Clinical Observation on Spot-Welding Electrocoagulation with Needle-Knife to Prevent Bleeding after Endoscopic Sphincterotomy: Report of 102 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHEN Yingzhou ^1,2 , ZHANG Bingyin ¹ , PANG Yong ¹ , TANG Lijun ¹ , ZHANG Lin ¹

1.Center of General Surgery, Chengdu General Hospital of Chengdu Military Area Command, Chengdu 610083, Sichuan Province, China;;
2.Department of Gastroenterology, People’s Hospital of Maanshan City, Maanshan 243000, Anhui Province, China;

Corresponding author：

Keywords：

Endoscopic sphincterotomy; Needleknife; Electrocoagulation; Bleeding

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ObjectiveTo evaluate the efficiency of the spot-welding electrocoagulation with needle-knife to prevent bleeding after endoscopic sphincterotomy (EST). MethodsThe clinical data of 187 patients underwent EST from August 2009 to October 2009 were retrospectively analyzed, study group （n=102) were treated with spotwelding electrocoagulation with needleknife and 110 000 noradrenaline washing, control group (n=85) were treated with 110 000 noradrenaline washing alone. The bleeding and complications after EST were observed. ResultsThe differences of gender, age, primary diseases, cormorbidities, nutritional status, and immune function were not significant between two groups (P gt;0.05). The bleeding after EST happened 4 cases (4.70%) in the control group and none in the study group. The bleeding rate of the study group was significantly lower than that of the control group (P lt;0.05). The bleeding cases in the control group were controlled successfully by spotwelding electrocoagulation with needleknife under endoscopy. Cholangitis occurred in 5 cases altogether, 1 case in each group deteriorated promptly and died of multiple organ failure syndrome, another 3 cases, 2 in the study group, 1 in the control group, were cured by PTCD and antibiotics. Biliary tract hemorrhage occurred one case in each group, which one died in the study group. Pancreatitis occurred 1 case in the study group and 2 cases in the control group, all of which were salvaged by conservative therapy. The incidences of complications were not significantly different between two groups (P gt;0.05). ConclusionsThe spotwelding electrocoagulation with needleknife can significantly reduce the bleeding rate after EST. It is an effective, safe, and easy technique, especially to rural areas.

Citation： SHEN Yingzhou ,ZHANG Bingyin,PANG Yong,TANG Lijun,ZHANG Lin. Clinical Observation on Spot-Welding Electrocoagulation with Needle-Knife to Prevent Bleeding after Endoscopic Sphincterotomy: Report of 102 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(10): 1074-1076. doi: Copy

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2.	Testoni PA. Why the incidence of postERCP pancreatitis varies considerably?factors affecting the diagnosis and the incidence of this complication [J]. JOP, 2002, 3(6): 195201.
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6.	王健, 杜波, 胡兵. EST后近期严重并发症及其危险因素分析 [J]. 中国普外基础与临床杂志, 2010, 17（5）: 486490.
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12.	Heo JH, Kang DH, Jung HJ, et al. Endoscopic sphincterotomy plus largeballoon dilation versus endoscopic sphincterotomy for removal of bileduct stones [J]. Gastrointest Endosc, 2007, 66(4): 720726.
13.	Ueki T, Otani K, Fujimura N, et al. Comparison between emergency and elective endoscopic sphincterotomy in patients with acute cholangitis due to choledocholithiasis: is emergency endoscopic sphincterotomy safe? [J]. J Gastroenterol, 2009, 44(10): 10801088.
14.	Kim KO, Kim TN, Kim SB, et al. Characteristics of delayed hemorrhage after endoscopic sphincterotomy [J]. J Gastroenterol Hepatol, 2010, 25(3): 532538.
15.	王浩, 臧建华, 吕东月. EST术中乳头出血45例分析 [J]. 中国实用医药, 2010, 5（5）: 7778.
16.	王祥, 于忆, 刘子燕, 等. EST术后迟发出血的内镜处理 [J]. 河北医药, 2009, 31（17）: 22352236.
17.	文卫, 范志宁, 王敏, 等. 针状刀乳头开窗术在困难性ERCP中的临床应用价值 [J]. 中国消化内镜, 2007, 1（7）: 911.
18.	苏秉忠, 陈平, 黄应龙, 等. ERCP术后相关并发症分析及处理 [J]. 中国消化内镜, 2007, 1（7）: 1618.
19.	蔡阳, 朱玮, 封光华, 等. EST严重并发症的外科治疗 [J]. 中华肝胆外科杂志, 2005, 11（9）: 616617.
20.	吴传良. ERCP常见并发症及防治策略 [J]. 医学研究杂志, 2009, 38（3）: 9293.
21.	张澍田, 冀明, 黄拥军. ERCP规范化操作 [J]. 临床消化病杂志, 2008, 20（4）: 208210.
22.	李雅洁, 杜勤, 黄智铭, 等. 经内镜逆行胰胆管造影并发症的防治 [J]. 实用医学杂志, 2008, 24（5）: 777779.
23.	张平, 龚彪, 潘亚敏. 内镜止血夹预防乳头括约肌切开术后出血的临床观察 [J]. 临床消化病杂志, 2005, 17（1）: 42.
24.	张紫平, 陈胜, 龚彪. 内镜下括约肌切开术后延迟性出血的防治探讨 [J]. 外科理论与实践, 2005, 10（4）: 373374.

1. 李国熊, 张啸. ERCP并发症及防治对策 [J]. 中国内镜杂志, 2005, 11（8）: 824827.
2. Testoni PA. Why the incidence of postERCP pancreatitis varies considerably?factors affecting the diagnosis and the incidence of this complication [J]. JOP, 2002, 3(6): 195201.
3. Lin LF, Siauw CP, Ho KS, et al. Hemoclip treatment for postendoscopic sphincterotomy bleeding [J]. J Chin Med Assoc, 2004, 67(10): 496499.
4. Li ZH, Chen M, Liu JK, et al. Endoscopic sphincterotomy in the treatment of cholangiopancreatic diseases [J]. World J Gastroenterol, 2005, 11(17): 26782680.
5. 龚彪, 王实, 别里克, 等. EST术后止血夹预防性止血的回顾性研究 [J]. 中华消化内镜杂志, 2006, 23（3）: 183185.
6. 王健, 杜波, 胡兵. EST后近期严重并发症及其危险因素分析 [J]. 中国普外基础与临床杂志, 2010, 17（5）: 486490.
7. 刘运祥, 黄留业. 实用消化内镜治疗学 [M]. 北京: 人民卫生出版社, 2008: 163.
8. 韩民, 孙诚谊, 胡韵, 等. 诊断性与治疗性ERCP并发症的原因分析及治疗体会(附130例报告) [J]. 贵州医药, 2008, 32（3）: 225226.
9. Toda N, Saito K, Wada R, et al. Endoscopic sphincterotomy and papillary balloon dilation for bile duct stones [J]. Hepatogastroenterology, 2005, 52(63): 700704.
10. Vandervoort J, Soetikno RM, Tham TC, et al. Risk factors for complications after performance of ERCP [J]. Gastrointest Endosc, 2002, 56(5): 652656.
11. Deng DH, Zuo HM, Wang JF, et al. New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation [J]. World J Gastroenterol, 2007, 13(32): 43854390.
12. Heo JH, Kang DH, Jung HJ, et al. Endoscopic sphincterotomy plus largeballoon dilation versus endoscopic sphincterotomy for removal of bileduct stones [J]. Gastrointest Endosc, 2007, 66(4): 720726.
13. Ueki T, Otani K, Fujimura N, et al. Comparison between emergency and elective endoscopic sphincterotomy in patients with acute cholangitis due to choledocholithiasis: is emergency endoscopic sphincterotomy safe? [J]. J Gastroenterol, 2009, 44(10): 10801088.
14. Kim KO, Kim TN, Kim SB, et al. Characteristics of delayed hemorrhage after endoscopic sphincterotomy [J]. J Gastroenterol Hepatol, 2010, 25(3): 532538.
15. 王浩, 臧建华, 吕东月. EST术中乳头出血45例分析 [J]. 中国实用医药, 2010, 5（5）: 7778.
16. 王祥, 于忆, 刘子燕, 等. EST术后迟发出血的内镜处理 [J]. 河北医药, 2009, 31（17）: 22352236.
17. 文卫, 范志宁, 王敏, 等. 针状刀乳头开窗术在困难性ERCP中的临床应用价值 [J]. 中国消化内镜, 2007, 1（7）: 911.
18. 苏秉忠, 陈平, 黄应龙, 等. ERCP术后相关并发症分析及处理 [J]. 中国消化内镜, 2007, 1（7）: 1618.
19. 蔡阳, 朱玮, 封光华, 等. EST严重并发症的外科治疗 [J]. 中华肝胆外科杂志, 2005, 11（9）: 616617.
20. 吴传良. ERCP常见并发症及防治策略 [J]. 医学研究杂志, 2009, 38（3）: 9293.
21. 张澍田, 冀明, 黄拥军. ERCP规范化操作 [J]. 临床消化病杂志, 2008, 20（4）: 208210.
22. 李雅洁, 杜勤, 黄智铭, 等. 经内镜逆行胰胆管造影并发症的防治 [J]. 实用医学杂志, 2008, 24（5）: 777779.
23. 张平, 龚彪, 潘亚敏. 内镜止血夹预防乳头括约肌切开术后出血的临床观察 [J]. 临床消化病杂志, 2005, 17（1）: 42.
24. 张紫平, 陈胜, 龚彪. 内镜下括约肌切开术后延迟性出血的防治探讨 [J]. 外科理论与实践, 2005, 10（4）: 373374.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Observation on Spot-Welding Electrocoagulation with Needle-Knife to Prevent Bleeding after Endoscopic Sphincterotomy: Report of 102 Cases

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