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Nishiwaki R, Imoto I, Oka S, Yasuma T, Fujimoto H, D'Alessandro-Gabazza CN, Toda M, Kobayashi T, Osamu H, Fujibe K, Nishikawa K, Hamaguchi T, Sugimasa N, Noji M, Ito Y, Takeuchi K, Cann I, Inoue Y, Kato T, Gabazza EC. Elevated plasma and bile levels of corisin, a microbiota-derived proapoptotic peptide, in patients with severe acute cholangitis. Gut Pathog 2023; 15:59. [PMID: 38037145 PMCID: PMC10688013 DOI: 10.1186/s13099-023-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Acute cholangitis is a severe, life-threatening infection of the biliary system that requires early diagnosis and treatment. The Tokyo Guidelines recommend a combination of clinical, laboratory, and imaging findings for diagnosis and severity assessment, but there are still challenges in identifying severe cases that need immediate intervention. The microbiota and its derived products have been implicated in the pathogenesis of acute cholangitis. Corisin is a microbiome-derived peptide that induces cell apoptosis, acute tissue injury, and inflammation. This study aimed to evaluate the potential of plasma and bile corisin as a biomarker of acute cholangitis. METHODS Forty patients with acute cholangitis associated with choledocholithiasis or malignant disease were enrolled. Nine patients without acute cholangitis were used as controls. Corisin was measured by enzyme immunoassays in plasma and bile samples. Patients were classified into severe and non-severe groups. The associations of plasma and bile corisin with the clinical grade of acute cholangitis and other parameters were analyzed by univariate and multivariate regression analysis. RESULTS Plasma and bile corisin levels were significantly higher in patients with acute cholangitis than in controls. Patients with severe acute cholangitis had significantly higher plasma and bile corisin levels than those with non-severe form of the disease. Bile corisin level was significantly correlated with markers of inflammation, coagulation, fibrinolysis, and renal function. Univariate analysis revealed a significant association of bile corisin but a weak association of plasma corisin with the clinical grade of acute cholangitis. In contrast, multivariate analysis showed a significant relationship between plasma corisin level and the disease clinical grade. The receiver operating characteristic curve analysis showed low sensitivity but high specificity for plasma and bile corisin to detect the severity of acute cholangitis. The plasma and bile corisin sensitivity was increased when serum C-reactive protein level was included in the receiver operating characteristic curve analysis. CONCLUSIONS Overall, these findings suggest that plasma and bile corisin levels may be useful biomarkers for diagnosing and monitoring acute cholangitis and that corisin may play a role in the pathophysiology of the disease by modulating inflammatory, coagulation and renal pathways.
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Affiliation(s)
- Ryo Nishiwaki
- Digestive Endoscopy Center, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Ichiro Imoto
- Digestive Endoscopy Center, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Satoko Oka
- Department of Internal Medicine, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Taro Yasuma
- Microbiome Research Center, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Hajime Fujimoto
- Microbiome Research Center, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
- Department of Pulmonary and Critical Care Medicine, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Corina N D'Alessandro-Gabazza
- Carl R. Woese Institute for Genomic Biology (Microbiome Metabolic Engineering), University of IL at Urbana-Champaign, Urbana, IL, USA
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Masaaki Toda
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Tetsu Kobayashi
- Microbiome Research Center, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
- Department of Pulmonary and Critical Care Medicine, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Hataji Osamu
- Respiratory Center, Matsusaka Municipal Hospital, Tonomachi1550, Matsusaka, Mie, 515-8544, Japan
| | - Kodai Fujibe
- Department of Gastroenterology, Matsusaka Municipal Hospital, Tonomachi1550, Matsusaka, Mie, 515-8544, Japan
| | - Kenichiro Nishikawa
- Department of Gastroenterology, Matsusaka Municipal Hospital, Tonomachi1550, Matsusaka, Mie, 515-8544, Japan
| | - Tetsuya Hamaguchi
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Natsuko Sugimasa
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Midori Noji
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Yoshiyuki Ito
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Kenji Takeuchi
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Isaac Cann
- Carl R. Woese Institute for Genomic Biology (Microbiome Metabolic Engineering), University of IL at Urbana-Champaign, Urbana, IL, USA
- Department of Microbiology, The University of IL at Urbana-Champaign, Urbana, IL, USA
- Department of Animal Science, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| | - Yasuhiro Inoue
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Toshio Kato
- Department of Surgery, Doshinkai Tohyama Hospital, Minamishinmachi 17-22, Tsu, Mie, 514-0043, Japan
| | - Esteban C Gabazza
- Microbiome Research Center, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan.
- Carl R. Woese Institute for Genomic Biology (Microbiome Metabolic Engineering), University of IL at Urbana-Champaign, Urbana, IL, USA.
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507, Japan.
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Khan H, Irfan MS, Ullah G, Afnan M, Younas R. Successful Management of Recurrent Cholangitis Post Cholecystectomy in a Primary Care Hospital. Cureus 2023; 15:e46450. [PMID: 37927630 PMCID: PMC10623185 DOI: 10.7759/cureus.46450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/07/2023] Open
Abstract
Cholangitis, a pathological disease characterized by inflammation of the biliary system, often occurs in conjunction with gallstone blockage and may lead to various problems, persisting for extended periods after cholecystectomy. The present report provides a comprehensive account of a clinical case involving a 35-year-old female patient who had undergone cholecystectomy three years before and is now experiencing symptoms consistent with cholangitis. The individual was originally given conservative therapy, which included the administration of intravenous ceftriaxone antibiotics, analgesics, fluids, and gastrointestinal treatment. Subsequently, they were sent to a tertiary care hospital for the performance of endoscopic retrograde cholangiopancreatography (ERCP) and the placement of a stent. Following a period of seven days, laboratory tests showed a return to normalcy, showing a positive outcome in response to the use of conservative management strategies. The patient made the decision to have an elective laparoscopic cholecystectomy, resulting in a favorable recuperation and a hospitalization period of 24 hours. The aforementioned results jointly demonstrate the efficacy of conservative therapy in treating cholangitis and the potential for eventual elective surgery in individuals experiencing prolonged gallbladder problems. In conclusion, this case underscores the need to maintain a state of alertness with respect to complications associated with cholecystectomy, such as cholangitis. It also emphasizes the effectiveness of conservative treatment approaches and the probable necessity for elective surgical intervention.
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Affiliation(s)
- Haris Khan
- Medicine, Rehman Medical College, Peshawar, PAK
| | | | - Gulfan Ullah
- Botany, Kohat University of Science and Technology, Kohat, PAK
| | - Muhammad Afnan
- Cardiovascular Medicine, Khyber Medical University Institute of Medical Sciences, Kohat, PAK
| | - Rabia Younas
- General Surgery, Tehsil Headquarters (THQ) Hospital Mian Channu, Mian Channu, PAK
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3
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Lyu Y, Ye S, Wang B. Early is Not Superior to Late Endoscopic Intervention for Acute Cholangitis. Surg Innov 2023:15533506231162995. [PMID: 36898980 DOI: 10.1177/15533506231162995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND Acute cholangitis (AC) is a common emergency with a significant mortality risk. This study aimed to compare urgent, early, and late endoscopic retrograde cholangiopancreatography (ERCP) for AC. METHOD We retrospectively evaluated patients diagnosed with AC from June 2016 to May 2021. According to the time of ERCP, patients were divided into urgent (≤24 h), early (24-48 h), and late (≥48 h) groups. Primary outcomes were technical success, in-hospital mortality, and 30-day mortality. Secondary outcomes were the length of hospital stay (LOS), ERCP-related adverse events, and 30-day readmission. RESULTS We divided 121 patients who underwent ERCP into urgent (N = 15), early (N = 19), and late groups (N = 87). There was no in-hospital mortality and no significant difference in technical success (93.3% (urgent) vs 89.5% (early) vs 96.6% (late); P = .41) and 30-day mortality (P = .82). LOS in the urgent and early groups was shorter than that in the late group (13.93 days vs 8.82 days vs 14.20 days, respectively; P = .02). There was no difference between groups for ERCP-related adverse events and 30-day readmission rates. CONCLUSIONS Urgent or early ERCP was not superior to late ERCP for technical success and 30-day mortality. However, urgent or early ERCP was associated with shorter LOS than late ERCP.
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Affiliation(s)
- Yunxiao Lyu
- Department of Hepatobiliary Surgery, Wenzhou Medical University Affiliated Dongyang Hospital, 117858Dongyang People's Hospital, Dongyang, P.R. China
| | - Shenjian Ye
- Department of Hepatobiliary Surgery, Wenzhou Medical University Affiliated Dongyang Hospital, 117858Dongyang People's Hospital, Dongyang, P.R. China
| | - Bin Wang
- Department of Hepatobiliary Surgery, Wenzhou Medical University Affiliated Dongyang Hospital, 117858Dongyang People's Hospital, Dongyang, P.R. China
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Yang Y, Zhang XX, Zhao L, Wang J, Guo WL. Development of a simplified model and nomogram in preoperative diagnosis of pediatric chronic cholangitis with pancreaticobiliary maljunction using clinical variables and MRI radiomics. Insights Imaging 2023; 14:41. [PMID: 36882647 PMCID: PMC9992494 DOI: 10.1186/s13244-023-01383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/04/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE The aim of this study was to develop a model that combines clinically relevant features with radiomics signature based on magnetic-resonance imaging (MRI) for diagnosis of chronic cholangitis in pancreaticobiliary maljunction (PBM) children. METHODS A total of 144 subjects from two institutions confirmed PBM were included in this study. Clinical characteristics and MRI features were evaluated to build a clinical model. Radiomics features were extracted from the region of interest manually delineated on T2-weighted imaging. A radiomics signature was developed by the selected radiomics features using the least absolute shrinkage and selection operator and then a radiomics score (Rad-score) was calculated. We constructed a combined model incorporating clinical factors and Rad-score by multivariate logistic regression analysis. The combined model was visualized as a radiomics nomogram to achieve model visualization and provide clinical utility. Receiver operating curve analysis and decision curve analysis (DCA) were used to evaluate the diagnostic performance. RESULTS Jaundice, protein plug, and ascites were selected as key clinical variables. Eight radiomics features were combined to construct the radiomics signature. The combined model showed superior predictive performance compared with the clinical model alone (AUC in the training cohort: 0.891 vs. 0.767, the validation cohort: 0.858 vs. 0.731), and the difference was significant (p = 0.002, 0.028) in the both cohorts. DCA confirmed the clinical utility of the radiomics nomogram. CONCLUSION The proposed model that combines key clinical variables and radiomics signature is helpful in the diagnosis of chronic cholangitis in PBM children.
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Affiliation(s)
- Yang Yang
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Xin-Xian Zhang
- Department of Radiology, Xuzhou Children's Hospital, Xuzhou, 221002, China
| | - Lian Zhao
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Jian Wang
- Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Wan-Liang Guo
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215025, China.
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Chen H, Wang B, Yang J, Wang C. IT COULD BE WORSE: A RARE CASE OF SPONTANEOUS CHOLEDOCHODUODENAL FISTULA WITH SUCCESSFUL DRAINAGE TO RELIEVE ACUTE SEVERE CHOLANGITIS. Gastroenterol Nurs 2023; 46:63-66. [PMID: 36706143 DOI: 10.1097/sga.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/08/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Hong Chen
- Hong Chen, MS, is from the Department of Clinical Pharmacy, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
- Biao Wang, MD, is from the Department of Endocrinology, Hospital of County Ningjin, Xingtai, Hebei, China
- Jie Yang, MD, is from the Outpatient Department, the Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of PLA, Beijing, China
- Chunhua Wang, MD, is from the Department of Gastroenterology, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
| | - Biao Wang
- Hong Chen, MS, is from the Department of Clinical Pharmacy, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
- Biao Wang, MD, is from the Department of Endocrinology, Hospital of County Ningjin, Xingtai, Hebei, China
- Jie Yang, MD, is from the Outpatient Department, the Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of PLA, Beijing, China
- Chunhua Wang, MD, is from the Department of Gastroenterology, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
| | - Jie Yang
- Hong Chen, MS, is from the Department of Clinical Pharmacy, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
- Biao Wang, MD, is from the Department of Endocrinology, Hospital of County Ningjin, Xingtai, Hebei, China
- Jie Yang, MD, is from the Outpatient Department, the Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of PLA, Beijing, China
- Chunhua Wang, MD, is from the Department of Gastroenterology, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
| | - Chunhua Wang
- Hong Chen, MS, is from the Department of Clinical Pharmacy, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
- Biao Wang, MD, is from the Department of Endocrinology, Hospital of County Ningjin, Xingtai, Hebei, China
- Jie Yang, MD, is from the Outpatient Department, the Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of PLA, Beijing, China
- Chunhua Wang, MD, is from the Department of Gastroenterology, the 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei, China
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6
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Guo WL, Geng AK, Geng C, Wang J, Dai YK. Combination of UNet++ and ResNeSt to classify chronic inflammation of the choledochal cystic wall in patients with pancreaticobiliary maljunction. Br J Radiol 2022; 95:20201189. [PMID: 35451311 PMCID: PMC10996311 DOI: 10.1259/bjr.20201189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/10/2022] [Accepted: 04/01/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to establish an automatic classification model for chronic inflammation of the choledoch wall using deep learning with CT images in patients with pancreaticobiliary maljunction (PBM). METHODS CT images were obtained from 76 PBM patients, including 61 cases assigned to the training set and 15 cases assigned to the testing set. The region of interest (ROI) containing the choledochal lesion was extracted and segmented using the UNet++ network. The degree of severity of inflammation in the choledochal wall was initially classified using the ResNeSt network. The final classification result was determined per decision rules. Grad-CAM was used to explain the association between the classification basis of the network and clinical diagnosis. RESULTS Segmentation of the lesion on the common bile duct wall was roughly obtained with the UNet++ segmentation model and the average value of Dice coefficient of the segmentation model in the testing set was 0.839 ± 0.150, which was verified through fivefold cross-validation. Inflammation was initially classified with ResNeSt18, which resulted in accuracy = 0.756, sensitivity = 0.611, specificity = 0.852, precision = 0.733, and area under curve (AUC) = 0.711. The final classification sensitivity was 0.8. Grad-CAM revealed similar distribution of inflammation of the choledochal wall and verified the inflammation classification. CONCLUSIONS By combining the UNet++ network and the ResNeSt network, we achieved automatic classification of chronic inflammation of the choledoch in PBM patients and verified the robustness through cross-validation performed five times. This study provided an important basis for classification of inflammation severity of the choledoch in PBM patients. ADVANCES IN KNOWLEDGE We combined the UNet++ network and the ResNeSt network to achieve automatic classification of chronic inflammation of the choledoch in PBM. These results provided an important basis for classification of choledochal inflammation in PBM and for surgical therapy.
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Affiliation(s)
- Wan-liang Guo
- Department of Radiology, Children’s Hospital of Soochow
University, Suzhou,
China
| | - An-kang Geng
- School of Biomedical Engineering (Suzhou), Division of Life
Sciences and Medicine, University of Science and Technology of China, 88
Keling Road, Suzhou,
China
- Suzhou Institute of Biomedical Engineering and Technology,
Chinese Academy of Sciences, 88 Keling Road,
Suzhou, China
| | - Chen Geng
- Suzhou Institute of Biomedical Engineering and Technology,
Chinese Academy of Sciences, 88 Keling Road,
Suzhou, China
| | - Jian Wang
- Pediatric Surgery, Children’s Hospital of Soochow
University, Suzhou,
China
| | - Ya-kang Dai
- Suzhou Institute of Biomedical Engineering and Technology,
Chinese Academy of Sciences, 88 Keling Road,
Suzhou, China
- Jinan Guoke Medical Engineering Technology Development Co.
LTD, Jinan,
China
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7
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Schepis T, Boškoski I, Tringali A, Bove V, Costamagna G. Palliation in Gallbladder Cancer: The Role of Gastrointestinal Endoscopy. Cancers (Basel) 2022; 14:1686. [PMID: 35406458 PMCID: PMC8997124 DOI: 10.3390/cancers14071686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/24/2022] Open
Abstract
Gallbladder cancer is a rare malignancy burdened by poor prognosis with an estimated 5-year survival of 5% to 13% due to late presentation, early infiltration of surrounding tissues, and lack of successful treatments. The only curative approach is surgery; however, more than 50% of cases are unresectable at the time of diagnosis. Endoscopy represents, together with surgery and chemotherapy, an available palliative option in advanced gallbladder cancers not eligible for curative treatments. Cholangitis, jaundice, gastric outlet obstruction, and pain are common complications of advanced gallbladder cancer that may need endoscopic management in order to improve the overall survival and the patients’ quality of life. Endoscopic biliary drainage is frequently performed to manage cholangitis and jaundice. ERCP is generally the preferred technique allowing the placement of a plastic stent or a self-expandable metal stent depending on the singular clinical case. EUS-guided biliary drainage is an available alternative for patients not amenable to ERCP drainage (e.g., altered anatomy). Gastric outlet obstruction is another rare complication of gallbladder malignancy growing in contact with the duodenal wall and causing its compression. Endoscopy is a less invasive alternative to surgery, offering different options such as an intraluminal self-expandable metal stent or EUS-guided gastroenteroanastomosis. Abdominal pain associated with cancer progression is generally managed with medical treatments; however, for incoercible pain, EUS-guided celiac plexus neurolysis has been described as an effective and safe treatment. Locoregional treatments, such as radiofrequency ablation (RFA), photodynamic therapy (PDT), and intraluminal brachytherapy (IBT), have been described in the control of disease progression; however, their role in daily clinical practice has not been established yet. The aim of this study is to perform a review of the literature in order to assess the role of endoscopy and the available techniques in the palliative therapy of advanced gallbladder malignancy.
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8
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Uğurlu ET, Kaya A. Management of our endoscopic retrograde cholangio pancreatography cases during the pandemic process. Int J Clin Pract 2021; 75:e14979. [PMID: 34633735 DOI: 10.1111/ijcp.14979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
AIM Endoscopic retrograde cholangio pancreatography (ERCP) is a technique in which endoscope and radiological imaging are used in combination in the diagnosis and treatment of diseases related to the pancreaticobiliary system. Our aim in this study is to discuss all aspects of approach strategies to ERCP patients whose operation is mandatory during the pandemic period, to draw the future perspective and to summarize the measures that the surgical team should take in terms of their own health and public health. MATERIALS AND METHODS During the pandemic period between 14 March and 31 December 2020, we accepted 270 patients to our ERCP unit. We made our analysis regarding the management of these cases under COVID-19 pandemic conditions. We presented our patients' form of application, application complaints, COVID- 19 contact stories, pre-procedure preparations, and our prevention methods to prevent COVID-19 transmission of the patient and healthcare team during the procedure, and post-procedure patient follow-up methods, and the management of our COVID-19-positive patients before the procedure. FINDINGS ERCP was applied to 270 patients. The COVID-19 test of 13 patients was positive before the procedure and they were taken to our COVID-19 isolated service. There was no problem in the anesthesia of patients who had positive COVID-19 PCR test and subsequently underwent ERCP. There was no difference in the discharge time after the ERCP procedure. CONCLUSION COVID-19 pandemic has significantly affected the management and safety of ERCP units. ERCP procedures should be performed by determining the urgency of patients so that their treatment needs are not delayed. Postponing cases without planning can develop an increased workload in centers offering ERCP, and this situation can lead to further delays or negative consequences.
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Affiliation(s)
- Esat Taylan Uğurlu
- General Surgery Clinic (Sağlık Bakanlığı Mehmet Akif İnan Eğitim Araştırma Hastanesi, Genel Cerrahi Kliniği), Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Ahmet Kaya
- Anesthesiology and Reanimation Clinic (Sağlık Bakanlığı Mehmet Akif İnan Eğitim Araştırma Hastanesi, Genel Cerrahi Kliniği), Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
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9
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Abstract
Gallbladder disorders encompass a wide breadth of diseases that vary in severity. We present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis-related disease, acute acalculous cholecystitis, functional gallbladder disorder, gallbladder polyps, gallbladder hydrops, porcelain gallbladder, and gallbladder cancer.
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10
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Muglia R, Lanza E, Poretti D, Colapietro F, Solbiati L, D'Antuono F, Gennaro N, Ceriani R, Pedicini V. Percutaneous transhepatic endoscopic lithotripsy of biliary stones with holmium laser for the treatment of recurrent cholangitis. Abdom Radiol (NY) 2020; 45:2561-2568. [PMID: 32367249 DOI: 10.1007/s00261-020-02554-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of percutaneous transhepatic endoscopic holmium laser biliary lithotripsy (PTBL) to treat recurrent cholangitis due to intra/extrahepatic stones, in patients not candidate for traditional endoscopic treatment. MATERIALS AND METHODS We retrospectively evaluated 28 patients (M:F = 19:9, mean age = 65 years, SD = 14) undergoing 43 PTBL for stone-related recurrent cholangitis from January 1, 2012 to January 31, 2019 in a single academic center. Data collected included demographics, location and number of stones, clinical success after one (primary) or more than one (secondary) PTBL, procedure time, duration of hospital stay, number of retreatments and post-procedural complications. Clinical success was defined as the resolution of cholangitis at 30-day follow-up. RESULTS PTBL were successful for 23/28 (82%) patients, 16 (57%) with one and 7 (88%) with repeat procedures. The remaining 5 (18%) patients were finally treated with surgery (3, 11%) or further antibiotics (2, 7%). PTBL were performed to treat intrahepatic stones (22 treatments, 51%), extrahepatic (14, 33%), and both intra/extrahepatic (7, 16%). One to three stones were found in 12/43 (28%) PTBL, more than three in 31/43 (72%). Single PTBL was performed in 20/28 (71%) patients, two in 3/28 (11%), three in 3/28 (11%), and four in 2/28 (7%). Median procedure duration was 115 (29-210, 95% CI 101-129) minutes; median hospital stay was 5.5 (2-42) days. The only major complication was the breakage of a guidewire tip, surgically retrieved; minor complications included one aspiration pneumonia and three instances of intrahepatic hemorrhage, treated conservatively. CONCLUSIONS PTBL was clinically successful in the 82% of patients not candidate for endoscopic treatment, with a low complication rate.
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Affiliation(s)
- Riccardo Muglia
- Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Ezio Lanza
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Dario Poretti
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesca Colapietro
- Training School in Internal Medicine, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Luigi Solbiati
- Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Felice D'Antuono
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicolò Gennaro
- Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Roberto Ceriani
- Department of Internal Medicine, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Vittorio Pedicini
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy
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Guo WL, Wang J. Preoperative one-stop magnetic resonance imaging evaluation of the pancreaticobiliary junction and hepatic arteries in children with pancreaticobiliary maljunction: a prospective cohort study. Surg Today 2020; 51:79-85. [PMID: 32656698 DOI: 10.1007/s00595-020-02077-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Pancreaticobiliary maljunction (PBM) is routinely assessed by intraoperative cholangiography (IOC), whereas accompanying abnormalities in the hepatic artery are assessed by preoperative contrast multi-slice computed tomography (MSCT). We evaluated the efficiency of performing one-stop preoperative magnetic resonance imaging (MRI) for delineating the anatomy of the pancreaticobiliary junction and the hepatic artery. METHODS The subjects of this prospective analysis were children who underwent Roux-en-Y surgery for PBM in our institution during a recent 3-year period. Preoperative one-stop MRI was conducted using 3.0-T MRI. The efficiency of one-stop MRI was compared with that of IOC for assessing the bile duct, and with contrast MSCT for assessing the blood vessels. RESULTS Sixty-five children underwent one-stop preoperative MRI, which had a 100% concordance rate, versus IOC for assessing the bile duct type. Protein plugs or cholelithiasis were identified by IOC in 8 children and by one-stop MRI in 45 children (P = 0.0233). Cholangitis was not identified by IOC in any children but it was identified by one-stop MRI in 29 children. MSCT was also performed in 46 children and revealed a variant hepatic artery in 9 and cholangitis in 21. One-stop MRI had a 100% concordance rate versus MSCT. CONCLUSION Preoperative one-stop MRI accurately delineates the bile duct anatomy as well as the hepatic artery, cholangitis, and protein plugs in children with PBM.
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Affiliation(s)
- Wan-Liang Guo
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Jian Wang
- Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215025, China.
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Ungur M, Babes PA, Maghiar A, Pop GM, Feder B. Diagnosis and Therapeutic Management in Postcholecistectomy Alithiasic Cholangitis. Maedica (Bucur) 2019; 14:247-253. [PMID: 31798740 DOI: 10.26574/maedica.2019.14.3.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction:The objective of the current retrospective study is to present the results of a personal research on the prevalence and treatment of alithiasic cholangitis in hospitalized patients. Material and methods:The research was based on the following criteria: case selection according to gender, age and diagnosis, anamnesis information, clinical, paraclinical, imagery and laboratory investigation methods, therapeutic approach. Results:Between 2016-2018, 109 cases had a discharge diagnosis of postcholecystectomy cholangitis following clinical and paraclinical examinations. In a large percentage, cholangitis was alithiasic, imagery assessments showing only a dilation of the intra- and/or extra-hepatic biliary ducts (81 cases, 91.01%). Conclusions:Alithiasic cholangitis has been the main biliary cause in the postcholecystectomy pathology in this reference study (91.01%). In hospitalized people with alithiasic cholangitis as main diagnosis, highlighted endoscopic retrograde cholangiopancreatography (ERCP) represented a modern therapeutic approach; this allows the improvement of sphincter Oddi functional disorders through sphincterotomy/sphincteroplasty (6.75%).
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Affiliation(s)
- Mariana Ungur
- Faculty of Medicine and Pharmacy, University of Oradea, Romania
| | | | - Adrian Maghiar
- Faculty of Medicine and Pharmacy, University of Oradea, Romania
| | | | - Bogdan Feder
- Faculty of Medicine and Pharmacy, University of Oradea, Romania
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Abstract
PURPOSE Endoscopy is playing an ever-increasing role in the management of acute biliopancreatic disorders. With the management paradigm shifting away from more invasive surgical approaches, surgeons need to be aware of the treatment options available to improve patient care. Our manuscript serves to improve surgeons' knowledge and understanding of these emerging treatment modalities to expand their algorithmic approach to biliopancreatic disorders. METHODS Specific acute biliopancreatic disorders were identified from the literature and personal practice to create a structured review of common problems experienced by a surgeon of the gastrointestinal tract. An exhaustive literature review was performed to identify and analyze endoscopic treatment modalities for these disorders. RESULTS Endoscopic therapies continue to expand rapidly with a robust supportive literature. Data on endoscopic treatment strategies for acute biliopancreatic disorders demonstrate valuable improvements in outcomes in a number of these disorders. DISCUSSION Acute biliopancreatic disorders represent one of the most challenging pathophysiologies that a surgeon of the gastrointestinal tract may face. This manuscript represents a review of available endoscopic instrumentation as well as the author's interpretation of the current literature regarding indications and outcomes of endoscopic management for acute biliopancreatic disorders. Although this article does not supplant formal training in therapeutic endoscopy, surgeons reading this article should understand the role endoscopy plays in the management of acute biliopancreatic disorders.
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Bilal M, Tayyem O, Saraireh H, Chowdhry M, Guturu P, Abougergi MS. Upper gastrointestinal hemorrhage is associated with poor outcomes among patients with acute cholangitis: a nationwide analysis. Eur J Gastroenterol Hepatol 2019; 31:586-92. [PMID: 30741727 DOI: 10.1097/MEG.0000000000001378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Acute cholangitis (AC) and upper gastrointestinal hemorrhage (UGIH) are common emergencies encountered by gastroenterologists. We aimed to evaluate the impact of UGIH on in-hospital mortality, morbidity and resource utilization among patients with AC. PATIENTS AND METHODS Adult admissions with a principal diagnosis of AC were selected from the National Inpatient Sample 2010-2014. The exposure of interest was significant UGIH (requiring red blood cell transfusion). The primary outcome was in-hospital mortality. Secondary outcomes were significant UGIH's incidence, morbidity (shock, prolonged mechanical ventilation and total parenteral nutrition), and resource utilization (length of hospital stay and total hospitalization charges and costs). Confounders were adjusted for using propensity matching and multivariate regression analysis. RESULTS A total of 50 375 admissions were included in the analysis, 747 of whom developed significant UGIH. After adjusting for confounders, the adjusted odds ratio (aOR) of in-hospital mortality for patients who developed UGIH was 7.1 (95% confidence interval: 2.1-23.9, P<0.01) compared with those who did not. Significant UGIH was associated with substantial increase in morbidity [shock: aOR: 4.1 (2.1-9.3), P<0.01, prolonged mechanical ventilation: aOR: 5.8 (2.2-12.4), P<0.01, total parenteral nutrition: aOR: 4.7 (1.9-10.7), P<0.01], and resource utilization [mean adjusted difference in: length of hospital stay: 7.01 (4.72-9.29), P<0.01 and total hospitalization charges: $81 818 ($58 109-$105 527), P<0.01 and costs: $25 230 ($17 805-$32 653), P<0.01]. Similar results were obtained using multivariate regression analysis. CONCLUSION Onset of significant UGIH among patients hospitalized with AC has a detrimental effect on in-hospital mortality, morbidity and resource utilization.
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Bar Yehuda S, Axlerod R, Toker O, Zigman N, Goren I, Mourad V, Lederman N, Cohen N, Matz E, Dushnitzky D, Gavish M, Borovsky N, Schwarts D, Dotan I, Turner D. The Association of Inflammatory Bowel Diseases with Autoimmune Disorders: A Report from the epi-IIRN. J Crohns Colitis 2019; 13:324-329. [PMID: 30304371 DOI: 10.1093/ecco-jcc/jjy166] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS There are conflicting data on the association between inflammatory bowel diseases [IBD] and autoimmunity disorders. The aim of this study was to explore this association including the effect of medications. METHODS We utilized health administrative data collected by three of the four health maintenance organizations [HMOs] in Israel, covering 52% of the country's population. We explored the prevalence of the following autoimmune disorders: insulin-dependent diabetes mellitus [IDDM], psoriasis, Sjögren syndrome, coeliac disease, systemic lupus erythematosus [SLE], primary sclerosis cholangitis [PSC] and autoimmune thyroiditis, among all IBD patients vs non-IBD controls. Case ascertainment was determined according to validated computerized algorithms. RESULTS In total, 12625 IBD patients were compared to 12625 controls. A total of 1395 [11.1%] IBD patients had at least one autoimmune disease compared with 740 [5.9%] of non-IBD controls (odds ratio [OR] = 1.99 [95% confidence interval 1.81-2.19]; p < 0.05); all autoimmune diseases, except for thyroiditis, were more prevalent among IBD patients. Adjusted for confounding variables, anti-tumour necrosis factor [anti-TNF] medications were associated with a higher prevalence of psoriasis (54 [5.7%] in IBD vs 177 [4.1%] in controls; OR = 1.50 [1.07-2.08]; p < 0.05) but lower prevalence of Sjögren (1 [0.1%] vs 39 [0.9%]; OR [95% CI] = 0.13 [0.02-0.94]; p < 0.05) and coeliac disease (11 [1.2%] vs 68 [1.6%]; OR [95% CI] = 0.51 [0.27-0.99]; p < 0.05). Thiopurines and 5-aminosalicylates were not associated with any autoimmune disorder. CONCLUSION IBD is associated with all autoimmune diseases explored here except for thyroiditis. Anti-TNF users have a higher prevalence of psoriasis, and lower prevalence of Sjögren and coeliac disease.
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Affiliation(s)
- Shahar Bar Yehuda
- The Juliet Keidan Institute of Paediatric Gastroenterology, Hepatology and Nutrition, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Israel
| | - Rachel Axlerod
- The Juliet Keidan Institute of Paediatric Gastroenterology, Hepatology and Nutrition, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Israel
| | - Ori Toker
- Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Israel
| | - Nir Zigman
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Iris Goren
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | | | | | | | - Eran Matz
- Leumit Health Services, Tel-Aviv, Israel
| | | | - Matan Gavish
- School of Computer Science and Engineering, The Hebrew University, Jerusalem, Israel
| | | | | | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Dan Turner
- The Juliet Keidan Institute of Paediatric Gastroenterology, Hepatology and Nutrition, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Israel
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Zhu H, Chai Y, Dong D, Zhang N, Liu W, Ma T, Wu R, Lv Y, Hu L. AICAR-Induced AMPK Activation Inhibits the Noncanonical NF-κB Pathway to Attenuate Liver Injury and Fibrosis in BDL Rats. Can J Gastroenterol Hepatol 2018; 2018:6181432. [PMID: 30662889 DOI: 10.1155/2018/6181432] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/17/2018] [Accepted: 11/29/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To evaluate the AMP-activated protein kinase- (AMPK-) mediated signaling and NF-κB-related inflammatory pathways that contribute to cholestatic diseases in the bile duct ligation (BDL) rat model of chronic cholestasis and verify the protective role of 5-Aminoimidazole-4-carboxamide1-β-D-ribofuranoside (AICAR) against hepatic injury and fibrosis triggered by cholestasis-related inflammation. METHODS Animals were randomly divided into three groups: sham-operated group, BDL group, and BDL+ AICAR group. Cholestatic liver injury was induced by common BDL. Two weeks later, rats in BDL+AICAR group started receiving AICAR treatment. Hepatic pathology was examined by haematoxylin and eosin (H&E) and sirius red staining and hydroxyproline assay was performed in evaluating the severity of hepatic cirrhosis. Real-time PCR and Western blot were performed for RNA gene expression of RNA and protein levels, respectively. RESULTS The BDL group showed liver injury as evidenced by histological changes and elevation in serum biochemicals, ductular reaction, fibrosis, and inflammation. The mRNA expression of canonical NF-κB inflammatory cytokines such as TNF-α, IL-1β, TGF-β, and the protein of noncanonical NF-κB, P100, and P52 was upregulated in the livers of BDL rats. The BDL rats with the administration of AICAR could induce AMPK activation inhibiting the noncanonical NF-κB pathway to attenuate liver injury and fibrosis in BDL rats. CONCLUSION The BDL model of hepatic cholestatic injury resulting in activation of Kupffer cells and recruitment of immune cells might initiate an inflammatory response through activation of the NF-κB pathway. The AMPK activator AICAR significantly alleviated BDL-induced inflammation in rats by mainly inhibiting the noncanonical NF-κB pathway and thus protecting against hepatic injury and fibrosis triggered by BDL.
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