A Comparative Study Of The Effects Of EPBD And Sest+EPBD On The Incidence Of Complication After Endoscopic Stone Extraction

Objective:Evaluate the effectiveness and safety of s EST+EPBD via the comparison between effects of EPBD and s EST+EPBD on the incidence of complication after endoscopic stone extraction.Methods:A totally of 335patients with choledocholithiasis who underwent ERCP from November 2009 to November 2018 in affiliated hospital of Guilin Medical College was selected.Group EPBD:All selected patients met the inclusion criteria,According to the exclusion criteria 19 of them were finalized as patients with complete clinical data（December 2009-July 2012）.Group s EST+EPBD:All selected patients met the inclusion criteria,According to the exclusion criteria 130 of them were finalized as patients with complete clinical data（December 2012-November2011）.Inclusion criteria:（1）All patients were clinically treated with ERCP for common bile duct stones in the affiliated hospital of Guilin Medical College.（2）All patients were diagnosed as patients with choledocholithiasis by imaging before operation.（3）All pre-operative amylases were within their normal range in selected cases（20-115U/L）.（4）Patient or family member of the patient had read and signed the informed consent.Exclusion criteria:（1）Patients with missing medical record data.（2）Patients with acute pancreatitis or acute exacerbation of chronic pancreatitis.（3）Patients who underwent ERCP stone extraction.（4）Patients with coagulopathy dysfunction（platelets less than70×10~9/L or APPT prolonged more than twice）.Date of preoperative amylase,liver function,common bile duct were collected for the imaging examination,intraoperative treatment（overall success,initial success,number of stones extraction,with or without ampulla diverticulum,with or without mechanical debris）,after the operation,symptoms and signs of postoperative abdominal pain were observed.Serum amylase was taken at 3hours and 24hours after the operation,liver function tests were performed at 24hours after the operation.Results:There were no significant differences in gender,age,number of stones,stone diameter,combined gallstones,cholecystectomy and duodenal diverticulum between the two groups（P>0.05）.There was a statistically significant difference in hospital stay between the two groups（t=-3.769,P=0.001<0.05）.There was no significant difference in the rate of initial success and overall success rate between the two groups（P>0.05）.Preoperative liver function of s EST+EPBD was statistically different from liver function 24 hours after operation（P<0.05）.Preoperative ALT of EPBD was statistically different from postoperative ALT（Z=-2.575,P=0.01<0.05）.Preoperative AST of EPBD was not statistically different from postoperative AST（Z=-1.633,P=0.102）.The total bilirubin in EPBD before operation was not statistically different from the total bilirubin 24 hours after operation（Z=-0.845,P=0.398>0.05）.There was no significant difference in the liver function between the s EST+EPBD and EPBD groups before and 24 hours after operation（P<0.05）.There was statistical significance of amylase at different time points（F=11.913,P<0.05）.There was no significant difference in the effect of different groups on amylase（F=0.399,P=0.529>0.05）.And there is no interaction between different groups and different times（F=1.518,P=0.223>0.05）.The ratio of amylase to preoperative amylase was statistically significant at each time point in the s EST+EPBD group.The ratio of amylase to preoperative amylase was statistically significant at each time point in the EPBD group.There was a statistically significant difference in amylase between s EST+EPBD and EPBD at 3 hours postoperatively（P<0.05）.There was no statistically significant difference in postoperative hyperamylasemia,postoperative pancreatitis,hemorrhage,perforation,and acute cholangitis between s EST+EPBD and EPBD（P>0.05）.There was significant statistical differences between the overall s EST+EPBD group and the overall complications of the EPBD group（x2=3.883,P=0.049<0.05）.Conclusions:1.The liver function of s EST+EPBD group was improved significantly after operation compared with that of EPBD group.2.s EST+EPBD does not increase the incidence of hyperamylasemia and pancreatitis.s EST+EPBD can reduce the number of hospital stays and protect sphincter function.It is a safe and effective way to extraction stones.