Background: Endoscopic excision for adenoma of the major duodenal papilla was introduced as an alternative to surgery, but postprocedure pancreatitis is a ser ious drawback. This study assessed the feasibility and the...Background: Endoscopic excision for adenoma of the major duodenal papilla was introduced as an alternative to surgery, but postprocedure pancreatitis is a ser ious drawback. This study assessed the feasibility and the safety of endoscopic papillectomy with a guidewire and pancreatic-duct stent insertion to prevent pa ncreatitis. Methods: Six patients were enrolled. The snare loop was passed over a guidewire that had been inserted into the pancreatic duct. Immediately after s nare resection, a pancreatic stent was placed along the indwelling guidewire. Re sults:En bloc papillectomy and pancreatic stent insertion were performed successfully in all patients. Pancreatitis did not develop acutely in any pati ent. Complications included cholangitis (n= 1) and late-onset pancreatitis owin g to the pancreatic stent(n = 1). Scant residual adenomatous tissue was present at resection margins in two patients and was treated endoscopically.Conclusions: Wire-guided endoscopic snare papillectomy in selected patients is a useful tec hnique that maintains pancreatic-duct access for stent placement. This appears to prevent pancreatitis and to improve the outcome for patients undergoing endos copic resection of papillary tumors.展开更多
Background To determine whether endoscopic papillary balloon dilation decrease s the risk of hemorrhage without increasing the risk of acute pancreatitis, the results of endoscopic papillary balloon dilation were comp...Background To determine whether endoscopic papillary balloon dilation decrease s the risk of hemorrhage without increasing the risk of acute pancreatitis, the results of endoscopic papillary balloon dilation were compared with those of end oscopic biliary sphincterotomy in patients with cirrhosis and coagulopathy. Meth ods Twenty-one patients with liver cirrhosis with coagulopathy had endoscopic p apillary balloon dilation for choledocholithiasis from January 2001 to September 2003.Twenty patients with cirrhosis and coagulopathy who underwent endoscopic b iliary sphincterotomy from January 1998 to December 2000, served as a historical control group. Results The rate of endoscopic biliary sphincterotomy related he morrhage was 30%(6/20),whereas the rate for endoscopic papillary balloon dilati on related hemorrhage was 0%(p=0.009). With regard to rates of hemorrhage in re lation to Child-Pugh class,most (n=5) of the bleeding complications occurred in patients with Child-Pugh class C cirrhosis; bleeding occurred in only one pati ent with Child-Pugh B cirrhosis. There was no significant difference between th e endoscopic biliary sphincterotomy and the endoscopic papillary balloon dilatio n groups for procedure-related pancreatitis (10%vs. 4.7%, respectively; p >0. 05).Conclusions Endoscopic papillary balloon dilation may significantly reduce the risk of bleeding compa red with endoscopic biliary sphincterotomy in patients with advanced cirrhosis a nd coagulopathy. In these patients, the substitution of endoscopic papillary bal loon dilation for endoscopic biliary sphincterotomy is recommended for treatment of choledocholithiasis.展开更多
Background and Study Aim: Endoscopic papillary balloon dilation(EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involv...Background and Study Aim: Endoscopic papillary balloon dilation(EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involve cutting the biliary sphincter. Although attempts have been made to study the influence of EPBD and EST on sphincter of Oddi function,there is little agreement on this issue. In this study we used a method different from those described in previous reports to clarify whether EPBD or EST preserves sphincter of Oddi function better. Patients and Methods: 200 patients with bile duct stones who met the eligibility criteria were randomly assigned to EPBD (n = 104) or an EST (n = 96) group. Sphincter of Oddi function was estimated by measurement of the activity of pancreatic enzymes in the common bile duct (CBD). Pure bile was collected immediately before EPBD or EST, at 1 week and at 1 year after the procedure. We also statistically investigated 14 factors other than EPBD or EST that might have the potential to affect sphincter of Oddi function. Results: There was no significant difference between the baseline characteristics of the EPBD and EST groups. A total of 91 patients (46 in the EPBD group and 45 in the EST group) remained in the trial. Pure bile was collected from the CBD of 86 patients (43 EPBD and 43 EST) 1 week after the procedure. CBD stones were extracted successfully in all cases. Before the procedure,there were no significant differences in the levels of the five pancreatic enzymes between the EPBD and EST groups. At 1 week after the procedure, in both groups, there were significant increases in the levels of the five pancreatic enzymes. At 1year after the procedure a complete series of pancreatic enzyme analyses was done in 33 patients (12 EPBD and 21 EST). There was no significant difference between the levels of the five pancreatic enzymes immediately before and 1 year after EPBD and EST.When the pancreatic enzyme levels of the two groups were directly compared, there was no significan展开更多
目的:观察下乳汤治疗产后缺乳的疗效。方法:选取62例产后缺乳患者,给予自拟中药下乳汤(当归、川芎、炒白芍、天花粉、生地黄、柴胡、桔梗、青皮、漏芦、白芷、王不留、穿山甲)治疗,1 d 1剂,3剂为1个疗程,1～3个疗程后判定疗效。结果:痊...目的:观察下乳汤治疗产后缺乳的疗效。方法:选取62例产后缺乳患者,给予自拟中药下乳汤(当归、川芎、炒白芍、天花粉、生地黄、柴胡、桔梗、青皮、漏芦、白芷、王不留、穿山甲)治疗,1 d 1剂,3剂为1个疗程,1～3个疗程后判定疗效。结果:痊愈50例,好转7例,无效5例,有效率占93.55%。结论:下乳汤治疗肝气郁滞型产后缺乳疗效确切。展开更多
文摘Background: Endoscopic excision for adenoma of the major duodenal papilla was introduced as an alternative to surgery, but postprocedure pancreatitis is a ser ious drawback. This study assessed the feasibility and the safety of endoscopic papillectomy with a guidewire and pancreatic-duct stent insertion to prevent pa ncreatitis. Methods: Six patients were enrolled. The snare loop was passed over a guidewire that had been inserted into the pancreatic duct. Immediately after s nare resection, a pancreatic stent was placed along the indwelling guidewire. Re sults:En bloc papillectomy and pancreatic stent insertion were performed successfully in all patients. Pancreatitis did not develop acutely in any pati ent. Complications included cholangitis (n= 1) and late-onset pancreatitis owin g to the pancreatic stent(n = 1). Scant residual adenomatous tissue was present at resection margins in two patients and was treated endoscopically.Conclusions: Wire-guided endoscopic snare papillectomy in selected patients is a useful tec hnique that maintains pancreatic-duct access for stent placement. This appears to prevent pancreatitis and to improve the outcome for patients undergoing endos copic resection of papillary tumors.
文摘Background To determine whether endoscopic papillary balloon dilation decrease s the risk of hemorrhage without increasing the risk of acute pancreatitis, the results of endoscopic papillary balloon dilation were compared with those of end oscopic biliary sphincterotomy in patients with cirrhosis and coagulopathy. Meth ods Twenty-one patients with liver cirrhosis with coagulopathy had endoscopic p apillary balloon dilation for choledocholithiasis from January 2001 to September 2003.Twenty patients with cirrhosis and coagulopathy who underwent endoscopic b iliary sphincterotomy from January 1998 to December 2000, served as a historical control group. Results The rate of endoscopic biliary sphincterotomy related he morrhage was 30%(6/20),whereas the rate for endoscopic papillary balloon dilati on related hemorrhage was 0%(p=0.009). With regard to rates of hemorrhage in re lation to Child-Pugh class,most (n=5) of the bleeding complications occurred in patients with Child-Pugh class C cirrhosis; bleeding occurred in only one pati ent with Child-Pugh B cirrhosis. There was no significant difference between th e endoscopic biliary sphincterotomy and the endoscopic papillary balloon dilatio n groups for procedure-related pancreatitis (10%vs. 4.7%, respectively; p >0. 05).Conclusions Endoscopic papillary balloon dilation may significantly reduce the risk of bleeding compa red with endoscopic biliary sphincterotomy in patients with advanced cirrhosis a nd coagulopathy. In these patients, the substitution of endoscopic papillary bal loon dilation for endoscopic biliary sphincterotomy is recommended for treatment of choledocholithiasis.
文摘Background and Study Aim: Endoscopic papillary balloon dilation(EPBD) is assumed to have a theoretical advantage over endoscopic sphincterotomy (EST) in preserving sphincter of Oddi function because it does not involve cutting the biliary sphincter. Although attempts have been made to study the influence of EPBD and EST on sphincter of Oddi function,there is little agreement on this issue. In this study we used a method different from those described in previous reports to clarify whether EPBD or EST preserves sphincter of Oddi function better. Patients and Methods: 200 patients with bile duct stones who met the eligibility criteria were randomly assigned to EPBD (n = 104) or an EST (n = 96) group. Sphincter of Oddi function was estimated by measurement of the activity of pancreatic enzymes in the common bile duct (CBD). Pure bile was collected immediately before EPBD or EST, at 1 week and at 1 year after the procedure. We also statistically investigated 14 factors other than EPBD or EST that might have the potential to affect sphincter of Oddi function. Results: There was no significant difference between the baseline characteristics of the EPBD and EST groups. A total of 91 patients (46 in the EPBD group and 45 in the EST group) remained in the trial. Pure bile was collected from the CBD of 86 patients (43 EPBD and 43 EST) 1 week after the procedure. CBD stones were extracted successfully in all cases. Before the procedure,there were no significant differences in the levels of the five pancreatic enzymes between the EPBD and EST groups. At 1 week after the procedure, in both groups, there were significant increases in the levels of the five pancreatic enzymes. At 1year after the procedure a complete series of pancreatic enzyme analyses was done in 33 patients (12 EPBD and 21 EST). There was no significant difference between the levels of the five pancreatic enzymes immediately before and 1 year after EPBD and EST.When the pancreatic enzyme levels of the two groups were directly compared, there was no significan
文摘目的:观察下乳汤治疗产后缺乳的疗效。方法:选取62例产后缺乳患者,给予自拟中药下乳汤(当归、川芎、炒白芍、天花粉、生地黄、柴胡、桔梗、青皮、漏芦、白芷、王不留、穿山甲)治疗,1 d 1剂,3剂为1个疗程,1～3个疗程后判定疗效。结果:痊愈50例,好转7例,无效5例,有效率占93.55%。结论:下乳汤治疗肝气郁滞型产后缺乳疗效确切。
