Risk Factors of Acute Pancreatitis in Oral Double Balloon Enteroscopy

Risk factors for postoperative stone formation in pediatric choledochal cysts: a study of 457 cases

Postoperative bile duct stones, including intrahepatic bile duct (IHD) stones and remnant distal common bile duct (remnant intrapancreatic common bile duct, RIPD) or common channel duct (CCD) stones, are long-term complications following choledochal cyst (CC) excision. We aimed to retrospectively review occurrence, associated factors, and treatment of postoperative bile duct stones. Records of 457 pediatric patients who underwent CC excision at Asan Medical Center (1992-2021) were retrospectively reviewed. Data on cholelithiasis, operation, and outcomes were analyzed. Overall, 457 pediatric patients underwent CC excision, with 21 developing intrahepatic duct (IHD) stones, primarily associated with Todani type IVa cysts, especially Tsuchida types 2 or 3, which are often linked to IHD dilation and upstream stenosis. Patients with RIPD/CCD stones were all identified with complicated Komi types, and the impact of pancreas divisum itself was unclear. Early surgery even before 6 months of age is associated with improved prognosis regarding the occurrence of IHD stones, but not related with RIPD/CCD stones. This is the largest retrospective study to date, comprising 21 IHD and 18 RIPD/CCD stones from 457 pediatric patients with CCs and their clinical outcomes. We found that the structural characteristics of the bile duct influence stone formation. In addition, our findings indicate the need for more systematic and long-term follow-up of patients with CCs after surgery.

Current treatment strategies for postoperative intrahepatic bile duct stones in congenital biliary dilatation: a single center retrospective study

BACKGROUND

Intrahepatic bile duct (IHBD) stones are one of the most common late complications of Roux-en-Y hepaticojejunostomy for congenital biliary dilatation (CBD). We report the current treatment strategies for IHBD stones and their outcomes in our institute.

METHODS

Between 1983 and 2021, 117 patients with CBD were surgically treated in our institute. Our treatment strategies included oral ursodeoxycholic acid (UDCA), double-balloon endoscopic retrograde cholangiography (DB-ERC), percutaneous cholangio-drainage (PTCD), and open surgery. A retrospective study was conducted using medical charts.

RESULTS

Postoperative IHBD stones were identified in 12 of 117 patients with CBD (10.2%). Five patients received UDCA, and small stones were successfully resolved in two cases. DB-ERC was performed eight times in five patients, but the endoscope could not reach the porta hepatis due to a long jejunal loop in two of five patients. One patient presented with severe acute pancreatitis induced by prolonged DB-ERC. PTCD was performed in three patients, two of whom finally underwent open surgery due to unsuccessful lithotomy. Open surgery was eventually performed in three patients. Lithotomy was performed in one patient; lithotomy with strictureplasty was performed in another patient. The other patient was diagnosed with intrahepatic cholelithiasis with adenocarcinoma. He underwent left lobectomy and died of carcinomatous peritonitis.

CONCLUSIONS

Oral UDCA may be effective for small stones. Although DB-ERC should be considered as a first-line interventional therapy for lithotomy, it may not be feasible due to a long jejunal loop, and pancreatitis may occur. Long-term follow-up and early detection and treatment for IHBD stones may yield a good prognosis.

Diagnostic value of capsule endoscopy and double-balloon enteroscopy in small bowel diseases

OBJECTIVE

To analyze the diagnostic value of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in small bowel diseases.

METHODS

The clinical data of 134 cases of CE and 109 cases of DBE examined in our gastroscopy room from January 2016 to December 2019 were retrospectively analyzed. The two groups of patients were compared as to disease diagnostic rate, examination time, examination tolerance, and incidence of adverse reactions.

RESULTS

The two groups showed no significant difference in general data (all P>0.05). The DBE group showed a higher disease diagnostic rate than the CE group (P<0.05). Significantly higher rates of suspected intestinal bleeding were observed in the DBE group than those of the CE group (P<0.05), but no significant differences were found in the diagnosis of unexplained abdominal pain, abdominal distension, and others (all P>0.05). The DBE group required a longer examination time, and had a higher incidence of adverse reactions, and a lower examination tolerance than the CE group (P<0.05).

CONCLUSION

Both DBE and CE are effective in small bowel diseases diagnoses, but DBE demonstrated greater potential in diagnosing small bowel bleeding.

Evidences supporting the vascular etiology of post-double balloon enteroscopy pancreatitis: Study in porcine model

Double balloon enteroscopy (DBE) is an endoscopic technique broadly used to diagnose and treat small bowel diseases. Among the associated complications of the oral DBE, post-procedure pancreatitis has taken the most attention due to its gravity and the thought that it might be associated to the technique itself and anatomical features of the pancreas. However, as the etiology has not been clarified yet, this paper aims to review the published literature and adds new results from a porcine animal model. Biochemical markers, histological sections and the vascular perfusion of the pancreas were monitored in the pig during DBE practice. A reduced perfusion of the pancreas and bowel, the presence of defined hypoxic areas and disseminated necrotic zones were found in the pancreatic tissue of pigs. All these evidences contribute to support a vascular distress as the most likely etiology of the post-DBE pancreatitis.