Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most common and serious complications of ERCP, which has become a major concern for digestive endoscopists. In the present study, we examine whether pancreatic duct stenting can reduce the incidence of PEP. Forty patients who underwent an ERCP in our hospital were selected according to their risk factors for PEP. They were randomly divided into two groups: (1) 20 subjects received a pancreatic duct stenting after ERCP to prevent pancreatitis (stent group, S); and (2) the other 20 subjects did not receive pancreatic duct stenting after ERCP (non-stent group, NS). Urine and serum amylase, and serum lipase were determined after the operation; symptoms of abdominal pain were monitored; cost of hospitalization was evaluated for the comparison. The results show that (1) 18 cases developed PEP, and they were significantly less in S group than in NS group (4 vs. 14 cases; P < 0.01); (2) Serum amylase was significantly lower in S group than in NS group (197.8 ± 339.7 vs. 825.4 ± 1253.4 U/l, respectively; P < 0.05); (3) The intensity of abdominal pain was 3.4 ± 0.8 in S group, compared to 4.1 ± 1.2 in NS group; (4) Duration of pharmaceutical treatment was not significantly different between the two groups (4.2 ± 1.4 vs. 6.1 ± 2.3 days, in S and NS group, respectively); and (5) The total hospitalization cost was significantly less in S group (8928 ± 2635 RMB) than in NS group (11288 ± 4325 RMB; P < 0.05). It is concluded that pancreatic duct stenting can reduce the incidence of PEP, shorten the duration of hospitalization, and therefore, lessen patients' financial burden. It is shown to be an effective way to prevent PEP.
With the digestive endoscopic tunnel technique (DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria (MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal (GI) tract. At present, the tunnel technique application range covers the following: (1) Treatment of lesions originating from the mucosal layer, e.g ., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis; (2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc .; and (3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment. The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism, and significance of DETT, prevention of infection and concepts of DETT-associated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract (indications and contraindications, procedures, pre- and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).
Background Gastroesophageal varices is a serious complication of compensated advanced chronic liver disease (cACLD). Primary prophylaxis to reduce the risk of variceal hemorrhage is recommended if high-risk varices (HRV) are detected. We performed this study to compare the accuracy, patients’ satisfaction and safety of detection of HRV by detachable string magnetically controlled capsule endoscopy (DS-MCCE) with esophagogastroduodenoscopy (EGD) as the reference. Methods We prospectively recruited participants with cACLD from 12 university hospitals (11 in China and one in the United Kingdom) between November 2018 and December 2019 (ClinicalTrials.gov, NCT03749954). All participants underwent DS-MCCE, followed by EGD within a week in a blinded fashion. Following endoscopy, and on the same day, participants were asked to fill in a satisfaction questionnaire regarding their experience. Findings A total of 105 eligible participants were enrolled. With EGD as the reference standard, the concordance index, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of DS-MCCE in diagnosis of HRV were 0•90 (95% confidence interval [CI]: 0•83–0•95), 92% (95% CI: 78–98%), 88% (95% CI: 78–95%), 80% (95% CI: 70–92%), 95% (95% CI: 90–100%), 7•91 (95% CI: 4•10–15•30), and 0•09 (95% CI: 0•03–0•30), respectively. The kappa score of 0•78 (95% CI: 0•65–0•90) suggested substantial agreement between DS-MCCE and EGD. Moreover, in participants undergoing EGD without sedation, the satisfaction of DS-MCCE was significantly better than that of EGD ( p < 0•0001, d = 1•15 [95%CI: 0•88–1•42]). All participants confirmed the excretion of the capsule, and no adverse events occurred. Interpretation DS-MCCE is an accurate alternative to EGD for detecting HRV in cACLD, which is safe and associated with better satisfaction. Funding A full list of funding can be found in the Funding Support section.
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