ObjectiveTo evaluate the efficiency of the spot-welding electrocoagulation with needle-knife to prevent bleeding after endoscopic sphincterotomy (EST). MethodsThe clinical data of 187 patients underwent EST from August 2009 to October 2009 were retrospectively analyzed, study group （n=102) were treated with spotwelding electrocoagulation with needleknife and 110 000 noradrenaline washing, control group (n=85) were treated with 110 000 noradrenaline washing alone. The bleeding and complications after EST were observed. ResultsThe differences of gender, age, primary diseases, cormorbidities, nutritional status, and immune function were not significant between two groups (Pgt;0.05). The bleeding after EST happened 4 cases (4.70%) in the control group and none in the study group. The bleeding rate of the study group was significantly lower than that of the control group (Plt;0.05). The bleeding cases in the control group were controlled successfully by spotwelding electrocoagulation with needleknife under endoscopy. Cholangitis occurred in 5 cases altogether, 1 case in each group deteriorated promptly and died of multiple organ failure syndrome, another 3 cases, 2 in the study group, 1 in the control group, were cured by PTCD and antibiotics. Biliary tract hemorrhage occurred one case in each group, which one died in the study group. Pancreatitis occurred 1 case in the study group and 2 cases in the control group, all of which were salvaged by conservative therapy. The incidences of complications were not significantly different between two groups (Pgt;0.05). ConclusionsThe spotwelding electrocoagulation with needleknife can significantly reduce the bleeding rate after EST. It is an effective, safe, and easy technique, especially to rural areas.
Objective To investigate whether intraductal electrocautery incision （IEI） could decrease the recurrence of post-liver transplant anastomotic strictures （PTAS） after conventional endoscopic intervention of balloon dilatation （BD） and plastic stenting （PS）. Methods The clinical data of 27 patients with PTAS who were given endoscopic treatment of BD＋PS or IEI＋BD＋PS in our hospital from January 2007 to October 2011 were reviewed retrospectively. Results The treatment of BD＋PS was initially successful in 9 of 11 （81.8%） cases， but showed recurrence in 5 of 9 （55.6%）. The treatment of IEI＋BD＋PS was initially successful in 14 of 16 （87.5%） cases, and the recurrence was observed only in 3 of 14 （21.4%）. The total diameter of inserted plastic stents in IEI＋BD＋PS group was significantly greater than that in BD＋PS group 〔（12±3.2） Fr vs. （8±1.3） Fr，P=0.039〕. All recurrences were successfully retreated by IEI＋BD＋PS. Procedure-related complications included pancreatitis in 5 cases （18.5%）, cholangitis in 8 cases （29.6%）, bleeding after EST in 1 cases （3.7%）, which were all cured with medical treatment. No complications related to intraductal endocautery incision procedure such as bleeding and perforation were observed. Median follow-up after completion of endoscopic therapy was 22 months （range 1-49 months）. Conclusions Intraductal electrocautery incision is an effective and safe supplement to balloon dilatation and plastic stenting treatment of PTAS, which can decrease the recurrence of anastomotic strictures in conventional endoscopic intervention.