| Objective:This study aims to compare the efficacy and safety of short-type single-balloon enteroscopy assisted ERCP,PTCD combined with Spyglass and traditional ERCP in patients with biliary tract diseases after surgically altered gastrointestinal anatomy and in the diagnosis and treatment,and to analyze the potential factors of ERCP surgery failure.Methods:This is a retrospective study that collected a total of 77 patients with combined biliary tract system disease after gastrointestinal reconstruction at Shanxi Provincial People’s Hospital from January 2018 to February 2023.And a total of 98 procedures were performed,of which 27 were short-type single-balloon enteroscopy assisted ERCP(s-SBE-ERCP group),18 were PTCD combined with Spyglass(PTCD+Spyglass group)and 53 traditional ERCP(traditional ERCP group).The collected case datas mainly included patient’s name,gender,age,American Society of Anesthesiologists physical status(ASA-PS),reasons for previous operation,surgical methods,surgical indications,treatment methods,postoperative complications,whether the first time treatment,the emergency surgery,the presence of native papilla.This study also analyzed The success rate of their procedures,the incidence of adverse events and the potential factors affecting ERCP failure.This study was approved by the hospital ethics committee.Results:1.Baseline data comparison: there was no significant difference in name,gender,age,ASA-PS,reasons for previous operation,surgical methods,surgical indications,treatment methods,postoperative complications,whether the first time treatment,the emergency surgery,the presence of native papilla between the three groups.2.Comparison of surgical success rate: The enteroscopy success rates of traditional ERCP,PTCD combined with Spyglass and s-SBE-ERCP were 83.01%(44/53),96.30%(26/27)and 100%(18/18).The cannulation success rates were 88.64%(39/44),92.30%(24/26)and 100%(18/18).The therapeutic intervention success rates were 97.44%(38/39),95.83%(23/24)and 94.44%(17/18),and total procedural success rates were71.70%(38/53),85.19%(23/27)and 94.44%(17/18).There was a statistically significant difference between the PTCD+Spyglass group and the traditional ERCP group in terms of therapeutic intervention success rate and total procedural success rate(P< 0.05).And There was no statistically significant difference between the s-SBE-ERCP group and the other two groups in terms of procedural success rate(P > 0.05).3.Comparison of early postoperative complications: Postoperative complications:The incidence of adverse events was similar in the s-SBE-ERCP,PTCD combined with Spyglass and traditional ERCP groups,and no serious adverse events occurred.4.Analysis of potential influencing factors of ERCP surgery failure: logistic m ultivariate regression analysis showed that the first ERCP(OR=5.334,95%CI:1.059-26.878)and ASA-PS≥3(OR=0.286,95%CI:0.088-0.924)were potential factors affect ing procedural failure.Conclusion:1.Comparing with the traditional ERCP,short-type single-balloon enteroscopy assisted ERCP and PTCD combined with Spyglass could improve the total procedural success rates of diagnostic and therapeutic means for biliary tract system diseases after gastrointestinal reconstruction.2.There was no serious adverse events occurred in any of them,which has a certain degree of safety.3.s-SBE-ERCP or PTCD combined with Spyglass can significantly improve the cannulation success rate of surgery compared with traditional ERCP.There was no statistically significant difference in the enteroscopy success rate,treatment success rate and total procedure success rate between s-SBE-ERCP,PTCD combined with Spyglass and traditional ERCP.4.The first-time ERCP and ASA-PS≥3 were potential surgical failure factors affecting the diagnosis and treatment of ERCP after gastrointestinal reconstruction. |
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