BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a premalignant biliarytype epithelial neoplasm with intraductal papillary or villous growth.Currently reported local palliative therapeutic modalities...BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a premalignant biliarytype epithelial neoplasm with intraductal papillary or villous growth.Currently reported local palliative therapeutic modalities,including endoscopic nasobiliary drainage,stenting and biliary curettage,endoscopic biliary polypectomy,percutaneous biliary drainage,laser ablation,argon plasma coagulation,photodynamic therapy,and radiofrequency ablation to relieve mechanical obstruction are limited with weaknesses and disadvantages.We have applied percutaneous transhepatic cholangioscopy(PTCS)-assisted biliary polypectomy(PTCS-BP)technique for the management of IPNB including mucin-hypersecreting cast-like and polypoid type tumors since 2010.AIM To assess the technical feasibility,efficacy,and safety of PTCS-BP for local palliative treatment of IPNB.METHODS Patients with mucin-hypersecreting cast-like or polypoid type IPNB and receiving PTCS-BP between September 2010 and December 2019 were included.PTCS-BP was performed by using a half-moon type snare with a soft stainless-steel wire,and the tumor was snared and resected with electrocautery.The primary outcome was its feasibility,indicated by technical success.The secondary outcomes were efficacy,including therapeutic success,curative resection,and clinical success,and safety.RESULTS Five patients(four with mucin-hypersecreting cast-like type and one with polypoid type IPNB)were included.Low-and high-grade intraepithelial neoplasia(HGIN)and recurrent IPNB with invasive carcinoma were observed in one,two,and two patients,respectively.Repeated cholangitis and/or obstructive jaundice were presented in all four patients with mucin-hypersecreting cast-like type IPNB.All five patients achieved technical success of PTCS-BP.Four patients(three with mucin-hypersecreting cast-like type and one with polypoid type IPNB)obtained therapeutic success;one with mucin-hypersecreting cast-like type tumors in the intrahepatic small bile duct and HGIN had residual tumors.All four patients with mucin-hypersecreting IPNB achieved clinical success.The patient with polypoid type IPNB achieved curative resection.There were no PTCS-BP-related serious adverse events.CONCLUSION PTCS-BP appears to be feasible,efficacious,and safe for local palliative treatment of both mucin-hypersecreting cast-like and polypoid type IPNB.展开更多
BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD...BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.展开更多
A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage...A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics, the fistula healed spontaneously without the need for further intervention.展开更多
AIM: To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs).
When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(E...When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(ESCP), percutaneous radiological therapy or surgery can be considered. Small case series reporting the initial experience with ESCP have been superseded by comprehensive reports of large cohorts. Although these reports are predominantly retrospective, they demonstrate that endoscopic ultrasound(EUS) guided biliary and pancreatic interventions are associated with high levels of technical and clinical success. The proce-dural complication rates are lower than those seen with percutaneous therapy or surgery. This article describes and discusses data published in the last five years relat-ing to EUS-guided biliary and pancreatic intervention.展开更多
目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆...目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆行胰胆管造影(ERCP)取石+ENGD治疗(ENGD组),另外25例行ERCP取石+经皮肝穿刺胆管引流(PTGD)(PTGD组),比较两组操作成功率、手术时间、并发症发生率、不良事件发生率、住院时间、治疗费用、患者满意度,以及二期腹腔镜胆囊切除(LC)手术时间、并发症发生率、腹腔引流管留置率及住院时间。结果 两组患者操作成功率均为100%。ENGD组和PTGD组在手术时间[(46.4±4.8)min vs (55.0±6.0)min]、治疗费用[(3.2±0.3)万元vs (3.5±0.3)万元]、患者满意度[5(5,5)分vs 4(4,5)分]方面的比较,差异具有统计学意义(P<0.05);ENGD组二期LC手术时间[(45.4±7.0)min vs (58.4±9.2)min]、并发症发生率[1(4.8%) vs 7(28.0%)]、腹腔引流管留置率[10(47.6%) vs 23(92.0%)]及住院时间[(3.6±0.7)d vs (4.7±0.6)d]均低于PTGD组,差异具有统计学意义(P<0.05)。结论 ENGD治疗胆总管结石合并急性化脓性胆囊炎安全、有效,患者满意度高,并能降低LC风险。展开更多
目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆...目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆管恶性肿瘤致梗阻性黄疸患者,采用简单随机分组方法,分为对照组和观察组,每组各45例。对照组患者采用PTCD治疗,观察组患者采用ERCP置入金属支架治疗。比较两组患者的住院天数、术后黄疸缓解率、术后腹痛、术后发热、支架通畅时间、术后并发症发生情况及总生存期等差异。结果观察组患者的住院天数[(12.53±3.98)d]较对照组[(18.77±4.26)d]明显缩短,差异具有统计学意义(P<0.01)。观察组和对照组患者的术后黄疸缓解率(93.33%vs.84.44%)和发热发生率(24.44%vs.33.33%)比较,差异均无统计学意义(P>0.05);观察组患者的术后腹痛发生率(8.89%)较对照组(31.11%)明显下降,差异具有统计学意义(P<0.05);观察组和对照组患者的腹痛消失时间(6.95±1.35 d vs.7.38±1.46 d)和体温恢复正常时间(2.48±0.69 d vs.2.74±0.83 d)比较,差异均无统计学意义(P>0.05)。观察组患者的支架通畅时间[(224.85±48.95)d]和总生存期[(331.14±46.84)d]较对照组[(157.89±42.16)d、(223.16±39.80)d]明显延长,差异具有统计学意义(P<0.01)。观察组患者的术后并发症总发生率(6.67%)较对照组(26.67%)明显降低,差异具有统计学意义(P<0.05)。结论对肝外胆管恶性肿瘤致梗阻性黄疸患者而言,ERCP置入金属支架与PTCD的效果相当,均可有效缓解胆道梗阻性黄疸。但相比于PTCD,ERCP置入金属支架治疗后胆道通畅时间延长,住院时间缩短,并发症发生率低,可促进患者肝功能恢复,延长生存时间,因此,ERCP置入金属支架治疗可作为临床治疗此类患者的一种安全、有效的方法。展开更多
文摘BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a premalignant biliarytype epithelial neoplasm with intraductal papillary or villous growth.Currently reported local palliative therapeutic modalities,including endoscopic nasobiliary drainage,stenting and biliary curettage,endoscopic biliary polypectomy,percutaneous biliary drainage,laser ablation,argon plasma coagulation,photodynamic therapy,and radiofrequency ablation to relieve mechanical obstruction are limited with weaknesses and disadvantages.We have applied percutaneous transhepatic cholangioscopy(PTCS)-assisted biliary polypectomy(PTCS-BP)technique for the management of IPNB including mucin-hypersecreting cast-like and polypoid type tumors since 2010.AIM To assess the technical feasibility,efficacy,and safety of PTCS-BP for local palliative treatment of IPNB.METHODS Patients with mucin-hypersecreting cast-like or polypoid type IPNB and receiving PTCS-BP between September 2010 and December 2019 were included.PTCS-BP was performed by using a half-moon type snare with a soft stainless-steel wire,and the tumor was snared and resected with electrocautery.The primary outcome was its feasibility,indicated by technical success.The secondary outcomes were efficacy,including therapeutic success,curative resection,and clinical success,and safety.RESULTS Five patients(four with mucin-hypersecreting cast-like type and one with polypoid type IPNB)were included.Low-and high-grade intraepithelial neoplasia(HGIN)and recurrent IPNB with invasive carcinoma were observed in one,two,and two patients,respectively.Repeated cholangitis and/or obstructive jaundice were presented in all four patients with mucin-hypersecreting cast-like type IPNB.All five patients achieved technical success of PTCS-BP.Four patients(three with mucin-hypersecreting cast-like type and one with polypoid type IPNB)obtained therapeutic success;one with mucin-hypersecreting cast-like type tumors in the intrahepatic small bile duct and HGIN had residual tumors.All four patients with mucin-hypersecreting IPNB achieved clinical success.The patient with polypoid type IPNB achieved curative resection.There were no PTCS-BP-related serious adverse events.CONCLUSION PTCS-BP appears to be feasible,efficacious,and safe for local palliative treatment of both mucin-hypersecreting cast-like and polypoid type IPNB.
文摘BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.
文摘A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics, the fistula healed spontaneously without the need for further intervention.
文摘AIM: To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs).
文摘When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(ESCP), percutaneous radiological therapy or surgery can be considered. Small case series reporting the initial experience with ESCP have been superseded by comprehensive reports of large cohorts. Although these reports are predominantly retrospective, they demonstrate that endoscopic ultrasound(EUS) guided biliary and pancreatic interventions are associated with high levels of technical and clinical success. The proce-dural complication rates are lower than those seen with percutaneous therapy or surgery. This article describes and discusses data published in the last five years relat-ing to EUS-guided biliary and pancreatic intervention.
文摘目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆行胰胆管造影(ERCP)取石+ENGD治疗(ENGD组),另外25例行ERCP取石+经皮肝穿刺胆管引流(PTGD)(PTGD组),比较两组操作成功率、手术时间、并发症发生率、不良事件发生率、住院时间、治疗费用、患者满意度,以及二期腹腔镜胆囊切除(LC)手术时间、并发症发生率、腹腔引流管留置率及住院时间。结果 两组患者操作成功率均为100%。ENGD组和PTGD组在手术时间[(46.4±4.8)min vs (55.0±6.0)min]、治疗费用[(3.2±0.3)万元vs (3.5±0.3)万元]、患者满意度[5(5,5)分vs 4(4,5)分]方面的比较,差异具有统计学意义(P<0.05);ENGD组二期LC手术时间[(45.4±7.0)min vs (58.4±9.2)min]、并发症发生率[1(4.8%) vs 7(28.0%)]、腹腔引流管留置率[10(47.6%) vs 23(92.0%)]及住院时间[(3.6±0.7)d vs (4.7±0.6)d]均低于PTGD组,差异具有统计学意义(P<0.05)。结论 ENGD治疗胆总管结石合并急性化脓性胆囊炎安全、有效,患者满意度高,并能降低LC风险。
文摘目的对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效。方法采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆管恶性肿瘤致梗阻性黄疸患者,采用简单随机分组方法,分为对照组和观察组,每组各45例。对照组患者采用PTCD治疗,观察组患者采用ERCP置入金属支架治疗。比较两组患者的住院天数、术后黄疸缓解率、术后腹痛、术后发热、支架通畅时间、术后并发症发生情况及总生存期等差异。结果观察组患者的住院天数[(12.53±3.98)d]较对照组[(18.77±4.26)d]明显缩短,差异具有统计学意义(P<0.01)。观察组和对照组患者的术后黄疸缓解率(93.33%vs.84.44%)和发热发生率(24.44%vs.33.33%)比较,差异均无统计学意义(P>0.05);观察组患者的术后腹痛发生率(8.89%)较对照组(31.11%)明显下降,差异具有统计学意义(P<0.05);观察组和对照组患者的腹痛消失时间(6.95±1.35 d vs.7.38±1.46 d)和体温恢复正常时间(2.48±0.69 d vs.2.74±0.83 d)比较,差异均无统计学意义(P>0.05)。观察组患者的支架通畅时间[(224.85±48.95)d]和总生存期[(331.14±46.84)d]较对照组[(157.89±42.16)d、(223.16±39.80)d]明显延长,差异具有统计学意义(P<0.01)。观察组患者的术后并发症总发生率(6.67%)较对照组(26.67%)明显降低,差异具有统计学意义(P<0.05)。结论对肝外胆管恶性肿瘤致梗阻性黄疸患者而言,ERCP置入金属支架与PTCD的效果相当,均可有效缓解胆道梗阻性黄疸。但相比于PTCD,ERCP置入金属支架治疗后胆道通畅时间延长,住院时间缩短,并发症发生率低,可促进患者肝功能恢复,延长生存时间,因此,ERCP置入金属支架治疗可作为临床治疗此类患者的一种安全、有效的方法。
