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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 8
Aug.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(8): 1911-1918

Safety and efficacy of modified pancreatic duct stent in biliary drainage after complete bile duct stone removal by endoscopic retrograde cholangiopancreatography

DOI: 10.3969/j.issn.1001-5256.2023.08.021
  • 1.

    College of Clinical Medicine, Guizhou Medical University, Guiyang 550004, China

  • 2.

    Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China

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  • Corresponding author: HAN Min, 409582096@qq.com (ORCID: 0000-0001-7218-5276)
  • Received Date: 2022-12-12
  • Accepted Date: 2023-02-07
  • Published Date: 2023-08-20
    Abstract
  •   Objective  To investigate the clinical application value of modified 7Fr pancreatic duct plastic stent in biliary drainage.  Methods  Clinical data were collected from 121 patients with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) lithotomy and biliary drainage in Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, from April 2021 to June 2022, and according to the method for postoperative biliary drainage, they were divided into modified stent group with 59 patients and nasobiliary drainage group with 60 patients. The patients in the modified stent group received drainage with the modified 7Fr pancreatic duct plastic stent, and those in the nasobiliary drainage group received nasobiliary drainage. A retrospective analysis was performed for their clinical data, and stent dislodgement was observed for the modified stent group. The two groups were compared in terms of clinical outcome, postoperative comfort, and postoperative complications. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups.  Results  Both groups achieved a stone clearance rate of 100%. There were significant differences between the two groups in the length of postoperative hospital stay and the total length of hospital stay (t=-3.997 and 2.317, both P < 0.05). After treatment, both groups had significant reductions in total bilirubin (TBil), direct bilirubin (DBil), indirect bilirubin (IBil), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (all P < 0.05), and there were no significant differences between the two groups in the changes in TBil, DBil, IBil, ALP, alanine aminotransferase, and AST after treatment (all P>0.05). Also, no significant differences were observed between the two groups in the changes in biochemical parameters after treatment (all P>0.05). There were significant differences between the two groups in comfort score within 24 hours after surgery and the time to first eating and drinking after surgery (t=2.001, 3.579, and 4.604, all P < 0.05). There were no significant differences in complications between the two groups (all P>0.05). In the modified stent group, the rate of spontaneous stent dislodgement was 83.05%, and there were no complications such as stent occlusion, displacement, rupture, perforation, and infection.  Conclusion  After complete bile duct stone removal by ERCP, biliary drainage using the modified 7Fr pancreatic duct plastic stent has a similar effect to nasobiliary drainage and can shorten the length of postoperative hospital stay, improve postoperative comfort, and accelerate postoperative recovery, with a relatively high spontaneous dislodgement rate. Therefore, it is safe and effective in clinical practice.

     

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    • References(35)
  • [1]
    MUKAI S, ITOI T, BARON TH, et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018[J]. J Hepatobiliary Pancreat Sci, 2017, 24(10): 537-549. doi: 10.1002/jhbp.496.
    [2]
    LIN Y, LIN XY, CHEN R, et al. Application of ERCP in treatment of common bile duct stones after cholecystectomy[J/OL]. Chin J Hepat Surg(Electronic Edition), 2021, 10(5): 502-505. DOI: 10.3877/cma.j.issn.2095-3232.2021.05.015.

    林颖, 林显艺, 陈荣, 等. ERCP在胆囊切除术后胆总管结石治疗中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(5): 502-505. DOI: 10.3877/cma.j.issn.2095-3232.2021.05.015.
    [3]
    DONG WF, PANG EJ, DAI ZL. Clinical efficacy of ERCP combined with LC in treatment of patients with cholecystolithiasis combined with choledocholithiasis and influencing factors for recurrence of choledocholithiasis after surgery[J]. Clin Misdiagn Misther, 2021, 34(5): 85-90. DOI: 10.3969/j.issn.1002-3429.2021.05.017.

    董维峰, 庞尔君, 代镇岭. ERCP联合LC治疗胆囊结石合并胆总管结石临床效果及术后胆总管结石复发影响因素分析[J]. 临床误诊误治, 2021, 34(5): 85-90. DOI: 10.3969/j.issn.1002-3429.2021.05.017.
    [4]
    DUMONCEAU JM, TRINGALI A, BLERO D, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline-updated october 2017[J]. Endoscopy, 2018, 50(9): 910-930. DOI: 10.1055/a-0659-9864.
    [5]
    CHENG J, LI QL, XU MD, et al. Clinical value of using pancreatic duct stent for bile duct drainage after endoscopic removal of common bile duct stones[J]. Chin J Dig Endosc, 2019, 36(9): 686-688. DOI: 10.3760/cma.j.issn.1007-5232.2019.09.015.

    成婧, 李全林, 徐美东, 等. 内镜取净胆总管结石后应用胰管支架行胆管引流的临床价值[J]. 中华消化内镜杂志, 2019, 36(9): 686-688. DOI: 10.3760/cma.j.issn.1007-5232.2019.09.015.
    [6]
    HE QB, WANG L, PENG CY, et al. Modified prophylactic 5-fr pancreatic duct stent enhances the rate of spontaneous dislodgement: A multicenter randomized controlled trial[J]. United European Gastroenterol J, 2018, 6(10): 1519-1526. DOI: 10.1177/2050640618804729.
    [7]
    LEE JK, LEE SH, KANG BK, et al. Is it necessary to insert a nasobiliary drainage tube routinely after endoscopic clearance of the common bile duct in patients with choledocholithiasis-induced cholangitis? A prospective, randomized trial[J]. Gastrointest Endosc, 2010, 71(1): 105-110. DOI: 10.1016/j.gie.2009.08.009.
    [8]
    BANKS PA, BOLLEN TL, DERVENIS C, et al. Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1): 102-111. DOI: 10.1136/gutjnl-2012-302779.
    [9]
    BALTHAZAR EJ, ROBINSON DL, MEGIBOW AJ, et al. Acute pancreatitis: value of CT in establishing prognosis[J]. Radiology, 1990, 174(2): 331-336. DOI: 10.1148/radiology.174.2.2296641.
    [10]
    COTTON PB, EISEN GM, AABAKKEN L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop[J]. Gastrointest Endosc, 2010, 71(3): 446-454. DOI: 10.1016/j.gie.2009.10.027.
    [11]
    PARK SY, PARK CH, CHO SB, et al. The safety and effectiveness of endoscopic biliary decompression by plastic stent placement in acute suppurative cholangitis compared with nasobiliary drainage[J]. Gastrointest Endosc, 2008, 68(6): 1076-1080. DOI: 10.1016/j.gie.2008.04.025.
    [12]
    LEE DW, CHAN AC, LAM YH, et al. Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: a prospective randomized trial[J]. Gastrointest Endosc, 2002, 56(3): 361-365. DOI: 10.1016/s0016-5107(02)70039-4.
    [13]
    OTANI K, UEKI T, MATSUMURA K, et al. Comparison between endoscopic biliary stenting and nasobiliary drainage in patients with acute cholangitis due to choledocholithiasis: is endoscopic biliary stenting useful?[J]. Hepatogastroenterology, 2015, 62(139): 558-563.
    [14]
    SHARMA BC, KUMAR R, AGARWAL N, et al. Endoscopic biliary drainage by nasobiliary drain or by stent placement in patients with acute cholangitis[J]. Endoscopy, 2005, 37(5): 439-443. DOI: 10.1055/s-2005-861054.
    [15]
    PERRI V, FAMILIARI P, TRINGALI A, et al. Plastic biliary stents for benign biliary diseases[J]. Gastrointest Endosc Clin N Am, 2011, 21(3): 405-433, viii. DOI: 10.1016/j.giec.2011.04.012.
    [16]
    GROMSKI MA, BICK BL, VEGA D, et al. A rare complication of ERCP: duodenal perforation due to biliary stent migration[J]. Endosc Int Open, 2020, 8(11): E1530-E1536. DOI: 10.1055/a-1231-4758.
    [17]
    MANES G, PASPATIS G, AABAKKEN L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline[J]. Endoscopy, 2019, 51(5): 472-491. DOI: 10.1055/a-0862-0346.
    [18]
    RASHDAN A, FOGEL EL, MCHENRYL Jr, et al. Improved stent characteristics for prophylaxis of post-ERCP pancreatitis[J]. Clin Gastroenterol Hepatol, 2004, 2(4): 322-329. DOI: 10.1016/s1542-3565(04)00062-x.
    [19]
    TSUCHAYA T, ITOI T, SOFULI A, et al. Temporary pancreatic stent to prevent post endoscopic retrograde cholangiopancreatography pancreatitis: a preliminary, single-center, randomized controlled trial[J]. J Hepatobiliary Pancreat Surg, 2007, 14(3): 302-307. DOI: 10.1007/s00534-006-1147-8.
    [20]
    KAWASHIMA H, ITOH A, OHNO E, et al. Is nasobiliary drainage unnecessary for drainage of acute suppurative cholangitis? Our experience[J]. Dig Endosc, 2010, 22(Suppl 1): S118-S122. DOI: 10.1111/j.1443-1661.2010.00959.x.
    [21]
    CHRISTOFORIDIS E, GOULIMARIS I, KANELLOS I, et al. Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors[J]. Endoscopy, 2002, 34(4): 286-292. DOI: 10.1055/s-2002-23630.
    [22]
    ANDRIULLI A, CLEMENTE R, SOLMI L, et al. Gabexate or somatostatin administration before ERCP in patients at high risk for post-ERCP pancreatitis: a multicenter, placebo-controlled, randomized clinical trial[J]. Gastrointest Endosc, 2002, 56(4): 488-495. DOI: 10.1067/mge.2002.128130.
    [23]
    FREEMAN ML, GUDA NM. Prevention of post-ERCP pancreatitis: a comprehensive review[J]. Gastrointest Endosc, 2004, 59(7): 845-864. DOI: 10.1016/s0016-5107(04)00353-0.
    [24]
    HE QB, XU T, WANG J, et al. Risk factors for post-ERCP pancreatitis and hyperamylasemia: A retrospective single-center study[J]. J Dig Dis, 2015, 16(8): 471-478. DOI: 10.1111/1751-2980.12258.
    [25]
    COTTON PB, GARROW DA, GALLAGHER J, et al. Risk factors for complications after ERCP: a multivariate analysis of 11, 497 procedures over 12 years[J]. Gastrointest Endosc, 2009, 70(1): 80-88. DOI: 10.1016/j.gie.2008.10.039.
    [26]
    BAE SS, LEE DW, HAN J, et al. Risk factor of bleeding after endoscopic sphincterotomy in average risk patients[J]. Surg Endosc, 2019, 33(10): 3334-3340. DOI: 10.1007/s00464-018-06623-8.
    [27]
    BAJBOUJ M, TREIBER M, LUDWIG L, et al. Forgotten biliary endoprosthesis. "Follow up" after 10 years[J]. Endoscopy, 2008, 40 Suppl 2: E221. DOI: 10.1055/s-2008-1077431.
    [28]
    LAWRNCE C, ROMAGNUOLO J, PAYNE KM, et al. Low symptomatic premature stent occlusion of multiple plastic stents for benign biliary strictures: comparing standard and prolonged stent change intervals[J]. Gastrointest Endosc, 2010, 72(3): 558-563. DOI: 10.1016/j.gie.2010.05.029.
    [29]
    LUBBERT C, WENDT K, FEISTHAMMEL J, et al. Epidemiology and resistance patterns of bacterial and fungal colonization of biliary plastic stents: a prospective cohort study[J]. PLoS One, 2016, 11(5): e0155479. DOI: 10.1371/journal.pone.0155479.
    [30]
    PISELLO F, GERACI G, LI VOLSI F, et al. Permanent stenting in "unextractable" common bile duct stones in high risk patients. A prospective randomized study comparing two different stents[J]. Langenbecks Arch Surg, 2008, 393(6): 857-863. DOI: 10.1007/s00423-008-0388-1.
    [31]
    SOFUNI A, MAGUCHI H, ITOI T, et al. Prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis by an endoscopic pancreatic spontaneous dislodgement stent[J]. Clin Gastroenterol Hepatol, 2007, 5(11): 1339-1346. DOI: 10.1016/j.cgh.2007.07.008.
    [32]
    NISHIWAKI M, MIZUNO C, YANO K, et al. Retroperitoneal perforation caused by migration of a pancreatic spontaneous dislodgement stent into periampullary diverticula[J]. Intern Med, 2018, 57(3): 351-355. DOI: 10.2169/internalmedicine.9054-17.
    [33]
    KEHLET H, SLIM K. The future of fast-track surgery[J]. Br J Surg, 2012, 99(8): 1025-1026. DOI: 10.1002/bjs.8832.
    [34]
    Chinese Research Hospital Association, Society for Hepatopancreatobiliary Surgery. Expert consensus on enhanced recovery after hepatobiliary & pancreatic surgery(2015 edition)[J]. J Clin Hepatol, 2016, 32(6): 1040-1045. DOI: 10.3969/j.issn.1001-5256.2016.06.004.

    中国研究型医院学会肝胆胰外科专业委员会. 肝胆胰外科术后加速康复专家共识(2015版)[J]. 临床肝胆病杂志, 2016, 32(6): 1040-1045. DOI: 10.3969/j.issn.1001-5256.2016.06.004.
    [35]
    VARADHAN KK, NEAL KR, DEJONG CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials[J]. Clin Nutr, 2010, 29(4): 434-440. DOI: 10.1016/j.clnu.2010.01.004.
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