BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct (CBD) stones, which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography. AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy. METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large (> 1.2 cm) CBD stones. After occlusion cholangiography confirmed CBD stone clearance, peroral cholangioscopy (POC) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via POC were graded on a 5-point scale (score 1, worst; score 5, best). Scores were documented after only stone removal (control) and after irrigation with 50 mL and 100 mL saline, respectively. The stone composition was analyzed using infrared spectroscopy. RESULTS Between October 2018 and January 2020, 47 patients had CBD clearance scores of 2.4 ± 1.1 without saline irrigation, 3.5 ± 0.7 with 50 mL irrigation, and 4.6 ± 0.6 with 100 mL irrigation ( P < 0.001). Multivariate analysis showed that CBD diameter > 15 mm [odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.01-0.49; P = 0.007] and periampullary diverticula (PAD) (OR = 6.51, 95%CI: 1.08-39.21; P = 0.041) were independent risk factors for residual stones. Bilirubin pigment stones constituted the main residual stones found in patients with PAD ( P = 0.004). CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy, especially in patients with PAD and/or a dilated (> 15 mm) CBD. Pigment residual stones are soft and commonly found in patients with PAD. Additional saline irrigation may be required to remove retained stones.
High‐frequency electrosurgery has been widely applied in digestive endoscopy with constantly expanding indications. However, high‐frequency electrosurgery may cause possible complications such as hemorrhage or perforation during or after the procedure, of which endoscopists must be cautious. Digestive endoscopists must have a firm grasp of the principles of high‐frequency electrosurgery as well as its safety issues so as to improve the safety of its clinical application. To this end, experts in gastroenterology and hepatology, digestive endoscopy, surgery, nursing and other related fields were invited to draft a consensus on the clinical application of high‐frequency electrosurgery in digestive endoscopy based on relevant domestic and international literatures and their experiences.
The urgent demand to replace the rapidly declining conventional reserves is driving China's operators to accelerate the development of deepwater reservoirs. SHENHAI Project is the first deepwater project operated by CNOOC China Ltd., locates in water of 1220m to 1546m in South China Sea. Deepwater completions differentiate themselves not only by unique technical challenges, but also by their high cost, risk, and long project cycles. A sound project management process is essential to ensure flawless execution. By reviewing the key steps of the SHENHAI deepwater completion campaign, such as upper completion design, critical equipment selection, interface management, workshop preparation, and final project execution, lessons learnt, etc., this paper provides both a job cycle of completion design-to-execution and a methodology to manage a complex project by addressing the challenges inherent in the deepwater completion process. As a result, the well completion campaign was completed ahead of schedule. A total of 11 deepwater wet-tree wells were successfully delivered as designed including two dual-zone hydraulic controlled intelligent wells. The upper completion design has been proven to be safe and reliable with first applications of several critical upper completion tools in the region, such as Nitrogen-Charged Surface Controlled Sub-surface Safety valve (SCSSV), Hydrostatic-Setting production packer and quartz-based permanent downhole pressure gauge. This success demonstrates the completion design and practices are applicable for this deepwater project and can be extended to further offset deepwater projects in this area. This paper describes case details of successful upper completions of SHENHAI project aiming to provide information and experiences for engineers who may face the similar challenges.
An intelligent completion design was installed in two wells in China's L field deepwater project. Both wells have dual-zone stack-pack sand-control lower completions. To handle critical well control concerns and enable production from each zone, an innovative intermediate string was installed to temporarily isolate the reservoir in each zone. The key components of the intermediate string were two types of temporary well barrier valve. One in-line barrier valve isolated tubing flow, which produced the lower zone, and another annular barrier valve isolated the annulus flow from upper zone. Both valves were installed permanently by the intermediate string. Before the intermediate string was deployed, the lower completion was completed by a stack-pack sand-control method. The intermediate string used one long tail pipe with a seal assembly to snap into the lower completion to separate the flow from the two zones. Both barrier valves were in the closed position after installation of the intermediate string. A safe and isolated casing environment was established before the upper completion was run in hole. After the upper completion was done, the two barrier valves were opened by applied pressure at the surface. The well could be tested safely, and the entire completion process was accomplished. In 2021, the intelligent well intermediate string completions were installed successfully in two wells in the southern coastal area of China. The two types of barrier isolation valve were installed, and pressure tested successfully. To separate the flow from the two zones, the space out of the intermediate string tail pipe was achieved by successfully running a seal assembly into a polished bore pre-installed between the sand-control completions of the two zones. After the intermediate completion was done, the upper completion was deployed safely in an isolated casing environment. In both wells, the two types of isolation valve were successfully opened by applied surface pressure, which verified a high reliability of barrier valve design. No through-tubing intervention was used in this project to open the valves. After completion installation, the wells were brought into production testing. Each zone of each well was tested separately, and a significantly different pressure response was observed by the downhole gauge, which verified the intelligent well zonal isolation was successfully achieved by the installed intermediate string per plan. This innovative intelligent well intermediate string completion design and the two types of barrier valve design/features represent an industry innovation. The project required new techniques for installation design and execution. This practice will benefit upcoming deepwater well completion designs, especially for high-pressure and high-temperature gas field development projects, where a temporary well suspension or well control is critical and essential for the project success.
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