Type I Mirizzi syndrome treated by electrohydraulic lithotripsy under the direct view of SpyGlass: A case report.

BACKGROUND: Mirizzi syndrome is an uncommon clinical complication for which the available treatment options mainly include open surgery, laparoscopic surgery, endoscopic retrograde cholangiopancreatography (ERCP), electrohydraulic lithotripsy, and laser lithotripsy. Here, a patient diagnosed with type I Mirizzi syndrome was treated with electrohydraulic lithotripsy under SpyGlass direct visualization, which may provide a reference to explore new treatments for Mirizzi syndrome. CASE SUMMARY: This paper describes a middle-aged female patient with suspected choledocholithiasis who complained for over 1 mo of intermittent abdominal pain, dark yellow urine, jaundice, and was proposed to undergo ERCP lithotomy. Mirizzi syndrome was found during the operation and confirmed by SpyGlass. Electrohydraulic lithotripsy was performed under the direct vision of SpyGlass. After the lithotripsy, the stones were extracted using the stone extraction basket and balloon. After the operation, the patient developed transient hyperamylasemia. Through a series of symptomatic treatments (such as fasting, fluids and anti-inflammation medications), the symptoms of the patient improved. Finally, laparoscopic cholecystectomy or open cholecystectomy was performed after a half-year post-operatively. CONCLUSION: Direct visualization-guided laser or electrohydraulic lithotripsy with SpyGlass is feasible and minimally invasive for type I Mirizzi syndrome without apparent unsafe outcomes.

A rare case of duodenal diaphragm in an adult during ERCP treatment for choledocholithiasis.

BACKGROUND: Duodenal Diaphragm in adults is very uncommon, caused by congenital and acquired changes. It is reported that acquired duodenal diaphragm is related to the long-term use of nonsteroidal anti-inflammatory drugs. We report an adult presentation of duodenal diaphragm in a 77-year-old woman, suffered from acute cholangitis and choledocholithiasis. She was performed endoscopic retrograde cholangiopancreatography (ERCP) procedure to remove the stone in common bile duct (CBD). After the stenosis ring dilated by endoscopic balloon dilatation, ERCP procedure was applied, and the CBD stone was removed successfully. CONCLUSION: Duodenal diaphragm is difficult to diagnose in clinic. Although the patient in this case had relatively mild symptoms of incomplete upper hemi-abdominal obstruction, these symptoms could be obscured by the emergency acute upper abdominal pain with fever as clinical manifestations of acute cholangitis.

Success rate and complications of ERCP performed during hands-on training courses: a multicenter study in China.

BACKGROUND: Hands-on endoscopy workshops are popular and valuable sources for the continuing medical education of endoscopists. Concerns, however, exist regarding clinical outcomes of procedures performed during hands-on training of ERCP. OBJECTIVE: We compared the success rates and complications between patients in the hands-on training courses and matched control patients. DESIGN: A retrospective, multicenter study. SETTING: Seven endoscopy centers in mainland China. PATIENTS: All patients who underwent ERCP during hands-on training courses at GI endoscopy conferences in China between January 2002 and December 2006 were included. MAIN OUTCOME MEASUREMENTS: Clinical and endoscopic characteristics, including age, sex, indication, therapeutic intervention, success rate, and complication, were collected. Differences in ERCP outcomes between domestic and foreign mentors were also compared. Conference, patient, and endoscopist-related variables were analyzed for potential risk factors associated with post-ERCP complications. RESULTS: Nine conferences with hands-on ERCP training, including 124 patients, were held at 7 endoscopy centers. There were no significant differences in the sex ratio, age, indication, and therapeutic intervention between patients for hands-on training (n = 124) and controls (n = 124). The success rates and overall complication rates were similar between the 2 groups (91.9% vs 92.7%, respectively, P = .811; 12.9% vs 9.7%, respectively, P = .422). Domestic mentors encountered more post-ERCP complications than foreign mentors (18.0% vs 0%, respectively, P = .001). Univariate analyses showed that a large-scale conference (P = .004), first-time mentorship (P = .015), and small case volume for the mentor (P = .015) were significantly associated with post-ERCP complications. Nominal significance in univariate testing was removed when analyzed in a comprehensive multivariate setting. LIMITATIONS: A nonrandomized retrospective trial with only 7 centers (9 conferences). CONCLUSIONS: The success rate and overall complication rate were similar between patients in the hands-on training and those who had routine ERCP procedures. A large-scale conference, first-time mentorship, and small case volume for the mentor may be associated with post-ERCP complications.

How safe and successful are live demonstrations of therapeutic ERCP? A large multicenter study.

OBJECTIVES: Live demonstrations of endoscopic retrograde cholangiopancreatography (ERCP) have a high educational value and contribute significantly to endoscopy development and training. However, the success and safety of live demonstration have been questioned. The aim of this study was to evaluate the success rate and complications of therapeutic ERCP among patients who participated in live demonstrations. METHODS: Patients who underwent therapeutic ERCP during live demonstrations at gastrointestinal endoscopy conferences in China between January 2002 and December 2007 were included. The matched control for each patient was a patient admitted to the same ERCP unit with similar indication, who received ERCP by an endoscopist with similar experience as those who performed the live demonstration. Patient's age, gender, indication, success rate, and complications of ERCP were collected and compared. ERCP outcomes between local and visiting faculty were also compared. RESULTS: In total, 36 conferences with live ERCP demonstrations involving 406 patients were held in 14 endoscopy centers. There were no significant differences in patients' gender, age, and indications between live demonstrations and controls. The overall complication rate of ERCP in live demonstrations was not significantly different compared with controls (10.3% vs. 8.6%, P=0.473). However, the success rate was significantly lower in live demonstrations than in controls (94.1% vs. 97.5%, P=0.021). The success and complication rates of ERCP performed by local faculty, domestic visiting, and foreign visiting faculties were similar. CONCLUSIONS: Although the success rate of therapeutic ERCP performed during live demonstrations was lower than that of routine procedures, the overall complication rate did not significantly increase. ERCP performed by visiting endoscopists was as safe as that done by local faculty in live demonstrations.