Search

Background/aims: Endoscopic ultrasonography (EUS) are relatively new alternatives to surgery for the treatment of benign lesions in the biliary duct. This study was to explore the value of EUS in the treatment of distal inflammatory biliary stricture., Methodology: 165 patients with distal inflammatory biliary stricture underwent EUS, according to EUS, endoscopic retrograde cholangiopancreatography (ERCP), intraductal ultrasonography (IDUS), endoscopic retrograde biliary drainage and endoscopic biliary dilation were performed. The clinical data about therapies and recovery of 22 patients was recorded and analyzed., Results: In 165 patients, 163 cases underwent ERCP and intraductal ultrasonography (IDUS) successfully following EUS. Total 356 ERCPs were performed with 87 biliary duct stents inserted. After EUS the liver function, the thickness and pressure of biliary duct were decreased compared to these before EUS. The complication rate was 5.1% (18/356). After a follow-up of 27.6±10.6 months, strictures had not recurred in 121 patients after stents removed., Conclusion: EUS for distal inflammatory biliary stricture can be selected as a safe, effective and minimally invasive therapeutic method.

Background/aims: The aims of this study were to assess the feasibility and safety of emergency ERCP and pancreatic duct (PD) stenting in acute biliary pancreatitis (ABP) patients in whom biliary endoscopic sphincterotomy proved difficult, and to compare the clinical outcome of those patients having emergency ERCP without pancreatic stent., Methodology: One hundred and ninety-one consecutive patients with ABP were included in this study. Patients were randomly assigned to either the stent group (n=78) or the no-stent group (n=113). In the stent group, 3-5Fr,5-7cm-long pancreatic stent insertion was initially applied and removed endoscopically 1-2 weeks post-ER-CP. All patients were hospitalized for medical therapy and were followed-up., Results: Mean age, initial symptom-to-ERCP times, Glasgow severity scores and peak amylase and CRP levels at initial presentation were not significantly different in the stent group vs. the no-stent group, and the selective biliary cannulation was achieved in 80% of the stent group and in 94% of the no-stent group (p=0.15). More importantly, the complication rate was significantly lower in the stent group (7.7% vs. 31.9%). There was no difference in mortality between the two groups statistically(1.3% vs. 3.5%)., Conclusions: Pancreatic duct stent-ing is a safe and effective procedure that may afford sufficient PD decompression to reverse the process of ABP, show better outcomes as compared to no-stent group. It is recommended to reduce the incidence of the complication in the emergency ERCP of ABP but difficult sphincterotomy. However, further prospective trials are needed.

Background/aims: This study aimed to evaluate the technical feasibility of laparoendoscopic single-site hepatectomy (LESH) and compared stress responses with laparoscopic hepatectomy (LH) through a perspective controlled trial., Methodology: Thirty small female family pigs as animal models were divided into LESH and LH groups randomly. The data about operations including operating time, blood loss and complication rates were recorded. The stress indicators, including adrenaline, serum cortisol, interleukin-1, interleukin-6 and white blood cell count, were measured at baseline and 1, 24 and 48 hours postoperatively., Results: In LESH group, 1 case was converted to LH for uncontrolled blooding. The other 29 cases underwent respective operations successfully. Postoperative recovery was without complications. Mean operative time of LESH group and LH group was 94.7±31.3 vs. 76.9±24.3min (p=0.0929). The blood loss of two groups was 72.5±26.4 vs. 66.3±21.2mL and there was no statistical difference. In both groups stress indicators showed a rising trend after operations and had no significant differences at the same time point., Conclusions: LESH is a safe, feasible and minimally invasive approach and has no different impact on stress responses compared to LH. It may be a reasonable alternative to apply in clinical practice by experienced laparoscopic physicians.

Background/aims: This study reports the initial experience with combined laparoendoscopic single-site surgery (LESS) referring to cholecystectomy, appendectomy, oophorocystectomy and liver cyst and renal cyst fenestration and explore the feasibility and safety of combined LESS., Methodology: From October 2008 to May 2011 selective 24 patients underwent combined LESS in our center. The single incision in umbilicus was about 2cm. All the operations were performed by the same surgical team and used conventional rigid instruments., Results: In 24 patients, combined laparoendoscopic single-site cholecystectomy and appendectomy were performed in 17 cases, combined cholecystectomy and liver cyst fenestration in 5 cases and combined cholecystectomy and oophorocystectomy in 2 cases. Twenty one patients were successfully operated and the other 3 were converted to conventional laparoscopic surgery because of separating Calot's triangle difficulty. The mean operating time was 87.3 minutes. One urinary retention (4.2%) and one fat liquefaction in abdominal incision (4.2%) occurred and were cured conservatively. There was no mortality in the study., Conclusions: Combined laparoendoscopic single-site surgery is safe, feasible, minimally invasive and cosmetic technique but is more difficult than conventional laparoscopic surgery. It is a reasonable alternative to be performed in selective patients by experienced laparoscopic surgeons.

Background/aims: To summarize our experience and results of combined endoscopic and laparoscopic treatment for Mirizzi syndrome (MS) retrospectively, and to evaluate the effect of the procedures of minimally invasive strategy., Methodology: Fifty-four patients with Mirizzi syndrome were admitted to our centre. Endoscopic procedures were performed firstly to identify the Csendes Types and alleviate jaundice. Different laparoscopic surgeries were adopted according to Csendes Types. The clinical data about operation and recovery of the two groups was recorded and compared., Results: Total 63 endoscopic procedures were performed successfully in 46 cases and failed in 3 cases. Five patients were found to have MS intraoperatively. Endoscopic complication rate was 31.7% (20/63). Forty-three patients underwent laparoscopic surgeries successfully and 7 cases were converted to open surgeries. The average laparoscopic operation time was 83.2±34.7min and postoperative hospital stay was 9.5±2.4 days. Postoperative complication rate was 16.3%. Median follow-up period was 38.6 (range, 16-83) months and 4 stone recurrence occurred., Conclusion: Combined endoscopic and laparoscopic approaches in treating patients with MS are technically feasible and minimally invasive. However, laparoscopic primary suture of the defect on the wall of common bile duct is difficult; hence it is recommended it be performed by experienced hands.

Background/aims: Endoscopic treatment for pancreatic pseudocysts (PPs) is a relatively new alternative to surgery. This study is to prospectively assess the value of endoscopic ultrasound (EUS) guided transgastric stenting in treatment of traumatic PPs., Methodology: Between January 2005 and January 2010, 14 patients admitted to our centre for traumatic PPs underwent EUS guided transgastric stenting. The clinical data about the therapies and recovery of the patients was recorded and analyzed., Results: All patients underwent EUS and a total of 21 EUS guided transgastric stentings were performed with a success rate of 90.5% (19/21); 2 patients required surgery because therapeutic endoscopy was unsuccessful or impossible. The mean operative time was 46min and mean postoperative hospital duration was 3.8 days. There was no procedure-related mortality. The complication rate was 19.0%with 2 infections of PPs and 2 stent obstructions. The median follow-up period was 29 months (range, 10-58 months). No recurrence or other complications were found., Conclusions: Endoscopic ultrasound guided transgastric stenting can be selected as a safe, effective and minimally invasive therapeutic method for traumatic PPs. More than 6 months of stent retention for traumatic PP may be reasonable, but larger comparative studies are still needed.