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Zhang T, Shu Y, Weng H, Weng M, Zhou Y, Cai W, Wang X. A therapeutic ERCP in an only 5.9 kg infant with obstruction jaundice using JF-260V duodenoscope. BMC Pediatr 2024; 24:281. [PMID: 38678261 PMCID: PMC11055377 DOI: 10.1186/s12887-024-04765-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) has found extensive use in pediatric patients; however, challenges persist in the application of therapeutic ERCP in infants. CASE PRESENTATION This case report details the presentation of a 5.9-kilogram infant with obstructive jaundice and suspected hemolytic anemia who underwent ERCP to alleviate biliary obstruction. The infant was admitted due to clay-colored stools, jaundice, and liver injury. Ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed dilation of the common bile duct (CBD) accompanied by the presence of stones. ERCP was conducted using a JF-260V duodenoscope under general anesthesia. Successful stone extraction and biliary drainage were achieved. CONCLUSIONS In centers with considerable expertise in ERCP and pediatric anesthesia, the use of a conventional adult duodenoscope for therapeutic ERCP in infants can be considered safe and feasible, provided careful and stringent patient selection criteria are applied. In the future, clear guidelines and standardized protocols for the indications and procedures of pediatric ERCP should be established.
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Affiliation(s)
- Tian Zhang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Street, Shanghai, 200092, China
| | - Yijun Shu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Street, Shanghai, 200092, China
| | - Hao Weng
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Street, Shanghai, 200092, China
| | - Mingzhe Weng
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Street, Shanghai, 200092, China
| | - Ying Zhou
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Street, Shanghai, 200092, China
| | - Wei Cai
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Street, Shanghai, 200092, China
| | - Xuefeng Wang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Street, Shanghai, 200092, China.
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Carboni Bisso I, Navarro Rey L, González Anaya J, Fernández Ceballos I, Las Heras M. Tracheobronchial jaundice. Medicina (B Aires) 2024; 84:393. [PMID: 38683535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Affiliation(s)
- Indalecio Carboni Bisso
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. E-mail:
| | - Leiniker Navarro Rey
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Julieta González Anaya
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Marcos Las Heras
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Liu XL, Tian H. A Duodenal Diverticulum Causing Obstructive Jaundice in a 68-Year-Old Man. Dig Dis Sci 2023; 68:4277-4278. [PMID: 37794294 DOI: 10.1007/s10620-023-08037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Xin-Liang Liu
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Hu Tian
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, Shandong, China.
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Huang C, Luo J. Obstructive Jaundice Due to Primary Duodenal Lymphoma. Radiology 2023; 309:e231559. [PMID: 38051192 DOI: 10.1148/radiol.231559] [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: 12/07/2023]
Affiliation(s)
- Cong Huang
- From the Department of Radiology, No. 926 Hospital, Joint Logistics Support Force of PLA, No. 147 Jianmin Rd, Kaiyuan, Yunnan 661699, China
| | - Junde Luo
- From the Department of Radiology, No. 926 Hospital, Joint Logistics Support Force of PLA, No. 147 Jianmin Rd, Kaiyuan, Yunnan 661699, China
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Mukai S, Itoi T. Preoperative endoscopic ultrasound-guided biliary drainage for primary drainage in obstructive jaundice. Expert Rev Gastroenterol Hepatol 2023; 17:1197-1204. [PMID: 38124621 DOI: 10.1080/17474124.2023.2293813] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Endoscopic transpapillary approach by endoscopic retrograde cholangiopancreatography (ERCP) is the established technique for preoperative biliary drainage (PBD). Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been reported to be a useful alternative technique after ERCP fail. However, the optimal strategy remain controversial. AREA COVERED This review summarizes the literature on EUS-BD techniques for PBD with a literature search using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials database between 2000 and 2023 using keywords for 'preoperative biliary drainage' and all types of EUS-BD techniques. EXPERT OPINION As there is no consensus on the optimal EUS-BD technique for PBD, selection of the EUS-BD approach depends on the patient's condition, the biliary obstruction site, the anastomosis after surgical intervention, and the preference of the endoscopist. However, we consider that EUS-HGS using a dedicated plastic stent may have some advantages in the adverse impact of surgical procedure because the location where the fistula is created by EUS-HGS is away from the site of the surgical procedure. Although there remain many issues that require further investigation, EUS-BD can be a feasible and safe alternative method of PBD for malignant biliary obstruction after ERCP fail.
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Affiliation(s)
- Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Jalili J, Javadrashid R, Alvandfar D, Falahatian M, Jafarizadeh A, Alihosseini S, Hashemizadeh SE. Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature. J Med Case Rep 2023; 17:385. [PMID: 37689729 PMCID: PMC10493028 DOI: 10.1186/s13256-023-04114-6] [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: 11/26/2022] [Accepted: 08/03/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Obstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS). CASE PRESENTATION The patient was a 77-year-old Azeri woman who presented with progressive jaundice, vague abdominal pain, and abdominal distension from 6 months ago. The intra- and extrahepatic bile ducts were dilated, the liver's margin was slightly irregular, and the echogenicity of the liver was mildly heterogeneous in the initial ultrasound exam. A huge cystic mass with peripheral calcification and compressive effect on the common bile duct (CBD) was also seen near the pancreatic head, which was connected to the superior mesenteric artery (SMA) and had internal turbulent blood flow on color Doppler ultrasound. According to the computed tomography angiography (CTA) findings, the huge mass of the pancreatic head was diagnosed as a true aneurysm of the pancreaticoduodenal artery caused by MALS. Two similar smaller aneurysms were also present at the huge aneurysm's superior margin. Due to impending rupture signs in the huge aneurysm, the severe compression effect of this aneurysm on CBD, and the patient's family will surgery was chosen for the patient to resect the aneurysms, but unfortunately, the patient died on the first day after the operation due to hemorrhagic shock. CONCLUSION In unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas, PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen (including transarterial embolization, open surgery, or combined method) depends on the patient's clinical status and radiological findings, but transarterial embolization would be safer and should be used as a first-line method.
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Affiliation(s)
- Javad Jalili
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Javadrashid
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dara Alvandfar
- Department of General Surgery, Emam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masih Falahatian
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Jafarizadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samin Alihosseini
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyedeh Elnaz Hashemizadeh
- Department of Surgical and Clinical Pathology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Sugiura R, Kuwatani M, Nishida M, Satoh M, Kawakubo K, Kato S, Hirata K, Nakajima M, Hirata H, Takishin Y, Sakamoto N. Significance of Shear Wave Dispersion Slope Values Before Versus After Biliary Drainage in Patients With Obstructive Jaundice: A Single-Center Prospective Observational Cohort Study. Ultrasound Q 2023; 39:152-157. [PMID: 37227117 DOI: 10.1097/ruq.0000000000000644] [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: 05/26/2023]
Abstract
ABSTRACT The shear wave dispersion (SWD) slope has become available in the clinical practice and is related to tissue viscosity. However, clinical evaluation using SWD was not yet performed for obstructive jaundice. We aimed to evaluate the change of SWD values between before and after biliary drainage in patients with obstructive jaundice. This prospective observational cohort study evaluated 20 patients with obstructive jaundice who underwent biliary drainage. The SWD and liver elasticity values were measured before versus after biliary drainage, comparing between days -5 and 0 (day 0), days 1 and 3 (day 2), and days 6 and 8 (day 7). The mean ± SD values of SWD measured at day 0, day 2, and day 7 were 15.3 ± 2.7, 14.2 ± 3.3, and 13.3 ± 2.4 m/s/kHz, respectively. Dispersion slope values were decreased significantly from day 0 to day 2, from day 2 to day 7, and from day 0 to day 7 ( P < 0.05). Liver elasticity levels and serum hepatobiliary enzymes were additionally decreased significantly over time after biliary drainage. The correlations between SWD and liver elasticity values were strong ( r = 0.91, P < 0.01). In conclusion, t he SWD values decreased significantly over time after biliary drainage concomitant with liver elasticity.
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Affiliation(s)
- Ryo Sugiura
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | | | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Megumi Satoh
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Shin Kato
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Koji Hirata
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Masahito Nakajima
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Hajime Hirata
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Yunosuke Takishin
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University, Faculty of Medicine and Graduate School of Medicine
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Jiang W, Fu X, Wang G, Qi H, Chen Z, Gao F. Effect of Biliary Tract Invasion with Obstructive Jaundice on the Prognosis of Patients With Unresectable Hepatocellular Carcinoma. Acad Radiol 2023; 30:483-491. [PMID: 36150964 DOI: 10.1016/j.acra.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES Biliary tract invasion (BTI) is associated with poor outcomes in patients with hepatocellular carcinoma (HCC). However, the presence of a BTI is a neglected variable for staging in the current guidelines. This study aimed to explore the effects of BTI with obstructive jaundice on the prognosis of patients with unresectable HCC. METHODS We retrospectively included 205 patients initially diagnosed with unresectable HCC who presented with obstructive jaundice due to BTI between January 2010 and June 2021. BTI was classified into four types according to the location of the biliary obstruction. Both clinical and treatment factors that affect median overall survival (mOS) were analyzed. RESULTS The mOS of patients with Barcelona Clinic Liver Cancer (BCLC) stages B, C, and D was 9.2 months, 3.4 months, and 1.8 months, respectively (p<.001). The mOS of BTI type I patients was superior to that of BTI type II patients (7.1 months vs. 3.2 months, p=.002). Patients who underwent successful biliary drainage had a longer mOS than those who underwent unsuccessful biliary drainage (10.4 months vs. 2.9 months, p<.001). In the multivariate analysis, BTI type I (p=.009), successful biliary drainage (p=.005), and HCC treatment (p<.001) were significant favorable prognostic factors that affected patient survival. CONCLUSION HCC patients with BTI type II may have a poorer prognosis than those with BTI type I. Effective biliary drainage and anti-cancer treatment may provide survival benefits to these patients. A more detailed staging system for HCC based on the state of BTI is needed.
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Affiliation(s)
- Weiwei Jiang
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaobo Fu
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Guobao Wang
- Department of Endoscopy, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Han Qi
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Zixiong Chen
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Fei Gao
- Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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Kusano Y, Shintani S, Inatomi O, Takeda Y, Otsuka T, Matsumoto H, Fujimoto T, Takahashi K, Bamba S, Andoh A. [A case of obstructive jaundice due to the movement of pancreatic calculi]. Nihon Shokakibyo Gakkai Zasshi 2022; 119:573-579. [PMID: 35691928 DOI: 10.11405/nisshoshi.119.573] [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: 06/15/2023]
Abstract
A 44-year-old man with a history of chronic alcoholic pancreatitis and Crohn's disease presented with abdominal pain. Computed tomography revealed pancreatic calculi in the head of the pancreas and a dilated pancreatic duct. The patient was diagnosed with an acute exacerbation of chronic pancreatitis due to the impact of pancreatic calculi on the main pancreatic duct. During the clinical course, the movement of pancreatic calculi to the major papilla was confirmed, leading to obstructive jaundice. Endoscopic treatment with sphincterotomy of the pancreatic duct was successful. Herein, we report the case of an unusual clinical course involving obstructive jaundice caused by the movement of pancreatic calculi.
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Affiliation(s)
- Yujin Kusano
- Department of Clinical Education Center, Shiga University of Medical Science
| | - Shuhei Shintani
- Department of Gastroenterology, Shiga University of Medical Science
| | - Osamu Inatomi
- Department of Gastroenterology, Shiga University of Medical Science
| | - Yoshiya Takeda
- Department of Gastroenterology, Shiga University of Medical Science
| | - Taketo Otsuka
- Department of Gastroenterology, Shiga University of Medical Science
| | | | | | | | - Shigeki Bamba
- Department of Endoscopy, Shiga University of Medical Science
| | - Akira Andoh
- Department of Gastroenterology, Shiga University of Medical Science
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Acharya S, Ningombam A, Sarkar A. Artifacts in peripheral smear - A peculiar likeness to Plasmodium falciparum gametocyte. INDIAN J PATHOL MICR 2022; 65:215-216. [PMID: 35075003 DOI: 10.4103/ijpm.ijpm_1041_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Shreyam Acharya
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Ningombam
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhirup Sarkar
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
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Abatzis-Papadopoulos M, Karamanos D, Papoutsis I, Tigkiropoulos K, Stavridis K, Lazaridis I, Saratzis N. Obstructive Jaundice Caused by a Large Intact Abdominal Aortic Aneurysm. Case Report and Literature Review. Ann Vasc Surg 2021; 79:442.e1-442.e7. [PMID: 34656713 DOI: 10.1016/j.avsg.2021.08.018] [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: 06/13/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obstructive jaundice caused by abdominal aortic aneurysm (AAA) is an extremely rare clinical presentation. We present an 85-year-old male with a large intact AAA causing obstructive jaundice and review the relevant literature. METHODS AND RESULTS The patient was referred to our hospital with jaundice and a palpable pulsatile abdominal mass. Computerized tomography (CT) angiogram and magnetic resonance cholangiopancreatography (MRCP) revealed an infrarenal AAA with maximal diameter of 8.5 cm compressing the pancreatic head and common bile duct, causing obstructive jaundice with elevated levels of total, and direct bilirubin. The patient was subjected to endovascular aneurysm repair (EVAR). Blood bilirubin gradually decreased to normal levels. No complications were reported during the immediate postoperative and at 3-month follow up period. Literature review suggests that our case is one of the largest intact AAAs which have been reported to cause biliary obstruction. CONCLUSIONS AAAs causing secondary obstructive jaundice is an uncommon clinical presentation requiring high clinical suspicion during differential diagnosis, so that patients can receive proper and early diagnosis and treatment.
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Affiliation(s)
- Manolis Abatzis-Papadopoulos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece.
| | - Dimitrios Karamanos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Ioakeim Papoutsis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Tigkiropoulos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Kyriakos Stavridis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Ioannis Lazaridis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Nikolaos Saratzis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
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Karki S, Phuyal A, Paudel RC, Bhandari A, Dahal MR. Role of Magnetic Resonance Cholangiopancreatography in the Evaluation of Obstructive Jaundice. Kathmandu Univ Med J (KUMJ) 2021; 19:35-40. [PMID: 34812155] [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: 06/13/2023]
Abstract
Background Magnetic Resonance Cholangiopancreatography is a reliable and highly sensitive imaging modality in the diagnosis of Obstructive jaundice. Objective To evaluate the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography as compared to Endoscopic Retrograde Cholangiopancreatography. Method A prospective, analytical study was conducted in the Department of Radiodiagnosis and Imaging at Dhulikhel Hospital between October 2018 and December 2020. Altogether 100 patients of all ages with obstructive jaundice undergoing Magnetic Resonance Cholangiopancreatography and Endoscopic Retrograde Cholangiopancreatography were included. The causes of obstructive jaundice as identified by Magnetic Resonance Cholangiopancreatography were compared to that of Endoscopic Retrograde Cholangiopancreatography considering Endoscopic Retrograde Cholangiopancreatography as gold standard for the diagnosis. Result Magnetic Resonance Cholangiopancreatography revealed choledocholithiasis in 60 (60%) patients, benign stricture - 14(14%), malignant stricture-11(11%), periampullary carcinoma in 8(8%) and normal study in 4(4%) patients. Endoscopic Retrograde Cholangiopancreatography showed choledocholithiasis in 59(59%) patients, strictures (benign in 13%, malignant in 10%), ascariasis in 3(3%) and normal findings in 5(5%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of Magnetic Resonance Cholangiopancreatography in detecting choledocholithiasis were 96.6%, 92.3%, 95%, and 95%. The same values for benign strictures were 92.3%, 97.7%, 85.7% and 98.9%, whereas those for malignant strictures were 90.9%, 98.8%, 90.9% and 98.8%. All values were 100% for peri-ampullary carcinoma and ascariasis. Hence, Magnetic Resonance Cholangiopancreatography showed good accuracy for detecting causes of obstructive jaundice (p < 0.05) as compared to Endoscopic Retrograde Cholangiopancreatography. Conclusion Magnetic Resonance Cholangiopancreatography is an accurate, non-invasive technique in evaluation of obstructive jaundice and offers similar diagnostic value compared to Endoscopic Retrograde Cholangiopancreatography.
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Affiliation(s)
- S Karki
- Department of Radiodiagnosis and Imaging, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A Phuyal
- Department of Radiodiagnosis and Imaging, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - R C Paudel
- Department of Radiodiagnosis and Imaging, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - A Bhandari
- Department of Radiodiagnosis and Imaging, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - M R Dahal
- Department of Radiodiagnosis and Imaging, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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13
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Angelescu M, Enciu O, Florescu V, Miron A. Obstructive Jaundice Secondary to Clip Migration in the Common Bile Duct 9 Years after Laparoscopic Cholecystectomy. Chirurgia (Bucur) 2020; 115:526-529. [PMID: 32876027 DOI: 10.21614/chirurgia.115.4.526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 11/23/2022]
Abstract
Surgical clip migration in the common bile duct with consecutive stone formation is a rare occurrence after laparoscopic cholecystectomy, less than 100 cases being reported so far. We report a case of a 55-year-old woman with obstructive jaundice due to bile duct stone formed around a migrated surgical clip 9 years after laparoscopic cholecystectomy. The patient presented with pain in the upper abdomen and jaundice. Abdominal ultrasound diagnosed dilation of the common bile duct and intrahepatic bile ducts. The diagnosis was confirmed by computed tomography which revealed a metal clip in the distal part of the common bile duct. The patient was managed successfully by endoscopic retrograde cholangiopancreatography (ERCP) and the surgical clip was retrieved using the Dormia basket. The exact mechanism of clip migration is not fully understood but may be explained by local inflammation and ineffective clipping. Although a rare occurrence, clip migration should not be excluded when considering the differential diagnosis of patients presenting with obstructive jaundice or cholangitis after laparoscopic cholecystectomy. Minimally invasive management by ERCP is the procedure of choice for migrated clips related complications but surgical common bile duct exploration may be necessary.
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Inan I, Sirik M. Diagnostic value of the choledochal sphericity index in the diagnosis of obstructive cholestasis using magnetic resonance cholangiopancreatography. Acta Gastroenterol Belg 2020; 83:571-575. [PMID: 33321013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND STUDY AIMS Dilatation of common bile duct (CBD) is the first sign in the diagnosis of obstructive jaundice. On magnetic resonance cholangiopancreatography (MRCP), the measurement of the CBD diameter is commonly performed on the widest part of the duct, and the long axis diameter is used in clinical practice. It is aimed to investigate the role of long axis, short axis and sphericity index (SI) of CBD in the diagnosis of obstructive cholestasis. PATIENTS AND METHODS MRCP images of 68 patients who had a bile duct diameter of ≥6 mm were retrospectively evaluated. The cases with a direct bilirubin value ?0.4 mg/dl were determined to be cholestasis. Using the curved planar images, the long and short axis measurements were obtained from the widest portion of the bile duct in the transverse section and SI were obtained by calculating the ratio of the long axis over short axis. Short axis, long axis and SI was compared between cholestatic and non-cholestatic group. RESULTS The mean age of the patients was 58.97 ± 17.84. Long axis, short axis, and SI showed statistically significant difference between groups (p=0.034, p=0.001, and p=0.014, respectively). Sensitivity and specificity were 60.7% and 80% for long axis, %53.6 and 82.5% for short axis, 65% and 71.4% for SI, respectively. CONCLUSIONS In addition to the long axis measurement, evaluation of the short axis measurement and calculation of the SI on MRCP examination will help exclude physiological dilatation in the suspicion of cholestasis.
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Affiliation(s)
- I Inan
- Biruni University Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - M Sirik
- Adiyaman University Faculty of Medicine, Department of Radiology, Adiyaman, Turkey
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Jolobe OMP. More on the triad of fever, epigastric pain and cholestatic jaundice. QJM 2020; 113:447-448. [PMID: 32125416 DOI: 10.1093/qjmed/hcaa074] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hamamoto H, Hashimoto S, Taguchi H, Kojima I, Kasai A, Tsuneyoshi K, Kuwazuru K, Arima S, Kanmura S, Ido A. Eosinophilic Gastroenteritis in Which Obstructive Jaundice Developed due to Invagination of the Duodenal Wall. Intern Med 2018; 57:1841-1847. [PMID: 29434146 PMCID: PMC6064693 DOI: 10.2169/internalmedicine.9312-17] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary enzyme levels. An upper gastrointestinal endoscopic examination showed that the mucosa of the gastroduodenal wall was edematous. Eosinophilic gastroenteritis (EGE) was diagnosed based on eosinophilic infiltration of the gastroduodenal mucosa. Computed tomography showed invagination of the duodenal wall into the common bile duct. The invagination of the duodenal wall improved after conservative therapy, while bile duct drainage was impossible due to the narrowing of the duodenal lumen. EGE was successfully treated without recurrence with steroids and antiallergic therapy. We herein report a rare case of EGE with obstructive jaundice.
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Affiliation(s)
- Hitomi Hamamoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Hiroki Taguchi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Issei Kojima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Ai Kasai
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kengo Tsuneyoshi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kosuke Kuwazuru
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shiho Arima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shuji Kanmura
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
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Qian JD, Hou FQ, Wang TL, Shao C, Wang GQ. Gilbert syndrome combined with prolonged jaundice caused by contrast agent: Case report. World J Gastroenterol 2018; 24:1486-1490. [PMID: 29632429 PMCID: PMC5889828 DOI: 10.3748/wjg.v24.i13.1486] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/07/2018] [Accepted: 02/25/2018] [Indexed: 02/06/2023] Open
Abstract
This case highlights a patient with Gilbert syndrome who underwent endoscopic retrograde cholangiopancreatography (ERCP) with removal of bile duct stones, who then experienced an unexplained increase in bilirubin, with total bilirubin (TBIL) levels increasing from 159.5 μmol/L to 396.2 μmol/L and to a maximum of 502.8 μmol/L after 9 d. Following the decrease in the TBIL level, enhanced magnetic resonance cholangiopancreatography (MRCP) was performed to exclude any possible remaining choledocholithiasis. Nevertheless, the serum bilirubin level increased again, with TBIL levels rising from 455.7 μmol/L to 594.8 μmol/L and a maximum level of 660.3 μmol/L with no remaining bile duct stones. A liver biopsy showed severe bile duct cholestasis with no inflammation. Based on the exclusion of other potential causes of hyperbilirubinemia and the fact that both instances of increased bilirubin occurred after ERCP and MRCP, the contrast agents iopromide and gadoterate meglumine were suspected to be the causes of the hyperbilirubinemia. As of the writing of this report, the patient’s bilirubin levels have spontaneously returned to baseline levels. In summary, ERCP and MRCP utilizing the contrast agents iopromide and gadoterate meglumine may possibly induce prolonged hyperbilirubinemia.
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Affiliation(s)
- Jian-Dan Qian
- Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, Beijing 100034, China
| | - Feng-Qin Hou
- Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, Beijing 100034, China
| | - Tai-Ling Wang
- Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chen Shao
- Department of Pathology, Beijing YouAn Hospital Capital Medical University, Beijing 100069, China
| | - Gui-Qiang Wang
- Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, Beijing 100034, China
- The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Peking University International Hospital, Beijing 102206, China
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Nishiwaki M, Mizuno C, Yano K, Oya H, Amano I, Matsumoto J, Tanaka I, Sawai N, Mizuno M, Shima T, Miyamoto Y, Okanoue T. Retroperitoneal Perforation Caused by Migration of a Pancreatic Spontaneous Dislodgement Stent into Periampullary Diverticula. Intern Med 2018; 57:351-355. [PMID: 29093393 PMCID: PMC5827315 DOI: 10.2169/internalmedicine.9054-17] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
An 85-year-old woman underwent endoscopic retrograde cholangiopancreatography (ERCP) for obstructive jaundice. Selective bile duct cannulation was unsuccessful because of periampullary diverticula (PAD). A pancreatic spontaneous dislodgement stent (PSDS) (5F diameter, 3 cm, straight type) was inserted to prevent post-ERCP pancreatitis. Three days after ERCP, she complained of abdominal pain, and computed tomography revealed retroperitoneal perforation because of PSDS migration to the PAD. If the papillary orifice is observed at the diverticular rim or in the diverticula, a pigtailed PSDS on the duodenal side or flanged stent on the pancreatic ductal side should be inserted in order to prevent this rare adverse event.
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Affiliation(s)
- Masatake Nishiwaki
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Chiemi Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Kota Yano
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Ichiro Amano
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Junko Matsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Izumi Tanaka
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Naoki Sawai
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | | | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
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Kang MK, Park JG, Lee HJ. Cholestatic Jaundice as a Paraneoplastic Manifestation of Prostate Cancer Aggravated by Steroid Therapy. Med Princ Pract 2018; 27:197-200. [PMID: 29320775 PMCID: PMC5968241 DOI: 10.1159/000486717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/18/2017] [Accepted: 01/10/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a rare case of paraneoplastic jaundice as a manifestation of prostate cancer. CLINICAL PRESENTATION AND INTERVENTION We report on a case of paraneoplastic syndrome in a 72-year-old man with prostate cancer that manifested with idiopathic jaundice. Although steroids can be used as treatment in patients with prostate cancer, they could exacerbate paraneoplastic jaundice. The jaundice that flared up after treatment with 40 mg prednisone was improved with antiandrogen treatment. CONCLUSION Physicians should be aware of the possibility of paraneoplastic jaundice in patients with prostate cancer. Appropriate antiandrogen therapy should be considered for paraneoplastic jaundice in these patients.
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Affiliation(s)
| | - Jung Gil Park
- *Jung Gil Park, Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, 170 Hyeonchungno, Nam-gu, Daegu 42415 (Republic of Korea), E-Mail
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Whaley KG. 50 Years Ago in The Journal of Pediatrics: Cholestyramine Therapy in Patients with a Paucity of Intrahepatic Bile Ducts. J Pediatr 2017; 190:107. [PMID: 29144238 DOI: 10.1016/j.jpeds.2017.05.027] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kaitlin Gibler Whaley
- Division of Gastroenterology, Hepatology, and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
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Imam S, Islam MN, Khan NA, Mostafa SN, Amin MS, Rahman S, Akhter P. Magnetic Resonance Cholangiopancreatography (MRCP) Evaluation of Obstructive Jaundice in Comparison with Endoscopic Retrograde Cholangiopancreatography (ERCP). Mymensingh Med J 2017; 26:420-425. [PMID: 28588181] [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: 06/07/2023]
Abstract
This cross sectional study was carried out in the department of Radiology and Imaging in collaboration with Department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2014 to evaluate the efficacy of Magnetic resonance cholangiopancreatography (MRCP) and ERCP in the management of obstructive jaundice and also to determine diagnostic validity accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in evaluation of obstructive jaundice. For this purpose, a total of 60 patients with obstructive jaundice who underwent MRCP and Endoscopic retrograde cholangiopancreatography (ERCP) in the above mentioned hospital were enrolled. More than one third (35.0%) patients were in 5th decade and the mean age was 46.2±12.9 years. Male female ratio was 1.1:1. Most (45.0%) of the patients had filling defect, 28.3% had concentric stenosis and 26.7% eccentric stenosis. In MRCP findings more than one third (35.0%) patients had choledocholithiasis followed by 26.7% had cholangiocarcinoma, 10.0% benign CBD stricture and 8.3% had ascariasis. In ERCP findings 31.7% patients had choledocholithiasis followed by 16.7% had cholangiocarcinoma, 13.3% benign CBD stricture and 10.0% ascariasis. All patients had increased serum bilirubin.
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Affiliation(s)
- S Imam
- Dr Sadia Imam, Consultant, Department of Radiology & Imaging, Ibn Sina Hospital, Dhanmondi, Dhaka, Bangladesh
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22
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Hasimu A, Gu JP, Ji WZ, Zhang HX, Zhu DW, Ren WX. Comparative Study of Percutaneous Transhepatic Biliary Stent Placement with or without Iodine-125 Seeds for Treating Patients with Malignant Biliary Obstruction. J Vasc Interv Radiol 2017; 28:583-593. [PMID: 28162906 DOI: 10.1016/j.jvir.2016.11.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 06/10/2016] [Revised: 10/03/2016] [Accepted: 11/11/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To prospectively evaluate safety and efficacy of biliary stent placement with iodine-125 (125I) seeds in patients with malignant obstructive jaundice (MOJ). MATERIALS AND METHODS From July 2011 to June 2014, 55 patients were enrolled (group A, 11 men and 17 women, mean age 70.93 y ± 8.58; group B, 14 men and 13 women, mean age 70.26 y ± 9.71). All patients were randomly assigned to placement of a biliary stent with 125I seeds (group A) or biliary stent only (group B). After stent placement, outcomes were measured regarding relief of MOJ. Clinical success rate, survival time, and safety were recorded. P < .05 was considered to indicate significant difference. RESULTS Stents were successfully placed in all 55 patients. MOJ was relieved in all patients, and there were no significant differences in complications related to stent insertion between the 2 groups. Mean and median stent patency were 191 days ± 19.8 (95% confidence interval [CI], 152-230 d) and 179 days ± 191.4 (95% CI, 87-267 d) in group A and 88.3 days ± 16.3 (95% CI, 61-114 d) and 77 days ± 88.2 (95% CI, 65-86 d) in group B (P < .001, log-rank test). Mean and median survival time were 222.6 days ± 21.0 (95% CI, 181-263 d) and 241 days ± 18.2 (95% CI, 179-270 d) in group A and 139.1 days ± 14.5 (95% CI, 110-167 d) and 142 days ± 16.3 (95% CI, 83-177 d) in group B (P < .001, log-rank test). CONCLUSIONS 125I seeds combined with biliary stent placement could significantly improve stent patency. The procedure seems to be safe and to extend survival compared with self-expandable biliary stent placement.
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Affiliation(s)
- Asihaer Hasimu
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Jun-Peng Gu
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Wei-Zheng Ji
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Hai-Xiao Zhang
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Di-Wen Zhu
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Wei-Xin Ren
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China.
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Godlevsky AI, Formanchuk TV, Gudz MA, Formanchuk AM. [TRANSHEPATIC FRAME-LIKE EXTERNAL-INTERNAL DRAINAGE OF BILIARY DUCTS FOR OBTURATION JAUNDICE]. Klin Khir 2017:78. [PMID: 30273462] [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: 06/08/2023]
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Magalhães-Costa P, Brito MJ, Pinto-Marques P. A diffusely enlarged pancreas: the (un)usual suspect. Rev Esp Enferm Dig 2016; 108:809-811. [PMID: 27931107] [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: 06/06/2023]
Abstract
An 81-years-old female presented with obstructive jaundice and a non-specific clinical picture of nausea and appetite loss. Labs demonstrated a conjugated hyperbilirrubinemia (7.7 mg/dL), increased aspartate aminotransferase and alanine aminotransferase (10xULN and 8xULN, respectively), increased lactate dehydrogenase (10xULN) and serum lipase (3xULN). CA 19.9 was 342 U/mL (Ref value < 37 U/mL). There was no evidence of peripheral lymphadenopathy or hepatosplenomegaly. Imaging (Figure 1A and 1B) revealed a marked homogeneous enlargement of the pancreas (without any well-defined mass), dilation of the extra and intra-hepatic bile ducts and ascites. Endoscopic ultrasound (Figure 1C and 1D) identified an enlarged homogeneous hypoechoic pancreas, without any well-defined lesion, no dilation of the main pancreatic duct, no peripancreatic or celiac enlarged lymph nodes. A fine-needle biopsy was performed yielding, on cytological examination and cell-block technique (Figure 2A and 2B), numerous medium/large sized atypical lymphoid cells that displayed a B-cell lineage immunophenotype (Figure 2A-2F). Even though, further characterization (by flow cytometric immunophenotyping) could not be obtained, a final diagnosis of primary pancreatic lymphoma (PPL) was assumed. Primary pancreatic lymphoma is a remarkably rare tumor of the pancreas, representing approximately 0.5% of all pancreatic neoplasms and <2% of all lymphomas (1,2). A correct diagnosis is crucial because therapeutic management differs from other pancreatic malignancies (pancreatic ductal adenocarcinoma, neuroendocrine tumor and metastases) (2,3). Two morphologic patterns of PPL are recognized: a focal form (occurring in the pancreatic head in 80% of cases) and a rarer diffuse/infiltrative pattern, as depicted herein, emulating an acute/autoimmune pancreatitis (1).
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Affiliation(s)
- Pedro Magalhães-Costa
- Gastroenterology Department, Hospital Egas Moniz, Crt Hospitalar Lisboa Ocident, Portugal
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Li M, Li K, Qi X, Wu W, Zheng L, He C, Yin Z, Fan D, Zhang Z, Han G. Percutaneous Transhepatic Biliary Stent Implantation for Obstructive Jaundice of Perihilar Cholangiocarcinoma: A Prospective Study on Predictors of Stent Patency and Survival in 92 Patients. J Vasc Interv Radiol 2016; 27:1047-1055.e2. [PMID: 27241392 DOI: 10.1016/j.jvir.2016.02.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/12/2016] [Accepted: 02/28/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate prognostic factors for stent patency and survival in patients with perihilar cholangiocarcinoma (pCCA) who underwent percutaneous biliary stent placement. MATERIALS AND METHODS This prospective study followed 92 consecutive patients with pCCA who underwent metal stent placement between January 2013 and July 2014. Of the total number of patients, 11 had ascites, and 36 had biliary obstruction for > 1 month at the time of stent placement. Cumulative patency and survival rates were assessed with Kaplan-Meier curves, and independent predictors were calculated with Cox regression. A new formula was developed to predict patient survival. RESULTS Tumor size was significantly associated with stent patency (hazard ratio = 2.425; 95% confidence interval, 1.134-5.168). Independent predictors of survival included lymph node metastasis, intrahepatic mass lesion, cancer antigen 19-9 (CA19-9), ascites, and duration of jaundice. A new equation was developed to assess risk: R = 7 × (duration of biliary obstruction-0 if < 30 d, 1 if > 30 d) + 7 × (CA19-9-0 if < 500, 1 if > 500) + 7 × (ascites-0 if none present, 1 if ascites present) + 10 × (lymph node metastasis-0 if no metastasis, 1 if metastasis present) + 9 (intrahepatic mass lesion-0 if absent, 1 if present). Among patients who developed stent occlusion, patients who underwent recanalization of the occluded stent had longer survival compared with patients who did not undergo recanalization (109 d vs 29 d, P = .001). CONCLUSIONS Prognostic factors for survival after percutaneous stent placement in patients with pCCA were tumor stage, duration of jaundice, CA19-9, and ascites. Tumor size affected stent patency. Prognosis for patients with reintervention after occlusion of the stent improved.
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Affiliation(s)
- Mingwu Li
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Kai Li
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Xingshun Qi
- State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Wenbin Wu
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Luanluan Zheng
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Chuangye He
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Zhanxin Yin
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China.
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Sasahira N, Hamada T, Togawa O, Yamamoto R, Iwai T, Tamada K, Kawaguchi Y, Shimura K, Koike T, Yoshida Y, Sugimori K, Ryozawa S, Kakimoto T, Nishikawa K, Kitamura K, Imamura T, Mizuide M, Toda N, Maetani I, Sakai Y, Itoi T, Nagahama M, Nakai Y, Isayama H. Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction. World J Gastroenterol 2016; 22:3793-3802. [PMID: 27076764 PMCID: PMC4814742 DOI: 10.3748/wjg.v22.i14.3793] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/03/2016] [Accepted: 01/30/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.
METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent (PS) or nasobiliary catheter (NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedure-related adverse events, stent/catheter dysfunction (occlusion or migration of PS/NBC, development of cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution (bilirubin level < 3.0 mg/dL) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.
RESULTS: In total, 419 patients were included in the study (PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients (46%), bile duct cancer in 172 (41%), gallbladder cancer in three (1%), and ampullary cancer in 50 (12%). The median serum total bilirubin was 7.8 mg/dL and 324 patients (77%) had ≥ 3.0 mg/dL. During the median time to surgery of 29 d [interquartile range (IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio (SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method (PS or NBC).
CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.
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Yurchenko VV. [Acute cholangitis in interstenosis space accompanied by two-component unit of the main bile duct]. Voen Med Zh 2016; 337:31-35. [PMID: 27263209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Palliative treatment of obstructive jaundice with the help of biliary endoprosthesis due to the possible complication of post-intervention in the form of insolvency stent deformation or dislocation. The study features in the postoperative period of the main bile duct endoprosthesis about their two-component unit, described the syndrome of the closed space of the bile ducts. On the basis of observation of 14 patients with the given anatomical feature of endoscopic, who were underwent stenting, was assessed frequency of the syndrome and possibilities of its prevention. Interstenosis space expansion of the main bile duct can be a reason for local cholangitis. For the prevention of cholangitis, it should be carried out a separate drainage of interstenosis space with the help of endoprosthesis or by proximal supra-stenotic extension of two or more stents.
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Sipliviy VA, Yevtushenko DV, Petrenko GD, Andreyeshchev SA, Yevtushenko AV. [SURGICAL TREATMENT OF ACUTE CHOLANGITIS IN CHOLEDOCHOLITHIASIS]. Klin Khir 2016:34-37. [PMID: 27249924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The results of surgical treatment of 184 patients for obstructive jaundice and an acute cholangitis in choledocholithiasis were analyzed. Acute cholangitis was diagnosed in 62 (33.7%) patients. Sensitivity of a Tokyo Guidelines (2013)--TG 13 criteria for diagnosis and estimation of the course severity of an acute cholangitis was studied. Dynamics of postoperative laboratory parameters was studied. There was established, that occurrence of obturation jaundice and cholangitis coincides with pronounced hepatic function disorders, which are preserved after a bile outflow restoration also, and changes in peripheral blood. Severity of inflammatory reaction reflects hematological indices, the most informative of which is an intoxication index.
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Lin YH, Tsai KB, Chen SC, Chuang WL. Extremely rare cause of obstructive jaundice: Non-neoplastic, noninfectious lymphadenitis. Kaohsiung J Med Sci 2015; 31:442-3. [PMID: 26228286 DOI: 10.1016/j.kjms.2015.04.009] [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: 09/25/2014] [Revised: 03/23/2015] [Accepted: 04/27/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yi-Hung Lin
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kun-Bow Tsai
- Department of Pathology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan; Faculty of Pathology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shinn-Cherng Chen
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Wan-Long Chuang
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Iurchenko VV. [Is suprastenotic dilatation a mandatory symptom of impaired bile outflow?]. Vestn Rentgenol Radiol 2015:18-22. [PMID: 26302618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study the rate, nature, and symptoms of bile flow impairments running without developing suprastenotic dilatation. MATERIAL AND METHODS A total of 1082 patients undergoing endoscopic retrograde cholangiopancreatography for the differential diagnosis of jaundices were followed up. According to the diameter of the common bile duct, the patients were classified into cholangioectasia and non-cholangioectasia groups. The investigators studied the causes of bile evacuation disorders; the levels of bilirubin, hepatic transferases, and alkaline phosphatase; the duration and periodicity of obstructive jaundice; extended compression of suprastenotic dilatation; the occurrence of other symptoms; and the efficiency of additional procedures for the differential diagnosis of hepatic and obstructive jaundices. RESULTS There was no suprastenotic dilatation in 11 cases: in noncircular amorphous internal hepatocholedochal blocks, in cicatrical stenoses of the hepatocholedoch, in excessive metastatic spread into the hepatic portal and parenchyma, extended stenosis of the common bile duct does not lead to intrahepatic cholangiectasia. In 9 cases, instrumental palpation and aspiration biopsy were used to visualize common bile duct stenosis in order to elucidate its nature, degree, and rigidity. Endobiliary stenting was employed for the differential diagnosis of jaundices. CONCLUSION No suprastenotic dilatation was seen in 0.8% of patients with organic bile flow impairment. In these cases, obstacles to bile flow may be suggested by clear-cut variations in the diameter of the hepaticocholedoch and its deformity. The absence of suprastenotic dilatation may be partly explained by excessive metastatic liver involvement and malignant hepatoduodenal ligament infiltration. When suprastenotic dilatation is absent, instrumental palpation and diagnostic and therapeutic stenting may be used for the differential diagnosis of obstructive and hepatic jaundices.
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Ogura T, Higuchi K. Does endoscopic ultrasound-guided biliary drainage really have clinical impact? World J Gastroenterol 2015; 21:1049-1052. [PMID: 25632176 PMCID: PMC4306147 DOI: 10.3748/wjg.v21.i4.1049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 11/29/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023] Open
Abstract
The well established, gold standard method for treatment of obstructive jaundice involves biliary drainage under endoscopic retrograde cholangiopancreatography (ERCP) performed by pancreatobiliary endoscopists. Recently, interventions using endoscopic ultrasound (EUS) have been developed not only for obtaining cytological and histological diagnosis, but also for biliary drainage as alternative method. EUS-guided biliary drainage (EUS-BD) was first reported by Giovannini et al. EUS-BD broadly includes EUS-guided rendezvous technique, EUS-guided choledochoduodenostomy, and EUS-guided hepaticogastrostomy. More recently, EUS-guided antegrade stenting and EUS-guided gallbladder drainage have also been reported. many case reports, series, and retrospective studies on EUS-BD have been reported. However, because prospective studies and comparisons between the different biliary drainage methods have not been reported, the technical success, functional success, adverse events, and stent patency with long-term follow up of EUS-BD are still unclear. Therefore, prospective, randomized controlled studies addressing these issues are needed. Despite this, EUS-BD undoubtedly is clinically useful as an alternative biliary drainage method. EUS-BD has the potential to be a first-line biliary drainage method instead of ERCP if results of clinical trials are favorable and the technique is simplified.
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Affiliation(s)
- Te-Chun Shen
- Department of Internal Medicine, China Medical University Hospital, China Medical University, Taiwan
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Triest L, Mana F, Willekens I, Urbain D. Obstructive jaundice at the age of 24. Fasciola hepatica. Acta Gastroenterol Belg 2014; 77:272-273. [PMID: 25090831] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Guillory SG, Jordan MD, Spieler BM, Safley ML, Hutchings JJ, Saketkoo LA, Lopez FA. Clinical case of the month: a 44-year-old woman with jaundice and abdominal pain. J La State Med Soc 2014; 166:129-133. [PMID: 25075732] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Shane G Guillory
- Chief Resident of the Internal Medicine Program in the Department of Medicine at Louisiana State University Health Sciences Center in New Orleans
| | - Matthew D Jordan
- Second-Year Resident in Internal Medicine in the Department of Medicine at LSUHSC-New Orleans
| | - Bradley M Spieler
- Assistant Professor in the Department of Radiology at LSUHSC-New Orleans
| | - Matthew L Safley
- Chief Resident of the Department of Pathology at LSUHSC-New Orleans
| | - John J Hutchings
- Assistant Professor in the Department of Gastroenterology at LSUHSC-New Orleans
| | - Leslie A Saketkoo
- Assistant Professor in the Department of Rheumatology; Scleroderma and Sarcoidosis Patient Care and Research Center Director; and Associate Director of the Rheumatology Fellowship at LSUHSC-New Orleans
| | - Fred A Lopez
- Richard Vial Professor and Vice Chair for Education in the Department of Medicine at LSUHSC-New Orleans
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Sarikaya M, Köklü S, Ergül B, Doğan Z. Cholangitis resulting from a fragmented plastic biliary stent. Am Surg 2014; 80:E88-E89. [PMID: 24666854] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Murat Sarikaya
- Ankara Education and Research Hospital, Gastroenterology Clinic, Ankara, Turkey
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Alekseev KI, Maady AS, Osipov AS, Vasil'ev IV. [The experience of biliary self-expendable nitinol stents for malignant jaundice]. Eksp Klin Gastroenterol 2014:81-87. [PMID: 25518487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
THE AIM to analyze the effectiveness and possible complications of endoscopic biliary drainage (BD) using self-expanding metal stent (SEMS) in patients with malignant jaundice (MJ). METHODS From January 2010 to January 2014 in endoscopy department of Pirogov National medical and surgical Center were operated 64 patients with MJ, 38 of them with SEMS. The average patient's age was 65.4 ± 14.5 years. The mean duration of jaundice was 13 ± 5.4 days before drainage. The remaining 6 patients (15.8%) were operated with preliminary PTBD. In all 38 patients were diagnosed unresectable tumors. RESULTS successful endoscopic BD were achieved in all 38 patients. 35 patients were drained with transpapillary SEMS and 3 patients with EUS-guided choledochoduodenoanastomoses (EUS-CDA). Early postoperative complications were observed in 3 (7.8%) patients with no lethality. CONCLUSION endoscopic BD with SEMS is an effective method of internal drainage for inoperable pancreatobiliary tumors, providing adequate BD for the entire duration of life expectancy. In case of failed transpapillary drainage EUS-guided biliodigestive anastomoses were performed. The complication rate of endoscopic BD in patients with malignant pancreatobiliary tumors in our study was 7.8% and comparable with complication level due to ERCP/EST for benign pathology.
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Ajiki T, Fukumoto T, Ueno K, Okazaki T, Matsumoto I, Ku Y. Three-dimensional computed tomographic cholangiography as a novel diagnostic tool for evaluation of bile duct invasion of perihilar cholangiocarcinoma. Hepatogastroenterology 2013; 60:1833-1838. [PMID: 24719915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIMS This study assessed the results of preoperative evaluation of ductal invasion by perihilar cholangiocarcinoma, imaged using 3-dimensional (3D) CT cholangiography compared to conventional endoscopic retrograde cholangiography (ERC) and magnetic resonance cholangiopancreatography (MRCP). METHODOLOGY ERC, MRCP and 3D-CT cholangiography were planned in 24 patients with preoperatively diagnosed perihilar cholangiocarcinoma. Evaluations of bile duct images using each of 3 modalities were classified into 2 groups (the Visualization uncertain (VU) group and the Visualization certain and clear (VCC) group) according to the quality of biliary images. The results of pathological assessments and preoperative radiological evaluations were compared. RESULTS In the bile duct evaluation, the rates between the 2 groups were not significantly different across the three modalities. 3D-CT cholangiography evaluated tumour involvement most clearly in patients with obstructive jaundice (p = 0.044), and ERC evaluated biliary tree more clearly compared to MRCP or 3D-CT cholangiography in patients without obstructive jaundice (p = 0.051). For evaluation of pathological tumor invasion in the VCC group, 3D-CT cholangiography enabled a correct diagnosis in 7 of 11 patients, and R0 resection was achieved in 8 of 11 patients. CONCLUSIONS 3D-CT cholangiography offers accurate preoperative assessment of bile duct invasion by perihilar cholangiocarcinoma, especially in patients with obstructive jaundice.
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Jeremic L, Stojanovic M, Radojkovic M, Zlatic A, Ignjatovic N, Jeremic S. Tuberculous lymphadenitis as a cause of obstructive jaundice. Chirurgia (Bucur) 2013; 108:725-728. [PMID: 24157120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 06/02/2023]
Abstract
Obstructive jaundice secondary to abdominal tuberculosis is extremely rare. We present a patient with jaundice secondary to compression of the common bile duct by TB lymphadenitis. A 49-year-old woman was admitted to our department for nausea,epigastric pain and jaundice. Abdominal ultrasonography and computer tomography scan were suggestive of stenosis of the distal common bile duct caused by a retro pancreatic mass. At laparotomy, an enlarged lymph node behind the head of the pancreas was found, causing compression and stenosis of the distal parts of the choledochus. The lymph node frozen section analysis showed epithelioid granuloma with caseous necrosis,strongly suggesting tuberculous origin. Choledochoduodenal anastomosis was performed. Definitive pathohistological examination confirmed TB lymphadenitis. ATB should be considered as a potential cause of jaundice especially in immuno compromised patients and endemic areas. Diagnosing abdominal tuberculosis can be a challenging task. No satisfactory diagnostic gold standard is available so that in most cases the diagnosis cannot be reached before exploratory laparotomy.Early detection enables successful conservative treatment and eliminates the necessity of surgery.
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MESH Headings
- Anastomosis, Surgical
- Antitubercular Agents/therapeutic use
- Cholecystectomy
- Common Bile Duct Diseases/diagnostic imaging
- Common Bile Duct Diseases/etiology
- Common Bile Duct Diseases/surgery
- Diagnosis, Differential
- Early Diagnosis
- Female
- Follow-Up Studies
- Humans
- Jaundice, Obstructive/diagnostic imaging
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/surgery
- Middle Aged
- Peritonitis, Tuberculous/complications
- Radiography
- Treatment Outcome
- Tuberculosis, Lymph Node/complications
- Tuberculosis, Lymph Node/diagnostic imaging
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Lymph Node/microbiology
- Tuberculosis, Lymph Node/surgery
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Qin JJ, Xia YX, Lv L, Wang ZJ, Zhang F, Wang XH, Sun BC. Successful disintegration, dissolution and drainage of intracholedochal hematoma by percutaneous transhepatic intervention. World J Gastroenterol 2012; 18:7122-7126. [PMID: 23323019 PMCID: PMC3531705 DOI: 10.3748/wjg.v18.i47.7122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/28/2012] [Indexed: 02/06/2023] Open
Abstract
Hemobilia is a rare biliary complication of liver transplantation. The predominant cause of hemobilia is iatrogenic, and it is often associated with traumatic operations, such as percutaneous liver intervention, endoscopic retrograde cholangiopancreatography, cholecystectomy, biliary tract surgery, and liver transplantation. Percutaneous transhepatic cholangiography and liver biopsy are two major causes of hemobilia in liver transplant recipients. Hemobilia may also be caused by coagulation defects. It can form intracholedochal hematomas, causing obstructive jaundice. Herein we describe a patient with an intracholedochal hematoma resulting in significant obstructive jaundice after liver transplantation for fulminant hepatic failure. Previous studies have shown that percutaneous transhepatic manipulation is a major cause of hemobilia after liver transplantation, but in our case, percutaneous transhepatic intervention was used to relieve the biliary obstruction and dissolve the biliary clot, with a good outcome.
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Garcarek J, Kurcz J, Guziński M, Janczak D, Sasiadek M. Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. ADV CLIN EXP MED 2012; 21:621-632. [PMID: 23356199] [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: 06/01/2023]
Abstract
BACKGROUND Percutaneous transhepatic biliary drainage (PTBD) is a method of biliary tree decompression, applied as palliative treatment in patients with malignant biliary tree critical stenosis/obstruction, but also as a potentially curative treatment in patients with non-malignant biliary tree stenosis. Novel instrumentation dedicated to PTBD has been designed in recent years, which makes it possible to perform more advanced procedures in patients with severe extensive malignant biliary tree stenosis/obstruction. OBJECTIVES The first primary goal of the study was to compare both the rate and types of short- and long-term complications in patients who had undergone PTBD between 2000 and 2006 with patients treated between 2007 and 2011. The second primary goal of the study was to work out an original algorithm of efficient management in patients undergoing PTBD. An additional goal was to assess the efficacy of PTBD and the overall survival of the patients. MATERIAL AND METHODS One-hundred twenty-eight consecutive PTBD procedures performed between 2000 and 2006 in patients with malignant biliary jaundice were analyzed retrospectively. Similarly, retrospective analysis of 73 consecutive procedures in patients with malignant biliary jaundice performed between 2007 and 2011 was carried out. Subsequently, the results of both subsets were compared to each other. The PTBD procedure was guided fluoroscopy each time. PTBD involved external biliary drainage and/or stenting of the strictured/occluded segments of extra- and intrahepatic biliary ducts. RESULTS The analysis demonstrated a statistically significant decrease in the overall incidence of short- and long-term complications in patients undergoing PTBD in 2007-2011 in comparison to the subset treated in 2000-2006. Among the early complications, a significant decrease in sub- and pericapsular contrasted bile leaks was shown. The evaluation of long-term complications demonstrated lower incidence of the falling out of the draining catheter. The implementation of novel instrumentation made it possible to perform biliary stenting in 63.7% cases of common bile duct (CBD) obstruction (vs. 37.5% in procedures carried out in 2000-2006). However, no statistically significant difference in survival between the two analyzed subsets was demonstrated. CONCLUSIONS The analysis of rate and types of complications made it possible to establish authors own algorithm of management in different types of biliary obstructions and strictures. The modification of procedure technique, pos-tinterventional management and usage of the new generation of low-profile instrumentation for percutaneous access dedicated to PTBD has resulted in a significant reduction of the complication rate in the last 5 years. Higher frequency of CBD stenting improves the quality of life in this subset of patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Chi-Square Distribution
- Decompression, Surgical/adverse effects
- Decompression, Surgical/instrumentation
- Decompression, Surgical/methods
- Decompression, Surgical/mortality
- Digestive System Neoplasms/complications
- Digestive System Neoplasms/mortality
- Drainage/adverse effects
- Drainage/instrumentation
- Drainage/mortality
- Female
- Fluoroscopy
- Humans
- Jaundice, Obstructive/diagnostic imaging
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/mortality
- Jaundice, Obstructive/surgery
- Male
- Middle Aged
- Palliative Care
- Poland
- Postoperative Complications/etiology
- Postoperative Complications/therapy
- Quality of Life
- Radiography, Interventional
- Retrospective Studies
- Stents
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Jerzy Garcarek
- Chair of Radiology, Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
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Białek A, Kedzierska L, Jaroszewicz-Heigelmann H, Marlicz W, Starzyńska T. [Endoscopic ultrasound guided biliary drainage--case report]. Pol Merkur Lekarski 2012; 32:242-245. [PMID: 22708282] [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: 06/01/2023]
Abstract
Endoscopic biliary drainage (EBD) performed via retrograde cholangiopancreatography (ERCP) is a widely accepted method of treatment of obstructive jaundice. However, in some patients (around 15% of cases) due to various reasons proper cannulation of the biliary tract cannot be achieved, and these individuals are most commonly qualified for transcutaneous drainage or surgical intervention. Unfortunately, both of these procedures are accompanied with high rate of complications. In this paper we report a case of a patient suffering from non-operative, rarely occurring tumor of the papilla of Vater (rhabdomyosarcoma), who was treated with novel endoscopic procedure for obstructive jaundice. This patient presented indications for biliary drainage, however, the endoscopic intervention using classical retrograde access was technically impossible. Endoscopic ultrasonography-guided needle puncture was performed to visualize from the duodenal bulb the bile duct, that was amputated in its distal parts by the tumor mass. A guidewire was inserted through the needle, dilated, prosthesis was successfully inserted and normal gall flow was achieved. Authors have not observed any complications after this intervention. To our best knowledge, we are the first who performed such endoscopic procedure in Poland.
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Affiliation(s)
- Andrzej Białek
- Pomorski Uniwersytet Medyczny w Szczecinie, Katedra i Klinika Gastroenterologii.
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Maluf-Filho F, Retes FA, Neves CZ, Sato CFM, Kawaguti FS, Jureidini R, Ribeiro U, Bacchella T. Transduodenal endosonography-guided biliary drainage and duodenal stenting for palliation of malignant obstructive jaundice and duodenal obstruction. JOP 2012; 13:210-214. [PMID: 22406603] [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: 05/31/2023]
Abstract
CONTEXT Endosonography-guided biliary drainage has been used over the last few years as a salvage procedure when endoscopic retrograde cholangiopancreatography fails. Malignant gastric outlet obstruction may also be present in these patients. We report the results of both procedures during the same session in patients with duodenal and biliary obstruction due to malignant disease. METHODS A retrospective review from a prospective collected database. RESULTS Technical success was achieved in all five patients; however, only three patients experienced relief of jaundice and gastric outlet obstruction. CONCLUSIONS Endosonography-guided biliary drainage and duodenal stenting in the same session is feasible. However, severe complications may limit the procedure. This is a challenging procedure and should be done by experts with special attention to patient's selection.
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Affiliation(s)
- Fauze Maluf-Filho
- Cancer Institute of São Paulo University Medical School, São Paulo, SP, Brazil.
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Iakovlev AI, Semenov VB, Emel'ianov NV, Mokrov KV, Akulenko SV, Zarechnova NV. [Tactics of preoperative infusion therapy in obturation jaundice]. Klin Khir 2011:15-17. [PMID: 22295543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The influence of the infusion therapy content on a hepatic function of bile outflow (HFBO), a bilirubin content and the enzymes activity in obturation jaundice in 139 patients was studied up. In 54 patients (the first group) a Ringer solution and 10% solution of glucose in 1:1 ratio were applied; in 37 patients (the second group) - a sterofundin-G-5 solution; in 48 patients (the third group) - remaxol in a dose of 800 ml/day. Application of sterofundin-G-5 and remaxol as a component of infusion therapy have promoted a bile outflow intensity enhancement in early postoperative period in comparison with such while Ringer solution and 10% solution of glucose application. Remaxol more effectively have eliminated a hyperbilirubinemia, enzymemia and a HFBO disorder, than sterofundin-G-5.
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Tapping CR, Byass OR, Cast JEI. Cytological sampling versus forceps biopsy during percutaneous transhepatic biliary drainage and analysis of factors predicting success. Cardiovasc Intervent Radiol 2011; 35:883-9. [PMID: 21647806 DOI: 10.1007/s00270-011-0193-z] [Citation(s) in RCA: 25] [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: 04/07/2011] [Accepted: 05/09/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the accuracy of cytological sampling and forceps biopsy in obstructing biliary lesions and to identify factors predictive of success. METHODS Consecutive patients (n = 119) with suspected malignant inoperable obstructive jaundice treated with percutaneous transhepatic biliary drainage during 7 years were included (60 male; mean age 72.5 years). All patients underwent forceps biopsy plus cytological sampling by washing the forceps device in cytological solution. Patient history, procedural and pathological records, and clinical follow-up were reviewed. Statistical analysis included chi-square test and multivariate regression analysis. RESULTS Histological diagnosis after forceps biopsy was more successful than cytology: Sensitivity was 78 versus 61%, and negative predictive value was 30 versus 19%. Cytology results were never positive when the forceps biopsy was negative. The cytological sample was negative and forceps sample positive in 2 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 1 case of benign disease. Diagnostic accuracy was predicted by low bilirubin (p < 0.001), aspartate transaminase (p < 0.05), and white cell count (p ≤ 0.05). CONCLUSIONS This technique is safe and effective and is recommended for histological diagnosis during PTBD in patients with inoperable malignant biliary strictures. Diagnostic yield is greater when bilirubin levels are low and there is no sepsis; histological diagnosis by way of forceps biopsy renders cytological sampling unnecessary.
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Affiliation(s)
- C R Tapping
- Department of Radiology, Hull Royal Infirmary, UK
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Abstract
BACKGROUND Differentiating between benign and malignant causes of obstructive jaundice can be challenging, even with the advanced imaging and endoscopic techniques currently available. In patients with obstructive jaundice, the predictive accuracy of bilirubin levels at presentation was examined in order to determine whether such data could be used to differentiate between malignant and benign disease. METHODS A total of 1,026 patients with obstructive jaundice were identified. Patients were divided into benign and malignant groups. The benign patients were subgrouped into those with choledocholithiasis and those with inflammatory strictures of the biliary tree. Bilirubin levels at presentation and other demographic data were obtained from case records. RESULTS Area under the curve (AUC) values for bilirubin as a predictor of malignancy were highly significant for all benign presentations and for those with benign biliary strictures (AUC: 0.8 for both groups; P < 0.001). A bilirubin level > 100 µmol/l was determined to provide the optimum sensitivity and specificity for malignancy in all patients and in those without choledocholithiasis (71.9% and 86.9%, 71.9% and 88.0%, respectively). The application of a bilirubin level > 250 µmol/l achieved specificities of 97.1% and 98.0% in each subgroup of patients, respectively. CONCLUSIONS In patients with obstructive jaundice, bilirubin levels in isolation represent an important tool for discriminating between benign and malignant underlying causes.
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Affiliation(s)
- Giuseppe Garcea
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK.
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Yamakawa M, Kawamoto S, Kouda M, Inaba F, Kindaichi S, Takahashi T, Iwase K. Therapeutic sclerosis of a small liver cyst that caused obstructive jaundice. J Vasc Interv Radiol 2011; 22:695-8. [PMID: 21377381 DOI: 10.1016/j.jvir.2010.12.002] [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: 09/16/2010] [Revised: 11/27/2010] [Accepted: 12/04/2010] [Indexed: 11/19/2022] Open
Abstract
The authors describe the case of a small liver cyst (2 cm in diameter) causing obstructive jaundice that was treated with aspiration and therapeutic sclerosis. The procedure was performed with use of a microcatheter and wire system to access the cyst, which was injected with minocycline hydrochloride. At present, 9 months after treatment, the levels of hepatobiliary enzymes are within normal ranges, and no sign of cyst regrowth has been detected on imaging.
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Affiliation(s)
- Miho Yamakawa
- Department of Diagnostic Imaging, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan.
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Kozlov AV, Tarazov PG, Polikarpov AA, Popov VV. [Complications of trans- and suprapapillary percutaneous and transhepatic stenting of bile ducts in patients with mechanical jaundice of tumorous etiology]. Vestn Khir Im I I Grek 2011; 170:79-83. [PMID: 22191264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The authors made an analysis of complications in percutaneous endobiliary prostheses in 82 patients for obturative jaundice of tumorous etiology. The stents were placed over the major duodenal papilla and transpapillary. There were no lethal outcomes. Complications developed in 10 patients (12.2%) were: purulent cholangitis, stent migration or occlusion, abscess of the anterior abdominal wall, formation of biloma and hemobilia. Complications were arrested using conservative methods of treatment and/or minimally invasive procedures. Endoprostheses of bile ducts were shown to be an effective and relatively safe method of correction of mechanical jaundice of tumorous etiology. The number of complications in transpapillary stenting was not greater than in suprapapillary method.
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Siddiqui AA, Sreenarasimhaiah J, Lara LF, Harford W, Lee C, Eloubeidi MA. Endoscopic ultrasound-guided transduodenal placement of a fully covered metal stent for palliative biliary drainage in patients with malignant biliary obstruction. Surg Endosc 2010; 25:549-55. [PMID: 20632191 DOI: 10.1007/s00464-010-1216-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [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: 03/20/2010] [Accepted: 06/14/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided biliary drainage (EUSBD) has been described as a viable alternative to percutaneous transhepatic cholangiography (PTC) in patients in whom ERCP has been unsuccessful. The purpose of our study was to assess the utility of EUSBD using a newly released, fully covered, self-expanding, biliary metal stent (SEMS) for palliation in patients with an obstructing malignant biliary stricture. METHODS We collected data on all patients who presented with obstructive jaundice and who underwent transduodenal EUSBD after a failed ERCP. Eight patients presented with biliary obstruction from inoperable pancreatic cancer or cholangiocarcinoma. Reasons for failed ERCP were duodenum stenosis, high-grade malignant stenosis of the common bile duct, periampullary tumor infiltration, failure to access the common bile duct, and periampullary diverticulum. EUS was used to access the common bile duct from the duodenum after which a guidewire was advanced upwards toward the liver hilum. The metal stent was then advanced into the biliary tree. Technical success was defined as correct stent deployment across the duodenum. Clinical success was defined as serum bilirubin level decreased by 50% or more within 2 weeks after the stent placement. RESULTS Technical and clinical success was achieved in all eight patients. No stent malfunction or occlusion was observed. Complications included one case of duodenal perforation, which required surgery, and one case of self-limiting abdominal pain. CONCLUSIONS EUSBD with a fully covered SEMS in whom ERCP is unsuccessful is effective for palliation of biliary obstruction. The limitations of our study are that we had a small number of patients and a limited follow-up time.
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Affiliation(s)
- Ali A Siddiqui
- Department of Internal Medicine, Dallas Veterans Affairs Medical Center, 4500 S. Lancaster Road (111B1), Dallas, TX 75216, USA.
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Belletrutti PJ, Gerdes H, Schattner MA. Successful endoscopic ultrasound-guided transduodenal biliary drainage through a pre-existing duodenal stent. JOP 2010; 11:234-236. [PMID: 20442518] [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: 05/29/2023]
Abstract
CONTEXT When ERCP fails in the setting of combined biliary and duodenal obstruction, EUS-guided biliary drainage has emerged as an alternate method of biliary decompression. CASE REPORT We present a case of a 40-year-old man with advanced pancreatic cancer and a pre-existing duodenal wall stent who subsequently develops jaundice due to biliary obstruction. An ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Transduodenal biliary drainage was achieved using EUS guidance to create a choledochoduodenostomy tract. A fully covered metal biliary stent was then deployed through the mesh of the duodenal wall stent. The patient's jaundice and pruritus subsequently resolved. CONCLUSION This is the first report of successful transduodenal EUS-guided biliary drainage performed through an existing enteral wall stent and can still be considered as an alternate mode of biliary drainage in this setting.
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Affiliation(s)
- Paul J Belletrutti
- Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Schäfer C, Zech CJ, Göke B. [Obstructive jaundice: harmless stone or malignant tumour? Diagnosis and management from a gastroenterologist's perspective]. MMW Fortschr Med 2009; 151:33-36. [PMID: 20085073] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Claus Schäfer
- Med. Klinik und Poliklinik II, Klinikum der Universität München- Grosshadern.
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