1
|
Wang DD, Wu S, Kong BB, Song LL. Hemophagocytic lymphohistiocytosis with jaundice as first manifestation: A case report. World J Clin Cases 2023; 11:8212-8218. [PMID: 38130789 PMCID: PMC10731184 DOI: 10.12998/wjcc.v11.i34.8212] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening condition. It is an immune-mediated disease that has a wide range of causes, elicits a hyperinflammatory response, and results in multiple organ damage. Clinical presentations vary, and in some cases, jaundice occurs as the first symptom. CASE SUMMARY We report the case of a 71-year-old female patient who presented with jaundice. She was admitted to our hospital because of the occurrence of "jaundice for half a month", and upon examination, obstructive jaundice with choledocholithiasis and gallstones was suggested. Cholecystectomy and choledocholithotomy were performed. However, the jaundice did not improve after surgery. We found splenomegaly, cytopenia, hypertriglyceridemia, hypofibrinogenemia, and elevated ferritin. Bone marrow biopsy revealed hemophagocytosis. Later, cardiac arrest occurred when she returned 3 wk after the surgery. We considered that HLH was triggered by septic shock. The patient's condition deteriorated rapidly, with multiple organ dysfunction and severe gastrointestinal bleeding. Corticosteroid therapy and symptomatic treatment failed to save her life. CONCLUSION Jaundice rarely presents as the first symptom in HLH patients. The HLH in this case was triggered by septic shock with jaundice as the first symptom. Clinicians should try hard to reduce missed diagnoses and misdiagnoses.
Collapse
Affiliation(s)
- Dan-Dan Wang
- Department of Emergency Medicine, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing 102218, China
| | - Sheng Wu
- Department of Emergency Medicine, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing 102218, China
| | - Bing-Bing Kong
- Department of Emergency Medicine, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing 102218, China
| | - Lin-Lin Song
- Department of Emergency Medicine, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing 102218, China
| |
Collapse
|
2
|
Shibuki T, Okumura K, Sekine M, Kobori I, Miyagaki A, Sasaki Y, Takano Y, Hashimoto Y. Covered self-expandable metallic stents versus plastic stents for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction. Clin Endosc 2023; 56:802-811. [PMID: 37032113 PMCID: PMC10665611 DOI: 10.5946/ce.2022.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND/AIMS Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan. METHODS Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than recurrent biliary obstruction and technical success rate of reintervention were evaluated. RESULTS PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than recurrent biliary obstruction between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309). CONCLUSION cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.
Collapse
Affiliation(s)
- Taro Shibuki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Kei Okumura
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Masanari Sekine
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Ikuhiro Kobori
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Aki Miyagaki
- Department of Gastroenterology, Toyooka Hospital, Hyogo, Japan
| | - Yoshihiro Sasaki
- Department of Gastroenterology, National Organization Disaster Medical Center, Tokyo, Japan
| | - Yuichi Takano
- Department of Gastroenterology, Fujigaoka Hospital, Showa University, Kanagawa, Japan
| | - Yusuke Hashimoto
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
- Division of Gastroenterology, Department of Internal Medicine, University of Florida, Jacksonville, FL, USA
| |
Collapse
|
3
|
Matsumoto K, Kato H, Morimoto K, Miyamoto K, Saragai Y, Kawamoto H, Okada H. Comparison of Bilateral and Trisegment Drainage in Patients with High-Grade Hilar Malignant Biliary Obstruction: A Multicenter Retrospective Study. Gut Liver 2023; 17:170-178. [PMID: 35851039 PMCID: PMC9840928 DOI: 10.5009/gnl220012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023] Open
Abstract
Background/Aims Bilateral endoscopic drainage with self-expanding metallic stent (SEMS) can be used to effectively manage hilar malignant biliary obstruction. However, the benefits of using a trisegment drainage method remain unknown. Methods This study retrospectively reviewed the data of 125 patients with Bismuth type IIIa or IV unresectable malignant strictures who underwent bilateral endoscopic drainage using SEMSs at four tertiary centers. The patients were divided into the bilateral and trisegment drainage groups for comparison. The primary endpoint was stent patency and the secondary endpoints were technical success, technical and clinical success of reintervention, and overall survival. Results The technical success rates of the bilateral and trisegment drainage groups were 95% (34/36) and 90% (80/89) (p=0.41), respectively, with median stent patency durations of 226 and 170 days (p=0.26), respectively. Although the technical success of reintervention was not significantly different between the two groups (p=0.51), the clinical success rate of reintrvention was significantly higher in the trisegment drainage group (73% [11/15] vs 96% [47/49], p=0.009). The median survival times were 324 and 323 days in the bilateral and trisegment drainage groups, respectively (p=0.72). Multivariate Cox hazards model revealed no stent patency-associated factor; however, chemotherapy was associated with longer survival. Conclusions Although no significant difference was noted with respect to stent patency, significantly higher clinical success rates were achieved with reintervention using the trisegment drainage method than using the bilateral drainage method alone.
Collapse
Affiliation(s)
- Kazuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan,Corresponding AuthorKazuyuki Matsumoto, ORCIDhttps://orcid.org/0000-0002-5102-7452, E-mail
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Kosaku Morimoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Kazuya Miyamoto
- Department of Gastroenterology, Tsuyama Central Hospital, Okayama, Japan
| | - Yosuke Saragai
- Department of Gastroenterology, Iwakuni Medical Center, Hiroshima, Japan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2, Kawasaki Medical School, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| |
Collapse
|
4
|
Houssni JEL, Cherraqi A, Chehrastane R, Jellal S, Hsain IH, Oukacem S, Adjou N, Saouab R, En nouali H, Fenni JEL. Lemmel syndrome: an unusual cause of biliary obstruction secondary to a duodenal juxta-ampullary diverticulum: a report of two cases. Radiol Case Rep 2023; 18:1147-1151. [PMID: 36660561 PMCID: PMC9842954 DOI: 10.1016/j.radcr.2022.11.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 01/12/2023] Open
Abstract
Lemmel's syndrome is a rare cause of obstructive jaundice caused by a periampullary duodenal diverticulum compressing the intrapancreatic common bile duct with resultant bile duct dilatation, patients with Lemmel's syndrome usually present with abdominal pain or jaundice. Cross-sectional imaging is beneficial in making the diagnosis noninvasively, thus eliminating other pathologies of the peri-ampullary region. Although rare, we recognize the importance of considering this syndrome to be able to make a diagnosis and offer timely treatment. We present 2 cases of Lemmel's syndrome whose diagnosis is retained based on a CT scan and magnetic resonance cholangiopancreatography.
Collapse
|
5
|
Okamoto T. Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer. World J Gastroenterol 2022; 28:985-1008. [PMID: 35431494 PMCID: PMC8968522 DOI: 10.3748/wjg.v28.i10.985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/03/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.
Collapse
Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke’s International Hospital, Chuo-ku 104-8560, Tokyo, Japan
| |
Collapse
|
6
|
Sakellariou S, Michaelides C, Voulgaris T, Vlachogiannakos J, Manesis E, Tiniakos DG, Delladetsima I. Keratin 7 expression in hepatic cholestatic diseases. Virchows Arch 2021; 479:815-824. [PMID: 34312700 PMCID: PMC8516784 DOI: 10.1007/s00428-021-03152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 11/21/2022]
Abstract
We evaluated keratin 7 (K7) hepatocellular expression in 92 patients with common types of acute and chronic cholestatic diseases caused by bile duct obstruction/destruction or parenchymal lesions [acute hepatitis (n=20), mixed/pure cholestasis (n=16), primary biliary cholangitis-PBC (n=35), primary sclerosing cholangitis-PSC (n=10), vanishing bile duct syndrome (n=3), complete large bile duct obstruction due to space-occupying lesions (n=8)]. K7 immunohistochemical hepatocellular expression and ductular reaction (DR) were semi-quantitatively assessed. Results were correlated with liver enzyme serum levels, cholestasis type, histological features, hepatocellular Ki67 labelling index (LI) and HepPar1 expression. Hepatocellular K7 expression was detected in 87% (81/92) cases and in all cholestatic disease types with lowest incidence in pure/mixed cholestasis and highest in incomplete bile duct obstruction (iBDO), reaching 100% in PSC. K7-positive hepatocytes had low Ki67 LI (0-5%) retaining HepPar1 expression, irrespective of disease type. PSC cases had high K7 hepatocellular expression even with intact bile ducts, a feature that may aid differential diagnosis of cholestatic syndromes. K7 hepatocellular expression significantly correlated with cholestasis type, bile duct loss and fibrosis stage. It was higher in milder acute cholestatic hepatitis showing inverse correlation with hepatocyte proliferation and serum transaminase levels. In iBDO, younger age independently correlated with high K7 expression, while serum GGT levels showed a nearly significant correlation. Correlation with DR findings implied that K7-positive hepatocytes may result through metaplasia. In conclusion, K7 hepatocellular expression is a sensitive though non-specific marker of cholestasis. It may represent a cytoprotective reaction of resting hepatocytes in cholestasis of longer duration especially in younger patients.
Collapse
Affiliation(s)
- S Sakellariou
- 1st Department of Pathology, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 75 Mikras Asias str, 11527, Athens, Greece
| | - C Michaelides
- 1st Department of Pathology, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 75 Mikras Asias str, 11527, Athens, Greece
| | - T Voulgaris
- Academic Department of Gastroenterology and Hepatology, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma str, 11527, Athens, Greece
| | - J Vlachogiannakos
- Academic Department of Gastroenterology and Hepatology, Laiko General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma str, 11527, Athens, Greece
| | - E Manesis
- Liver Unit, Euroclinic, 7-9 Athanasiadou str, 11521, Athens, Greece
| | - D G Tiniakos
- Department of Pathology, Aretaieion Hospital, National and Kapodistrian University of Athens, 76 Vasilissis Sofias Ave, 11528, Athens, Greece. .,Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
| | - I Delladetsima
- 1st Department of Pathology, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 75 Mikras Asias str, 11527, Athens, Greece
| |
Collapse
|
7
|
Lim H, Hwang S, Ko GY, Han H. Congenital web of the common bile duct combined with multiple intrahepatic duct stricture: a report of successful radiological intervention. Yeungnam Univ J Med 2021; 39:161-167. [PMID: 34233403 PMCID: PMC8913910 DOI: 10.12701/yujm.2021.01179] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/12/2021] [Indexed: 11/04/2022] Open
Abstract
Congenital web formations are extremely rare anomalies of the extrahepatic biliary tree. We herein report a case of common bile duct septum combined with multiple intrahepatic bile duct strictures in a 74-year-old female patient who was successfully treated with radiological intervention. The patient initially visited the hospital because of upper abdominal pain. Imaging studies revealed multifocal strictures with dilatation in both intra- and extrahepatic ducts; the final clinical diagnosis was congenital common bile duct web combined with multiple intrahepatic duct strictures. Surgical treatment was not indicated because multiple biliary strictures were untreatable, and the disease was clinically diagnosed as benign. The multiple strictures were extensively dilated twice through bilateral percutaneous transhepatic biliary drainage (PTBD) for 2 months. After 1 month of observation, PTBD catheters were successfully removed. The patient is doing well at 6 months after completion of the radiological intervention, with the maintenance of normal liver function. Congenital web of the bile duct is very rare, and its treatment may vary depending on the patterns of biliary stenosis. In cases where surgical intervention is not indicated for congenital web and its associated disease, radiological intervention with balloon dilatation can be a viable therapeutic option.
Collapse
Affiliation(s)
- Hanseul Lim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyejin Han
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Chung HY, Hsu CC, Hung YL, Chen HW, Wong MS, Fu CY, Tsai CY, Chen MY, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Alternative application of percutaneous cholecystostomy in patients with biliary obstruction. Abdom Radiol (NY) 2021; 46:2891-2899. [PMID: 33388808 DOI: 10.1007/s00261-020-02898-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/18/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Percutaneous cholecystostomy (PC) is an important modality for acute cholecystitis and has been applied for other clinical scenarios as well. In the present study, we aimed to investigate an alternative use of PC for obstructive jaundice. METHODS From January 2012 to December 2018, eligible subjects were selected from patients undergoing PC in our institute. The characteristics, spectrum of underlying disease, indication for PC performance, details of the procedure, and treatment effect were all investigated. RESULTS During the study period, 1364 patients underwent PC. Seventy patients fulfilled the defined inclusion criteria. While 47 patients were diagnosed with malignant biliary obstruction with or without cholangitis, 23 patients were diagnosed with nonmalignant biliary obstruction and acute cholangitis. There were 63 patients (90%) diagnosed with acute cholangitis. Pancreatic cancer (n = 24, 51%) and advanced malignancy (n = 28, 59%) were noted mostly in the group with malignant biliary obstruction. Treatment effects were proven by laboratory data, including the white blood cell count, C-reactive protein level, and hepatic function. CONCLUSION PC can temporize definitive therapies and serve as an alternative treatment for patients with nonmalignant conditions. For patients with advanced malignancy, PC can serve as a palliative procedure that has a high success rate and low complication rate and effectively relieves biliary obstruction.
Collapse
Affiliation(s)
- Hung-Yu Chung
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chih-Chieh Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Man Si Wong
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Ming-Yang Chen
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan.
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan.
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 333, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| |
Collapse
|
9
|
Chantarojanasiri T, Ratanachu-Ek T, Pausawasdi N. What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy. Clin Endosc 2021; 54:301-308. [PMID: 34082486 PMCID: PMC8182256 DOI: 10.5946/ce.2021.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/25/2021] [Indexed: 02/07/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.
Collapse
Affiliation(s)
| | | | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
10
|
Hyun JJ, Irani SS, Ross AS, Larsen MC, Gluck M, Kozarek RA. Incidence and Significance of Biliary Stricture in Chronic Pancreatitis Patients Undergoing Extracorporeal Shock Wave Lithotripsy for Obstructing Pancreatic Duct Stones. Gut Liver 2021; 15:128-134. [PMID: 32393009 PMCID: PMC7817933 DOI: 10.5009/gnl19380] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/04/2020] [Accepted: 01/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background/Aims This study assessed the significance of biliary stricture in symptomatic chronic pancreatitis patients requiring extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) to remove obstructing pancreatic calculi. Methods A total of 97 patients underwent ESWL followed by ERCP to remove pancreatic calculi between October 2014 and October 2017 at Virginia Mason Medical Center. Significant biliary stricture (SBS) was defined as a stricture with upstream dilation on computed tomography scan or magnetic resonance cholangiopancreatography scans accompanied by cholestasis and/or cholangitis. SBS was initially managed by either a plastic stent or fully covered self-expandable metallic stent (fcSEMS). If the stricture did not resolve, the stent was replaced with either multiple plastic stents or another fcSEMS. Data were collected by retrospectively reviewing the medical records. Results Biliary strictures were noted in approximately one-third of patients (34/97, 35%) undergoing ESWL for pancreatic calculi. Approximately one-third of the biliary strictures (11/34, 32%) were SBS. Pseudocysts were more frequently found in those with SBS (36% vs 8%, p=0.02), and all pseudocysts in the SBS group were located in the pancreatic head. The initial stricture resolution rates with fcSEMSs and plastic prostheses were 75% and 29%, respectively. The overall success rate for stricture resolution was 73% (8/11), and the recurrence rate after initial stricture resolution was 25% (2/8). Conclusions Although periductal fibrosis is the main mechanism underlying biliary stricture development in chronic pancreatitis, inflammation induced by obstructing pancreatic calculi, including pseudocysts, is an important contributing factor to SBS formation during the acute phase.
Collapse
Affiliation(s)
- Jong Jin Hyun
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.,Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Shayan S Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Andrew S Ross
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Michael C Larsen
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Michael Gluck
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| |
Collapse
|
11
|
Yamao K, Takenaka M, Ogura T, Hashimoto H, Matsumoto H, Yamamoto M, Ikeura T, Kurita A, Li ZL, Shiomi H, Chiba Y, Kudo M, Sanuki T. Utility and Safety of a Novel Fully Covered Metal Stent in Unresectable Distal Malignant Biliary Obstruction. Dig Dis Sci 2020; 65:3702-3709. [PMID: 32036515 DOI: 10.1007/s10620-020-06114-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 08/18/2019] [Accepted: 01/27/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Self-expandable metal stents (SEMSs) are widely used in patients with distal malignant biliary obstruction. A SEMS that can avoid occlusion as much as possible is desirable. AIMS The aim of this multicenter single-arm prospective study was to assess the clinical effectiveness and safety of a novel fully covered braided SEMS. METHODS We enrolled consecutive patients with distal malignant biliary obstruction between February 2016 and November 2017 at ten tertiary-care medical centers. RESULTS We included 79 patients with a median age of 76 years; 47 (59.5%) patients were men. The technical and clinical success rate was 98.7% and 93.6%, respectively. Recurrent biliary obstruction occurred in 14 patients (17.9%); stent ingrowth, overgrowth, migration, and other occurred in five (6.4%), four (5.1%), four (5.1%), and one (1.3%) patients, respectively. All reinterventions in patients with recurrent biliary obstruction were successful via the transpapillary approach. Adverse events occurred in 15 patients (19.2%); cholangitis, pancreatitis, and others occurred in ten (12.8%), three (3.8%), and two (2.6%) patients, respectively. The stent patency probability at 6 months was 48.5%. Median time to stent patency was 171 days, median time to recurrent biliary obstruction was 536 days, and median survival time was 195 days. CONCLUSIONS We confirmed the utility and safety of a novel fully covered braided SEMS with low axial force and high radial force in patients with malignance biliary obstruction. This novel SEMS is recommended in patients with distal malignant biliary obstruction.
Collapse
Affiliation(s)
- Kentaro Yamao
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takeshi Ogura
- The Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan
| | - Hiroaki Hashimoto
- Department of Gastroenterology, Bell Land General Hospital, Sakai, Osaka, 599-8247, Japan
| | - Hisakazu Matsumoto
- Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, 640-8558, Japan
| | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka, 560-8565, Japan
| | - Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, 573-1191, Japan
| | - Akira Kurita
- Digestive Disease Center, Kitano Hospital, Osaka, 530-8480, Japan
| | - Zhao Liang Li
- Department of Gastroenterology, Takarazuka City Hospital, Takarazuka, Osaka, 665-0827, Japan
| | - Hideyuki Shiomi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Tsuyoshi Sanuki
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, 675-1392, Japan
| |
Collapse
|
12
|
Corbi LE, Tannuri ACA, de Aro Braz MJ, Paes VR, Sbragia L, Figueira RL, da Costa KM, Coelho MCM, Gonçalves JO, Serafini S, Tannuri U. Does Biliodigestive Anastomosis Have Any Effect on the Reversal of Hepatopulmonary Syndrome in a Biliary Cirrhosis Experimental Model? Dig Dis Sci 2019; 64:3192-202. [PMID: 31076984 DOI: 10.1007/s10620-019-05658-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Biliary cirrhosis is associated with hepatopulmonary syndrome (HPS), which is related to increased posttransplant morbidity and mortality. AIMS This study aims to analyze the pathophysiology of biliary cirrhosis and the onset of HPS. METHODS Twenty-one-day-old Wistar rats were subjected to common bile duct ligation and were allocated to two groups: group A (killed 2, 3, 4, 5, or 6 weeks after biliary obstruction) and group B (subjected to biliodigestive anastomosis 2, 3, 4, 5, or 6 weeks after the first procedure and killed 3 weeks later). At the killing, arterial blood was collected for the analyses, and samples from the liver and lungs were collected for histologic and molecular analyses. The gasometric parameters as well as the expression levels of ET-1, eNOS, and NOS genes in the lung tissue were evaluated. RESULTS From a total of 42 blood samples, 15 showed hypoxemia (pO2 < 85 mmHg) and 17 showed an increased oxygen gradient [p (A-a) O2 > 18 mmHg]. The liver histology revealed increased ductular proliferation after common bile duct ligation, and reconstruction of bile flow promoted decreased ductular proliferation 5 and 6 weeks post-common bile duct ligation. Pulmonary alterations consisted of decreased parenchymal airspace and increased medial wall thickness. Biliary desobstruction promoted transitory improvements 5 weeks after biliary obstruction (increased parenchymal airspace and decreased MWT-p = 0.003 and p = 0.004, respectively) as well as increased endothelin expression levels (p = 0.009). CONCLUSIONS The present model showed lung tissue alterations promoted by biliary obstruction. The biliodigestive anastomosis had no clear direct effects on these alterations.
Collapse
|
13
|
Zimmer V. Antegrade papillotome navigation as a novel next-line approach for internalization of percutaneous transhepatic biliary drainage. Clin Res Hepatol Gastroenterol 2019; 43:e9-e11. [PMID: 29685628 DOI: 10.1016/j.clinre.2018.03.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/11/2018] [Indexed: 02/04/2023]
Abstract
There is an increasing rivalry between percutaneous transhepatic (PTBD) vs. endoscopic ultrasound-guided biliary drainage (EUS-BD) as rescue techniques after failed endoscopic retrograde cholangiography (ERC) access. While EUS-BD procedures hold a bright future, innovations in PTBD technique are still possible and clinically meaningful, at least so, under the a conceptual framework understanding PTBD as a bridging, anatomy-respecting technology for definitive biliary metal stenting. This, however, calls for successful PTBD internalization as a sine qua non. Against this background, here, I present a novel approach of PTBD internalization using a standard triple-lumen papillotome as a stiff catheter for probing and assisting in guidewire cannulation of the route to the duodenum. This is the first report on such re-purposed use of a papillotome, which may be instrumental in fine-tuning contrast media filling and crossing angulations within the biliary system. Taken together, innovative advancements and variations in PTBD technique, such as the presented "antegrade papillotome navigation", may rescue difficult PTBD internalization and, thus, potentially obviate the need for alternative approaches, including pure EUS-BD or even more complex hybrid PTBD-EUS procedures.
Collapse
Affiliation(s)
- V Zimmer
- Department of Medicine, Marienhausklinik St. Josef Kohlhof, 66539 Neunkirchen, Germany; Department of Medicine II, Saarland University Medical Center, Saarland University, 66421 Homburg, Germany.
| |
Collapse
|
14
|
Moreau F, Blanchard C, Perret C, Flet L, Douane F, Frampas E, Mirallie E, Croyal M, Aguesse A, Krempf M, Prieur X, Pichelin M, Cariou B, Le May C. In vivo evidence for transintestinal cholesterol efflux in patients with complete common bile duct obstruction. J Clin Lipidol 2018; 13:213-217.e1. [PMID: 30342919 DOI: 10.1016/j.jacl.2018.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/27/2018] [Accepted: 09/15/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Beyond the hepatobiliary pathway, studies have demonstrated that direct transintestinal cholesterol efflux (TICE) of plasma-derived cholesterol may contribute to reverse cholesterol transport. The clinical evidence of TICE in human remains challenged because of the difficulty to discriminate the hepatobiliary and transintestinal routes in vivo. OBJECTIVE To provide the first proof of concept that TICE exists in vivo in humans by demonstrating that plasma labeled cholesterol can be excreted in the feces of patients with complete bile duct obstruction. METHODS Plasma, bile, and fecal cholesterol excretion was measured by mass spectrometry 24, 48, and 72 hours after intravenous injection of D7-cholesterol in two patients presenting cholangiocarcinomas with a total obstruction of their primary bile duct. RESULTS No trace of bile acids was detected in the feces of the two patients. Despite this, a significant amount of plasma D7-cholesterol was quantified in the feces of the two patients 48 hours and 72 hours after the intravenous injection. CONCLUSION Our data bring a direct proof that TICE is an active pathway in humans.
Collapse
Affiliation(s)
- François Moreau
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France
| | - Claire Blanchard
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France; Service de Clinique de Chirurgie Digestive et Endocrinienne, CHU de Nantes, France
| | | | | | | | - Eric Frampas
- Department of Radiology, CHU Nantes, Nantes, France
| | - Eric Mirallie
- Service de Clinique de Chirurgie Digestive et Endocrinienne, CHU de Nantes, France
| | - Mikael Croyal
- INRA, UMR 1280, Physiologie des Adaptations Nutritionnelles, CHU Nantes, France; CRNHO, West Human Nutrition Research Center, CHU, Nantes, France
| | - Audrey Aguesse
- INRA, UMR 1280, Physiologie des Adaptations Nutritionnelles, CHU Nantes, France; CRNHO, West Human Nutrition Research Center, CHU, Nantes, France
| | - Michel Krempf
- INRA, UMR 1280, Physiologie des Adaptations Nutritionnelles, CHU Nantes, France; CRNHO, West Human Nutrition Research Center, CHU, Nantes, France
| | - Xavier Prieur
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France
| | - Matthieu Pichelin
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France; L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Bertrand Cariou
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France; L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Cédric Le May
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France.
| |
Collapse
|
15
|
Cui W, Fan W, Lu M, Zhang Y, Yao W, Li J, Wang Y. The safety and efficacy of percutaneous intraductal radiofrequency ablation in unresectable malignant biliary obstruction: A single-institution experience. BMC Cancer 2017; 17:288. [PMID: 28438130 PMCID: PMC5404294 DOI: 10.1186/s12885-017-3278-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
Background Patients with unresectable malignant biliary obstruction have limited life expectancy because of limited stent patency and tumor progression. The aim of our study was to retrospectively evaluate the safety and efficacy of combining intraductal RFA with biliary metal stent placement for patients with malignant biliary obstruction. Methods Patients who received percutaneous intraductal RFA and biliary stent placement for malignant biliary obstruction between 2013 and 2015 were identified. Outcomes were stent patency, technique and clinical success rate, overall survival (OS) and complication rates. Kaplan-Meier and Cox regression analyses were used to examine the association of various factors with stent patency and OS. Complications and laboratory abnormalities were recorded. Results Fifty patients were treated with percutaneous RFA and stent placement. The rates of technical success and clinical success were 98% and 92%, respectively. The median stent patency was 7.0 (95% confidence interval [CI]: 5.3, 8.7) months and OS was 5.0 (95% CI: 4.0, 6.0) months. On univariable analysis, previously cholangitis was an independent poor prognosis factor for recurrent biliary obstruction. OS was improved in patients who received more than one intervention compared to those who received only one intervention (log-rank P = 0.007), and in those treated without versus those treated with sequential chemotherapy (log-rank P = 0.017). On multivariable analysis, the occurrence of more than one intervention (P = 0.019) had independent prognostic significance for OS. Conclusion Percutaneous RFA and stent placement is a technically safe and feasible therapeutic option for the palliative treatment of malignant biliary obstruction. The long-term efficacy and safety of the procedure is promising, but further study is required via randomized and prospective trials.
Collapse
Affiliation(s)
- Wei Cui
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wenzhe Fan
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Mingjian Lu
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yingqiang Zhang
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wang Yao
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jiaping Li
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Yu Wang
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
| |
Collapse
|
16
|
Heo JH, Kang JY, Lee MS, Cho BH, Hwang SY, Song JH, Yang JI, Choi JS. [A Case of Biliary Obstruction Caused by Liver Cyst]. Korean J Gastroenterol 2016; 68:270-273. [PMID: 27871164 DOI: 10.4166/kjg.2016.68.5.270] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Most cystic lesions of the liver are found incidentally in imaging studies because they are not symptomatic, and generally do not require treatment. Rarely, however, symptomatic hepatic cysts may develop complications and require treatment. Here, we describe a case of a 77-year-old woman who developed biliary obstruction with abdominal pain due to compression of the bile duct by a simple hepatic cyst. We confirmed the diagnosis based on symptoms and imaging studies. The patient'ssymptoms improved after simple cyst ablation by sclerotherapy.
Collapse
Affiliation(s)
- Jae Hyuk Heo
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ju Yeon Kang
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Myong Seob Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byeong Hak Cho
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seon Yeong Hwang
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jeong Hoon Song
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ju Il Yang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Sik Choi
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
17
|
Jeon SJ, Min JK, Kwon SY, Kim JH, Moon SY, Lee KH, Kim JH, Choe WH, Cheon YK, Kim TH, Park HS. Portal biliopathy treated with endoscopic biliary stenting. Clin Mol Hepatol 2016; 22:172-6. [PMID: 27044769 PMCID: PMC4825162 DOI: 10.3350/cmh.2016.22.1.172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 12/17/2022] Open
Abstract
Portal biliopathy is defined as abnormalities in the extra- and intrahepatic ducts and gallbladder of patients with portal hypertension. This condition is associated with extrahepatic venous obstruction and dilatation of the venous plexus of the common bile duct, resulting in mural irregularities and compression of the biliary tree. Most patients with portal biliopathy remain asymptomatic, but approximately 10% of them advance to symptomatic abdominal pain, jaundice, and fever. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are currently used as diagnostic tools because they are noninvasive and can be used to assess the regularity, length, and degree of bile duct narrowing. Management of portal biliopathy is aimed at biliary decompression and reducing the portal pressure. Portal biliopathy has rarely been reported in Korea. We present a symptomatic case of portal biliopathy that was complicated by cholangitis and successfully treated with biliary endoscopic procedures.
Collapse
Affiliation(s)
- Sung Jin Jeon
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jae Ki Min
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - So Young Kwon
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jun Hyun Kim
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Sun Young Moon
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Kang Hoon Lee
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jeong Han Kim
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Won Hyeok Choe
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Young Koog Cheon
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Tae Hyung Kim
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Chen L, Lu Y, Wu JC, Bie L, Xia L, Gong B. Diagnostic Utility of Endoscopic Retrograde Cholangiography/Intraductal Ultrasound (ERC/IDUS) in Distinguishing Malignant from Benign Bile Duct Obstruction. Dig Dis Sci 2016; 61:610-7. [PMID: 26423079 DOI: 10.1007/s10620-015-3896-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Received: 07/25/2015] [Accepted: 09/18/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Accurately differentiating malignant diseases from benign ones in patients having bile duct obstruction is of significant importance and remains a major clinical problem. This study investigated the diagnostic yield of endoscopic retrograde cholangiography/intraductal ultrasound (ERC/IDUS) in distinguishing malignant from benign bile duct obstruction and assessed some image findings from ERC/IDUS which might be useful in differentiation. METHODS From January 2008 to January 2015, patients who underwent ERC/IDUS for bile duct obstruction were enrolled. Patient's ERC/IDUS diagnosis was compared with the final diagnosis determined by pathologic findings and/or clinical outcome of follow-up. RESULTS One hundred and ninety-three patients with bile duct obstruction were included. IDUS correctly identified 94 of 97 malignant diseases and 76 of 96 benign diseases with sensitivity, specificity, and accuracy rate of 96.91, 79.17, and 88.08 %, respectively. Additionally, the accuracy rate of IDUS for diagnosis of proximal bile duct obstruction was higher than that of distal bile duct obstruction (98.08 vs. 82.73 %, p = 0.006). Besides, there was a significant difference in the length at the obstruction site between benign and malignant diseases (13.76 ± 7.37 vs. 19.97 ± 11.37 mm, p < 0.001) as well as thickness of bile duct wall at the site of obstruction (3.06 ± 0.92 vs. 7.03 ± 3.70 mm, p = 0.008). Biliary wall thickness >7 mm without extrinsic compression had a positive predictive value (PPV) of 100 % for including malignancy, while length ≧20 mm demonstrated a PPV of 93.44 %. CONCLUSIONS ERC/IDUS is effective in distinguishing malignant from benign bile duct obstruction, thus helping in further clinical management.
Collapse
Affiliation(s)
- Lu Chen
- Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Yi Lu
- Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Jia-Chuan Wu
- Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Like Bie
- Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Lu Xia
- Digestive Endoscopy Center, Shanghai International Medical Center, 4358 Kangxin Road, Shanghai, 201318, China.
| | - Biao Gong
- Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| |
Collapse
|
19
|
Budimir I, Sabol Pusic M, Nikolic M, Dorosulic Z, Ljubicic N, Stajduhar E, Mise I, Vazdar L, Sarcevic B. Obstructive Jaundice as an Uncommon Manifestation of Metastatic Breast Cancer. World J Oncol 2015; 6:297-300. [PMID: 29147419 PMCID: PMC5649949 DOI: 10.14740/wjon762w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 12/25/2022] Open
Abstract
Invasive ductal carcinoma is the most common type of breast cancer and accounts for about 70-85% of all invasive breast carcinomas. It primarily metastasizes to the bone, lungs, regional lymph nodes, liver and brain. Most of breast cancer recurrence occurs within the first 5 years of diagnosis, particularly for ER negative disease. Gastrointestinal tract involvement is very rare and is detected in only 10% of all the cases, and it usually derives from lobular breast cancer rather than the much more common cell type of ductal breast cancer. Early diagnosis is very important because it enables prompt and adequate choice of treatment and improves patient’s long-term prognosis. In this report we describe an unusual case of obstructive jaundice caused by metastases from invasive ductal breast cancer to the lymph nodes of the hepatoduodenal ligament with extramural compression of the distal common bile duct and tumor invasion to the lumen of the duct. Our goal is to emphasize possible diagnostic pitfalls and increase the clinical awareness and the importance of intensive follow-up in patients with breast cancer, even years after the initial diagnosis.
Collapse
Affiliation(s)
- Ivan Budimir
- Department of Gastroenterology and Hepatology, Interventional Gastroenterology Unit, University Hospital Center "Sestre Milosrdnice", Vinogradska Street 29, Zagreb 10000, Croatia
| | - Mateja Sabol Pusic
- Department of Internal Medicine, Cantonal hospital Cakovec, I. G. Kovacica 1e, Cakovec 40000, Croatia
| | - Marko Nikolic
- Department of Gastroenterology and Hepatology, Interventional Gastroenterology Unit, University Hospital Center "Sestre Milosrdnice", Vinogradska Street 29, Zagreb 10000, Croatia
| | - Zdravko Dorosulic
- Department of Gastroenterology and Hepatology, Interventional Gastroenterology Unit, University Hospital Center "Sestre Milosrdnice", Vinogradska Street 29, Zagreb 10000, Croatia
| | - Neven Ljubicic
- Department of Gastroenterology and Hepatology, Interventional Gastroenterology Unit, University Hospital Center "Sestre Milosrdnice", Vinogradska Street 29, Zagreb 10000, Croatia
| | - Emil Stajduhar
- Department of Radiology, University Hospital Center "Sestre Milosrdnice", Vinogradska Street 29, Zagreb 10000, Croatia
| | - Ivana Mise
- Department of Clinical Citology, University Hospital Center "Sestre Milosrdnice", Vinogradska Street 29, Zagreb 10000, Croatia
| | - Ljubica Vazdar
- Department of Oncology, University Hospital Center "Sestre Milosrdnice", Ilica 197, Zagreb 10000, Croatia
| | - Bozena Sarcevic
- Department of Oncology, University Hospital Center "Sestre Milosrdnice", Ilica 197, Zagreb 10000, Croatia
| |
Collapse
|
20
|
Heath JE, Goicochea LB, Staats PN. Biliary stent-related alterations can be distinguished from adenocarcinoma on bile duct brushings using a limited number of cytologic features. J Am Soc Cytopathol 2015; 4:282-289. [PMID: 31051766 DOI: 10.1016/j.jasc.2015.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 06/21/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although it is widely accepted that cytologic alterations secondary to a biliary stent can be difficult to distinguish from adenocarcinoma in pancreatobiliary exfoliative cytology, no systematic study has been undertaken to identify the cytologic features that best distinguish these entities. MATERIALS AND METHODS A training set of 29 bile duct brushings (14 with biliary stents, originally classified as atypical or suspicious, with >6 months of benign clinical follow-up; and 15 diagnosed as adenocarcinoma with histologic confirmation) was evaluated for the following: nuclear enlargement, nuclear contour, nuclear overlap, chromatin distribution, nuclear-cytoplasmic ratio, anisonucleosis, macronucleoli, mitoses, acute inflammation, disorganization, necrosis, cell borders, single atypical cells, and 2 distinct cell populations. A distinct validation set of 31 equivocal stented brushings-13 later diagnosed with carcinoma and 18 with ≥6 months of benign follow-up-were similarly evaluated. Cases were categorized as benign or malignant using a scoring algorithm based on statistically significant features. RESULTS Five features achieved statistical significance: atypical single cells (P = 0.0001), 2 distinct cell populations (P = 0.0007), and anisonucleosis (P = 0.0422) favored malignancy; distinct cell borders (P = 0.0018) and acute inflammation (P = 0.0035) favored benign. The algorithm correctly classified 12 of 14 benign and 15 of 15 malignant cases in the training set and 16 of 18 benign and 7 of 13 malignant cases in the validation set. CONCLUSIONS Most bile duct brushings from patients with biliary stents could be definitively and correctly classified as either benign or malignant using 5 morphologic features: single atypical cells, binary cell population, anisonucleosis, distinct cell borders, and acute inflammation.
Collapse
Affiliation(s)
- Jonathon E Heath
- Department of Pathology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, Maryland
| | - Lindsay B Goicochea
- Department of Pathology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, Maryland
| | - Paul N Staats
- Department of Pathology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, Maryland.
| |
Collapse
|
21
|
Sun S, Zhang C, Qin MF, Zou FS, Liu DQ, Li DH, Yuan HC. Changes in expression of hepatic fibrosis related cell factors in rats with bile duct obstruction. Shijie Huaren Xiaohua Zazhi 2014; 22:1402-1408. [DOI: 10.11569/wcjd.v22.i10.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the roles of cytokines related to the pathological process of biliary obstruction and hepatic fibrosis.
METHODS: Rats were divided into two groups: an experimental group and a control group. The experimental group underwent ligation of the common bile duct to induce bile duct obstruction (BDO), and the control group received laparotomy only without ligation. Rats were sacrificed after the operation. Expression of genes of interest was detected by PCR.
RESULTS: Expression of COL-Ⅰand transforming growth factor-β (TGF-β1) changed significantly from day 1, and that of HGF showed a significant change from day 3. In the BDL group, expression of COL-Ⅰand TGF-β1 showed no significant differences during the period from day 3 to day 7, and that of HGF showed no significant differences during the periods from day 1 to day 3 and from day 7 to day 21, while statistically significant differences were observed in other periods. These findings suggest that expression of COL-Ⅰand TGF-β1 increased fastest from days 1 to 3, and that of HGF increased fastest from days 3 to 7.
CONCLUSION: The findings of the present study suggest that the period before day 3 is a stage of rapid fibrosis, the period between days 3 and 7 is a stage of slow fibrosis, and the period after day 7 is a stage of continuous progression of fibrosis.
Collapse
|
22
|
Gurda GT, Zhu Q, Bai H, Pan D, Schwarz KB, Anders RA. The use of Yes-associated protein expression in the diagnosis of persistent neonatal cholestatic liver disease. Hum Pathol 2014; 45:1057-64. [PMID: 24746211 DOI: 10.1016/j.humpath.2014.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 01/06/2014] [Accepted: 01/08/2014] [Indexed: 12/19/2022]
Abstract
Although physiologic jaundice of neonates is common, persistent neonatal cholestasis is life-threatening and has multiple etiologies. Among these etiologies, biliary atresia (BA) requires rapid diagnosis and treatment. In diagnosing BA, the surgical pathologist must recognize subtle histologic changes, often with only a small core liver biopsy. To aid in the differential diagnosis of neonatal cholestasis, we investigated Yes-associated protein (YAP), a regulator of organ size and bile duct development. We examined whether a YAP immunostain can highlight emerging hepatobiliary epithelium in BA (n = 28) versus other causes of persistent cholestasis (non-BA; n = 15) and thus serve as a useful diagnostic marker in persistent neonatal jaundice. We show significantly (P < .01) more high-grade (<2) fibrosis and ductular proliferation among BA versus non-BA cases. Likewise, there was significantly more high-grade (2-3/3) cytoplasmic and nuclear YAP staining in BA (97% and 89%) versus non-BA (20% and 13%). High-grade nuclear YAP staining was both sensitive (88%) and specific (87%) for the diagnosis of BA. In contrast to neonatal cholestasis, the differences in YAP localization in cholestatic/obstructed versus nonobstructed adult livers were not significant. Lastly, we found that pharmacologic inhibition of the YAP complex in both cholangiocyte and cholangiocarcinoma cell lines blocked compensatory bile duct proliferation, an early marker of BA that requires nuclear YAP expression, in a time- and dose-dependent manner. In summary, we show that YAP expression modulates both bile duct proliferation and liver damage/fibrosis while acting as a sensitive and specific marker in the differential diagnosis of persistent neonatal cholestasis.
Collapse
|
23
|
Abstract
The care of the patient with cholestasis hinges on identifying the etiology, treating reversible causes, and managing chronic cholestatic processes. PBC and PSC are important causes of chronic cholestasis, and are the most common causes of cholestatic liver disease. Effective therapy is available for patients with PBC, whereas none exists for patients with PSC. Awareness of the complications that may be associated with cholestasis and implementing the appropriate management are essential.
Collapse
Affiliation(s)
- Andrea A Gossard
- Cholestatic Liver Disease Study Group, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | | |
Collapse
|
24
|
Song TJ, Hyun YS, Lee SS, Park DH, Seo DW, Lee SK, Kim MH. Endoscopic ultrasound-guided choledochoduodenostomies with fully covered self-expandable metallic stents. World J Gastroenterol 2012; 18:4435-40. [PMID: 22969210 PMCID: PMC3436062 DOI: 10.3748/wjg.v18.i32.4435] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/16/2012] [Accepted: 08/18/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the long-term outcomes of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with a fully covered self-expandable metallic stent (FCSEMS).
METHODS: From April 2009 to August 2010, 15 patients with distal malignant biliary obstructions who were candidates for alternative techniques for biliary decompression due to a failed endoscopic retrograde cholangiopancreatography (ERCP) were included. These 15 patients consisted of 8 men and 7 women and had a median age of 61 years (range: 30-91 years). The underlying causes of the distal malignant biliary obstruction were pancreatic cancer (n = 9), ampulla of Vater cancer (n = 2), renal cell carcinoma (n = 1), advanced gastric cancer (n = 1), lymphoma (n = 1), and duodenal cancer (n = 1).
RESULTS: The technical success rate of EUS-CDS with an FCSEMS was 86.7% (13/15), and functional success was achieved in 100% (13/13) of those cases. In two patients, the EUS-CDS failed because an FCSEMS with a delivery device could not be passed into the common bile duct. The mean duration of stent patency was 264 d. Early adverse events developed in three patients (3/13, 23.1%), including self-limited pneumoperitoneum in two patients and cholangitis requiring stent reposition in one patient. During the follow-up period (median: 186 d, range: 52-388 d), distal stent migration occurred in four patients (4/13, 30.8%). In 3 patients, the FCSEMS could be reinserted through the existing choledochoduodenal fistula tract.
CONCLUSION: EUS-CDS with an FCSEMS is technically feasible and can lead to effective palliation of distal malignant biliary obstructions after failed ERCP.
Collapse
|
25
|
Abstract
Biliary obstructions are rarely caused by a foreign body and have received sparse attention. We present an unusual case with pruritis and abdominal pain caused by impacted full length surgical gauze within the common bile duct. The patient had previously undergone an open cholecystectomy. Radiological investigations were inconclusive and suggestive of either a calculus or a cholangiocarcinoma. Surgical exploration revealed full length surgical gauze within the common bile duct. Because imaging modalities are often non-determinant, the possibility of biliary tract obstruction from a foreign body should be borne in mind for patients with unusual presentations, especially those who have previously undergone surgery.
Collapse
Affiliation(s)
- Vimal Bhandari
- Department of Surgery, Vardhaman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | | | | | | | | |
Collapse
|
26
|
Yang DH, Lee SK, Moon SH, Park DH, Lee SS, Seo DW, Kim MH. Percutaneous transhepatic cholangioscopic intervention in the management of complete membranous occlusion of bilioenteric anastomosis: report of two cases. Gut Liver 2009; 3:352-5. [PMID: 20431776 PMCID: PMC2852725 DOI: 10.5009/gnl.2009.3.4.352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 06/23/2009] [Indexed: 11/04/2022] Open
Abstract
Postoperative biliary stricture is a relatively rare but serious complication of biliary surgery. Although Rouxen-Y hepaticojejunostomy or choledochojejunostomy are well-established and fundamental therapeutic approaches, their postoperative morbidity and mortality rates have been reported to be up to 33% and 13%, respectively. Recent studies suggest that percutaneous transhepatic intervention is an effective and less invasive therapeutic modality compared with traditional surgical treatment. Compared with fluoroscopic intervention, percutaneous with cholangioscopy may be more useful in biliary strictures, as it can provide visual information regarding the stricture site. We recently experienced two cases complete membranous occlusion of the bilioenteric anastomosis and successfully treated both patients using percutaneous transhepatic cholangioscopy.
Collapse
Affiliation(s)
- Dong-Hoon Yang
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
Cholecystectomy is a commonly performed operation but there is still controversy whether dissection of the gall bladder should proceed from the fundus to the cystic duct or in the opposite direction. In usual practice the fundus-first method is adopted whenever difficulty is encountered in visualizing the anatomy of the cystic duct and Calot's triangle. Although haemorrhage is a little greater than with the duct-first method the risk of damage to the common bile duct or right hepatic artery is minimized. This article describes a brief experience with thirty randomized patients in whom cholecystectomies were performed with planned fundus-first approach.
Collapse
Affiliation(s)
- H R Gupta
- Reader, Dept of Surgery, Armed Forces Medical College, Pune - 411 040
| | - K K Maudar
- Professor and Head, Dept of Surgery, Armed Forces Medical College, Pune - 411 040
| |
Collapse
|