BACKGROUND Endoscopic sphincterotomy(EST) is widely regarded as the first choice in the management of common bile duct(CBD) stones. However, for some patients, this treatment is not possible. The percutaneous transhep...BACKGROUND Endoscopic sphincterotomy(EST) is widely regarded as the first choice in the management of common bile duct(CBD) stones. However, for some patients, this treatment is not possible. The percutaneous transhepatic balloon dilation(PTBD)technique has been suggested as an alternative but has yet to gain wide acceptance.AIM To review cases of PTBD for removing CBD stones and explore the safety and efficacy of this treatment.METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched EMBASE,PubMed, and Web of Science for cases of PTBD that underwent CBD stone removal from 1981 to January 2019. We analyzed all relevant articles available in full text. We extracted data on patient's age, gender, overall technique success rate, reasons for technique failure, and the presence and type of major and minor complications. We analyzed the data and reported the results in a table and text.Altogether, we retrieved 12 case series and 6 case reports, for a total of 1347 patients. Thirty cases were excluded due to a lack of patient data.RESULTS The overall technique success rate for removing a CBD stone was 98.5%(1327/1347) and 98.1%(109/111) for removing concurrent CBD and gallbladder stones. Based on available data(n = 1312), mean age of all patients(687 males and625 females) was 68.9 years. The total number of procedures in the remaining 1317 patients(after exclusion) was 3237(average 2.4 procedures per patient). The total number of failures for eliminating a CBD stone was 20, and the reasons for failure included: Stone impaction(n = 10), intrahepatic bile duct stricture(n = 5),large stone(n = 2), severe CBD dilation(n = 1), multiple stones(n = 1), and duodenal perforation(n = 1). Various major complications related to the procedure were reported, but the incidence rate was low(1.4%). No pancreatitis or procedure related mortality was reported. Minor complications including transient hyperamylasemia, nausea, vomiting, abdominal pain, fever, and mild hemobilia were reported. For 218 patients(88 patients with unsuccessful endoscopic removal due to anatomical change and large or impacted stone and130 cases who refused endoscopic procedure due to poor general condition or other additional disease), the CBD stones were successfully pushed into the duodenum by performing the PTBD procedure.CONCLUSION PTBD is a safe and effective approach in the nonoperative management of CBD stones. PTBD provides an alternative treatment when endoscopic procedures fail or are unsuitable for the patient.展开更多
Bacteria play an important role in the formation of primary Common Bile Duct(CBD)stones.However,the composition and function of the microbiota of bile duct in patients with primary CBD stones remained to be explored.W...Bacteria play an important role in the formation of primary Common Bile Duct(CBD)stones.However,the composition and function of the microbiota of bile duct in patients with primary CBD stones remained to be explored.We utilized the 16S rRNA gene high-throughput sequencing technology to analyze the microbial diversity and community composition of biliary and duodenal microbiota in 15 patients with primary CBD stones and 4 patients without biliary tract diseases.Alpha diversity analysis showed that the microbiota richness was similar in bile and intestinal fluid;Beta diversity analysis showed that there were differences in the composition between biliary microbiota and the duodenal microbiota,but the abundance of the main groups showed similarities.The composition of the biliary microbiota from gallstone patients was more complex,as was the duodenal microbiota.Proteobacteria and Firmicutes were the dominant bacteria at phylum level,accounting for at least 75%of the total reads in each subgroup.Pseudomonas and EscherichiaShigella were the major genus among subgroups,but Escherichia-Shigella had increased abundance in duodenal microbiota with primary choledocholithiasis,which may play an important role in stone formation.It is noteworthy that Clostridiumsensu_stricto,Lachnospiraceae_UCG-008,Butyrivibrio and Roseburia which could produce short chain fatty acids(SCFAs),were significantly decreased in biliary microbiota with primary CBD stones(p<0.05).Our study provided new insights into the compositional of normal biliary microbiota.The micro-ecology of biliary and duodenal in patients with stones is complex and closely related,and there is a potential for dysbacteriosis.The decrease in abundance of certain major acid-producing bacteria affects the health of the biliary tract and thus leads to the formation of stones.展开更多
基金Supported by the Natural Science Foundation of Shandong Province,Nos.2014ZRE27479,ZR2018PH032,and ZR2018PH033the National Natural Science Foundation of China,No.6167276
文摘BACKGROUND Endoscopic sphincterotomy(EST) is widely regarded as the first choice in the management of common bile duct(CBD) stones. However, for some patients, this treatment is not possible. The percutaneous transhepatic balloon dilation(PTBD)technique has been suggested as an alternative but has yet to gain wide acceptance.AIM To review cases of PTBD for removing CBD stones and explore the safety and efficacy of this treatment.METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched EMBASE,PubMed, and Web of Science for cases of PTBD that underwent CBD stone removal from 1981 to January 2019. We analyzed all relevant articles available in full text. We extracted data on patient's age, gender, overall technique success rate, reasons for technique failure, and the presence and type of major and minor complications. We analyzed the data and reported the results in a table and text.Altogether, we retrieved 12 case series and 6 case reports, for a total of 1347 patients. Thirty cases were excluded due to a lack of patient data.RESULTS The overall technique success rate for removing a CBD stone was 98.5%(1327/1347) and 98.1%(109/111) for removing concurrent CBD and gallbladder stones. Based on available data(n = 1312), mean age of all patients(687 males and625 females) was 68.9 years. The total number of procedures in the remaining 1317 patients(after exclusion) was 3237(average 2.4 procedures per patient). The total number of failures for eliminating a CBD stone was 20, and the reasons for failure included: Stone impaction(n = 10), intrahepatic bile duct stricture(n = 5),large stone(n = 2), severe CBD dilation(n = 1), multiple stones(n = 1), and duodenal perforation(n = 1). Various major complications related to the procedure were reported, but the incidence rate was low(1.4%). No pancreatitis or procedure related mortality was reported. Minor complications including transient hyperamylasemia, nausea, vomiting, abdominal pain, fever, and mild hemobilia were reported. For 218 patients(88 patients with unsuccessful endoscopic removal due to anatomical change and large or impacted stone and130 cases who refused endoscopic procedure due to poor general condition or other additional disease), the CBD stones were successfully pushed into the duodenum by performing the PTBD procedure.CONCLUSION PTBD is a safe and effective approach in the nonoperative management of CBD stones. PTBD provides an alternative treatment when endoscopic procedures fail or are unsuitable for the patient.
文摘Bacteria play an important role in the formation of primary Common Bile Duct(CBD)stones.However,the composition and function of the microbiota of bile duct in patients with primary CBD stones remained to be explored.We utilized the 16S rRNA gene high-throughput sequencing technology to analyze the microbial diversity and community composition of biliary and duodenal microbiota in 15 patients with primary CBD stones and 4 patients without biliary tract diseases.Alpha diversity analysis showed that the microbiota richness was similar in bile and intestinal fluid;Beta diversity analysis showed that there were differences in the composition between biliary microbiota and the duodenal microbiota,but the abundance of the main groups showed similarities.The composition of the biliary microbiota from gallstone patients was more complex,as was the duodenal microbiota.Proteobacteria and Firmicutes were the dominant bacteria at phylum level,accounting for at least 75%of the total reads in each subgroup.Pseudomonas and EscherichiaShigella were the major genus among subgroups,but Escherichia-Shigella had increased abundance in duodenal microbiota with primary choledocholithiasis,which may play an important role in stone formation.It is noteworthy that Clostridiumsensu_stricto,Lachnospiraceae_UCG-008,Butyrivibrio and Roseburia which could produce short chain fatty acids(SCFAs),were significantly decreased in biliary microbiota with primary CBD stones(p<0.05).Our study provided new insights into the compositional of normal biliary microbiota.The micro-ecology of biliary and duodenal in patients with stones is complex and closely related,and there is a potential for dysbacteriosis.The decrease in abundance of certain major acid-producing bacteria affects the health of the biliary tract and thus leads to the formation of stones.
