The clinical analysis of endoscopic pancreaticobiliary separation in the treatment of occult pancreaticobiliary reflux

Objective: To investigate the aetiology of occult pancreaticobiliary reflux (OPBR) and the curative effect of EST in patients with cholecystolithiasis. Methods: The clinical data of 47 OPBR patients with cholecystolithiasis from October 2013 to October 2016 were analyzed retrospectively. Results: The average gallbladder bile amylase (GBA) of 47 patients was 864 ± 575 U/L. Forty patients underwent endoscopic retrograde cholangiopancreatography (ERCP), among which 26 patients were diagnosed with papillitis, 16 patients with peripapillary diverticulum, 14 patients with nipple overlength, five patients with nipple atrophy, three patients with ampullary calculi and two patients with papillary tumour. Thirty-three patients underwent endoscopic sphincterotomy (EST), after the operation, 16 patients reexamined GBA, in which 15 patients had normal GBA, and the difference of GBA was statistically significant (1161 ± 764 U/L vs 47 ± 17 U/L, t =5.641, P <0.05). After following up of 1 to 4 years, 27 patients without cholecystectomy who underwent EST had no recurrence of calculus, and in 9 patients who did not undergo EST, two patients had a recurrence of calculus. There was a significant difference in the recurrence rate of calculus ( χ 2 =21.340, P <0.05). Conclusion: Pancreaticobiliary junction disease is an essential cause of OPBR and cholecystolithiasis formation. EST can reduce the retention of pancreatic reflux juice both in gallbladder and bile duct and can reduce the recurrence rate of cholecystolithiasis after choledochoscopic lithotomy.