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Wang P, Song GD, Xie WC, Song ZS. Comparison of one-step laparoscopy and two-step endolaparoscopy in the treatment of secondary choledocholithiasis: A multicenter retrospective clinical study. Technol Health Care 2023:THC220610. [PMID: 36847032 DOI: 10.3233/thc-220610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND There are two minimally invasive ways of treating cholecystolithiasis combined with choledocholithiasis, but there remains some controversy regarding which technique is better, since they both have advantages and disadvantages. The one-step method involves laparoscopic cholecystectomy, laparoscopic common bile duct exploration, and primary close (LC + LCBDE + PC), while the two-step procedure consists of endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy, and laparoscopic cholecystectomy (ERCP + EST + LC). OBJECTIVE This multicenter retrospective study aimed to analyze and compare the effects of the two techniques. METHODS The data of patients who underwent either one-step LCBDE + LC + PC or two-step ERCP + EST + LC treatment for gallstones in the gallbladder and bile duct at the Shanghai Tenth People's Hospital, Shanghai Tongren Hospital, and Taizhou Fourth People's Hospital between January 1, 2015 and December 31, 2019 were collected, and the preoperative indicators of the two groups were compared. RESULTS The surgical success rate of the one-step laparoscopic group was 96.23% (664/690), the transit abdominal opening rate was 2.03% (14/690), and there were 21 cases of postoperative bile leakage. The success rate of the two-step endolaparoscopic surgery was 78.95% (225/285), the transit opening rate was 2.46% (7/285), and there were 43 postoperative cases of pancreatitis and five of cholangitis. Postoperative cholangitis, pancreatitis, postoperative stone recurrence, postoperative hospitalization, and treatment costs were significantly lower (P< 0.05) in the one-step laparoscopic group than in the two-step endolaparoscopic group. However, the amount of intraoperative bleeding, the postoperative extraction time of the abdominal drainage tube, and the incidence of bile leakage were higher (P< 0.05) in the one-step laparoscopic group than in the two-step endolaparoscopic group. CONCLUSION The two methods of treating choledocholithiasis combined with choledocholithiasis that were analyzed in this study were safe and effective, and each method had its own advantages.
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Affiliation(s)
- Ping Wang
- Department of General Surgery, Taizhou Fourth People's Hospital, Taizhou, Jiangsu, China
| | - Guo-Dong Song
- Department of General Surgery, Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Wang-Cheng Xie
- Department of Hepatobiliary Surgery, Shanghai Tenth People's Hospital, Shanghai, China
| | - Zhen-Shun Song
- Department of Hepatobiliary Surgery, Shanghai Tenth People's Hospital, Shanghai, China
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Tunruttanakul S, Verasmith K, Patumanond J, Mingmalairak C. Development of a Predictive Model for Common Bile Duct Stones in Patients With Clinical Suspicion of Choledocholithiasis: A Cohort Study. Gastroenterology Res 2022; 15:240-252. [PMID: 36407811 PMCID: PMC9635785 DOI: 10.14740/gr1560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Current choledocholithiasis guidelines heavily focus on patients with low or no risk, they may be inappropriate for populations with high rates of choledocholithiasis. We aimed to develop a predictive scoring model for choledocholithiasis in patients with relevant clinical manifestations. METHODS A multivariable predictive model development study based on a retrospective cohort of patients with clinical suspicion of choledocholithiasis was used in this study. The setting was a 700-bed public tertiary hospital. Participants were patients who had completed three reference tests (endoscopic retrograde cholangiography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography) from January 2019 to June 2021. The model was developed using logistic regression analysis. Predictor selection was conducted using a backward stepwise approach. Three risk groups were considered. Model performance was evaluated by area under the receiver operating characteristic curve, calibration, classification measures, and decision curve analyses. RESULTS Six hundred twenty-one patients were included; the choledocholithiasis prevalence was 59.9%. The predictors were age > 55 years, pancreatitis, cholangitis, cirrhosis, alkaline phosphatase level of 125 - 250 or > 250 U/L, total bilirubin level > 4 mg/dL, common bile duct size > 6 mm, and common bile duct stone detection. Pancreatitis and cirrhosis each had a negative score. The sum of scores was -4.5 to 28.5. Patients were categorized into three risk groups: low-intermediate (score ≤ 5), intermediate (score 5.5 - 14.5), and high (score ≥ 15). Positive likelihood ratios were 0.16 and 3.47 in the low-intermediate and high-risk groups, respectively. The model had an area under the receiver operating characteristic curve of 0.80 (95% confidence interval: 0.76, 0.83) and was well-calibrated; it exhibited better statistical suitability to the high-prevalence population, compared to current guidelines. CONCLUSIONS Our scoring model had good predictive ability for choledocholithiasis in patients with relevant clinical manifestations. Consideration of other factors is necessary for clinical application, particularly regarding the availability of expert physicians and specialized equipment.
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Affiliation(s)
- Suppadech Tunruttanakul
- Department of Surgery, Sawanpracharak Hospital, Nakhon Sawan 60000, Thailand,Corresponding Author: Suppadech Tunruttanakul, Department of Surgery, Sawanpracharak Hospital, Muang, Nakhon Sawan 60000, Thailand.
| | | | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chatchai Mingmalairak
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani 10120, Thailand
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Zimmer V. "Lever Technique": A Novel Approach to Cope with Unstable Scope Position during Bottom-up Needle Knife Access (with Video). Euroasian J Hepatogastroenterol 2021; 11:95-96. [PMID: 34786363 PMCID: PMC8566154 DOI: 10.5005/jp-journals-10018-1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Needle knife papillotomy has become an invaluable advanced biliary access technique in routine endoscopic retrograde cholangiopancreatography (ERCP). Albeit poorly standardized in terms of procedural details, usually superficial cuts are applied to open the bile duct in an onion-like manner. However, this implies the capability to direct cuts from some distance from the papilla controlling needle knife movements in a complex fashion involving elevator movements. Here, an as-yet unreported technique designated the "lever technique" is presented for difficult needle knife access, when encountering technical difficulties, such as unstable scope position and awkward bile duct angle to allow for controlled needle knife navigation. In such variant rescue approach involving well-characterized prepapillary stone impaction by preceding same-session endoscopic ultrasound (EUS), thus providing some safety plane, ultranear-view instrumentation is coupled with exclusive needle knife navigation by moving the large dial, thus moving scope and needle knife-like as one endoscopic device. How to cite this article: Zimmer V. "Lever Technique": A Novel Approach to Cope with Unstable Scope Position during Bottom-up Needle Knife Access (with Video). Euroasian J Hepato-Gastroenterol 2021;11(2):95-96.
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Affiliation(s)
- Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Homburg, Deutschland, Germany
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Dietrich CF, Bekkali NL, Burmeister S, Dong Y, Everett SM, Hocke M, Ignee A, On W, Hebbar S, Oppong K, Sun S, Jenssen C, Braden B. Controversies in ERCP: Indications and preparation. Endosc Ultrasound 2021; 11:186-200. [PMID: 34677145 PMCID: PMC9258020 DOI: 10.4103/eus-d-21-00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of the series of papers on controversies of biliopancreatic drainage procedures is to discuss the pros and cons of the varying clinical practices and techniques in ERCP and EUS for drainage of biliary and pancreatic ducts. The first part focuses on indications, clinical and imaging prerequisites before ERCP, sedation options, post-ERCP pancreatitis (PEP) prophylaxis, and other related technical topics. In the second part, specific procedural ERCP-techniques including precut techniques and its timing as well as management algorithms are discussed. In addition, controversies in EUS-guided bile duct and pancreatic drainage procedures are under preparation.
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Affiliation(s)
- Christoph F Dietrich
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, China; Johann Wolfgang Goethe University, Frankfurt/Main, Germany; Department of Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Noor L Bekkali
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sean Burmeister
- Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Meiningen, Germany
| | - Andre Ignee
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany
| | - Wei On
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Srisha Hebbar
- University Hospitals of North Midlands, North Midlands, United Kingdom
| | - Kofi Oppong
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Markisch-Oderland, Strausberg; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Johann Wolfgang Goethe University, Frankfurt/Main, Germany
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Zhou X, Long J, Wang H, Yi S, Zhao J. Clinical observation of octreotide combined with diclofenac sodium in preventing ERCP-related pancreatitis. Am J Transl Res 2021; 13:7179-7185. [PMID: 34306479 PMCID: PMC8290821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/23/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To elucidate the efficacy of octreotide in combination with diclofenac sodium in the prevention of ERCP-related pancreatitis, and investigate its impact on patients' serum amylase, white blood cell (WBC) count, adverse effects, hyperamylasemia and hemorheology. METHODS The prospective study was conducted, in which 124 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) in our hospital were evenly divided into 2 groups, the observation group (n=62) and the control group (n=62), via a random number table method. The control group was administered diclofenac sodium lidocaine hydrochloride via injection after ERCP, while the observation group was given octreotide acetate on the basis of the control group. The incidence of pancreatitis, serum amylase level, WBC count, incidence of adverse effects and hyperamylasemia, and hemorheology levels were compared between these two groups of patients. RESULTS The incidence of pancreatitis in the observation group was significantly lower than that in the control group (P<0.05). After treatment, the serum amylase level at 24 h post-surgery in the observation group was notably lower than that in the control group (P<0.001). The WBC count at 2 h and 24 h post-surgery in the observation group were both significantly lower than those in the control group (all P<0.001). The incidence of total adverse reactions in the observation group was remarkably lower than that in the control group (P<0.01). The incidence of hyperamylasemia in the observation group was considerably lower than that in the control group (P<0.001). Twenty-four hours post-surgery, the whole blood viscosity at high shear rate, whole blood viscosity at low shear rate, and plasma viscosity in the observation group were all significantly lower than those in the control group (all P<0.001). CONCLUSION The combination of octreotide and diclofenac sodium could effectively prevent the occurrence of ERCP-related pancreatitis, which reduced the incidence of hyperamylasemia, decreased the WBC count and serum amylase level, improved the hemorheology, and lowered the incidence of adverse effects in patients after ERCP. Therefore, this therapeutic strategy is worthy of clinical propagation and application.
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Affiliation(s)
- Xian Zhou
- Department of Hepatobiliary Surgery, Nanhua Hospital, Nanhua UniversityHengyang, Hunan Province, China
| | - Jianwu Long
- Department of Hepatobiliary Surgery, Nanhua Hospital, Nanhua UniversityHengyang, Hunan Province, China
| | - Hui Wang
- Department of Gastrointestinal Surgery, Nanhua Hospital, Nanhua UniversityHengyang, Hunan Province, China
| | - Shijie Yi
- Department of Gastrointestinal Surgery, Nanhua Hospital, Nanhua UniversityHengyang, Hunan Province, China
| | - Jun Zhao
- Department of Gastrointestinal Surgery, Nanhua Hospital, Nanhua UniversityHengyang, Hunan Province, China
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Anwer M, Asghar MS, Rahman S, Kadir S, Yasmin F, Mohsin D, Jawed R, Memon GM, Rasheed U, Hassan M. Diagnostic Accuracy of Endoscopic Ultrasonography Versus the Gold Standard Endoscopic Retrograde Cholangiopancreatography in Detecting Common Bile Duct Stones. Cureus 2020; 12:e12162. [PMID: 33489574 PMCID: PMC7813932 DOI: 10.7759/cureus.12162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and objectives Stone in the biliary tract is one of the most common causes of hospitalization. However, it is difficult to determine the prevalence of gallstones in the general population because they are often asymptomatic. Thus, management lies in the proper clearance of the common bile duct (CBD) along with the removal of the gallbladder, for which it must be diagnosed on time with proper accuracy. Imaging modalities including magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) provide true visualization of choledocholithiasis with comparable sensitivities. The gold standard ERCP is an invasive procedure and may cause complications, such as pancreatitis, perforation, and bleeding. EUS is a minimally invasive procedure to assess the biliary tract using high-frequency sound waves. Until now the EUS has not been addressed much in our local tertiary care setups and this study was conducted to evaluate its accuracy in the diagnosis of choledocholithiasis. The objective of our study is to determine the diagnostic accuracy (specificity and sensitivity) of EUS versus ERCP for the diagnosis of choledocholithiasis. Materials and methods This retrospective study was conducted on patients suspected of having choledocholithiasis undergoing both EUS and ERCP based on their history, clinical symptoms, and laboratory test results including upper abdominal pain, deranged liver function enzymes, and a dilated CBD on radiology. EUS was initially performed for the diagnosis of extrahepatic biliary obstruction followed by one or more of the confirmatory criterion standard tests (including ERCP). In order to reduce the chances of passage of stone resulting in negative analysis, only those patients were included in which both procedures were conducted temporally close together (24-72 hours in most instances). The main outcome measures were diagnostic accuracy with the help of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using a receiver operating characteristic curve. A total of 123 patients met the inclusion criteria via non-probability consecutive sampling methods. Results The mean age of our study population was 50.30 ± 13.91. We included 63 males (51.2%) and 60 females (48.8%). The most frequent indication for undergoing diagnostic procedures was deranged liver function tests (67.47%). The frequent comorbidities reported were hypertension (29.26%), diabetes (21.95%), chronic liver disease (16.26%), and ischemic heart disease (4.87%). Mean alkaline phosphatase and gamma-glutamyl transferase levels were markedly raised from the baseline in the study population. Post-ERCP complications were also reported in some of the study participants. About 85 patients (69.10%) were diagnosed with choledocholithiasis among the study participants. The diagnostic accuracy of EUS was compared with ERCP revealed an area under the curve (AUC) of 0.930, standard error of 0.031, 95% confidence interval of 0.868-0.991, the sensitivity of 89.5%, specificity of 96.5%, positive predictive value of 91.9%, and negative predictive value of 95.3%. Conclusion It is recommended that ERCP can be selectively conducted or excluded in patients with biliary obstruction in case of EUS negative, thus minimizing the complications and morbidity associated with an invasive procedure, with our results showing a comparative diagnostic accuracy of EUS.
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Affiliation(s)
- Mohsin Anwer
- General Surgery, Liaquat National Hospital, Karachi, PAK
| | | | - Sheeraz Rahman
- General Surgery, Liaquat National Hospital, Karachi, PAK
| | - Shanil Kadir
- Gastroenterology, Liaquat National Hospital, Karachi, PAK
| | - Farah Yasmin
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Dania Mohsin
- General Surgery, Liaquat National Hospital, Karachi, PAK
| | - Rumael Jawed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | | | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Maira Hassan
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
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Salmanroghani H, Mirvakili M, Mirjalili M, Baghbanian M, Salmanroghani R. The Efficacy and Safety of Low Dose versus Usual Dose of Hyoscine During Endoscopic Retrograde Cholangiopancreatography: A Randomized Clinical Trial. Clin Pharmacol 2020; 12:123-130. [PMID: 32903953 PMCID: PMC7445520 DOI: 10.2147/cpaa.s263531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of low dose versus usual dose of Hyoscine during endoscopic retrograde cholangiopancreatography (ERCP). Patients and Methods This randomized, open-label clinical trial included 282 patients undergoing ERCP who had duodenal peristalsis interfering with cannulation. Patients were randomly divided into two groups: Group one and two received low (5 mg) and usual (10 mg) dose of Hyoscine, respectively. Cardiovascular service consultation was performed for all patients before entering the study and performing ERCP. Hyoscine was injected intravenously, and the spasmolytic effect of the drug was assessed while the papilla was in a completely enface view. The time interval between cessation of peristalsis and its further onset was recorded by the chronometer. Also, patient’s heart rate and blood pressure were monitored during ERCP by digital monitoring. Results The results showed no statistically significant differences in the mean duration of peristalsis, the duration of the antispasmodic activity and the time required to increase the heart rate between two groups (P=0.38, P=0.48, P=0.32, respectively). No significant differences were observed regarding the average of heart rate and mean arterial blood pressure (MAP) before drug administration between the two groups (P=0.182 and P=0.29, respectively), but after the drug administration, tachycardia and hypotension were significantly higher in the second group (P=0.007 and P=0.001, respectively). There was no statistically significant difference in the frequency of arrhythmia between two groups (P=0.08). The results also showed that tachycardia and hypotension occurred more frequently in men and elderly patients (P <0.05). Conclusion A low dose of Hyoscine is as effective as the usual dose and its side effects such as alteration in blood pressure and heart rate are much fewer, especially in men and elderly patients.
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Affiliation(s)
- Hassan Salmanroghani
- Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Massoud Mirvakili
- Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahtabalsadat Mirjalili
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmud Baghbanian
- Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Roham Salmanroghani
- Medical Student Research Center, Tehran University of Medical Sciences, Tehran, Iran
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El bacha H, Prat F. Endoscopic management of iatrogenic EUS-related duodenal perforations with over-the-scope clips. Endosc Int Open 2020; 8:E59-E63. [PMID: 31921985 PMCID: PMC6949172 DOI: 10.1055/a-0967-4718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Iatrogenic endoscopic ultrasound (EUS) perforations are life-threatening adverse event and to date, surgery has been the main treatment for them. The aim of this study was to assess feasibility and safety of conservative treatment with over-the-scope clips (OTSC). Patients and methods We performed a retrospective study, including iatrogenic EUS duodenal perforation with conservative endoscopic management from 2011 to August 2018. Patients who initial had surgical management were excluded. Results In 8504 EUS procedure occurred, 13 perforations occurred (0.15 %). Eleven patients were included in the study, all women. Mean patient age was 75 years (range 68 - 88). Eighth of 11 perforations (72.7 %) were due to a radial probe and three of 11 (27.3 %) were due to a curvilinear probe. Eleven procedures (100 %) were performed as diagnostic. Defect size ranged from 10 to 15 mm. All procedures were successful. Three of eleven patients (27 %) had a stay in intensive care unit for less than 72 hours and length of total hospital stay ranged from 3 to 22 days. Conclusion Conservative endoscopic treatment of Iatrogenic EUS perforation, with OTSC is feasible, efficient and safe.
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Affiliation(s)
- Hicham El bacha
- Medecine B, Hôpital ibn-sina, Mohamed V University, Rabat, Morocco,Corresponding author Hicham El Bacha Rue Ait Mhammed SouissiRabatMaroc+05 37 77 58 56
| | - Frederic Prat
- Gastroenterology Department, Hôpital Cochin, Paris, France
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Zhang M, Zhang J, Sun X, Xu J, Zhu J, Yuan W, Yan Q. Clinical analysis of treatment strategies to cholecystocholedocholithiasis patients with previous subtotal or total gastrectomy: a retrospective cohort study. BMC Surg 2018; 18:54. [PMID: 30092786 PMCID: PMC6085697 DOI: 10.1186/s12893-018-0388-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background Previous gastrectomy can lead to an increased incidence of cholecystocholedocholithiasis (CCL) and increased morbidity rate. However, the appropriate treatment strategy for patients with CCL and a history of gastrectomy remains unclear. Methods We performed a retrospective cohort study of patients with CCL and a history of gastrectomy who underwent either one-stage laparoscopic common bile duct (CBD) exploration with stone clearance and laparoscopic cholecystectomy (LCBDE+LC) or two-stage endoscopic retrograde cholangiopancreatography followed by LC (ERCP+LC) from May 2010 to March 2018. Results The success rate of ERCP for CBD stone clearance was 81.2% in patients with a history of Billroth I gastrectomy and 23.7% in patients with a history of Billroth II or Roux-en-Y esophagojejunostomy [χ2 = 97.67, P < 0.001, risk ratio (RR) = 3.43]. The success rate of second-step LC after successful ERCP for removal of CBD stones and the success rate of LCBDE+LC after ERCP treatment failure were 96.8 and 87.7%, respectively, in patients with preoperative intra-abdominal adhesion evaluation scores of ≤3 points. These success rates were 28.6 and 27.6%, respectively, in patients with scores of > 3 points (χ2 = 59.70, P < 0.001, RR = 3.38 and χ2 = 53.41, P < 0.001, RR = 3.27, respectively). Conclusions Based on the results of this study, ERCP+LC seems to be an attractive strategy for treatment of CCL in patients with a history of Billroth I gastrectomy, and LCBDE+LC appears to be suitable for patients with a history of Billroth II or Roux-en-Y esophagojejunostomy. Preoperative evaluation of intra-abdominal adhesions helps to reduce the conversion rate of laparoscopic surgery.
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Affiliation(s)
- Mingjie Zhang
- Department of Hepatobiliary surgery, Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), No. 198, Hongqi Road, Huzhou, 313000, Zhejiang Province, China
| | - Jianxin Zhang
- Department of General surgery, The NO.3 People's hospital of Changxing County, No. 19, Tianneng Road, Changxing, 313104, Zhejiang Province, China
| | - Xu Sun
- Department of Hepatobiliary surgery, Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), No. 198, Hongqi Road, Huzhou, 313000, Zhejiang Province, China
| | - Jie Xu
- Department of General surgery, The NO.3 People's hospital of Changxing County, No. 19, Tianneng Road, Changxing, 313104, Zhejiang Province, China
| | - Jing Zhu
- Department of General surgery, The NO.3 People's hospital of Changxing County, No. 19, Tianneng Road, Changxing, 313104, Zhejiang Province, China
| | - Wenbin Yuan
- Department of Hepatobiliary surgery, Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), No. 198, Hongqi Road, Huzhou, 313000, Zhejiang Province, China
| | - Qiang Yan
- Department of Hepatobiliary surgery, Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), No. 198, Hongqi Road, Huzhou, 313000, Zhejiang Province, China.
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