Endoscopic Diagnosis And Treatment Of Pancreatic Biliary System Tumors

Objective:To evaluate the effect of pancreiatic duct and bile duct drainage before pancreaticoduodenectomy on perioperative period of pancreaticoduodenectomy.To summarize the clinical experience of endoscopic ultrasonic-guided bile duct puncture and drainage(EUS-BD)for bile duct drainage,and to evaluate the effect of EUS-BD as a firstline preoperative bile duct drainage on perioperative period of pancreaticoduodenectomy.Methods:The clinical data of patients undergoing pancreaticoduodenectomy in Cancer Hospital of Chinese Academy of Medical Sciences from January 2015 to February 2021 were recorded,and the effects of bile duct drainage therapy and non-bile duct drainage therapy on pancreaticoduodenectomy were analyzed retrospectively.the effects of pancreatic duct stent implantation and non-pancreatic duct stent implantation on perioperative period of pancreaticoduodenectomy were compared.The safety and efficacy of EUS-BD were retrospectively analyzed,and the effects of EUS-BD and ERCP on perioperative period of pancreaticoduodenectomy were compared.Results:(1)A total of 308 patients underwent pancreaticoduodenectomy,including 176 patients in non-bile duct drainage group and 132 patients in bile duct drainage group.In the comparative analysis between the non-bile duct drainage group and the bile duct drainage group,there were significant differences in total bilirubin,ALT and AST between the two groups(250[166;324]vs 61.7[11.8;203]p<0.001).The subgroup analysis of patients with TBIL≧250umol/L(34 cases in non-bile duct drainage group and 66 cases in bile duct drainage group)showed that the operation time in bile duct drainage group was longer than that in non-bile duct drainage group(348[289;444]vs 303[252;332]p=0.008).The incidence of severe complication in the bile duct drainage group was lower than that in the non-bile duct drainage group(9(13.6%)vs 14(41.2%)p=0.004),and the incidence of pancreatic leakage was relatively lower(15(22.7%)vs 17(50.0%)p=0.011).For patients with non-severe obstructive jaundice,there was no significant difference in postoperative complications between bile duct drainage group and non-bile duct drainage group.(2)At the same time,29 patients underwent cholangiopancreatic drainage and 54 patients underwent biliary drainage alone.The results of multivariate regression model analysis showed that the incidence of postoperative gastrointestinal dysfunction was higher in cholangiopancreatic duct drainage than simple bile duct drainage(20.7%vs 5.56%p=0.06).(3)The total technical success rate of EUS-BD group was 96.6%(28/29),and the clinical success rate was 92.9%(26/28).The overall incidence of complications was 20.79%(6/29).EUS-BD technique was used in preoperative bile duct drainage group compared with ERCP technique in preoperative bile duct drainage group.The results showed that there was no significant difference in the incidence of postoperative complications between the two groups,but the operation time of bile duct drainage(44.5 ± 20.2min,28.0 ±7.35min,p=0.026)and pancreaticoduodenectomy(307±30.2min,386±130min,min,p=0.069)were relatively shorter.Conclusion:(1)Preoperative bile duct drainage will not benefit patients with total bilirubin<250umol/L.For patients with total bilirubin≧250umol/L,preoperative bile duct drainage can reduce the incidence of severe postoperative complications.(2)The implantation of pancreatic duct stent during biliary drainage though ERCP before pancreaticoduodenectomy may increase the incidence of gastrointestinal dysfunction after operation.(3)EUS-BD is a safe and effective technique for reducing jaundice in clinical bile duct drainage.Compared with preoperative EUS-BD technique and ERCP technique,the operation time of bile duct drainage and pancreaticoduodenectomy were relatively shorter.Background and Aim:Adenomas of the major duodenal papilla have malignant potential.Endoscopic papillectomy,as the preferred procedure,is associated with serious complications,limiting its widespread application.We explore different surgical strategies of endoscopic papillectomy to evaluate the prognosis and promotion value.Methods:Data of patients who underwent endoscopic duodenectomy in Cancer Hospital of Chinese Academy of Medical Sciences from September 26,2015 to August 25,2021 were collected.We have adopted two different surgical strategies:strategy A refers to submucosal injection without hemostatic clamp closure and cholangiopancreatic duct stent placement;Strategy B refers to no submucosal injection and wound closure with hemostatic clamp,placement of bile duct and/or pancreatic duct stents.A retrospective case-control study was used to compare the incidence of postoperative complications of different strategies.Results:In this study,a total of 34 patients underwent endoscopic papillectomy,of which 12 received strategy B and the rest received strategy A.There was no statistical difference in baseline characteristics including sex,age,body mass index and wound size between the two groups.Patients who received strategy B had a lower rate of postoperative bleeding(0 vs 27.3%score 0.069)and shorter hospital stays(7.5 vs 10 minutes 0.016).There were 3 cases of perforation in strategy A group and none in strategy B group.In addition,there was no significant difference in the incidence of perforation,cholangitis and pancreatitis between the two groups.Conclusions:According to our experience,the implementation of endoscopic papillectomy for strategy B,including no submucosal injection,closure of wounds with hemostatic clips,and placement of biliary and/or pancreatic duct stents,is suitable for promotion because of its low postoperative bleeding rate and short hospital stay.