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Glaysher MA, Beable R, Ball C, Carter NC, Knight BC, Pucher PH, Mercer SJ, van Boxel G. Intra-operative ultrasound assessment of the biliary tree during robotic cholecystectomy. J Robot Surg 2023; 17:2611-2615. [PMID: 37632601 DOI: 10.1007/s11701-023-01701-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
Image-guided assessment of bile ducts and associated anatomy during laparoscopic cholecystectomy can be achieved with intra-operative cholangiography (IOC) or laparoscopic ultrasound (LUS). Rates of robotically assisted cholecystectomy (RC) are increasing and herein we describe the technique of intra-corporeal biliary ultrasound during RC using the Da Vinci system. For intraoperative evaluation of the biliary tree during RC, in cases of suspected choledocholithiasis, the L51K Ultrasound Probe (Hitachi, Tokyo, Japan) is used. The extrahepatic biliary tree is scanned along its length, capitalising on the benefits of the full range of motion offered by the articulated robotic instruments and integrated ultrasonic image display using TileProTM software. Additionally, this technique avoids the additional time and efforts required to undock and re-dock the robot that would otherwise be required for selective IOC or LUS. The average time taken to perform a comprehensive evaluation of the biliary tree, from the hepatic ducts to the ampulla of Vater, is 164.1 s. This assessment is supplemented by Doppler ultrasound, which is used to fully delineate anatomy of the porta hepatis, and accurate measurements of the biliary tree and any ductal stones can be taken, allowing for contemporaneous decision making and management of ductal pathologies. Biliary tract ultrasound has been shown to be equal to IOC in its ability to diagnose choledocholithiasis, but with the additional benefits of being quicker and having higher completion rates. We have described our practice of using biliary ultrasound during robotically assisted cholecystectomy, which is ergonomically superior to LUS, accurate and reproducible.
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Affiliation(s)
- Michael A Glaysher
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
| | - Richard Beable
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Christopher Ball
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Nicholas C Carter
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Benjamin C Knight
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Philip H Pucher
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- School of Bioscience and Pharmacy, University of Portsmouth, Portsmouth, UK
| | - Stuart J Mercer
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Gijs van Boxel
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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2
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Chen M, Zhang X, Zhou W, Zhang N, Wang G, Zhou L. Percutaneous Ultrasound Cholangiography With Microbubbles in Children With Biliary Diseases. Ultrasound Q 2023; 39:228-234. [PMID: 37918027 DOI: 10.1097/ruq.0000000000000654] [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] [Indexed: 11/04/2023]
Abstract
ABSTRACT The application of intracavity contrast-enhanced ultrasound in the evaluation of biliary disease has been confirmed valuable among pediatric population. This pictorial essay aims to demonstrate the role of percutaneous ultrasound cholangiography (PUSC) with microbubbles in the diagnosis of different pediatric biliary diseases in our center. The biliary system's morphologic characteristics in PUSC mode of neonatal hepatitis, biliary atresia, choledochal cysts, and biliary complications of hepatobiliary surgery are presented.
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Affiliation(s)
- Meixi Chen
- From the Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
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3
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Zhang DY, Yang S, Geng HX, Yuan YJ, Ding CJ, Yang J, Li MY. Real-time continuous image guidance for endoscopic retrograde cholangiopancreatography based on 3D/2D registration and respiratory compensation. World J Gastroenterol 2023; 29:3157-3167. [PMID: 37346159 PMCID: PMC10280790 DOI: 10.3748/wjg.v29.i20.3157] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND It has been confirmed that three-dimensional (3D) imaging allows easier identification of bile duct anatomy and intraoperative guidance of endoscopic retrograde cholangiopancreatography (ERCP), which reduces the radiation dose and procedure time with improved safety. However, current 3D biliary imaging does not have good real-time fusion with intraoperative imaging, a process meant to overcome the influence of intraoperative respiratory motion and guide navigation. The present study explored the feasibility of real-time continuous image-guided ERCP. AIM To explore the feasibility of real-time continuous image-guided ERCP. METHODS We selected 2 3D-printed abdominal biliary tract models with different structures to simulate different patients. The ERCP environment was simulated for the biliary phantom experiment to create a navigation system, which was further tested in patients. In addition, based on the estimation of the patient's respiratory motion, preoperative 3D biliary imaging from computed tomography of 18 patients with cholelithiasis was registered and fused in real-time with 2D fluoroscopic sequence generated by the C-arm unit during ERCP. RESULTS Continuous image-guided ERCP was applied in the biliary phantom with a registration error of 0.46 mm ± 0.13 mm and a tracking error of 0.64 mm ± 0.24 mm. After estimating the respiratory motion, 3D/2D registration accurately transformed preoperative 3D biliary images to each image in the X-ray image sequence in real-time in 18 patients, with an average fusion rate of 88%. CONCLUSION Continuous image-guided ERCP may be an effective approach to assist the operator and reduce the use of X-ray and contrast agents.
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Affiliation(s)
- Da-Ya Zhang
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Shuo Yang
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Hai-Xiao Geng
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Yu-Jia Yuan
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Chi-Jiao Ding
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Jian Yang
- School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China
| | - Ming-Yang Li
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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4
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Lie H, Irawan A, Sudirman T, Budiono BP, Prabowo E, Jeo WS, Rudiman R, Sitepu RK, Hanafi RV, Hariyanto TI. Efficacy and Safety of Near-Infrared Florescence Cholangiography Using Indocyanine Green in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:434-446. [PMID: 36576572 DOI: 10.1089/lap.2022.0495] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Achieving critical view of safety is a key for a successful laparoscopic cholecystectomy (LC) procedure. Near-infrared fluorescence cholangiography using indocyanine green (NIF-ICG) in LC has been extensively used and accepted as beneficial auxiliary tool to visualize extrahepatic biliary structures intraoperatively. This study aimed to analyze its safety and efficacy. Materials and Methods: Searching for potential articles up to March 25, 2022 were conducted on PubMed, Europe PMC, and ClinicalTrials.gov databases. Articles on the near infrared fluorescence during laparoscopy cholecystectomy were collected. Review Manager 5.4 software was utilized to perform the statistical analysis. Results: Twenty-two studies with a total of 3457 patients undergo LC for the analysis. Our meta-analysis revealed that NIF-ICG technique during LC was associated with shorter operative time (Std. Mean Difference -0.86 [95% confidence interval (CI) -1.49 to -0.23], P = .007, I2 = 97%), lower conversion rate (risk ratio [RR] 0.28 [95% CI 0.16-0.50], P < .0001, I2 = 0%), higher success in identification of cystic duct (CD) (RR 1.24 [95% CI 1.07-1.43], P = .003, I2 = 94%), higher success in identification of common bile duct (CBD) (RR 1.31 [95% CI 1.07-1.60], P = .009, I2 = 90%), and shorter time to identify biliary structures (Std. Mean Difference -0.52 [95% CI -0.78 to -0.26], P < .0001, I2 = 0%) compared with not using NIF-ICG. Conclusions: NIF-ICG technique beneficial for early real-time visualization of biliary structure, shorter operative time, and lower risk of conversion during LC. Larger randomized clinical trials are still needed to confirm the results of our study.
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Affiliation(s)
- Hendry Lie
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Andry Irawan
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Taufik Sudirman
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Bernardus Parish Budiono
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Diponegoro University, Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Erik Prabowo
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Diponegoro University, Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Wifanto Saditya Jeo
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ryanto Karobuana Sitepu
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Ricarhdo Valentino Hanafi
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
| | - Timotius Ivan Hariyanto
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospitals, Tangerang, Indonesia
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Ladd AD, Zarate Rodriguez J, Lewis D, Warren C, Duarte S, Loftus TJ, Nassour I, Soma D, Hughes SJ, Hammill CW, Zarrinpar A. Low vs Standard-Dose Indocyanine Green in the Identification of Biliary Anatomy Using Near-Infrared Fluorescence Imaging: A Multicenter Randomized Controlled Trial. J Am Coll Surg 2023; 236:711-717. [PMID: 36728303 DOI: 10.1097/xcs.0000000000000553] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Near-infrared fluorescence imaging using intravenous indocyanine green (ICG) facilitates intraoperative identification of biliary anatomy. We hypothesize that a much lower dose of ICG than the standard decreases hepatic and background fluorescence and improves bile duct visualization. STUDY DESIGN In this multicenter randomized controlled trial, 55 adult patients undergoing laparoscopic cholecystectomy were randomized to low-dose (0.05 mg) or standard-dose (2.5 mg) ICG preoperatively on the day of surgery. A quantitative assessment was performed on recorded videos from the operation using ImageJ software to quantify the fluorescence intensity of the bile duct, liver, and surrounding/background fat. Operating surgeons blinded to ICG dose provided a qualitative assessment of various aspects of the visualization of the extrahepatic biliary tree comparing near-infrared fluorescence to standard visible light imaging using a scale of 1 to 5 (1, unsatisfactory; 5, excellent). Quantitative and qualitative scores were compared between the groups to determine any significant differences between the doses. RESULTS The bile duct-to-liver and bile duct-to-background fat fluorescence intensity ratios were significantly higher for the low-dose group compared with the standard-dose group (3.6 vs 0.68, p < 0.0001; and 7.5 vs 3.3, p < 0.0001, respectively). Low-dose ICG had a slightly higher (ie better) mean score on the qualitative assessment compared to the standard dose, although the differences were not statistically significant. CONCLUSIONS Low-dose ICG leads to quantitative improvement of biliary visualization using near-infrared fluorescence imaging by minimizing liver fluorescence; this further facilitates routine use during hepatobiliary operations.
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Affiliation(s)
- Alexandra D Ladd
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Jorge Zarate Rodriguez
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO (Zarate Rodriguez, Hammill)
| | - Duncan Lewis
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Curtis Warren
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Sergio Duarte
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Tyler J Loftus
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Ibrahim Nassour
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Daiki Soma
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Steven J Hughes
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Chet W Hammill
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO (Zarate Rodriguez, Hammill)
| | - Ali Zarrinpar
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
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6
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Intharah T, Wiratchawa K, Wanna Y, Junsawang P, Titapun A, Techasen A, Boonrod A, Laopaiboon V, Chamadol N, Khuntikeo N. BiTNet: Hybrid deep convolutional model for ultrasound image analysis of human biliary tract and its applications. Artif Intell Med 2023; 139:102539. [PMID: 37100509 DOI: 10.1016/j.artmed.2023.102539] [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: 01/23/2022] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Certain life-threatening abnormalities, such as cholangiocarcinoma, in the human biliary tract are curable if detected at an early stage, and ultrasonography has been proven to be an effective tool for identifying them. However, the diagnosis often requires a second opinion from experienced radiologists, who are usually overwhelmed by many cases. Therefore, we propose a deep convolutional neural network model, named biliary tract network (BiTNet), developed to solve problems in the current screening system and to avoid overconfidence issues of traditional deep convolutional neural networks. Additionally, we present an ultrasound image dataset for the human biliary tract and demonstrate two artificial intelligence (AI) applications: auto-prescreening and assisting tools. The proposed model is the first AI model to automatically screen and diagnose upper-abdominal abnormalities from ultrasound images in real-world healthcare scenarios. Our experiments suggest that prediction probability has an impact on both applications, and our modifications to EfficientNet solve the overconfidence problem, thereby improving the performance of both applications and of healthcare professionals. The proposed BiTNet can reduce the workload of radiologists by 35% while keeping the false negatives to as low as 1 out of every 455 images. Our experiments involving 11 healthcare professionals with four different levels of experience reveal that BiTNet improves the diagnostic performance of participants of all levels. The mean accuracy and precision of the participants with BiTNet as an assisting tool (0.74 and 0.61, respectively) are statistically higher than those of participants without the assisting tool (0.50 and 0.46, respectively (p<0.001)). These experimental results demonstrate the high potential of BiTNet for use in clinical settings.
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Affiliation(s)
- Thanapong Intharah
- Visual Intelligence Laboratory, Department of Statistics, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand.
| | - Kannika Wiratchawa
- Visual Intelligence Laboratory, Department of Statistics, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand
| | - Yupaporn Wanna
- Visual Intelligence Laboratory, Department of Statistics, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand
| | - Prem Junsawang
- Visual Intelligence Laboratory, Department of Statistics, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand
| | - Attapol Titapun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Anchalee Techasen
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Arunnit Boonrod
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Vallop Laopaiboon
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Nittaya Chamadol
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Narong Khuntikeo
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand.
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7
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Teoh MMK, Nyandoro MG, Fahey B, Labib A, Ballal M. Double trouble: a complete duplication of the biliary system. ANZ J Surg 2022; 92:3379-3380. [PMID: 35445782 DOI: 10.1111/ans.17714] [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] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Mary M K Teoh
- General Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Munyaradzi G Nyandoro
- General Surgery, Fiona Stanley Hospital, St John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Brian Fahey
- General Surgery, St John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Amro Labib
- General Surgery, St John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Mohammed Ballal
- General Surgery, School of Medicine, St John of God Murdoch Hospital, The University of Western Australia, Perth, WA, Australia
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8
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Yu Z, Ou G, Wang R, Zhang Q. Artificial Intelligence Algorithm-Based CTA Imaging for Diagnosing Ischemic Type Biliary Lesions after Orthotopic Liver Transplantation. Comput Math Methods Med 2022; 2022:3399892. [PMID: 35027941 PMCID: PMC8752212 DOI: 10.1155/2022/3399892] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022]
Abstract
The study focused on the clinical application value of artificial intelligence-based computed tomography angiography (CTA) in the diagnosis of orthotopic liver transplantation (OLT) after ischemic type biliary lesions (ITBL). A total of 66 patients receiving OLT in hospital were selected. Convolutional neural network (CNN) algorithm was used to denoise and detect the edges of CTA images of patients. At the same time, the quality of the processed image was subjectively evaluated and quantified by Hmax, Ur, Cr, and other indicators. Then, the digital subtraction angiography (DSA) diagnosis and CTA diagnosis based on CNN were compared for the sensitivity, specificity, positive predictive value, negative predictive value, and patient classification results. It was found that CTA can clearly reflect the information of hepatic aorta lesions and thrombosis in patients with ischemic single-duct injury after liver transplantation. After neural network algorithm processing, the image quality is obviously improved, the lesions are more prominent, and the details of lesion parts are also well displayed. ITBL occurred in 40 (71%) of 56 patients with abnormal CTA at early stage. ITBL occurred in only 8 (12.3%) of 65 patients with normal CTA at early stage. Early CTA manifestations had high sensitivity (72.22%), specificity (87.44%), positive predictive value (60.94%), and negative predictive value (92.06%) for the diagnosis of ITBL. It was concluded that artificial intelligence-based CTA had high clinical application value in the diagnosis of ITBL after OLT.
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Affiliation(s)
- Zhenxing Yu
- Department of General Surgery, Affiliated Mindong Hospital of Fujian Medical University, Fu'an, 355000 Fujian, China
| | - Guixue Ou
- Department of General Surgery, Affiliated Mindong Hospital of Fujian Medical University, Fu'an, 355000 Fujian, China
| | - Ruihua Wang
- Department of General Surgery, Affiliated Mindong Hospital of Fujian Medical University, Fu'an, 355000 Fujian, China
| | - Qinghua Zhang
- Department of General Surgery, Affiliated Mindong Hospital of Fujian Medical University, Fu'an, 355000 Fujian, China
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9
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Freesmeyer M, Drescher R, Kühnel C, Gühne F, Greiser J. Hepatobiliary Excretion PET/CT With 68Ga-TAoS-DAZA to Evaluate Bile Duct Patency. Clin Nucl Med 2022; 47:59-60. [PMID: 34034319 DOI: 10.1097/rlu.0000000000003719] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT Tri-alkoxysalicyl-1,4-diazepan-6-amine (TAoS-DAZA) ligands, radiolabelled with 68Ga, have been proposed as PET/CT agents for depiction and quantification of hepatobiliary function and evaluation of bile excretion. In the presented case, a patient with hepatocellulary carcinoma underwent PET/CT with the TAoS-derivate 68Ga-tri-methoxysalicyl-(TMoS)-DAZA to determine the patency of intrahepatic and extrahepatic bile ducts, in particular of a stent in the common bile duct. The PET/CT was performed without complications. Evaluation of bile excretion over time was possible. 68Ga-TAoS-DAZA PET/CT may be an option for dynamic imaging of the excretory hepatic function to visualize the biliary tree and to rule out cholestasis.
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Affiliation(s)
- Martin Freesmeyer
- From the Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
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10
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Liang L, Zhuang D, Feng X, Zhang K, Zhi X. The postoperative choledochoscopy in the management of the residual hepatolithiasis involving the caudate lobe: A retrospective study. Medicine (Baltimore) 2021; 100:e26996. [PMID: 34477129 PMCID: PMC8415990 DOI: 10.1097/md.0000000000026996] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/31/2021] [Indexed: 01/05/2023] Open
Abstract
To reveal the role of the postoperative choledochoscopy in treating the residual calculi in the caudate lobe (CL) of the liver.We recruited 66 patients with T-tube/percutaneous transhepatic cholangioscopy tract who still had residual gallstones in the CL at least 6 weeks after the operation. Imaging examinations determined the gallstones' locations in the patients, and all of them underwent the postoperative choledochoscopic examination through the T-tube/percutaneous transhepatic cholangioscopy tract for therapeutic intervention.Among the 66 patients, the residual gallstones were mostly located in the Spiegel lobe (48/66, 72.7%), and the residual gallstones that located in the origin of the CL bile branches were successfully determined in the 57 patients (57/66, 86.4%), the remaining 9 patients were unclear because the proximal ducts were severely narrow or even atresia. The mean frequency of the postoperative choledochoscopy was 3.6 (range, 1-10) times. There were 9 patients with complications, and no mortality occurred. In the origin-proved 57 patients, 6 patients failed to remove the gallstones altogether, and the final residual gallstone clearance rate was 77.3% (51/66). There was no significant difference between the Spiegel lobe and the other parts of the CL in determining the bile duct's origins, gallstone clearance rate, and complications. However, the frequency of choledochoscopy in the other parts of the CL was more than in the Spiegel lobe.The postoperative choledochoscopy, an essential method for treating the residual gallstones in the CL, commands high efficiency for calculi extraction and fewer complications. The main reasons for failing to remove the residual gallstones are that the bile duct's origins could not be determined, and the distal bile ducts are atretic in the CL.
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Affiliation(s)
- Li Liang
- Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan, Shandong, China
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Donghai Zhuang
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xianguang Feng
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kai Zhang
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xuting Zhi
- Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan, Shandong, China
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11
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Tebala GD, Bond-Smith G. Indocyanine Green Fluorescence in Elective and Emergency Laparoscopic Cholecystectomy. A Visual Snapshot. Surg Technol Int 2020; 37:69-71. [PMID: 33031562] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Positive identification of the biliary anatomy is a crucial step during laparoscopic cholecystectomy to prevent iatrogenic biliary injuries. While it is usually quite straightforward in elective cholecystectomies, it may be very challenging in an emergency setting, when inflammation and adhesions at the gallbladder pedicle make identification of the common bile duct a difficult and risky manoeuvre. Indocyanine green (ICG) is a dye that, when injected intravenously at 0.2-0.5 mg/kg, concentrates in the bile and becomes fluorescent under near-infrared light. When administered well in advance, ideally 24 hours before the procedure, ICG is completely cleared by the liver and reaches a good concentration in the bile, thus allowing a good fluorescence-cholangiogram. Unfortunately, in emergency cholecystectomy-when it would be most needed-the injection of ICG cannot be planned with such long notice. However, even when injected less than 1 hour before the operation, ICG may be able to reach a sufficient concentration in the bile. This report shows that ICG-fluorescence can be helpful in identifying the extrahepatic biliary anatomy during the dissection of Calot's triangle in both elective and emergency cases.
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Affiliation(s)
- Giovanni D Tebala
- Surgical Emergency Unit, Department of General Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford (UK)
| | - Giles Bond-Smith
- Surgical Emergency Unit, Department of General Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford (UK)
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12
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Nicola M, Onorati M, Albertoni MM, Bianchi CL, De Nucci G, Mandelli ED, Nicola L, Di Nuovo F. Fine Needle Aspiration versus Fine Needle Biopsy of Biliopancreatic Lesions: Are They Really Opposing Techniques or Can They Be Complementary? Our Experience in a Large Cohort of Cases from a Single Institution. Acta Cytol 2020; 65:40-47. [PMID: 33099544 DOI: 10.1159/000510755] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Nowadays, endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA), and fine needle biopsy (FNB) are considered the best procedures for the diagnosis of biliopancreatic lesions. These methods represent a milestone since they proved to be both safe for the patient and useful to achieve diagnostic material useful to plan the best treatment strategy. OBJECTIVE Since in the literature, a debate between cytology and histology supporters is still ongoing and the trend is changing in favor of FNB, we would like to present our experience about the diagnostic yield of FNA and FNB. The aim of our study is to highlight FNA versus FNB diagnostic role of biliopancreatic lesions, highlight advantages, and drawbacks of these procedures, and our view on these 2 procedures and whether they should still be considered complementary or opposing techniques. METHODS We retrospectively reviewed our hospital series of 469 EUS diagnostics procedures of biliopancreatic lesions performed in 419 patients, between 2015 and 2019. RESULTS The overall adequacy rates of FNA and FNB were, respectively, 98.9 and 100%. Stratifying cases according to anatomic location of the mass (pancreas vs. biliary system), we detected 168 malignancies out of 349 pancreatic lesions (168/349; 48.1%), while biliary system cases positive for malignancy represented 33.8% (23/68 cases) (p value = 0.045, χ2 test). As for concomitant FNB, our series displayed a high rate of diagnostic concordance (88.8%). CONCLUSIONS Despite numerous data published, it is still unclear which is the most feasible method to use; therefore, we compared FNA, FNB, or their combination to understand the best applicable technique. Our experience confirmed that FNA is extremely efficient in the diagnosis of biliopancreatic lesions, especially in the hands of expert endoscopists and pathologists. Considering anatomic location, EUS-FNA is more accurate for mass-forming neoplasms in the pancreatic parenchyma rather than for lesions of the biliary system. Moreover, concomitant FNB usually confirmed the cytological diagnosis, allowing a deeper immunohistochemical characterization of the neoplasia. This proves that a "pure" cytology and "pure" histology approach should be looked differently since these are complementary techniques especially if we can obtain a cellblock from FNA.
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Affiliation(s)
- Marta Nicola
- Pathology Unit, ASST Rhodense, Garbagnate Milanese, Italy,
| | - Monica Onorati
- Pathology Unit, ASST Rhodense, Garbagnate Milanese, Italy
| | | | | | - Germana De Nucci
- Gastroenterology Unit, ASST Rhodense, Garbagnate Milanese, Italy
| | | | - Lidia Nicola
- Department of Earth and Environmental Sciences, University of Pavia, Pavia, Italy
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13
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Bati AH, Guler E, Ozer MA, Govsa F, Erozkan K, Vatansever S, Ersin MS, Elmas ZN, Harman M. Surgical planning with patient-specific three-dimensional printed pancreaticobiliary disease models - Cross-sectional study. Int J Surg 2020; 80:175-183. [PMID: 32622058 DOI: 10.1016/j.ijsu.2020.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 04/15/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Three-dimensional (3D) printing has been increasingly used in medical applications with the creation of accurate patient-specific 3D printed models in medical imaging data. This study has been planned based on the fact that research on 3D printing in pancreaticobiliary disease is limited due to lack of studies on validation of model accuracy. METHODS This is an innovative study where general surgery residents are presented 5 distinct hepatopancreatobiliary disease scenarios to generate a perception and required to compare their perception level of these cases with magnetic resonance cholangiopancreatography (MRCP), 3D images and 1:1 solid models that the pathology, diverse diagnosis and presurgery diagnosis stages can be observed. This study is single-centered. RESULTS The dilated pancreaticobiliary intervention based on scenarios for general surgery residency was more original since there was no prior study that includes both model building and the evaluation of the perception created by the model. Five scenarios provided qualitative assessment with results showing the usefulness of 3D models when used as clinical tools in preoperative planning, simulation of interventional procedures, surgical education, and training. The perception level in the 3D model, MRCP (Z: 3.854, p: 0.000) and the 3D image (Z: 2.865, p: 0.004) was higher; likewise, the 3D-STL image was higher compared to the MRCP image (Z: 3.779, p: 0.000). All subspecialists agree that 3D models provided better understanding of dilated pancreaticobiliary pathoanatomy and improved surgical planning. CONCLUSIONS A thoroughly outlined genuine patient situation layout aimed for general surgery training can be installed and monitored with the support of 3D printing technology of this study. This can be utilized to develop the comprehension of pathoanatomical variations of complex pancreaticobiliary illness and to adopt a surgical approach.
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Affiliation(s)
| | | | - Mehmet Asim Ozer
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Turkey
| | - Figen Govsa
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Turkey.
| | - Kamil Erozkan
- Department of General Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Safa Vatansever
- Department of General Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Muhtar Sinan Ersin
- Department of General Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
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14
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Yamashita S, Tago M, Katsuki NE, Nishi TM, Yamashita SI. Relationships between sites of abdominal pain and the organs involved: a prospective observational study. BMJ Open 2020; 10:e034446. [PMID: 32571855 PMCID: PMC7311042 DOI: 10.1136/bmjopen-2019-034446] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/09/2020] [Accepted: 05/29/2020] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVES Abdominal pain is one of the most frequent chief complaints in primary care settings. The aim of the present study was to determine the positive likelihood ratios (PLRs) and negative likelihood ratios (NLRs) of the relationships between the sites of abdominal pain and the organs involved. DESIGN Prospective observational study. SETTING A single tertiary centre, a university hospital in Japan. PARTICIPANTS A total of 2591 new outpatients visited the Department of General Medicine at a university hospital from April 2017 to March 2018. Of these, 326 patients aged ≥20 years with abdominal pain were enrolled. RESULTS Sites of abdominal pain were classified into 11 categories including nine different abdominal sections, 'generalised abdomen' and 'site-indeterminate'. The PLRs between 'right subcostal' and 'liver and biliary tract'; between 'right subcostal' and 'musculoskeletal' ; between 'epigastric' and 'oesophagus, stomach and duodenum'; between 'right or left flank' and 'urinary tract'; between 'left flank' and 'dermatological'; and between 'mid-lower' and 'intestinal' ranged from 2.17 to 4.14. The PLRs between 'epigastric' and 'urinary tract'; between 'mid-lower' and 'liver and biliary tract'; between 'periumbilical' and 'urinary tract'; and between 'generalised abdomen' and 'oesophagus, stomach and duodenum' were low, ranging from 0.17 to 0.25. The NLR ranged from 0.5 to 1.5, excluding the relationship between 'left flank' and 'dermatological'. CONCLUSION The presence of pain at right subcostal, epigastric, right or left flank and mid-lower sites might be useful for identifying the organs involved. Additionally, the presence of pain at mid-lower, epigastric, periumbilical and generalised abdominal sites might be helpful for denying the involvement of some organs. Some sites of abdominal pain can be indicative of the organs involved.Trial registration numberUMIN000037686.
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Affiliation(s)
| | - Masaki Tago
- General Medicine, Saga University Hospital, Saga, Japan
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15
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Peh KH, Eugene Chan BT. Biliary cystadenoma: A rare occurrence. Med J Malaysia 2020; 75:307-308. [PMID: 32467552] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Biliary cystadenoma is a rare benign tumour with the potential to transform into malignant carcinoma of the biliary ductal system. There is difficulty in differentiating a benign one from a malignant biliary cystadenoma, and therefore these lesions should always be completely resected. We report a case of biliary cystadenoma which underwent a complete resection.
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Affiliation(s)
- K H Peh
- MAHSA University, Faculty of Medicine, Department of Surgery, Kuala Lumpur, Malaysia.
| | - B T Eugene Chan
- MAHSA University, Faculty of Medicine, Department of Microbiology, Kuala Lumpur, Malaysia
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16
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Wu D, Xue D, Zhou J, Wang Y, Feng Z, Xu J, Lin H, Qian J, Cai X. Extrahepatic cholangiography in near-infrared II window with the clinically approved fluorescence agent indocyanine green: a promising imaging technology for intraoperative diagnosis. Theranostics 2020; 10:3636-3651. [PMID: 32206113 PMCID: PMC7069080 DOI: 10.7150/thno.41127] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/31/2020] [Indexed: 12/16/2022] Open
Abstract
Rationale: Biliary tract injury remains the most dreaded complication during laparoscopic cholecystectomy. New intraoperative guidance technologies, including near-infrared (NIR) fluorescence cholangiography with indocyanine green (ICG), are under comprehensive evaluation. Previous studies had shown the limitations of traditional NIR light (NIR-I, 700-900 nm) in visualizing the biliary tract structures in specific clinical situations. The aim of this study was to evaluate the feasibility of performing the extrahepatic cholangiography in the second NIR window (NIR-II, 900-1700 nm) and compare it to the conventional NIR-I imaging. Methods: The absorption and emission spectra, as well as fluorescence intensity and photostability of ICG-bile solution in the NIR-II window were recorded and measured. In vitro intralipid® phantom imaging was performed to evaluate tissue penetrating depth in NIR-I and NIR-II window. Different clinical scenarios were modeled by broadening the penetration distance or generating bile duct injuries, and bile duct visualization and lesion site diagnosis in the NIR-II window were evaluated and compared with NIR-I imaging. Results: The fluorescence spectrum of ICG-bile solution extends well into the NIR-II region, exhibiting intense emission value and excellent photostability sufficient for NIR-II biliary tract imaging. Extrahepatic cholangiography using ICG in the NIR-II window obviously reduced background signal and enhanced penetration depth, providing more structural information and improved visualization of the bile duct or lesion location in simulated clinical scenarios, outperforming the NIR-I window imaging. Conclusions: The conventional clinically approved agent ICG is an excellent fluorophore for NIR-II bile duct imaging. Fluorescence cholangiography with ICG in the NIR-II window could provide adequate visualization of the biliary tract structures with increased resolution and penetration depth and might be a valid option to increase the safety of cholecystectomy in difficult cases.
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Affiliation(s)
- Di Wu
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Dingwei Xue
- Department of Urology, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Jing Zhou
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Yifan Wang
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Zhe Feng
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Junjie Xu
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Hui Lin
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Jun Qian
- State Key Laboratory of Modern Optical Instrumentations, Centre for Optical and Electromagnetic Research, College of Optical Science and Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
- Zhejiang Provincial Key Laboratory of Laparoscopic Technology, Hangzhou, 310016, China
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17
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Oldhafer KJ, Reese T, Fard-Aghaie M, Strohmaier A, Makridis G, Kantas A, Wagner KC. [Intraoperative fluorescence angiography and cholangiography with indocyanine green in hepatobiliary surgery]. Chirurg 2019; 90:880-886. [PMID: 31559461 DOI: 10.1007/s00104-019-01035-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/16/2022]
Abstract
Intraoperative fluorescence angiography and cholangiography with indocyanine green (ICG) are increasingly used in routine hepatobiliary surgery. Its usage is manifold. It improves and facilitates navigation especially in minimal invasive and robotic surgery and therefore increases the safety of the surgical intervention. In laparoscopic cholecystectomy for example, the bileduct anatomy can be easily visualized, even in complicated cholecystitis or anatomical variants without being too time consuming. ICG fluorescence also enables the visualization of vascular structures and perfusion. Anatomical liver resections, for example in hepatocellular carcinoma (HCC), can be performed easily as liver segments and territories can be identified. Anatomical resection is becoming more important, e.g. in the treatment of HCC. Another useful application is the intraoperative detection of bile leakages after liver resection. In particular, the intraoperative control of a biliodigestive anastomosis is possible with ICG fluorescence cholangiography and therefore reduces morbidity. Even primary and secondary liver tumors can be detected with ICG fluorescence. Whereas well-differentiated HCCs homogeneously take up ICG, poorly differentiated HCCs and metastases do not: however, in these cases the adjacent liver parenchyma stores ICG more intensively than healthy liver tissue, which creates a ring-like fluorescence pattern. To conclude, the use of ICG fluorescence in hepatobiliary surgery is diverse but in Germany it is still at the beginning compared to other countries.
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Affiliation(s)
- Karl J Oldhafer
- Department für Chirurgie, Klinik für Leber‑, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
- Asklepios Campus Hamburg, Semmelweis Universität Budapest, Hamburg, Deutschland.
| | - Tim Reese
- Department für Chirurgie, Klinik für Leber‑, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
- Asklepios Campus Hamburg, Semmelweis Universität Budapest, Hamburg, Deutschland
| | - Mohammad Fard-Aghaie
- Department für Chirurgie, Klinik für Leber‑, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
- Asklepios Campus Hamburg, Semmelweis Universität Budapest, Hamburg, Deutschland
| | - Alina Strohmaier
- Department für Chirurgie, Klinik für Leber‑, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
- Asklepios Campus Hamburg, Semmelweis Universität Budapest, Hamburg, Deutschland
| | - Georgios Makridis
- Department für Chirurgie, Klinik für Leber‑, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
- Asklepios Campus Hamburg, Semmelweis Universität Budapest, Hamburg, Deutschland
| | - Alexandros Kantas
- Department für Chirurgie, Klinik für Leber‑, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
- Asklepios Campus Hamburg, Semmelweis Universität Budapest, Hamburg, Deutschland
| | - Kim C Wagner
- Department für Chirurgie, Klinik für Leber‑, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
- Asklepios Campus Hamburg, Semmelweis Universität Budapest, Hamburg, Deutschland
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18
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Ferreira BDC, Correia D. Ultrasound Assessment of Hepatobiliary and Splenic Changes in Patients With Dengue and Warning Signs During the Acute and Recovery Phases. J Ultrasound Med 2019; 38:2015-2024. [PMID: 30549307 DOI: 10.1002/jum.14890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/04/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate whether abdominal ultrasound (US) with a gallbladder (GB) contractility study or motor function test can be used as a diagnostic tool in patients with dengue and warning signs in acute and recovery phases. METHODS Fifty-one individuals in the acute phase of dengue presenting with warning signs (dengue group) and 49 healthy individuals without a history of dengue or hepatobiliary disease (control group) were studied with abdominal US and a GB contractility study. RESULTS Statistical differences in US measurements of the liver (right lobe, P = .012; left lobe, P = .001) and spleen (P = .008) dimensions, GB wall thickness (P < .001), and the GB emptying fraction (P < .001) were observed in dengue during the acute phase compared with the control group. After 60 days, abdominal US of the dengue group showed a statistical difference in liver (right lobe, P < .001; left lobe, P = .078) and spleen (P < .001) dimensions, GB wall thickness, and the GB emptying fraction (P < .001) compared with the results obtained during the acute phase. Furthermore, a statistical difference in the spleen volume and GB emptying fraction (P < .001) was observed when comparing dengue after clinical recovery and the control group. Abdominal pain in patients with dengue was positively associated with hepatomegaly (P = .031), splenomegaly (P = .008), increased GB wall thickness (P = .016), and a reduced GB emptying fraction (P = .038) during the acute phase and with splenomegaly (P = .001) and a reduced GB emptying fraction (P = .003) after clinical recovery. CONCLUSIONS Abdominal US with a GB motor function test can be used as a diagnostic tool in patients with dengue during acute and recovery phases.
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Affiliation(s)
| | - Dalmo Correia
- Infectious Diseases, Federal University of Triângulo Mineiro, Uberaba, Brazil
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19
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Krutsri C, Kida M, Yamauchi H, Iwai T, Imaizumi H, Koizumi W. Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. World J Gastroenterol 2019; 25:3313-3333. [PMID: 31341358 PMCID: PMC6639547 DOI: 10.3748/wjg.v25.i26.3313] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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: 03/22/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy must be performed by a highly experienced endoscopist. The challenges are accessing the afferent limb in different types of reconstruction, cannulating a papilla with a reverse orientation, and performing therapeutic interventions with uncommon endoscopic accessories. The development of endoscopic techniques has led to higher success rates in this group of patients. Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction; however, these success rate is lower in long-limb reconstruction. ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length; however, it must be performed by a highly experienced and skilled endoscopist. Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography, but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy. Laparoscopic-assisted ERCP has an almost 100% success rate in long-limb reconstruction because of the use of a conventional side-view duodenoscope, which is compatible with standard accessories. This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy. This review focuses on the advantages, disadvantages, and outcomes of various procedures that are suitable in different situations and reconstruction types. Emerging new techniques and their outcomes are also discussed.
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Affiliation(s)
- Chonlada Krutsri
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Mitsuhiro Kida
- Department of Gastroenterology, Graduate School of Medicine, Kitasato University Hospital, Kanagawa 252-0375, Japan
| | - Hiroshi Yamauchi
- Department of Gastroenterology, Graduate School of Medicine, Kitasato University Hospital, Kanagawa 252-0375, Japan
| | - Tomohisa Iwai
- Department of Gastroenterology, Graduate School of Medicine, Kitasato University Hospital, Kanagawa 252-0375, Japan
| | - Hiroshi Imaizumi
- Department of Gastroenterology, Graduate School of Medicine, Kitasato University Hospital, Kanagawa 252-0375, Japan
| | - Wasaburo Koizumi
- Department of Gastroenterology, Graduate School of Medicine, Kitasato University Hospital, Kanagawa 252-0375, Japan
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20
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Schmitz D, Vogl T, Nour-Eldin NEA, Radeleff B, Kröger JC, Mahnken AH, Ittrich H, Gehl HB, Plessow B, Böttcher J, Tacke J, Wispler M, Rosien U, Schorr W, Joerdens M, Glaser N, Fuchs ES, Tal A, Friesenhahn-Ochs B, Leimbach T, Höpner L, Weber M, Gölder S, Böhmig M, Hetjens S, Rudi J, Schegerer A. Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study. Eur Radiol 2019; 29:3390-3400. [PMID: 31016441 DOI: 10.1007/s00330-019-06208-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/10/2018] [Revised: 03/20/2019] [Accepted: 03/27/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs. METHODS A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals. Recommended national DRLs are set at the 75th percentile of all DAPs. RESULTS Twenty-three facilities (9 interventional radiology depts. and 14 gastroenterology depts.) returned the questionnaire (12%). Five hundred sixty-five PBIs with 19 different interventions were included in the analysis. DAPs (range 4-21,510 cGy·cm2) and FTs (range 0.07-180.33 min) varied substantially depending on the centre and type of PBI. The DAPs of initial PBIs were significantly (p < 0.0001) higher (median 2162 cGy·cm2) than those of follow-up PBIs (median 464 cGy·cm2). There was no significant difference between initial PBIs with ultrasound-guided bile duct puncture (2162 cGy·cm2) and initial PBIs with fluoroscopy-guided bile duct puncture (2132 cGy·cm2) (p = 0.85). FT varied substantially (0.07-180.33 min). CONCLUSIONS DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. PBI with US-guided bile duct puncture did not reduce DAP, when compared to PBI with fluoroscopy-guided bile duct puncture. National DRLs of 4300 cGy·cm2 for initial PBIs and 1400 cGy·cm2 for follow-up PBIs are recommended. KEY POINTS • DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. • PBI with US-guided bile duct puncture did not reduce DAP when compared to PBI with fluoroscopy-guided bile duct puncture. • DRLs of 4300 cGy·cm2for initial PBIs (establishing a transhepatic tract) and 1400 cGy·cm2for follow-up PBIs (transhepatic tract already established) are recommended.
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Affiliation(s)
- Daniel Schmitz
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany.
| | - Thomas Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Boris Radeleff
- Department for Diagnostic and Interventional Radiology, Sana Municipal Hospital Hof, Hof, Germany
| | - Jens-Christian Kröger
- Institute for Diagnostic and Interventional Radiology, University Medicine Rostock, Rostock, Germany
| | - Andreas H Mahnken
- Institute for Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany
| | - Harald Ittrich
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg, Hamburg, Germany
| | - Hans-Björn Gehl
- Institute for Diagnostic Radiology, Municipal Hospital Bielefeld, Bielefeld, Germany
| | - Bernd Plessow
- Radiological Institute, University Medicine Greifswald, Greifswald, Germany
| | - Joachim Böttcher
- Institute for Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Josef Tacke
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, Municipal Hospital Passau, Passau, Germany
| | - Markus Wispler
- Community Hospital Havelhöhe, Gastroenterology, Berlin, Germany
| | - Ulrich Rosien
- Medical Clinic, Israelite Hospital Hamburg, Hamburg, Germany
| | - Wolfgang Schorr
- Department of Gastroenterology and Interventional Endoscopy, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany
| | - Markus Joerdens
- Department of Gastroenterology, Oncology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicolas Glaser
- Clinic for Internal Medicine II: Gastroenterology, Oncology, Endocrinology and Infectiology, University Hospital Freiburg, Freiburg, Germany
| | - Erik-Sebastian Fuchs
- Department of Gastroenterology, Infectiology, Diabetology and Gastrointestinal Oncology (Medical Clinic C), Ludwigshafen Municipal Hospital, Ludwigshafen, Germany
| | - Andrea Tal
- Medical Clinic I: Gastroenterology and Hepatology, Pneumology and Allergology, Endocrinology and Diabetology as Nutritional Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Bettina Friesenhahn-Ochs
- Clinic for Internal Medicine II: Gastroenterology, Hepatology, Endocrinology, Diabetology and Nutritional Medicine, Saarland University Hospital, Homburg, Germany
| | - Thomas Leimbach
- Clinic for Gastroenterology, Hepatology, Gastrointestinal Oncology, Municipal Hospital Bogenhausen Munich, Munich, Germany
| | - Lars Höpner
- Clinic for Gastrointestinal Diseases/Medical Clinic I, Municipal Clinic of Braunschweig, Braunschweig, Germany
| | - Marko Weber
- Clinic for Internal Medicine IV: Gastroenterology, Hepatology, Infectiology, Interdisciplinary Endoscopy, University Hospital Jena, Jena, Germany
| | - Stefan Gölder
- Medical Clinic III - Gastroenterology, Municipal Hospital Augsburg, Augsburg, Germany
| | - Michael Böhmig
- Medical Clinic I (Gastroenterology, Hepatology, Oncology, Infectiology), Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics and Biomathematics of Mannheim University Hospital, Heidelberg University-Hospital, Heidelberg, Germany
| | - Jochen Rudi
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany
| | - Alexander Schegerer
- Department for Radiation Protection and Health, Federal Office of Radiation Protection, Salzgitter, Germany
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Koukoura O, Kelesidou V, Delianidou M, Athanasiadis A, Dagklis T. Prenatal sonographic diagnosis of biliary tract malformations. J Clin Ultrasound 2019; 47:292-297. [PMID: 30729537 DOI: 10.1002/jcu.22705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 01/10/2019] [Accepted: 01/20/2019] [Indexed: 06/09/2023]
Abstract
Congenital anomalies of the biliary tract include a variety of pathologic conditions, such as biliary atresia, choledochal cysts, gallbladder agenesis, congenital cholelithiasis, and gallbladder duplication. Although most of these malformations are rare and benign conditions, they may occasionally represent a major threat to extrauterine life. Visualization of a normal-sized gallbladder should be a mandatory component of the second-trimester anomaly ultrasound scan. Advances in prenatal sonography enable the detection of biliary tract congenital malformations. In this review, we discuss the detection rates, sonographic features, and prognosis of the most frequently prenatally diagnosed biliary tract malformations.
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Affiliation(s)
- Ourania Koukoura
- Department of Obstetrics and Gynecology, University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Veroniki Kelesidou
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marina Delianidou
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Pilton JL, Chau J, Foo TS, Hall EJ, Martinez-Taboada F, Podadera JM, Makara MA. Hepatic computed tomography and cholangiography by use of gadoxetic acid in healthy cats. Am J Vet Res 2019; 80:385-395. [PMID: 30919679 DOI: 10.2460/ajvr.80.4.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate 3 doses of gadoxetic acid (Gd-EOB-DPTA) for hepatic CT and cholangiography in cats and to determine optimal timing for hepatobiliary image acquisition and evaluation of the contrast-enhanced hepatobiliary anatomy. ANIMALS 6 healthy cats. PROCEDURES Cats were anesthetized; sequential CT scans were performed 0, 5, 25, 45, 65, and 85 minutes after IV administration of Gd-EOB-DTPA at low (0.0125 mmol/kg), medium (0.1 mmol/kg), and high (0.3 mmol/kg) doses. Hepatobiliary enhancement for each dose was objectively assessed over time and by use of a subjective semiquantitative visual assessment score. RESULTS No contrast-related adverse effects were detected. Each increase in dose of contrast medium resulted in a significant increase in HU across the hepatobiliary system. The liver had a significantly higher number of HU at 45 minutes, with homogenous enhancement at all doses of contrast medium. Contrast-enhanced cystic and bile duct HU were significantly higher and maximal at 65 minutes. Contrast-enhanced gallbladder HU did not plateau by 85 minutes. At a high dose of contrast medium, 12 of 60 (20%) biliary tract scores indicated no enhancement, 34 (57%) indicated poor enhancement, and 14 (23%) indicated moderate enhancement. No cat had excellent enhancement of the biliary tract at any dose. CONCLUSIONS AND CLINICAL RELEVANCE Gd-EOB-DTPA-enhanced hepatic CT and cholangiography in cats were safely performed and provided good hepatic enhancement but poor to moderate enhancement of the biliary tract. This technique may be useful for assessing the liver parenchyma in cats, but its value for assessing the biliary tract is questionable.
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Abstract
"The anatomy of the biliary tree is notoriously variable. This variation is the bane of the hepatobiliary surgeon, to whom an understanding of biliary anatomic variation is key to the planning and safe conduct of liver surgery, from oncological resections to split-liver transplantation. The hepatic diverticulum, also termed "the liver bud," is the first semblance of the biliary system in the human embryo. A variety of techniques used in the mid twentieth century for imaging the biliary tree have since been abandoned in favor of more practical, safer, less invasive, and more sensitive and specific contemporary methods."
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Affiliation(s)
- Jad E Abou-Khalil
- Hepatobiliary and Pancreatic Surgery Unit, The University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Box 202, Ottawa, Ontario K1H8L6, Canada.
| | - Kimberly A Bertens
- Hepatobiliary and Pancreatic Surgery Unit, The University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Box 202, Ottawa, Ontario K1H8L6, Canada
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Li FC, Lee SL, Lin HM, Lin CJ, Wang SS, Lee YY, Lo SY, Sun TL, Chen WL, Lo W, Horton N, Xu C, Chiang SJ, Chen YF, Lee HS, Dong CY. Dynamic visualization of the recovery of mouse hepatobiliary metabolism to acetaminophen-overdose damage. J Biophotonics 2019; 12:e201800296. [PMID: 30302934 DOI: 10.1002/jbio.201800296] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
Acetaminophen (APAP) overdose is one of the world's leading causes of drug-induced hepatotoxicity. Although traditional methods such as histological imaging and biochemical assays have been successfully applied to evaluate the extent of APAP-induced liver damage, detailed effect of how APAP overdose affect the recovery of hepatobiliary metabolism and is not completely understood. In this work, we used intravital multiphoton microscopy to image and quantify hepatobiliary metabolism of the probe 6-carboxyfluorescein diacetate in APAP-overdose mice. We analyzed hepatobiliary metabolism for up to 7 days following the overdose and found that the excretion of the probe molecule was the most rapid on Day 1 following APAP overdose and slowed down on Days 2 and 3. On Day 7, probe excretion capability has exceeded that of the normal mice, suggesting that newly regenerated hepatocytes have higher metabolic capabilities. Our approach may be further developed applied to studying drug-induced hepatotoxicity in vivo.
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Affiliation(s)
- Feng-Chieh Li
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Sheng-Lin Lee
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Hung-Ming Lin
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Chih-Ju Lin
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Sheng-Shun Wang
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yu-Yang Lee
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Su-Yen Lo
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Tzu-Lin Sun
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Wen Lo
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Nicholas Horton
- School of Engineering and Applied Physics, Cornell University, Ithaca, New York
| | - Chris Xu
- School of Engineering and Applied Physics, Cornell University, Ithaca, New York
| | - Shu-Jen Chiang
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yang-Fang Chen
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Hsuan-Shu Lee
- Institute of Biotechnology, National Taiwan University, Taipei, Taiwan, Republic of China
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Chen-Yuan Dong
- Department of Physics, National Taiwan University, Taipei, Taiwan, Republic of China
- Center for Optoelectronic Biomedicine, National Taiwan University, Taipei, Taiwan, Republic of China
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan, Republic of China
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Kulali F, Acar A, Semiz-Oysu A, Canbak T, Tolan K, Bukte Y. Misleading findings of liver-specific MR contrast agent for radiological diagnosis of cysto-biliary communication in hydatid cysts. Radiol Med 2019; 124:460-466. [PMID: 30725396 DOI: 10.1007/s11547-019-01000-4] [Citation(s) in RCA: 4] [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: 06/24/2018] [Accepted: 01/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the effectiveness of gadoxetic acid-enhanced magnetic resonance cholangiopancreatography (CE-MRCP) and T2-weighted half-Fourier acquisition single-shot turbo spin-echo (T2W HASTE) sequences for diagnosis of cysto-biliary communication in hydatid cysts compared to surgical results. METHODS Preoperative abdominal magnetic resonance imaging examinations of patients who underwent surgery for hepatic hydatid cysts were reviewed by two radiologists retrospectively. A total of 45 patients with hydatid cysts were included. Of 45, 27 also had CE-MRCPs. T2W HASTE sequences and CE-MRCPs were investigated separately for cysto-biliary communication. The relationship between radiological and surgical results was analyzed. The interobserver agreement was evaluated. RESULTS Of 45 hydatid cysts, there were surgically proven 21 cysts without biliary communications and 24 cysts with biliary communications. All cysts with biliary communications were shown on T2W HASTE sequences. There was no leakage of gadoxetic acid into these cysts (n = 24). Sensitivity, specificity, negative predictive value, positive predictive value (PPV), and accuracy of diagnosis of cyst with biliary communication on T2W HASTE sequences was 100%, 63.64%, 100%, 66.67%, and 78.95%, respectively. Specificity (77.78%), PPV (87.50%), and accuracy (91.30%) were increased in ≥ 10 cm cysts. There was almost perfect interobserver agreement (K = 0.81-1.00). CONCLUSION Leakage of gadoxetic acid inside the cyst indicates biliary communication. However, the lack of leakage does not rule out cysto-biliary communication. When biliary communication is clearly shown on T2W HASTE sequences, it should be reported as cysto-biliary communication even if there is no leakage of gadoxetic acid into the cyst on CE-MRCP.
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Affiliation(s)
- Fatma Kulali
- Radiology Department, University of Health Sciences Umraniye Training and Research Hospital, Adem Yavuz Street. No: 1, Umraniye, 34764, Istanbul, Turkey.
| | - Aylin Acar
- General Surgery Department, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Aslihan Semiz-Oysu
- Radiology Department, University of Health Sciences Umraniye Training and Research Hospital, Adem Yavuz Street. No: 1, Umraniye, 34764, Istanbul, Turkey
| | - Tolga Canbak
- General Surgery Department, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Kerem Tolan
- General Surgery Department, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Yasar Bukte
- Radiology Department, University of Health Sciences Umraniye Training and Research Hospital, Adem Yavuz Street. No: 1, Umraniye, 34764, Istanbul, Turkey
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Rao SX, Wang J, Wang J, Jiang XQ, Long LL, Li ZP, Li ZL, Shen W, Zhao XM, Hu DY, Zhang HM, Zhang L, Huan Y, Liang CH, Song B, Zeng MS. Chinese consensus on the clinical application of hepatobiliary magnetic resonance imaging contrast agent: Gadoxetic acid disodium. J Dig Dis 2019; 20:54-61. [PMID: 30693659 DOI: 10.1111/1751-2980.12707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/27/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Sheng Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Jin Wang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xin Qing Jiang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Li Ling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Zi Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Zhen Lin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Xin Ming Zhao
- Department of Diagnostic Imaging, Chinese Academy of Medical Sciences Cancer Hospital, Beijing, China
| | - Dao Yu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hui Mao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Lin Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yi Huan
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Chang Hong Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guanggong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Meng Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China
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Arslan MF, Haliloğlu N, Erden A. MR cholangiopancreatography findings of biliary tract complications after liver
transplantation. Turk J Med Sci 2018; 48:1006-1012. [PMID: 30384568 DOI: 10.3906/sag-1803-68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: We aimed to present the magnetic resonance cholangiopancreatography (MRCP) findings of biliary tract complications after liver transplantation. Materials and methods: Seventy-five patients who underwent MRCP in our department between July 2011 and July 2015 after liver transplantation were retrospectively evaluated. The MRCP images were reevaluated by three radiologists in consensus. Diagnostic confirmation of MRCP findings was obtained with direct cholangiographic examinations or with clinical, radiological, and laboratory findings and concordance between MRCP findings and the final diagnosis was investigated. Results: Twenty-seven of the 75 patients had normal MRCP findings and at least one type of biliary tract complication was detected on the MR images of 48 patients. These complications included anastomotic stricture, dilatation of the biliary tract, nonanastomotic stricture, biliary leakage, cholangitis, biloma, abscess due to cholangitis, biliary stone-sludge, and donor-to-recipient bile duct disproportion. Thirty of the 75 patients were followed only by clinical and laboratory findings without further imaging. Forty-five patients underwent direct cholangiographic examinations. At the end of the follow-up period, 28 of the 75 patients were considered free of biliary tract complications, and at least one bile duct complication was diagnosed in 47 patients. Conclusion: With its high sensitivity and specificity, MRCP should be the first choice of method in the diagnosis and follow-up of biliary complications after liver transplantation.
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Fahlenkamp UL, Adams LC, Böker SM, Engel G, Huynh Anh M, Wagner M, Hamm B, Makowski MR. Feasibility of gadoxetate disodium enhanced 3D T1 MR cholangiography (MRC) with a specific inversion recovery prepulse for the assessment of the hepatobiliary system. PLoS One 2018; 13:e0203476. [PMID: 30183778 PMCID: PMC6124795 DOI: 10.1371/journal.pone.0203476] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/21/2018] [Indexed: 11/30/2022] Open
Abstract
Aim To compare the potential of a gadoxetate disodium enhanced navigator-triggered 3D T1 magnetic-resonance cholangiography (MRC) sequence with a specific inversion recovery prepulse to T2-weighted MRCP for assessment of the hepatobiliary system. Materials and methods 30 patients (12 male, 18 female) prospectively underwent conventional navigator-triggered 3D turbo spin-echo T2-weighted MRCP and 3D T1 MRC with a specific inversion pulse to minimise signal from the liver 30 minutes after administration of gadoxetate disodium on a 1.5 T MRI system. For qualitative evaluation, biliary duct depiction was assessed segmentally following a 5-point Likert scale. Visualisation of hilar structures as well as image quality was recorded. Additionally, the extrahepatic bile ducts were assessed quantitatively by calculation of signal-to-noise ratios (SNR). Results The advantages of T1 3D MRC include reduced affection of image quality by bowel movement and robust depiction of the relative position of the extrahepatic bile ducts in relation to the portal vein and the duodenum compared to T2 MRCP. However, overall T1 3D MRC did not significantly (p > 0.05) improve the biliary duct depiction compared to T2 MRCP in all segments: Common bile duct 4.1 vs. 4.4, right hepatic duct 3.6 vs. 4.2, left hepatic duct 3.5 vs. 4.1. Image quality did not differ significantly (p > 0.05) between both sequences (3.6 vs. 3.5). SNR measurements for the hepatobiliary system did not differ significantly (p > 0.05) between navigator-triggered T1 3D MRC and T2 MRCP. Conclusions This preliminary study demonstrates that T1 3D MRC of a specific inversion recovery prepulse has potential to complement T2 MRCP, especially for the evaluation of liver structures close to the hilum in the diagnostic work-up of the biliary system in patients receiving gadoxetate disodium.
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Affiliation(s)
- Ute Lina Fahlenkamp
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | | | - Sarah Maria Böker
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Günther Engel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Minh Huynh Anh
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Wagner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Lin CJ, Lee SL, Wang WH, Hovhannisyan VA, Huang YD, Lee HS, Dong CY. Multiphoton dynamic imaging of the effect of chronic hepatic diseases on hepatobiliary metabolism in vivo. J Biophotonics 2018; 11:e201700338. [PMID: 29388745 DOI: 10.1002/jbio.201700338] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/29/2018] [Indexed: 05/18/2023]
Abstract
In this study, intravital multiphoton microscopy was used to quantitatively investigate hepatobiliary metabolism in chronic pathologies of the liver. Specifically, through the use of the probe molecule 6-carboxyfluorescein diacetate, the effects of liver fibrosis, fatty liver, and hepatocellular carcinoma on the metabolic capabilities of mouse liver were investigated. After the acquisition of time-lapse images, a first order kinetic model was used to calculate rate constant resolved images of various pathologies. It was found that the ability of the liver to metabolically process the probe molecules varies among different pathologies, with liver fibrosis and fatty liver disease negatively impacted the uptake, processing, and excretion of molecules. The approach demonstrated in this work allows the study of the response of hepatic functions to different pathologies in real time and is useful for studying processes such as pharmacokinetics through direct optical imaging.
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Affiliation(s)
- Chih-Ju Lin
- Department of Physics, National Taiwan University, Taipei, Taiwan
| | - Sheng-Lin Lee
- Department of Physics, National Taiwan University, Taipei, Taiwan
| | - Wei-Hsiang Wang
- Department of Physics, National Taiwan University, Taipei, Taiwan
| | | | - Yao-De Huang
- Department of Physics, National Taiwan University, Taipei, Taiwan
| | - Hsuan-Shu Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Yuan Dong
- Department of Physics, National Taiwan University, Taipei, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
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Sugimoto M, Takagi T, Suzuki R, Konno N, Asama H, Sato Y, Irie H, Watanabe K, Nakamura J, Kikuchi H, Waragai Y, Takasumi M, Hikichi T, Ohira H. Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail. World J Gastroenterol 2018; 24:2392-2399. [PMID: 29904246 PMCID: PMC6000294 DOI: 10.3748/wjg.v24.i22.2392] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/27/2018] [Revised: 03/29/2018] [Accepted: 05/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the location to which a pancreatic stent should be inserted to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
METHODS Over a ten-year period at our hospital, 296 patients underwent their first ERCP procedure and had a pancreatic stent inserted; this study included 147 patients who had ERCP performed primarily for biliary investigation and had a pancreatic stent inserted to prevent PEP. We divided these patients into two groups: 131 patients with a stent inserted into the pancreatic head (head group) and 16 patients with a stent inserted up to the pancreatic body or tail (body/tail group). Patient characteristics and ERCP factors were compared between the groups.
RESULTS Pancreatic amylase isoenzyme (p-AMY) levels in the head group were significantly higher than those in the body/tail group [138.5 (7.0-2086) vs 78.5 (5.0-1266.5), P = 0.03] [median (range)]. No cases of PEP were detected in the body/tail group [head group, 12 (9.2%)]. Of the risk factors for post-ERCP hyperamylasemia (≥ p-AMY median, 131 IU/L), procedure time ≥ 60 min [odds ratio (OR) 2.65, 95%CI: 1.17-6.02, P = 0.02) and stent insertion into the pancreatic head (OR 3.80, 95%CI: 1.12-12.9, P = 0.03) were identified as independent risk factors by multivariate analysis.
CONCLUSION Stent insertion up to the pancreatic body or tail reduces the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Naoki Konno
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Yuki Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Hiroki Irie
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Ko Watanabe
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1247, Japan
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1247, Japan
| | - Hitomi Kikuchi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1247, Japan
| | - Yuichi Waragai
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1247, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima 960-1247, Japan
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Rao HB, Prakash A, Sudhindran S, Venu RP. Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions. World J Gastroenterol 2018; 24:2061-2072. [PMID: 29785075 PMCID: PMC5960812 DOI: 10.3748/wjg.v24.i19.2061] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 03/28/2018] [Revised: 04/28/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023] Open
Abstract
Biliary stricture complicating living donor liver transplantation (LDLT) is a relatively common complication, occurring in most transplant centres across the world. Cases of biliary strictures are more common in LDLT than in deceased donor liver transplantation. Endoscopic management is the mainstay for biliary strictures complicating LDLT and includes endoscopic retrograde cholangiography, sphincterotomy and stent placement (with or without balloon dilatation). The efficacy and safety profiles as well as outcomes of endoscopic management of biliary strictures complicating LDLT is an area that needs to be viewed in isolation, owing to its unique set of problems and attending complications; as such, it merits a tailored approach, which is yet to be well established. The diagnostic criteria applied to these strictures are not uniform and are over-reliant on imaging studies showing an anastomotic narrowing. It has to be kept in mind that in the setting of LDLT, a subjective anastomotic narrowing is present in most cases due to a mismatch in ductal diameters. However, whether this narrowing results in a functionally significant narrowing is a question that needs further study. In addition, wide variation in the endotherapy protocols practised in most centres makes it difficult to interpret the results and hampers our understanding of this topic. The outcome definition for endotherapy is also heterogenous and needs to be standardised to allow for comparison of data in this regard and establish a clinical practice guideline. There have been multiple studies in this area in the last 2 years, with novel findings that have provided solutions to some of these issues. This review endeavours to incorporate these new findings into the wider understanding of endotherapy for biliary strictures complicating LDLT, with specific emphasis on diagnosis of strictures in the LDLT setting, endotherapy protocols and outcome definitions. An attempt is made to present the best management options currently available as well as directions for future research in the area.
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Affiliation(s)
- Harshavardhan B Rao
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita University, Kochi 682041, India
| | - Arjun Prakash
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita University, Kochi 682041, India
| | - Surendran Sudhindran
- Department of Transplant and Vascular Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi 682041, India
| | - Rama P Venu
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita University, Kochi 682041, India
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Pugliese V, Antonelli G, Vincenti M, Gatteschi B. Endoductal Tissue Sampling of Biliary Strictures through Endoscopic Retrograde Cholangiopan Creatography (ERCP). Tumori 2018; 83:698-702. [PMID: 9267491 DOI: 10.1177/030089169708300314] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim and background Pathological proof of malignant in biliary strictures is useful in the preoperative setting as it helps define therapeutic planning and prognosis, and reduces the length of the subsequent surgical intervention. However, it is difficult to obtain. The aim of this study was to evaluate the yield of histological and cytological examination of endobiliary samples obtained during endoscopic retrograde cholangiopancreatography (ERCP). Methods Endobiliary forceps biopsy and brush cytology were performed during ERCP examination in 52 consecutive patients, 36 with malignant and 16 with benign strictures. Results Histology and cytology turned out to have the same sensitivity (53%). The gain in sensitivity achieved by combining the two techniques was limited, reaching a value of 61%. The specificity, however, was 100% for both methods. Most of the few complications observed were due to sphincterotomy and subsided spontaneously or with medical treatment. However, one patient experienced a serious complication and chose to be treated by surgical intervention. The complication was caused by forceps biopsy. Conclusions This study shows that 1) sampling of biliary strictures during ERCP is the primary approach to tissue diagnosis; 2) brush cytology alone is sufficient in clinical practice; 3) forceps biopsy must always be used to sample intra-ampullary strictures but should be considered as a secondary step to sample strictures located more proximally, in the bile ducts, if previous cytology was negative.
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Affiliation(s)
- V Pugliese
- Dipartimento di Oncologia, Università degli Studi, Genova, Italy
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Naseer M, Dailey FE, Juboori AA, Samiullah S, Tahan V. Epidemiology, determinants, and management of AIDS cholangiopathy: A review. World J Gastroenterol 2018; 24:767-774. [PMID: 29467548 PMCID: PMC5807936 DOI: 10.3748/wjg.v24.i7.767] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 12/24/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 02/06/2023] Open
Abstract
Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus (HIV), and its advanced state, acquired immunodeficiency syndrome (AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to anti-retroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management.
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Affiliation(s)
- Maliha Naseer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Francis E Dailey
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Alhareth Al Juboori
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Sami Samiullah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Veysel Tahan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
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Abstract
Fasciola hepatica is an endemic trematode that affects millions of people worldwide. The human being can be an accidental host through consumption of contaminated food or water. The authors present a case of hepatic fascioliasis in a 69-year-old Portuguese woman who recently traveled from Egypt, Brazil, and India.
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Affiliation(s)
- Aires Martins
- Cirurgia Geral da Unidade Local de Saúde do Alto Minho, Hospital de Santa Luzia, Estrada de Santa Luzia, Viana do Castelo, Portugal.
- , Rua dos Valados, 54 Aldeia - Dem, 4910-186, Caminha, Portugal.
| | - Álvaro Gonçalves
- Cirurgia Geral da Unidade Local de Saúde do Alto Minho, Hospital de Santa Luzia, Estrada de Santa Luzia, Viana do Castelo, Portugal
| | - Teresa Almeida
- Cirurgia Geral da Unidade Local de Saúde do Alto Minho, Hospital de Santa Luzia, Estrada de Santa Luzia, Viana do Castelo, Portugal
| | - Luís Lopes
- Cirurgia Geral da Unidade Local de Saúde do Alto Minho, Hospital de Santa Luzia, Estrada de Santa Luzia, Viana do Castelo, Portugal
| | - Alberto Midões
- Cirurgia Geral da Unidade Local de Saúde do Alto Minho, Hospital de Santa Luzia, Estrada de Santa Luzia, Viana do Castelo, Portugal
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Revzin MV, Scoutt LM, Garner JG, Moore CL. Right Upper Quadrant Pain: Ultrasound First! J Ultrasound Med 2017; 36:1975-1985. [PMID: 28586152 DOI: 10.1002/jum.14274] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/27/2017] [Indexed: 06/07/2023]
Abstract
Acute right upper quadrant (RUQ) pain is a common presenting symptom in emergency departments and outpatient medical practices, and is most commonly attributable to biliary and hepatic pathology. Ultrasound should be used as a first-line imaging modality for the diagnosis of gallstones and cholecystitis, as it allows the differentiation of medical and surgical causes of upper abdominal pathology, and in many circumstances is sufficient to guide patient management. Knowledge of strengths and limitations of ultrasound in the evaluation of RUQ is paramount in correct diagnosis. A spectrum of RUQ pathology for which a RUQ ultrasound examination should reasonably be considered as the initial imaging modality of choice will be reviewed.
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Affiliation(s)
- Margarita V Revzin
- Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Leslie M Scoutt
- Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Joseph G Garner
- Department of Medicine and Infectious Diseases, Hospital of Central Connecticut, New Britain, Connecticut, USA
| | - Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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36
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Back SJ, Maya CL, Khwaja A. Ultrasound of congenital and inherited disorders of the pediatric hepatobiliary system, pancreas and spleen. Pediatr Radiol 2017; 47:1069-1078. [PMID: 28779194 DOI: 10.1007/s00247-017-3869-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/26/2017] [Accepted: 04/11/2017] [Indexed: 12/17/2022]
Abstract
Ultrasound is often the initial imaging examination performed of the solid organs of the pediatric abdomen. The sonographic appearance of the hepatobiliary system, pancreas and spleen changes with growth and development. This article reviews the normal US appearance of these organs in children and illustrates, through case examples, congenital and inherited conditions that affect them.
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Affiliation(s)
- Susan J Back
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Carolina L Maya
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Asef Khwaja
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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37
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Kettunen JLT, Parviainen H, Miettinen PJ, Färkkilä M, Tamminen M, Salonen P, Lantto E, Tuomi T. Biliary Anomalies in Patients With HNF1B Diabetes. J Clin Endocrinol Metab 2017; 102:2075-2082. [PMID: 28324003 DOI: 10.1210/jc.2017-00061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/06/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023]
Abstract
CONTEXT The clinical spectrum of organogenetic anomalies associated with HNF1B mutations is heterogeneous. Besides cystic kidney disease, diabetes, and various other manifestations, odd cases of mainly neonatal and posttransplantation cholestasis have been described. The biliary phenotype is incompletely defined. OBJECTIVE To systematically characterize HNF1B-related anomalies in the bile ducts by imaging with magnetic resonance imaging (MRI) or magnetic resonance cholangiopancreatography (MRCP). SETTING AND PATIENTS Fourteen patients with HNF1B mutations in the catchment area of the Helsinki University Hospital were evaluated with upper abdominal MRI and MRCP. Blood samples and clinical history provided supplemental data on the individual phenotype. MAIN OUTCOME MEASURE(S) Structural anomalies in the biliary system, medical history of cholestasis, other findings in abdominal organs, diabetes and antihyperglycemic treatment, hypomagnesemia, and hyperuricemia. RESULTS Structural anomalies of the bile ducts were found in seven of 14 patients (50%). Six patients had choledochal cysts, which are generally considered premalignant. CONCLUSIONS Structural anomalies of the biliary system were common in HNF1B mutation carriers. The malignant potential of HNF1B-associated choledochal cysts warrants further studies.
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Affiliation(s)
- Jarno L T Kettunen
- Department of Endocrinology, Abdominal Centre, Helsinki University Hospital, Helsinki 00029, Finland
- Folkhalsan Research Center; and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki 00014, Finland
| | - Helka Parviainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Päivi J Miettinen
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki 00029, Finland
| | - Martti Färkkilä
- University of Helsinki, Department of Gastroenterology, Abdominal Centre, and Helsinki University Hospital, Helsinki 00029, Finland
| | - Marjo Tamminen
- Department of Internal Medicine, Central Hospital of Kymenlaakso, Kotka 48210, Finland
| | - Pia Salonen
- Department of Pediatrics, Central Hospital of Päijät-Häme, Lahti 15850, Finland
| | - Eila Lantto
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Tiinamaija Tuomi
- Department of Endocrinology, Abdominal Centre, Helsinki University Hospital, Helsinki 00029, Finland
- Folkhalsan Research Center; and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki 00014, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki 00014, Finland
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38
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Appropriate Use Criteria for Hepatobiliary Scintigraphy in Abdominal Pain: Summary and Excerpts. J Nucl Med 2017; 58:9N-11N. [PMID: 28572300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
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Kortes N, Gnutzmann D, Konietzke P, Mayer P, Sumkauskaite M, Kauczor HU, Radeleff BA. Occlusion of a Long-Term Transpleural Biliary Drainage Tract Using a Gelatin Pledget (Hep-Plug ™). Cardiovasc Intervent Radiol 2017; 40:1800-1803. [PMID: 28508251 DOI: 10.1007/s00270-017-1695-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022]
Abstract
This case describes a technique used to close a long-term 14F transpleural biliary drainage catheter tract to prevent biliopleural fistula and further complications. We deployed a compressed gelatin foam pledget provided in a pre-loaded delivery device (Hep-Plug™) along the intrahepatic tissue tract for sealing it against the pleural cavity. The device used is easy to handle and gives the Interventional Radiologist the possibility to safely manage and prevent complications after percutaneous transhepatic interventions.
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Affiliation(s)
- Nikolas Kortes
- Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Daniel Gnutzmann
- Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Philip Konietzke
- Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Philipp Mayer
- Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Migle Sumkauskaite
- Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Boris A Radeleff
- Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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40
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Abstract
RATIONALE Von Hippel-Lindau (VHL) disease is a rare inherited, autosomal-dominant syndrome caused by heterozygous germline mutations in the VHL gene. VHL patients are prone to develop benign and malignant tumors and cysts in multiple organ systems involving kidneys, pancreas and central nervous system (CNS). The varied and complex clinical manifestations and radiological findings of VHL are of interest. PATIENT CONCERNS We report a 38-year-old woman with a ten-year history of VHL disease involving both pancreas and biliary system. To the best of our knowledge, direct involvement of the biliary system in VHL disease has never been reported. DIAGNOSES The diagnosis was established via computed tomography scan and was confirmed by genetic testing. INTERVENTIONS The patient chose to receive conservative treatment and was followed up by magnetic resonance cholangiopancreatography and magnetic resonance imaging examination. OUTCOMES Renal angiomas and cysts were found during follow-up and there were no evidence of malignant change of the pancreas and biliary system. LESSONS We described the first case of VHL-associated choledochal cysts and may present new visceral manifestations of VHL disease. Gastroenterologists should be aware of the clinical presentations of this rare disease for early detection of its life-threatening manifestations.
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Affiliation(s)
- Xu-Ting Zhi
- Department of General Surgery, Qilu Hospital, Shandong University
| | - Qi-Yu Bo
- Department of Operating Room, Qilu Hospital, Shandong University
| | - Feng Zhao
- Department of General Surgery, Qihe County Hospital of Traditional Chinese Medicine, Jinan, China
| | - Dong Sun
- Department of General Surgery, Qilu Hospital, Shandong University
| | - Tao Li
- Department of General Surgery, Qilu Hospital, Shandong University
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Majlesara A, Golriz M, Hafezi M, Saffari A, Stenau E, Maier-Hein L, Müller-Stich BP, Mehrabi A. Indocyanine green fluorescence imaging in hepatobiliary surgery. Photodiagnosis Photodyn Ther 2016; 17:208-215. [PMID: 28017834 DOI: 10.1016/j.pdpdt.2016.12.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [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] [Received: 11/14/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 02/08/2023]
Abstract
Indocyanine green (ICG) is a fluorescent dye that has been widely used for fluorescence imaging during hepatobiliary surgery. ICG is injected intravenously, selectively taken up by the liver, and then secreted into the bile. The catabolism and fluorescence properties of ICG permit a wide range of visualization methods in hepatobiliary surgery. We have characterized the applications of ICG during hepatobiliary surgery into: 1) liver mapping, 2) cholangiography, 3) tumor visualization, and 4) partial liver graft evaluation. In this literature review, we summarize the current understanding of ICG use during hepatobiliary surgery. Intra-operative ICG fluorescence imaging is a safe, simple, and feasible method that improves the visualization of hepatobiliary anatomy and liver tumors. Intravenous administration of ICG is not toxic and avoids the drawbacks of conventional imaging. In addition, it reduces post-operative complications without any known side effects. ICG fluorescence imaging provides a safe and reliable contrast for extra-hepatic cholangiography when detecting intra-hepatic bile leakage following liver resection. In addition, liver tumors can be visualized and well-differentiated hepatocellular carcinoma tumors can be accurately identified. Moreover, vascular reconstruction and outflow can be evaluated following partial liver transplantation. However, since tissue penetration is limited to 5-10mm, deeper tissue cannot be visualized using this method. Many instances of false positive or negative results have been reported, therefore further characterization is required.
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Affiliation(s)
- Ali Majlesara
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Mohammadreza Hafezi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arash Saffari
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Esther Stenau
- Division of Computer-assisted medical interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Maier-Hein
- Division of Computer-assisted medical interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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42
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Vlek SL, van Dam DA, Rubinstein SM, de Lange-de Klerk ESM, Schoonmade LJ, Tuynman JB, Meijerink WJHJ, Ankersmit M. Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review. Surg Endosc 2016; 31:2731-2742. [PMID: 27844236 PMCID: PMC5487840 DOI: 10.1007/s00464-016-5318-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022]
Abstract
Background Near-infrared imaging with indocyanine green (ICG) has been extensively investigated during laparoscopic cholecystectomy (LC). However, methods vary between studies, especially regarding patient selection, dosage and timing. The aim of this systematic review was to evaluate the potential of the near-infrared imaging technique with ICG to identify biliary structures during LC. Methods A comprehensive systematic literature search was performed. Prospective trials examining the use of ICG during LC were included. Primary outcome was biliary tract visualization. Risk of bias was assessed using ROBINS-I. Secondly, a meta-analysis was performed comparing ICG to intraoperative cholangiography (IOC) for identification of biliary structures. GRADE was used to assess the quality of the evidence. Results Nineteen studies were included. Based upon the pooled data from 13 studies, cystic duct (Lusch et al. in J Endourol 28:261–266, 2014) visualization was 86.5% (95% CI 71.2–96.6%) prior to dissection of Calot’s triangle with a 2.5-mg dosage of ICG and 96.5% (95% CI 93.9–98.4%) after dissection. The results were not appreciably different when the dosage was based upon bodyweight. There is moderate quality evidence that the CD is more frequently visualized using ICG than IOC (RR 1.16; 95% CI 1.00–1.35); however, this difference was not statistically significant. Conclusion This systematic review provides equal results for biliary tract visualization with near-infrared imaging with ICG during LC compared to IOC. Near-infrared imaging with ICG has the potential to replace IOC for biliary mapping. However, methods of near-infrared imaging with ICG vary. Future research is necessary for optimization and standardization of the near-infrared ICG technique. Electronic supplementary material The online version of this article (doi:10.1007/s00464-016-5318-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S L Vlek
- Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - D A van Dam
- Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - S M Rubinstein
- Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands
| | | | - L J Schoonmade
- Medical Library, VU University, Amsterdam, The Netherlands
| | - J B Tuynman
- Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - W J H J Meijerink
- Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - M Ankersmit
- Department of Surgery, VU University Medical Centre, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
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Abstract
Purpose: To prospectively evaluate the interobserver agreement in US examination of the gallbladder and the biliary tract performed by an experienced and a novice radiologist. Material and Methods: Fifty consecutive patients underwent US examination because of clinically suspected gallstones. The examination was performed by a consultant and a trainee radiologist on the same day. The following outcome measures were registered: presence of gallstones, filling of the gallbladder, thickness of the gallbladder wall, splitting of the gallbladder wall, fluid around the gallbladder, diameter of the common bile duct (CBD), and presence of CBD stones. Results: None of the radiologists observed CBD stones or fluid around the gallbladder. The CBD was clearly distinguished by both observers in all patients. There was good agreement in the conclusions of the two radiologists regarding the presence of gallbladder stones and substantial agreement regarding the filling of the gallbladder and splitting of the gallbladder wall. Significant difference existed in the measurements by the two radiologists regarding the thickness of the gallbladder wall and the diameter of the CBD. Conclusion: The novice radiologist's expertise in the primary diagnosis of uncomplicated gallstone disease was as good as the one provided by the experienced colleague. The significant interobserver difference in the measurements of the thickness of the gallbladder wall and the CBD diameter might indicate that assessment of these parameters requires extensive practise and the opinion of an experienced colleague must be sought in cases where complications are suspected.
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Affiliation(s)
- Teodor P Grantcharov
- Department of Surgical Gastroenterology 435, University of Copenhagen, Hvidovre Hospital, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark
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44
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Abstract
Aim: To analyse if preoperative radiology is of value in patients with uncomplicated gallstone disease. Material: 312 patients intended for laparoscopic cholecystectomy were randomly allocated to undergo preoperative radiology (intravenous cholangiography or magnetic resonance cholangiography) or to a control group. Intraoperative cholangiography was not used routinely in either group. Results: There was no bile duct injury and no difference in complication frequency between the two groups. The incidence of common bile duct stones was 3,8 % within the first postoperative year with no statistical difference between the two groups. Conclusions: Routine preoperative evaluation of the bile tree seems unnecessary before laparoscopic cholecystectomy in patients with uncomplicated gallstone disease.
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Affiliation(s)
- J Järhult
- Centre for Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden.
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45
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Odagiri H. [6. Inspection of Hepatocellular Carcinoma 4: Nuclear Medicine Scan]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:522-529. [PMID: 27320156 DOI: 10.6009/jjrt.2016_jsrt_72.6.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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46
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Abstract
In this pictorial essay, we review the 3-dimensional sonographic appearance of the normal gallbladder and biliary tree, as well as the appearance of congenital and acquired biliary tract disorders. Using examples, we demonstrate the advantage of 3-dimensional scanning compared with 2-dimensional sonography and, even in certain cases, magnetic resonance cholangiopancreatography.
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Affiliation(s)
- Susan J Frank
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York USA
| | - Jessica Kurian
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York USA
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47
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Koizumi K, Sasajima J, Kawamoto T, Sugiyama Y, Muto M, Muto M, Ishikawa C, Inoue M, Kohgo Y. Multiple Cancers of the Biliary Tract and Pancreatic Duct after Cholecystectomy for Gallbladder Cancer in a Patient with Pancreaticobiliary Maljunction. Intern Med 2016; 55:141-6. [PMID: 26781013 DOI: 10.2169/internalmedicine.55.4706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Indexed: 11/06/2022] Open
Abstract
We herein report the rare case of a 76-year-old woman who underwent cholecystectomy with bile duct resection for advanced gallbladder cancer associated with pancreaticobiliary maljunction (PBM) and subsequently developed multiple cancers of the pancreaticobiliary system (the distal bile duct, intrahepatic duct and pancreatic duct) after the operation. We performed conventional endoscopic retrograde cholangiopancreatography (ERCP) using a side-viewing scope to evaluate the masses in the distal bile duct and the pancreatic duct. We also performed ERCP using double-balloon enteroscopy (DBE) to observe the mass in the intrahepatic duct. It was possible to directly observe the lesion using DBE and to perform a biopsy under visual control. All lesions were correctly diagnosed by the combination of ERCP using different endoscopes. The present case suggests that it is necessary to pay close attention (with regard to carcinogenesis) to the whole pancreaticobiliary system in patients with PBM. In addition, the combination of ERCP using DBE and a side-viewing scope may be useful for making a precise diagnosis in patients with altered biliary anatomy who have multiple cancers of the pancreaticobiliary system.
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Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
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48
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Hiraga M. [Ultrasound Examination of the Abdomen]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:1185-1193. [PMID: 27867180 DOI: 10.6009/jjrt.2016_jsrt_72.11.1185] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Masao Hiraga
- Kirishima City Medical Association Medical Center
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49
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Yamaguchi H, Kosugiyama K, Honda S, Tadao O, Taketomi A, Iwata S. Down Syndrome with Patent Ductus Venosus and Hepato-Biliary-Pancreatic Abnormalities. Indian J Pediatr 2016; 83:78-80. [PMID: 26096864 DOI: 10.1007/s12098-015-1797-0] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 05/18/2015] [Indexed: 11/27/2022]
Abstract
The association between Down syndrome and congenital portosystemic shunts, most commonly caused by patent ductus venosus, remains relatively unknown. The authors present a girl with Down syndrome with patent ductus venosus, pancreaticobiliary maljunction and paucity of interlobular bile ducts, presenting with neonatal cholestasis and transient abnormal myeloproliferative disorder. To the best of authors' knowledge, no report of the concurrent presence of the above in Down syndrome has been published.
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Affiliation(s)
- Hiroshi Yamaguchi
- Department of Pediatrics, Teine Keijinkai Hospital, 1 Jo 12-1-40, Maeda, Teine-ku, Sapporo, Japan.
| | - Kiyotaka Kosugiyama
- Department of Pediatrics, Teine Keijinkai Hospital, 1 Jo 12-1-40, Maeda, Teine-ku, Sapporo, Japan
| | - Shohei Honda
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan
| | - Okada Tadao
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan
| | - Seido Iwata
- Department of Pediatrics, Teine Keijinkai Hospital, 1 Jo 12-1-40, Maeda, Teine-ku, Sapporo, Japan
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Mulaik MW. It's That Time of Year. Radiol Manage 2015; 37:33-39. [PMID: 26713345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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