Based on the analysis of core,logging,and testing data,the fourth member of the Cretaceous Quantou Formation(K_(2)q^(4))in the Sanzhao depression,Songliao Basin,is investigated in order to understand the sedimentary c...Based on the analysis of core,logging,and testing data,the fourth member of the Cretaceous Quantou Formation(K_(2)q^(4))in the Sanzhao depression,Songliao Basin,is investigated in order to understand the sedimentary characteristics and hydrocarbon exploration significance of a retrograding shallow-water delta.The results show that during the sedimentary period of K_(2)q^(4),the Sanzhao depression with a gentle basement experienced stable tectonic subsidence and suffered a long-term lake level rise caused by paleoclimate changes(from semiarid to semihumid),the K_(2)q^(4)in the study area were dominated by a fining-upward deltaic succession and had relatively stable thickness.From the bottom to the top,the color of mudstone gradually changes from purplish-red to gray and grayish-green,the contents of caliche nodules decrease gradually,while the presence of pyrite in sediments becomes frequent.Channel sandstones mainly composed of siltstone and fine sandstone with developed high-energy sedimentary structures constitute the main sand bodies of deltaic deposits,but the scale of channel sandstones decrease upward.Despite the long-term lake level rise and fining-upward sedimentary succession,purplish-red mudstone,caliche nodules and thin channel sandstones are still broadly distributed in the study area,and thin channel sandstones can be found at the top of K_(2)q^(4)covered by the black oil shale of Qingshankou Formation.These assertations suggest that the study area was dominated by retrograding shallow-water delta deposits during the sedimentary period of K_(2)q^(4).In comparison with modern Poyang Lake,we infer that during the sedimentary period of K_(2)q^(4),the study area experienced frequent lake level fluctuations triggered by paleoclimate changes despite the long-term lake level rise,and the lake level fluctuations control the deposition of retrograding shallow-water delta.In addition,most of the thin channel sandstones distributed at the top of K_(2)q^(4)and covered by black oil shale are generally immersed in oil,indicating that the thin channel sandstones formed at the top of a retrograding shallow-water delta sedimentary succession are favorable targets for lithological reservoir exploration.展开更多
BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehe...BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of H...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.展开更多
BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement impro...BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.展开更多
High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatograph...High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.展开更多
This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a...This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)is a cornerstone procedure for the diagnosis and management of pancreatic and hepatobiliary diseases.Although its diagnostic role has been increasingly supplanted by...Endoscopic retrograde cholangiopancreatography(ERCP)is a cornerstone procedure for the diagnosis and management of pancreatic and hepatobiliary diseases.Although its diagnostic role has been increasingly supplanted by nonin-vasive imaging modalities such as magnetic resonance imaging(MRI)and mag-netic resonance cholangiopancreatography,the therapeutic applications of ERCP have continued to expand.ERCP is widely used and has a generally favorable safety profile.However,it is important to recognize expected post-procedural imaging findings and serious complications that can arise.The increasing comple-xity of therapeutic interventions and the growing volume of procedures have led to a higher incidence of complications that often present with overlapping clinical and laboratory features,underscoring the critical role of imaging in differential diagnosis.This review focused on the typical normal ERCP findings and the imaging characteristics of common complications,including pancreatitis,bleeding,ERCP-related infections,perforations,and stent-related complications.Computed tomography(CT)is particularly valuable in timely recognition,management,and surgical decision-making for these complications.Furthermore,MRI offers a radiation-free alternative for managing complications in selected patients.Therefore,radiological modalities,particularly CT and MRI,are critical tools for the rapid diagnosis,management,and surgical decision-making processes for post-ERCP complications.展开更多
BACKGROUND Periampullary diverticulum(PAD)is a common anatomical variant,but its association with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)remains controversial.While PAD may alter amp...BACKGROUND Periampullary diverticulum(PAD)is a common anatomical variant,but its association with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)remains controversial.While PAD may alter ampullary anatomy,increasing technical difficulty during ERCP,existing studies report inconsistent findings on its role in PEP pathogenesis.We hypothesize that PAD presence,particularly type B,shows a significant association with PEP development and may interact with procedural factors like pancreatic duct guidewire insertion.AIM To examine the association between PAD(including subtypes A/B)and PEP incidence after ERCP for choledocholithiasis.METHODS We conducted a retrospective cohort study of 615 patients undergoing ERCP at two tertiary hospitals from 2023 to 2025.Participants were stratified into PAD(n=183;subtype A=125,subtype B=58)and non-PAD(n=432)groups.The primary outcome was PEP incidence.Multivariable logistic regression adjusted for age,sex,hypertension,diabetes,gallbladder surgery,and guidewire insertion.Statistical significance was set at P<0.05(two-tailed).RESULTS PAD prevalence was 29.8%(183/615).PEP occurrence was more frequent in PAD patients[15.3%(28/183)]than in non-PAD patients[4.2%(18/432)],odds ratio(OR)=3.86,95%confidence interval:2.03-7.35,P<0.001.Type B PAD showed a stronger association with PEP than type A(OR=14.16,95%confidence interval:5.84-34.34,P<0.001).Guidewire pancreatic duct entry was linked to higher PEP odds in PAD patients(adjusted OR=5.02,P<0.05).Hypertension also demonstrated an association with PEP in the PAD subgroup(P=0.012).CONCLUSION PAD,particularly type B,is independently associated with PEP after ERCP.Patients with these features,especially those with hypertension or pancreatic duct instrumentation,may benefit from enhanced monitoring and prophylaxis.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation,which is often challenging and associated with complications.In difficult cannulation cases,early precutting is freque...BACKGROUND Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation,which is often challenging and associated with complications.In difficult cannulation cases,early precutting is frequently used.However,its efficacy and optimal indications require further evaluation.AIM To evaluate the efficacy and safety of early precut(EP)in difficult bile duct cannulation.METHODS This retrospective analysis of endoscopic retrograde cholangiopancreatography procedures was performed for bile duct cannulation in patients with naive papillae who required advanced cannulation techniques(ACTs).These patients were admitted between April 2020 and March 2024 and were analyzed for risk factors,success rates,and complications.Outcomes were compared between the EP group and the conventional other ACTs group,with a focus on cases with oral protrusion large(oral protrusion-L).RESULTS The need for ACTs was identified as an independent risk factor for complications[odds ratio(OR)=5.4;95%confidence interval:1.887-15.53].Malignant biliary strictures(OR=2.58)and oral protrusion-L(OR=2.77)were also identified as independent risk factors for requiring ACTs.The EP group had a significantly higher second-line cannulation success rate(97.9%vs 73.2%,P=0.001)and lower complication rate(8.3%vs 39.0%,P=0.001)than the other ACTs group.Additionally,similar benefits were observed in the oral protrusion-L cases.CONCLUSION This study provides compelling evidence that EP is a viable alternative and a superior strategy in cases requiring ACTs,particularly oral protrusion-L.展开更多
Biliary stent placement and removal are common medical procedures,but they carry risks of chyme regurgitation and residual common bile duct stones(CBDS),highlighting the necessity of intra-biliary cleansing during sec...Biliary stent placement and removal are common medical procedures,but they carry risks of chyme regurgitation and residual common bile duct stones(CBDS),highlighting the necessity of intra-biliary cleansing during secondary endoscopic stent removal.AIM To compare the incidence of chyme reflux into the common bile duct and residual or recurrent CBDS,and the safety of intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend vs single pigtail biliary stents.METHODS We included 554 patients undergoing secondary duodenoscopy for biliary stent removal and intra-biliary cleansing from March 2019 to September 2024.Patients were divided into a single pigtail biliary stent group and a duodenal bend biliary stent group(DBBSG).Chyme reflux and CBDS occurrences were compared using the Cox proportional hazards model.RESULTS The median age of the patients included was 62 years(interquartile range:51-70),with 53.11%being female.During stent removal,DBBSG showed higher rates of chyme reflux(23.27%vs 9.65%,P<0.001)and CBDS(42.77%vs 21.05%,P<0.001)compared to the single pigtail biliary stent group.No significant differences were found in the incidence of adverse reactions between the two groups(P>0.05),and no serious events or deaths occurred.DBBSG patients had increased risks of chyme reflux(hazard ratio=2.793;95%confidence interval:1.695-4.603;P<0.001)and CBDS(hazard ratio:2.475;95%confidence interval:1.732-3.536;P<0.001).CONCLUSION Duodenal bend biliary stents increase the risk of chyme reflux into the common bile duct and CBDS.The safety of intra-biliary cleaning during stent removal has been validated,and as a result,it is recommended that endoscopists perform intra-biliary cleaning during duodenoscopic removal of duodenal bend biliary stents.展开更多
BACKGROUND Despite advancements,endoscopic retrograde cholangiopancreatography(ERCP)poses challenges,including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.AIM To compare dome and tapered t...BACKGROUND Despite advancements,endoscopic retrograde cholangiopancreatography(ERCP)poses challenges,including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.AIM To compare dome and tapered tip sphincterotomes,focusing on their efficacy in achieving successful biliary cannulation and reducing the incidence of post-ERCP pancreatitis.METHODS In this prospective,single-blind,randomized pilot study conducted at Inha Uni-versity Hospital,85 patients undergoing ERCP were equally divided into dome and tapered tip sphincterotome groups.The co-primary outcomes were the success rate of selective biliary cannulation and incidence of post-ERCP pancre-atitis.The secondary outcomes included biliary cannulation time,number of unintended pancreatic duct access events,and total procedure time.RESULTS The success rates of selective biliary cannulation were 74.4%and 85.7%in the dome and tapered tip groups,respectively,with no significant difference(P=0.20).Similarly,the incidence of post-ERCP pancreatitis did not differ significantly between the groups(5 cases in the tapered tip group vs 6 in the dome tip group,P=0.72).However,difficult cannulation was significantly more common in the dome tip group than in the tapered tip group(P=0.05).Selective biliary cannula-tion time emerged as a significant predictor of post-ERCP pancreatitis(multivariate odds ratio=9.33,95%confi-dence interval:1.31-66.44,P=0.03).CONCLUSION This study indicated that the sphincterotome tip type does not markedly affect biliary cannulation success or post-ERCP pancreatitis rates.However,cannulation duration is a key risk factor for post-ERCP pancreatitis.These findings provide preliminary insights that highlight the importance of refining ERCP practices,including sphinc-terotome selection,while underscoring the need for larger multicenter studies to improve procedure time and patient safety.展开更多
This letter aims to discuss the article,published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2025.Endoscopic retrograde cholangiopan-creatography(ERCP)is widely acknowledged as an effective...This letter aims to discuss the article,published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2025.Endoscopic retrograde cholangiopan-creatography(ERCP)is widely acknowledged as an effective procedure for managing biliary obstruction.However,its use in very elderly patients,partic-ularly centenarians,presents unique challenges related to both safety and efficacy.In this report,we share our experience with three centenarian patients who underwent ERCP for biliary obstruction in our unit.Remarkably,all patients had favorable outcomes,and no significant adverse events were observed.展开更多
This study presents a comprehensive overview of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP),detailing its epidemiology,pathophysiology,prevention,and treatment.PEP is the most common com...This study presents a comprehensive overview of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP),detailing its epidemiology,pathophysiology,prevention,and treatment.PEP is the most common complication of ERCP,with an incidence of 3%,16%,and above 20%in high-risk patients.Proposed mechanisms include mechanical trauma,pancreatic-duct(PD)hypertension,oxidative stress,and dysbiosis-driven inflammation.Mitochondrial oxidative stress is a central pathological driver:It activates the NLRP3 inflammasome and the STING pathway,perpetuating a deleterious“injury-inflammation"cycle.Risk factors encompass patient characteristics,procedural variables,and operator-related factors.Preventive strategies combine pharmacological and procedural measures.Rectal non-steroidal anti-inflammatory drugs(NSAIDs),such as indomethacin,inhibit prostaglandin synthesis.European guidelines report that NSAIDs reduce the overall incidence of PEP,with odds ratios of 0.24-0.63.Subgroup analyses indicate the greatest benefit in high-risk cohorts,with mixed-risk groups also deriving more benefit than average-risk groups.In high-risk patients,prophylactic PD stenting markedly lowers PEP incidence by alleviating ductal hypertension.Aggressive fluid resuscitation enhances pancreatic perfusion and decreases the frequency of moderate-to-severe PEP.Recent therapeutic advances emphasize targeted interventions.Mitochondria-directed nanomedicines cross the blood-pancreas barrier,scavenge reactive oxygen species,and attenuate inflammatory cascades.A multidisciplinary team(MDT)approach optimizes infection control and manages complications in severe PEP,improving clinical outcomes.Future research should focus on addressing genetic susceptibility,developing novel targeted agents,and integrating artificial intelligence-assisted risk stratification to refine personalized prevention and therapy.This article reviews the epidemiological and pathophysiological foundations of PEP,evaluates evidencebased preventive strategies(e.g.,NSAIDs,pancreatic duct stenting),and discusses emerging approaches such as gene therapy.It also summarizes advances in treating mild and severe PEP,highlights the role of MDT care,identifies current knowledge gaps,and proposes directions for future research,including the discovery of novel biomarkers and the development of personalized preventive and therapeutic strategies.展开更多
Objective:The management of urethral stricture disease depends on the location,length of stricture,and associated urethral pathology.These parameters are obtained from preoperative imaging,with conventional urethrogra...Objective:The management of urethral stricture disease depends on the location,length of stricture,and associated urethral pathology.These parameters are obtained from preoperative imaging,with conventional urethrogram(retrograde urethrogram and micturating cystourethrogram[RGU/MCU])being the diagnostic tool of choice despite its many shortcomings.Sono-urethrogram(SUG)is an alternative that addresses most issues of RGU/MCU.Studies comparing RGU/MCU with SUG are limited.With the objective of comparing these two imaging modalities in the evaluation of urethral stricture disease,a prospective study was conducted.Methods:Fifty-six patients suspected of urethral stricture disease on clinical evaluation and confirmed either on RGU/MCU or urethro-cystoscopy were included in the study.SUG was performed by the experienced consultant radiologist who was blinded to the report of RGU/MCU.Findings of RGU/MCU and SUG were compared to intraoperative findings,which served as the reference standard.Results:The median length of the stricture determined intraoperatively was 16.5 mm,by RGU/MCU was 5.8 mm,and by SUG was 13.5 mm.The diagnostic accuracy for determination of the stricture location was 93%for RGU/MCU and 98%for SUG.SUG identified spongiofibrosis in 90%of patients with higher accuracy for the severe degree of spongiofibrosis.Conclusion:SUG has been shown to be more accurate than RGU/MCU in estimating stricture length(both short and intermediate)and localizing the stricture location.Use of SUG in conjunction with RGU/MCU helps in better guidance of stricture management by improving preoperative assessment.Further studies with larger sample sizes are warranted.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-ter...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-term ERCP outcomes,particularly using established quality benchmarks.AIM To evaluate ERCP indications,success rates,complications,and quality performance at a high-volume tertiary care center in Pakistan over a 17-year period.METHODS This retrospective study analyzed 13215 ERCP procedures performed between 2006 and 2023.Data included demographics,indications,cannulation rates,complications,and pediatric cases.Findings were assessed against American Society of Gastroenterology/European Society of Gastrointestinal Endoscopy quality indicators.RESULTS Biliary ERCP accounted for 93.1%of procedures;choledocholithiasis was the most common indication(40%).Cannulation success was 93.9%for biliary and 94.2%for pancreatic ERCP.Pediatric ERCP comprised 4%of cases,mostly for stones and chronic pancreatitis.Bleeding(1.7%)and post-ERCP pancreatitis(2.3%)were the most frequent complications.Performance met or exceeded most American Society of Benchmarks.CONCLUSION This study offers insight into nearly two decades of ERCP practice within a public sector hospital.Our experience echoes the quality and efficiency of ERCP not previously available in Pakistan.As healthcare systems in resourcelimited sectors expand,our findings serve as a reference point.Continued training and quality improvement studies can further enhance ERCP effectiveness in the region and beyond.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)serves an essential role in treating biliary diseases,especially in choledocholithiasis.However,due to the limited human lifespan,there remains a paucity ...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)serves an essential role in treating biliary diseases,especially in choledocholithiasis.However,due to the limited human lifespan,there remains a paucity of clinical investigations on ERCP treatment in patients over 90 years old.AIM To explore the effectiveness and safety of ERCP in super-older patients aged≥90 years with choledochal stones.METHODS This study retrospectively analyzed data from patients(aged≥65 years)with choledocholithiasis who received ERCP treatment in our hospital from 2011 to 2023.Among them,patients≥90 years old were in the super-older group,and patients aged 65-89 years were in the older group.Baseline data,including gender,number of stones,stone size,gallbladder stones,periampullary diverti-culum,and common bile duct intubation of patients in the two groups,were mat-ched by adopting the 1:1 propensity score matching method.RESULTS After matching,44 patients were included in both the super-older group and the older group.The incidence of stroke in the super-older group was markedly higher than that in the older group[34.1%(15/44)vs 6.8%(3/44),P=0.008].The success rate of the ERCP procedure in the super-older group was 90.9%(40/44),compared to that in the older group[93.2%(41/44),P=1.000].Although endo-scopic papillary balloon dilation was more frequently used in the super-older group than in the older group[61.4%(27/44)vs 18.2%(8/44),P<0.001],there was no significant difference in terms of stone removal rate,the incidence of complications,mortality,recurrence,and length of hospitalization between the two groups(P>0.05).CONCLUSION ERCP is safe and effective in super-older patients≥90 years old with choledocholithiasis.展开更多
BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stent...BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stents(MPSs)or fully covered self-expandable metal stents(cSEMSs)represent the standard treatment for BAS post-OLT.Recently,cSEMSs have emerged as the primary option for managing BAS post-OLT.AIM To compare the resolution and recurrence of BAS rates in these patients.METHODS This retrospective cohort study was conducted in a single tertiary care center(Hospital Israelita Albert Einstein,São Paulo,Brazil).We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022.Patients were stratified into two groups according to therapy:(1)MPSs;and(2)cSEMSs.Primary endpoints were to compare stricture resolution and recurrence among the groups.The secondary endpoint was to identify predictive factors for stricture recurrence.RESULTS A total of 104 patients were included.Overall stricture resolution was 101/104(97.1%).Stricture resolution was achieved in 83/84 patients(99%)in the cSEMS group and 18/20 patients(90%)in the MPS group(P=0.094).Failure occurred in 3/104 patients(2.8%).Stricture recurrence occurred in 9/104 patients(8.7%).Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups(P=0.201).A multivariate analysis identified the number of ERCP procedures(hazard ratio=1.4;95%confidence interval:1.194-1.619;P<0.001)and complications(hazard ratio=2.8;95%confidence interval:1.008-7.724;P=0.048)as predictors of stricture recurrence.CONCLUSION cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence.The number of ERCP procedures and complications were predictors of stricture recurrence.展开更多
基金financially supported by the National Science and Technology Major Project of China(H.M.Y.,grant number 2016ZX05013006-006)Natural Science Foundation of Hubei Province of China(L.H.,grant number 2020CFB745)
文摘Based on the analysis of core,logging,and testing data,the fourth member of the Cretaceous Quantou Formation(K_(2)q^(4))in the Sanzhao depression,Songliao Basin,is investigated in order to understand the sedimentary characteristics and hydrocarbon exploration significance of a retrograding shallow-water delta.The results show that during the sedimentary period of K_(2)q^(4),the Sanzhao depression with a gentle basement experienced stable tectonic subsidence and suffered a long-term lake level rise caused by paleoclimate changes(from semiarid to semihumid),the K_(2)q^(4)in the study area were dominated by a fining-upward deltaic succession and had relatively stable thickness.From the bottom to the top,the color of mudstone gradually changes from purplish-red to gray and grayish-green,the contents of caliche nodules decrease gradually,while the presence of pyrite in sediments becomes frequent.Channel sandstones mainly composed of siltstone and fine sandstone with developed high-energy sedimentary structures constitute the main sand bodies of deltaic deposits,but the scale of channel sandstones decrease upward.Despite the long-term lake level rise and fining-upward sedimentary succession,purplish-red mudstone,caliche nodules and thin channel sandstones are still broadly distributed in the study area,and thin channel sandstones can be found at the top of K_(2)q^(4)covered by the black oil shale of Qingshankou Formation.These assertations suggest that the study area was dominated by retrograding shallow-water delta deposits during the sedimentary period of K_(2)q^(4).In comparison with modern Poyang Lake,we infer that during the sedimentary period of K_(2)q^(4),the study area experienced frequent lake level fluctuations triggered by paleoclimate changes despite the long-term lake level rise,and the lake level fluctuations control the deposition of retrograding shallow-water delta.In addition,most of the thin channel sandstones distributed at the top of K_(2)q^(4)and covered by black oil shale are generally immersed in oil,indicating that the thin channel sandstones formed at the top of a retrograding shallow-water delta sedimentary succession are favorable targets for lithological reservoir exploration.
文摘BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
文摘BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.
文摘High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.
文摘This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is a cornerstone procedure for the diagnosis and management of pancreatic and hepatobiliary diseases.Although its diagnostic role has been increasingly supplanted by nonin-vasive imaging modalities such as magnetic resonance imaging(MRI)and mag-netic resonance cholangiopancreatography,the therapeutic applications of ERCP have continued to expand.ERCP is widely used and has a generally favorable safety profile.However,it is important to recognize expected post-procedural imaging findings and serious complications that can arise.The increasing comple-xity of therapeutic interventions and the growing volume of procedures have led to a higher incidence of complications that often present with overlapping clinical and laboratory features,underscoring the critical role of imaging in differential diagnosis.This review focused on the typical normal ERCP findings and the imaging characteristics of common complications,including pancreatitis,bleeding,ERCP-related infections,perforations,and stent-related complications.Computed tomography(CT)is particularly valuable in timely recognition,management,and surgical decision-making for these complications.Furthermore,MRI offers a radiation-free alternative for managing complications in selected patients.Therefore,radiological modalities,particularly CT and MRI,are critical tools for the rapid diagnosis,management,and surgical decision-making processes for post-ERCP complications.
文摘BACKGROUND Periampullary diverticulum(PAD)is a common anatomical variant,but its association with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)remains controversial.While PAD may alter ampullary anatomy,increasing technical difficulty during ERCP,existing studies report inconsistent findings on its role in PEP pathogenesis.We hypothesize that PAD presence,particularly type B,shows a significant association with PEP development and may interact with procedural factors like pancreatic duct guidewire insertion.AIM To examine the association between PAD(including subtypes A/B)and PEP incidence after ERCP for choledocholithiasis.METHODS We conducted a retrospective cohort study of 615 patients undergoing ERCP at two tertiary hospitals from 2023 to 2025.Participants were stratified into PAD(n=183;subtype A=125,subtype B=58)and non-PAD(n=432)groups.The primary outcome was PEP incidence.Multivariable logistic regression adjusted for age,sex,hypertension,diabetes,gallbladder surgery,and guidewire insertion.Statistical significance was set at P<0.05(two-tailed).RESULTS PAD prevalence was 29.8%(183/615).PEP occurrence was more frequent in PAD patients[15.3%(28/183)]than in non-PAD patients[4.2%(18/432)],odds ratio(OR)=3.86,95%confidence interval:2.03-7.35,P<0.001.Type B PAD showed a stronger association with PEP than type A(OR=14.16,95%confidence interval:5.84-34.34,P<0.001).Guidewire pancreatic duct entry was linked to higher PEP odds in PAD patients(adjusted OR=5.02,P<0.05).Hypertension also demonstrated an association with PEP in the PAD subgroup(P=0.012).CONCLUSION PAD,particularly type B,is independently associated with PEP after ERCP.Patients with these features,especially those with hypertension or pancreatic duct instrumentation,may benefit from enhanced monitoring and prophylaxis.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation,which is often challenging and associated with complications.In difficult cannulation cases,early precutting is frequently used.However,its efficacy and optimal indications require further evaluation.AIM To evaluate the efficacy and safety of early precut(EP)in difficult bile duct cannulation.METHODS This retrospective analysis of endoscopic retrograde cholangiopancreatography procedures was performed for bile duct cannulation in patients with naive papillae who required advanced cannulation techniques(ACTs).These patients were admitted between April 2020 and March 2024 and were analyzed for risk factors,success rates,and complications.Outcomes were compared between the EP group and the conventional other ACTs group,with a focus on cases with oral protrusion large(oral protrusion-L).RESULTS The need for ACTs was identified as an independent risk factor for complications[odds ratio(OR)=5.4;95%confidence interval:1.887-15.53].Malignant biliary strictures(OR=2.58)and oral protrusion-L(OR=2.77)were also identified as independent risk factors for requiring ACTs.The EP group had a significantly higher second-line cannulation success rate(97.9%vs 73.2%,P=0.001)and lower complication rate(8.3%vs 39.0%,P=0.001)than the other ACTs group.Additionally,similar benefits were observed in the oral protrusion-L cases.CONCLUSION This study provides compelling evidence that EP is a viable alternative and a superior strategy in cases requiring ACTs,particularly oral protrusion-L.
基金Supported by the Key Specialty Construction Project of Shanghai Pudong New Area Health Commission,No.PWZzk2022-17the Featured Clinical Discipline Project of Shanghai Pudong,No.PWYts2021-06+1 种基金Clinical Research Project of Shanghai East Hospital,No.DFLC2022019Shanghai Dongfang Hospital Key Discipline Department of Gallstone Disease,No.2024-DFZD-005DS.
文摘Biliary stent placement and removal are common medical procedures,but they carry risks of chyme regurgitation and residual common bile duct stones(CBDS),highlighting the necessity of intra-biliary cleansing during secondary endoscopic stent removal.AIM To compare the incidence of chyme reflux into the common bile duct and residual or recurrent CBDS,and the safety of intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend vs single pigtail biliary stents.METHODS We included 554 patients undergoing secondary duodenoscopy for biliary stent removal and intra-biliary cleansing from March 2019 to September 2024.Patients were divided into a single pigtail biliary stent group and a duodenal bend biliary stent group(DBBSG).Chyme reflux and CBDS occurrences were compared using the Cox proportional hazards model.RESULTS The median age of the patients included was 62 years(interquartile range:51-70),with 53.11%being female.During stent removal,DBBSG showed higher rates of chyme reflux(23.27%vs 9.65%,P<0.001)and CBDS(42.77%vs 21.05%,P<0.001)compared to the single pigtail biliary stent group.No significant differences were found in the incidence of adverse reactions between the two groups(P>0.05),and no serious events or deaths occurred.DBBSG patients had increased risks of chyme reflux(hazard ratio=2.793;95%confidence interval:1.695-4.603;P<0.001)and CBDS(hazard ratio:2.475;95%confidence interval:1.732-3.536;P<0.001).CONCLUSION Duodenal bend biliary stents increase the risk of chyme reflux into the common bile duct and CBDS.The safety of intra-biliary cleaning during stent removal has been validated,and as a result,it is recommended that endoscopists perform intra-biliary cleaning during duodenoscopic removal of duodenal bend biliary stents.
基金Supported by the Shihwa Medical Center Research Fund.
文摘BACKGROUND Despite advancements,endoscopic retrograde cholangiopancreatography(ERCP)poses challenges,including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.AIM To compare dome and tapered tip sphincterotomes,focusing on their efficacy in achieving successful biliary cannulation and reducing the incidence of post-ERCP pancreatitis.METHODS In this prospective,single-blind,randomized pilot study conducted at Inha Uni-versity Hospital,85 patients undergoing ERCP were equally divided into dome and tapered tip sphincterotome groups.The co-primary outcomes were the success rate of selective biliary cannulation and incidence of post-ERCP pancre-atitis.The secondary outcomes included biliary cannulation time,number of unintended pancreatic duct access events,and total procedure time.RESULTS The success rates of selective biliary cannulation were 74.4%and 85.7%in the dome and tapered tip groups,respectively,with no significant difference(P=0.20).Similarly,the incidence of post-ERCP pancreatitis did not differ significantly between the groups(5 cases in the tapered tip group vs 6 in the dome tip group,P=0.72).However,difficult cannulation was significantly more common in the dome tip group than in the tapered tip group(P=0.05).Selective biliary cannula-tion time emerged as a significant predictor of post-ERCP pancreatitis(multivariate odds ratio=9.33,95%confi-dence interval:1.31-66.44,P=0.03).CONCLUSION This study indicated that the sphincterotome tip type does not markedly affect biliary cannulation success or post-ERCP pancreatitis rates.However,cannulation duration is a key risk factor for post-ERCP pancreatitis.These findings provide preliminary insights that highlight the importance of refining ERCP practices,including sphinc-terotome selection,while underscoring the need for larger multicenter studies to improve procedure time and patient safety.
文摘This letter aims to discuss the article,published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2025.Endoscopic retrograde cholangiopan-creatography(ERCP)is widely acknowledged as an effective procedure for managing biliary obstruction.However,its use in very elderly patients,partic-ularly centenarians,presents unique challenges related to both safety and efficacy.In this report,we share our experience with three centenarian patients who underwent ERCP for biliary obstruction in our unit.Remarkably,all patients had favorable outcomes,and no significant adverse events were observed.
文摘This study presents a comprehensive overview of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP),detailing its epidemiology,pathophysiology,prevention,and treatment.PEP is the most common complication of ERCP,with an incidence of 3%,16%,and above 20%in high-risk patients.Proposed mechanisms include mechanical trauma,pancreatic-duct(PD)hypertension,oxidative stress,and dysbiosis-driven inflammation.Mitochondrial oxidative stress is a central pathological driver:It activates the NLRP3 inflammasome and the STING pathway,perpetuating a deleterious“injury-inflammation"cycle.Risk factors encompass patient characteristics,procedural variables,and operator-related factors.Preventive strategies combine pharmacological and procedural measures.Rectal non-steroidal anti-inflammatory drugs(NSAIDs),such as indomethacin,inhibit prostaglandin synthesis.European guidelines report that NSAIDs reduce the overall incidence of PEP,with odds ratios of 0.24-0.63.Subgroup analyses indicate the greatest benefit in high-risk cohorts,with mixed-risk groups also deriving more benefit than average-risk groups.In high-risk patients,prophylactic PD stenting markedly lowers PEP incidence by alleviating ductal hypertension.Aggressive fluid resuscitation enhances pancreatic perfusion and decreases the frequency of moderate-to-severe PEP.Recent therapeutic advances emphasize targeted interventions.Mitochondria-directed nanomedicines cross the blood-pancreas barrier,scavenge reactive oxygen species,and attenuate inflammatory cascades.A multidisciplinary team(MDT)approach optimizes infection control and manages complications in severe PEP,improving clinical outcomes.Future research should focus on addressing genetic susceptibility,developing novel targeted agents,and integrating artificial intelligence-assisted risk stratification to refine personalized prevention and therapy.This article reviews the epidemiological and pathophysiological foundations of PEP,evaluates evidencebased preventive strategies(e.g.,NSAIDs,pancreatic duct stenting),and discusses emerging approaches such as gene therapy.It also summarizes advances in treating mild and severe PEP,highlights the role of MDT care,identifies current knowledge gaps,and proposes directions for future research,including the discovery of novel biomarkers and the development of personalized preventive and therapeutic strategies.
文摘Objective:The management of urethral stricture disease depends on the location,length of stricture,and associated urethral pathology.These parameters are obtained from preoperative imaging,with conventional urethrogram(retrograde urethrogram and micturating cystourethrogram[RGU/MCU])being the diagnostic tool of choice despite its many shortcomings.Sono-urethrogram(SUG)is an alternative that addresses most issues of RGU/MCU.Studies comparing RGU/MCU with SUG are limited.With the objective of comparing these two imaging modalities in the evaluation of urethral stricture disease,a prospective study was conducted.Methods:Fifty-six patients suspected of urethral stricture disease on clinical evaluation and confirmed either on RGU/MCU or urethro-cystoscopy were included in the study.SUG was performed by the experienced consultant radiologist who was blinded to the report of RGU/MCU.Findings of RGU/MCU and SUG were compared to intraoperative findings,which served as the reference standard.Results:The median length of the stricture determined intraoperatively was 16.5 mm,by RGU/MCU was 5.8 mm,and by SUG was 13.5 mm.The diagnostic accuracy for determination of the stricture location was 93%for RGU/MCU and 98%for SUG.SUG identified spongiofibrosis in 90%of patients with higher accuracy for the severe degree of spongiofibrosis.Conclusion:SUG has been shown to be more accurate than RGU/MCU in estimating stricture length(both short and intermediate)and localizing the stricture location.Use of SUG in conjunction with RGU/MCU helps in better guidance of stricture management by improving preoperative assessment.Further studies with larger sample sizes are warranted.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-term ERCP outcomes,particularly using established quality benchmarks.AIM To evaluate ERCP indications,success rates,complications,and quality performance at a high-volume tertiary care center in Pakistan over a 17-year period.METHODS This retrospective study analyzed 13215 ERCP procedures performed between 2006 and 2023.Data included demographics,indications,cannulation rates,complications,and pediatric cases.Findings were assessed against American Society of Gastroenterology/European Society of Gastrointestinal Endoscopy quality indicators.RESULTS Biliary ERCP accounted for 93.1%of procedures;choledocholithiasis was the most common indication(40%).Cannulation success was 93.9%for biliary and 94.2%for pancreatic ERCP.Pediatric ERCP comprised 4%of cases,mostly for stones and chronic pancreatitis.Bleeding(1.7%)and post-ERCP pancreatitis(2.3%)were the most frequent complications.Performance met or exceeded most American Society of Benchmarks.CONCLUSION This study offers insight into nearly two decades of ERCP practice within a public sector hospital.Our experience echoes the quality and efficiency of ERCP not previously available in Pakistan.As healthcare systems in resourcelimited sectors expand,our findings serve as a reference point.Continued training and quality improvement studies can further enhance ERCP effectiveness in the region and beyond.
基金Supported by the Natural Science Foundation of China,No.81974442and Science and Technology Project of Guangzhou City,No.2024A03J0670.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)serves an essential role in treating biliary diseases,especially in choledocholithiasis.However,due to the limited human lifespan,there remains a paucity of clinical investigations on ERCP treatment in patients over 90 years old.AIM To explore the effectiveness and safety of ERCP in super-older patients aged≥90 years with choledochal stones.METHODS This study retrospectively analyzed data from patients(aged≥65 years)with choledocholithiasis who received ERCP treatment in our hospital from 2011 to 2023.Among them,patients≥90 years old were in the super-older group,and patients aged 65-89 years were in the older group.Baseline data,including gender,number of stones,stone size,gallbladder stones,periampullary diverti-culum,and common bile duct intubation of patients in the two groups,were mat-ched by adopting the 1:1 propensity score matching method.RESULTS After matching,44 patients were included in both the super-older group and the older group.The incidence of stroke in the super-older group was markedly higher than that in the older group[34.1%(15/44)vs 6.8%(3/44),P=0.008].The success rate of the ERCP procedure in the super-older group was 90.9%(40/44),compared to that in the older group[93.2%(41/44),P=1.000].Although endo-scopic papillary balloon dilation was more frequently used in the super-older group than in the older group[61.4%(27/44)vs 18.2%(8/44),P<0.001],there was no significant difference in terms of stone removal rate,the incidence of complications,mortality,recurrence,and length of hospitalization between the two groups(P>0.05).CONCLUSION ERCP is safe and effective in super-older patients≥90 years old with choledocholithiasis.
文摘BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stents(MPSs)or fully covered self-expandable metal stents(cSEMSs)represent the standard treatment for BAS post-OLT.Recently,cSEMSs have emerged as the primary option for managing BAS post-OLT.AIM To compare the resolution and recurrence of BAS rates in these patients.METHODS This retrospective cohort study was conducted in a single tertiary care center(Hospital Israelita Albert Einstein,São Paulo,Brazil).We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022.Patients were stratified into two groups according to therapy:(1)MPSs;and(2)cSEMSs.Primary endpoints were to compare stricture resolution and recurrence among the groups.The secondary endpoint was to identify predictive factors for stricture recurrence.RESULTS A total of 104 patients were included.Overall stricture resolution was 101/104(97.1%).Stricture resolution was achieved in 83/84 patients(99%)in the cSEMS group and 18/20 patients(90%)in the MPS group(P=0.094).Failure occurred in 3/104 patients(2.8%).Stricture recurrence occurred in 9/104 patients(8.7%).Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups(P=0.201).A multivariate analysis identified the number of ERCP procedures(hazard ratio=1.4;95%confidence interval:1.194-1.619;P<0.001)and complications(hazard ratio=2.8;95%confidence interval:1.008-7.724;P=0.048)as predictors of stricture recurrence.CONCLUSION cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence.The number of ERCP procedures and complications were predictors of stricture recurrence.
