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Norio Kubo, Norifumi Harimoto, Kei Shibuya, Norihiro Ishii, Mariko Tsukagoshi, Takamichi Igarashi, Akira Watanabe, Kenichiro Araki, Masaya Miyazaki, Hiroyuki Kuwano, Ken Shirabe
BACKGROUND: Bile leakage after hepatectomy still causes relatively serious problems, and some types of bile leakage are intractable. CASE PRESENTATION: We report a case of postoperative isolated bile duct leakage managed successfully by combination therapy of percutaneous transhepatic portal vein embolization (PTPE) and bile duct ablation with ethanol. A 61-year-old man diagnosed with hepatocellular carcinoma underwent partial hepatectomy. On postoperative day 1, bile leakage was detected at the drainage tube...
June 19, 2018: Surgical Case Reports
Syed Hasan, Zubair Khan, Mohammad Saud Khan, Umar Darr, Toseef Javaid, Raheel Ahmed, Ali Nawras
We present a case of a 60-year-old female patient who has significant medical history of renal cell carcinoma diagnosed 2 years back and had undergone right nephrectomy and chemotherapy. She presented to the hospital with complaints of abdominal pain and jaundice of 2 weeks duration and was found to have periampullary mass lesion causing compression of distal common bile duct on imaging with computed tomography of abdomen. Endoscopic retrograde cholangiography and endoscopic ultrasound showed ampullary mass lesion causing biliary obstruction along with abdominal lymphadenopathy...
June 2018: Gastroenterology Research
Muhammad Ali Khan, Zubair Khan, Claudio R Tombazzi, Chiranjeevi Gadiparthi, Wade Lee, C Mel Wilcox
BACKGROUND: Endoscopic retrograde cholangiography and endoscopic sphincterotomy (ES) with subsequent cholecystectomy is the standard of care for the management of patients with choledocholithiasis. There is conflicting evidence in terms of mortality reduction, prevention of complications specifically biliary pancreatitis and cholangitis with the use of early cholecystectomy particularly in high-risk surgical and elderly patients. AIMS: We conducted this systematic review and meta-analysis of randomized controlled trials to compare the early cholecystectomy versus wait and watch strategy after ES...
June 16, 2018: Journal of Clinical Gastroenterology
Divyanshoo R Kohli, Tilak U Shah, Doumit S BouHaidar, Ravi Vachhani, M Shadab Siddiqui
INTRODUCTION: Current practice guidelines recommend prophylactic antibiotics prior to endoscopic retrograde cholangiopancreatography (ERCP) in liver transplant recipients (LTR). This study evaluated the risk of clinically significant infections after ERCP in LTR who received antibiotic prophylaxis compared to those who did not. METHODS: This retrospective case-cohort study evaluated all LTR who underwent elective, outpatient ERCP from 2008 to 2015. Hospitalized patients, pediatric allograft recipients and patients with cholangitis or incomplete biliary drainage were excluded...
May 28, 2018: Digestive and Liver Disease
Yunfu Lv, Jie Yue, Xiaoguang Gong, Xiaoyu Han, Hongfei Wu, Jie Deng, Yejuan Li
The aim of the present study was to evaluate the prevalence and causes of spontaneous remission of obstructive jaundice in rats. Healthy male and female Wistar rats (180-220 g) were randomly assigned to receive common bile duct ligation (CBDL) and transection (group A), CBDL only (group B), or CBD dissection without ligation or transection (control group C; n=36 in each group). There was a difference in eye and skin jaundice prevalence between groups A and B from 14 days after surgery. The level of total bilirubin (TB) did not continue to increase in group A and began to decrease in the majority of rats in group B (P<0...
June 2018: Experimental and Therapeutic Medicine
Andrea Tenca, Harri Mustonen, Kati Lind, Eila Lantto, Kaija-Leena Kolho, Sonja Boyd, Johanna Arola, Kalle Jokelainen, Martti Färkkilä
BACKGROUND AND AIMS: Endoscopic retrograde cholangiography (ERCP) has been considered the gold standard for the diagnosis and follow-up of primary sclerosing cholangitis, but it has been replaced by less invasive magnetic resonance imaging and cholangio-pancreatography (MRI-MRCP). However, the role of these two techniques in the evaluation of disease activity and severity needs to be elucidated. METHODS: Patients with primary sclerosing cholangitis (n: 48, male 31, median age: 35...
June 14, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Yogesh P Takalkar, Mandar S Koranne, Kumar S Vashist, Pranalee G Khedekar, Mahadeo N Garale, Sameer A Rege, Abhay N Dalvi
A 50-year-old female presented to us with features of obstructive jaundice. Investigations revealed cholelithiasis with single large impacted calculus in the common bile duct (CBD) and significant dilatation of extrahepatic biliary tree. Incidentally, the patient was also detected to have situs inversus totalis (SIT). Attempt at extraction of the calculus in the CBD by endoscopic retrograde cholangiography failed, and a 7F stent was placed. The patient was subjected to laparoscopic cholecystectomy, CBD exploration with the extraction of the offending calculus and laparoscopic choledochoduodenostomy (LCDD)...
July 2018: Journal of Minimal Access Surgery
Mohammed Amine Benatta
This study focused on endoscopic examination of a prominent papilla which showed two separate orifices revealing separate entrance of the main pancreatic duct and of the common bile duct (A). This was the most rare anatomoendoscopic variation, accounting for only 10% of retrograde cholangiopancreatographies using endoscopic approach (ERCP). However, it facilitated selective biliary catheterization (SBC) in our patient, as one might have expected. Papilla had a pseudo polypoid appearance and a biliary orifice (BO) at the right angle toward the duodenal wall; hence this was a more difficult approach than that via the pancreatic orifice (PO) which, on the other hand, required undesired pancreatic catheterization (B)...
2018: Pan African Medical Journal
Charles Mastier, Pierre-Jean Valette, Mustapha Adham, Jean-Yves Mabrut, Olivier Glehen, Thierry Ponchon, Pascal Rousset, Agnès Rode
PURPOSE: To assess the effectiveness of percutaneous radiological treatment for complex biliary leaks compared to simple biliary leaks. MATERIALS AND METHODS: We retrospectively analyzed 101 percutaneous treatments for bile leak performed from January 1994 to January 2012. Sixty (59%) bile leaks were classified as simple and 41 (41%) as complex based on a morphological classification that considered eight types of biliary wound on cholangiography images. The main treatment was percutaneous transhepatic biliary drainage (PTBD), and additional procedures were performed when required...
June 5, 2018: Cardiovascular and Interventional Radiology
Sumera Rizvi, John Eaton, Ju Dong Yang, Vinay Chandrasekhara, Gregory J Gores
The diagnosis of malignant biliary strictures remains problematic, especially in the perihilar region and in primary sclerosing cholangitis (PSC). Conventional cytology obtained during endoscopic retrograde cholangiography (ERC)-guided brushings of biliary strictures is suboptimal due to limited sensitivity, albeit it remains the gold standard with a high specificity. Emerging technologies are being developed and validated to address this pressing unmet patient need. Such technologies include enhanced visualization of the biliary tree by cholangioscopy, intraductal ultrasound, and confocal laser endomicroscopy...
May 2018: Seminars in Liver Disease
Haoyang Zhu, Dinghui Dong, Yu Luo, Fenggang Ren, Jing Zhang, Wenjun Tan, Aihua Shi, Liangshuo Hu, Rongqian Wu, Yi Lyu
A biliary contrast agents pushing device, including a syringe pushing system and a remote controller is introduced. The syringe pushing system comprises an injector card slot, a support platform and an injection bolus fader. A 20 mL syringe can be fitted on the syringe pushing system and kept with the ground about 30 degree. This system can perform air bubble pumping back and contrast agents bolus injection as well as speed adjustment. Remote controller is an infrared remote control which can start and stop the syringe pushing system...
January 30, 2018: Zhongguo Yi Liao Qi Xie za Zhi, Chinese Journal of Medical Instrumentation
Ali Akbar, Quynh T Tran, Satheesh P Nair, Salil Parikh, Muhammad Bilal, Mohammed Ismail, Jason M Vanatta, James D Eason, Sanjaya K Satapathy
Background: Biliary strictures (BS) are common complication after liver transplantation. We aimed to determine the accuracy of magnetic resonance cholagiopancreatography (MRCP) in diagnosing BS in liver transplant recipients (LTRs) when compared to direct cholangiographic methods (endoscopic resonance cholagiopancreatography [ERCP] and/or percutaneous transhepatic cholangiography [PTC]). Methods: Retrospective chart review of 910 LTRs (July 2008 to April 2015) was performed, and a total of 39 patients with duct-to-duct anastomosis (22 males; 56...
May 2018: Transplantation Direct
Masaki Miyazawa, Shogo Matsuda, Uichiro Fuchizaki
A 79-year-old man was introduced to our hospital for obstructive jaundice. Computed tomography (CT) showed the stricture of the common bile duct (CBD) and the cystic duct (CD) (Fig. 1). Suspicious diagnosis was cholangiocarcinoma. Endoscopic retrograde cholangiography (ERC) showed the stricture of the CBD and the CD dilatation. This article is protected by copyright. All rights reserved.
May 22, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Harshavardhan B Rao, Arjun Prakash, Surendran Sudhindran, Rama P Venu
Biliary stricture complicating living donor liver transplantation (LDLT) is a relatively common complication, occurring in most transplant centres across the world. Cases of biliary strictures are more common in LDLT than in deceased donor liver transplantation. Endoscopic management is the mainstay for biliary strictures complicating LDLT and includes endoscopic retrograde cholangiography, sphincterotomy and stent placement (with or without balloon dilatation). The efficacy and safety profiles as well as outcomes of endoscopic management of biliary strictures complicating LDLT is an area that needs to be viewed in isolation, owing to its unique set of problems and attending complications; as such, it merits a tailored approach, which is yet to be well established...
May 21, 2018: World Journal of Gastroenterology: WJG
Jacqueline van den Bos, Fokko P Wieringa, Nicole D Bouvy, Laurents P S Stassen
BACKGROUND: Though often only briefly described in the literature, there are clearly factors that have an influence on the fluorescence intensity, and thereby the usefulness of the technique. This article aims to provide an overview of the factors influencing the fluorescence intensity of fluorescence imaging with Indocyanine green, primarily focussed on NIRF guided cholangiography. METHODS: A systematic search was conducted to gain an overview of currently used methods in NIRF imaging in laparoscopic cholecystectomies...
May 18, 2018: Surgical Endoscopy
Ausra Aleknaite, Gintaras Simutis, Juozas Stanaitis, Jonas Valantinas, Kestutis Strupas
Background: Accurate risk evaluation of choledocholithiasis prior to laparoscopic cholecystectomy is essential to determine optimal management strategy. Objective: Our study aimed to evaluate the accuracy of separate predictors and Vilnius University Hospital Index (VUHI = A/30 + 0.4 × B; A = total bilirubin concentration (µmol/l), B = common bile duct (CBD) diameter (mm) measured by ultrasound) diagnosing choledocholithiasis and to assess different management strategies (cholecystectomy with intraoperative cholangiography and endoscopic retrograde cholangiopancreatography (ERCP))...
April 2018: United European Gastroenterology Journal
Guru Prasad Painuly, Ankur Gupta, Mini Singhal, Bhavna Bansal
Gall bladder duplication is a rare congenital anomaly. True duplication is still rarer. Pre-operative detection helps in avoiding complications or missing the gall bladder during surgery. Ultrasonography (USG) and magnetic resonance cholangiography are investigation of choice. Laparoscopic cholecystectomy is the preferred modality for management of double gall bladder. We present a case diagnosed as cholelithiasis on USG. While doing laparoscopic surgery 2 gall bladders were found. She had a normal gall bladder that was lying in the supraduodenal area...
May 4, 2018: Journal of Minimal Access Surgery
Theodore W James, Y Claire Fan, Todd H Baron
BACKGROUND & AIMS: EUS-guided hepaticoenterostomy (EUS-HE) is usually reserved for palliation of malignant biliary obstruction after failed endoscopic retrograde cholangiography (ERC) or inaccessible biliary tree in surgically altered anatomy (SAA). We describe outcome of EUS-HE and antegrade therapy for benign biliary disease in patients with SAA. METHODS: Retrospective review of 20 consecutive patients with surgically altered anatomy and benign biliary obstruction who underwent EUS-HE performed by one endoscopist at a tertiary center over a three-year period...
May 2, 2018: Gastrointestinal Endoscopy
Kyle Bender, Joel Lewin, Harriet O'Rourke, Freya C Hugh, Nicholas O'Rourke, Thomas J Hugh
BACKGROUND: The laparoscopic approach is considered the standard of care for cholecystectomy. Attempts to minimize incisions with single site and natural orifice approaches have shown promise but also have limitations. Technological advances have facilitated decreased port size, which may have a variety of benefits. The aim of this study was to determine the feasibility of an all 5-mm port approach for patients undergoing both elective and emergency laparoscopic cholecystectomy. METHODS: A consecutive series of laparoscopic cholecystectomies at three different hospitals using all 5-mm ports was prospectively evaluated...
April 24, 2018: ANZ Journal of Surgery
V Zimmer
There is an increasing rivalry between percutaneous transhepatic (PTBD) vs. endoscopic ultrasound-guided biliary drainage (EUS-BD) as rescue techniques after failed endoscopic retrograde cholangiography (ERC) access. While EUS-BD procedures hold a bright future, innovations in PTBD technique are still possible and clinically meaningful, at least so, under the a conceptual framework understanding PTBD as a bridging, anatomy-respecting technology for definitive biliary metal stenting. This, however, calls for successful PTBD internalization as a sine qua non...
April 20, 2018: Clinics and Research in Hepatology and Gastroenterology
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