1
|
Kokas B, Szijártó A, Farkas N, Ujváry M, Móri S, Kalocsai A, Szücs Á. Percutaneous transhepatic drainage is safe and effective in biliary obstruction-A single-center experience of 599 patients. PLoS One 2021; 16:e0260223. [PMID: 34793565 PMCID: PMC8601527 DOI: 10.1371/journal.pone.0260223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. METHODS In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. RESULTS 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. DISCUSSION The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.
Collapse
Affiliation(s)
- Bálint Kokas
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Attila Szijártó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, University of Pécs, Pécs, Hungary
| | - Miklós Ujváry
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Móri
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Adél Kalocsai
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Ákos Szücs
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
- * E-mail:
| |
Collapse
|
2
|
Pekçevik R, Ballı Ö. Percutaneous Intraductal Microwave Ablation and Self-expandable Metallic Stenting: A New Treatment Method for Malignant Extrahepatic Biliary Obstruction. Cardiovasc Intervent Radiol 2020; 44:110-117. [PMID: 33145700 DOI: 10.1007/s00270-020-02684-2] [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: 05/16/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the patency and clinical efficacy of percutaneous intraductal microwave ablation (PIMWA) and uncovered self-expandable metallic stents (USEMs) in inoperable malignant extrahepatic biliary obstruction. MATERIALS AND METHODS The procedures to be performed on patients with malignant inoperable extrahepatic biliary obstruction were decided by a multidisciplinary team including an interventional radiologist. In our study, 141 patients were evaluated retrospectively. Twenty-one patients who underwent PIMWA + USEMs with the MedWaves AveCure microwave system (AveCure® Intelligent Controller and Super-Flex Smart Catheter) and met the inclusion criteria were included in the study. Complications related to the intervention, stent patency, survival time, serum bilirubin levels, and the general condition of the patients were noted. RESULTS The median stent patency and the median survival time were 108 and 143 days, respectively. The rates of 30-day, 2-month, 6-month and 8-month survival were 95.2%, 85.7%, 38.1%, and 14.3%, respectively. CONCLUSION The PIMWA + USEMs procedure is a safe, effective, and minimally invasive alternative palliative treatment method in patients with malignant inoperable extrahepatic biliary obstruction.
Collapse
Affiliation(s)
- Rıdvan Pekçevik
- Department of Interventional Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, 35360, İzmir, Turkey.
| | - Ömür Ballı
- Department of Interventional Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, 35360, İzmir, Turkey
| |
Collapse
|
3
|
Yuan XL, Wei B, Ye LS, Wu CC, Tan QH, Yao MH, Zhang YH, Zeng XH, Li Y, Zhang YY, Hu B. New antireflux plastic stent for patients with distal malignant biliary obstruction. World J Gastroenterol 2019; 25:2373-2382. [PMID: 31148908 PMCID: PMC6529883 DOI: 10.3748/wjg.v25.i19.2373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/28/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction (MBO). However, the main problem with stent placement is the relatively short duration of stent patency. Although self-expanding metal stents (SEMSs) have a longer patency period than plastic stents (PSs), the higher costs limit the wide use of SEMSs. A PS with an antireflux valve is an attractive idea to prolong stent patency, but no ideal design for an antireflux PS (ARPS) has been proposed. We developed a new ARPS with a “duckbilled” valve attached to the duodenal end of the stent.
AIM To compare the patency of ARPSs with that of traditional PSs (TPSs) in patients with unresectable distal MBO.
METHODS We conducted a single-center, prospective, randomized, controlled, double-blind study. This study was conducted at the West China Hospital of Sichuan University. Consecutive patients with extrahepatic MBO were enrolled prospectively. Eligible patients were randomly assigned to receive either an ARPS or a TPS. Patients were followed by clinic visits or telephone interviews every 1-2 mo until stent exchange, death, or the final study follow-up in October 2018. The primary outcome was the duration of stent patency. Secondary outcomes included the rate of technical success, the rate of clinical success, adverse events, and patient survival.
RESULTS Between February 2016 and December 2017, 38 patients were randomly assigned to two groups, with 19 patients in each group, to receive ARPSs or TPSs. Stent insertion was technically successful in all patients. There were no significant differences between the two groups in the rates of clinical success or the rates of early or late adverse events (P = 0.660, 1.000, and 1.000, respectively). The median duration of stent patency in the ARPS group was 285 d [interquartile range (IQR), 170], which was significantly longer than that in the TPS group (median, 130 d; IQR, 90, P = 0.005). No significant difference in patient survival was noted between the two groups (P = 0.900).
CONCLUSION The new ARPS is safe and effective for the palliation of unresectable distal MBO, and has a significantly longer stent patency than a TPS.
Collapse
Affiliation(s)
- Xiang-Lei Yuan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bin Wei
- Department of Gastroenterology, the First Hospital of Xi’an City, Xi’an 710002, Shaanxi Province, China
| | - Lian-Song Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chun-Cheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qing-Hua Tan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ming-Hong Yao
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Hang Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xian-Hui Zeng
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Yan Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
4
|
Taylor T, Wheatley M, Gupta N, Nusbaum J. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment [digest]. Emerg Med Pract 2018; 20:1-2. [PMID: 29634896] [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: 06/08/2023]
Abstract
There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature. [Points & Pearls is a digest of Emergency Medicine Practice.].
Collapse
Affiliation(s)
- Todd Taylor
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| | - Matthew Wheatley
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| | - Nachi Gupta
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey Nusbaum
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
5
|
Taylor T, Wheatley M. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment. Emerg Med Pract 2018; 20:1-24. [PMID: 29565526] [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] [Received: 12/01/2017] [Accepted: 12/10/2017] [Indexed: 06/08/2023]
Abstract
There are approximately 52,000 visits a year to emergency departments for patients presenting with jaundice. While many of these patients will not have immediately life-threatening pathology, it is essential that the emergency clinician understands the pathophysiology of jaundice, as this will guide the appropriate workup to detect critical diagnoses. Patients who present with jaundice could require intravenous antibiotics, emergent surgery, and, in severe cases, organ transplantation. This issue will focus on the challenge of evaluating and treating the jaundiced patient in the ED using the best available evidence from the literature.
Collapse
Affiliation(s)
- Todd Taylor
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| | - Matthew Wheatley
- Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA
| |
Collapse
|
6
|
Rew SJ, Lee DH, Park CH, Jeon J, Kim HS, Choi SK, Rew JS. Comparison of intraductal ultrasonography-directed and cholangiography-directed endoscopic retrograde biliary drainage in patients with a biliary obstruction. Korean J Intern Med 2016; 31:872-9. [PMID: 27097771 PMCID: PMC5016288 DOI: 10.3904/kjim.2015.291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/16/2016] [Accepted: 01/23/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic retrograde biliary drainage (ERBD) has become a standard procedure in patients with a biliary obstruction. Intraductal ultrasonography (IDUS) has emerged as a new tool for managing extrahepatic biliary diseases. IDUS-directed ERBD can be performed without conventional cholangiography (CC). The goal of this study was to assess the effectiveness and safety of IDUS-directed ERBD compared to CC-directed ERBD in patients with an extrahepatic biliary obstruction. METHODS A total of 210 patients who had undergone IDUS-directed ERBD (IDUS-ERBD, n = 105) and CC-directed ERBD (CC-ERBD, n = 105) between October 2013 and April 2014 were analyzed retrospectively. The primary outcome measure was the procedural success rate. Secondary outcome measures included clinical outcomes, total procedure time, radiation exposure time, and overall complication rates. RESULTS The total technical success rate of ERBD was 100% (105/105) in the IDUS-ERBD and CC-ERBD groups. Mean procedure time was slightly prolonged in the IDUS-ERBD group than that in the CC-ERBD group (32.1 ± 9.9 minutes vs. 28.4 ± 11.6 minutes, p = 0.023). Mean radiation exposure time was one-third less in the IDUS-ERBD group than that in the CC-ERBD group (28.0 ± 49.3 seconds vs. 94.2 ± 57.3 seconds, p < 0.001). No significant differences in complication rates were detected between the groups. CONCLUSIONS IDUS-ERBD was equally effective and safe as CC-ERBD in patients with an extrahepatic biliary obstruction. Although IDUS-ERBD increased total procedure time, it significantly decreased radiation exposure.
Collapse
Affiliation(s)
| | | | - Chang-Hwan Park
- Correspondence to Chang-Hwan Park, M.D. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6296 Fax: +82-62-228-1330 E-mail:
| | | | | | | | | |
Collapse
|
7
|
Han SJ, Lee TH. [Can Endoscopic Ultrasonography-guided Biliary Drainage Using Self-expandable Metal Stents in Malignant Distal Biliary Obstruction Be a Substitute When Endoscopic Retrograde Cholangiopancreatography Has Failed?]. Korean J Gastroenterol 2015; 66:64-6. [PMID: 26410898 DOI: 10.4166/kjg.2015.66.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
8
|
Madhu MP, Agarwal V, Soni A, Pokharna RK, Nijhawan S, Sharma G, Rai GP. Etiological spectrum of extra hepatic biliary obstructive (EHBO) at a tertiary care centre in Northern India. Trop Gastroenterol 2015; 36:142-143. [PMID: 26710493 DOI: 10.7869/tg.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
9
|
Tonolini M. Reversible acute duodenitis as a complication of endoscopic biliary stenting. J Gastrointestin Liver Dis 2014; 23:8. [PMID: 24689087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
10
|
Skipenko OG, Bedzhanian AL, Sokolina IA, Khrustaleva MV, Khovrin VV, Chardarov NK, Skipenko TO, Ganiev FA. [The treatment of the sponateneous biloma and choledocholithiasis after the liver resection on the reason of the giant hemangioma]. Khirurgiia (Mosk) 2012:76-80. [PMID: 22810542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patient with giant rapidly growing liver hemangioma who carried out right hemihepatectomy is reported. The feature if this case is choledocholithiasis after liver resection followed by its rare complication (spontaneous biloma) in 6 years after surgery. Minimally invasive procedures (percutaneous drainage, endoscopic papillotomy and stenting) eliminated each of bile collection and cause of biliary obstruction without surgical intervention.
Collapse
|
11
|
Horaguchi J, Fujita N, Noda Y, Kobayashi G, Ito K, Obana T, Koshita S, Kanno Y, Ogawa T, Yamashita Y, Kato Y. Endosonography-guided biliary drainage with one-step placement of a newly designed fully covered metal stent for malignant biliary obstruction. Dig Endosc 2011; 23:207. [PMID: 21429037 DOI: 10.1111/j.1443-1661.2010.01081.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
12
|
Weston BR, Ross WA, Liu J, Lee JH. Clinical outcomes of nitinol and stainless steel uncovered metal stents for malignant biliary strictures: is there a difference? Gastrointest Endosc 2010; 72:1195-200. [PMID: 21111871 DOI: 10.1016/j.gie.2010.08.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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: 05/28/2010] [Accepted: 08/11/2010] [Indexed: 01/09/2023]
Abstract
BACKGROUND Self-expandable metal stents (SEMSs) made from nitinol (N) were developed as a potentially more effective alternative to conventional stainless steel (SS) stents. OBJECTIVE To compare clinical outcomes of N versus SS stents in the management of malignant biliary strictures. DESIGN Retrospective study. SETTING Tertiary-care cancer center. PATIENTS All patients with first-time N (Flexxus) and SS (Wallstent) uncovered biliary SEMSs placed between January 2006 and October 2007. INTERVENTIONS SEMS placement. RESULTS A total of 81 N and 96 SS stents were placed. The most common cancer diagnosis was pancreatic (80.2% N; 62.5% SS; P = .06). The most frequent site of stricture was the common bile duct (85.2% N; 86.5% SS; P = .31). Biliary decompression was achieved in 93.8% of the N group and 86.4% of the SS group (P = .22). Immediate stent manipulation was required in 4 patients in each group. Subsequent intervention for poor drainage was performed in 17 N (21%) and 26 SS (27%) stents at mean times of 142.1 days (range, 5-541 days; median, 77 days) and 148.1 days (range, 14-375; median, 158.5), respectively (P = .17). The occlusion rate between N and SS stents was not significant (P = .42). The overall durations of stent patency in the N and SS group were similar (median 129 and 137 days, respectively; P = .61), including the subgroup analysis performed on patients with pancreatic cancer (P = .60) and common duct strictures (P = .77). Complication rates were low in both groups (early: 3.7% N, 6.3% SS; late: 2.5% N, 3.1% SS). Ninety percent underwent chemotherapy and 38% radiation therapy in each group. LIMITATIONS Retrospective design. CONCLUSION Similar outcomes were achieved with N and SS stents regarding efficacy, duration of stent patency, occlusion rates, and complications. Our results are most applicable to patients with common duct strictures and pancreatic cancer.
Collapse
Affiliation(s)
- Brian R Weston
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA
| | | | | | | |
Collapse
|
13
|
Lehner C, McAnulty J. Management of extrahepatic biliary obstruction: a role for temporary percutaneous biliary drainage. Compend Contin Educ Vet 2010; 32:E1. [PMID: 20960408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Extrahepatic biliary obstruction (EHBO) is a life-threatening condition with several etiologies that leads to numerous systemic physiologic derangements. It often presents as an emergency condition and causes significant morbidity and mortality in small animals. Conventional treatment consists of corrective surgical procedures, frequently on an emergency basis, which have been associated with mortality rates of 28% to 64% in dogs. Mortality is exacerbated by prolonged anesthetic times. Cats with EHBO are at a similarly high risk for anesthetic and surgical complications, and their prognosis is considered guarded. To decrease mortality, attention must be focused on presurgical patient stabilization and integrated postoperative medical management strategies.
Collapse
|
14
|
Popovici P, Moraru E. [Nutrition in cholestasis and long-term impact on trasnplant]. Rev Med Chir Soc Med Nat Iasi 2010; 114:726-730. [PMID: 21243798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Plurietiological hepatic cholestasis involves an increased risk of protein-caloric malnutrition and specifical nutritional deficiencies. Biological investigations to determine deficiencies in fat-soluble vitamins are essential for specific nutritional therapy . Although malnutrition is not an absolute contraindication for liver transplantation, its gravity has complex consequences in relation to this intervention. MATERIAL AND METHOD The authors present a study conducted over a period of 5 years following the analysis of 293 children diagnosed with intra- or extrahepatic abnormalities that caused varying degrees of cholestasis. RESULTS In the study group, the percentage of infants with cholestasis was 45.39% (133 cases) and among them 62.12% had malnutrition (82 children). Clinical evaluation of fat-soluble vitamins deficiency, in particular, but also of the soluble and minerals was performed in all patients. Liver transplantation was successfully performed in three cases. CONCLUSIONS Most important factors affecting growth after transplantation were age at the time of the liver transplant and primary diagnosis that required transplant. The role of nutritional support prior to liver transplantation is of great importance. Quality nutritional support change impact that malnutrition has on survival after liver transplantation.
Collapse
Affiliation(s)
- Paula Popovici
- Clinica a II-a Pediatrie, Facultatea de Medicină, Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi
| | | |
Collapse
|
15
|
Yasumoto T, Yokoyama S, Nagaike K. Percutaneous transcholecystic metallic stent placement for malignant obstruction of the common bile duct: preliminary clinical evaluation. J Vasc Interv Radiol 2010; 21:252-8. [PMID: 20123209 DOI: 10.1016/j.jvir.2009.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 10/04/2009] [Accepted: 10/10/2009] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the technical success and clinical effectiveness of percutaneous transcholecystic placement of self-expanding metallic stents for the treatment of malignant obstructions of the common bile duct. MATERIALS AND METHODS Fifteen patients with malignant obstruction at the lower level of the common bile duct not amenable to surgery were retrospectively reviewed in this study. In all patients, conventional biliary drainage via transhepatic peripheral duct access or endoscopic retrograde biliary drainage (ERBD) were technically difficult or deemed so at imaging evaluation. The causes of obstruction were cholangiocarcinoma (n = 7), pancreatic carcinoma (n = 6), and metastatic lymphadenopathy from gastric carcinoma in the hepatoduodenal ligament (n = 2). Following percutaneous cholecystostomy, a 5-F catheter was inserted into the common bile duct, duodenum, or the anastomosed jejunum through the cystic duct and the malignant obstruction and metallic stents were placed. The technical success was defined as the removal of the drainage tube after the stent placement for the obstruction. The mean follow-up period was 25.4 months. RESULTS Sixteen stents were placed in 15 patients. Technical success was achieved in all patients (100%) without major complications. Minor complications included controllable pain or self-limited hemobilia in six of the 15 patients (40%). Lower bilirubin levels compared with those before the procedure were achieved in 14 of the 15 patients (93%). CONCLUSIONS Percutaneous transcholecystic placement of metallic stents is a feasible and effective method to manage malignant obstruction at the lower level of the common bile duct not amenable to surgery when conventional biliary drainage via transhepatic peripheral duct access or ERBD were technically difficult or deemed so at imaging evaluation.
Collapse
Affiliation(s)
- Taku Yasumoto
- Department of Radiology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka City, Osaka 560-8565, Japan.
| | | | | |
Collapse
|
16
|
|
17
|
Abu Al Rub F, Whitt K, Tombazzi C. Disseminated histoplasmosis presenting with biliary obstruction and duodenal ulcer. Tenn Med 2009; 102:45-46. [PMID: 19634648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Disseminated histoplasmosis is an AIDS-defining illness which usually involves the liver and gastrointestinal tract, most commonly the small bowel. Abdominal pain, diarrhea, GI bleeding, hepatosplenomegaly and small bowel obstruction are well described presentations. Still gastrointestinal histoplasmosis often results in either vague symptomatology or no symptoms. Pancreaticobiliary disease related to disseminated histoplasmosis is not well characterized. We report the case of a young female with advanced HIV infection and biliary obstruction and a periampullary duodenal ulcer due to disseminated histoplasmosis.
Collapse
|
18
|
Olschewski P, Fikatas P, Pratschke J, Neumann U, Neuhaus P, Puhl G. Endoscopic management of biliary obstruction after successful reuse of a liver graft. Ann Transplant 2009; 14:51-54. [PMID: 19487795] [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] [Received: 03/24/2009] [Accepted: 04/10/2009] [Indexed: 05/27/2023] Open
Abstract
The widening gap between donated organs and potential recipients waiting for liver transplantation leads towards intensive efforts to increase the availability of liver grafts. This aim can be accomplished by using organs with extended criteria for acceptance like advanced age, steatosis or donation after cardiac death with prolonged warm ischemic time. Far less frequently, but also worthwhile considering as a valuable source for donor organs is the possibility to reuse organs in case of brain death after orthotopic liver transplantation (OLT). In this case the first organ recipient has to be evaluated to become a potential organ donor for a second recipient. <br /> In our study we report on a case in which we reused a liver graft 24 hours after the first transplantation and present the successful endoscopic management of biliary obstruction.<br />
Collapse
Affiliation(s)
- Peter Olschewski
- Clinic for General, Visceral and Transplantation Surgery, Charité Campus Virchow-Klinikum, University Medicine, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
19
|
Abstract
BACKGROUND Distal migration is one of the common complications after insertion of a covered metallic stent. Stent repositioning or removal is not always possible in every patient. Therefore, trimming using an argon plasma coagulator (APC) may be a good alternative method to solve this problem. METHODS Metallic stent trimming by APC was performed in 2 patients with biliary Wallstent migration and in another patient with esophageal Ultraflex stent migration. The power setting was 60-100 watts with an argon flow of 0.8 l/min. OBSERVATIONS The procedure was successfully performed and all distal parts of the stents were removed. No significant collateral damage to the nearby mucosa was observed. CONCLUSIONS In a patient with a distally migrated metallic stent, trimming of the stent is possible by means of an APC. This new method may be applicable to other sites of metallic stent migration.
Collapse
Affiliation(s)
- Rungsun Rerknimitr
- Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10310, Thailand.
| | | | | | | |
Collapse
|
20
|
Haber GB. Ampullary and biliary stenosis: a delayed sphincterotomy complication--easy to forget, tough to treat. Gastrointest Endosc 2007; 66:717-9. [PMID: 17905012 DOI: 10.1016/j.gie.2007.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 07/11/2007] [Indexed: 02/08/2023]
|
21
|
Veldkamp MC, Rauws EAJ, Dijkgraaf MG, Fockens P, Bruno MJ. Iatrogenic ampullary stenosis: history, endoscopic management, and outcome in a series of 49 patients. Gastrointest Endosc 2007; 66:708-16; quiz 768, 770. [PMID: 17640637 DOI: 10.1016/j.gie.2006.12.041] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 12/18/2006] [Indexed: 01/27/2023]
Abstract
BACKGROUND Iatrogenic ampullary stenosis is a late complication of endoscopic interventions that affects the sphincter of Oddi. OBJECTIVE To evaluate the history, endoscopic treatment, and outcome of iatrogenic ampullary stenosis. DESIGN Patients' charts, endoscopic reports, and x-ray films were reviewed and scored. Long-term follow-up data were obtained by means of contact with attending specialists, general physicians, and patients. Ampullary stenoses were distinguished by 2 types: type I, limited to the intraduodenal portion of the sphincter complex; type II, all other types, including extension of the stenosis into the common bile duct (CBD). SETTING Tertiary referral center. PATIENTS All patients treated for iatrogenic ampullary stenosis at our institution during the last 15 years were included. MAIN OUTCOME MEASUREMENTS Success of endoscopic treatment. RESULTS Forty-nine patients were included (mean age 54 years; 36 women; type I, n = 18, type II, n = 31). Treatment consisted of extending the sphincterotomy in type I stenoses and included stent treatment and/or balloon dilation in type II. During endoscopic treatment of ampullary stenosis, complications occurred in 8 of 49 patients. There were no procedure-related deaths. Median (range) follow-up after treatment was 2124 (240-4544) days. From an intention-to-treat perspective, endoscopic therapy of ampullary stenosis showed a long-term success rate of 83% in type I and 65% in type II CBD stenosis. In patients identified as treated successfully by endoscopy, blood samples obtained prospectively after a median (range) follow-up of 1971 (99-3320) days did not show signs of clinically relevant cholestasis. CONCLUSIONS Endoscopic therapy is successful in the majority of patients and should be regarded as first-line treatment for iatrogenic ampullary stenosis.
Collapse
Affiliation(s)
- Mariëlle C Veldkamp
- Department of Gastroenterology and Hepatology, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | |
Collapse
|
22
|
Harvey AM, Holt PE, Barr FJ, Rizzo F, Tasker S. Treatment and long-term follow-up of extrahepatic biliary obstruction with bilirubin cholelithiasis in a Somali cat with pyruvate kinase deficiency. J Feline Med Surg 2007; 9:424-31. [PMID: 17475529 DOI: 10.1016/j.jfms.2007.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2007] [Indexed: 10/23/2022]
Abstract
A 2-year-old female neutered Somali cat was presented with vomiting and acute onset jaundice 1 year after diagnosis of pyruvate kinase (PK) deficiency. Diagnostic investigations revealed a moderate regenerative haemolytic anaemia, severe hyperbilirubinaemia and elevated liver enzymes. Ultrasonography revealed marked distension of the gall bladder and common bile duct (CBD), consistent with extrahepatic biliary obstruction (EHBO). At cholecystotomy, the gall bladder contained purulent material, and two obstructive choleliths were removed from the CBD by choledochotomy. The cat recovered from surgery uneventfully, and serum liver enzymes and bilirubin normalised within 10 days. Postoperative treatment consisted of cephalexin, metronidazole and ursodeoxycholic acid (UDCA). Bacterial culture of the gall bladder contents yielded a pure growth of an Actinomyces species. Cholelith analysis revealed that they consisted of 100% bilirubin. Antibiotic treatment was stopped 4 weeks after surgery but UDCA was continued indefinitely. The cat remains clinically well with no recurrence of cholelithiasis 20 months after initial presentation. This is the first report of successful treatment and long-term follow-up of a cat with EHBO due to bilirubin cholelithiasis in association with PK deficiency-induced chronic haemolysis.
Collapse
Affiliation(s)
- Andrea M Harvey
- Department of Clinical Veterinary Science, Division of Companion Animals, University of Bristol, Langford, Bristol BS405DU, UK.
| | | | | | | | | |
Collapse
|
23
|
Kitajima Y, Ohara H, Nakazawa T, Ando T, Hayashi K, Takada H, Tanaka H, Ogawa K, Sano H, Togawa S, Naito I, Hirai M, Ueno K, Ban T, Miyabe K, Yamashita H, Yoshimura N, Akita S, Gotoh K, Joh T. Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures. J Gastroenterol Hepatol 2007; 22:1615-20. [PMID: 17573833 DOI: 10.1111/j.1440-1746.2007.05037.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [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: 12/20/2022]
Abstract
BACKGROUND AND AIM Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated. METHODS After endoscopic retrograde cholangiography, brushing cytology was performed, followed by forceps biopsy. In patients with obstructive jaundice, endoscopic biliary drainage (EBD) was subsequently performed. To investigate the influences of bile duct brushing cytology and forceps biopsy on EBD, patients who underwent subsequent EBD by plastic stent were compared with patients who underwent EBD alone. RESULTS The samples for cytology were collected successfully in all cases, and the sensitivity for malignancy/benignity, specificity, and accuracy were 71.6%, 100%, and 75.0%, respectively. The biopsy sampling was successful in 51 patients, and samples applicable to the evaluation were collected in all 51 patients. The sensitivity for malignancy/benignity, specificity, and accuracy were 65.2%, 100%, and 68.6%, respectively. Combination of the two procedures increased the sensitivity and accuracy to 73.5% and 76.6%, respectively. The time required for cytology and biopsy was 11.7 min, which is relatively short. Cytology and biopsy did not affect drainage. Regarding accidents, bile duct perforation occurred during biopsy in one patient (1.9%), but was rapidly improved by endoscopic biliary drainage. CONCLUSIONS Transpapillary brushing cytology and forceps biopsy could be performed in a short time. The diagnosis rate was high, and the incidence of complication was low, having no influence on subsequent biliary drainage.
Collapse
Affiliation(s)
- Yasuhiro Kitajima
- Department of Internal Medicine and Bioregulation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Wojtuń S, Gil J, Zyśko B. [The use of endoscopic method in treatment of strictures of biliary tree]. Pol Merkur Lekarski 2007; 22:477-81. [PMID: 17679400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The strictures of bilitary tree may occur as a result of benign and malignant pathologies of liver and pancreas. The benign stricture of biliary tree are usually results of the surgery and if it is possible the endoscopic methods should be implemented in this group of patients. In case of the stricture of biliary tree in the course of the chronic pancreatitis a surgery should be chosen, because the widening and endoscopic stenting don't allow the long term removal of stricture. In course of cholangitis sclerosans endoscopic treatment is to ensure bile flow. The treatment of malignant stricture of biliary tree depends on the early diagnosis, placement and the extension of malignant lesion. Among the patients who are qualified to radical treatment, the surgical treatment should be applied. Palliative surgical treatment is usually used in laparotomy, when the non-removable tumor was diagnosed. In case of disqualification of the patient from surgical treatment in palliative treatment of malignant stricture of biliary tree, the method of choice is the endoscopic treatment and in case of failure from the pericotaneous drainage should be applied. The palliative endoscopic treatment usually is based on widening the stricture and putting into bilitary tree the plastic stent or more effective selfplacing metal ones, which are usually more effective, The achievement of long lasting medical effects after application of endoscopic methods relies on the cause leading to extrahepatic cholestasis and the extension of common bile structure. In most cases they do have character of urgent or palliative treatment. The study shows some of the treatment methods and the combination of different techniques, which may be used in case of bile flow obstruction because of the stricture of biliary tree. The final choice of treatment method is based on the clinical condition of a patient and the availability of the method and experience at using it.
Collapse
MESH Headings
- Bile Duct Diseases/diagnosis
- Bile Duct Diseases/therapy
- Bile Duct Neoplasms/diagnosis
- Bile Duct Neoplasms/therapy
- Biliary Tract Surgical Procedures
- Catheterization
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/therapy
- Cholestasis, Extrahepatic/diagnosis
- Cholestasis, Extrahepatic/etiology
- Cholestasis, Extrahepatic/therapy
- Cholestasis, Intrahepatic/diagnosis
- Cholestasis, Intrahepatic/etiology
- Cholestasis, Intrahepatic/therapy
- Constriction, Pathologic/etiology
- Constriction, Pathologic/therapy
- Humans
- Palliative Care
- Postoperative Complications
- Sphincterotomy, Endoscopic
- Stents
Collapse
Affiliation(s)
- Stanisław Wojtuń
- Wojskowy Instytut Medyczny w Warszawie, Klinika Gastroenterologii CSK MON.
| | | | | |
Collapse
|
25
|
Affiliation(s)
- Z S Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | | |
Collapse
|
26
|
Suk KT, Kim HS, Kim JW, Baik SK, Kwon SO, Kim HG, Lee DH, Yoo BM, Kim JH, Moon YS, Lee DK. Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction. Gastrointest Endosc 2006; 64:522-9. [PMID: 16996343 DOI: 10.1016/j.gie.2006.06.022] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [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: 02/18/2006] [Accepted: 06/05/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cholecystitis related to metal stent placement is a morbid event. OBJECTIVE This study evaluated the risk factors of cholecystitis after metal stenting for malignant biliary obstruction. PATIENTS Between December 1997 and April 2003, 155 patients who were treated with a metal stent for malignant biliary obstruction were retrospectively enrolled. MAIN OUTCOME MEASUREMENTS The incidence and characteristics of patients with cholecystitis were evaluated and compared with those of patients without cholecystitis. Patient characteristics and tumor or procedure-related data were recorded for the following variables: sex, age, tumor and stent length, stent type (covered vs uncovered), cholangitis before ERCP, degree of gallbladder filling with contrast medium during ERCP, primary disease type (Klatskin vs others), presence of gallbladder stones, and the relationship of the cystic duct orifice to the location of the tumor (across vs others). RESULTS There were 15 (9.7%) patients diagnosed with cholecystitis after metal stent insertion. The onset of cholecystitis was on average 4.6 days (range 1 to 26) after the procedure. We found that an obstruction across the cystic duct orifice by tumor (P < .01, odds ratio 12.7) and the presence of gallbladder stone (P = .01, odds ratio 6.6) were positively related to the cholecystitis after metal stent insertion. LIMITATIONS The limitations of the study were the use of multiple types of stents and the retrospective design. CONCLUSIONS This study demonstrated that an obstruction across the cystic duct by tumor and the presence of gallbladder stone were risk factors for the development of cholecystitis after metal stent placement.
Collapse
Affiliation(s)
- Ki Tae Suk
- Divisions of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Katsinelos P, Paikos D, Kountouras J, Chatzimavroudis G, Paroutoglou G, Moschos I, Gatopoulou A, Beltsis A, Zavos C, Papaziogas B. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness. Surg Endosc 2006; 20:1587-93. [PMID: 16897286 DOI: 10.1007/s00464-005-0778-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 04/02/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Stent clogging is the major limitation of palliative treatment for malignant biliary obstruction. Metal stents have much better patency than plastic stents, but are more expensive. Preliminary data suggest that the recently designed plastic (Tannenbaum) stent has better duration of patency than the polyethylene stent. This study aimed to compare the efficacy and cost effectiveness between the Tannenbaum stent without side holes and the uncovered metal stent for patients with malignant distal common bile duct obstruction. METHODS In this study, 47 patients (median age, 73 years, range, 56-86 years) with inoperable malignant distal common bile duct strictures were prospectively randomized to receive either a Tannenbaum stent (n = 24) or an uncovered self-expandable metal stent (n = 23). The patients were clinically evaluated, and biochemical tests were analyzed if necessary until their death or surgery for gastric outlet obstruction. Cumulative first stent patency and patient survival were compared between the two groups. Cost-effectiveness analysis also was performed for the two study groups. RESULTS The two groups were comparable in terms of age, gender, and diagnosis. The median first stent patency was longer in the metal group than in the Tannenbaum stent group (255 vs 123.5 days; p = 0.002). There was no significant difference in survival between the two groups. The total cost associated with the Tannenbaum stents was lower than for the metal stents (17,700 vs 30,100 euros; p = 0.001), especially for patients with liver metastases (3,000 vs 6,900 euros; p < 0.001). CONCLUSIONS Metal stent placement is an effective treatment for inoperable malignant distal common bile duct obstruction, but Tannenbaum stent placement is a cost-saving strategy, as compared with metal stent placement, especially for patients with liver metastases and expected short survival time.
Collapse
Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, Central Hospital, 41 Ethnikis Aminis St., Thessaloniki, 546 35, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Yilmaz E, Erkan T, Sentürk H, Kutlu T, Cokuğraşçullu F. Vater's papillary stenosis in a child with abdominal pain. Pediatr Int 2006; 48:406-8. [PMID: 16911088 DOI: 10.1111/j.1442-200x.2006.02233.x] [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: 11/29/2022]
Affiliation(s)
- Elif Yilmaz
- Department of Pediatrics, Division of Gastroenterology, Cerrahpaşa Medical School, Istanbul University, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
29
|
|
30
|
Abstract
BACKGROUND Biliary access at ERCP rendezvous is usually achieved by withdrawing a wire passed antegrade via the accessory channel of the duodenoscope, which is then used for over-the-wire cannulation. The wire is time consuming to maneuver and may be damaged during withdrawal. OBJECTIVE Description of a simple technique for cannulation at rendezvous that overcomes these problems. DESIGN Observational study. SETTING Gastroenterology department of a teaching district general hospital. PATIENTS Fourteen consecutive patients undergoing rendezvous after percutaneous transhepatic cholangiography (PTC). INTERVENTION A transpapillary drain was placed at PTC in 13 patients. At rendezvous, cannulation alongside the drain was attempted with a sphincterotome cannula. After successful cannulation, the drain was progressively withdrawn, allowing retrograde therapeutic intervention. RESULTS In all 13 patients, parallel cannulation was successful, allowing stone removal or biliary stent placement, with cannulation alongside a guidewire in the fourteenth patient. There were no complications except right hypochondrial pain after drain removal. CONCLUSIONS Parallel cannulation is straightforward and effective, avoiding the need for guidewire manipulation.
Collapse
Affiliation(s)
- William Dickey
- Department of Gastroenterology, Altnagelvin Hospital, Dungiven Road, Londonderry BT47 6SB, Northern Ireland, UK
| |
Collapse
|
31
|
|
32
|
Maire F, Hammel P, Ponsot P, Aubert A, O'Toole D, Hentic O, Levy P, Ruszniewski P. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol 2006; 101:735-42. [PMID: 16635221 DOI: 10.1111/j.1572-0241.2006.00559.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [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: 12/11/2022]
Abstract
BACKGROUND Life expectancy in patients with unresectable pancreatic cancer has improved by using new chemotherapeutic regimens. Biliary and digestive stenoses can be endoscopically treated in most cases. However, long-term efficacy of these stenting procedures remains unknown. AIM To evaluate the incidence of biliary and duodenal stenoses as well as technical success and short- and long-term patency of endoscopically deployed stents in patients with unresectable pancreatic cancer. PATIENTS AND METHODS All consecutive patients with unresectable cancer of the pancreatic head seen between January 1999 and September 2003 in our center were retrospectively studied. Patients with biliary and/or duodenal stenoses underwent endoscopic stent insertion as first intention therapy. Outcomes included technical and clinical success, stent patency, and survival. RESULTS One hundred patients, median age 65 yr (32-85), with locally advanced (62%) or metastatic (38%) pancreatic cancer were studied. Eighty-three percent received at least one line of chemotherapy. The actuarial median survival was 11 months (0.7-29.3). Biliary and duodenal stenoses occurred in 81 and 25 patients, respectively. A biliary stent was successfully placed in 74 patients (91%). When a self-expandable metallic stent was first introduced (N = 59), a single stent was sufficient in 41 patients (69%) (median duration of stent patency 7 months (0.4-21.1)). Duodenal stenting was successful in 24 patients (96%); among them, 96% required a single stent (median duration of stent patency 6 months [0.5-15.7]). In the 23 patients who developed both biliary and duodenal stenoses, combined stenting was successful in 91% of cases. No major complication or death occurred related to endoscopic treatment. CONCLUSION Endoscopic palliative treatment of both biliary and duodenal stenoses is safe and effective in the long term, including in patients with combined obstructions. Use of such palliative management is justified as repeat procedures are rarely required even in patients who have a long survival.
Collapse
Affiliation(s)
- Frédérique Maire
- Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Guerrero Hernández I, Weimersheimer Sandoval M, López Méndez E, Hernández Calleros J, Tapia AR, Uribe M. Biliary stricture caused by portal biliopathy: case report and literature review. Ann Hepatol 2006; 4:286-8. [PMID: 16432497] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Portal biliopathy is a rare condition that is usually not diagnosed and only in few cases causes symptoms. Those symptoms are caused by vascular obstruction of the biliary tree in patients with portal hypertension. We report a case of a 29 years man who presented with history of intermittent jaundice, persistent elevation of hepatic function test and hematemesis as a manifestation of portal hypertension without liver damage. We present the clinical, radiological and pathological characteristics and literature review of the cases that had been reported, their diagnoses, treatment and clinical implication.
Collapse
Affiliation(s)
- Ignacio Guerrero Hernández
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México Distrito Federal, México.
| | | | | | | | | | | |
Collapse
|
34
|
Ornellas LC, Santos GDC, Nakao FS, Ferrari AP. Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection. Arq Gastroenterol 2006; 43:20-3. [PMID: 16699613 DOI: 10.1590/s0004-28032006000100007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND: Confirmation of malignancy within biliary strictures is endoscopically challenging. Dilation of strictures has been reported to enhance cytological diagnosis. AIM: To compare brush cytology results before and after biliary stricture dilation. PATIENTS AND METHODS: Patients with extra-hepatic biliary stricture at endoscopic retrograde cholangiopancreatography were included in the study. Brushing was performed before and immediately after dilation using a 10 Fr dilating catheter. Cytology samples were classified as: negative for malignancy, presence of atypical cells, insufficient material, suspicious for malignancy or positive for malignancy. Final diagnosis was established by surgery, biopsy or follow-up. RESULTS: Biliary brush cytology was performed in 50 patients, with an overall sensitivity of 40% and 27.5%, before and after dilation, respectively. The combination of results increased cancer detection rate to 45%. There were 5/50 (10%) minor complications and one death related to the procedure. CONCLUSIONS: Brush cytology performed before biliary stricture dilation has a similar cancer detection rate to that following dilation, although the combination of results enhances sensitivity.
Collapse
|
35
|
Tyagi P, Puri AS. Removal of self-expandable metallic wallstent--a case report. Trop Gastroenterol 2006; 27:58-9. [PMID: 16910067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Self-expandable metallic stents (SEMS) have become the preferred palliative treatment for patients with malignant biliary obstruction; endoscopic stent placement is less invasive than surgery and is rapidly effective. A longer duration of patency makes SEMS superior to plastic stents for palliation of patients with malignant stricture. Few cases of removal of an uncovered SEMS are reported in case of a blocked stent. We report the first case report of removal of covered biliary SEMS from India.
Collapse
Affiliation(s)
- Pankaj Tyagi
- Department of Gastroenterology, GB Pant Hospital, New Delhi
| | | |
Collapse
|
36
|
Prelipcean CC, Mihai C, Gogălniceanu P, Drug VL, Chirilă N. [Under-evaluated extrahepatic manifestations of cholestasis]. Rev Med Chir Soc Med Nat Iasi 2006; 110:32-37. [PMID: 19292075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Biliary stasis can occur in many different diseases. Pruritus, metabolic bone disease, deficiencies of fat-soluble vitamins, steatorrhea, hyperlipidemia and fatigue represent the major extra-hepatic manifestations of cholestatic liver disease that considerably affect the patient's quality of life. The present article reviews pathogenetic and clinical aspects of and current therapeutic approaches to extra-hepatic manifestations of cholestatic liver disease.
Collapse
|
37
|
Haruta H, Yamamoto H, Mizuta K, Kita Y, Uno T, Egami S, Hishikawa S, Sugano K, Kawarasaki H. A case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation. Liver Transpl 2005; 11:1608-10. [PMID: 16315301 DOI: 10.1002/lt.20623] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [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: 02/07/2023]
Abstract
Biliary complications remain a major concern after living donor liver transplantation. We describe a pediatric case who underwent a successful endoscopic balloon dilatation of biliary-enteric stricture following living donor liver transplantation using a newly developed method of enteroscopy. The 7-year-old boy with late biliary stricture of choledochojejunostomy was admitted 6 years after transplantation. Since percutaneous transhepatic cholangiography was technically difficult in this case, endoscopic retrograde cholangiography was performed using a double-balloon enteroscope under general anesthesia. The enteroscope was advanced retrograde through the duodenum, jejunum, and the leg of Roux-Y by the double-balloon method, and anastomotic stricture of choledochojejunostomy was clearly confirmed by endoscopic retrograde cholangiography and endoscopic direct vision. Balloon dilatation was performed and the anastomosis was expanded. Restenosis was not noted as of 2 years after the treatment. In conclusion, endoscopic balloon dilation of biliary-enteric anastomotic stricture using a new enteroscopic method can be regarded as an alternative choice to percutaneous transhepatic management and surgical re-anatomists.
Collapse
Affiliation(s)
- Hidenori Haruta
- Department of Transplant Surgery, Jichi Medical School, Yakushiji, Minamikawachi, Tochigi 329-0498, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Mukai T, Yasuda I, Tomita E. [The best choice of biliary stents in hilar distal strictures due to inoperable malignacies]. Gan To Kagaku Ryoho 2005; 32:1612-4. [PMID: 16315886] [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: 05/05/2023]
Abstract
Recently, the treatment using biliary stents play an important role to improve the quality of life (QOL) in patients with inoperable malignant biliary obstruction. Long-term patency is preferable, but the convenience of treatment for stent obstruction should also be considered. In this study, we investigated which stent is currently the most appropriate in hilar and extrahepatic bile duct obstruction. In hilar obstruction, metallic stents (MS) had significantly longer patency than plastic tube stents (TS). As for extrahepatic bile duct obstruction, covered MS (CMS) and MS had significantly longer patency than TS. On the other hand, many difficulties occurred when the MS was obstructed. In some of these patients, it was difficult to place the internal drainage again and their QOL was severely impaired. CMS was more convenient because it could be removed when it was obstructed. These results may suggest that MS should be used carefully in the hilar obstruction and that CMS is the best for the treatment of extrahepatic bile duct obstruction.
Collapse
|
39
|
Yung K, Oviedo J, Farraye FA, Becker JM, Andrews CW, Lichtenstein D. Ampullary stenosis with biliary obstruction in duodenal Crohn's disease: a case report and review of the literature. Dig Dis Sci 2005; 50:1118-21. [PMID: 15986865 DOI: 10.1007/s10620-005-2715-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 12/13/2022]
Affiliation(s)
- Kenny Yung
- Section of Gastroenterology, Boston University Medical Center, Boston, Massachusetts 02118, USA
| | | | | | | | | | | |
Collapse
|
40
|
Bolukbas C, Bolukbas FF, Horoz M, Baba ZF, Eser M, Uzunkoy A, Ucar E, Kaya Z, Guran S. Magnetic resonance cholangiopancreatography in cholestatic diseases. Hepatogastroenterology 2005; 52:705-8. [PMID: 15966187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND/AIMS To evaluate the usefulness of magnetic resonance cholangiopancreatography in cholestasis. METHODOLOGY Sixty-seven patients with cholestasis underwent ultrasound and magnetic resonance cholangiopancreatography, subsequently. The results of ultrasound and magnetic resonance cholangiopancreatography were interpreted by two independent radiologists. RESULTS According to ultrasonographic findings intra- and extrahepatic cholestasis were diagnosed in 62.7% and 37.3% of patients, respectively. Magnetic resonance cholangiopancreatography revealed intra- and extrahepatic cholestasis in 52.2% and 47.8% of patients at the same group, respectively (p=0.016, kappa=0.789). Endoscopic retrograde cholangiopancreatography was indicated in 37.3% of patients (22.4% diagnostic, 14.9% therapeutic) according to ultrasonographic findings. However, 41.8% of patients had indication for endoscopic retrograde cholangiopancreatography following magnetic resonance cholangiopancreatography in the same group. In 20% of patients who needed diagnostic endoscopic retrograde cholangiopancreatography according to ultrasonographic findings, endoscopic retrograde cholangiopancreatography wasn't indicated after magnetic resonance cholangiopancreatography. Similarly, 8.9% of patients who didn't have indication for endoscopic retrograde cholangiopancreatography according to ultrasonographic findings underwent endoscopic retrograde cholangiopancreatography (p=0.508, kappa=0.72). CONCLUSIONS Magnetic resonance cholangiopancreatography is valuable in diagnosis of extrahepatic cholestasis in patients suspected with intrahepatic cholestasis according to ultrasonographic findings. Magnetic resonance cholangiopancreatography does not prevent endoscopic retrograde cholangiopancreatography requirement significantly in patients who need diagnostic endoscopic retrograde cholangiopancreatography following ultrasonography.
Collapse
Affiliation(s)
- C Bolukbas
- Department of Internal Medicine, , Harran University, Sanliurfa, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Jakobs R, Weickert U, Hartmann D, Riemann JF. [Interventional endoscopy for benign and malignant bile duct strictures]. Z Gastroenterol 2005; 43:295-303. [PMID: 15765303 DOI: 10.1055/s-2004-813546] [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: 10/25/2022]
Abstract
During the past years several endoscopic and interventional techniques have been developed for the treatment of bile duct strictures and have had a strong impact on therapeutic regimens. Benign stenoses of the bile duct are mainly caused by cholecystectomy or liver resection or by inflammatory diseases. Insertion of an endoprosthesis insertion or balloon dilation is clinically successful in 60 to 90 % of these patients and will result in adequate opening of the stricture. To date, only bile duct stenosis in chronic pancreatitis are not improved satisfactorily by endoscopy. The insertion of an endoprosthesis is a cornerstone in the treatment of malignant obstructive jaundice in patients with cancer. Several comparative studies have demonstrated the advantages of self-expanding metal stents (SEMS) over plastic prostheses in terms of patency. A selective use of SEMS is mandatory, as the costs for SEMS are high and many patients with malignant jaundice will die with their first plastic prosthesis in situ without stent occlusion. In patients with hilar cholangiocarcinoma, the combination of photodynamic therapy and endoprosthesis insertion might result in a survival advantage. The use of bioabsorbable stent materials or coating of the stent with antiproliferative drugs will improve the treatment results in the future.
Collapse
MESH Headings
- Bile Duct Neoplasms/drug therapy
- Bile Duct Neoplasms/mortality
- Bile Duct Neoplasms/therapy
- Bile Ducts, Intrahepatic
- Catheterization
- Cholangiocarcinoma/drug therapy
- Cholangiocarcinoma/mortality
- Cholangiocarcinoma/therapy
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangitis, Sclerosing/complications
- Cholecystectomy, Laparoscopic/adverse effects
- Cholestasis, Extrahepatic/diagnostic imaging
- Cholestasis, Extrahepatic/drug therapy
- Cholestasis, Extrahepatic/etiology
- Cholestasis, Extrahepatic/surgery
- Cholestasis, Extrahepatic/therapy
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/drug therapy
- Cholestasis, Intrahepatic/etiology
- Cholestasis, Intrahepatic/surgery
- Cholestasis, Intrahepatic/therapy
- Endoscopy
- Follow-Up Studies
- Forecasting
- Humans
- Jaundice, Obstructive/diagnostic imaging
- Jaundice, Obstructive/drug therapy
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/surgery
- Jaundice, Obstructive/therapy
- Pancreatitis/complications
- Photochemotherapy
- Prospective Studies
- Prosthesis Implantation
- Retrospective Studies
- Stents
- Time Factors
Collapse
Affiliation(s)
- R Jakobs
- Medizinische Klink C, Klinikum der Stadt Ludwigshafen gGmbH.
| | | | | | | |
Collapse
|
42
|
Abstract
Primary sclerosing cholangitis is characterized by progressive fibrosing inflammation of the bile ducts, leading to their obliteration, which results in cholestasis and, finally, cirrhosis of the liver. Over time, the majority of patients with advanced disease develop dominant stenoses of major bile ducts. Ursodeoxycholic acid (UDCA) treatment does not prevent the development of such stenoses. Endoscopic measures allow the opening of short- and long-segment stenoses of the common bile duct and also of short segment stenoses of the hepatic ducts. Inpatients treated by early endoscopic dilatation of dominant stenoses, as well as with UDCA,survival may be significantly improved (compared with the predicted survival).
Collapse
Affiliation(s)
- Adolf Stiehl
- Department of Medicine, University of Heidelberg, Heidelberg, Germany.
| | | |
Collapse
|
43
|
Eickhoff A, Schilling D, Jakobs R, Weickert U, Hartmann D, Eickhoff JC, Riemann JF. Long-term outcome of percutaneous transhepatic drainage for benign bile duct stenoses. Rocz Akad Med Bialymst 2005; 50:155-60. [PMID: 16358957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE The occurrence of benign bile duct stenoses is mostly associated with prior biliary surgery, pancreatic diseases or sclerosing cholangitis. It remains a challenging problem for gastroenterologists and surgeons, especially in case the endoscopic approach is not possible. The exact role of percutaneous transhepatic stenting for these patients has not been clearly defined yet. MATERIAL AND METHODS 36 patients with symptomatic benign bile duct stenoses or strictures after surgery underwent percutaneous transhepatic stenting and were studied prospectively. We were particularly interested in how many patients would achieve resolution of the stricture and tolerate removal of the drainage in the long-run. RESULTS The primary success rate of percutaneous transhepatic biliary drainage (PTBD) was 92% (33/36 patients). All patients presented improvement of jaundice and cholestasis. Relief of the stricture and clinical improvement was achieved in 72% (26/36) of patients after a median stenting time of 14.5 (6-34) months. 5.5% (2/36) required further stenting due to a persistent stricture. A clinical recovery without radiological stricture regression after stenting demonstrated 22% (8/36) of patients. Long-term failures were noted in 27% (10/36) of patients after a median follow-up of 48 months. CONCLUSIONS Percutaneous transhepatic stenting of symptomatic benign biliary strictures is safe and highly effective in achieving adequate internal bile drainage. There seems to be a therapeutic benefit not only for short-term interventional treatment but also as a sufficient long-term therapeutic alternative to surgery with tolerable complication rates.
Collapse
Affiliation(s)
- A Eickhoff
- Medical Department C, Gastroenterology, Hepatology and Oncology, Klinikum Ludwigshafen, Academic Hospital of the University of Mainz, Germany.
| | | | | | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- Paul R Tarnasky
- Digestive Health Associates of Texas, Methodist Dallas Medical Center, Dallas, TX, USA
| | | | | | | | | |
Collapse
|
45
|
Catalano MF, Linder JD, George S, Alcocer E, Geenen JE. Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: comparison of single vs. multiple simultaneous stents. Gastrointest Endosc 2004; 60:945-52. [PMID: 15605010 DOI: 10.1016/s0016-5107(04)02275-8] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.4] [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: 02/08/2023]
Abstract
BACKGROUND Common bile duct stenosis occurs in up to 30% of patients with chronic pancreatitis. Most such stenoses are found incidentally during ERCP, but others manifest as obstructive jaundice, recurrent cholangitis, secondary biliary cirrhosis, or choledocholithiasis. Operative drainage has been the main treatment despite the potentially high morbidity in patients with chronic pancreatitis. Endoscopic biliary drainage with a single stent has been successful in the short term. The aim of this study was to determine the long-term benefit of a single stent vs. multiple simultaneous stents for treatment of patients with chronic pancreatitis and symptoms because of distal common bile duct stenosis. METHODS Twelve consecutive patients with chronic pancreatitis and common bile duct stenosis underwent endoscopic placement of multiple simultaneous stents and were followed prospectively (Group II). Results were compared with a group of 34 patients in whom a single stent was placed before the start of the present study (Group I). All 46 patients (35 men, 11 women; age range 30-71 years) had chronic pancreatitis and common bile duct stenosis, and presented with symptoms indicative of obstruction (abdominal pain, jaundice, elevated biochemical tests of liver function, acute pancreatitis, cholangitis). The 34 patients in Group I had single stent (10F, 7-9 cm) placement, with exchange at 3 to 6 month intervals (1-4 exchanges) over a mean of 21 months. The 12 patients in Group II underwent placement of multiple simultaneous stents at 3-month intervals (single 10F stents added sequentially) over a mean of 14 months. Mean follow-up was 4.2 years in Group I and 3.9 years for Group II. Factors assessed included symptoms, biochemical tests of liver function, diameter of common bile duct stenosis, and complications. RESULTS In Group I, (34 patients), a total of 162 single stent placement/exchanges were performed (mean 5/patient). In Group II (12 consecutive patients), 8 patients had 4 (10F) stents placed simultaneously, and 4 patients had 5 (10F) stents. At the end of the treatment period, near normalization of biochemical tests of liver function was observed for all patients in Group II, whereas only marginal benefit was noted for patients in Group I. Four patients in Group I had recurrent cholangitis (6 episodes), whereas no patient in Group II had post-procedure cholangitis. In the 12 patients with multiple stents, distal common bile duct stenosis diameter increased from a mean of 1.0 mm to 3.0 mm after treatment; no change in diameter was noted in patients treated with a single stent. CONCLUSIONS Distal common bile duct stenosis secondary to chronic pancreatitis can be treated long term by stent placement. Multiple, simultaneous stents appear to be superior to single stent placement and may provide good long-term benefit. The former resulted in near normalization of biochemical tests of liver function and an increase in distal common bile duct diameter. Multiple stent placement may obviate the need for surgical diversion procedures.
Collapse
Affiliation(s)
- Marc F Catalano
- Pancreatric Biliary Center, St. Luke's Medical Center, Milwaukee, WI 53215, USA
| | | | | | | | | |
Collapse
|
46
|
Trambert JJ, Frost A, Malasky C. Extrahepatic bile duct obstruction and erosive disruption by cavitating porta hepatis nodal metastasis, treated by uncovered wallstent. Cardiovasc Intervent Radiol 2004; 27:379-82. [PMID: 15366223 DOI: 10.1007/s00270-004-0111-8] [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: 11/25/2022]
Abstract
A 45-year-old woman with advanced gastric carcinoma presented with obstructive jaundice. Percutaneous transhepatic cholangiography (PTC) revealed erosive disruption of the extrahepatic bile ducts by a cavitating metastasis in the porta hepatis, as well as a biliary-duodenal fistula. External-internal biliary drainage via the fistula was plagued by recurrent drain occlusion by necrotic debris. This was ultimately alleviated by successful catheterization of the distal common bile duct (CBD) through the cavity, and linking the common hepatic duct (CHD) and CBD with a Wallstent, across the cavity. This succeeded in improving internal biliary drainage and isolating the exfoliating debris of the cavity from the bile ducts.
Collapse
Affiliation(s)
- Jonathan J Trambert
- Department of Radiology, JD Weiler Hospital of the Albert Einstein College of Medicine, Bronx, NY 10461, USA.
| | | | | |
Collapse
|
47
|
Riemann JF, Damian U, Weickert U. [Obscure bile duct stenosis: diagnostic management]. Dtsch Med Wochenschr 2004; 129 Suppl 2:S133-4. [PMID: 15368193 DOI: 10.1055/s-2004-831831] [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: 10/26/2022]
MESH Headings
- Bile Duct Neoplasms/diagnosis
- Bile Duct Neoplasms/pathology
- Bile Duct Neoplasms/therapy
- Bile Ducts, Extrahepatic/pathology
- Biopsy
- Cholangiocarcinoma/diagnosis
- Cholangiocarcinoma/pathology
- Cholangiocarcinoma/therapy
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangiopancreatography, Magnetic Resonance
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/pathology
- Cholangitis, Sclerosing/therapy
- Cholestasis, Extrahepatic/diagnosis
- Cholestasis, Extrahepatic/etiology
- Cholestasis, Extrahepatic/therapy
- Common Bile Duct Neoplasms/diagnosis
- Common Bile Duct Neoplasms/pathology
- Common Bile Duct Neoplasms/therapy
- Diagnosis, Differential
- Diagnostic Imaging
- Gallstones/diagnosis
- Gallstones/pathology
- Gallstones/therapy
- Humans
- Magnetic Resonance Imaging
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Sensitivity and Specificity
- Sphincterotomy, Endoscopic
Collapse
Affiliation(s)
- J F Riemann
- Medizinische Klinik C, Gastroenterologie, Hepatologie und Diabetologie, Klinikum der Stadt Ludwigshafen gGmbH.
| | | | | |
Collapse
|
48
|
Abstract
BACKGROUND The aim of this study was to compare the success and complications of diagnostic and therapeutic ERCP in children (age <18 years) and adult patients. METHODS A retrospective case-controlled study was conducted in which all children undergoing ERCP at two centers (1994-2002) were identified from endoscopy databases and were matched with adult patients for all variables (e.g., indication, procedure complexity) except age. Outcomes with regard to technical success and complications were compared between the adult and the pediatric cohorts. Grade of procedure complexity and procedure-related complications were defined by using established criteria. RESULTS A total of 116 children (mean age 9.3 years, range 1 month to 17 years; median age 8.1 years) and 116 matched adult patients (mean age 56.3 years, range 20-83 years; median age 49.7 years) underwent 163 and 173 ERCP procedures, respectively. According to procedure complexity grade, each group included the same number of patients, grade I, 72 patients; grade II, 12 patients; and grade III, 32 patients. Procedure success rate was 97.5% in children vs. 98% in the adult cohort (p= not significant). The complication rate was not significantly different between children and adult patients (3.4% vs. 2.5%). Most complications were of mild severity and encountered only in patients who underwent grade III procedures, with the exception of a single adult in whom moderate post-sphincterotomy bleeding developed after extraction of a large bile duct stone (grade II complexity). CONCLUSIONS When ERCP is performed in children by expert endoscopists, the success rate is high and the complication rate is low, both being comparable with those for ERCP in adult patients.
Collapse
Affiliation(s)
- Shyam Varadarajulu
- Division of Gastroenterology-Hepatology, University of Alabama at Birmingham, 410 Lyons Harrison Research Building, 701 19th Street South, Birmingham, AL 35294, USA
| | | | | | | |
Collapse
|
49
|
Parlak E, Kuran SO, Dişibeyaz S, Ciçek B, Oğuz D, Sahin B. Endoscopic treatment of primary sclerosing cholangitis. Turk J Gastroenterol 2004; 15:144-8. [PMID: 15492911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND/AIMS Dominant stricture of an extrahepatic bile duct is responsible for symptoms and an exacerbation of cholestasis in 15-20% of patients with primary sclerosing cholangitis. The aim of this study was to evaluate the efficacy and safety of endoscopic treatment in this selected patient group. METHODS Retrospectively, we evaluated 16 patients who were treated endoscopically due to elevation of serum biochemical liver tests and symptoms which were attributable to dominant bile duct strictures during the period 1990 to 2003. Symptoms and biochemical liver tests were compared before and after treatment. RESULTS Sixteen patients underwent a total of 58 therapeutic endoscopic retrograde cholangiopancreatographies (ERCP). Sixteen endoscopic sphincterotomies, 15 balloon dilatations, 6 bougie dilatations, 3 stone/sludge extractions and 8 stentings were performed. Endoscopic therapy was technically successful in all patients (100%). Biochemical liver tests were significantly improved when compared with pretreatment values (p<0.001). Patients have been followed-up without stents except for the patients who had cholangiocarcinoma and cirrhosis at the beginning. Procedure-related early complications occurred in 8.6% of therapeutic endoscopic biliary procedures. There was no mortality due to endoscopic treatment. Two patients whose stents were changed every two to three months had cholangitis due to stenting during 13 stent periods. Four patients whose stents were changed in seven to 10 days developed suppurative cholangitis (total 6 stent periods). CONCLUSIONS Endoscopic therapy of symptomatic dominant strictures in primary sclerosing cholangitis is safe and effective. The cholangitis seen in long-term stenting seems to be solved by short-term stenting.
Collapse
MESH Headings
- Adult
- Bile Ducts, Extrahepatic/pathology
- Bile Ducts, Extrahepatic/surgery
- Catheterization
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/surgery
- Cholangitis, Sclerosing/therapy
- Cholestasis, Extrahepatic/surgery
- Cholestasis, Extrahepatic/therapy
- Constriction, Pathologic/surgery
- Constriction, Pathologic/therapy
- Female
- Humans
- Liver Function Tests
- Male
- Prosthesis Implantation/instrumentation
- Retrospective Studies
- Sphincterotomy, Endoscopic
- Stents
- Treatment Outcome
Collapse
Affiliation(s)
- Erkan Parlak
- Department of Gastroenterology Clinic, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
50
|
De Palma GD, Puzziello A, Aprea G, Persico F, Rega M, Ciamarra P, Patrone F, Masone S, Di Marino M, Persico M, Mastantuono L, Noceroni L, Persico G. [Ultrasound-guided endoscopic drainage, without radiological examination, in patients with neoplastic biliary obstruction. Preliminary results]. MINERVA CHIR 2004; 59:347-50. [PMID: 15278029] [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: 04/30/2023]
Abstract
AIM Endoscopic stent insertion has become the preferred method for palliation of malignant biliary obstruction. Currently, endoscopic stent placement involves the use of contrast media and radiological equipment to achieve direct opacification of the biliary duct systems, and to determine the location and the extension of biliary obstruction. This report proposes a new combination of ultrasonography and biliary endoscopy, with endoscopic stent placement entirely performed under US-guidance. METHODS US-guided stent placement was carried out in 8 patients. A guide-wire and a guiding-catheter were endoscopically introduced and identified, by US, the common bile duct across the stricture. Hydromer-coated polyurethane angled stents (10F) were finally inserted over the guide-wire/guiding-catheter by a pusher tube system. RESULTS Successful stent insertion was achieved in all patients. There were no complications. Successful drainage, with substantial reduction in bilirubin level, was achieved in all patients (14.2+/-9.5 vs 4.2+/-2.9 mg/dl at 1 week). CONCLUSION Endoscopic stent placement performed under US-guidance, is safe and effective. Further studies in a larger series, including more proximal strictures are suggested.
Collapse
Affiliation(s)
- G D De Palma
- Dipartimento di Chirurgia Generale e Tecnologie Avanzate, Settore Funzionale di Diagnostica e Terapia Endoscopica, Università degli Studi Federico II, Facoltà di Medicina e Chirurgia, Napoli, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|