Objective To compare the efficacy of precut over a pancreatic duct stent(PPDS)and transpancreatic precut sphincterotomy(TPS)for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective analysis was conducted on the clinical data of all consecutive patients underwent ERCP by the same doctor in our hospital between April 2019 and March 2023.According to the selected method during difficult biliary cannulation when guidewire entered pancreatic duct unintendedly,the patients were divided into two groups,1)PPDS group:placing a pancreatic duct stent first,then using a needle knife to cut bile duct sphincter on the surface of the pancreatic duct stent,preserving pancreatic duct sphincter,and then selectively cannulate bile duct;2)TPS group:precut through pancreatic duct sphincter first,then a pancreatic duct stent was placed,and bile duct was selectively cannulated.The success rate of biliary cannulation and ERCP-related complication between the two groups were compared.Results Among 762 ERCP patients,84 patients were enrolled in this study,44 patients in PPDS group,and 40 patients in TPS group.In PPDS group,42 patients(95.4%,42/44)had successful biliary cannulation.No post-ERCP pancreatitis(PEP),bleeding,perforation occurred in PPDS group.In TPS group,39 patients(97.5%,39/40)had successful biliary cannulation.Four patients(10.0%,4/40)had PEP in PPDS group,no bleeding or perforation occurred.All patients were cured.The success rate of biliary cannulation between two groups had no significant difference(P>0.05),while the rate of PEP had significant difference(P<0.05).Conclusions Both PPDS and TPS are good choice for difficult biliary cannulation with high success rate of biliary cannulation.PPDS is more suitable for patients with high-risk factors for PEP,while TPS is a simple technique.

Objective To compare the efficacy of precut over a pancreatic duct stent(PPDS)and transpancreatic precut sphincterotomy(TPS)for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective analysis was conducted on the clinical data of all consecutive patients underwent ERCP by the same doctor in our hospital between April 2019 and March 2023.According to the selected method during difficult biliary cannulation when guidewire entered pancreatic duct unintendedly,the patients were divided into two groups,1)PPDS group:placing a pancreatic duct stent first,then using a needle knife to cut bile duct sphincter on the surface of the pancreatic duct stent,preserving pancreatic duct sphincter,and then selectively cannulate bile duct;2)TPS group:precut through pancreatic duct sphincter first,then a pancreatic duct stent was placed,and bile duct was selectively cannulated.The success rate of biliary cannulation and ERCP-related complication between the two groups were compared.Results Among 762 ERCP patients,84 patients were enrolled in this study,44 patients in PPDS group,and 40 patients in TPS group.In PPDS group,42 patients(95.4%,42/44)had successful biliary cannulation.No post-ERCP pancreatitis(PEP),bleeding,perforation occurred in PPDS group.In TPS group,39 patients(97.5%,39/40)had successful biliary cannulation.Four patients(10.0%,4/40)had PEP in PPDS group,no bleeding or perforation occurred.All patients were cured.The success rate of biliary cannulation between two groups had no significant difference(P>0.05),while the rate of PEP had significant difference(P<0.05).Conclusions Both PPDS and TPS are good choice for difficult biliary cannulation with high success rate of biliary cannulation.PPDS is more suitable for patients with high-risk factors for PEP,while TPS is a simple technique.

Objective To assess the comparative efficacy of different methods for difficult biliary cannulation in endoscopic retrograde cholangio-pancreatography(ERCP)through a network meta-analysis.Methods Randomized controlled trials(RCTs)that compared the efficacy of different adjunctive methods(early or late needle-knife technique,pancreatic guidewire-assisted technique,pancreatic stent-assisted technique,transpancreatic sphincterotomy,persistent standard cannulation technique)for difficult biliary cannulation with each other were identified.The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis(PEP)were the outcomes of interest.Pairwise and network meta-analysis and ranking according to surface under the cumulative ranking curve(SUCRA)for all methods were performed.Results Eighteen RCTs were identified according to selection criteria,and 2 033 patients were enrolled.The use of transpancreatic sphincterotomy over persistent standard cannulation technique(RR=1.34,95%CI:1.02-1.77)and over pancreatic guidewire-assisted technique(RR=1.26,95%CI:1.00-1.60)significantly increased the success rate of biliary cannulation.Based on SUCRA ranking,transpancreatic sphincterotomy followed by early needle-knife techniques were ranked highest in terms of increasing the success rate of biliary cannulation.Only early needle-knife technique significantly decreased PEP rate when compared with persistent standard cannulation technique(RR=0.53,95%CI:0.30-0.94),whereas both early needle-knife techniques and transpancreatic sphincterotomy led to lower PEP rates as compared with pancreatic guidewire-assisted technique(RR=0.41,95%CI:0.17-0.99;RR=0.49,95%CI:0.25-0.96;respectively).Based on SUCRA ranking,early needle-knife technique followed by transpancreatic sphincterotomy were ranked highest for decreasing the PEP rate of biliary cannulation.Conclusions Transpancreatic sphincterotomy increases the success rate of difficult biliary cannulation in ERCP;early needle-knife technique and transpancreatic sphincterotomy are superior to other interventions in decreasing PEP rates and should be considered as a choice of difficult biliary cannulation.

Objective To investigate the short term efficacy and security of different diameters of ampulla balloon dilation in the treatment of choledocholithiasis. Methods 80 patients with extrahepatic bile duct stones treated by EPBD were included in this study. All the patients were divided into 8 mm group, 10 mm group, 12 mm group, 14 mm group, which were according to the diameter of common bile duct (CBD) and stones. CBD stones were removed with retrieved balloon, Dormia basket, and/or mechanical lithotripsy if necessary. The incidence of 24 h hemorrhage, acute pancreatitis, hyperamylasemia and intestinal perforation were observed, and the incidence of pneumobilia and duodenobiliary reflux two weeks after EPBD. Then analyzed the short-term efficacy of the four groups. Result The overall success of stone removal in all groups were 100.0%, there was no significant differences in bleeding, intestinal perforation, hyperamylasemia, pancreatitis between each group (P > 0.05) . There shows significant differences in pneumobilia and duodenobiliary reflux two weeks after EPBD (P < 0.05). The incidence of pneumobilia and duodenobiliary reflux increased with the size of the balloon. Conclusion The application of EPBD is effective and safe for bile duct stone removal, while with the increasing of balloon diameter, the function of Oddi sphincter has severely influenced.

Objective To assess the optimal timing of laparoscopic cholecystectomy ( LC ) in mild acute gallstone pancreatitis ( mAGP) .Methods From May 1, 2012 to August 30, 2015, consecutive patients with mAGP were prospectively assessed.Each patient underwent abdominal computed tomography scan within 48 h after mAGP onset to assess the presence of peripancreatitc fluid collection, and Marshall score was used to assess if there was organ failure.Patients with neither peripancreatic fluid collection by CT ( classified as grade A, B or C based on the Balthazar CT grading system) nor organ failure by clinical data (Marshall score <2) were randomized according to simple randomization into early laparoscopic cholecystectomy ( ELC; LC performed within 7 days after a pancreatitis attack, without waiting for symptom resolution) or late laparoscopic cholecystectomy ( LLC; LC performed ≥7 days following an attack, with complete remission of AGP symptoms) group.The mean LC operation time, bleeding during LC, post-LC complications and lengths of hospital stay between the ELC group and LLC group were compered.Results The study enrolled 102 patients with mAGP.A total of 49 and 53 patients were assigned to ELC and LLC group, respectively.The mean LC operation time and lengths of hospital stay were significantly shorter in the ELC group than in the LLC group [(19.9 ±5.3) vs(31.1 ±8.4) min;(7.9 ±1.8) vs (16.8 ±5.3) d, P<0.05], while there were no significant difference on bleeding during LC and post-LC complications.Conclusions LC for patients with mAGP who had neither peripancreatic fluid collection nor organ failure within 7 days after the onset was safe and feasible.

Objective To study the Effect of acute peripancreatitc fluid collection and pancreatic necrosis to the prognosis of acute pancreatitis.Methods Retrospectively analyzing the prognostic effect of acute peripancreatitc fluid collection and pancreatic necrosis according to the early Computed-Tomograghy of 323 consecutive acute pancreatitis patients from Jan 2003 to Dec 2007,the end points are systemic inflammation response syndrome ( SIRS),pancreatic infection,and mortality.Results Within 5d after onset,97 of 323 cases (30%) presented with SIRS and lasted more than 2d,12 cases (3.7%) occurred pancreatic infection during middle or late phase,14 cases died,the mortality is 4.3%.141 of 323 cases (43.7%) who had acute peripancreatic fluid collection presented with SIRS,acute peripancreatic fluid collection correlated significantly with the occurrence of SIRS,P ＜ 0.05.227 cases (277/323,85.8%) had no pancreatic necrosis,no pancreatic infection occurred,46 cases (46/323,14.2% )had pancreatic necrosis,pancreatic necrosis correlated significantly with pancreatic infection,P ＜ 0.05.Conclusions Acute poripancreafic fluid collection and pancreatic necrosis had different prognostic effect to acute pancreatitis.Acute peripancreatic fluid collection correlated well with the occurrence of SIRS during the early phase;Pancreatic necrosis may be infected during middle or late phase of acute pancreatitis,more extent of pancreatic necrosis,more possible that pancreatic infection will occur.

OBJECTIVE To analyze the effect of nanometer light catalysis decontamination machine on air disinfection in the hyperbaric oxygen(HBO) chamber in the hospital.METHODS The nanometer light catalysis decontamination machine was used to disinfect the HBO chamber air at the time of thirty minutes after patients leaving the chamber when the HBO therapy was finished,then the amount of bacteria in the air was monitored before and 1,2 and 3 hours after disinfection,respectively.RESULTS After disinfection using nanometer light catalysis decontamination machine,the amount of bacteria in the chamber air decreased from 764-1989 CFU/m3 before disinfection to 31-268 CFU/m3.The mean ratio of natural bacteria dissolution was more than 80%.CONCLUSIONS Using nanometer light catalysis decontamination machine is a safe and effective method for air disinfection in the HBO chamber.

OBJECTIVE To analyze the high risk factors and etiology character of ventilator-associated pneumonia(VAP) and provide the guidance for preventing VAP. METHODS Eighty three cases given mechanic ventilation over 48 hours in ICU of our hospital from Jan to Oct 2005 were observed.Thirty seven cases met the diagnosis criteria of VAP,while 46 cases without VAP were taken as control. RESULTS Airway secretion was cultivated and Gram-negative germ was the majority(58.0%).The first three pathogens were Pseudomonas aeruginosa(32.0%),Acinetobacter,and Staphylococcus epidermidis,22.0% cases had mixed infection with fungi.Except antiacid treatment,the following factors,such as long time for mechanical ventilation,trachea incision,corticosteroids treatment and coma state had significant relationship with the occurrence of VAP. CONCLUSIONS The occurrence of VAP is related with multiple clinical factors.Clinicians should reduce high risk factors to lower the occurrence of VAP.

OBJECTIVE To find out the situation of bacteriological contamination of oxygen humidified fluid in the hyperbaric oxygen chamber in Nanfang Hospital and take appropriate measures accordingly to provide valuable reference for avoiding possibly resulting hospital infection.METHODS Before and after beginning periodically changing oxygen humidified fluid,the humidifying fluid in the oxygen humidifiers of three hyperbaric oxygen chambers in this hospital was sampled once a season.The samples were analyzed with bacteria counting and identification.RESULTS The average amount of bacteria in the samples before and after changing oxygen humidified fluid was(7.9 ? 104) CFU/ml and(2.8 ? 103) CFU/ml,respectively.Identified bacteria were conditioned pathogens,including Chryseobacterium,Acinetobacter baumannii,Escherichia coli,Pseudomonas aeruginosa,Candida albicans,etc.Among them the frequency of Chryseobacterium was the highest.The results had no correlation with the changing of seasons.CONCLUSIONS Hyperbaric oxygen chamber should be disinfected periodically,the humidified fluid should be changed every day,and the amount of bacteria in it should lower than 103 CFU/ml.

Objective To explore the indications and efficacy of endoscopic papillary balloon dilation(EPBD) in the management of choledocholithiasis. Methods EPBD combined with a retrieval basket or balloon or both was performed to remove common bile duct stones in 42 cases from April 1999 to August 2001. The length and maximum diameter of the balloon were 5 0cm and 1 2cm respectively. The number of common bile duct stones must be less than 3, and the diameter must be less than or equal to 1 0cm. The balloon was inflated at pressure of (8～12)atm for 2min two times and the corresponding dilated diameter was 1 0cm～1 2cm. Results EPBD was performed successfully in all patients. The common bile duct stones were removed in 40 out of 42 patients, including endoscopic sphincterotomy(EST) in 4 patients, with the success rate being 95 2%(40/42). Stone removal failed in 2 patients. 3 cases had mild pancreatitis postoperatively. No complications such as bleeding or intestinal perforation occurred. Conclusions It is suitable to treat common bile duct stones by EPBD when the number of stones is less than 3 and the diameter is less than or equal to 1.0cm.