AIM To describe the efficacy and safety of endoscopic papillary large balloon dilatation(EPLBD) in the management of bile duct stones in a Western population. METHODS Data was collected from the endoscopic retrograde ...AIM To describe the efficacy and safety of endoscopic papillary large balloon dilatation(EPLBD) in the management of bile duct stones in a Western population. METHODS Data was collected from the endoscopic retrograde cholangiopancreatography(ERCP) and Radiology electronic database along with a review of case notes over a period of six years from 1 st August 2009 to 31 st July 2015 and incorporated into Microsoft excel. Statistical analyses were performed using Med Calc for Windows,version 12.5(Med Calc Software,Ostend,Belgium). Simple statistical applications were applied in order to determine whether significant differences exist in comparison groups. We initially used simple proportions to describe the study populations. Furthermore,we used chi-square test to compare proportions and categorical variables. Non-parametric Mann-Whitney U-test was applied in order to compare continuous variables. All comparisons were deemed to be statistically significant if P values were less than 0.05.RESULTS EPLBD was performed in 229 patients(46 females) with mean age of 68 ± 14.3 years. 115/229(50%) patients had failed duct clearance at previous ERCP referred from elsewhere with standard techniques. Duct clearance at the Index* ERCP(1 st ERCP at our centre) was 72.5%. Final duct clearance rate was 98%. EPLBD after fresh sphincterotomy was performed in 81(35.4%). Median balloon size was 13.5 mm(10-18). In addition to EPLBD,per-oral cholangioscopy(POC) and electrohydraulic lithotripsy(EHL) was performed in 35(15%) patients at index* ERCP. 63(27.5%) required repeat ERCP for stone clearance. 28(44.5%) required POC and EHL and 11(17.4%) had repeat EPLBD for complete duct clearance. Larger stone size(12.4 mm vs 17.4 mm,P < 0.000001),multiple stones(2,range(1-13) vs 3,range(1-12),P < 0.006) and dilated common bile duct(CBD)(12.4 mm vs 18.3 mm,P < 0.001) were significant predictors of failed duct clearance at index ERCP. 47 patients(20%) had ampullary or peri-ampullary diverticula. Procedure related adverse events included 2 cases of bleeding and pancreatitis(0.87%) each.CONCLUSION EPLBD is a safe and effective technique for CBDS removal. There is no difference in outcomes whether it is performed at the time of sphincterotomy or at a later procedure or whether there is a full or limited sphincterotomy.展开更多
Portal vein cannulation is a rare complication of endo-scopic retrograde cholangiopancreatography(ERCP).It has been reported that it usually occurs after endo-scopic sphincterotomy,whereas in cases without prior sphin...Portal vein cannulation is a rare complication of endo-scopic retrograde cholangiopancreatography(ERCP).It has been reported that it usually occurs after endo-scopic sphincterotomy,whereas in cases without prior sphincterotomy,the presence of portobiliary fistulas has been shown.Here,we present a case in which cannulation of the portal vein occurred despite careful wire-guided cannulation and the absence of sphinc-terotomy.Although fatal cases of cerebral and pulmo-nary air and/or bile embolism have been reported in patients with combined portal and hepatic vein trauma after ERCP and sphincterotomy,isolated portal vein cannulation,as in the current case,does not usu-ally result in mortality or serious morbidity.However,awareness of this rare complication is important so that no further intervention is performed.展开更多
China's 14th Five-Year Plan,for the period 2021e25,presents a real opportunity for China to link its longterm climate goals with its short-to medium-term social and economic development plans.China's recent c...China's 14th Five-Year Plan,for the period 2021e25,presents a real opportunity for China to link its longterm climate goals with its short-to medium-term social and economic development plans.China's recent commitment to achieving carbon neutrality by 2060 has set a clear direction for its economy,but requires ratcheting up ambition on its near-term climate policy.Against this background,this paper discusses major action areas for China's 14th Five-Year Plan after COVID-19,especially focusing on three aspects:the energy transition,a new type of sustainable urban development,and investment priorities.China's role in the world is now of a magnitude that makes its actions in the immediate future critical to how the world goes forward.This decade,2021e2030,is of fundamental importance to human history.If society locks in dirty and high-carbon capital,it raises profound risks of irreversible damage to the world's climate.It is crucial for China to peak its emissions in the 14th Five-Year Plan(by 2025),making the transition earlier and cheaper,enhancing its international competitiveness in growing new markets and setting a strong example for the world.The benefits for China and the world as a whole could be immense.展开更多
Nick Stern和Bob Ward认为,我们正处在历史上一个关键的时期,不仅面临着生物多样性和环境退化带来的危机日益增长,还有全球疫情大流行的灾难。但我们依然拥有很多机遇来改变全球经济,开启一个更加美好繁荣的新时代。新型冠状病毒肺炎疫...Nick Stern和Bob Ward认为,我们正处在历史上一个关键的时期,不仅面临着生物多样性和环境退化带来的危机日益增长,还有全球疫情大流行的灾难。但我们依然拥有很多机遇来改变全球经济,开启一个更加美好繁荣的新时代。新型冠状病毒肺炎疫情大流行让世界面对全球性威胁时的脆弱性暴露无遗。疾病本身以及疾控措施的实施严重影响了人们的生活和生计。展开更多
文摘AIM To describe the efficacy and safety of endoscopic papillary large balloon dilatation(EPLBD) in the management of bile duct stones in a Western population. METHODS Data was collected from the endoscopic retrograde cholangiopancreatography(ERCP) and Radiology electronic database along with a review of case notes over a period of six years from 1 st August 2009 to 31 st July 2015 and incorporated into Microsoft excel. Statistical analyses were performed using Med Calc for Windows,version 12.5(Med Calc Software,Ostend,Belgium). Simple statistical applications were applied in order to determine whether significant differences exist in comparison groups. We initially used simple proportions to describe the study populations. Furthermore,we used chi-square test to compare proportions and categorical variables. Non-parametric Mann-Whitney U-test was applied in order to compare continuous variables. All comparisons were deemed to be statistically significant if P values were less than 0.05.RESULTS EPLBD was performed in 229 patients(46 females) with mean age of 68 ± 14.3 years. 115/229(50%) patients had failed duct clearance at previous ERCP referred from elsewhere with standard techniques. Duct clearance at the Index* ERCP(1 st ERCP at our centre) was 72.5%. Final duct clearance rate was 98%. EPLBD after fresh sphincterotomy was performed in 81(35.4%). Median balloon size was 13.5 mm(10-18). In addition to EPLBD,per-oral cholangioscopy(POC) and electrohydraulic lithotripsy(EHL) was performed in 35(15%) patients at index* ERCP. 63(27.5%) required repeat ERCP for stone clearance. 28(44.5%) required POC and EHL and 11(17.4%) had repeat EPLBD for complete duct clearance. Larger stone size(12.4 mm vs 17.4 mm,P < 0.000001),multiple stones(2,range(1-13) vs 3,range(1-12),P < 0.006) and dilated common bile duct(CBD)(12.4 mm vs 18.3 mm,P < 0.001) were significant predictors of failed duct clearance at index ERCP. 47 patients(20%) had ampullary or peri-ampullary diverticula. Procedure related adverse events included 2 cases of bleeding and pancreatitis(0.87%) each.CONCLUSION EPLBD is a safe and effective technique for CBDS removal. There is no difference in outcomes whether it is performed at the time of sphincterotomy or at a later procedure or whether there is a full or limited sphincterotomy.
文摘Portal vein cannulation is a rare complication of endo-scopic retrograde cholangiopancreatography(ERCP).It has been reported that it usually occurs after endo-scopic sphincterotomy,whereas in cases without prior sphincterotomy,the presence of portobiliary fistulas has been shown.Here,we present a case in which cannulation of the portal vein occurred despite careful wire-guided cannulation and the absence of sphinc-terotomy.Although fatal cases of cerebral and pulmo-nary air and/or bile embolism have been reported in patients with combined portal and hepatic vein trauma after ERCP and sphincterotomy,isolated portal vein cannulation,as in the current case,does not usu-ally result in mortality or serious morbidity.However,awareness of this rare complication is important so that no further intervention is performed.
文摘China's 14th Five-Year Plan,for the period 2021e25,presents a real opportunity for China to link its longterm climate goals with its short-to medium-term social and economic development plans.China's recent commitment to achieving carbon neutrality by 2060 has set a clear direction for its economy,but requires ratcheting up ambition on its near-term climate policy.Against this background,this paper discusses major action areas for China's 14th Five-Year Plan after COVID-19,especially focusing on three aspects:the energy transition,a new type of sustainable urban development,and investment priorities.China's role in the world is now of a magnitude that makes its actions in the immediate future critical to how the world goes forward.This decade,2021e2030,is of fundamental importance to human history.If society locks in dirty and high-carbon capital,it raises profound risks of irreversible damage to the world's climate.It is crucial for China to peak its emissions in the 14th Five-Year Plan(by 2025),making the transition earlier and cheaper,enhancing its international competitiveness in growing new markets and setting a strong example for the world.The benefits for China and the world as a whole could be immense.
