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Objective To evaluate the efficacy and safety of the unilateral and bilateral drainage in hilar malignant biliary obstruction with a meta?analysis of relevant studies. Methods A systematic electronic search with keywords “ biliary stent”, “hilar tumor” and “malignant biliary obstruction” was independently performed by two reviewers in major electronic databases of Pubmed, EMBASE, Cochrane Library and Web of Science. A meta?analysis was conducted using Revman 5?? 1 software. Results Six studies were included with a total number of 558 patients, of whom 307 patients underwent unilateral biliary drainage and 251 pa?tients bilateral drainage. There was no significant difference in early complications ( OR = 1?? 03,95% CI:0?? 58?1?? 81,P = 0?? 93), later complications (OR = 0?? 98,95%CI:0?? 46?2?? 07,P = 0?? 95), operation success rate (OR= 1?? 42,95%CI:0?? 76?2?? 66,P = 0?? 28),drainage efficacy or median survival time between the two groups. Compared with unilateral biliary drainage, bilateral biliary drainage had a longer time of stent patency (MD = - 29?? 12,95% CI:- 38?? 55?- 19?? 70,P< 0?? 001). Conclusion Both unilateral and bilateral biliary drainage are safe and effective for hilar malignant biliary obstruction, but more high quality clinical researches are needed.
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Objective To investigate clinical efficacy and safety of endoscopic multiband mucosec-tomy(EMBM)for esophageal submucosal tumors(SMTs).Methods Data of 51 patients with SMTs diag-nosed between Jan 2012 and Aug 2014 were retrospectively studied.Of the 51 patients,33 patients(34 le-sions)received EMBMand 18 patients received endoscopic submucosal resection(ESMR).The operation success rates,complete resection rates,procedure time,complications and the follow-up of group EMBMand group ESMR were compared.Results All of 51 cases had successful endoscopic treatment with no perfora-tion,infection or obvious bleeding.Follow-up showed no recurrence after operation.Compared with group ESMR,group EMBM had higher complete resection rate [97.1% (33 /34)VS 61.1% (11 /18 ),P =0.010],shorter operation time[(6.3 ±1.8)min VS (21.4 ±3.8)min,P =0.001]and lower complication rate[6.1%(2 /33)VS 27.8%(5 /18),P =0.024].Conclusion EMBM is simple,safe and effective for treating SMTs originating from muscularis mucosa or submucosa which are less than 2.0 cm in diameter.
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This study was designed to observe the negative pressure in the cup during cupping, and to investigate the influence of negative pressure on the depth of filiform-needle inserted and retained. In the beginning, the change of pressure after cupping on acupoint BL23 for a span of 20 minutes was recorded. Acupuncture on acupoint BL23 was performed; the filiform-needle was retained and followed by cupping at different levels of negative pressure, and the changes of the depth of needle insertion was measured. The results showed: the absolute value of the negative pressure in the cup goes down with time and is significantly lower after 20 minutes (P < 0.05); the negative pressure in the cup causes the retreat of the inserted needle; and under the same pressure, there is a greater length measurement in needle retreat for male than for female (P < 0.01). The length of needle retreat is related to the pressure in the cupping-cup and to gender.
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Female , Humans , Male , Young Adult , Acupuncture Points , Acupuncture Therapy , Methods , Combined Modality Therapy , Medicine, Chinese Traditional , Methods , Pressure , Sex FactorsABSTRACT
Objective To evaluate the effectiveness and safety of needle-knife fistulotomy (NKF)for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of patients, who received NKF on the back of major papilla when bile duct could not be accessed by conventional cannulation and/or other pre-cut methods during ERCP, were retrospectively reviewed. The success rate of deep cannulation and its complications were observed and analyzed. Results NKF was performed in 108patients due to difficult cannulation, which succeeded in 97 (91.2%) in access to the bile duct and failed in 11 patients with malignant biliary strictures. The failure rate in patients with distal malignant obstruction was higher (25. 8%, 8/31) than those with proximal lesions (5.3%, 3/57) (P = 0. 014, χ2 = 5. 983).Post-ERCP pancreatitis occurred in 5 cases (4. 6%), with the incidence significantly higher in NKF-failure group (18. 2%, 2/11) than that in NKF-suocess group (3.1% ,3/97) (P = 0. 006, χ2 = 7.418). Intestinal perforation occurred in 1 patient and cholangitis developed in 4 others, which all recovered after conservative managements. Conclusion NKF for difficult cannulations in ERCP is safe and effective, especially in hands of experienced operators, but cannulation success rate is relatively low in distal malignant biliary obstruction.
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Objective To investigate the efficiency and safety of endoscopic large balloon dilation following small sphincterotomy (ESBD) for treatment of common bile duct (CBD) stones, and to prospectively compare it with traditional sphincterotomy (ES). Methods Patients with single or multiple calculi in extra-hepatic bile ducts and with the diameter of CBD larger than 13 mm, were randomized into 2 groups to receive maximal sphincterotomy (ES group), or partial sphincterotomy plus sphincteroplasty with 15mm-balloon (ESBD group), respectively, followed by conventional stones removal and/or lithotripsy. The success rate of stone clearance, operation time and related complications were observed. Results A total of 86 patients were enrolled in 2 endoscopy centers, with 2 excluded because of papillary pre-cut in 1 and non-compliance with the protocol in the other, and were randomly divided into groups ES and ESBD, with 42 patients in each. The clinical characteristics, including average diameter of CBD, size and quantity of calculi, and incidences of peri-ampullary diverticulum, of patients in both groups were all similar. Stones clearance with single session in 2 groups were 88% and 93%, respectively (P =0. 531 ). The operation time were (25.76 ± 12. 74) min and (26. 38 ± 12. 86) min ( P = 0. 825 ). The rate of mechanical lithotripsy was 36% and 25%, respectively (P=0. 363). Complications occurred in 5 cases in ES group (3 mild, 2 medium), and 2 mild complications occurred in ESBD group (no statistical difference). No death happened in any group.Conclusion ESBD is an effective method for clearance of extra-hepatic bile duct stones with the similar safety, compared with traditional sphincterotomy. It could be an optimal alternative for those with large stones or difficult sphincterotomy.
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Objective To evaluate the feasibility of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents. Methods A total of 9 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ were enrolled in the current study, with a mean serum bilirubin at 162. 8 ± 193. 8 μmol/L before the procedure. Two guide wires were selectively inserted into the left and right intrahepatic ducts and kept in site. After aggressive dilatation for beth sides, the metal stents were deployed one by one bilaterally. Success rate of the procedure, remission of jaundice, early complications, and short-term clinical outcome were ob-served. Results The procedure was succeeded in all patients with Y type stent in 2, plastic stent transition in 1 and parallel stenting in 6, which took an average time of 38. 1 min. The most convenient way was the parallel method with both distal ends of the stents remaining at outside of papilla. The serum bilirubin re-turned to normal level within 3 weeks in all patients except 1, and no major complications were observed. Conclusion Simultaneous endoscopic bilateral metal stent placement is technically feasible and safe, with the benefit of prompt and effective control of jaundice and infection, caused by hilar tumors. A better method is to place specially designed endoprotheses in parallel and leave the distal ends outside papilla.
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Objective: To explore the underlying mechanism by which acupuncture regulates the peripheral leukocyte count and observe the relationship between the effects of electroacupuncture (EA) and the spleen ultrastructure in leukopenia. Methods: Leukopenia models of rabbits were established by injecting cyclophosphamide (CY) into rabbits' ear vein,and then the rabbits were treated with acupuncture. The peripheral leukocyte count and classification were measured daily. At last, after the animals were anesthesized, the abdominal cavity was opened, and a piece of spleen tissue was cut. The diameter of splenic sinusoid basal lamina eyehole was measured under electric microscope. Results: The peripheral blood leukocyte count in the EA group increased significantly with shift to right of the granulocyte nuclei compared with model control group (P＜0.01). Moreover, the calibers of splenic sinusoid basal lamina eyehole in the EA group were larger than those in the model control group (P＜0.05). Conclusion: Acupuncture can enhance the peripheral leukocyte count by promoting spleen activity in the early phase of leukopenia.