BACKGROUND AND AIMS:Post-ERCP pneumobilia is not uncommon; however, studies focusing on the long-term prognosis of patients with post-ERCP pneumobilia are limited. This study aimed to explore long-term prognosis and risk factors associated with post-ERCP pneumobilia in patients with common bile duct stones (CBDSs). METHODS:We conducted a retrospective analysis of 1380 patients who underwent ERCP for CBDSs at our hospital from January 2010 to December 2017. Patients were selected based on inclusion and exclusion criteria and divided into pneumobilia and nonpneumobilia groups, followed by propensity score matching. The matched groups were then compared in terms of incidence rates of both single and multiple recurrences of CBDSs, acute cholangitis, and acute cholecystitis. Multivariate logistic regression analysis was used to explore risk factors associated with pneumobilia. RESULTS:After propensity matching, there was no significant difference in the rate of single recurrence of CBDSs (22.5% vs 30%; P = .446) between the pneumobilia and nonpneumobilia groups. However, the incidences of multiple recurrences of CBDSs (32.5% vs 12.5%; P = .032) and acute cholangitis without stone recurrence (32.5% vs 2.5%; P = <.001) were significantly higher in the pneumobilia group. Based on multivariate logistic regression analysis, in addition to a dilated CBD (diameter of >1 cm) (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.03-3.76; P = .043), endoscopic sphincterotomy with moderate incision (OR, 5.38; 95% CI, 1.14-25.47; P = .034) and with large incision (OR, 8.7; 95% CI, 1.83-41.46; P = .007) were identified as independent risk factors for pneumobilia after initial ERCP. CONCLUSIONS:Patients with post-ERCP pneumobilia have increased risk of multiple recurrences of CBDSs and acute cholangitis without stone recurrence. Independent risk factors for pneumobilia include peripapillary diverticulum, a dilated CBD (>1 cm), and endoscopic sphincterotomy with moderate and large incisions. A normal-sized CBD appears to serve as a secondary barrier against enterobiliary reflux, necessitating further research for confirmation.

Objective:Currently, endoscopic retrograde cholangiopancreatography(ERCP)is the main modality for the removal of common bile duct stones.During ERCP procedures, radiation damage to the patient from a single procedure, as well as cumulative radiation damage to the operator from multiple procedures, is a problem that can′t be ignored. The advent of cholangioscopy has allowed indirect images during the procedure to become direct images, which can substantially reduce the need for intraoperative fluoroscopy.In this study, we explored the feasibility and safety of extraction for small-caliber and sediment-like common bile duct stones under cholangioscopy.Methods:Eight patients diagnosed with CBDSs (stones≤1 cm in diameter, or sediment-like stones) without previous ERCP at PLA General Hospital First Medical Center, from July 2022 to September 2022, were included. The clinical characteristics and treatment outcomes of the 8 patients were prospectively collected and analyzed.Results:The extraction of CBDSs by basket catheter under cholangioscopy was achieved in four cases, and the remaining four cases received aspiration extraction. Technical success was achieved in all 8 cases in a single procedure and one patient developed postoperative pancreatitis.Conclusion:This study initially demonstrated the feasibility and safety of extraction for small-caliber and sediment-like common bile duct stones under direct view of the choledochoscope.

The portable disposable large-channel endoscope was developed in-house by our team. It ensures successful gastroscopic treatment with good image condition, water supply, air supply, suction and maneuverability. In addition, the risk of infection transmission from reusable gastroscopes could be avoided. In conclusion, portable disposable large-channel endoscope and the twin forceps clip are a good choice in emergency treatment and certain circumstances.

Objective:In this study, we compared the effectiveness and safety of the portable disposable large-channel endoscope and a conventional gastroscope in hemostasis and endoscopic submucosal dissection (ESD).Methods:Rabbits were treated with debridement and hemostasis after general anesthesia. After constructing the model of gastrorrhagia, the endoscopic surgeons randomly selected a gastroscope to debridement the bleeding site and spray hemostatic powder to achieve hemostasis. We will compare the overall operation time, the amount of hemostatic powder, the success rate of hemostasis and the times of plugging of the powder delivery tube between the two groups. Overall operation time, the amount of hemostatic powder, the success rate of hemostasis and the times of plugging of the powder delivery tube were compared between the 2 types of endoscopes. Bama pigs would receive ESD treatment after general anesthesia. The experiment was completed by experienced endoscopic physicians. Total duration of ESD, success rate of en bloc resection, perforation rate, device failure rate, satisfaction with the use of endoscope system and picture rating were compared between the 2 types of endoscopes.Result:Both groups successfully completed hemostasis. There was no difference between the dosage of hemostatic powder in the experimental group (2.54±0.97) g and that in the control group (2.25±0.79) g. The powder delivery tube in the control group was blocked once. In the overall operation time, the experimental group (86.62±13.68) s was significantly shorter than that in the control group (101.75±17.14) s, with P value=0.004. Both groups completed 16 ESDs. There were no significant differences between the total duration of ESD in the experimental group (19.22±9.50) min and that in the control group (17.72±5.15) min, with P value =0.985. There were no differences in success rate of en bloc resection and picture rating between the 2 types of gastroscopes. Neither of the gastroscopes caused perforation during ESD. There was no failure of the instruments in both groups. The satisfactions evaluation of two groups were basically satisfactory and above.Conclusion:The portable disposable large-channel digestive endoscope could perform gastroscopy and treatment effectively, which is of great significance in reducing infection and breaking the restriction of the use of endoscope.

Objective:This study aim to established an in-vivo porcine model for the training of super minimally invasive endoscopic dissection (ESTD).Methods:The trainees were trained for 3 months, and a total of 8 live pigs were operated. Super minimally invasive endoscopic submucosal dissection (ESD) and ESTD animal training models were established. The trainees studied the surgical theory, performed ESTD and ESD under the guidance of senior doctors. We recorded the overall operation time, tunnel length, wound area size, and operation speed (wound area/ time). A questionnaire was used to detect changes in competence before and after training. Data were analyzed using the SPSS.23 statistical software.Results:The ESD and ESTD surgical anatomy models showed no ununtreated intraoperative major bleeding and delayed postoperative bleeding during surgical training. Two cases of small esophageal perforation appeared in ESTD models, all were closed with soft tissue clips. None of the surgical models had delayed perforation. There ESD cases and one ESTD case were unfinished and senior doctors needed to take over, and no animal died.Conclusion:The in-vivo porcine model is effective and feasible for endoscopic tunneling and submucosal dissection surgery training, which is beneficial to improve the endoscopic learning curve of trainees.