we reviewed the stone removal rate and complications of 545 ESTs performed at high-volume centers and 13 EPBD-reported cases in children with CBDSs. Results: CBDSs of all patients who underwent EPBD in our institution were successfully removed. No bleeding or perforation was noted; pancreatitis was observed in three patients. In an analysis of 545 ESTs in children, the stone removal rate was high, ranging from 83% to 100% (mean 96%). The incidence of pancreatitis was 0-9.6% (mean 4.4%), and the grade of pancreatitis was almost mild. The bleeding frequency was 1.3-5.4% (mean 2.7%). With regards to the grade of bleeding, seven cases were mild (64%) and four were moderate (36%). Compared with adults who underwent EST, the frequencies of pancreatitis and bleeding were almost equal in children; however, in children, once bleeding occurs, it has a higher risk of leading to blood transfusion. Stone removal via EPBD in children has a 100% success rate. Pancreatitis was responsible for all complications were related; its frequency was 46% (6/13 patients, including five mild cases and one moderate case), which is higher than that of EST and adult cases who underwent EPBD. In most children with pancreatitis, pancreatic enzyme levels returned to normal within 2-3 days following EPBD, and no severe cases caused by EPBD were reported. Conclusions: CBDS removal via EPBD in children has a high success rate with very low risk of bleeding and perforation. Although pancreatitis frequently occurs, most cases are mild. Sphincter of Oddi function preservation via EPBD is expected to prevent long-term stone recurrence and biliary tract infection, and EPBD is considered to be an effective method for CBDS removal in children.
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Affiliation(s)
- Katsunori Kouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University, Ohwadashinden 477-96, Yachiyo 276-8524, Japan
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University, Ohwadashinden 477-96, Yachiyo 276-8524, Japan
| | - Aki Matsuoka
- Department of Pediatric Surgery, Tokyo Women's Medical University, Ohwadashinden 477-96, Yachiyo 276-8524, Japan
| | - Kiyoaki Yabe
- Department of Pediatric Surgery, Tokyo Women's Medical University, Ohwadashinden 477-96, Yachiyo 276-8524, Japan
| | - Hiroko Yoshizawa
- Department of Pediatric Surgery, Tokyo Women's Medical University, Ohwadashinden 477-96, Yachiyo 276-8524, Japan
| | - Chikako Nakata
- Department of Pediatric Surgery, Tokyo Women's Medical University, Ohwadashinden 477-96, Yachiyo 276-8524, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Tokyo University, Hongou 7-3-1, Bunkyou-ku, Tokyo 113-8655, Japan
| | - Harutoshi Sugiyama
- Department of Gastroenterology, Tokyo Women's Medical University, 8-1 Shinjuku-ku, Tokyo 162-8666, Japan
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Tari E, Gagyi EB, Rancz A, Veres DS, Váncsa S, Hegyi PJ, Hagymási K, Hegyi P, Erőss B. Morphology of the papilla can predict procedural safety and efficacy of ERCP-a systematic review and meta-analysis. Sci Rep 2024; 14:7341. [PMID: 38538734 PMCID: PMC10973369 DOI: 10.1038/s41598-024-57758-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
Endoscopic Retrograde Cholangiopancreatography (ERCP) is the primary therapeutic procedure for pancreaticobiliary disorders, and studies highlighted the impact of papilla anatomy on its efficacy and safety. Our objective was to quantify the influence of papilla morphology on ERCP outcomes. We systematically searched three medical databases in September 2022, focusing on studies detailing the cannulation process or the rate of adverse events in the context of papilla morphology. The Haraldsson classification served as the primary system for papilla morphology, and a pooled event rate with a 95% confidence interval was calculated as the effect size measure. Out of 17 eligible studies, 14 were included in the quantitative synthesis. In studies using the Haraldsson classification, the rate of difficult cannulation was the lowest in type I papilla (26%), while the highest one was observed in the case of type IV papilla (41%). For post-ERCP pancreatitis, the event rate was the highest in type II papilla (11%) and the lowest in type I and III papilla (6-6%). No significant difference was observed in the cannulation failure and post-ERCP bleeding event rates between the papilla types. In conclusion, certain papilla morphologies are associated with a higher rate of difficult cannulation and post-ERCP pancreatitis.
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Affiliation(s)
- Edina Tari
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Endre Botond Gagyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Selye János Doctoral College for Advanced Studies, Semmelweis University, Budapest, Hungary
| | - Anett Rancz
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Dániel Sándor Veres
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pecs, Hungary
| | - Péter Jenő Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pecs, Hungary
| | - Krisztina Hagymási
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Surgery, Transplantation, and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pecs, Hungary
| | - Bálint Erőss
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.
- Institute for Translational Medicine, Medical School, University of Pécs, Pecs, Hungary.
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Manti M, Shah J, Papaefthymiou A, Facciorusso A, Ramai D, Tziatzios G, Papadopoulos V, Paraskeva K, Papanikolaou IS, Triantafyllou K, Arvanitakis M, Archibugi L, Vanella G, Hollenbach M, Gkolfakis P. Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:340. [PMID: 38399627 PMCID: PMC10890215 DOI: 10.3390/medicina60020340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
Choledocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10-15% of patients have complex biliary stones, requiring additional procedures for an optimum clinical outcome. A plethora of endoscopic methods is available for the removal of difficult biliary stones, including papillary large balloon dilation, mechanical lithotripsy, and electrohydraulic and laser lithotripsy. In-depth knowledge of these techniques and the emerging literature on them is required to yield the most optimal therapeutic effects. This narrative review aims to describe the definition of difficult bile duct stones based on certain characteristics and streamline their endoscopic retrieval using various modalities to achieve higher clearance rates.
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Affiliation(s)
- Magdalini Manti
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece; (M.M.); (G.T.); (K.P.)
| | - Jimil Shah
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Apostolis Papaefthymiou
- Endoscopy Unit, Cleveland Clinic London, London SW1X 7HY, UK;
- Department of Gastroenterology, General University Hospital of Larissa, 41110 Larissa, Greece;
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 00161 Foggia, Italy;
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA;
| | - Georgios Tziatzios
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece; (M.M.); (G.T.); (K.P.)
| | - Vasilios Papadopoulos
- Department of Gastroenterology, General University Hospital of Larissa, 41110 Larissa, Greece;
| | - Konstantina Paraskeva
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece; (M.M.); (G.T.); (K.P.)
| | - Ioannis S. Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine—Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece; (I.S.P.); (K.T.)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine—Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece; (I.S.P.); (K.T.)
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, University Hospital of Brussels (HUB), 1070 Brussels, Belgium;
| | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Vita-Salute San Raffaele University, 20132 Milan, Italy; (L.A.); (G.V.)
| | - Giuseppe Vanella
- Pancreato-Biliary Endoscopy and Endosonography Division, Vita-Salute San Raffaele University, 20132 Milan, Italy; (L.A.); (G.V.)
| | - Marcus Hollenbach
- Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, D-04103 Leipzig, Germany;
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, 14233 Athens, Greece; (M.M.); (G.T.); (K.P.)
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, University Hospital of Brussels (HUB), 1070 Brussels, Belgium;
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Li YY, Miao YS, Wang CF, Yan J, Zhou XJ, Chen YX, Li GH, Zhu L. Optimal dilation duration of 10 mm diameter balloons after limited endoscopic sphincterotomy for common bile duct stones: a randomized controlled trial. Sci Rep 2024; 14:971. [PMID: 38200057 PMCID: PMC10782008 DOI: 10.1038/s41598-023-50949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Limited endoscopic sphincterotomy (EST) combined with endoscopic papillary balloon dilation (EPBD) is widely used. However, the optimal duration of small balloon dilation in choledocholithiasis remains controversial. We aimed to determine the optimal duration for 10 mm diameter balloon dilation after limited EST in choledocholithiasis. In this randomized controlled clinical trial, 320 patients were randomly assigned to receive small balloon dilation (10 mm in diameter) for 1 min (n = 160) or 3 min (n = 160) after deep bile duct cannulation. No significant difference in success rate of stone extraction between the two groups was observed. The incidence of post-ERCP pancreatitis (PEP) was higher in the 1 min group (10.6%) than in the 3 min group (4.4%) (P = 0.034). The logistic regression analysis showed that guidewire into the pancreatic duct, cannulation time > 5 min and 1 min balloon dilation were independent risk factors for PEP. There were no significant differences in other post-ERCP adverse events such as acute cholangitis, bleeding, perforation, etc. between the two groups. In conclusion, 3 min in duration was determined to be the optimal dilation condition for the removal of common bile duct stones.
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Affiliation(s)
- Yuan-Yuan Li
- Department of Gastroenterology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yin-Shui Miao
- Department of Gastroenterology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Cai-Feng Wang
- Department of Gastroenterology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Jing Yan
- Department of Gastroenterology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Xiao-Jiang Zhou
- Department of Gastroenterology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - You-Xiang Chen
- Department of Gastroenterology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Guo-Hua Li
- Department of Gastroenterology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
| | - Liang Zhu
- Department of Gastroenterology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
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Gu J, Guo X, Sun Y, Fan B, Li H, Luo T, Luo H, Liu J, Gao F, Gao Y, Tan G, Liu X, Yang Z. Efficacy and complications of inoperable malignant distal biliary obstruction treatment by metallic stents: fully covered or uncovered? Gastroenterol Rep (Oxf) 2023; 11:goad048. [PMID: 37622087 PMCID: PMC10444961 DOI: 10.1093/gastro/goad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/09/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023] Open
Abstract
Obstructive jaundice caused by malignant distal biliary obstruction is a common clinical symptom in patients with inoperable biliary-pancreatic cancer. Endoscopic retrograde cholangiopancreatography (ERCP)-guided stent implantation is an effective treatment for obstructive jaundice. Internal stent drainage is more physiologic and associated with a better quality of life than external stent drainage methods such as percutaneous transhepatic gallbladder drainage or percutaneous transhepatic cholangiodrainage. Self-expanding metallic stents, which may be covered and uncovered, are commonly used. However, some uncertainties remain regarding the selection of metallic stents, including drainage patency time, clinical effect, stent migration, and post-operative complications such as pancreatitis, bleeding, and cholecystitis. This review aims to summarize the current progress and controversies surrounding the use of covered or uncovered metallic stents in inoperable common biliary obstruction via ERCP.
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Affiliation(s)
- Jiangning Gu
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, P. R. China
- Department of Hepatobiliary Surgery, The First affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Xiaoyi Guo
- Department of Hepatobiliary Surgery, The First affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Yong Sun
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, P. R. China
| | - Bin Fan
- Department of General Surgery, The First Hospital of Northwest University (Xi'an No. 1 Hospital), Xi'an, Shaanxi, P. R. China
| | - Haoran Li
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, P. R. China
| | - Ting Luo
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, P. R. China
| | - Haifeng Luo
- Department of Hepatobiliary Surgery, The First affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Jiao Liu
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, P. R. China
| | - Feng Gao
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, P. R. China
| | - Yuan Gao
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, P. R. China
| | - Guang Tan
- Department of Hepatobiliary Surgery, The First affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Xiaoming Liu
- Department of Anesthesiology, The First affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zhuo Yang
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, P. R. China
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Zobeiri M, Shavakhi A, Zobeiri M, Khodadoostan M, Shavakhi A. Risk factors for ERCP-related complications and what is the specific role of ASGE grading system. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023; 28:7. [PMID: 36974109 PMCID: PMC10039106 DOI: 10.4103/jrms.jrms_150_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 02/25/2023]
Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) is one of the main therapeutic and sometimes diagnostic methods in biliary and pancreatic diseases. A grading system for the difficulty of ERCP (grade one to four, the higher grade represents the more complexity of the procedure) has been developed by the American Society for Gastrointestinal Endoscopy (ASGE). This study aimed to assess the prevalence of ERCP-related complications, their common risk factors, and specifically the role of difficulty of the procedure based on ASGE grading. Material and Methods This cross-sectional study was performed on 620 ERCP-operated patients over 4 years in two tertiary referral centers affiliated with Isfahan University of Medical Sciences. Data about the difficulty of procedures based on the ASGE grading scale, complications including pancreatitis, bleeding, infection, perforation, arrhythmia, respiratory suppression, aspiration, and major common risk factors were collected. Results The overall prevalence of complications was 11.6% including pancreatitis 8.2%, perforation 0.8%, gastrointestinal bleeding 1.3%, cholangitis 2.4%, and cardiopulmonary problems 0.5% (arrhythmia 0.3% and respiratory depression 0.2%). Patients with pancreatic contrast injection (66.7% vs. 11.3% P = 0.04) and sphincter of Oddi dysfunction (SOD) (44.4% vs. 11.1%; P = 0.01) showed a statistically significant higher overall complication rate. The association of these risk factors remained significant in multivariable logistic regression analysis. Patients with pancreatic contrast injection also showed a statistically significant higher prevalence of post-ERCP pancreatitis (66.7% vs. 11.3% P = 0.04). Furthermore, a significantly higher prevalence of arrhythmia (3.6% vs. 0; P = 0.008) was observed among patients with difficult cannulation. Based on the ASGE difficulty grading score, most of the patients were classified as grade 2 (74.2%) and 3 and 4 (23.4%). No statistically significant difference was noted between the difficulty-based groups in terms of complications. Conclusion The current study showed that the most critical risk factors of ERCP-induced complications were pancreatic contrast injection and SOD. ASGE grading scale for ERCP complexity did not predict the occurrence of complications in our study population.
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Alhaddad O, Elsabaawy M, Kamal A, Edrees A, Mansour T. Combined surgical and intraoperative endoscopic rescue of a biliary incarcerated balloon dilator: a successful rescue in a fortunate patient. EGYPTIAN LIVER JOURNAL 2022; 12:6. [DOI: 10.1186/s43066-022-00172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 01/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Endoscopic papillary balloon dilatation (EPBD) is the second proposed maneuver for the endoscopic retrieval of common bile duct stones after endoscopic sphincterotomy (EST). Being less traumatic, EPBD is acknowledged for fewer procedure-related complications compared to (EST).
Case presentation
We present a 55-year-old lady, who was referred to the pancreato-biliary division, Gastrointestinal Endoscopy Unit, National Liver Institute, Menoufia University, for endoscopic management of a high likelihood of choledocholithiasis. Unfortunately, during the procedure, the balloon dilator was incarcerated inside the common bile duct (CBD) with failure of all endoscopic extraction trials. Because of the resultant cholangio-pancreatitis, the incarcerated inflated balloon had to be removed immediately. Open surgical rescue of the case in conjunction with the intraoperative endoscopic biliary stent deployment had made it possible to save the patient.
Conclusion
This case is one of the few reports of incarcerated balloon dilator during EPBD and failure of endoscopic retrieval, with subsequent acute pancreatitis/hepato-cholangitis, and gall bladder mucocele. Despite being a critical surgical candidate and owing to the attentive timely surgical intervention collaborated with the intra-operative endoscopic management, the case was fortunate.
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Long J, Li J, Liu L, Zhou X, Lu X. Analysis of Clinical Effects of Intubation and Sphincterotomy With Wire-guided Incision Knife Plus Balloon Dilatation in the Treatment of Choledocholithiasis: A Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech 2022; 32:558-563. [PMID: 36197121 DOI: 10.1097/sle.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND To investigate the clinical effects of intubation and sphincterotomy with wire-guided incision knife plus balloon dilatation (ISBD) in the treatment of choledocholithiasis, a randomized controlled trial was conducted. METHODS A total of 270 patients with choledocholithiasis confirmed by computed tomography or magnetic resonance imaging from January 2016 to July 2018 in our hospital were enrolled in the research. All patients were randomly divided into 3 groups: ISBD group, endoscopic sphincterotomy (EST) group, and endoscopic sphincterotomy plus balloon dilation group, respectively. The clinical effects, complications, and inflammation indexes of the 3 groups were detected. SPSS software was used for statistics and analysis of results. RESULTS There were no significant differences in basic characteristics of the 3 groups. Although there was no significant difference in the total stone clearance rate among the 3 groups, the first stone clearance rate and the large stone clearance rate in ISBD group were significantly higher than those in EST group. Compared with the other 2 groups, the total operation time and complications in ISBD group were significant lower. The serum levels of interleukin-6, C-reactive protein (CRP), procalcitonin (PCT), carbohydrate antigen 19-9, and carcinoembryonic antigen in ISBD group were significant lower than those in EST group, and CRP and PCT in ISBD group were markedly lower than those in endoscopic sphincterotomy plus balloon dilation group. CONCLUSIONS ISBD treatment simplifies the operation procedure, shortens the operation time, reduces postoperative inflammation and complications, and makes ERCP stone removal simpler, safer, and more efficient for patients with common bile duct stones.
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Affiliation(s)
| | - Jing Li
- Endocrinology, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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12
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Yu ZY, Liang C, Yang SY, Zhang X, Sun Y. The therapeutic effect of balloon dilatation with different duration for biliary duct calculi: A network meta-analysis. J Minim Access Surg 2022; 18:327-337. [PMID: 35708376 PMCID: PMC9306115 DOI: 10.4103/jmas.jmas_304_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To systematically evaluate the application effect of endoscopic papillary balloon dilatation (EPBD) with different balloon dilatation duration for biliary duct calculi, and find the most appropriate dilatation duration for EPBD using a network meta-analysis. Materials and Methods: PubMed, Embase and Cochrane Library databases were searched for relevant randomised controlled trials (RCTs) published up to August 2020. Node split, consistency and inconsistency models analysis were all conducted in network meta-analysis. Results: Eighteen RCTs with 2256 participants were finally analysed. EPBD was divided into four categories based on balloon dilatation duration, including EPBD (P0.5), EPBD (>0.5, ≤1), EPBD (1, ≤2) and EPBD (>2, ≤5). Compared with EPBD (>0.5, ≤1), EPBD (>2, ≤5) had a lower risk of early complications (odds ratio [OR] = 0.23, 95% credible interval [CI] = 0.05–0.96) and post-endoscopic procedure pancreatitis (PEP) (OR = 0.17, 95% CI = 0.03–0.72). Endoscopic sphincterotomy (EST) tended to have less need for mechanical lithotripsy (OR = 0.37, 95% CI = 0.16–0.88) and PEP (OR = 0.26, 95% CI = 0.08–0.71) than EPBD (>0.5, ≤1). EPBD (>2, ≤5) was the safest endoscopic procedure with respect to early complications (surface area under cumulative ranking curves [SUCRA] = 79.0) and PEP (SUCRA = 85.3). In addition, EPBD (>2, ≤5) and EST had the highest probability of being the best (SUCRA = 82.6) and the worst (SUCRA = 10.8), respectively, regarding late complications. Conclusion: EPBD and EST are two methods used to treat uncomplicated choledocholithiasis (stone diameter <10 mm and stone number <3). The extension of balloon dilatation duration has no significant influence on successful stone removal in the first endoscopic session or preventing the need for mechanical lithotripsy. However, it can reduce the risk of early complications, especially PEP. What's more, EPBD seems to have less late complications compared with EST, and the effect of prolonged balloon dilatation duration on late complications still needs to be further explored. Therefore, 2–5 min is the recommended dilatation duration range for EPBD using balloon with ≤10 mm diameter. Further research based on a specific population and with a longer follow-up time are needed.
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Affiliation(s)
- Zhi Yuan Yu
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chen Liang
- Difficult and Complicated Liver Diseases and Artificial Liver Center, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, You' an Hospital, Capital Medical University, Beijing, China
| | - Shi Yu Yang
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xu Zhang
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yan Sun
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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Single-operator peroral pancreatoscopy in the preoperative diagnostics of suspected main duct intraductal papillary mucinous neoplasms: efficacy and novel insights on complications. Surg Endosc 2022; 36:7431-7443. [PMID: 35277769 PMCID: PMC9485081 DOI: 10.1007/s00464-022-09156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/18/2022] [Indexed: 11/20/2022]
Abstract
Background Distinguishing intraductal papillary mucinous neoplasms (IPMNs) from other pancreatic cystic lesions is essential since IPMNs carry the risk of becoming malignant. Differentiating the main pancreatic duct involving IPMNs (MD-IPMNs) through conventional imaging is deficient. Single-operator peroral pancreatoscopy (SOPP) represents a promising method offering additional information on suspected lesions in the pancreatic main duct (MD). We aimed to determine the role of SOPP in the preoperative diagnostics of suspected MD-IPMNs and identify factors contributing to SOPP-related complications. Materials and Methods In this primarily retrospective study, SOPPs were performed at three high-volume centers on suspected MD-IPMNs. Primary outcome was the clinical impact of SOPP to subsequent patient care. Additionally, we documented post-SOPP complications and analyzed several assumed patient- and procedure-related risk factors. Results One hundred and one (101) SOPPs were performed. Subsequent clinical management was affected due to the findings in 86 (85%) cases. Surgery was planned for 29 (29%) patients. A condition other than IPMN explaining MD dilatation was found in 28 (28%) cases. In 35 (35%) cases, follow-up with MRI was continued. Post-SOPP pancreatitis occurred in 20 (20%) patients and one of them was fatal. A decrease in odds of post-SOPP pancreatitis was seen as the MD diameter increases (OR 0.714 for 1.0 mm increase in MD diameter, CI 95% 0.514–0.993, p = 0.045). Furthermore, a correlation between lower MD diameter values and higher severity post-SOPP pancreatitis was seen (TJT = 599, SE = 116.6, z = − 2.31; p = 0.020). History of pancreatitis after endoscopic retrograde cholangiopancreatography was a confirmed risk factor for post-SOPP pancreatitis. Conclusions between complications and other risk factors could not be drawn. Conclusion SOPP aids clinical decision-making in suspected MD-IPMNs. Risk for post-SOPP pancreatitis is not negligible compared to non-invasive imaging methods. The risk for pancreatitis decreases as the diameter of the MD increases.
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Cheng C, Tang K, Cheng S, Fang H, Shiue S, Suk F, Lien G, Wu M. Comparison of endoscopic papillary large‐balloon dilatation with endoscopic sphincterotomy in clearing large common bile duct stones: A systematic review and meta‐analysis of randomized controlled trials. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chao‐Ling Cheng
- Graduate Institute of Clinical Medicine, College of Medicine Taipei Medical University Taipei Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Kung‐Pei Tang
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Sheng‐Wei Cheng
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Hua‐Chen Fang
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Sheng‐Jie Shiue
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Fat‐Moon Suk
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Gi‐Shih Lien
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Ming‐Shun Wu
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
- Integrative Therapy Center for Gastroenterologic Cancers, Wan Fang Hospital Taipei Medical University Taipei Taiwan
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15
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Nakai Y, Kusumoto K, Itokawa Y, Inatomi O, Bamba S, Doi T, Kawakami T, Suzuki T, Suzuki A, Endoh B, Chikugo K, Mizumoto Y, Tanaka K. Emergency Endoscopic Retrograde Cholangiopancreatography Did Not Increase the Incidence of Postprocedural Pancreatitis Compared With Elective Cases: A Prospective Multicenter Observational Study. Pancreas 2022; 51:41-47. [PMID: 35195594 PMCID: PMC8865204 DOI: 10.1097/mpa.0000000000001958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/06/2021] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to identify the incidence of and risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after emergency endoscopic retrograde cholangiopancreatography (ERCP). METHODS We performed a prospective multicenter observational study of 3914 patients who underwent ERCP. We compared the incidence of PEP after emergency and elective ERCP. RESULTS A total of 3410 patients were enrolled in this study. Post-ERCP pancreatitis occurred in 44 of 800 patients (5.5%) and in 190 of 2418 patients (7.9%) in the emergency and elective groups, respectively. No significant difference was noted between the groups (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.52-1.03; P = 0.07). Multivariate analysis showed that the following factors increased the risk for PEP after emergency ERCP: contrast medium injection into the pancreatic duct (OR, 2.56; 95% CI, 1.30-5.03; P = 0.005), >4 cannulation attempts (OR, 5.72; 95% CI, 2.61-12.50; P < 0.001), and endoscopic papillary balloon dilatation (OR, 9.24; 95% CI, 2.13-40.10; P < 0.001). CONCLUSIONS No significant difference was noted in the incidence of PEP in patients after emergency and elective ERCP. We may prevent PEP even after emergency ERCP by avoiding contrast injection into the pancreatic duct, multiple cannulation attempts, and endoscopic papillary balloon dilatation.
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Affiliation(s)
- Yoshitaka Nakai
- From the Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto
| | - Kiyonori Kusumoto
- From the Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto
| | - Yoshio Itokawa
- From the Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto
| | - Osamu Inatomi
- Division of Gastroenterology, Department of Medicine
| | - Shigeki Bamba
- Division of Clinical Nutrition, Shiga University of Medical Science, Shiga
| | - Toshifumi Doi
- Department of Gastroenterology, Kyoto First Red Cross Hospital
| | - Takumi Kawakami
- Department of Gastroenterology, Kyoto First Red Cross Hospital
| | - Takahiro Suzuki
- Department of Gastroenterology, Kyoto First Red Cross Hospital
| | - Azumi Suzuki
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
| | - Bunji Endoh
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koki Chikugo
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yoshinori Mizumoto
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital
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16
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Zhu F, Guan Y, Wang J. Efficacy and safety of the rotatable sphincterotome during ERCP in patients with prior Billroth II gastrectomy (with videos). Surg Endosc 2021; 35:4849-4856. [PMID: 33733322 DOI: 10.1007/s00464-021-08417-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Selective biliary cannulation (SBC) is currently accepted as the first challenge of endoscopic retrograde cholangiopancreatography (ERCP), especially in patients with altered anatomy such as Billroth II gastrectomy. A rotatable sphincterotome (RS) might be considered useful for guiding the directional axis of SBC. This study aimed to evaluate the efficacy and safety of RS for biliary cannulation in patients with prior Billroth II gastrectomy. METHODS This is a retrospective cohort study conducted to compare the efficacy and safety between RS (RS group) and conventional sphincterotome of pulling arciform knife (PAF, PAF group). The success rate of SBC and endoscopic sphincterotomy (EST) were evaluated in both the groups. Moreover, the outcomes of the procedure and adverse events were also compared between the two groups. RESULTS Eighty-six consecutive prior Billroth II gastrectomy patients who underwent ERCP with RS or PAF during the study period were enrolled. After excluding 7 patients, there were 41 patients in the RS group and 38 in the PAF group. The baseline characteristics were similar in both the groups. There was no significant difference in the clinical success rates of SBC in RS group (95.12%) versus PAF group (84.21%), (P = 0.1082). Successful SBC within 5 min was 87.80% in RS group and 23.68% in PAF group (P < 0.0001). The success rate of EST was 89.74% in RS group and 28.13% in PAF group (P < 0.0001). The incidence of post-ERCP pancreatitis (PEP) showed significant differences between RS (2.44%) and PAF groups (21.05%; P = 0.0061). CONCLUSIONS Although RS has comparable success rates of SBC over PAF in patients with prior Billroth II gastrectomy, RS has facilitated the procedure by increasing the success rate of EST and SBC within 5 min, and the incidence of PEP was lowered as well.
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Affiliation(s)
- Feng Zhu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Pudong New District, Shanghai, 200120, China.
| | - Yaping Guan
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Pudong New District, Shanghai, 200120, China
| | - Jing Wang
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Pudong New District, Shanghai, 200120, China
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Best Procedure for the Management of Common Bile Duct Stones via the Papilla: Literature Review and Analysis of Procedural Efficacy and Safety. J Clin Med 2020; 9:jcm9123808. [PMID: 33255554 PMCID: PMC7760048 DOI: 10.3390/jcm9123808] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Endoscopic management of common bile duct stones (CBDS) is standard; however, various techniques are performed via the papilla, and the best procedure in terms of both efficacy and safety has not been determined. Methods: Endoscopic procedures were classified into five categories according to endoscopic sphincterotomy (EST) and balloon dilation (BD): (1) EST, (2) endoscopic papillary BD (≤10 mm) (EPBD), (3) EST followed by BD (≤10 mm) (ESBD), (4) endoscopic papillary large BD (≥12 mm) (EPLBD), and (5) EST followed by large BD (≥12 mm) (ESLBD). We performed a literature review of prospective and retrospective studies to compare efficacy and adverse events (AEs). Each procedure was associated with different efficacy and AE profiles. Results: In total, 19 prospective and seven retrospective studies with a total of 3930 patients were included in this study. For EST, the complete stone removal rate at the first session, rate of mechanical lithotripsy (ML), and rate of overall AEs in EST were superior to EPBD, but a higher rate of bleeding was found for EST. Based on one retrospective study, complete stone removal rate at the first session, rate of ML, and rate of overall AEs were superior for ESBD vs. EST, and the rate of bleeding for the former was also lower. Complete stone removal rate at the first session and rate of ML for ESLBD were superior to those for EST, with no significant difference in rate of AEs. For EST vs. EPLBD, complete stone removal rate at the first session and rate of ML were superior for the latter. For EPLBD vs. ESLBD, the efficacy and safety were similar. Conclusions: ESBD is considered the best procedure for the management of small CBDS, but strong evidence is lacking. For large CBDS, both ESLBD and EPLBD are similar.
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Morishita K, Sasaki H. Surgical procedure for unexpected balloon burst complication during endoscopic balloon dilatation in a patient with common bile duct stones. Surg Case Rep 2020; 6:258. [PMID: 33006680 PMCID: PMC7532242 DOI: 10.1186/s40792-020-01014-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/21/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Endoscopic balloon dilatation (EBD) is the established treatment for common bile duct (CBD) stones. Although pancreatitis and bleeding have been reported as major complications of EBD, balloon-related complications are rarely reported in EBD. CASE PRESENTATION A 30-year-old woman with suspected CBD stones underwent endoscopic retrograde cholangiopancreatography (ERCP) and EBD. During EBD, the balloon of the EBD catheter suddenly burst at the biliary sphincter. We therefore performed surgical intervention: removal of the broken EBD catheter and T-tube drainage. Finally, the patient was discharged without any complications. CONCLUSIONS We present a case involving a burst balloon of an EBD catheter as a rare complication during EBD, as well as the surgical technique that was used to treat this complication.
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Affiliation(s)
- Koji Morishita
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Hideaki Sasaki
- Department of Emergency Medicine, Okinawa Red Cross Hospital, Okinawa, Japan
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Chen PH, Tung CF, Peng YC, Yeh HZ, Chang CS, Chen CC. Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study. BMC Gastroenterol 2020; 20:310. [PMID: 32988368 PMCID: PMC7520951 DOI: 10.1186/s12876-020-01455-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications. Methods A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis. Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.
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Affiliation(s)
- Po-Han Chen
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Taiwan Boulevard, Taichung, 40705, Taiwan
| | - Chun-Fang Tung
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Taiwan Boulevard, Taichung, 40705, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Chung Peng
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Taiwan Boulevard, Taichung, 40705, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Taiwan Boulevard, Taichung, 40705, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Taiwan Boulevard, Taichung, 40705, Taiwan
| | - Chia-Chang Chen
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Taiwan Boulevard, Taichung, 40705, Taiwan.
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20
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Ishii S, Fujisawa T, Ushio M, Takahashi S, Yamagata W, Takasaki Y, Suzuki A, Okawa Y, Ochiai K, Tomishima K, Kanazawa R, Saito H, Shiina S, Isayama H. Evaluation of the safety and efficacy of minimal endoscopic sphincterotomy followed by papillary balloon dilation for the removal of common bile duct stones. Saudi J Gastroenterol 2020; 26:290342. [PMID: 32719239 PMCID: PMC8019135 DOI: 10.4103/sjg.sjg_162_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/03/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIM A sufficiently open papilla is needed to remove common bile duct stones (CBDS) but endoscopic sphincterotomy (EST) requires a high level of skill and is difficult with endoscopic papillary balloon dilation (EPBD). The main adverse event of EST is bleeding and perforation and that of EPBD is post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. To reduce these adverse events we employed minimal EST followed by papillary dilation (ESBD), and retrospectively evaluated its efficacy and safety compared with EST. PATIENTS AND METHODS CBDS patients who underwent EST (n = 114) or ESBD (n = 321) at Juntendo University Hospital from January 2009 to December 2018 were consecutively enrolled, retrospectively. The exclusion criteria were large-balloon dilation (≥ 12 mm), large CBDS (>12 mm), and previous EST/EPBD. We compared the overall stone removal rate, incidence of adverse event, procedure time, number of ERCP procedures, and rate of mechanical lithotripsy (ML) between the two groups. RESULTS Complete stone removal was successful in both ESBD and EST group. However, the rate of multiple ERCP sessions was significantly lower (35.1% vs. 12.8%, P < 0.001), procedure time was shorter (31.6 vs. 25.8 min, P = 0.01), and rate of ML was lower (16.7% vs. 7.8%, P = 0.01) in ESBD group. Bleeding was significantly more frequent in the EST group (9.6% vs. 1.2%, P < 0.001), particularly acute bleeding (7.9% vs. 0.9%, P < 0.001). CONCLUSIONS ESBD is more efficient and safer in the management of CBD stones than EST. A prospective randomized study comparing ESBD with EST is needed to establish this combination technique.
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Affiliation(s)
- Shigeto Ishii
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Toshio Fujisawa
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Mako Ushio
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Sho Takahashi
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Wataru Yamagata
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Takasaki
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Akinori Suzuki
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshihiro Okawa
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazushige Ochiai
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ko Tomishima
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryo Kanazawa
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
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21
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Matsubayashi CO, Ribeiro IB, de Moura DTH, Brunaldi VO, Bernardo WM, Hathorn KE, de Moura EGH. Is Endoscopic Balloon Dilation Still Associated With Higher Rates of Pancreatitis?: A Systematic Review and Meta-Analysis. Pancreas 2020; 49:158-174. [PMID: 32049951 DOI: 10.1097/mpa.0000000000001489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The objective of this study was to compare the efficacy and safety of endoscopic papillary balloon dilation (EPBD), endoscopic sphincterotomy (ES), and the combination of large balloon dilation and ES (ES + EPLBD) in the treatment of common bile duct stones, with a special focus on postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials (RCTs) which evaluated at least one of the following outcomes: PEP, complete stone removal in the first ERCP, need for mechanical lithotripsy, recurrence of common bile duct stones, bleeding, and cholangitis. Twenty-five RCTs were selected for analysis. Pancreatitis rates were higher for EPBD than for ES (P = 0.003), as were severe pancreatitis rates (P = 0.04). However, in the 10-mm or greater balloon subgroup analysis, this difference was not shown (P = 0.82). Rates of PEP were higher in the subgroup of non-Asian subjects (P = 0.02), and the results were not robust when RCTs that used endoscopic nasobiliary drainage were omitted. The incidence of pancreatitis was comparable between EPLBD and ES + EPLBD. All 3 approaches were equally efficacious. Nevertheless, the results should be interpreted with caution, because pancreatitis is a multifactorial pathology, and RCTs can have limited generalizability.
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Affiliation(s)
- Carolina Ogawa Matsubayashi
- From the Gastrointestinal Endoscopy Unit, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Igor Braga Ribeiro
- From the Gastrointestinal Endoscopy Unit, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Vitor Ottoboni Brunaldi
- From the Gastrointestinal Endoscopy Unit, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Wanderley Marques Bernardo
- From the Gastrointestinal Endoscopy Unit, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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22
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Risks of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis and Hyperamylasemia After Endoscopic Papillary Balloon Dilation: A Retrospective Analysis. Surg Laparosc Endosc Percutan Tech 2019; 29:280-284. [PMID: 30870313 DOI: 10.1097/sle.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is currently unclear whether endoscopic papillary balloon dilation (EPBD) is associated with increased severe postendoscopic retrograde cholangiopancreatography pancreatitis (PEP)-related morbidity owing to conflicting reports. This study aimed to investigate whether EPBD increases the risk of PEP and hyperamylasemia. Clinical data of patients with choledocholithiasis, treated at the Second Affiliated Hospital of Harbin Medical University from January 2015 to December 2016 were analyzed. Patients were divided into the EPBD group and endoscopic sphincterotomy (EST)+EPBD group, and their characteristics and PEP and hyperamylasemia incidences were compared. Incidences related to dilated balloon diameter were also analyzed. There were no significant differences in patient characteristics and the incidences of PEP (2.6% vs. 0%; P=0.257) and hyperamylasemia (4.4% vs. 5.6%; P=0.954) between the 2 groups. Results were similar even with different balloon dilatations. EPBD without endoscopic sphincterotomy did not increase the risk of PEP and hyperamylasemia. It is a safe option for choledocholithiasis patients.
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23
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Liu P, Lin H, Chen Y, Wu YS, Tang M, Lai L. Comparison of endoscopic papillary large balloon dilation with and without a prior endoscopic sphincterotomy for the treatment of patients with large and/or multiple common bile duct stones: a systematic review and meta-analysis. Ther Clin Risk Manag 2019; 15:91-101. [PMID: 30666119 PMCID: PMC6331186 DOI: 10.2147/tcrm.s182615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim To compare endoscopic papillary large balloon dilation (EPLBD) alone with EPLBD following endoscopic sphincterotomy (EST) in patients with large and/or multiple common bile duct stones. Methods We conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library database to identify relevant available articles until July 19, 2018. Complete common bile duct stone (CBDS) removal rate, frequency of mechanical lithotripsy (ML) usage, total procedure time and intra- and postoperative adverse events were analyzed. We used RevMan 5.3 to perform the pooled analyses. Results Seven RCTs matched the selection criteria. A total of 369 patients underwent EPLBD alone, and 367 patients underwent EPLBD following EST. Our meta-analysis revealed that there were no significant differences in terms of initial success rate (OR =0.69, 95% CI=0.44–1.09, P=0.11), frequency of ML usage (OR =1.18, 95% CI=0.68–2.05, P=0.55), rate of post-endoscopy pancreatitis (PEP) (OR =0.88, 95% CI=0.43–1.78, P=0.72), total procedure time (MD =1.52, 95% CI=-0.13–3.17, P=0.07), or other intra- and postoperative adverse events between the groups for patients with large and/or multiple CBDSs. Conclusions EPLBD alone was comparable to EPLBD with prior EST in patients with large and/or multiple CBDSs. Further studies are required to confirm the mechanisms of PEP in patients who accept EPLBD during endoscopic retrograde cholangiopancreatography (ERCP).
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Affiliation(s)
- Pan Liu
- Department of Hepatobiliary Surgery, The First People's Hospital of Neijiang, Sichuan, People's Republic of China,
| | - Huapeng Lin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, People's Republic of China
| | - Yuanyuan Chen
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yu-Shen Wu
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Maocai Tang
- Department of Gastrointestinal Surgery, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Liang Lai
- Department of Hepatobiliary Surgery, The First People's Hospital of Neijiang, Sichuan, People's Republic of China,
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24
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Zulli C, Grande G, Tontini GE, Labianca O, Geraci G, Sciumè C, Antypas P, Fiocca F, Manes G, Devani M, Manta R, Maurano A. Endoscopic papillary large balloon dilation in patients with large biliary stones and periampullary diverticula: Results of a multicentric series. Dig Liver Dis 2018; 50:828-832. [PMID: 29709460 DOI: 10.1016/j.dld.2018.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Stone extraction represents the most frequent indication for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic papillary large balloon dilation (EPLBD) is a recent introduced approach consisting of an endoscopic papillary large balloon dilation following limited endoscopic sphyncterotomy (ES), which has been proven to be safe and effective for extraction of large common bile duct (CBD) stones. Peri-ampullary diverticula (PAD) are described in 10-20% of patients undergoing ERCP. Aim of our study is to evaluate efficacy and safety of EPLBD for the extraction of large biliary stones in patients with PAD. METHODS The prospectively collected endoscopy databases of 4 Italian ERCP high-volume centers were reviewed retrospectively, and all consecutive patients with an instrumental diagnosis of large biliary stones and PAD, between September 2014 and October 2016, were included in this study. RESULTS Eighty-one patients (36 males, median age 75 years) were treated between September 2014 and October 2016. Deep biliary cannulation was reached in 78/80 patients. Successful extraction was achieved in 74/78 patients at the first attempt. AEs occurred in 8 patients (1 severe). Younger age, stone size and incomplete stone extraction were significantly associated with AEs. CONCLUSIONS EPLBD is an effective and safe technique in patients with PAD and large biliary stones, which avoids the need of other techniques, thereby reducing the risks of adverse events.
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Affiliation(s)
- Claudio Zulli
- Digestive Endoscopy Unit, University Hospital G. Fucito, Ruggi d'Aragona, Salerno, Italy
| | - Giuseppe Grande
- Department of Gastroenterology and Digestive Endoscopy Unit, OCSAE Hospital, Modena, Italy.
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Orazio Labianca
- Digestive Endoscopy Unit, University Hospital G. Fucito, Ruggi d'Aragona, Salerno, Italy
| | - Girolamo Geraci
- Section of General and Thoracic Surgery, School of Medicine, University Hospital "Paolo Giaccone" of Palermo, Palermo, Italy
| | - Carmelo Sciumè
- Section of General and Thoracic Surgery, School of Medicine, University Hospital "Paolo Giaccone" of Palermo, Palermo, Italy
| | - Pavlos Antypas
- Emergency Endoscopy Unit, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Fausto Fiocca
- Emergency Endoscopy Unit, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Gianpiero Manes
- Department of Gastroenterology "Salvini" Hospital, Garbagnate, Milan, Italy
| | - Massimo Devani
- Department of Gastroenterology "Salvini" Hospital, Garbagnate, Milan, Italy
| | - Raffaele Manta
- Department of Gastroenterology and Digestive Endoscopy Unit, OCSAE Hospital, Modena, Italy
| | - Attilio Maurano
- Digestive Endoscopy Unit, University Hospital G. Fucito, Ruggi d'Aragona, Salerno, Italy
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25
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Abstract
PURPOSE OF REVIEW In 10-15% of the cases, conventional methods for removing bile duct stones by ERCP/balloon-basket extraction fail. The purpose of this review is to describe endoscopic techniques in managing these "difficult bile duct stones." RECENT FINDINGS Endoscopic papillary large balloon dilation with balloon extraction ± mechanical lithotripsy is the initial approach used to retrieve large bile duct stones. With advent of digital cholangioscopy, electrohydraulic and laser lithotripsy are gaining popularity. Enteroscopy-assisted or laparoscopic-assisted approaches can be used for those with gastric bypass anatomy. Difficulties in removing bile duct stones can be related to stone-related factors such as the size and location of the stone or to altered anatomy such as stricture in the bile duct or Roux-en-Y anatomy. Several endoscopy approaches and techniques have described in the recent past that have greatly enhanced our ability to remove these "difficult" bile duct stones.
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Affiliation(s)
- Murad Aburajab
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200, West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Kulwinder Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200, West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
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26
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Feng J, Cui NQ, Cai W, Li C, Zheng MW, Zhang C. Papillary balloon dilatation combined with endoscopic sphincterotomy for treatment of common bile duct stones: Efficacy and factors affecting stone recurrence. Shijie Huaren Xiaohua Zazhi 2018; 26:263-269. [DOI: 10.11569/wcjd.v26.i4.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy of endoscopic papillary balloon dilatation (EPBD) combined with endoscopic sphincterotomy (EST) in the treatment of common bile duct stones and to identify the factors affecting the recurrence of stones.
METHODS One hundred patients with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) at our hospital between January 2014 and January 2016 were randomly divided into a control group and an experimental group. The patients in the control group and experimental group were given EST lithotomy and small-incision endoscopic sphincterotomy (SEST) combined with EPBD, respectively. The one-time success rate, total success rate, and the incidence of complications after ERCP were comparatively analyzed. The Kaplan-Meier survival curve of patients with postoperative stone recurrence was plotted, and the Cox regression model was used to explore the risk factors for postoperative recurrence in patients.
RESULTS The maximum diameter of the stones (t = -1.055, P = 0.294), the rate of multiple stones (χ2 = 0.644, P = 0.422), the maximum diameter of bile duct (t = -0.820, P = 0.414), and the stone removal success rate (94.0% and 100.0%, χ2 = 1.375, P = 0.241) differed significantly between the control group and the experimental group. There was no significant difference in the one-time success rate between the control group and the experimental group (84.0% and 96.0%, χ2 = 4.332, P = 0.037). The incidence of complications after ERCP in the control group and experimental group was 17.02% and 6.0%, respectively (χ2 = 4.337, P = 0.036). A total of 97 patients were followed, with stone recurrence occurring in 11 cases. In the 97 patients followed, the incidence of complications after ERCP in the control group and experimental group was 17.02% and 6.0%, respectively (χ2 = 2.927, P = 0.087). Log-rank test showed that the risk of gallstone recurrence in the experimental group was significantly lower than that in the control group (HR = 0.285, 95%CI: 0.095-0.888, P = 0.044). Multivariate Cox regression analysis showed that multiple endoscopic procedures, common bile duct angulation (≤ 145°), and EST were risk factors for ERCP recurrence.
CONCLUSION The success rate and safety of EPBD combined with LEST in the management of common bile duct stones are high, and the risk of long-term stone recurrence is low. Multiple endoscopic operations and common bile duct angulation (≤ 145°) are risk factors for stone recurrence.
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