Objective To investigate the risk factors of recurrent common bile duct （CBD） stones after treatment with endoscopic retrograde cholangiopancreatography （ERCP）. Methods A total of 802 patients with CBD stone and with complete follow-up data were recruited to the study, among which 297 patients were accompanied with gallstone, 222 patients having undergone cholecystectomy before ERCP and 283 having no gallstones. The CBD stone recurrent frequency and the possible risk factors were calculated with uni- and multi-variate logistic regression analysis. Results The patients were followed up at a mean duration of 84. 8 months, and CBD stone re-occurred in 92 （11.5%）. Both uni- and multivariate analysis showed gallstones, CBD larger than 1.5 cm, endoscopic mechanical lithotrity （EML） and angle of bile duct less than 120° were risk factors of recurrence. Multivariate analysis showed cholesterol stones, cholangeal stricture or sphincter of Oddis dysfunction （SOD） were all risk factors for reccurrence. Univariate analysis revealed that history of cholecystectomy or Billroth Ⅱ gastrectomy, stones larger than 1.5 cm and multiple stones were risk factors of recurrence. Conclusion For those with CBD stones undergoing ERCP, gallstone,common bile larger than 1. 5cm, EML and the angle of CBD less than 120° are major risk factors of recurrence. History of cholecystectomy and Billroth Ⅱ gastrectomy, SOD, large CBD stone （ ≥1.5 cm）, cholesterol stone and multiple stones are also associating risk factors.
Key words:
Cholangiopancreatography, endoscopic retrograde; Choledocholithiasis; Recurrence; Risk factors
OBJECTIVE:To verify and evaluate the effect and safety of pantoprazole in treating hemorrhage of upper digestive tract. METHODS:Using randomized group sampling,paired control and multicenter study,the hemostatic effects and adverse reactions of pantoprazole(PZ)and omeprazole (OZ) were observed in 160 cases who received PZ(40mg im qd and iv 3-5 days) or OZ (40mg im qd and iv 3-4 days) .RESULTS: The effective rates of PZ and OZ group were 96.67% and 95.00% respectively without difference between two groups(P0.05) .The rates of ARDs of PZ and OZ group were 6.67% and 6.67% respectively without difference between two groups. The ARDs were mild.There were no significant changes of hematopoietic, hepatic and renal functions and routine urine examination in both groups after treatment .CONCLUSION: PZ shows satisfactory therapeutic effect on hemorrhage of upper digestive tract and no marked ARDs.It is worth extending and applying.
Objective To study on the endoscopic resection of submucosal tumors (SMT) in gastro-intestinal tract with especial regards to the effectiveness and safety, and the value of endoscopic ultrasonogra phy ( EUS) in SMT before endoscopic resection. Methods Endoscopic therapy was performed in 71 patients with gastrointestinal SMT diagnosed by endoscopy, and of them 64 patients (90. 1 % ) were examined by EUS before the procedure. The SMT located in the esophagus 36 cases, stomach 29 cases, duodenum 3 cases and rectum 3 cases. The median tumor diameter was 14. 2 mm ( ranged 6-20 mm). Endoscopic mucosal resection was performed using a two-channel endoscope after submucosal injection of saline solution in 55 cases, then the SMT resected. In 16 patients, the SMT was resected completely with one-step standard procedure using cap-fitted endoscope ( 10 cases, the SMT less than 10 mm in diameter) or two-channel endoscope (6 cases). Results Sixty-eight of seventy-one solid SMT were removed completely under endoscopy and 2 SMT (one ectopic pancreas and one gastric leiomyoma) were resected incompletely; the findings were showed at 4th week by repeated endoscopy. One patient with rectal leiomyoma required surgical resection after unsuccessful endoscopic resection. The follow up period was 18. 7 months on average, no recurrences were found in 67 cases. Histological results showed 51 (71. 8% ) leiomyomas, one granular cell tumor, 4 fibromas, 3 ectopic pancreas, 3 lipomas, 2 stromal tumors and 2 carcinoids in the SMT. Five tumors of mesenchymal tissue , their histological origin cannot be firmly defined due to lack of immunoassayed specimen. Bleeding occurred in only 9 of 71 cases and was easily managed with endoscopic haemostatic measures. One patient with stromal tumor suffered from gastric perforation after the procedure. Conclusions Endoscopic resection of gastrointestinal SMT is a safe and effective procedure and obtains the histological diagnosis simultaneously. EUS is helpful in selecting indicated cases for endoscopic resection.
Objective The efficacy of endoscopic treatment for chronic pancreatitis was studied. Methods 29 patients with chronic pancreatitis, received the therapy of endoscopy. Of the series 27 had endoscopic pancreatic sphincterotomy (EPST)， as a preceding treatment in 19 cases, 8 had minor papillotomy, 6 subjected to endoscopic sphincterotomy (EST). Pancreatic stones were extracted with basket (n=9) and duct dilated with balloon or bougienage (n=14) followed by pancreatic duct endoprothesis (PDE, n=7) and nasal pancreatic drainage (NPD, n=3). Pancreatic functions were tested before and after therapy (n=13). Results Abdominal pain was eliminated or redcuced obviously in 26/29 (89.7％ ) cases. Pancreatic stone was extracted successfully in 6/9 cases, no occlusion detected in 7 instances having PDE at the end of 6 weeks when the prothesis was withdrawn. In 6 cases with abnormal glucose metabolism reexanmined with oral gluose tolerance test (75g O－ GTT) and immunoreactive insulin (IRI) test, it was found that one patient turned to normal type from boardline type and one turned to boardline type from the abnormal. Acute panceratitis ensued in 2 cases, infection of pancreatic fluid occured in 1. Abdominal pain recurred in 3 out of 18 followed up for one and half years. Conclusion Endoscopic management for chronic pancreatitis is relatively effective and secure.
Objective To explore the impact of basal sphincter of Oddi （SO） pressure on pancre- atobiliary reflux （PBR）. Methods A total of 120 consecutive patients who received therapeutic ERCP for biliary tract diseases with or without the history of EST were enrolled, and were assigned to normal basal SO pressure group （n = 23 ）, elevated basal pressure group （ n = 55 ） and EST group （ n = 24）. Basal SO pressure, bile amylase （BA）and bacteria culture findings were compared between the three groups. Results There were no differences in positive rate of bacteria culture, SO pressure increase and BA between the normal basal SO pressure group and elevated basal pressure group. In the latter group, negative correlation was observed between SO pressure and BA. The BA value [ median（ quartile range） ] in patients with common bile duet I〉 15 mm [4270 （12 337）U/L] was significantly higher than that in patients with common bile duct 〈 15 mm [ 279. 5 （1370）U/L]. Furthermore, significant difference in both the proportion of elevated BA patients （83.3% vs. 59.0% ） （P 〈0.05） and the positive rate of bacteria culture （75.0% vs. 33.3% ） was seen between the intact papilla patients in the former two groups and those in EST group （P 〈 0. 05 ）. Conclusion There was no direct correlation between the elevated basal SO pressure and PBR, but marked increase in diameter of common bile duct can lead to a rise in BA. Moreover, although EST can bring about PBR and bile bacterial infection, it may facilitate the outflow of the refluent pancreatic juice by relieving eholestasis.
Key words:
Sphincter of Oddi manometry; Normal pancreatobiliary junction; Biliary amylase; Pancreatobiliary reflux
Objective Tumor markers, CEA, CA50, CA19 9 in pure pancreatic juice(PPJ) were determined in this study to clarify their diagnostic values for pancreatic disorders.Methods Through ERCP catheter a certain amount of PPJ was drawn from patients with pancreatic duct abnormality(n=45) and without pancreatic disorder(n=20).CEA, CA50 and CA19 9 in both serum and PPJ were tested with radioimmunoassay.Results The cutoff level of CEA, CA50 and CA19 9 in PPJ remained at 45μg/L, 35kU/L and 5000kU/L respectively.In patient with pancreatic cancer,the sensitivity of CEA in PPJ showed significance( P 0.05) when compared with that in serum,while the specificity and accuracy of CEA, CA50 and CA19 9 were insignificant( P 0.05).The false positive rate of CEA,CA50 and CA19 9 in PPJ from nonpancreatic subjects appeared 0%,5% and 5% correspondingly,the false positivity of those in PPJ from those with chronic pancreatitis were 10%,0% and 20% accordingly.Taking two of the three tumor markers above cutoff level at same time as positivity standard,the sensitivity and specificity of the markers in diagnosing pancreatic cancer rose to 45.8% and 100% respectively.Conclusion Simultaneous assay of the three markers plays an essential and compensatory role,beneficial to differentiate pancreatic malignancy from the benign.
PGA is the mail encryption software which bases on RSA public key encryption system It is a mixed compound algorithm using with several algorithms this paper makes user to know which factors may reduce PGP security through discussing several algorithms security and how to avoid using them in order to improve mail security.
Objective To explore the impact of pancreatobiliary reflux （PBR） in normal pancreato- biliary junction on gallbladder. Methods A total of 54 patients receiving cholecystectomy for gallbladder diseases underwent uhrasonography to evaluate the thickness of gallbladder wall, inner layer and gallbladder wall blood flow before operation. The bile juice was sampled during ERCP in 45 patients with common bile duct stone and during cholecystectomy in 9 patients to detect amylase level. All patients with normal panere- atobiliary junction enrolled in the study were assigned into PBR group （ n = 24 ） and controlled group （ n = 30） according to their bile amylase level. Resected gallbladder specimens were examined histopathologically and then tested for expression of COX2, Ki-67 and p53 immunohistochemically. Results PBR group in- eluded 20 cases of cholelithiasis and 4 gallbladder polyp, among which 23 were occult PBR （OPBR） and 1 high confluence of pancreatobiliary ducts （ HCPBD）, which was similar to pancreatobiliary maljunction （PBM） pathologically. The control group recruited 28 cases of cholelithiasis and 2 gallbladder polyp. There were no differences in frequency of inflammation, hyperplasia, metaplasia or expression of p53 between the two groups （ p 〉 0.05 ） , while higher presence of dysplasia and higher expression of COX2 and Ki-67 were seen in PBR group （ p 〈 0.05）. Conclusion In patients with OPBR, although hyperplasia and metaplasia in gallbladder epithelium were similar to those induced by cholelithiasis, dysplasia and active proliferation might relate to progress to malignancy.
Key words:
Gallbladder; High confluence of pancreatobiliary ducts; Occult ancreatobiliary reflux; Biliary amylase
Objective To investigate the value of biliary tumor markers for differential diagnosis of the benign and malignant biliary tract diseases. Methods Tumor markers （CAl9-9, CEA and CA242） ex-amination and bacterial culture were performed in a total of 160 patients, who underwent therapeutic endo-scopic retrograde cholangiopancreatography （ERCP） for biliary diseases. Results There were significant differences between malignant group and benign group in bile and serum in the level of CA19-9, CEA and CA242 （ P 〈 0.05 ） ; Cut-off value, according to ROC curve, was 239 ku/1 in CA19-9, 40 ng/ml in CEA and 60 ku/ml in CA242, respectively. There were significant differences between the bile marker and the serum marker in sensitivity, accuracy, negative predicative value of CEA （ P 〈 0.05 ）. No significant differences was found in specificity between the serum group and the bile group. There were significant differences in bile CA19-9 level between cholangiocareinoma, pancreatic cancer,duodenal papilla carcinoma with carcino-ma metastasizing to bile duet, and hepatocellular carcinoma （ P 〈 0. 05 ）. Both in benign group and malig-nant group, there were significant differences in CA19-9 level between infectious bile and noninfectious bile （ P 〈 0. 05 ）. Conclusion The level of CA19-9, CEA and CA242 in bile can be applied to differentiate be- nign and malignant biliary diseases. The bile tumor markers do not have advantage over serum tumor markers in specificity for diagnosis. Bile bacterial infection can result in the elevation of bile CA19-9 while it does not have impact on differential diagnosis.
Key words:
Bile duct stricture; Benign and malignant; Bile; Tumor markers ; Cholangio-pancreatography, Endoscopic Retrograde
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)
