Combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage
概要目 的通过探讨胃镜联合胆道镜在腹腔镜胆总管探查术 (LCBDE) 中的应用, 为胆总管结石的手术治疗提供更多的手术方式, 改善患者生活质量, 降低手术难度。创新点摒弃了以往 LCBDE 术后需行 T 管引流的方式, 以鼻胆管代替 T 管, 改善患者生活质量。 同时胃镜的操作难度较内镜逆行胰胆管造影 (ERCP) 低。 因此, 本手术方式可以得到更好的推广。方 法研究对象为 2017 年 7 月 1 日至 2017 年 10 月 30 日于浙江大学医学院附属邵逸夫医院就诊的胆总管结石患者。 收集这些患者的年龄、 性别等临床数据, 排除那些不能耐受麻醉、 患急性胰腺炎及急性胆管炎、 并发肝内胆管结石及胆总 管结石呈泥沙状或者絮状的患者。 对患者行胃镜联合胆道镜的 LCBDE 手术, 统计其手术时长、 术中出血量、 术后并发症、 术后住院时长以及住院花费。结 论胃镜联合胆道镜放置鼻胆管在预防 LCBDE 术后胆漏上切实有效, 且由于术后无需留置 T 管, 对患者的生活质量有所改善。 同时, 本手术方式对手术操作技术的要求较低, 对于初学胆总管一期缝合的医师来说, 可降低其术后胆漏的概率 。
CONCLUSION: technical success, treatment success, procedure duration, and overall adverse event rate were comparable between ERCP-BD and EUS-BD in decompressing malignant distal biliary obstruction. Nevertheless, EUS-BD had a significantly lower rate of PEP and a lower tendency toward stent reintervention than ERCP-BD. Therefore, EUS-BD might be a suitable alternative to ERCP-BD when performed by experts. PMID: 31729233 [PubMed - as supplied by publisher]
The American Society for Gastrointestinal Endoscopy (ASGE) recommends prophylactic pancreatic duct stent placement (PPS) and rectal nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the incidence and severity of post-ERCP pancreatitis (PEP) in high-risk individuals and suggests that rectal indomethacin may decrease the risk and severity of PEP in average-risk individuals. The European Society for Gastrointestinal Endoscopy (ESGE) recommends rectal indomethacin for all patients undergoing ERCP.
Conclusions In a meta-analysis of randomized trials comparing EUS-BD to conventional biliary drainage modalities, no difference in technical or clinical success was observed. Importantly, EUS-BD was associated with decreased risks of stent/catheter dysfunction when compared to both PTBD and ERCP, and decreased post-procedure pancreatitis when compared to ERCP, suggesting the potential role for EUS-BD as an alternative first-line therapy in distal malignant biliary obstruction. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract&...
Abstract Bile duct injuries can occur after abdominal trauma, postoperatively after cholecystectomy, liver resection or liver transplantation and also as a complication of endoscopic retrograde cholangiopancreatography (ERCP). The clinical appearance of bile duct injuries is highly variable and depends primarily on the underlying cause. In addition to the high perioperative morbidity, following successful initial complication management, bile duct injuries can lead to significant long-term complications. The treatment requires close interdisciplinary cooperation between surgery, interventional gastroenterolog...
CONCLUSIONS: temporary placement of FCSEBMS seems to be a technically feasible treatment option for post-ERCP bleeding with a high clinical success rate. The complication rate was low, although randomized studies are needed. PMID: 31696724 [PubMed - as supplied by publisher]
Conclusions: Same-session EUS-FNA and ERCP-based tissue sampling is superior to either method alone in the diagnosis of suspected malignant biliary strictures. Considering these results, combination sampling should be performed when possible. PMID: 31684700 [PubMed - as supplied by publisher]
CONCLUSIONThis is the fist case of a pancreaticopleural fistula with superinfected pancreatic necrosis managed with a video-assisted retroperitoneal pancreatic necrosectomy. This case will give surgeons another tool to treat these conditions that has less complications than other resective pancreatic surgeries and can solve both complications.
In this study, a small optically stimulated luminescence (OSL) dosimeter called the nanoDot was used to evaluate and measure the amount of radiation; this dosimeter was developed by Landauer Ltd. and was specifically designed for point measurements. There are numerous studies that have reported the usefulness of personal OSL dosimeters other than the nanoDot to measure scattered radiation. Here, we evaluated the amount of scattered radiation, along with the degree of reduction achieved with the use of a protective curtain, while employing a personal OSL dosimeter and nanoDot. When the scattered radiation dose was measured ...
Single-use duodenoscopy is one strategy to decrease infectious outbreaks associated with endoscope reuse. The aim of this study was to test the feasibility, preliminary safety and performance of a new single-use duodenoscope in a clinical setting.