Sphincter Of Oddi Research Articles

Current Gallstone Treatment Methods, State of the Art.

This study aims to provide valuable references for clinicians in selecting appropriate surgical methods for biliary tract stones based on patient conditions. In this paper, the advantages and disadvantages of various minimally invasive cholelithiasis surgical techniques are systematically summarized and innovative surgical approaches and intelligent stone removal technologies are introduced. The goal is to evaluate and predict future research priorities and development trends in the field of gallstone surgery. In recent years, the incidence of gallstone-related diseases, including cholecystolithiasis and choledocholithiasis, has significantly increased. This surge in cases has prompted the development of several innovative methods for gallstone extraction, with minimally invasive procedures gaining the most popularity. Among these techniques, PTCS, ERCP, and LCBDE have garnered considerable attention, leading to new surgical techniques; however, it must be acknowledged that each surgical method has its unique indications and potential complications. The primary challenge for clinicians is selecting a surgical approach that minimizes patient trauma while reducing the incidence of complications such as pancreatitis and gallbladder cancer and preventing the recurrence of gallstones. The integration of artificial intelligence with stone extraction surgeries offers new opportunities to address this issue. Regarding the need for preoperative preparation for PTCS surgery, we recommend a combined approach of PTBD and PTOBF. For ERCP-based stone extraction, we recommend a small incision of the Oddi sphincter followed by 30 s of balloon dilation as the optimal procedure. If conditions permit, a biliary stent can be placed post-extraction. For the surgical approach of LCBDE, we recommend the transduodenal (TD) approach. Artificial intelligence is involved throughout the entire process of gallstone detection, treatment, and prognosis, and more AI-integrated medical technologies are expected to be applied in the future.

A Grading System for Assessing the Status of the Sphincter of Oddi During Intraoperative Choledochoscopy: A Surgeon's Perspective.

The aim of this study was to establish a simple and practical grading system for evaluating the status of the sphincter of Oddi (SO) during intraoperative choledochoscopy. This system helps identify relevant variables that influence the status of the SO and provides recommendations for preventing stone recurrence. Ninety-three patients were selected retrospectively from a total of 316 patients diagnosed with choledocholithiasis between July 2020 and June 2023. All patients underwent common bile duct (CBD) exploration surgery and intraoperative choledochoscopy. The status of the SO was assessed during choledochoscopy. According to the severity of the condition, the patients were categorized into 4 groups. Data from each group, grades 1, 2, 3, 4, was analyzed statistically. The number of patients in grade 1 was significantly lower than that of the other 3 groups. Except for grade 1, patients in grade 4 exhibited significant differences compared with the other 2 groups in terms of the diameter of the CBD, size of stones, presence of pneumobilia, and history of endoscopic retrograde cholangiopancreatography (ERCP) ( P <0.05). There were no significant differences between the groups in terms of sex, age, liver function, number of stones, history of gastrectomy, cholecystectomy, or CBD exploration. The grading system helps us classify different sphincter functions and better understand the formation of choledocholithiasis by subdividing the status of the SO. Endoscopic sphincterotomy (EST) treatment can easily result in the loss of SO function, which increases the risk of stone recurrence.

Effect of endoscopic sphincterotomy and endoscopic papillary balloon dilation endoscopic retrograde cholangiopancreatographies on the sphincter of Oddi.

Endoscopic retrograde cholangiopancreatography (ERCP), with its clinical ad-vantages of less trauma and faster recovery, has become the primary treatment for choledocholithiasis. To investigate the effects of different ERCP procedures on the sphincter of Oddi. The clinical data of 91 patients who underwent ERCP at Yixing Hospital of Traditional Chinese Medicine between February 2018 and February 2021 were analyzed retrospectively. The patients were divided into endoscopic sphincterotomy (EST, n = 24) and endoscopic papillary balloon dilation (EPBD, n = 67) groups. The duration of operation, pancreatic development, pancreatic sphincterotomy, intubation difficulties, stone recurrence, and incidence of reflux cholangitis and cholecystitis were statistically analyzed in patients with a history of choledocholithiasis, pancreatitis, and Oddi sphincter dysfunction in the EST and EPBD groups. Differences in hypertension, diabetes, increased bilirubin, small diameter of the common bile duct, or ampullary diverticulum between the two groups were not significant. Statistically significant differences were observed between the two groups concerning sex and age (< 60 years). Patients with a history of choledocholithiasis, pancreatitis, and Oddi sphincter dysfunction were higher in the EST group than in the EPBD group. The number of cases of pancreatic development, pancreatic duct sphincterotomy, and difficult intubation were higher in the EST group than in the EPBD group. The number of Oddi's sphincter manometries, ERCP surgical outcomes, and guidewires entering the pancreatic duct several times in EST group were lower than those in the EPBD group. The numbers of stone recurrences, reflux cholangitis, and cholecystitis were higher in the EST group than in the EPBD group. In summary, common bile duct stones, pancreatitis history, and multiple guided wire introductions into the pancreatic duct are independent risk factors for EST and EPBD. Based on this evidence, this study can provide actionable insights for clinicians and researchers.

The analysis of medical prescriptions for patients with duodenal ulcer in hospital setting

The analysis of medical prescriptions for patients with duodenal ulcer in hospital setting

Spasmolytic Effect of Flopropione Does Not Involve Catechol-O- methyltransferase (COMT) Inhibition.

Flopropione (Flo) has been used for gallstone and urolithiasis as a spasmolytic agent almost exclusively in Japan. According to the package insert, its main mechanism is catechol-O-methyltransferase (COMT) inhibition and anti-serotonergic effect. This is obviously contrary to pharmacological common sense, but it is described that way in pharmacology textbooks and occurs in questions in the National Examination for Pharmacists in Japan. As this is a serious problem in education, we re-examined the action of Flo. The guinea pig ureter was hardly contracted by serotonin, but noradrenaline (NA) elicited repetitive twitch contraction, which was inhibited by Flo. The sphincter of Oddi (SO) exhibited a spontaneous repetitive twitch contraction, which was inhibited by NA and Flo. The inhibitory effect of NA was reversed by α- and β-blockers, whereas that of Flo was not. Entacapone, a representative COMT inhibitor, did not affect the movement of the ureter and the SO. Nifedipine suppressed carbachol-induced contraction of the taenia coli, spontaneous movement of the SO, and NA-induced contraction of the ureter to almost the same extent, whereas Flo did not inhibit the taenia coli, but inhibited the contraction of the SO and the ureter. The inhibitory pattern of Flo resembled that of the ryanodine receptor agonist 4-chloro-m-cresol and the inositol 1,4,5-trisphosphate (IP3) receptor antagonist 2-aminoethoxydiphenyl borate. It is concluded that COMT inhibition or serotonin inhibition is not involved in the spasmolytic action of Flo. Flo might act on ryanodine receptors and/or IP3 receptors, which are responsible for periodic Ca release from Ca stores, to disrupt coordinated Ca dynamics.

Pathogenesis of Functional Biliary Pain and Pharmacology of Trimebutin

Aim: to provide data on the pathogenesis of functional biliary pain and provide rationale for the use of trimebutine for this indication.Key points. Biliary pain is one of the most frequent reasons for patients to see a doctor. The diagnosis of functional disorder of the gallbladder and Oddi's sphincter is legitimate only after the exclusion of organic causes from both the gastrointestinal tract and other organs and systems. The initial appeal to surgeons with a complaint of pain in the epigastrium or right hypochondrium may lead to unjustified surgical intervention that does not bring relief to the patient's suffering. The consequences of cholecystectomy also have an anatomical and physiological justification for the occurrence or preservation of biliary pain. Currently, two main hypotheses are being considered to explain its cause: increased intraluminal pressure due to morphological and functional obstacles to bile outflow and visceral hypersensitivity. In the multilevel system of regulation of the gallbladder and sphincter apparatus, the opioid system occupies a special place. The agonist of peripheral receptors of the enkephalinergic system, trimebutine, in clinical studies led to the relief of biliary pain in more than 80 % of patients with functional biliary disorders, while a significant decrease in the severity of diarrhea, dyspeptic, and constipation syndromes was revealed.Conclusion. The prescription of the peripheral receptor agonist of the enkephalinergic system, trimebutine, is pathogenetically justified for functional biliary pain.

Sphincter of Oddi Dysfunction Induces Gallstone by Inhibiting the Expression of ABCB11 via PKC-α.

The abnormal increase of Oddi sphincter pressure and total bile duct pressure may play an important role in the formation of cholesterol stones, but the specific molecular mechanism is still unclear. This study aims to investigate it through in vitro and in vivo experiments. A mouse model of Oddi sphincter dysfunction was constructed by stone-inducing diet. We compared the two groups with PKC-α inhibitor GÖ6976 and PKC-α agonist thymeleatoxin. Oddi sphincter pressure and total bile duct pressure were measured. Biochemical analysis of total cholesterol, bile acid and bilirubin was then conducted. The histopathologic changes of bile duct were observed by HE staining and the ultrastructure of liver cells and surrounding tissues was observed by transmission electron microscopy. Through the above experiments, we found that the change of PKC-α expression may affect the formation process of gallstones. The relationship between PKC-α and ABCB11 was further verified by in vitro and in vivo experiments. Our results suggest that ABCB11 and PKC-α are co-expressed in the tubule membrane of hepatocytes and interact with each other in hepatocytes. The high cholesterol diet further enhances the activation of PKC-α and thus reduces the expression of ABCB11. The formation of cholesterol stones is associated with the down-regulation of ABCB11 expression in the tubule membrane of hepatocytes due to kinase signaling. This is the first study to demonstrate that sphincter of Oddi dysfunction induces gallstones through PKC-α inhibition of ABCB11 expression.

OGBN P25 A systematic review and clinical evaluation of Morphine Versus pethidine as a good drug choice to control for biliary colic before and after cholecystectomy

Abstract Background The most commonly recommended pharmaceuticals for biliary and pancreatic pain are arguably morphine and pethidine, both of which can elicit varying effects at the gallbladder, common bile duct, and sphincter of Oddi levels. Morphine stimulates Oddi's sphincter motility, causing upper abdominal pain and biliary distress symptoms in certain patients. Pethidine is thought to have less consequences on the sphincter of Oddi than morphine. This analysis aims to evaluate the comparative outcomes and effect of morphine versus pethidine on the sphincter of Oddi and biliary colic control. Methods A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library and Science Direct. Comparative studies comparing effect of morphine versus pethidine on sphincter of Oddi pressure were included. Revman 5.4 (Cochrane, London, United Kingdom) was used for the data analysis. Results The results show four studies were eligible to be included in this review with a total number of 151 patients divided between morphine group (n=111) and pethidine group (n=40). Two prospective studies and two clinical trials were included in this review. The rate of sphincter of Oddi pressure was significantly higher in morphine group compared to pethidine group: odds ratio (OR)=1.39, and (OR) =7.82, p=0.005, respectively. Conclusions The analysis shows significant difference in sphincter of Oddi pressure when morphine used as analgesic drug to control the biliary colic compared to pethidine which seems to provide low pressure at the level of sphincter of Oddi and good control of biliary colic than morphine, however more studies and clinical trials are needed.

Possibilities of modern pharmacotherapy in patients with dysfunction of the sphincter of Oddi

Pain in the right hypochondrium is one of the most frequent complaints in patients with diseases of the biliary system. According to statistics, every tenth person experiences unpleasant sensations in the upper right abdomen after drinking alcohol, fatty, fried or salty food, as well as after psychoemotional and physical exertion. The most common of the pathologies of the biliary system is the sphincter of Oddi dysfunction (SOD). SOD is a clinical syndrome caused by a functional disorder of sphincter of Oddi (SO), which leads to the development of abdominal pain syndrome, increased activity of liver and / or pancreatic enzymes, dilatation of the common bile duct and the main pancreatic duct. One of the methods of treatment of SOD is drug therapy, accompanied by the following groups of drugs: antispasmodics, nitrates, choleretics, antidepressants, etc. At the same time, many medications show low efficacy against SOD, or cause pronounced side effects. At present, for the treatment of sphincter of Oddi dysfunction, the domestic drug from the group of myotropic antispasmodics, hymecromon, Holicron, has the optimal characteristics in terms of price-quality ratio in the Russian pharmacological market. The drug has a selective antispasmodic effect on SO, and also has a choleretic effect. Mechanism of antispasmodic action is an increase in the concentration of nitric oxide (II) and cyclic mononucleotides, which through a cascade of biochemical reactions leads to a decrease in the number of calcium ions in the cell and a decrease in the tone of smooth myocytes of SO and gallbladder. The drug is absorbed into the blood in a small amount, which excludes its systemic effect and determines the selectivity of the effect on the biliary system. According to the results of clinical testing and consideration of a specific clinical case, it can be concluded that the use of hymecromone (Holicron) reduces the severity of pain syndrome and reduces dyspepsia syndrome, good tolerability and absence of side effects that would require withdrawal of the drug are also recorded.

Meta-analysis on clinical outcomes of suprapapillary versus transpapillary stent insertion in malignant biliary obstruction.

Endoscopic biliary stenting is an essential treatment for malignant biliary obstruction (MBO). However, the optimal location for the placement of metal stents (MS) or plastic stents (PS) during the management of MBO, whether above (suprapapillary) or across (transpapillary) the sphincter of Oddi (SO), has not been thoroughly evaluated. This meta-analysis aims to compare the clinical outcomes associated with endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary stents placed above and across the SO in patients with MBO. A comprehensive search of electronic databases was carried out to identify studies published from inception to April 2022. The clinical outcomes examined including stent patency, stent occlusion, and overall adverse events (AEs) such as cholangitis, post-ERCP pancreatitis (PEP), cholecystitis, stent migration, and bleeding. The selection of a random-effects model or fixed-effects model was based on the presence of heterogeneity. A total of 12 articles involving 751 patients were analyzed. The findings showed that the suprapapillary approach had longer stent patency compared to the transpapillary approach (mean difference: 38.58; 95% confidence interval 16.02-61.14, P < 0.0001). Additionally, the suprapapillary approach was associated with a lower risk of stent occlusion and overall AEs (P = 0.04, P = 0.002, respectively), particularly in the incidence of PEP (P = 0.009). The incidence of cholangitis, cholecystitis, stent migration, and bleeding were similar between the suprapapillary and transpapillary approaches. The subgroup analyses indicated that suprapillary PS had a significant decrease in the incidence of stent occlusion and longer stent patency, while suprapillary MS had a significant decrease in the incidence of overall AEs and PEP than the transpapillary approach. Compared with the transpapillary approach, the suprapapillary stent had superiority in longer stent patency, lower rates of stent occlusion and overall AEs, and notably, a lower incidence of PEP. The incidence of cholangitis, cholecystitis, stent migration, and bleeding were similar between the suprapapillary and transpapillary approaches. Further large-scale randomized controlled studies are needed to confirm our findings. CRD42022336435.

Endoclip papillaplasty (ECPP) versus limited EST plus EPLBD for a decrease in recurrent choledocholithiasis: a prospective cohort study.

Limited EST plus EPLBD has been widely used for the therapy of large CBDS; however, long-term complication-relevant studies suggested that it damaged the function of the sphincter of Oddi (SO) and resulted in recurrent choledocholithiasis. Thus, we designed Endoclip papillaplasty (ECPP) and previous studies have shown that it successfully restored the function of SO. In this study, we designed a prospective cohort and aimed to verify the safety and effectiveness of ECPP. Eligible patients were divided into the ECPP group and the limited EST plus EPLBD group based on papillary morphology and the ratio of maximum size of stones to length of intramural segments of CBD. All participants in the ECPP group received endoscopy at 3weeks to retrieve the biliary stent, perform SOM, and were divided into grade A and grade B based on the healing grade of SO. All patients were followed up every 6months until recurrent choledocholithiasis, patient death, or at the 36-month follow-up end. The primary outcome was the incidence of recurrent choledocholithiasis. The secondary outcomes included mechanical lithotrip usage and adverse events. The incidences of recurrent choledocholithiasis in the ECPP group and limited EST plus EPLBD group were 13.6 and 22.1%, respectively (P = 0.204). The ECPP-A group had a lower incidence of recurrent choledocholithiasis than the limited EST plus EPLBD groups (5.1 vs. 22.1%, P = 0.020*), and certified the function of SO successfully restored in the ECPP-A group. The ECPP-A group had a decrease in recurrent choledocholithiasis, and ECPP was safe and effective for CBDS.

Addiction and the Risk of Common Bile Duct Stones: A 4-Year Retrospective Population-Based Study in Mashhad, Iran.

As a common digestive disorder, choledocholithiasis can have serious consequences, including death. Given that opioids have been shown to contribute to the spasm of Oddi's sphincter, which results in biliary stasis in the common bile duct (CBD), it is likely that opioids can also raise the prevalence of choledocholithiasis. In this regard, this study aimed to investigate how common opium addiction was among choledocholithiasis patients in Mashhad, Iran. The current retrospective observational study was conducted on 599 patients with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP), utilizing information gathered at the Ghaem hospital in Mashhad, Iran, between 2011 and 2015. Patient data were collected from files and records using certain criteria such as gender, opium addiction, hepatic enzymes (AST, ALT, ALP), plasma levels of total bilirubin, and direct bilirubin. The size of the CBD stones as well as the correlation between the gallbladder and CBD stones were calculated. From among 599 patients included, 345 (57.6%) were female and 254 (42.4%) were male. Moreover, 195 patients (32.2%) had opiate addictions. The size of the CBD stone was correlated with the patient's age (r=0.17, P=0.001). The average stone measured 12.22±3.32 mm. There were notable differences in the mean size of the CBD stone (P<0.001) between addicted and non-addicted cases; specifically, the mean CBD stone size in addicted cases was 12.715.13 mm while it was 12.34.33 mm in non-addicted cases. This study showed patients with CBD stones have a higher rate of opium addiction compared to the general population, indicating a possible link between the two conditions.

Short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy in the treatment of gallbladder cancer and its effects on median survival time and postoperative complications.

To explore the short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy (CJ) in the treatment of gallbladder cancer (GC) and its effects on the median survival time and postoperative complications. The clinical data of 121 patients who underwent laparoscopic cholecystectomy (LC) in department of hepatobiliary surgery of the hospital from January 2018 to December 2018 were retrospectively analyzed. According to the adjuvant treatment methods, the patients were divided into 2 groups: the control group (n = 61, LC + bile duct T-tube drainage) and experimental group (n = 60, LC + CJ). The perioperative indicators, short-term efficacy, median survival time, postoperative complications and immune stress response were compared between the 2 groups of patients before and after propensity score matching. The surgical time, postoperative anal first exhaust time, and intraoperative blood loss in the experimental group were no different from those in the control group (P > .05), but the hospital stay was shorter than that in the control group (P < .05). There was no difference in the effective rate of treatment and median survival time between the 2 groups (P > .05). The total incidence rate of complications in the experimental group at 14 days after surgery was lower than that in the control group (P < .05). Day 3 after surgery, the levels of immunoglobulin M (IgM) and immunoglobulin G (IgG) of the experimental group were higher than those of the control group (P < .05), while the level of C-reactive protein (CRP) was lower than that of the control group (P < .05). Compared with bile duct T-tube drainage, LC + CJ in the treatment of GC can better shorten the postoperative hospital stay and reduce the postoperative complications and immune stress response, but and the median survival time of the 2 is similar, which can be promoted in clinical practice.

Постхолецистектомічний синдром: новий погляд на давню проблему та можливості патогенетичної терапії

In the article, from the modern standpoint, the pathogenetic and clinical characteristics of PCS as a dysfunction of the sphincter of Oddi are given, the mechanisms for the development of this pathology, the principles of therapy with the inclusion of the drug Rowachol, containing six plant monoterpenes, are disclosed. The materials of our own observations of the treatment of patients with Oddi sphincter dysfunction after laparoscopic cholecystectomy by Rowachol are presented. Anti-inflammatory, litholytic, hypocholesterolemic and pleiotropic effects of Rowachol have been proved. Rowachol should be positioned as a pathogenetic natural remedy for treatment of Oddi sphincter dysfunction and biliary sludge in patients undergoing cholecystectomy for cholelithiasis.

Hepatolithiasis Classification Based on Anatomical Hepatectomy

BackgroundThis study aims to propose a novel classification system to standardize the treatment of hepatolithiasis. MethodsA hepatolithiasis classification named LHO was proposed to represent the distribution of stones in the segmental bile ducts and the hepatic atrophy associated with the stones (L), the existence of stones or strictures in the hilar bile duct (H), and dysfunction of the Oddi sphincter (O), which can be used to formulate ideal surgical protocols. One hundred and forty-seven primary hepatolithiasis patients treated between 2013 and 2018 were classified into different types and divided into two groups. If the patient’s actual surgical procedure matched the ideal surgical protocol, the patients were included in the matching group; otherwise, patients were included in the nonmatching group. The rates of residual stones, recurrence, and a good quality of life (QOL) were analyzed among the patients in the matching and nonmatching groups and previous reports. ResultsAccording to the classification of each patient, 77.6% of the patients were included in the matching group, and 22.4% were included in the nonmatching group. The rates of residual stones, recurrence, and a good QOL were significantly better in the matching group than in the nonmatching group (9.6% vs. 27.3%; 8.0% vs. 35.0%; 89.5% vs. 65.4%); the rates of residual stones and a good QOL were also better than those in previous reports (9.6% vs. 19.1%; 89.5% vs. 61.6%). ConclusionsThe LHO classification can comprehensively reflect the key points of treatment, which is beneficial for formulating effective and standardized surgical plans of hepatolithiasis.

Effects of turmeric powder on intestinal and biliary functions: The influence of curcuminoids concentration on spontaneous contractility

• Curcuminoid content of two Curcuma longa L. food powders was determined by HPLC. • Different curcuminoid content reduced spontaneous contractility. • The amount of curcuminoids may be relevant for the formulation of functional foods. Two turmeric food powders (C1 and C 2) were studied for curcuminoid content and their effects on the guinea pig intestinal tract in vitro. C1 contained a higher curcuminoid content than C2 (5.22% vs 2.31%). C1 and C2 increased gallbladder (∼10%) and biliary smooth muscle tone (∼15%), without affecting the sphincter of Oddi smooth muscle contractility. C2 was more effective than C1 in lowering ileum tone (–22% vs −37%), whereas the reverse occurred in the colon (-50% vs −20%). Standard Fast Fourier transforms and absolute powers analysis of the frequency bands highlighted that, in the bile duct, C2 induced contractions of higher variability and ampler oscillations of low-frequency waves. At the Oddi sphincter, C1 had a biphasic effect, increasing and then drastically decreasing the oscillations. The same occurred with C2 in the ileum, while both samples reduced the fluctuations in the colon.

α-Subunit Tyrosine Phosphorylation Is Required for Activation of the Large Conductance Ca2+-Activated Potassium Channel in the Rabbit Sphincter of Oddi

Large conductance Ca2+-activated potassium (BKCa) channels are regulated by intracellular free Ca2+ concentrations ([Ca2+]i) and channel protein phosphorylation. In hypercholesterolemia (HC), motility impairment of the sphincter of Oddi (SO) is associated with abnormal [Ca2+]i accumulation in smooth muscle cells of the rabbit SO (RSOSMCs), which is closely related to BKCa channel activity. However, the underlying mechanisms regulating channel activity remain unclear. In this study, an HC rabbit model was generated and used to investigate BKCa channel activity of RSOSMCs via SO muscle tone measurement invitro and manometry invivo, electrophysiological recording, intracellular calcium measurement, and Western blot analyses. BKCa channel activity was decreased, which correlated with [Ca2+]i overload and reduced tyrosine phosphorylation of the BKCa α-subunit in the HC group. The abnormal [Ca2+]i accumulation and decreased BKCa channel activity were partially restored by Na3VO4 pretreatment but worsened by genistein in RSOSMCs in the HC group. This study suggests that α-subunit tyrosine phosphorylation is required for [Ca2+]i to activate BKCa channels, and there is a negative feedback between the BKCa channel and the L-type voltage-dependent Ca2+ channel that regulates [Ca2+]i. This study provides direct evidence that tyrosine phosphorylation of BKCa α-subunits is required for [Ca2+]i to activate BKCa channels in RSOSMCs, which may be the underlying physiological and pathologic mechanism regulating the activity of BKCa channels in SO cells.

Opportunities of using oral intraluminal laser lithotripsy for a large calculus of the common bile duct (clinical report)

There is a clinical report of successful oral intraluminal laser lithotripsy with subsequent lithoextraction of a large concretion of the common bile duct in a patient with choledocholithiasis and mechanical jaundice. For the intraluminar lithotripsy a tulium laser "Urolaz" was used with energy modes 0,025-0,05-0,1 J, up to a maximum of 0.5 J. The average power is 6-10 W. Laser exposure was carried out by pulses in an aqueous medium in order to prevent carbonation of the light guide and smoke. The effect of exposure to the concretion was manifested in its fragmentation and the formation of small particles without damage of the mucous membrane of the common bile duct. The total duration of the intervention was 45 minutes. The method is effective and safe, thus it avoids the need of endoscopic papillosphincterotomy and violation of the anatomical integrity and physiological function of the Oddi sphincter.

Long-term outcomes of surgical approaches for bilateral hepatolithiasis: A real-world six-decade experience at a single center.

Bilateral hepatolithiasis is an intractable disease and repeated attacks of acute cholangitis seriously threaten patient health. The surgical approaches evolve along with gradually greater understanding of its pathophysiology. This is a retrospective cohort study for bilateral hepatolithiasis from January 1958 to December 2018. Before May 1993 (Group A, n=70), three surgical approaches were adopted: 37 patients with common bile duct exploration (CBDE), 29 with choledochoenterostomy (CE) and four with partial hepatectomy (PH). After June 1993 (Group B, n=150), 101 patients underwent Oddi sphincter-preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS), and 16 with CBDE, 21 with CE, 12 with PH. The perioperative and long-term outcomes were compared. After 1993, the cholangitis recurrence rate significantly decreased from 49.2% to 20.9%, and the stone recurrence rate from 76.3% to 37.1% (both P < .001). Also, the stone-/cholangitis-free durations were prolonged significantly (median: 50.8 vs 26.4/49.6 vs 16.2 months, both P < .001). Preoperative cholangitis was an independent risk factor for stone recurrence (hazard ratio [HR]=1.863, P=.018), and residual stone for cholangitis recurrence (HR=2.838, P < .001). OSPCHS and PH were protective surgical approaches for recurrent stone (CBDE: reference; OSPCHS: HR=.469, P=.016, PH: HR=.219, P=.018) and cholangitis (CBDE: reference; OSPCHS: HR=.421, P=.010, PH: HR=.283, P=.093). For bilateral hepatolithiasis, the management should focus on hepatobiliary lesion eradication and Oddi sphincter function preservation.

Gastroesophageal reflux disease combined with Oddi sphincter dysfunction: control of health-related quality of life in patients

Background. Due to the need to assess the impact of comorbid pathology (GERD and Oddi sphincter dysfunction), it is not possible to use such well-known specific questionnaires as the GERD Health-Related Quality of Life Questionnaire, the Quality of Life in Reflux and Dyspepsia and others. The purpose: to study Health-Related Quality of Life (HRQoL) before and after treatment in patients with GERD, combined with dysfunction of the sphincter of Oddi, using Short Form Health Status Survey (SF-36) and the self-developed specific questionnaire. Materials and methods. 30 patients with comorbid diseases GERD and Oddi’s sphincter dysfunction were studied. SF-36 and the self-developed specific questionnaire were used. Results. The specific questionnaire for patients with gastoesophageal reflux disease combined with Sphincter of Oddi dysfunction was worked out. The evaluation of the questionnaire (patients comprehensiveness of questions, timesuming etc.) was explored. Using SF-36, it was significant improvement of HRQoL for all scales after treatment compared with initial data: physical functioning (PF, (77,1±2,0) versus (71,4±2,2)), role-physical functioning (RP, (52,1±5,0) versus (30,6±2,4)), bodily pain (BP, (65,8±1,2) versus (48,7±2,1)), social functioning (SF, (69,5±2,0) versus (50,8±2,1)), mental health (MH, (68,5±2,1) versus (49,8±1,8)), role emotional (RE, (65,2±4,7) versus (35,8±3,7)), vitality (VT, (63,3±2,1) versus (43,2±2,2)), general health (GH, (58,1±2,4) versus (46,1±1,7) points). All patients had decreased HRQoL due to comorbid GERD and sphincter dysfunction Oddi. Moderate or significant disorders of activity and rhythm of life due to these diseases was revealed, but after treatment there was an improvement in significant HRQoL in all patients, in addition to psycho-emotional perception of their diseases became more positive. Conclusions. All patients had decreased HRQoL due to comorbid GERD and sphincter dysfunction Oddi, and it improved after treatment in most of patients.