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Cao JH, Mu ZH, Li HM, Li GX, Chen J, Yao JJ, Yang XW, Wang S. Utility of enteral nutrition via percutaneous transhepatic cholangiography drainage catheterization in late-stage malignant obstructive jaundice. Scand J Gastroenterol 2024; 59:570-576. [PMID: 38252748 DOI: 10.1080/00365521.2024.2305274] [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: 11/15/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Objective: The purpose of this study was to explore the clinical benefits of establishing an enteral nutrition (EN) pathway via percutaneous transhepatic cholangiography drainage (PTCD) catheterization in patients with late-stage malignant obstructive jaundice (MOJ).Methods: We selected 30 patients diagnosed as having late-stage MOJ with malnutrition. A dual-lumen biliary-enteral nutrition tube was placed via PTCD along with a biliary stent implantation. Postoperative EN was provided, and we observed the time taken for tube placement, its success rate, complications, and therapeutic efficacy.Results: Tube placement was successful in all 30 patients with an average procedural time of 5.7 ± 1.4 min with no tube placement complications. Compared to preoperative measures, there was a significant improvement in postoperative jaundice reduction and nutritional indicators one month after the procedure (p < 0.05). Post-placement complications included tube perileakage in 5 cases, entero-biliary reflux in 4 cases, tube blockage in 6 cases, tube displacement in 4 cases, accidental tube removal in 3 cases, and tube replacement due to degradation in 8 cases, with tube retention time ranging from 42 to 314 days, averaging 124.7 ± 37.5 days. All patients achieved the parameters for effective home-based enteral nutrition with a noticeable improvement in their quality of life.Conclusion: In this study, we found that the technique of establishing an EN pathway via PTCD catheterization was minimally invasive, safe, and effective; the tube was easy to maintain; and patient compliance was high. It is, thus, suitable for long-term tube retention in patients with late-stage MOJ.
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Affiliation(s)
- Jian-Hua Cao
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Zhan-Hu Mu
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Hai-Ming Li
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Gao-Xiang Li
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Jie Chen
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Jian-Jun Yao
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
| | - Xue-Wen Yang
- Department of Ultrasonography, The First People's Hospital of Yinchuan, Ningxia, China
| | - Sheng Wang
- Department of Hepatobiliary Surgery, The First People's Hospital of Yinchuan, Ningxia, China
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Bezabih YS, Gebremariam SN. Perioperative outcomes after open biliary bypass for malignant biliary obstruction (MBO) in resource-limited setups; a multicenter prospective cohort study, 2023. Eur J Surg Oncol 2024; 50:108254. [PMID: 38457860 DOI: 10.1016/j.ejso.2024.108254] [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: 12/30/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Obstructive jaundice is the most common symptom of malignant diseases of the extrahepatic biliary system and necessitates either non-operative or operative biliary bypass. Because of percutaneous and endoscopic approaches, the use of palliative surgical procedures has decreased in recent years. However, in resource-limited situations, open biliary bypasses remain a viable option. This study aimed to identify factors associated with adverse perioperative outcomes following open biliary bypass. METHODS From June 2022 to May 2023, 69 patients underwent open biliary bypass for malignant biliary obstruction. Postoperative morbidity and mortality within 30 days of surgery were assessed. A Kaplan-Meier was used for categorical variables, and a log-rank test was used to determine the statistically significant difference between variables. A Cox regression analysis was conducted to identify factors associated to time to develop complications. RESULTS The hazard of developing complications among those with preoperative cholangitis was 2.49 times higher than those without preoperative cholangitis (HR 2.49, 95% CI [1.06, 5.84]). For every hour increment in the length of surgery, the hazard of getting complications increased by 2.47 times (HR 2.47, 95% CI [1.28, 4.77]). As serum bilirubin increased by 1 mg/dl, the hazard of developing complications increased by 14% (HR 1.14, 95% CI [1.03, 1.17]). CONCLUSION Patients who had long operation times, preoperative cholangitis, and elevated total bilirubin levels are at increased risk for poor perioperative outcomes. Clinicians may use these results to optimize these patients to decrease their elevated risk of serious morbidity and mortality.
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Chen VH, Jiang SX, Ko HH. A Rare Cause of Cholestatic Liver Enzyme Elevation From a Common Entity. Gastroenterology 2024; 166:e6-e9. [PMID: 37839500 DOI: 10.1053/j.gastro.2023.10.006] [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: 09/21/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Victoria H Chen
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shirley X Jiang
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hin Hin Ko
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
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Imai Y, Sekine M, Aoyama K, Kojima S, Sasaki G, Sato A, Matsumoto K, Morino M, Kashima H, Koito Y, Miura T, Takahashi Y, Ishii T, Tsuboi R, Otake H, Yoshikawa S, Uehara T, Asano T, Matsumoto S, Miyatani H, Oshiro H, Mashima H. Primary Bile Duct Diffuse Large B-cell Lymphoma Diagnosed by Repeated Endoscopic Ultrasound-guided Fine-needle Aspiration and Endoscopic Retrograde Cholangiopancreatography. Intern Med 2024; 63:493-501. [PMID: 37344437 PMCID: PMC10937144 DOI: 10.2169/internalmedicine.1776-23] [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: 02/16/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
A 54-year-old man was admitted with obstructive jaundice. Computed tomography showed common bile duct stricture and a tumor around the celiac artery. Repeated endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) as well as a laparotomic biopsy around the celiac artery were diagnostically unsuccessful. Since the bile duct stricture progressed, EUS-FNA and ERCP were performed a third time, finally leading to the diagnosis of diffuse large B-cell lymphoma. The treatment plan and prognosis of obstructive jaundice differ greatly depending on the disease. It is important to conduct careful follow-up and repeated histological examinations with appropriate modifications until a diagnosis is made.
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Affiliation(s)
- Yurika Imai
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Masanari Sekine
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Kayoko Aoyama
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Shu Kojima
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Goya Sasaki
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Azumi Sato
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Keita Matsumoto
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Mina Morino
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Hitomi Kashima
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Yudai Koito
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Takaya Miura
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Yuko Takahashi
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Takehiro Ishii
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Rumiko Tsuboi
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Haruka Otake
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Shuhei Yoshikawa
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Takeshi Uehara
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Takeharu Asano
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Hiroyuki Miyatani
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
| | - Hisashi Oshiro
- Department of Pathology, Jichi Medical University Saitama Medical Center, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Japan
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Lojanatorn P, Ruangwattanapaisarn N, Klaisuban W, Tanpowpong P. Primary pancreatic lymphoma in a child presenting with rapidly progressive obstructive jaundice. Pediatr Neonatol 2024; 65:87-88. [PMID: 37953103 DOI: 10.1016/j.pedneo.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/07/2023] [Accepted: 09/08/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Ponlakit Lojanatorn
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nichanan Ruangwattanapaisarn
- Department of Diagnostic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wipawi Klaisuban
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pornthep Tanpowpong
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Kulikov YD, Teterin YS, Mironova AS, Yartsev PA, Rohas Tadevosyan TE, Nugumanova KA. [Endoscopic stenting for malignant pancreatobiliary strictures]. Khirurgiia (Mosk) 2024:29-33. [PMID: 38258685 DOI: 10.17116/hirurgia202401129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To improve the outcomes in patients with malignant obstructive jaundice using intraluminal stenting. MATERIAL AND METHODS The present study included 62 patients with clinical symptoms of malignant obstructive jaundice. In the main group, we performed biliary stenting with self-expanding multi-perforated stents (Hanarostent Multi-hole Biliary). Microscopic perforations of these stents prevent migration and reduce the risk of blocking the cystic and main pancreatic ducts. In the control group, stenting was performed with fully and partially covered self-expanding stents. RESULTS Lower incidence of obstructive cholecystitis and acute pancreatitis in the main group was associated with multiperforated stents reducing the risk of blocking the main pancreatic and cystic ducts. CONCLUSION In our study, multiperforated stents excluded migration and reduced the incidence of complications (acute cholecystitis from 11.5 to 3.8%, acute pancreatitis from 15.3 to 7.7%).
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Affiliation(s)
- Yu D Kulikov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - Yu S Teterin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A S Mironova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - P A Yartsev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | | | - K A Nugumanova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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Li Y, Wang H, Yu T, Hou S, Zhang L. Bending the distal tip of a guidewire aids in cannulation of an occluded uncovered biliary metal stent. Rev Esp Enferm Dig 2023; 115:728-729. [PMID: 37366029 DOI: 10.17235/reed.2023.9749/2023] [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] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Biliary metal stent implantation is an effective treatment for malignant obstructive jaundice. But it's well known that stents put in for a long time can become occluded and cause jaundice and cholangitis. At this time, endoscopic intervention is usually required to replace the stent or re-insert the stent. Re-cannulation for metal stent occlusion is challenging because the guide wire may pass through the side holes of the uncovered metal stents, resulting in prolonged surgical time and exposure to radiation. Here we present a small tip that may help endoscopists complete the re-cannulation of an uncovered metal stent in a very short time.
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Affiliation(s)
- Yaoting Li
- Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, China
| | - Hao Wang
- Gastroenterology, Shijiazhuang Third Hospital , China
| | - Tingting Yu
- Biliopancreatic Endoscopic Surgery , The Second Hospital of Hebei Medical University, China
| | - Senlin Hou
- Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, China
| | - Lichao Zhang
- Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, china
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8
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Ko CY, Huang TS, Wu PS, Lin JC. Pancreatic metastasis with obstructive jaundice: A rare recurrence pattern of breast cancer after a 10-year interval. Asian J Surg 2023; 46:5781-5783. [PMID: 37704480 DOI: 10.1016/j.asjsur.2023.08.147] [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] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Chih-Yu Ko
- Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Tun-Sung Huang
- Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.
| | - Pao-Shu Wu
- Department of Pathology, Mackay Memorial Hospital, Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei City, Taiwan
| | - Jiunn-Chang Lin
- Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan
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9
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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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10
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Soto Dopazo M, Díaz González MD, García Antuña E, Fernández Fernández JC. Obstructive jaundice secondary to a pseudoaneurysm in anatomical variant of the hepatic artery. Gastroenterol Hepatol 2023; 46:813-814. [PMID: 36435377 DOI: 10.1016/j.gastrohep.2022.11.003] [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] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Macarena Soto Dopazo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Cabueñes, Gijón, Asturias, España.
| | - María Desirée Díaz González
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - Elsa García Antuña
- Servicio de Radiodiagnóstico, Hospital Universitario de Cabueñes, Gijón, Asturias, España
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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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12
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Guo LH, Miao M, Ye GL. SpyGlass in Diagnosis of Hepatocellular Carcinoma with Right Hepatic Duct Tumor Thrombus Hemorrhage: A Case Report. Chin Med Sci J 2023; 38:309-314. [PMID: 38073063 DOI: 10.24920/004273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Hepatocelluar carcinoma presenting as a biliary duct tumor thrombus is a relatively rare entity, with poor prognosis. The primary clinical manifestation of this disease is obstructive jaundice, which can often be misdiagnosed. A 59-year-old female patient was admitted with sudden onset of abdominal pain. Laboratory tests suggested obstructive jaundice, and enhanced magnetic resonance imaging of the upper abdomen did not show obvious biliary dilatation. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography suggested an occupying lesion in the upper bile duct. SpyGlass and biopsy finally confirmed hepatocellular carcinoma with right hepatic duct tumor thrombus hemorrhage. The SpyGlass Direct Visualization System, as an advanced biliary cholangioscopy device, showed the advantages of single-person operation as well as easy access to and visualization of the lesion.
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Affiliation(s)
- Li-Hua Guo
- Department of Gastroenterology, the First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315020, China
| | - Min Miao
- Department of Gastroenterology, the First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315020, China
| | - Guo-Liang Ye
- Department of Gastroenterology, the First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315020, 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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Liu X, Xu B, Zeng Y, Chen P, Wang Y. Case report: Severe cholestatic jaundice associated with hyperthyroidism treated with methimazole. Medicine (Baltimore) 2023; 102:e35972. [PMID: 37960740 PMCID: PMC10637443 DOI: 10.1097/md.0000000000035972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
RATIONALE We present a case of a 43-year-old female patient diagnosed with hyperthyroidism. This study aims to demonstrate the rare association between hyperthyroidism and severe cholestatic jaundice, and the effectiveness of methimazole treatment. PATIENT CONCERNS The patient developed severe jaundice, a typically mild symptom in most hyperthyroidism cases. DIAGNOSIS The severe jaundice was suspected to be a result of cholestasis induced by hyperthyroidism, with other potential causes such as drug-induced or autoimmune liver dysfunction being ruled out. OUTCOMES The patient was effectively treated with methimazole. Outcomes: Treatment with methimazole alleviated the severe cholestatic jaundice and restored normal thyroid function. LESSONS The specific mechanism of cholestasis as a secondary complication of hyperthyroidism remains unclear, and there are no specific biochemical markers for cholestasis caused by this hormonal disease. This case underscores the possibility of severe jaundice as a clinical manifestation of hyperthyroidism, and highlights antithyroid drug treatment as an effective strategy for managing severe cholestatic jaundice.
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Affiliation(s)
- Xiaoqiang Liu
- Department of Gastroenterology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
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15
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Sun H, Yang M, Wang F, Zhao D, Qu X, Yan Z, Li F, Liu L. Comparison of intraluminal brachytherapy combined with and without stent placement for treatment of obstructive jaundice induced by tumor thrombus. Brachytherapy 2023; 22:833-839. [PMID: 37734995 DOI: 10.1016/j.brachy.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To compare the safety and efficacy of intraluminal brachytherapy with iodine-125 (125I) seed strand implantation combined with and without stent placement to treat patients with obstructive jaundice induced by tumor thrombus. METHODS Between January 2018 and June 2022, 42 patients with malignant obstructive jaundice (MOJ) induced by tumor thrombus were included. 20 patients received 125I seed strand implantation and stent placement (group A). The remaining 22 patients, implanted 125I seed strands only, served as control (group B). The two groups' overall survival and jaundice-free survival were compared using the Kaplan-Meier method and log-rank test. RESULTS During the follow-up period, the mean survival time of group A was 38.0 ± 4.1 months (95%CI, 30.0-46.1 months), while that of group B was 25.1 ± 2.8 (95% CI, 19.5-30.6 months) (p = 0.406). The mean survival rates of 12 months for all patients, group A, and group B was 66.7%, 65%, and 68%, respectively. The mean jaundice-free survival of group A and group B were 34.0 ± 3.6 months (95% CI, 27.9-41.2months) and 22.9 ± 2.7 months (95%CI, 17.5-28.2months) (p = 0.254), respectively. Two PTBD drainage tube infection cases occurred in group A and group B separately. CONCLUSIONS 125I intraluminal brachytherapy is an effective and safe therapy for treating patients with obstructive jaundice induced by tumor thrombus.
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Affiliation(s)
- HuiYi Sun
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - MinJie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - FeiHang Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - DanYang Zhao
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - XuDong Qu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - ZhiPing Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - FuYou Li
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - LingXiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China; National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
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16
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Jeji PS, Patnaik SK, Behera MK, Narayan J, Sahu MK, Mishra D, Singh A, Pati GK. Obstructive Jaundice with skin involvement - An unusual presentation of Myeloid Sarcoma. INDIAN J PATHOL MICR 2023; 66:862-864. [PMID: 38084550 DOI: 10.4103/ijpm.ijpm_1108_21] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Biliary obstruction secondary to malignancy is a common clinical problem. Rarely, biliary obstruction is due to leukemia, and obstructive jaundice in these patients usually presents late in the course of the disease. We present a rare case of a patient who presented with fever, jaundice, and pruritus with multiple nodular swellings in the left shoulder, left thigh, and lower back. Magnetic resonance cholangiopancreatography (MRCP) revealed periampullary mass lesion causing dilated common bile duct (CBD) and intrahepatic bile ducts; hence, endoscopic retrograde cholangiography with plastic stenting was done. Biopsy from the shoulder lesion revealed a mesenchymal tumor, and immunohistochemistry (IHC) confirmed the lesion as myeloid sarcoma. Myeloid sarcoma is an extramedullary tumor, a subtype of acute myeloid leukemia, and presentation as biliary lesions with multiple anatomical sites is very rare. The patient was started on chemotherapy after the normalization of bilirubin. The patient showed improvement of skin lesions and normalization of liver function test (LFT) after 3 weeks of chemotherapy.
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Affiliation(s)
- Pukhraj S Jeji
- Department of Medical Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Swarup K Patnaik
- Department of Medical Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Manas K Behera
- Department of Hepatology, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Jimmy Narayan
- Department of Medical Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Manoj K Sahu
- Department of Medical Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Debakanta Mishra
- Department of Medical Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Ayaskanta Singh
- Department of Medical Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Girish K Pati
- Department of Medical Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
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Mundhada RO, Chopde AN, Kharat R, Rane S, Goel M, Patkar S. Hepatocellular carcinoma (HCC) masquerading as hilar cholangiocarcinoma: An unusual presentation of jaundice. INDIAN J PATHOL MICR 2023; 66:880-882. [PMID: 38084556 DOI: 10.4103/ijpm.ijpm_900_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Jaundice usually occurs in the late stages of hepatocellular carcinoma (HCC). Obstructive jaundice is rarely seen as an initial presentation of HCC, as opposed to cholangiocarcinoma. Various causes of obstructive jaundice in these cases also known as "Icteric HCC" have been described such as tumour thrombi, compression, infiltration or tumours arising from native hepatocytes in the bile duct. We present a case of 74-year-old gentleman with "Icteric HCC" that clinically and radiologically mimicked cholangiocarcinoma for which the patient underwent left hepatectomy with Roux-en-Y hepaticojejunostomy. Histopathology revealed dilated large duct with polygonal sheets of cells of hepatoid morphology which stained diffusely positive for both glypican 3 and Hep-par 1. The epicentre was in the left hepatic duct with no discernible liver lesion and the tumour probably originated from the ectopic hepatocytes within the biliary duct The patient was disease free at 1.5 years of follow up. In conclusion, HCC should be a differential for obstructive jaundice. Patients with such "Icteric HCC" benefit from surgical resection with favourable outcomes. The prognosis in such patients is better than in patients of HCC with jaundice due to hepatic insufficiency.
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Affiliation(s)
- Rohit O Mundhada
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit N Chopde
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Reshma Kharat
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Swapnil Rane
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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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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Huang J, Gao X, Wang M, Yang Z, Xiang L, Li Y, Yi B, Gu J, Wen J, Lu K, Zhao H, Ma D, Chen L, Ning J. Prophylactic Administration with Methylene Blue Improves Hemodynamic Stabilization During Obstructive Jaundice-Related Diseases' Operation: a Blinded Randomized Controlled Trial. J Gastrointest Surg 2023; 27:1837-1845. [PMID: 37101089 PMCID: PMC10511601 DOI: 10.1007/s11605-022-05499-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/21/2022] [Indexed: 04/28/2023]
Abstract
OBJECTIVES Patients with obstruction jaundice are at a high risk of hypotension and need high volume of fluids and a high dose of catecholamine to maintain organ perfusion during operation procedure. All these likely contribute to high perioperative morbidity and mortality. The aim of the study is to evaluate the effects of methylene blue on the hemodynamics in patients undergoing surgeries associated with obstructive jaundice. DESIGN A prospective, randomized, and controlled clinical study. SETTING The enrolled patients randomly received 2 mg/kg of methylene blue in saline or saline (50 ml) before anesthesia induction. The primary outcome was the frequency and dose of noradrenaline administration to maintain mean arterial blood pressure over 65 mmHg or > 80% of baseline, and systemic vascular resistance (SVR) over 800 dyne/s/cm5 during operation. The secondary outcomes were liver and kidney functions, and ICU stay. PATIENTS Seventy patients were enrolled in the study and randomly assigned to receive either methylene blue or control (n = 35/group). RESULTS Fewer patients received noradrenaline in the methylene blue group when compared with the control group (13/35 vs 23/35, P = 0.017), and the noradrenaline dose administrated during operation was reduced in the methylene blue group when compared with the control group (0.32 ± 0.57 mg vs 1.787 ± 3.51 mg, P = 0.018). The blood level of creatinine, glutamic oxalacetic transaminase, and glutamic-pyruvic transaminase after the operation was reduced in the methylene blue group when compared with the control group. CONCLUSIONS Prophylactic administration of methylene blue before operation associated with obstructive jaundice improves hemodynamic stability and short-term prognosis. QUESTION Methylene blue use prevented refractory hypotension during cardiac surgery, sepsis, or anaphylactic shock. It is still unknown that methylene blue on the vascular hypo-tone associated with obstructive jaundice. FINDINGS Prophylactic administration with methylene blue improved peri-operative hemodynamic stability, and hepatic and kidney function on the patients with obstructive jaundice. MEANINGS Methylene blue is a promising and recommended drug for the patients undergoing the surgeries of relief obstructive jaundice during peri-operation management.
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Affiliation(s)
- Jian Huang
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Xian Gao
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Moran Wang
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Zhen Yang
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Lunli Xiang
- Department of Nephrology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Yongshuai Li
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Bin Yi
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Jianteng Gu
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Jing Wen
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Kaizhi Lu
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Hongwen Zhao
- Department of Nephrology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW109NH UK
| | - Li Chen
- Breast Disease Center, Southwest Hospital, Third Military Medical University, Chongqing, 400038 China
| | - Jiaolin Ning
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038 China
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Kandurova KY, Sumin DS, Mamoshin AV, Potapova EV. Deconvolution of the fluorescence spectra measured through a needle probe to assess the functional state of the liver. Lasers Surg Med 2023; 55:690-701. [PMID: 37300892 DOI: 10.1002/lsm.23695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Currently, one of the most pressing issues for surgeons in the treatment of obstructive jaundice is the ability to assess the functional state of the liver and to detect and determine the degree of liver failure in a timely manner with simple and objective techniques. In this regard, the use of fluorescence spectroscopy method can be considered as one of the ways to improve the informativity of existing diagnostic algorithms in clinical practice and to introduce new diagnostic tools. Thus, the aim of the work was to study in vivo the functional state of liver parenchyma by the method of fluorescence spectroscopy implemented through a needle probe and assess the contribution of the main tissue fluorophores to reveal new diagnostic criteria. MATERIALS AND METHODS We compared data from 20 patients diagnosed with obstructive jaundice and 11 patients without this syndrome. Measurements were performed using a fluorescence spectroscopy method at excitation wavelengths of 365 and 450 nm. Data were collected using a 1 mm fiber optic needle probe. The analysis was based on the comparison of the results of deconvolution with the combinations of Gaussian curves reflecting the contribution of the pure fluorophores in the liver tissues. RESULTS The results showed a statistically significant increase in the contribution of curves reflecting NAD(P)H fluorescence, bilirubin, and flavins in the group of patients with obstructive jaundice. This and the calculated redox ratio values indicated that the energy metabolism of the hepatocytes may have shifted to glycolysis due to hypoxia. An increase in vitamin A fluorescence was also observed. It may also serve as a marker of liver damage, indicating impaired vitamin A mobilization from the liver due to cholestasis. CONCLUSIONS The results obtained reflect changes associated with shifts in the content of the main fluorophores characterizing hepatocyte dysfunction caused by accumulation of bilirubin and bile acids and after disturbance of oxygen utilization. The contributions of NAD(P)H, flavins, and bilirubin as well as vitamin A can be used for further studies as promising diagnostic and prognostic markers for the course of liver failure. Further work will include collecting fluorescence spectroscopy data in patients with different clinical effects of obstructive jaundice on postoperative clinical outcome after biliary decompression.
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Affiliation(s)
- Ksenia Y Kandurova
- Research and Development Center of Biomedical Photonics, Orel State University, Orel, Russia
| | - Dmitry S Sumin
- Research and Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- Department of Interventional Radiology, Orel Regional Clinical Hospital, Orel, Russia
| | - Andrian V Mamoshin
- Research and Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- Department of Interventional Radiology, Orel Regional Clinical Hospital, Orel, Russia
| | - Elena V Potapova
- Research and Development Center of Biomedical Photonics, Orel State University, Orel, Russia
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21
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Maruyama H, Ishikawa-Kakiya Y, Tanoue K, Higashimori A, Fujiwara Y. Preloading guidewire method: EUS-guided hepaticogastrostomy. Arab J Gastroenterol 2023; 24:183-185. [PMID: 37532660 DOI: 10.1016/j.ajg.2023.06.002] [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: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Hirotsugu Maruyama
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Japan.
| | - Yuki Ishikawa-Kakiya
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Kojiro Tanoue
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Akira Higashimori
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Japan
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Medas R, Ferreira-Silva J, Girotra M, Barakat M, Tabibian JH, Rodrigues-Pinto E. Best Practices in Pancreatico-biliary Stenting and EUS-guided Drainage. J Clin Gastroenterol 2023; 57:553-568. [PMID: 36040964 DOI: 10.1097/mcg.0000000000001760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Indications for endoscopic placement of endoluminal and transluminal stents have greatly expanded over time. Endoscopic stent placement is now a well-established approach for the treatment of benign and malignant biliary and pancreatic diseases (ie, obstructive jaundice, intra-abdominal fluid collections, chronic pancreatitis etc.). Ongoing refinement of technical approaches and development of novel stents is increasing the applicability and success of pancreatico-biliary stenting. In this review, we discuss the important developments in the field of pancreatico-biliary stenting, with a specific focus on endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-associated developments.
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Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar São João
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joel Ferreira-Silva
- Gastroenterology Department, Centro Hospitalar São João
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mohit Girotra
- Digestive Health Institute, Swedish Medical Center, Seattle, WA
| | | | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar
- UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA CA
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João
- Faculty of Medicine of the University of Porto, Porto, Portugal
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Bolduan F, Geisel D, Pahl S, Wree A, Tacke F. Painless jaundice with segmental obstructive cholestasis. J Hepatol 2023; 79:e16-e18. [PMID: 37193627 DOI: 10.1016/j.jhep.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Felix Bolduan
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, 13353 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, 13353 Berlin, Germany
| | - Stefan Pahl
- Department of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, 10117, Berlin, Germany
| | - Alexander Wree
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, 13353 Berlin, Germany
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, 13353 Berlin, Germany.
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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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25
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Ur Rahman A, Joseph C, Green J, Ellis Owen R, Gazal K. Unique case of abdominal aortic aneurysm causing obstructive jaundice and duodenal obstruction. J R Coll Physicians Edinb 2023; 53:30-34. [PMID: 36708217 DOI: 10.1177/14782715231152729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Obstruction of the duodenum by an abdominal aortic aneurysm (AAA) (aortoduodenal syndrome) has rarely been reported. It presents with symptoms of upper gastrointestinal (GI) tract obstruction. Obstructive jaundice caused by an AAA is also extremely rare and requires high clinical suspicion. We present a unique case with informed consent of an elderly gentleman who presented with both rare presentations over a course of few months. After extensive literature search, we have found case reports of patients showing either of the two unusual presentations, but none were found to show them together.
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Affiliation(s)
| | | | - John Green
- University Hospital Llandough, Cardiff, UK
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26
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Yoshimura C, Murata J, Yamauchi A, Sunaga K, Kato M, Takigawa A, Nawa T, Akamatsu H, Kobayashi I, Tsujii M. [An anatomical case of obstructive jaundice due to the rapid enlargement of hepatic peribiliary cysts in end-stage alcoholic liver cirrhosis]. Nihon Shokakibyo Gakkai Zasshi 2023; 120:927-934. [PMID: 37952968 DOI: 10.11405/nisshoshi.120.927] [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: 11/14/2023]
Abstract
A man in his 60s had end-stage alcoholic cirrhosis. About six months before his death, hepatic peribiliary cysts (HPBC) rapidly increased, and he developed jaundice and liver failure. The pathological autopsy performed after his death revealed that his intrahepatic bile duct was pressured due to multiple cysts caused by HPBC, which resulted in liver failure. Some cases of HPBC have been associated with alcoholic cirrhosis;however, no other cases of increased HPBC in a short period of time have been reported. Although identifying the cause of increased HPBC in a short time is difficult in this case, it may be have been caused by continuous alcohol drinking after the onset of HPBC. Most patients with HPBC have liver cirrhosis and obstructive jaundice that may promote liver failure as in this case. Therefore, patients with HPBC should not only be instructed for abstinence but also promptly consider effective treatments in the event of obstructive jaundice to prevent liver dysfunction.
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Affiliation(s)
| | - Jun Murata
- Department of Gastroenterology, Higashiosaka City Medical Center
- Department of Gastroenterology, Ikeda City Hospital
| | - Amane Yamauchi
- Department of Pathology, Higashiosaka City Medical Center
| | - Koji Sunaga
- Department of Gastroenterology, Higashiosaka City Medical Center
| | - Mina Kato
- Department of Gastroenterology, Higashiosaka City Medical Center
| | - Atsuo Takigawa
- Department of Gastroenterology, Higashiosaka City Medical Center
| | - Takatoshi Nawa
- Department of Gastroenterology, Higashiosaka City Medical Center
| | - Haruki Akamatsu
- Department of Gastroenterology, Higashiosaka City Medical Center
| | - Ichizo Kobayashi
- Department of Gastroenterology, Higashiosaka City Medical Center
| | - Masahiko Tsujii
- Department of Gastroenterology, Higashiosaka City Medical Center
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Petrovsky AN, Bondarenko YS, Belova VE, Tupikin RS, Popov DA. [Hemobilia as a sign of arterio-biliary fistula]. Khirurgiia (Mosk) 2023:77-82. [PMID: 37850899 DOI: 10.17116/hirurgia202304177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Hepatic artery aneurysms (HAA) are rare (20% of all visceral arteries). Most often, HAAs are asymptomatic and detected at autopsy. However, their ruptures and/or bleeding following pressure ulcers in visceral gastrointestinal organs are a significant clinical and diagnostic problem. We present 2 patients with obstructive jaundice and hemobilia. Diagnostics revealed aneurysm of the right hepatic artery with arterio-biliary fistula. Life-threatening hemobilia is a consequence of HAA rupture into biliary system. Endovascular approach is preferable for HAA without clinical manifestations. Awareness of this disease is important for early detection and active surgical intervention before possible complications.
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Affiliation(s)
- A N Petrovsky
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - Yu S Bondarenko
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - V E Belova
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - R S Tupikin
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - D A Popov
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
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Kachmazova AV, Teterin YS, Tigiev LR, Yartsev PA, Rogal ML, Bayramov RS. [Endoscopic treatment of obstructive jaundice in patients with Klatskin tumor]. Khirurgiia (Mosk) 2023:55-60. [PMID: 37850895 DOI: 10.17116/hirurgia202304155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To improve treatment outcomes in patients with Klatskin tumor and obstructive jaundice by using of endoscopic bilioduodenal stenting. MATERIAL AND METHODS There were 1904 transpapillary interventions between August 2017 and February 2022. Endoscopic bilioduodenal stenting was performed in 250 patients including 25 (10%) ones with Klatskin tumor. RESULTS Bilioduodenal plastic and self-expanding stents were installed in 19 (76%) and 6 (24%) patients, respectively. In Klatskin tumor type I, 11 patients (44%) underwent bilioduodenal stenting of common hepatic duct with plastic stent; 5 (20%) patients with Klatskin tumor type II received self-expanding stents. In case of tumor type IIIA, 3 (12%) patients underwent stenting of the right lobar duct with plastic stent. Four (16%) patients with Klatskin tumor type III B underwent stenting of the left lobar duct. Two 2 (8%) patients with Klatskin tumor type IV underwent bilateral bilioduodenal stenting with plastic and bifurcation self-expanding stents. Peroral cholangioscopy using the SpyGlass DS system was performed in 4 (16%) patients. No intraoperative complications were identified. One (4%) patient developed gastrointestinal bleeding in 2 postoperative days after retrograde intervention that did not require surgery. Moreover, 1 (4%) patient with distal dislocation of plastic bilioduodenal stent required redo bilioduodenal stenting. Three (12%) patients died from multiple organ failure despite adequate biliary decompression, and 22 (88%) patients were discharged in 8±5 days after retrograde intervention. CONCLUSION Bilioduodenal stenting as minimally invasive and physiological method was highly effective for obstructive jaundice in patients with Klatskin tumor. Peroral cholangioscopy using the SpyGlass system provides effective and safe direct visualization of the biliary tract, as well as biopsy for morphological verification and prescription of chemotherapy in patients with intraductal growth of tumor.
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Affiliation(s)
- A V Kachmazova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - Yu S Teterin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - L R Tigiev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - P A Yartsev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - M L Rogal
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - R Sh Bayramov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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Bademci R, Temidayo Talabi MO, Salas P, Blanco MR, Riart GC, Bollo J, Raventós VA. Impact of biliary drainage prior to pancreatectomy. Acta Chir Belg 2022; 122:390-395. [PMID: 33929304 DOI: 10.1080/00015458.2021.1920659] [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: 05/20/2019] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is still a lack of clarity about the benefits of preoperative biliary drainage (PBD), which was introduced to improve the perioperative outcome in patients with obstructive jaundice caused by a periampullary tumour. The aim of this study was to determine whether operative and postoperative complications increase in patients undergoing PBD during pancreatoduodenectomy (PD). MATERIAL AND METHODS Retrospective examination was made of patients who underwent PBD for a periampullary tumour in our hospital between 2006 and 2014. From these, the patients were identified who had PBD with endoscopic retrograde cholangiopancreatography and these patients were further separated into two groups, as one group of patients with plastic stents and the other group of patients with metallic stents. Patients with pancreas head cancer were also separated into two groups as those who were and were not applied with PBD. The preoperative, intraoperative and postoperative characteristics of the patients were evaluated. RESULTS A total of 123 patients were retrospectively reviewed. Biliary stent placement with PBD was applied to 48 patients, of whom 31 had metallic stents and 17 had plastic stents. In general, there was no difference between the PBD and the non-PBD groups in respect of the preoperative, operative and postoperative results. When patients with tumour of the pancreas head only were examined, the rate of wound infection was higher in the PBD group and there was no difference in the other parameters. Moreover, there was no difference between the patients with metallic stents and those with plastic stents in respect of outcomes. CONCLUSIONS With the exception of wound site infection, although no difference was observed between the PBD and the non-PBD groups based on intraoperative and postoperative complications, because of the distinctive inherent complications of PBD it is essential to manage such patients properly and to carefully select the patients for the PBD procedure.
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Affiliation(s)
- Refik Bademci
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, University Autònoma de Barcelona, Bellaterra, Spain
| | - Michael Olusegun Temidayo Talabi
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, University Autònoma de Barcelona, Bellaterra, Spain
| | - Pedro Salas
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, University Autònoma de Barcelona, Bellaterra, Spain
| | - Manuel Rodríguez Blanco
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, University Autònoma de Barcelona, Bellaterra, Spain
| | - Gemma Cerdán Riart
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, University Autònoma de Barcelona, Bellaterra, Spain
| | - Jesus Bollo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, University Autònoma de Barcelona, Bellaterra, Spain
| | - Vicente Artigas Raventós
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, University Autònoma de Barcelona, Bellaterra, Spain
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Scherber PR, Gäbelein G, Spiliotis AE, Igna D, Holländer S, Jacob P, Hofmann J, Glanemann M. Role of biliary drainage before pancreatoduodenectomy for pancreatic adenocarcinoma: a retrospective study. Minerva Surg 2022; 77:550-557. [PMID: 35230040 DOI: 10.23736/s2724-5691.22.09414-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/17/2023]
Abstract
BACKGROUND Utilization of preoperative biliary drainage prior to pancreatoduodenectomy for patients with pancreatic ductal adenocarcinoma and obstructive jaundice remains controversial. METHODS All patients that underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma at the authors' institution were analyzed retrospectively to evaluate the effect of endoscopic biliary drainage on postoperative outcomes and long-term survival. Age, gender, ASA-Score, operative time, blood loss, intraoperative transfusion rate, and postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, bleeding, bile fistula, wound infections, sepsis, pulmonary and cardiac complications as well as the need for relaparotomy were analyzed. RESULTS Two hundred eighty-five patients with similar baseline characteristics underwent pancreatoduodenectomy, 151 patients with biliary drainage (group 1) and 134 without drainage (group 2). More than 60% of patients had one or more postoperative complications, without significant difference between the two groups (P=0.140). The overall incidence of pancreatic fistula was 21.75% in both groups (group 1: 19.87% vs. group 2: 23.88%, P=0.659). Wound healing impairment was the only postoperative complication that differed significantly between the two groups (group 1: 24.50% vs. group 2: 8.96%, P<0.001). In multivariate risk analysis, biliary drainage was the only independent risk factor for wound healing impairment (OR 4.126; 95% CI: 1.295-13.143; P=0.017). The median overall survival was similar in both groups. CONCLUSIONS Preoperative endoscopic biliary drainage is associated with an increased risk for wound healing impairment and wound infections. Therefore, biliary drainage should not be used routinely in patients with obstructive jaundice prior to pancreatoduodenectomy.
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Affiliation(s)
- Philipp R Scherber
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Gereon Gäbelein
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Antonios E Spiliotis
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany -
| | - Dorian Igna
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Sebastian Holländer
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Peter Jacob
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Julia Hofmann
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Matthias Glanemann
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
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31
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Ryou SY, Sung PS. A rare cause of obstructive jaundice in a patient with hepatocellular carcinoma. Dig Liver Dis 2022; 54:1721-1722. [PMID: 35999137 DOI: 10.1016/j.dld.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/30/2022] [Accepted: 08/04/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Se Young Ryou
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea; The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
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32
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van Gils L, Verbeek R, Wellerdieck N, Bollen T, van Leeuwen M, Schwartz M, Vleggaar F, Molenaar IQQ, van Santvoort H, van Hooft J, Verdonk R, Weusten B. Preoperative biliary drainage in severely jaundiced patients with pancreatic head cancer: A retrospective cohort study. HPB (Oxford) 2022; 24:1888-1897. [PMID: 35803831 DOI: 10.1016/j.hpb.2022.05.1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/22/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines recommend against preoperative biliary drainage (PBD) in patients with pancreatic head cancer if bilirubin levels are <250 μmol/l. However, patients with higher bilirubin levels undergo PBD, despite the lack of supporting evidence. This study aims to evaluate outcomes in patients with a bilirubin level ≥250 and < 250. METHODS Patients were identified from databases of 3 centers. Outcomes were compared in patients with a bilirubin level ≥250 versus <250 both at the time of diagnosis and directly prior to surgery. RESULTS 244 patients were included. PBD was performed in 64% (123/191) with bilirubin <250 at diagnosis and 91% (48/53) with bilirubin ≥250. PBD technical success (83% vs. 81%, p = 0.80) and PBD related complications (33% vs. 29%, p = 0.60) did not differ between these groups. Analyzing bilirubin levels ≥250 versus <250 directly prior to surgery, no differences in severe postoperative complications and mortality were found. CONCLUSIONS In patients with a pancreatic head cancer, PBD technical success and complications, and severe postoperative complications did not differ between patients with a bilirubin level ≥250 and < 250. Our study does not support a different approach regarding PBD in patients with severe jaundice.
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Affiliation(s)
- Luuk van Gils
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Romy Verbeek
- Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, the Netherlands
| | - Nienke Wellerdieck
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thomas Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Maarten van Leeuwen
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Matthijs Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
| | - Frank Vleggaar
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - I Q Quintus Molenaar
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hjalmar van Santvoort
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Janine van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert Verdonk
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bas Weusten
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
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Huang XH, Wu SH, Li P, Ke Q, Weng XT, Li L, Liu DX, Zhuang SW, Sun JH, Guo WH. [Percutaneous biliary stent combined with brachytherapy for malignant obstructive jaundice: a multicenter retrospective controlled study]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:702-709. [PMID: 36038338 DOI: 10.3760/cma.j.cn501113-20220728-00399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the efficacy, safety and prognostic factors of percutaneous biliary stent combined with iodine-125 seed chain brachytherapy (radiotherapy) in the treatment of malignant obstructive jaundice. Methods: Data of 107 cases with malignant obstructive jaundice treated with percutaneous biliary stent implantation from January 2017 to December 2020 were retrospectively analyzed. Among them, 58 cases received biliary stent combined with iodne-125 seed chain brachytherapy (study group), and 49 cases received biliary stent implantation (control group). The changes of bilirubin, stent patency time, complications, overall survival (OS) and prognostic factors were analyzed in both groups. Results: The incidence of complications in the study group and the control group were 17.2% and 18.3% respectively, and the difference was not statistically significant (P=0.974). Serum total bilirubin levels were decreased significantly in both groups at one month after surgery (P<0.001). Postoperative stent patency time was significantly better in the study group (10.0±1.6 months) (95% CI: 8.2~12.5) than that in the control group (5.2±0.4 months) (95% CI: 4.1~6.0, P<0.001). The median OS was longer in the study group (11.2±1.8 months) (95% CI: 9.2~12.8) than that in the control group (8.0±1.1 months) (95% CI: 8.0~12.8, P<0.001). Multivariate analysis result showed that stent combined with brachytherapy (HR=0.08, 95% CI:0.04~0.15, P<0.001) and receiving further anti-tumor therapy after surgery (HR=0.27, 95% CI:0.15~0.49, P<0.001) were independent risk factors affecting the patency of biliary stents. Preoperative percutaneous transhepatic biliary drainage (HR=0.46, 95%CI:0.28~0.74, P=0.002), stent combined with brachytherapy (HR=0.23, 95%CI:0.14~0.39, P<0.001) and receiving further anti-tumor therapy after surgery (HR=0.37, 95%CI:0.22~0.61, P<0.001) were independent risk factors affecting OS. Conclusion: Percutaneous biliary stent combined with brachytherapy is safe and effective in the treatment of malignant obstructive jaundice, which can significantly prolong the patency time of biliary stent and the survival time of patients.
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Affiliation(s)
- X H Huang
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025,China
| | - S H Wu
- Department of Interventional Radiology, Zhangzhou Municipal Hospital, Zhangzhou 350025, China
| | - P Li
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 350025, China
| | - Q Ke
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025,China
| | - X T Weng
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025,China
| | - L Li
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025,China
| | - D X Liu
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 350025, China
| | - S W Zhuang
- Department of Interventional Radiology, Zhangzhou Municipal Hospital, Zhangzhou 350025, China
| | - J H Sun
- Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - W H Guo
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025,China
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Kazami Y, Arita J, Nishioka Y, Kawaguchi Y, Ichida A, Ishizawa T, Akamatsu N, Kaneko J, Nakai Y, Koike K, Hasegawa K. Preoperative Predictive Features of Invasive Carcinoma Among Intraductal Papillary Mucinous Neoplasm of the Pancreas. Pancreas 2022; 51:642-648. [PMID: 35835103 DOI: 10.1097/mpa.0000000000002078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Noninvasive intraductal papillary mucinous neoplasms (IPMNs) theoretically do not metastasize. The purpose of this study is to preoperatively distinguish invasive carcinomas associated with IPMN from noninvasive IPMN. METHODS A total of 131 patients who underwent surgical resection for IPMN were retrospectively analyzed to identify the predictors of invasive carcinoma, based on the International Association of Pancreatology Consensus Guidelines. RESULTS Of the 131 patients, 29 (22%) had invasive carcinomas and 102 (78%) had noninvasive IPMN. An enhancing mural nodule (MN) greater than or equal to 5 mm, obstructive jaundice, an abrupt change in the caliber of the pancreatic duct (PD) with distal pancreatic atrophy, and lymphadenopathy were the significant predictors of invasive carcinoma in univariate analysis. The optimal cutoff value for the size of the enhancing MN to differentiate invasive carcinoma was 13 mm. In multivariate analysis, enhancing MN greater than or equal to 13 mm, obstructive jaundice, and an abrupt change in the PD caliber were the independent predictors. When all these factors were absent, only 17% were invasive carcinomas. CONCLUSIONS Enhancing MN greater than or equal to 13 mm, obstructive jaundice, and an abrupt change in the PD caliber were predictive factors for invasive carcinoma. Systematic lymph node dissection may be omitted when a high-risk patient has none of these factors.
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Affiliation(s)
- Yusuke Kazami
- From the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery
| | - Junichi Arita
- From the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery
| | - Yujiro Nishioka
- From the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery
| | | | - Akihiko Ichida
- From the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery
| | - Takeaki Ishizawa
- From the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery
| | - Nobuhisa Akamatsu
- From the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery
| | - Junichi Kaneko
- From the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- From the Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery
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Bestari MB, Nugraha ES, Abdurachman SA. Secondary Choledocholithiasis in Obstructive Jaundice Patient due to Choledochoduodenal-fistula Stricture. Acta Med Indones 2022; 54:283-287. [PMID: 35818650] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Choledochoduodenal fistula (CDF) is a rare condition marked by an abnormal connection between the biliary duct and duodenum. The common etiology of secondary CDF are cholecystolithiasis, tumor, and duodenal ulcer. CDF may also caused by prior inflammatory condition or as a complication of radiation therapy. Management for this case is based on the patient condition. Herein we aimed to present a case of secondary choledocholithiasis due to stricture in the CDF which presented with cholangitis treated by self-expanding metal stent (SEMS) for biliary drainage. Patient admitted with jaundice, fever, right upper quadrant pain, and history of cholecystectomy. Diagnosis of CDF was determined by endoscopic retrograde cholangiopancreatography (ERCP) and followed by putting biliary stent for urgent biliary drainage. The follow up result after stent removal was excellent.
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Affiliation(s)
- Muhammad Begawan Bestari
- Division of Gastroenterohepatology Department of Internal Medicine Faculty of Medicine - University of Padjadjaran Hasan Sadikin General Hospital Bandung.
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Arumugam SK, Ramalingam R, Ramalingam R. A Male Infant with Cholestatic Jaundice, Hemolytic Anemia, and Thrombocytopenia. Neoreviews 2022; 23:e121-e124. [PMID: 35102384 DOI: 10.1542/neo.23-2-e121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Duan B, Zhao X, Fan S, Zhou L, Zhang X. A rare case report of obstructive jaundice caused by mucus-producing cholangiocarcinoma. Medicine (Baltimore) 2022; 101:e28478. [PMID: 35060499 PMCID: PMC8772676 DOI: 10.1097/md.0000000000028478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Cholangiocarcinoma is a common cause of obstructive jaundice but is mainly associated with solid mass and not semisolid secretion. In this report, the patient was admitted to the hospital with obstructive jaundice; however, no solid mass was found to lead to jaundice. PATIENT CONCERNS The patient developed symptoms of obstructive jaundice for 10 days, including fatigue and yellow skin staining. DIAGNOSES Postoperative pathological examination of the bile duct wall revealed cholangioadenocarcinoma, and the jelly like contents were inflammatory secretions. INTERVENTIONS The patient underwent laparotomy and was diagnosed with obstructive jaundice. An exploratory laparotomy revealed that the content in the biliary duct tree was a jelly like inflammatory secretion. OUTCOMES Follow-up data revealed that the levels of total bilirubin and aminotransferase were normal, and a computed tomography scan showed no tumor mass. LESSONS There are very few reports about obstructive jaundice caused by inflammatory secretion that almost filled up the biliary tree. Internal drainage of the cholestatic bile can be achieved through endoscopic retrograde cholangiopancreatograpy, or external drainage can be achieved through percutaneous transhepatic biliary drainage, which can relieve the symptoms of biliary obstruction and improve the patient's quality of life.
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Li M, Wang HS, Wang CL, Zhang L, Yang XL, Xu Y, Gao W, Guo Z, Yu HP. [Risk factors of pancreatitis after percutaneous transhepatic biliary drainage in patients with pancreatic cancer and obstructive jaundice]. Zhonghua Nei Ke Za Zhi 2022; 61:82-85. [PMID: 34979775 DOI: 10.3760/cma.j.cn112138-20210204-00101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To explore the risk factors and preventive strategies of pancreatitis after percutaneous transhepatic biliary drainage (PTBD) in patients with pancreatic cancer and obstructive jaundice. Methods: A total of 241 patients were retrospectively analyzed from May 2001 to October 2014 in Tianjin Medical University Cancer Institute and Hospital. The possibly correlated 9 factors were analyzed, including gender, age, hemoglobin level, total bilirubin level, degree of pancreatic duct dilatation, degree of pancreatic atrophy, degree of biliary stenosis, the pancreatic duct visualization, and drainage mode. Results: Univariate analysis suggested that pancreatic duct dilatation, pancreatic atrophy, visualized pancreatic duct and drainage mode were associated with the incidence of pancreatitis after PTBD (P<0.05). Logistic regression analysis showed that visualization of pancreatic duct (OR=6.33) was a risk factor for pancreatitis, while pancreatic duct dilatation (OR=0.14), pancreatic atrophy (OR=0.12) and external drainage (OR=0.11) were protective factors for pancreatitis. Conclusion: In pateints with pancreatic cancer and obstructive jaundice, pancreatic duct dilatation and pancreatic atrophy predict low risk of pancreatitis after PTBD,while intraoperative pancreatic duct visualization and internal or external drainage may increase the incidence of postoperative pancreatitis.
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Affiliation(s)
- M Li
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Reserch Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300000, China The Affiliated Hospital of Hebei University, Experimental Center of Hebei University Hospital, Baoding 071000, China
| | - H S Wang
- The Affiliated Hospital of Hebei University, Experimental Center of Hebei University Hospital, Baoding 071000, China
| | - C L Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Reserch Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300000, China
| | - L Zhang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Reserch Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300000, China
| | - X L Yang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Reserch Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300000, China
| | - Y Xu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Reserch Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300000, China
| | - W Gao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Reserch Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300000, China
| | - Z Guo
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Reserch Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300000, China
| | - H P Yu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Reserch Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300000, 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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40
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Smith LR, Coomer W, Gupta S, Boyce T. Jaundice and a testicular lump: a rare cause of malignant biliary obstruction. Ann R Coll Surg Engl 2022; 104:e4-e5. [PMID: 34730434 DOI: 10.1308/rcsbull.2022.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Biliary obstruction from metastatic deposits in the pancreas is rare. We present a case of primary testicular lymphoma (PTL) with pancreatic metastasis. A 56-year-old man presented to the general surgical department with signs and symptoms of obstructive jaundice. A computed tomography scan revealed multiple pancreatic metastases and a right primary testicular malignancy. Histology and positron emission tomography scanning subsequently confirmed PTL with pancreatic metastases. Metastasis to the pancreas from primary testicular malignancy is extremely rare. There is variation in prognosis between primary and secondary pancreatic malignancies and therefore in atypical cases of malignant biliary obstruction consideration must be given to the rarer secondary malignancies.
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41
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Thieu HV, Minh TB, Tuong TTK, Duc NM. Cutoff Values for Serum Ferritin in"&#".ord($0).";""&#".ord($0).";"Predicting Cirrhosis Severity due to Cholestatic Jaundice in Vietnamese Children. Med Arch 2022; 76:122-126. [PMID: 35774043 PMCID: PMC9233469 DOI: 10.5455/medarh.2022.76.122-126] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/15/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ha-Van Thieu
- Department of Pediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Children’s Hospital 2, Ho Chi Minh City, Vietnam
| | - Thach Binh Minh
- Department of Pediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Tran-Thi Khanh Tuong
- Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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42
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Yartsev PA, Teterin YS, Mironova KA, Askerov AC. [Oral cholangioscopy for biliary system diseases]. Khirurgiia (Mosk) 2022:28-34. [PMID: 36223147 DOI: 10.17116/hirurgia202210128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To improve the results of treatment of obstructive jaundice by using of oral cholangioscopy. MATERIAL AND METHODS There were 321 patients with obstructive jaundice between October 2020 and November 2021. Of these, cholangioscopy (SpyGlass video system) was used in 18 patients. Patients were divided into two groups: group 1 (n=9) - malignant biliary strictures; group 2 (n=9) - choledocholithiasis with large calculi (≥1.2 cm). At admission, all patients underwent laboratory and instrumental examination. In the first group, bilioduodenal stenting with plastic stents 7 and 10 Fr in diameter, 7 to 12 cm long or self-expanding nitinol stents 0.8-1.0 cm in diameter, 6 to 10 cm long was carried out. Patients with large calculi underwent targeted laser lithotripsy under endoscopic control until formation of 1-cm fragments. These fragments were removed using a lithoextraction balloon and Dormia basket. RESULTS Cholangioscopy (SpyGlass system) was performed within 2 days after admission. In group 1, tumor tissue overgrowths were found during cholangioscopy. Five out of 9 (55.6%) patients underwent bilioduodenal stenting for adequate biliary drainage. Of these, 4 (44.5%) patients developed acute edematous pancreatitis on the first postoperative day. This complication regressed after 3-4 days under therapy. Four (44.5%) patients died from cancer-related multiple organ failure. In group 2, cholangioscopy effectively visualized the calculus and ensured its destruction by laser contact lithotripsy. Intraoperative and postoperative complications were not revealed in both groups. CONCLUSION SpyGlass system is effective and safe for diagnosis and treatment in 100% of patients with extrahepatic biliary strictures and/or large calculi.
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Affiliation(s)
- P A Yartsev
- Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - Yu S Teterin
- Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - K A Mironova
- Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - A Ch Askerov
- Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
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43
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Li ZM, Jiao DC, Han XW, Lei QY, Zhou XL, Xu M. Preliminary application of brachytherapy with double-strand 125I seeds and biliary drainage for malignant obstructive jaundice. Surg Endosc 2021; 36:4932-4938. [PMID: 34845555 DOI: 10.1007/s00464-021-08848-6] [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: 01/25/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the efficacy and safety of brachytherapy with double-strand 125I seeds and biliary drainage for malignant obstructive jaundice. METHODS AND MATERIALS 42 patients with obstructive jaundice because of extrahepatic cholangiocarcinoma were enrolled. 22 patients (group A) received a biliary stent with common drainage tube implantation, and 20 patients (group B) received a biliary stent with double-strand 125I seeds radiotherapy drainage tube placement. The length, location and pathological stage of biliary stricture were recorded in the two groups. Total bilirubin (TBIL), direct bilirubin (DBIL), IgA, IgG, IgM, alanine aminotransferase and white blood cell (WBC) count were measured before and after percutaneous transhepatic cholangial drainage (PTCD). Tumor diameter was measured before and three months after PTCD, and the difference were calculated. Stent patency time, survival time, and complications were recorded. RESULTS There was no significant difference in the length, location and pathological stage of biliary stenosis between the two groups. There was no significant difference in TBIL, DBIL, IgA, IgG, IgM, alanine aminotransferase and WBC count between the two groups before or after PTCD (P > 0.05). Three months after PTCD, tumors growth in group A and tumors shrinkage in group B. The difference in tumor size between the two groups before and after PTCD was statistically significant (P < 0.05). The average stent patency times in groups A and B were 3.55 ± 0.76 months and 8.76 ± 1.85 months, respectively (P < 0.05). The average survival times in groups A and B were 133.5 ± 27.8 days and 252.5 ± 114.5 days, respectively (P < 0.05). There was no statistically significant difference in the incidence of complications between the two groups (P > 0.05). CONCLUSION Double-strand 125I seeds radiotherapy biliary drainage tubes can safely and effectively control tumors, prolong the patency of biliary stents, and prolong patient survival.
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Affiliation(s)
- Zong-Ming Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - De-Chao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xin-Wei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Qin-Yu Lei
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xue-Liang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Miao Xu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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44
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Rane SV, Thanage R, Chandnani S, Rathi PM. Graves' disease associated with cholestatic jaundice and persistent diarrhoea. BMJ Case Rep 2021; 14:e244367. [PMID: 34753719 PMCID: PMC8578937 DOI: 10.1136/bcr-2021-244367] [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] [Accepted: 09/25/2021] [Indexed: 11/03/2022] Open
Abstract
Liver involvement in Graves' disease can be seen as a part of autoimmune process or rarely, due to the direct effects of thyrotoxicosis on liver. Hyperthyroidism can also have gastrointestinal manifestations like frequent bowel movements, diarrhoea, even malabsorption with steatorrhoea. We report a 36-year-old man with hyperthyroidism, presenting with cholestatic jaundice and persistent small bowel diarrhoea. He was diagnosed to have Graves' disease and after ruling out more common causes, the cause of cholestatic jaundice was supposed to be Graves' disease. Considering this possibility, the patient was started on treatment with carbimazole. As patient's thyroid function tests started improving, he showed significant clinical and biochemical improvement from liver point of view as well.
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Affiliation(s)
- Siddhesh Vijay Rane
- Gastroenterology, Topiwala National Medical College, Mumbai, Maharashtra, India
| | - Ravi Thanage
- Gastroenterology, Topiwala National Medical College, Mumbai, Maharashtra, India
| | - Sanjay Chandnani
- Gastroenterology, Topiwala National Medical College, Mumbai, Maharashtra, India
| | - Pravin M Rathi
- Gastroenterology, Topiwala National Medical College, Mumbai, Maharashtra, India
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45
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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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46
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Meng QQ, Gao Y, Hu LH, Qian W, Lin H, Zhang YR, Pan J, Li ZS, Xin L, Wang LW. Limited Role of Endoscopic Biliary Drainage Before Steroid Treatment for Autoimmune Pancreatitis With Significant Obstructive Jaundice. Pancreas 2021; 50:e65-e66. [PMID: 34714290 DOI: 10.1097/mpa.0000000000001883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Qian-Qian Meng
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China or
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47
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Kuwatani M, Kawakubo K, Sugimori K, Inoue H, Kamada H, Ishiwatari H, Kato S, Iwashita T, Yoshida M, Hashimoto S, Itonaga M, Mizukami Y, Nomura Y, Katanuma A, Sakamoto N. Trial protocol: a randomised controlled trial to verify the non-inferiority of a partially covered self-expandable metal stent to an uncovered self-expandable metal stent for biliary drainage during neoadjuvant therapy in patients with pancreatic cancer with obstructive jaundice (PUN-NAC trial). BMJ Open 2021; 11:e045698. [PMID: 34244257 PMCID: PMC8268904 DOI: 10.1136/bmjopen-2020-045698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION Neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy (NAC/NACRT) for resectable/borderline resectable pancreatic cancers was recently performed to improve clinical outcomes and led to good results, although it remains controversial whether NAC/NACRT is beneficial for resectable pancreatic cancer. A few recent studies revealed longer patency and lower cost related to the stent occlusion of a metal stent than those of a plastic stent during NAC/NACRT. It also remains controversial which type of self-expandable metal stent (SEMS) is the most suitable for patients with resectable/borderline resectable pancreatic cancer during NAC/NACRT: an uncovered SEMS (USEMS), a fully covered SEMS (FCSEMS) or a partially covered SEMS (PCSEMS). So far, two randomised controlled trials indicated that a USEMS and an FCSEMS were similar in preoperative stent dysfunction and adverse event rate. Thus, we aimed to verify the non-inferiority of a PCSEMS to a USEMS in this multicentre randomised controlled trial. METHODS AND ANALYSIS We designed a multicentre randomised controlled trial, for which we will recruit 100 patients with resectable/borderline resectable pancreatic cancer and distal biliary obstruction scheduled for NAC/NACRT from 13 high-volume institutions. Patients will be randomly allocated to the PCSEMS group or USEMS group. The primary outcome measure is the preoperative biliary event rate. Data will be analysed after completion of the study. We will calculate the 95% CIs of the incidence of preoperative biliary events in each group and analyse whether the difference between them is within the non-inferiority margin (10%). ETHICS AND DISSEMINATION This study has been approved by the institutional review board of Hokkaido University Hospital. The results will be submitted for presentation at an international medical conference and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER UMIN000041737; jRCT1012200002.
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Affiliation(s)
- Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Kazuya Sugimori
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Inoue
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideki Kamada
- Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan
| | | | - Shin Kato
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Takuji Iwashita
- Department of Gastroenterology, Gifu University, Gifu, Japan
| | - Makoto Yoshida
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shinichi Hashimoto
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masahiro Itonaga
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yusuke Mizukami
- Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Nomura
- Department of Gastroenterology, IMS Sapporo Digestive Disease Center General Hospital, Sapporo, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
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48
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Saini AG, Attri SV. Cholestatic Jaundice in Sulphite Oxidase Deficiency - An Unusual Association: Correspondence. Indian J Pediatr 2021; 88:628-629. [PMID: 33205359 DOI: 10.1007/s12098-020-03560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Arushi Gahlot Saini
- Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Savita Verma Attri
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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49
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Gómez-Rázuri K, Espino-Saavedra W. [Neurofibroma of the bile duct: a rare cause of cholestatic jaundice that mimics Klatskin’s tumor]. Rev Gastroenterol Peru 2021; 41:117-120. [PMID: 34724694] [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: 06/13/2023]
Abstract
The neurofibroma of the bile duct is an extremely rare and generally asymptomatic disease, however, it maybe cause obstructive jaundice and mimic a Klatskin tumor, leading to radical surgical treatment and increased patient morbidity. We present the case of a 62-year-old woman who underwent cholecystectomy 10 years ago, with jaundice and pain in the right upper quadrant, as well as auxiliary tests compatible with cholestasis. Dilation of the bile duct and the presence of a tumor in the left hepatic duct were observed by magnetic cholangioresonance. The preoperative clinical diagnosis was hilar cholangiocarcinoma, but the histopathological study revealed a neoplasm composed of spindle cells without atypia or mitotic activity, whose neurogenic lineage supported by its positivity to protein S100 in immunohistochemistry. We report the case given its infrequency in the literature and its relevance, as it is a benign entity, as a differential diagnosis of cancer.
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50
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Hasan MS. Factors Affecting Morbidity and Mortality after ERCP for Obstructive Jaundice. Mymensingh Med J 2021; 30:523-530. [PMID: 33830138] [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: 06/12/2023]
Abstract
Endoscopic Retrograde Cholangio Pancreaticography (ERCP) is an invasive procedure which can be used for therapeutic purpose. But it has versatile complications. It depends upon patient factors and gastroenterologist's expertise. This study was done to determine factors affecting morbidity and mortality after ERCP for obstructive jaundice. The prospective observational study was conducted among 30 patients with obstructive jaundice in the department of Gastroenterology and Surgery of Combined Military Hospital (CMH), Dhaka during the period of July 2016 to December 2016. After obtaining a detailed history, general physical and systemic examinations were done for all enrolled patients and they were subjected to do relevant investigations. The data were collected by the active participation of the patient and patient was interviewed by the preformed case record form. ERCPs were carried out in a standard fashion by using a side viewing duodenoscope. Every variable like number of pancreatic duct cannulation, sphincterotomy, whether pre-cut or wire guided cannulation, number of failed removal of CBD stone and incomplete drainage was recorded by a trained assistant. The data analysis of 30 patients yielded that mean age of patient was 43.8 years. Most of the patients (50.0%) were in 41-60 years of age group. Among the respondents, 90.0% were male and 10.0% were female. The most common indication of ERCP was sphincterotomy with stone extraction (66.7%). About one tenth of study patients, 3(10.0%) developed post ERCP complications. The most common post ERCP complications were intra-procedural bleeding (66.7%) followed by pancreatitis (33.3%). Both of the complications were in mild form. In multivariate analysis it was found that history of acute pancreatitis, suspected SOD, needle knife and supra-papillary fistulotomy had more risks. Three (10.0%) patients developed complications, among which 66.7% had intra-procedural bleeding and 33.3% had pancreatitis. Middle aged person, male gender, precut sphincterotomy and history of acute pancreatitis are the commonest significant post ERCP morbidity and mortality predictors.
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Affiliation(s)
- M S Hasan
- Lt Col (Dr) Md Shafiqul Hasan, Medicine Specialist, Combined Military Hospital, Mymensingh, Bangladesh; E-mail:
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