Determinants of long-term complications of endoscopic sphincterotomy are infections and high risk factors of bile duct and not sphincter of Oddi dysfunction

Yang, Jianfeng; Jin, Hangbin; Gu, Weigang; Xiao, Zhao; Zhang, Xiaofeng

doi:10.1097/meg.0000000000000295

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…EST had been reported as an effective method for CBD stone removal by several randomized controlled trials (RCTs) [4,5], and many clinical guidelines recommended EST as a standard therapy for CBD stone removal [6]. However, the procedurerelated complications are also very common, including acute pancreatitis, severe bleeding, dysfunction of the papillary muscle, and perforation [7]. Therefore, EPBD was introduced as an alternative method [8].…”

Section: Introductionmentioning

confidence: 99%

Sphincterotomy plus balloon dilation versus sphincterotomy alone for choledocholithiasis: a meta-analysis

et al. 2019

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Background Endoscopic sphincterotomy plus balloon dilation (ESBD) is considered to be a promising method for the removal of large common bile duct (CBD) stones. However, when compared with endoscopic sphincterotomy (EST) alone, the efficacy and safety of ESBD remain controversial. This meta-analysis aimed to compare the efficacy and safety of ESBD vs. EST for the removal of large CBD stones. Methods Electronic databases were searched up to 15 July 2018 for literature that compared ESBD with EST for the removal of CBD stones. Pooled odds ratios (ORs) of the stone clearance rate and the complication rate were used to compare the efficacy and safety of ESBD vs. EST. Results A total of 18 studies with 2789 patients were included. The results showed that the stone removal rate was much higher in the ESBD group than in the EST group, both across all endoscopic retrograde cholangiopancreatography (ERCP) sessions (OR 2.68, 95 % confidence interval [CI] 1.79 to 4.01) and during the first ERCP session (OR 2.07, 95 %CI 1.37 to 3.12). The ESBD group had fewer complications than EST alone (OR 0.63, 95 %CI 0.47 to 0.85). Moreover, the ESBD group needed less mechanical lithotripsy (OR 0.38, 95 %CI 0.24 to 0.61) and had a shorter procedure time (mean difference – 4.05, 95 %CI – 7.02 to – 1.09) than EST alone. Conclusion The efficacy and safety of ESBD were superior to those of EST for the removal of large CBD stones. Moreover, less mechanical lithotripsy and shorter procedure times were needed with ESBD to manage large stones.

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Section: Introductionmentioning

confidence: 99%

Sphincterotomy plus balloon dilation versus sphincterotomy alone for choledocholithiasis: a meta-analysis

et al. 2019

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“…Yuan et al [17] reported that the basal SO pressure values in two groups of Chinese patients with choledocholithiasis were 30.88 ± 16.11 and 27.80 ± 15.88 mmHg. In a study by Yang et al [18], values of basal SO pressure, amplitude, and frequency were not reported. Our data showed mean basal SO pressure higher than 40 mmHg and indicated possible roles of SO dysfunction in patients with CBD stones.…”

Section: Discussionmentioning

confidence: 99%

“…Our results showed the involvement of SO dysfunction in patients with CBD stones and demonstrated the feasibility of EST in ERCP. Yang et al [18] reported that, instead of weakened SO function after papillotomy [15], biliary infection was a main risk factor for long-term complications after EST.…”

Section: Discussionmentioning

confidence: 99%

Manometric Measurement of the Sphincter of Oddi in Patients with Common Bile Duct Stones: A Consecutive Study of the Han Population of China

Feng

Zhang

Jiao

et al. 2017

Gastroenterology Research and Practice

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Objective. Role of dysfunction of the sphincter of Oddi (SO) in choledocholithiasis is controversial. This study was to evaluate SO motor activity in patients with common bile duct (CBD) stones in the Han population of China. Patients and Methods. In this study, 76 patients with CBD stones were enrolled in a single tertiary endoscopy center. Data of SO motor activities was prospectively evaluated by endoscopic manometry. Mean basal SO pressure, amplitude, and frequency were collected and analyzed. Results. The mean basal SO pressure, amplitude, and frequency were 52.7 ± 40.0 (1.60–171.1) mmHg, 39.9 ± 19.7 (14.9–115.5) mmHg, and 5.7 ± 3.2 (1.3–13.8)/min, respectively. The basal SO pressure was higher in patients with CBD stones < 10 mm in diameter than that in those with CBD stones larger than 10 mm in diameter (60.7 ± 41.0 mmHg versus 36.8 ± 29.4 mmHg, P = 0.043). There was no significant difference in the basal SO pressure, amplitude, and frequency when compared with the CBD diameter, CBD stone number, prior cholecystectomy, periampullary diverticula, and symptoms. Levels of alanine aminotransferase, aspartate transaminase, γ-glutamyl transpeptidase, and alkaline phosphatase showed no significant difference in patients with normal or elevated basal SO pressure. Conclusion. These results identify that, in Chinese Han population, abnormalities of SO motor activity are associated with CBD stones.

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“…Sphincter of Oddi (SO) maintains the pressure gradient between the common bile duct (CBD) and the duodenal lumen, preventing duodenal fluid and bacterial reflux into the bile duct 7 . Yang et.al have demonstrated that after EST, SO contraction amplitude and frequency reduced markedly, and bacterial reflux into the bile duct played a role in the development of recurrent choledocholithiasis 8 . Recently, we have reported a novel method to close patulous papilla after EST: endoscopic endoclip papilloplasty (EEPP) 9 .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic endoclip papilloplasty preserves sphincter of oddi function

Wang

Chang

Zhang

et al. 2020

Eur J Clin Investigation

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Background Endoscopic sphincterotomy (EST) can destroy sphincter of Oddi (SO) structure and function. The purpose of this study was to assess the feasibility of endoscopic endoclip papilloplasty (EEPP) in restoring SO function after EST. Methods Seven 26‐week‐old domestic pigs were divided into control and EEPP groups. Necropsy and haematoxylin‐eosin staining plus anti‐α‐smooth muscle actin (α‐SMA) staining of papilla and sphincter of Oddi manometry (SOM) were conducted in animals at three independent time points. Results EST and EEPP were safely performed in all 7 pigs without serious adverse events. For primary outcome, compared to the controls, EEPP generated smaller dilation and less inflammation. Fibrous repair of the papilla was observed at 24 weeks after EEPP. For secondary outcome, in the control group, SO basal pressure (17.25 ± 18.14 to 5.50 ± 0.71 mmHg), SO contraction amplitude (46.00 ± 19.20 to 34.50 ± 48.79 mmHg), peak (4.50 ± 4.04 to 1.50 ± 2.12) and frequency (3.05 ± 3.29 to 1.41 ± 2.19/min) were reduced after EST. Further reductions to almost 0 of these SOM parameters were observed 3 weeks later, including common bile duct pressure and SO contraction period. In contrast, in the EEPP group, these manometric data were recovered to pre‐EST levels, including CBD pressure (11.5 ± 7.31 vs 11 ± 2.16 mmHg), SO pressure (17.50 ± 17.75 vs 18.20 ± 21.39 mmHg) and SO contraction amplitude (53.67 ± 21.54 vs 60.00 ± 36.08 mmHg). However, no significant differences were observed between control and EEPP groups by Student t test. Conclusions In this porcine study, EEPP accelerated and improved papillary healing after EST, further preserved SO function.

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Determinants of long-term complications of endoscopic sphincterotomy are infections and high risk factors of bile duct and not sphincter of Oddi dysfunction

Abstract: Weakened SO function is not a decisive factor for long-term complications of EST, which were mainly influenced by biliary tract infection and high risk factors of the biliary tract.

Cited by 5 publications

References 31 publications

Sphincterotomy plus balloon dilation versus sphincterotomy alone for choledocholithiasis: a meta-analysis

Sphincterotomy plus balloon dilation versus sphincterotomy alone for choledocholithiasis: a meta-analysis

Manometric Measurement of the Sphincter of Oddi in Patients with Common Bile Duct Stones: A Consecutive Study of the Han Population of China

Endoscopic endoclip papilloplasty preserves sphincter of oddi function

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