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cholangitis guidelines

Karan Gulaya, Shamit S Desai, Kent Sato
The role of percutaneous cholecystostomy (PC) in the management of acute cholecystitis and cholangitis is outlined in the revised 2013 Tokyo Guidelines. These two emergencies constitute the vast majority of PC performed today for therapeutic purposes, and research has repeatedly shown the utility of PC in these conditions. PC is typically employed in the management of critically ill patients who are not surgical candidates. Indications and contraindications to PC are reviewed. Additional innovative applications of PC have been developed since it was first described in 1980...
December 2016: Seminars in Interventional Radiology
Ken Liu, Ruoxi Wang, Viraj Kariyawasam, Mark Wells, Simone I Strasser, Geoff McCaughan, Crispin Corte, Rupert W Leong
BACKGROUND&AIMS: Epidemiological data on primary sclerosing cholangitis (PSC) outside the Northern hemisphere is limited. Similarly, the impact of inflammatory bowel disease (IBD) on PSC outcomes remains unclear. We aimed to study the epidemiology and outcomes of PSC patients with and without IBD in an Australian cohort. METHODS: We retrospectively studied PSC patients attending two tertiary referral hospitals over 20years. Diagnosis of PSC was made according to international guidelines by positive cholangiography and/or liver biopsy (for small duct PSC) with supporting clinical and laboratory evidence RESULTS: 208 PSC patients (61% male) were studied (2,271patient-years follow-up)...
November 28, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Gyotane Umefune, Hirofumi Kogure, Tsuyoshi Hamada, Hiroyuki Isayama, Kazunaga Ishigaki, Kaoru Takagi, Dai Akiyama, Takeo Watanabe, Naminatsu Takahara, Suguru Mizuno, Saburo Matsubara, Natsuyo Yamamoto, Yousuke Nakai, Minoru Tada, Kazuhiko Koike
BACKGROUND: Procalcitonin is being increasingly used to diagnose and grade acute systemic bacterial infection at an early stage of disease onset. The aim of this prospective study was to evaluate the usefulness of procalcitonin for severity grading of acute cholangitis on patient admission. METHODS: Patients with acute cholangitis were prospectively enrolled. The severity of acute cholangitis was graded on the basis of the 2013 Tokyo guidelines (Japanese Society of Hepato-Biliary-Pancreatic Surgery, 2013)...
October 25, 2016: Journal of Gastroenterology
Atsushi Tanaka, Xiong Ma, Osamu Yokosuka, Martin Weltman, Hong You, Deepak N Amarapurkar, Yoon Jun Kim, Zaigham Abbas, Diana A Payawal, Ming-Ling Chang, Cumali Efe, Ersan Ozaslan, Masanori Abe, Robert Mitchell-Thain, Mikio Zeniya, Kwang Hyub Han, John M Vierling, Hajime Takikawa
During the 25th annual meeting of the Asia-Pacific Association for the Study of the Liver (APASL 2016) in Tokyo, we organized and moderated an inaugural satellite symposium on the autoimmune liver diseases, autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). Following the keynote lecture by John M. Vierling (USA), speakers from the Asia-Pacific region provided an up-to-date perspective on the epidemiology, clinical practice and research in AIH and PBC in the Asia-Pacific region. Although epidemiology and clinical features of AIH seem to be similar in East Asia compared to those in western countries, the majority of patients with AIH are detected at an advanced stage and have higher mortality rates in South Asia, indicating an unmet need for earlier diagnosis and the initiation of appropriate immunosuppressive treatment...
September 20, 2016: Hepatology International
Pouya Iranmanesh, Olivier Tobler, Sandra De Sousa, Jean-Louis Frossard, Philippe Morel, Christian Toso
BACKGROUND AND AIMS: Initial cholecystectomy for patients at intermediate risk of common bile duct (CBD) stones (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) showed shorter length of stay and fewer CBD investigations without increased morbidity compared with sequential CBD endoscopic assessment and subsequent cholecystectomy in a randomized controlled trial. The objectives were to prospectively validate these results in daily clinical practice and discuss current guidelines...
August 25, 2016: Gastrointestinal Endoscopy
Alexander C Schwed, Monica M Boggs, Xuan-Binh D Pham, Drew M Watanabe, Michael C Bermudez, Amy H Kaji, Dennis Y Kim, David S Plurad, Darin J Saltzman, Christian de Virgilio
Importance: Acute cholangitis (AC), particularly severe AC, has historically required urgent endoscopic decompression, although the timing of decompression is controversial. We previously identified 2 admission risk factors for adverse outcomes in AC: total bilirubin level greater than 10 mg/dL and white blood cell count greater than 20 000 cells/µL. Objectives: To validate previously identified prognostic factors in AC, evaluate the effect of timing of endoscopic retrograde cholangiopancreatography on clinical outcomes, and compare recent experience with AC vs an historical cohort...
November 1, 2016: JAMA Surgery
Yuichi Takano, Masatsugu Nagahama, Naotaka Maruoka, Eiichi Yamamura, Nobuyuki Ohike, Tomoko Norose, Hiroshi Takahashi
BACKGROUND AND STUDY AIMS: Gallstone impaction at the ampulla of Vater is a critical condition, and the standard treatment is endoscopic papillotomy. However, the clinical features remain largely unclear, and some patients are reluctant to undergo papillotomy because of a bleeding tendency. The aim of this study was to clarify the clinical features of gallstone impaction at the ampulla of Vater and to examine the effectiveness of endoscopic biliary drainage without papillotomy. PATIENTS AND METHODS: We retrospectively examined 30 patients who had undergone endoscopic treatment for gallstone impaction at the ampulla of Vater between 2010 and 2015...
July 2016: Endoscopy International Open
Andrea Tenca, Martti Färkkilä, Johanna Arola, Tytti Jaakkola, Roberto Penagini, Kaija-Leena Kolho
BACKGROUND: The natural history of pediatric-onset primary sclerosing cholangitis (PSC) and overlap with autoimmune hepatitis (PSC/AIH) is poorly known. OBJECTIVE: The aim of this study was to evaluate the clinical outcome of patients with pediatric-onset disease in a tertiary referral center. METHODS: We traced 33 patients (median age at diagnosis 16 years), with PSC or PSC/AIH in cholangiography and liver histology diagnosed between December 1993 and 2011, at Helsinki University Hospital...
August 2016: United European Gastroenterology Journal
Kaoru Omori, Kanako Yoshida, Masaki Yokota, Tsutomu Daa, Masahiro Kan
We encountered two patients with overlapping features of primary biliary cholangitis and autoimmune hepatitis within the same family. A 68-year-old woman presented at our hospital from a previous medical institution because of the diagnosis of primary biliary cholangitis. Her 49-year-old daughter was admitted with liver dysfunction 4 years later. When compared, these two related patients were found to have overlapping features of primary biliary cholangitis and autoimmune hepatitis. Their human leukocyte antigen haplotype was DRB1*04:05/DRB1*15:02...
October 2016: Clinical Journal of Gastroenterology
Gobind Anand, Yuval A Patel, Hsin-Chieh Yeh, Mouen A Khashab, Anne Marie Lennon, Eun Ji Shin, Marcia I Canto, Patrick I Okolo, Anthony N Kalloo, Vikesh K Singh
Background. Consensus guidelines recommend that patients at high risk for choledocholithiasis undergo endoscopic retrograde cholangiopancreatography (ERCP) without additional imaging. This study evaluates factors and outcomes associated with performing magnetic resonance cholangiopancreatography (MRCP) prior to ERCP among patients at high risk for choledocholithiasis. Methods. An institutional administrative database was searched using diagnosis codes for choledocholithiasis, cholangitis, and acute pancreatitis and procedure codes for MRCP and ERCP...
2016: Canadian Journal of Gastroenterology & Hepatology
V A Sipliviy, D V Yevtushenko, G D Petrenko, S A Andreyeshchev, A V Yevtushenko
The results of surgical treatment of 184 patients for obstructive jaundice and an acute cholangitis in choledocholithiasis were analyzed. Acute cholangitis was diagnosed in 62 (33.7%) patients. Sensitivity of a Tokyo Guidelines (2013)--TG 13 criteria for diagnosis and estimation of the course severity of an acute cholangitis was studied. Dynamics of postoperative laboratory parameters was studied. There was established, that occurrence of obturation jaundice and cholangitis coincides with pronounced hepatic function disorders, which are preserved after a bile outflow restoration also, and changes in peripheral blood...
January 2016: Klinichna Khirurhiia
Jianbo Lin, Huidong Sun, Jiangong Li, Yanhong Zheng, Cunhua Shao, Yang Hong Zhang, Hong Chang
BACKGROUND: Presepsin is a new emerging inflammatory biomarker. The primary purpose of this study was to elucidate the predictive usability of presepsin for severity assessment in patients with acute cholangitis (AC). METHODS: A total of 119 treatment-naive patients with AC (64 males, 55 females) were enrolled in this study. Patients were classified with Grade I (mild), Grade II (moderate), or Grade III (severe) AC based on severity assessment guidelines. Presepsin concentrations were measured on admission...
2016: Clinical Laboratory
Rosario Fornaro, Michela Caratto, Elisa Caratto, Giuseppe Caristo, Francesco Fornaro, Davide Giovinazzo, Camilla Sticchi, Marco Casaccia, Enzo Andorno
The association between inflammatory bowel disease (IBD) and colorectal cancer (CRC) has been widely shown. This association is responsible for 10% to 15% of deaths in patients with IBD, even if according to some studies, the risk of developing CRC seems to be decreased. An adequate surveillance of patients identified as at-risk patients, might improve the management of IBD-CRC risk. In this article we review the literature data related to IBD-CRC, analyze potential risk factors such as severity of inflammation, duration, and extent of IBD, age at diagnosis, sex, family history of sporadic CRC, and coexistent primary sclerosing cholangitis, and update epidemiology on the basis of new studies...
September 2016: Clinical Colorectal Cancer
Rodrigo Manuel Nárvaez Rivera, José Alberto González González, Roberto Monreal Robles, Diego García Compean, Jonathan Paz Delgadillo, Aldo Azael Garza Galindo, Héctor Jesús Maldonado Garza
BACKGROUND/AIMS: Few studies have validated the performance of guidelines for the prediction of choledocholithiasis (CL). Our objective was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines for the identification of CL. METHODS: A two-year prospective evaluation of patients with suspected CL was performed. We evaluated the ASGE guidelines and its component variables in predicting CL. RESULTS: A total of 256 patients with suspected CL were analyzed...
June 2016: Revista Española de Enfermedades Digestivas
Zhipeng Sun, Yubing Zhu, Bin Zhu, Guangzhong Xu, Nengwei Zhang
Tokyo Guideline 2013 (TG13) is an international guideline for the diagnosis, classification and treatment of acute cholangitis. Progress and controversy for the two years after TG13 was summarized. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are both effective imaging tests for common bile duct (CBD) stones. More factors e.g. obesity may be involved in severity assessment. Initiation of broad-spectrum antibiotics addressing the typical Gram-negative enteric bacteria spectrum and early biliary drainage are the mainstay therapeutic options...
February 2016: Bioscience Trends
Jill K J Gaidos, Stephen J Bickston
Colitis-associated colorectal neoplasia (CRN) is a well-known complication of chronic inflammation of the colon either with ulcerative colitis (UC) or colonic Crohn's disease (CD). Studies have shown that inflammatory bowel disease (IBD) patients have an overall higher risk for colorectal dysplasia and cancer compared to the general population and this risk is further increased by certain associated factors, including extent of disease, duration of disease, and age at onset. In addition, other risk factors not related to IBD can also further increase the risk for CRN, such as a family history of sporadic colon cancer and a concomitant diagnosis of primary sclerosing cholangitis...
May 2016: Inflammatory Bowel Diseases
Jochen Schneider, Alexander Hapfelmeier, Sieglinde Thöres, Andreas Obermeier, Christoph Schulz, Dominik Pförringer, Simon Nennstiel, Christoph Spinner, Roland M Schmid, Hana Algül, Wolfgang Huber, Andreas Weber
BACKGROUND: Acute cholangitis is a life-threatening bacterial infection of the biliary tract. Main focus of this study was to create a useful risk prediction model that helps physicians to assign patients with acute cholangitis into different management groups. METHODS: 981 cholangitis episodes from 810 patients were analysed retrospectively at a German tertiary center. RESULTS: Out of eleven investigated statistical models fit to 22 predictors, the Random Forest model achieved the best (cross-)validated performance to predict mortality...
2016: BMC Gastroenterology
Azah A Althumairi, Mark G Lazarev, Susan L Gearhart
Inflammatory bowel disease (IBD) is associated with increased risk of colorectal cancer (CRC). The risk is known to increase with longer duration of the disease, family history of CRC, and history of primary sclerosing cholangitis. The diagnosis of the neoplastic changes associated with IBD is difficult owing to the heterogeneous endoscopic appearance and inter-observer variability of the pathological diagnosis. Screening and surveillance guidelines have been established which aim for early detection of neoplasia...
January 21, 2016: World Journal of Gastroenterology: WJG
Dong-Hoon Yang
Ulcerative colitis is an idiopathic chronic inflammatory bowel disease and its incidence in Korea has rapidly increased over the past two decades. Since ulcerative colitis is associated with increased risk for colorectal cancer, annual or biannual colonoscopy with four quadrant random biopsies at every 10 cm segments has been recommended for surveillance of colitic cancer in patients with long standing left-sided or extensive colitis. Recent epidemiologic data and meta-analysis suggest that the increment of colorectal cancer risk in ulcerative colitis was not larger than that of previous studies...
December 2015: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
F Åberg, A Abdulle, A Mäkelä, M Nissinen
Guidelines recommend colonoscopy screening for possible asymptomatic inflammatory bowel disease (IBD) in all patients diagnosed with primary sclerosing cholangitis (PSC). PSC-IBD warrants regular dysplasia-surveillance colonoscopy. However, no consensus exists regarding follow-up colonoscopy in PSC patients without IBD who remain asymptomatic. We describe a 43-year-old female who had undergone liver transplantation (LT) due to advanced PSC. Previous colonoscopies had been normal. The post-transplantation course was uneventful, with no rejections and signs of PSC recurrence...
November 2015: Transplantation Proceedings
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