Nasobiliary drainage after endoscopic papillary balloon dilatation may prevent postoperative pancreatitis

AIM:To evaluate the necessity of endoscopic nasobiliary drainage(ENBD)catheter placement after clearance of common bile duct(CBD)stones.METHODS:Patients enrolled in this study were randomly divided into two groups,according to whether or not they received ENBD after the removal of CBD stones.Group 1(ENBD group)was then subdividedinto three groups:G1a patients received an endoscopic papillary balloon dilatation(EPBD),G1b patients received an endoscopic sphincterotomy(EST),and G1c patients received neither.Group 2(non-ENBD group)patients were also subdivided into three groups(G2a,G2b,and G2c),similar to Group 1.The maximum CBD diameter,the time for C-reactive protein(CRP)to normalize,levels of serum amylase,total serum bilirubin(TB)and alanine aminotransferase(ALT),and postoperative hospitalization duration(PHD)were measured.RESULTS:A total of 218 patients(139 males,79females),with an average age of 60.1±10.8 years,were enrolled in this study.One hundred and thirteen patients who received ENBD were included in Group 1,and 105patients who did not receive ENBD were included in Group 2.The baseline clinical characteristics were similar in both groups.There were no significant differences in post-endoscopic retrograde cholangiopancreatography(ERCP)-related complications when Groups 1 and 2 were compared.Seventy-seven patients underwent EPBD,and41 received an ENBD tube(G1a)and 36 did not(G2a).Seventy-three patients underwent EST,and 34 patients received an ENBD tube(G1b)and 39 did not(G2b).The remaining 68 patients underwent neither EPBD nor EST;of these patients,38 received an ENBD tube(G1c)and 30 did not(G2c).For each of the three pairs of subgroups(G1a vs G2a,G1b vs G2b,G1c vs G2c),there were no significant differences detected in the PHD or the time to normalization of CRP,TB and ALT.In the EPBD group,the incidence of post-ERCP pancreatitis,hyperamylasemia and overall patient complications was significantly higher for G2a(post-ERCP pancreatitis:6/36vs 0/41,P=0.0217;hyperamylasemia:11/36 vs 4/41,P=0.0215;overall patient complications:18/36 vs 7/41,P=0.0029).CONCLUSION:After successful CBD stone clearance,ENBD is only beneficial when an EPBD procedure hasbeen performed.

Minor endoscopic sphincterotomy followed by large balloon dilation for large choledocholith treatment

AIM To evaluate early and late outcomes of endoscopic papillary large balloon dilation(EPLBD) with minor endoscopic sphincterotomy(m EST) for stone removal.METHODS A total of 149 consecutive patients with difficult common bile duct(CBD) stones(diameter ≥ 10 mm or ≥ 3 stones) underwent conventional endoscopic sphincterotomy(EST) or m EST plus EPLBD from May 2012 to April 2016. Their demographic, laboratory and procedural data were collected, and pancreaticobiliary complications were recorded.RESULTS Sixty-nine(94.5%) of the patients in the EPLBD + m EST group and 64(84.2%) in the conventional EST group achieved stone clearance following the first session(P = 0.0421). The procedure time for EPLBD + m EST was shorter than for EST alone(42.1 ± 13.6 min vs 47.3 ± 11.8 min, P = 0.0128). The overall rate of early complications in the EPLBD + m EST group(11%) was lower than in the EST group(21.1%); however, the difference was not significant(P = 0.0938). The cumulative recurrence rate of cholangitis and CBD stones between the two groups was also similar. The procedure time was independently associated with post-endoscopic retrograde cholangiopancreatography pancreatitis(OR = 6.374, 95%CI: 1.193-22.624, P = 0.023), CBD stone diameter ≥ 16 mm(OR = 7.463, 95%CI: 2.705-21.246, P = 0.0452) and use of mechanical lithotripsy(OR = 9.913, 95%CI: 3.446-23.154, P = 0.0133) were independent risk factors for stone recurrence. CONCLUSION EPLBD with m EST is more effective than EST alone for difficult CBD stone removal, with shorter procedure time and fewer early complications.

New index to predict esophageal variceal bleeding in cirrhotic patients

AIM: To develop a safe, simple, noninvasive and affordable system to predict esophageal variceal bleeding (EVB) in decompensated cirrhosis patients.

Factors Influencing Dual Phase Steel Flanging Limit Punching

Based on pre punching to hot rolled martensitic and bainitic dual phase steels with similar elongation and work hardening index （n）, as well as similar thickness and hole expansion test using taper die, analysis of the hole expansion rate indicated significant difference in their flanging performance. The results indicated that mechanical property was not the only major factor that influenced flanging. Further analysis of the hole border microstructure, work hardening condition, and fracture property showed that the fracture property of sheets was the major factor that influenced flanging performance.