New common bile duct morphological subtypes:Risk predictors of common bile duct stone recurrence

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is the primary treatment for removing common bile duct(CBD)stones.The risk factors for CBD stone recurrence after ERCP have been discussed for many years.However,the influence of CBD morphology has never been noticed.AIM To evaluate CBD morphology and other predictors affecting CBD stone recurrence in average patients.METHODS A retrospective analysis of 502 CBD stone patients who underwent successful therapeutic ERCP for stone extraction at our centre from February 2020 to January 2021 was conducted.CBD morphology and other predictors affecting CBD stone recurrence were examined by univariate analysis and multivariate logistic regression analysis.RESULTS CBD morphology(P<0.01),CBD diameter≥1.5 cm[odds ratio(OR)=2.20,95%CI:1.08-4.46,P=0.03],and endoscopic biliary sphincterotomy with balloon dilation(ESBD)(OR=0.35,95%CI:0.17-0.75,P<0.01)are three independent risk factors for CBD stone recurrence.Furthermore,the recurrence rate of patients with the S type was 6.61-fold that of patients with the straight type(OR=6.61,95%CI:2.61-16.77,P<0.01).The recurrence rate of patients with the polyline type was 2.45-fold that of patients with the straight type(OR=2.45,95%CI:1.14-5.26,P=0.02).The recurrence rate of S type patients was 2.70-fold that of patients with the polyline type(OR=2.70,95%CI:1.08-6.73,P=0.03).Compared with no-ESBD,ESBD could decrease the risk of recurrence.CONCLUSION CBD diameter≥1.5 cm and CBD morphology,especially S type and polyline type,were associated with increased recurrence of CBD stones.In addition,ESBD was related to decreased recurrence.Patients with these risk factors should undergo periodic surveillance and standard prophylactic therapy.

Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is the primary choice for removing common bile duct(CBD)stones in Billroth II anatomy patients.The recurrence of CBD stones is still a challenging problem.AIM To evaluate CBD morphology and other predictors affecting CBD stone recurrence.METHODS A retrospective case-control analysis was performed on 138 CBD stones patients with a history of Billroth II gastrectomy,who underwent therapeutic ERCP for stone extraction at our center from January 2011 to October 2020.CBD morphology and other predictors affecting CBD stone recurrence were examined by univariate analysis and multivariate logistic regression analysis.RESULTS CBD morphology(P<0.01)and CBD diameter≥1.5 cm(odds ratio[OR]=6.15,95%confidence interval[CI]:1.87-20.24,P<0.01)were the two independent risk factors.In multivariate analysis,the recurrence rate of patients with S type was 16.79 times that of patients with straight type(OR=16.79,95%CI:4.26-66.09,P<0.01),the recurrence rate of patients with polyline type was 4.97 times that of patients with straight type(OR=4.97,95%CI:1.42-17.38,P=0.01),and the recurrence rate of S type patients was 3.38 times that of patients with polyline type(OR=3.38,95%CI:1.07-10.72,P=0.04).CONCLUSION CBD morphology,especially S type and polyline type,is associated with increased recurrence of CBD stones in Billroth II anatomy patients.

应用二氧化氯气体消毒消化内镜的初步研究（英文）

目的:以大型消化内镜中心控制消化内镜消毒成本的需求为牵引,评价二氧化氯气体应用于消化内镜消毒的可行性。创新点:首次研究了二氧化氯气体对细长管腔内部的消毒效果及其影响因素,并以此为基础研究了采用主动灌流方法的二氧化氯气体消毒消化内镜的原型机。方法:设计了一种聚四氟乙烯(PTFE)细长管腔实验装置(长2 m,内径1 mm),在其进气端、中部和出气端分别设置PTFE菌片容器。将含有PTFE菌片和细长管腔和置于平皿内的PTFE菌片装载于一种消毒实验原型机中,通过主动灌流使二氧化氯气体流过细长管腔,平皿内的PTFE菌片直接曝露于二氧化氯气体中,分别评价二氧化氯气体对PTFE细长管腔内壁和外壁的消毒效果。以萎缩芽孢杆菌为指示微生物,评价二氧化氯剂量(浓度与时间的乘积)、相对湿度、流过细长管腔的流量及有机干扰物对消毒效果的影响。同时使用实验原型机对8条消化内镜进行了实效验证实验。结论:实验结果表明,除了相对湿度、二氧化氯剂量和有机干扰物都显著影响二氧化氯气体的消毒效果外(图3、5和6),随着经过细长管腔流量的增大,二氧化氯气体对细长管腔内部的芽孢杀灭对数值有减小的趋势(图4)。按照本文设计的流程,应用实验原型机对8条消化内镜消毒后,未检出存活的微生物。应用二氧化氯气体消毒消化内镜时,其每条内镜的消毒剂成本小于3元人民币。