短单气囊小肠镜在Roux-en-Y术后患者经内镜逆行胰胆管造影中的应用

目的:评估短单气囊小肠镜(single balloon enteroscope, SBE )辅助下经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)在Roux-en-Y术后患者中的应用价值。方法:收集鼓楼医院消化内镜中心2019年5月—20...     

治疗性经内镜逆行胰胆管造影在慢性胰腺炎患者中的应用

目的：探讨治疗性经内镜逆行胰胆管造影（ERCP）在慢性胰腺炎（CP）治疗中的价值。方法对2008年1月－2012年12月间在南京医科大学附属苏州市立医院应用 ERCP 治疗的30例 CP 患者进行回顾性分析。观察术前及术后24h 血淀粉酶变化,动态观察患者治疗前后腹痛缓解情况,随访脂肪泻、焦虑患者病情,定期复查腹部影像学或 ERCP 明确胰腺病变及胰管支架情况。结果所有患者均顺利完成 ERCP 并放置胰管支架,术后72 h 腹痛缓解率83．3％,1例因症状改善不明显至外科手术,术后病死率为0。结论ERCP 是治疗 CP 的有效手段,具有安全、有效、创伤小等优点。     

经内镜逆行胰胆管造影在胆胰疾病中的应用

近年来,随着内镜技术和介入技术的不断发展,许多新的设备和方法已经应用于临床,使得经内镜逆行胰胆管造影(ERCP)在胆胰疾病中的应用迅速发展。回顾并总结了ERCP在胆胰疾病中的应用,包括ERCP在胃肠道改道术后患者、孕妇患者、胆道良恶性狭窄患者、胰腺假性囊肿患者中的应用,Spy Glass、光动力学疗法、射频消融术的应用,ERCP相关十二指肠穿孔的处理及ERCP术后胰腺炎的预防等。ERCP的发展和应用使得胆胰疾病的诊治不断向前迈进。     

经内镜逆行胰胆管造影中清醒镇静麻醉的应用研究

目的 探讨咪唑安定镇静麻醉在逆行胰胆管造影检查（ERCP）中应用的可行性和价值。方法 120例行ERCP检查的患者，常规术前准备后肌肉注射咪唑安定0.15mg/kg,20min后开始检查，术中观察患者的生命体征和耐受程度，并进行镇静分级与评分（国际标准化方式OAA／S）。术后对患者进行遗忘率调查及医生和患者满意度的调查。结果 所有病例均能顺利完成操作。平均动脉压，心率，血氧饱和度无明显改变，不良反应明显减少，次日患者满意度达98％。结论 咪唑安定肌肉注射清醒镇静状态下进行ERCP检查治疗，可使患者更好的与医生进行配合，同时可使患者遗忘不良记忆，安全可靠。     

经内镜逆行胰胆管造影术在胰胆管合流异常诊治中的价值分析

目的探讨胰胆管合流异常（pancreaticobiliary maljunction,PBM）及其相关疾病谱的临床特点,总结治疗性经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)在该病诊治中的应用价值。方法收集2006年6月—2021年3月在北京大学第三医院消化内科因腹痛、黄疸、发热等症状入院行ERCP诊治的52例PBM患者的资料。总结PBM的临床特点、分型、相关疾病谱变化和ERCP诊治过程。结果52例PBM患者中,女性多见,常见临床表现为腹痛和黄疸,其中Ⅰ型20例、Ⅱ型25例 、Ⅲ型7例,合并胆总管囊肿者占50.0%。从首次发病到我院明确诊断为PBM的时间跨度平均为12.2年,其中主要临床问题发生变化的有24例（46.2%）。共进行69例次ERCP操作,5例次患者失败（7.2%）,PBM的困难插管率为34.6%（18/52）,其中11例需借助高级插管技术,同期可比非PBM4 275例ERCP的困难插管率为15.4%（657/4 275）,两者相比差异有统计学意义（χ2=14.455,P＜0.05）。患者行多种治疗性ERCP操作,包括内镜下十二指肠乳头切开术、胰管支架置入术、胆管和胰管结石取石术等,操作成功率为92.8%（64/69）,ERCP术后胰腺炎的发生率为15.4%(8/52)。结论PBM患者的主要临床问题可能随时间发生变化。ERCP技术在PBM及相关疾病的诊治中发挥重要作用,但插管难度较大,术后并发症相对较高。     

经内镜逆行胰胆管造影在儿童胰腺疾病诊治中的进展

儿童胰腺疾病多表现为先天发育异常所致的慢性胰腺炎及外伤所致的胰管断裂等,严重影响患儿生长发育及生活质量。近年来,经内镜逆行胰胆管造影(ERCP)已逐渐成为儿童胰腺疾病诊治最重要的手段。本文结合自身经验,对ERCP及相关技术在儿童胰腺疾病诊治中的临床应用及相关进展进行论述。     

胃肠道重建后经内镜逆行性胰胆管造影术诊疗策略

<正>胃肠道重建后经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)在技术上极具挑战性,操作成功率和并发症发生率迥然不同。内镜医师面临的挑战主要包括正确识别输入袢、吻合口肠袢成角锐利阻碍进镜、输入袢过长、十二指肠乳头位置改变、缺少合适的内镜设备及器械、腹膜腔术后粘连等等。迄今,国内外内镜专家为提高胃肠道重建后ERCP操作的成功率及降低并发症进行了不断地探索,现综述     

治疗性经内镜逆行胰胆管造影在胆胰疾病治疗中的应用

目的分析治疗性经内镜逆行胰胆管造影(ERCP)对胆胰疾病患者肝功能和治疗效果的影响。方法筛选2005年1月-2015年7月北京市垂杨柳医院应用电子十二指肠镜行ERCP治疗的397例胆胰疾病患者。根据不同病种分为8组:良性梗阻组(109例)、恶性梗阻组(47例)、胰腺炎组(27例)、异物梗阻组(127例)、单纯性胆管炎组(19例)、胆瘘组(15例)、十二指肠乳头憩室组(29例)、肝移植术后组(24例)。实施ERCP前1天和实施ERCP 4周后检测受试者的肝功能:ALT、AST、ALP、GGT和TBil。ERCP治疗完成后1个月对疗效进行全面评估。计量资料同组治疗前后比较采用配对t检验,多组间比较采用方差分析;计数资料组间比较采用χ~2检验。结果各组受试者实施ERCP后,其ALT、AST、ALP、GGT以及TBil均有显著改善,即ERCP可以明显改善受试者肝功能(P值均0.05)。疗效评估发现,ERCP治疗后,各组的症状均有明显缓解,单纯性胆管炎组全部治愈,而肝移植术后组和恶性梗阻组只能达到好转的效果。结论治疗性ERCP可显著改善患者的肝功能;但对肝移植术后患者和胆胰肿瘤患者,需要在进行ERCP治疗的同时实施腹腔镜手术联合治疗。     

内镜下乳头括约肌预切开术在经内镜逆行胰胆管造影胆管插管困难患者中的应用

<正>随着微创外科的发展,经内镜逆行胰胆管造影(ERCP)已经成为胆胰疾病诊断和治疗的常规手段。选择性乳头插管是ERCP诊治的基础,但由于解剖变异、结石嵌顿、乳头狭窄、肿瘤侵袭等诸多原因,导致一些患者行ERCP时常规插管失败。内镜下十二指肠乳头括约肌预切开术(precutsphincterotomy,PST)是一种特殊技巧的乳头切开术,是常规插管方法失败后常用的方法,可大大提高内镜插管的成功率。4年来作者在     

内镜下逆行胰胆管造影在高龄急性胆囊炎患者中的临床应用

目的探讨内镜下逆行胰胆管造影（ERCP）在高龄（≥75岁）急性胆囊炎患者中的临床应用。方法回顾性分析2008年1月至2012年12月拟行ERCP治疗的75岁以上胆囊炎患者。本次急性发作时间为1～5 d,均经影像学（包括腹部超声、CT及磁共振）确诊为急性胆囊炎。所有手术患者均给予留置鼻-胆囊引流（ENGBD）,术后观察腹部体征、体温、C反应蛋白（CRP）,腹部影像学及记录胆囊引流情况,出院后定期随访。结果共有24名患者,其中男13例,女11例,年龄75～88岁,平均（81.0±3.2）岁接受ERCP检查,其中术前诊断18例为结石性胆囊炎（75.0%）,6例为非结石性胆囊炎（25%）,13例（54.2%）合并胆总管结石。所有患者均成功留置鼻胆引流管,21例（87.5%）于术后腹痛缓解,体温降至正常,CRP于术后6 d内均降至正常。2例（8.3%）术后出现高淀粉酶,3 d后降至正常。无ERCP相关穿孔、出血、术后胰腺炎、死亡等并发症出现。术后随访3～12个月,23例（95.8%）症状长期缓解,1例因症状反复出现行腹腔镜手术。结论对于无法行急诊手术的高龄急性胆囊炎患者,行ERCP留置鼻-胆囊引流管治疗是一种安全、有效的治疗方法。     

Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy

Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Percutaneous treatment, Laparoscopy-assisted ERCP, endoscopic ultrasound-guided anterograde intervention, and open surgery are effective treatments. However, treatment should be noninvasive, effective, and safe. We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications. BEA-ERCP still requires high expertise-level techniques and is far from a routinely performed procedure. Various techniques have been proposed to facilitate scope insertion (insertion with percutaneous transhepatic biliary drainage (PTBD) rendezvous technique, Short type single-balloon enteroscopes with passive bending section, Intraluminal injection of indigo carmine, CO₂ inflation guidance), cannulation (PTBD or percutaneous transgallbladder drainage rendezvous technique, Dilation using screw drill, Rendezvous technique combining DBE with a cholangioscope, endoscopic ultrasound-guided rendezvous technique), and treatment (overtube-assisted technique, Short type balloon enteroscopes) during BEA-ERCP. The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients. A standard procedure for ERCP yet to be established for patients with a reconstructed intestine. At present, BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as first-line treatment. In this article, we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.     

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic accessories.The development of endoscopic techniques has led to higher success rates in this group of patients.Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb reconstruction.ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled endoscopist.Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy.Laparoscopic-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard accessories.This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy.This review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction types.Emerging new techniques and their outcomes are also discussed.     

Large dilating balloon to allow endoscope insertion for successful endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy (with video)

Background and purpose

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy can be present unique challenges. One of the major obstacles preventing successful ERCP is acute angulation and long afferent loops in patients with Billroth II gastrectomy or Roux-en-Y anastomosis. Here, we described a novel technique for successful endoscope insertion using a large dilating balloon.

Methods

The large dilating balloon (maximum diameter 20 mm) is used as an anchor for endoscope insertion (hooking method) in patients with Billroth II gastrectomy in whom no other endoscopes could be advanced into the end of the duodenum or the Roux-en-Y anastomosis.

Results

The hooking method allows the endoscope to be advanced into the proximal afferent loop, even in patients with sharp angulation of the Y limb.

Conclusions

To the best of our knowledge, this is the first report on the use of a large dilating balloon for endoscope insertion in patients with surgically altered anatomy, in particular Roux-en-Y anastomosis. We believe this technique may be effective for difficult cases like the present case.     

Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article

Endoscopic retrograde cholangiopancreatography (ERCP) is a combination of endoscopy and fluoroscopy that is commonly used in the management of pancreatobiliary diseases. ERCP can be challenging if performed in surgically altered anatomy, such as a Billroth II reconstruction, compared with native anatomy and usually has a lower success rate. We identified five emerging challenges in such patients. These are the choice of endoscope, the identification of afferent loop, reaching the duodenal stump, cannulation in the reverse position, and endoscopic sphincterotomy. Performing ERCP in patients with a Billroth II reconstruction needs adequate knowledge, proper skill, and experience to achieve a good clinical outcome.     

Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients

AIM: To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions. METHODS: In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded. RESULTS: Push-enteroscopy (overall, 16 procedures) reached entera...     

Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy

AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed intestine.METHODS:Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine.Short-type SBE is a direct-viewing endoscope with the following specifications:working length,1520 mm;total length,1840 mm;channel diameter,3.2 mm.In addition,short-type SBE has a water-jet channel.The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012.Reconstruction was performed by Billroth-Ⅱ(B-Ⅱ) gastrectomy in 6 patients(8 sessions),Roux-en-Y(R-Y) gastrectomy in 14 patients(21 sessions),and R-Y hepaticojejunostomy in 2 patients(2 sessions).We retrospectively studied the rate of reaching the blind end(papilla of Vater or choledochojejunal anastomosis),mean time required to reach the blind end,diagnostic success rate(defined as the rate of successfully imaging the bile and pancreatic ducts),therapeutic success rate(defined as the rate of successfully completing endoscopic treatment),mean procedure time,and complications.RESULTS:Among the 31 sessions of ERCP,the rate of reaching the blind end was 88% in B-Ⅱ gastrectomy,91% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The mean time required to reach the papilla was 18.3 min in B-Ⅱ gastrectomy,21.1 min in R-Y gastrectomy,and 32.5 min in R-Y hepaticojejunostomy.The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-Ⅱ gastrectomy,90% and 87% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-Ⅱ gastrectomy,94% and 92% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.Because the channel diameter was 3.2 mm,stone extraction could be performed with a wire-guided basket in 12 sessions,and wireguided intraducta     

合并十二指肠乳头旁憩室的胆胰疾病患者行经内镜逆行胰胆管造影的操作技巧

目的探讨合并十二指肠乳头旁憩室行经内镜逆行胰胆管造影术(ERCP)的操作技巧。方法回顾性分析2013年3月-2015年2月于山东省交通医院肝胆内镜科行ERCP合并十二指肠乳头旁憩室患者867例的临床资料,分析插管成功率、治疗效果及并发症发生情况。结果插管成功率99.8%,使用切开刀直接插管成功793例,采用双导丝及胰管支架占据44例,止血夹固定乳头法3例,预切开25例,2例未能成功插管。治疗过程中出现胰腺炎5例,穿孔1例,延迟性出血1例,经保守治疗后均治愈。结论 ERCP治疗合并十二指肠乳头旁憩室的胆胰疾病,应明确ERCP、内镜下乳头括约肌切开术适应证,根据乳头特点采用针对性的操作技巧,有助于提高成功率,减少并发症,是一种安全的微创治疗方法。     

胰十二指肠切除术后行内镜逆行胰胆管造影术诊治的回顾性分析

目的评估胰十二指肠切除术后行内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)的有效性和安全性及内镜选择策略。方法回顾性分析2013年1月—2021年12月在空军军医大学第一附属医院消化内镜中心接受ERCP诊治的34例胰十二指肠切除术后患者的临床资料, 分析插镜成功率、诊断成功率、治疗成功率、ERCP成功率和不良事件的发生情况。结果 34例患者接受了50例次ERCP诊治。胰十二指肠切除术后ERCP的插镜成功率、诊断成功率、治疗成功率和ERCP成功率分别为92.0%(46/50)、93.5%(43/46)、88.4%(38/43)和76.0%(38/50)。结肠镜和气囊辅助式小肠镜辅助ERCP的成功率分别为76.0%(19/25)和75.0%(18/24);共有3例不良事件, 1例患者术中发生胆肠吻合口黏膜撕裂, 1例患者术中发生心跳呼吸骤停, 1例患者术后发生胆管炎。结论胰十二指肠切除术后行ERCP总体是有效和安全的。胰十二指肠切除术后使用结肠镜和气囊辅助式小肠镜辅助ERCP具有相似的成功率。