Release date: 2015-12-18 ~ A prospective study in Korea showed that for patients with common bile duct stones (CBD), endoscopic direct bile duct stone removal is safe and feasible only by intracavitary ultrasound without conventional cholangiography. The paper was published in the November issue of Gastrointest Endosc 2015, 82(5): 939. The study included a total of 39 untreated patients with CBD. The inclusion criteria were: 1 age between 20 and 90 years; 2 clinical diagnosis of CBD by abdominal ultrasonography and CT examination, diameter <20 mm. Exclusion criteria were: 1 endoscopic duodenal papillary incision or balloon dilatation; 2 history of upper digestive tract surgery; 3 upper gastrointestinal stenosis; 4 other serious diseases; 5 pancreatic and biliary tumors. Endoscopic devices for ERCP operation are standard duodenoscopy and intracavitary ultrasound devices. During the endoscopic procedure, the investigator first found the duodenal papilla of the patient and underwent selective bile duct intubation under the guidance of a guidewire. After the 0.035-inch guide wire was inserted into the common bile duct, the IDUS ultrasound probe was inserted along the guide wire and placed at the confluence of the common hepatic duct for IDUS observation. During operation, if it is not determined whether the guide wire is inserted into the common bile duct, the surgeon can perform X-ray examination to confirm. After the common bile duct stones were observed by IDUS, the duodenal papillary incision was performed, the IDUS probe was taken out, and the stone was taken through a basket or a balloon. In addition, during the stone removal process, the researchers performed mechanical debris on the more difficult bile duct stones. After completion of the stone removal, IDUS was performed again on all patients to confirm that the bile duct stones had been completely removed. The primary outcome of this study was the success rate of bile duct stones without cholangiography; secondary assessments were fluoroscopy time, IDUS operating time, total operating time, and adverse reaction rates. The results of the study showed that of the 39 patients enrolled at baseline, 1 patient had a choledocholithiasis >20 mm in diameter, and sputum was excluded from the study; 15 patients had diverticulum around the ampulla of the duodenum. All patients enrolled in the study underwent IDUS, and 29 patients successfully completed selective bile duct intubation without a duodenal papillectomy. The average common bile duct stone diameter observed by IDUS was 8.5 mm, and the average bile duct width was 12.0 mm. Before the stone removal, 35 patients underwent a duodenal papillary incision. After the administration of IDUS and no cholangiography, 26 patients were successfully treated with stone removal. All patients did not have traditional ERCP angiography. The average time of the IDUS operation to observe the common bile duct was 55 seconds, and the average operation time was 1368 seconds. X-ray fluoroscopy was applied to 13 patients, and the average operation time was 10 seconds. All patients underwent biliary stone removal under IDUS guidance without serious intraoperative and postoperative complications. (Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University) â– Expert reviews Wide application of IDUS in bile duct stone removal Zhang Jiantian, Beijing Friendship Hospital, Capital Medical University Biliary calculi are common clinical diseases. Patients usually take jaundice as the first symptom. ERCP can directly image the biliary system and has high resolution. It can further define the location and quantity of bile duct stones for further interventional therapy. Since the 1970s, ERCP has been the gold standard for the diagnosis of extrahepatic bile duct stones, and ERCP combined with angiography for biliary stone removal is currently the main minimally invasive treatment. However, the judgment of ERCP on the content of bile duct is based on the contrast of its shape and contrast agent. Many factors such as the nature and size of the stone, the influence of biliary air bubbles, the contrast agent concentration and the injection speed will affect the accuracy of ERCP in judging the stone. . With the innovation of endoscopic technology, endoscopic ultrasound (EUS) plays an important role in the diagnosis and treatment of digestive diseases, especially the application of IDUS. The IDUS probe has the characteristics of small diameter and high frequency. The frequency is mostly 12~30MHz, the diameter is about 2mm, and the maximum resolution of the image is 0.07~0.18mm. When ERCP is performed, the IDUS device can be fed into the pancreatic duct through the guide wire. After entering the bile duct, the sensitive area can be repeatedly scanned to clearly display the structure inside the lumen. In addition, the audio image of IDUS is a transverse image of the bile duct wall and its lesions with the bile duct as the axis. The resolution is high, the stone can be scanned at a close distance, the positioning of the common bile duct stones is high, the qualitative accuracy is high, and the angle can be multi-angled. Stereoscopic observation. There was a study using traditional EUS assessment, diagnosis of bile duct stones, and then ERCP angiography for stone removal. At the time, the researchers of the study proposed whether the diagnosis and treatment of bile duct stones could be completed simultaneously by developing an endoscopic device. The above-mentioned Korean forward-looking research has realized this idea. The researchers combined IDUS with ERCP, without the use of traditional cholangiography, but only through IDUS to complete the observation and evaluation of common bile duct stones. Under the guidance of IDUS, choledocholithiasis was successfully performed without any adverse reactions. Traditional angiography may lead to cholangitis, intrahepatic cholestasis, postoperative pancreatitis, etc. after ERCP stone removal. In this study, no contrast injection was given, which reduced the incidence of these complications. The incidence of asymptomatic transient amylase increased was only 7.9%, and the average time of X-ray examination was only 10 seconds, which was significantly shorter than that. Traditional contrast time. However, there are still some shortcomings in this study: there are no randomly selected patients, no control group is set, and the treatment effect on large stones is not clear. Therefore, more research is needed to assess the clinical safety and feasibility of this method. It is believed that IDUS will become a safer and more effective technique for the diagnosis and treatment of biliary and pancreatic diseases, and is widely used in clinical practice. Source: Medical Forum Network Galaxy Horizontal Arm Cmm,Multi-Functional Cmm Machine,Automatic Horizontal Cmm,Milling Horizontal Cmm Automated Precision Inc. , https://www.apiasean.com
Common bile duct stones are common diseases of the digestive system, which can lead to a series of serious complications. With the continuous development of endoscopic techniques, endoscopic methods have become the main and preferred method for the treatment of bile duct stones. Endoscopic retrograde cholangiopancreatography (ERCP) can accurately image the pancreaticobiliary system and has a high accuracy in the diagnosis of extrahepatic bile duct stones. However, due to the influence of operators, contrast agent concentration and stone density, some cases are missed and Misdiagnosed. Intrabiliary ultrasound (IDUS) is a safe and effective method for the diagnosis of common bile duct stones in recent years. It can combine endoscopic and high-resolution ultrasound imaging without angiography. The endoscope provides real-time, high-quality images of the pancreaticobiliary system, which is not affected by intestinal gases, and has a good development effect on small-sized low-density negative stones. IDUS makes ERCP more perfect. The combination of the two is a combination of diagnosis and treatment. It plays an important role in the diagnosis and treatment of pancreaticobiliary diseases, especially bile duct stones, and has received more and more attention.
â– Introduction to research