Application of ERCP in diagnosis and treatment of patients with pancreaticobiliary maljunction

doi:10.3877/cma.j.issn.2095-3232.2024.05.019

Abstract

Abstract:

Objective

To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of pancreaticobiliary maljunction (PBM).

Methods

Clinical data of 83 PBM patients who underwent ERCP in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2018 to December 2022 were retrospectively analyzed. Among them, 39 patients were male and 44 female, aged (30±16) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. Clinical manifestations, PBM classification, procedures, clinical efficacy and complications of ERCP were observed.

Results

Among 4 769 patients undergoing ERCP, the detection rate of PBM was 1.74%(83/4 769). During ERCP, 39 cases (47%) were diagnosed with type Ⅰ biliary-pancreatic (B-P) maljunction, 27 cases (33%) of type Ⅱ pancreatic-biliary (P-B) maljunction, 17 cases (20%) of type Ⅲ complicated maljunction.25 cases (30%) of PBM were complicated with pancreatic divisum. 83 patients were treated with ERCP for175 times, and the success rate of intubation was 98.9%(173/175). Among them, 26 cases underwent ERCP once, and the remaining 57 cases received ERCP for 2-5 times. The symptoms of abdominal pain were relieved in 79 patients after surgery. Postoperatively, TB, ALT, AST and GGT levels were significantly decreased in 15 patients with obstructive jaundice. Postoperatively, WBC, neutrophil percentage and procalcitonin level were significantly declined in 11 patients with fever. Postoperative complications occurred in 13 case-times, including hyperamylasemia in 8 case-times, postoperative pancreatitis in2 case-times, postoperative bleeding in 2 case-times and cholecystitis after ERCP in 1 case-time, respectively. The average length of hospital stay was (5.8±2.3) d.

Conclusions

For the treatment of PBM, ERCP possesses high efficacy, mild complications, high controllability and safety in clinical diagnosis and treatment. Compared with traditional surgery, ERCP has multiple advantages of less trauma, higher repeatability and shorter length of hospital stay, which can serve as the optimal treatment for PBM patients.

Key words: Cholangiopancreatography, endoscopic retrograde (ERCP), Pancreaticobiliary mal-junction (PBM), Pancreas divisum

Jinxin Huang, Jiajun Chen, Xuan Wang, Yan Qu, Xiwen Zhang, Fu Li. Application of ERCP in diagnosis and treatment of patients with pancreaticobiliary maljunction[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 699-704.

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References 25

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时间	NRS（分）	TB（μmol/L）	ALT（U/L）	AST（U/L）	GGT（U/L）	WBC（×10⁹/L）	中性粒细胞百分比（%）	降钙素原（ng/ml）
治疗前	7.7±1.8	77±13	325±98	331±94	319±107	9.6±3.7	82±9	0.11±0.02
治疗后	2.8±1.5	37±11	200±61	200±59	201±61	7.5±2.2	71±3	0.08±0.01
t值	18.441	20.765	10.124	10.504	8.588	4.414	9.759	12.582
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

时间	NRS（分）	TB（μmol/L）	ALT（U/L）	AST（U/L）	GGT（U/L）	WBC（×10⁹/L）	中性粒细胞百分比（%）	降钙素原（ng/ml）
治疗前	7.7±1.8	77±13	325±98	331±94	319±107	9.6±3.7	82±9	0.11±0.02
治疗后	2.8±1.5	37±11	200±61	200±59	201±61	7.5±2.2	71±3	0.08±0.01
t值	18.441	20.765	10.124	10.504	8.588	4.414	9.759	12.582
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

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