RESUMEN
OBJECTIVES: To assess mid-term outcome of biodegradable biliary stents (BBSs) to treat benign biliary strictures refractory to standard bilioplasty. METHODS: Institutional review board approval was obtained and patient consent was waived. 107 patients (61 males, 46 females, mean age 59 ± 16 years), were treated. Technical success and complications were recorded. Ninety-seven patients (55 males, 42 females, aged 57 ± 17 years) were considered for follow-up analysis (mean follow-up 23 ± 12 months). Fisher's exact test and Mann-Whitney U tests were used and a Kaplan-Meier curve was calculated. RESULTS: The procedure was always feasible. In 2/107 cases (2 %), stent migration occurred (technical success 98 %). 4/107 patients (4 %) experienced mild haemobilia. No major complications occurred. In 19/97 patients (18 %), stricture recurrence occurred. In this group, higher rate of subsequent cholangitis (84.2 % vs. 12.8 %, p = 0.001) and biliary stones (26.3 % vs. 2.5 %, p = 0.003) was noted. Estimated mean time to stricture recurrence was 38 months (95 % C.I 34-42 months). Estimated stricture recurrence rate at 1, 2, and 3 years was respectively 7.2 %, 26.4 %, and 29.4 %. CONCLUSION: Percutaneous placement of a BBS is a feasible and safe strategy to treat benign biliary strictures refractory to standard bilioplasty, with promising results in the mid-term period. KEY POINTS: ⢠Percutaneous placement of a BBS is 100 % feasible. ⢠The procedure appears free from major complications, with few minor complications. ⢠BBSs offer promising results in the mid-term period. ⢠With a BBS, external catheter/drainage can be removed early. ⢠BBSs represent a new option in treating benign biliary stenosis.
Asunto(s)
Implantes Absorbibles , Enfermedades de las Vías Biliares/cirugía , Implantación de Prótesis , Stents , Sistema Biliar , Constricción Patológica/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Endoscopía Gastrointestinal/métodos , Endosonografía , Esófago/cirugía , Yeyuno/cirugía , Anastomosis Quirúrgica/efectos adversos , Constricción Patológica/etiología , Constricción Patológica/terapia , Trastornos de Deglución/etiología , Femenino , Humanos , Persona de Mediana Edad , Ultrasonografía IntervencionalRESUMEN
AIMS AND BACKGROUND: To analyze the procedural difficulties in the placement of metal stents in stenoses of the digestive tract and optimize the technique. METHODS: Twenty-nine patients with digestive tract stenoses were treated from January 1999 to December 2004. In 14 cases the stricture was anastomotic (9 colorectal, 3 esophageal, 1 gastroesophageal and 1 gastrojejunal), in 13 esophageal, in 1 gastric and in 1 duodenal. The stenosis was due to scarring in 5 patients and was malignant in 24 patients (primary in 17 cases and secondary in 7 cases). RESULTS: The procedure achieved technical success in all cases but 2. For each of the different segments the technical difficulties and the adopted procedural solutions were analyzed. CONCLUSIONS: The interventional radiology approach yielded results comparable to those reported for the endoscopic method and was always well tolerated. The need to rely on materials mostly designed for endoscopic use can make radiological use difficult in some cases.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias Gastrointestinales/diagnóstico por imagen , Tracto Gastrointestinal/diagnóstico por imagen , Tracto Gastrointestinal/patología , Radiografía Abdominal , Radiografía Intervencional , Stents , Adulto , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/etiología , Constricción Patológica/terapia , Diseño de Equipo , Femenino , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/patología , Neoplasias Gastrointestinales/cirugía , Tracto Gastrointestinal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
We report the case of a patient who developed myoclonus and hyperalgesia following administration of high-dose subarachnoid morphine. This complication occurred with 40-80 mg/day continuous infusion. The pathophysiology of these side effects is discussed.
Asunto(s)
Hiperalgesia/inducido químicamente , Morfina/efectos adversos , Mioclonía/inducido químicamente , Esquema de Medicación , Humanos , Inyecciones Espinales , Masculino , Persona de Mediana Edad , Morfina/administración & dosificaciónRESUMEN
PURPOSE: To assess the feasibility of percutaneous transhepatic biliary drainage (PTBD) for the treatment of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts, its efficacy in restoring the integrity of bile ducts, and technical procedures to reduce morbidity. METHODS: Seventeen patients out of 936 undergoing PTBD over a 20-year period had a noncholestatic liver and were retrospectively reviewed. All patients underwent surgery for cancer and suffered a postsurgical biliary leak of 345 ml/day on average; 71% were in poor condition and required permanent nutritional support. An endoscopic approach failed or was excluded due to inaccessibility of the bile ducts. RESULTS: Established biliary leaks and site of origin were diagnosed an average of 21 days (range 1-90 days) after surgery. In all cases percutaneous access to the biliary tree was achieved. An external (preleakage) drain was applied in 7 cases, 9 patients had an external-internal fistula bridging catheter, and 1 patient had a percutaneous hepatogastrostomy. Fistulas healed in an average of 31 days (range 3-118 days ) in 15 of 17 patients (88%) following PTBD. No major complications occurred after drainage. Post-PTBD cholangitis was observed in 6 of 17 patients (35%) and was related to biliary sludge formation occurring mostly when drainage lasted >30 days and was of the external-internal type. Median patient survival was 17.7 months and in all cases the repaired biliary leaks remained healed. CONCLUSIONS: PTBD is a feasible, effective, and safe procedure for the treatment of postsurgical biliary leaks. It is therefore a reliable alternative to surgical repair, which entails longer hospitalization and higher costs.