Objective To investigate therapeutic effect of endoscopic sphincterotomy with small incision (SES) combined with endoscopic papillary balloon dilation (EPBD) in treatment of larger common bile duct stones. Methods The clinical data of 80 patients with common bile duct stones treated in our hospital from February 2014 to October 2015 were retrospectively analyzed. These patients were divided into endoscopic sphincterotomy (EST) group (n = 40) and SES+EPBD group (n = 40) according to the therapeutic methods. The diameter of common bile duct stone was 10–20 mm. The operation status, recurrence rate and residual rate of common bile duct stone, and complications rate within 3 months after operation were compared between these two groups. Results The age and gender had no significant differences between these two groups (P>0.05). The operation time was shorter (P<0.05) and the intraoperative bleeding was less (P<0.05) in the SES+EPBD group as compared with the EST group. There were no significant differences in the hospital stay and recovery time of gastrointestinal function between these two groups (P>0.05). The levels of ALT, AST, DBIL, and TBIL in these two groups before treatment had no significant differences (P>0.05); after treatment, the above indicators of liver function in the SES+EPBD group were significantly lower than those in the EST group (P<0.05), and which were significantly decreased more in the same group (P<0.05). The residual stone, stone recurrence, and complications such as acute pancreatitis, acute cholangitis, bile leakage and postoperative hemorrhage were not found in the SES+EPBD group, the rates of these indicators in the SES+EPBD group were significantly lower than those in the EST group (P<0.05). Conclusion SES combined with EPBD has a good therapeutic effect on larger common bile duct stones (diameter of common bile duct stone is 10–20 mm) and recurrence rate is low.
ObjectiveTo discuss the diagnosis and endoscopic therapy of pancreaticobiliary maljunction by multidisciplinary team (MDT).MethodThe preoperative MDT discussion and the diagnosis and treatment process of patient with pancreaticobiliary maljunction in the Fifth People’s Hospital of Zunyi in 2019 were summarized.ResultsThe patient was admitted for “upper abdominal pain approximately 10 h”. The obvious extramural confluence of the pancreaticobiliary tract was observed and the length of common channel was approximately 1.8 cm. But the junction of the pancreaticobiliary tract was obviously controlled by the sphincter of Oddi, and the amylase value of the bile was higher than that of the serum. After the MDT discussion, there were still doubts about the diagnosis of pancreaticobiliary maljunction or high confluence of pancreaticobiliary ducts. After the left hepatic lateral lobectomy and exploration of common bile duct, the amylase value of bile, which was collected by the T-tube, was still obviously increased. Then the endoscopic sphincterotomy was performed, the amylase value of the bile decreased obviously and no abnormality was found in the follow-up for half a year after discharge.ConclusionsConcept and diagnostic criteria of “Japanese clinical practice guidelines for pancreaticobiliary maljunction” are conflicting and inaccurate. Severity of pancreaticobiliary reflux and change of amylase value of bile might have a more important diagnostic value. Endoscopic sphincterotomy might be suitable for a few special types of pancreaticobiliary maljunction.
ObjectiveTo explore the efficacy and safety of endoscopic sphincterotomy (EST) in the treatment of sphincter of Oddi dysfunction (SOD).MethodsThe clinical data of 95 cases of SOD treated with EST in Affiliated Hospital of Guizhou Medical University and Tumor Hospital Affiliated to Guizhou Medical University from January 2014 to January 2019 were collected retrospectively, to evaluate and analyze the effect of clinical diagnosis and treatment of EST on SOD patients.ResultsAmong 95 SOD patients, 86 were biliary type SOD and 9 were pancreatic type SOD. All 95 patients underwent EST. The Verbal Rating Scales-5 (VRS-5) scores before EST were all 3 or 4 points, and the VRS-5 scores decreased after treatment in each type of SOD patients, the difference were all statistically significant (P<0.05). After treatment, levels of ALT, AST, ALP, TBiL, and DBiL in biliary type SOD Ⅰ and type Ⅱ were significantly lower than before (P<0.05); ALT, AST, ALP, GGT, and blood and urine amylase in patients with pancreatic type SOD after EST were significantly decreased than before (P<0.05), and the biochemical indicators of patients with SOD Ⅲ before and after treatment did not change significantly (P>0.05). After EST treatment, 70 (81.4%) of the 86 patients with bile type SOD showed significant effect, and 10 patients (11.6%) were effective, with an overall effective rate of 93.0% (80/86). Among the 16 patients with bile type SOD Ⅰ, 14 patients (87.5%) received significant effect, and 1 patient (6.3%) was effective, with an overall effective rate of 93.8% (15/16). That 51 patients with bile type SOD Ⅱ received EST, of which 43 patients (84.3%) were significantly effective and 6 patients (11.8%) were effective, with an overall response rate of 96.1% (49/51). Among the 19 patients with bile type SOD Ⅲ treated with EST, 13 patients (68.4%) were significantly effective and 3 patients (15.8%) were effective, with the overall effective rate was 84.2% (16/19). There was no statistically significant difference in the overall effective rate of patients with 3 types of biliary type SOD patients (P>0.05). Endoscopic treatment was effective in all 9 cases of pancreatic type SOD, with an overall effective rate of 100%. There were 5 patients (5.3%) of acute pancreatitis after EST, and no bleeding, perforation, cholangitis or other complications occurred. All patients were interviewed for 1 to 5 years postoperatively, the median follow-up duration was 2.33 year, during the follow-up period, nolong-term complications such as Oddi sphincter restenosis and cholangitis caused by intestinal bile reflux.ConclusionESTis a minimally invasive, safe, and effective treatment for SOD in patients with bile duct type and pancreatic duct type, and it is an important treatment for SOD.