Objective:To systematically evaluate the efficacy of epinephrine in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).Methods:Randomized controlled trials (RCTs) on epinephrine for preventing PEP from inception to October 10, 2020 were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, VIP Information Network, China National Knowledge Infrastructure,WanFang Data,and clinical trial registration platforms including ClinicalTrials.gov,WHO International Clinical Trial Registration Platform. Literature was screened independently by two reviewers, data were extracted and the risk of bias of included studies were assessed. The meta-analysis was performed by RevMan 5.3.Results:A total of 410 papers were retrieved and 8 RCTs involving 4 208 patients were included. The results of meta-analysis showed that compared with the saline group, the epinephrine could reduce the incidence of PEP ( RR=0.29,95% CI:0.16-0.50, P<0.001). There were no significant differences in the therapeutic effect between group epinephrine and group indomethacin ( RR=0.17,95% CI:0.02-1.39, P=0.100) or group indomethacin combined with epinephrine and group indomethacin ( RR=1.15,95% CI:0.61-2.16, P=0.670). Conclusion:Local spraying of epinephrine on the duodenal papilla can reduce the incidence of PEP compared with normal saline. But the epinephrine or combination of indomethacin and epinephrine fails to reveal any benefit over indomethacin alone in preventing PEP.

Objective:To compare the efficacy and safety of stone extraction with a single peroral choledochoscopy system under direct visualization and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) for non-difficult common bile duct stones.Methods:A total of 164 patients with common bile duct stones who underwent stone extraction by using the single peroral choledochoscopy system under direct visualization (the observation group, n=82) and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) (the control group, n=82) from January 2018 to April 2022 in Dongfang Hospital, Beijing University of Chinese Medicine were enrolled. The observation group was directly selected from the database, while the control group was randomly matched by age stratification with baseline data validated. The success rates of intubation, stone removal, postoperative complication incidence, and radiation exposure between the two groups were compared. Results:There was no significant difference between the baseline data of the observation group and the control group ( P>0.05). The number of patients with detected stones≥2 in the observation group and the control group were 59 (71.95%) and 37 (45.12%) respectively with significant difference ( χ 2=12.16, P=0.001). The success rates of bile duct intubation in the observation group and the control group were both 100.00% (82/82). The success rates of stone extraction were 98.78% (81/82) and 100.00% (82/82) respectively with no significant difference ( P>0.05). The one-time stone removal rates of the two groups were 93.90% (77/82) and 92.68% (76/82) respectively with no significant difference ( χ2=0.10, P=0.755). There was no significant difference in the incidence of postoperative complications between the observation group and the control group ( P>0.05). The amount of intraoperative ray exposure volume in the observation group was significantly lower than that of the control group [10.20 (6.69, 18.94) mGy VS 15.41 (10.70, 22.77) mGy, U=2 462.00, P=0.003]. Conclusion:The efficacy and safety of stone extraction with single peroral choledochoscopy system under direct visualization are comparable to those of traditional X-ray ERCP for non-difficult common bile duct stones, but it can significantly reduce the intraoperative ray exposure volume during therapeutic ERCP stone extraction.

Objective To investigate the value of transient elastography (TE) in the staging of hepatic fibrosis in patients with autoimmune liver disease (ALD). Methods PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP databases were searched for English and Chinese articles on TE in the staging of hepatic fibrosis in ALD published from January 2000 to January 2021. Two reviewers independently performed data extraction for the articles included, and QUADAS2 was used for quality assessment. The bivariate mixed effects model in Stata 15.0 software was used to perform the Meta-analysis. Results A total of 11 articles were included, with 1041 patients in total. In the diagnosis of significant hepatic fibrosis (F≥2), TE had a pooled sensitivity of 0.81 (95% CI : 0.75-0.86), a specificity of 0.87(95% CI 0.79-0.92), and an area under the receiver operating characteristic curve (AUC) of 0.91(95% CI 0.88-0.93); in the diagnosis of advanced hepatic fibrosis (F≥3), TE had a pooled sensitivity of 0.81(95% CI 0.74-0.87), a sensitivity of 0.90(95% CI 0.85-0.93), and an AUC of 0.92(95% CI 0.90-0.94); in the diagnosis of early-stage liver cirrhosis (F4), TE had a pooled sensitivity of 0.87(95% CI 0.74-0.93), a specificity of 0.93(95% CI 0.87-0.97), and an AUC of 0.96(95% CI 0.94-0.97). Conclusion TE has a good diagnostic value in evaluating significant liver fibrosis, advanced liver fibrosis, and early-stage liver cirrhosis in patients with ALD, especially with a relatively high diagnostic accuracy for early-stage liver cirrhosis.