Clinical Study Of EUS+ERCP Combined Qingyi Decoction In The Treatment Of Acute Biliary Pancreatitis

Background and ObjectiveAcute biliary pancreatitis(ABP) is one of the most common surgical disease, and its major cause is bile duct calculi. With the development of society and the changing of eating habits of people, the incidence of ABP increased year by year. Therefore, how to effectively diagnose and treat ABP has become the focus of many studies in recent years.The common diagnostic methods for ABP include abdominal ultrasound, computed tomography(CT), magnetic resonance cholangiopancreatography(MRCP) and endoscopic retrograde cholangiopancreatography(ERCP). However, these diagnosis and treatment methods have some limitations, for example, abdominal ultrasound will be influenced by gastrointestinal gas, abdominal fat, and stone diameter.Endoscopicul trasonography(EUS) combined with ERCP has become an important diagnostic and therapeutic method for ABP patients in recent years. In addition, the level of plasma D-dimer is closely related to the severity of pancreatitis. EUS is a new technology developed in recent years and used to diagnosis bile duct. Some studies indicate that the diagnostic sensitivity of EUS for choledocholithiasis is 97%.Conservative therapy and open operation are traditional treatments for ABP patients.Conservative treatments cannot relieve bile duct obstruction and are easy to delay treatment; traditional surgery is traumatic for ABP patients and may increase the organ burden on patients, as well as accompanied by a high incidence of complications and mortality.Endoscopic therapy gradually expose the advantages in recent years.Endoscopic therapy is simple, minimally invasive, effective, and less complications. However, endoscopic treatment timing is still controversial, and it is now generally believed that endoscopic treatment should be completed within 72 h as soon as the ABP is diagnosed.Nowadays, the combination of traditional Chinese herbs and ABP traditional treatment scheme achieved good effect for ABP patients. Our hospital has used EUS + ERCP joint Qingyitang to treat ABP for years, and achieved good clinical results and social benefits.The main purpose of this study was to investigate the effect of EUS + ERCP joint Qingyitang in the diagnosis and treatment of ABP and to further clarify the timing of endoscopic treatment of ABP. MethodsWe prospectively studied 80 ABP patients from October 2013 to August 2014 in our hospital and All patients were given anti-infection, aprotinin, rehydration therapy, and received EUS and(or) ERCP treatment within 72 h after admission to our hospital. Whether to receive ERCP treatment is based on the results of EUS examination and the patient’s condition during the operation. Then we randomly divided these patients into two groups: endoscopic therapy + Qingyitang group(n=37) and endoscopic therapy group(n=38). Moreover, patients in endoscopic therapy + Qingyitang group were given oral and enema Qingyitang treatment. The relief time of abdominal pain, clinical efficacy, length of stay, hospital costs, recovery time of biochemical markers, changes in plasma concentrations of D-dimer, and the complication rate were monitored in the two groups. ResultsThere are no differences in gender, age, clinical performance after admission in the two groups(P > 0.05). Abdominal pain relief time, urine amylase/ALP/ALP/GGT recovery time, and hospital stays were significantly shorter in endoscopic therapy + Qingyitang group than in the control group, the difference between the two groups was statistically significant(P < 0.05). Hospital costs were lower in endoscopic therapy + Qingyitang group than in the control group, the difference between the two groups was statistically significant(P < 0.05). TBIL recovery time of patients in endoscopic therapy + Qingyitang group was not different significantly than those in the control group(P > 0.05). Plasma D-dimer levels in preoperative and postoperative day 1 showed no significant difference(P > 0.05), while plasma D-dimer levels in the fourth day and the seventh day after operation between the two groups were statistically significant(P < 0.05). The complication rates were not significantly different between the two groups(P > 0.05). The cure rate was significantly higher in endoscopic therapy + Qingyitang group, the difference was statistically significant(P <0.05), but there was no significant difference in efficiency between the two groups. Conclusion1. Qingyitang can decrease plasma D-dimer concentrations in patients with ABP and improve microcirculation, thus avoiding the aggravation of pancreatic injury.2. The therapeutic effect EUS + ERCP combined with Qingyitang is better than simple endoscopic therapy without Chinese herbal medicine in the treatment of acute biliary pancreatitis.