Study On The Value Of ERCP For Diagnosis And Treatment Of Obstructivs Jaundice

Background Obstructive jaundice is a common form symptoms,which is a commonmanifestations of many diseases. The cause of obstructive jaundice also is a complex diseasebecause of it’s diversified diagnosis and treatment. Since the 1960s , The technology of ERCP isgradually used in clinical, with the continuous improvement of technology and accumulationof experience，ERCP become one of the indispensable means of diagnosis and treatment ofbiliary and pancreatic diseases.Objective Explore the value of ERCP in diagnosis and treatment of obstructive jaundice.Methods Retrospective analyze the clinical data of 172 inpatients with obstructive jaundicetreated in the Beijing Military General Hospital, Department of Gastroenterology from January2009 to January 2011.Results 172 patients underwent ERCP examination, of which 161 cases with intubation, thesuccess rate of intubation was 93.6% (161/172).In 172 patients, 142 cases underwent ultrasoundexamination, 155 cases abdominal CT, 31 MRCP examination, 161 patients underwent ERCPexamination.The accuracy of the four methods was 61.2% (87/142), 80.6% (125/155), 90.3%(28/31), 94.5% (152/161) respectively. Pairwise comparison studies have shown that Correct ratein descending order of ERCP, MRCP, CT, ultrasound, the lowest rates of diagnosis wasultrasound, there were significant differences compared with the other three kinds .The correctrate of ERCP is better than MRCP, but both statistically no significant difference (P> 0.05).In161 cases with successful intubation, patients with different indications underwent differentendoscopic treatments, of which 105 cases enderwent EST，113 cases ENBD , 25 casesERBD, 26 cases EMBD，4 cases PTCD joint with ERCP docking drainage. Analyze thebiochemical changes before treatment, 7days and 14 days after treatment with self-control , thedifference was statistically significant(P <0.01).43 patients with suspected malignant biliary stricture in the 161 cases with ERCPexamination were checked by Biliary cells brushing biopsy.The results suggested that: Biliarycells brushing biopsy had statistically significant differences between the benign and malignantbiliary stenosis (χ2= 9.68, p <0.05), but the sensitivity only was 33.33% in tumor diagnosis .172 patients in 56 cases of tumor markers CA19-9 increased the malignant group of 13cases, 43 cases of benign group. Prompt increases in benign and malignant obstructive jaundicewith significant differences in non-parametric Wilcoxon rank sum test (U = 2.775, P = 0.006), astatistically significant difference. Conclusion ERCP has the incomparable advantage compared with other imagingmethods in the diagnosis of obstructive jaundice；ERCP technology is minimally invasive, safeand effective，has become the first choice to deal with obstructive jaundice. Although thesensitivity of endoscopic biliary brushing biopsy is lower, affected by the level of handler ,therewas great significance in distinguishing benign and malignant obstructive jaundice, which needslarge sample studies to confirm; Tumor markers CA19-9 was significantly increased inmalignant obstructive jaundice, Prompt of significance in the differential diagnosis of benign andmalignant obstructive jaundice, But the diagnosis needs to combined with other inspectiontechniques.