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2.
Chinese Journal of Hepatology ; (12): 264-275, 2022.
Article in Chinese | WPRIM | ID: wpr-928465

ABSTRACT

In 2015, the Chinese Society of Hepatology and Chinese Society of Gastroenterology issued a consensus on the diagnosis and management of primary biliary cholangitis (PBC). In the past years, more clinical studies have been reported in the field of PBC. To provide guidance to the clinical diagnosis and management of patients with PBC, the Chinese Society of Hepatology invited a panel of experts to assess the new clinical evidence and formulated the current guidelines which comprises 26 clinical recommendations.


Subject(s)
Cholangitis/therapy , Consensus , Gastroenterology , Humans , Liver Cirrhosis, Biliary/therapy
3.
Rev. cuba. pediatr ; 92(4): e1168, oct.-dic. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1149922

ABSTRACT

Basada en la mejor evidencia científica disponible, se presenta la guía de práctica clínica en atresia de vías biliares, la cual se define como una obstrucción progresiva de las vías biliares intra- o extrahepáticas en recién nacidos y lactantes pequeños y causa ictericia colestásica grave y cirrosis hepática. Es una enfermedad poco frecuente, de etiología desconocida, con mayor incidencia en países asiáticos. Clínicamente se expresa por ictericia obstructiva, acolia, coluria y hepatoesplenomegalia. Los complementarios expresan una hiperbilirrubinemia directa con aumento de las enzimas hepáticas, y el diagnóstico se confirma en nuestro hospital con la colangiografía, generalmente en el curso de una laparoscopía. El tratamiento es quirúrgico y consiste en la portoenterostomía de Kasai, con mejores resultados en cuanto al drenaje biliar si se realiza antes de los 60 días de vida, así como el trasplante hepático. La enfermedad tiene un curso progresivo hacia la cirrosis hepática en etapas tempranas de la vida, sobre todo si no se realiza el diagnóstico y tratamiento quirúrgico precozmente, con implicaciones en la supervivencia y calidad de vida de estos pacientes. Por tanto, referir precozmente al paciente con sospecha de atresia de vías biliares a un centro especializado es la piedra angular de la actitud médica. La presente guía de práctica clínica pretende ofrecer las herramientas técnicas estandarizadas para mejorar los resultados a los pacientes con esta enfermedad, así como contribuir con la docencia y las investigaciones(AU)


Based on the best scientific evidence available, it is presented the clinical practice guidelines on biliary atresia. This disease is defined as a progressive obstruction of the intra and/or extrahepatic bile ducts in newborns and young infants, causing severe cholestatic jaundice and cirrhosis of the liver. It is a rare disease of unknown etiology, with a higher incidence in Asian countries. It is clinically expressed by obstructive jaundice, acholia, choluria and hepatosplenomegaly. Laboratory tests show a direct hyperbilirubin and elevated liver enzymes, and in our hospital, the diagnosis is confirmed by a cholangiography, usually during a laparoscopy procedure. It has surgical treatment and it involves a Kasai portoenterostomy, with better results regarding biliary drainage if it is performed before 60 days of life, as well as liver transplant. This condition has a progressive course towards liver cirrhosis in early stages of life, mainly if the diagnosis and surgical treatment are not made timely, with implications for the survival and quality of life of these patients. Therefore, early referral of the patient with suspected biliary atresia to a specialized center is the cornerstone of the medical attitude. This clinical practice guidelines aims to offer standardized technical tools to improve the outcome for patients with this disease, as well as to contribute to teaching and research(AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Biliary Atresia/surgery , Biliary Atresia/epidemiology , Jaundice, Obstructive/complications , Liver Cirrhosis, Biliary/complications
6.
Rev. colomb. gastroenterol ; 34(4): 385-398, oct.-dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1092966

ABSTRACT

Resumen La prevalencia de las enfermedades hepáticas en el embarazo no es despreciable, ya que estas se presentan en 3%-5% de todas las gestaciones. Entre las múltiples causas se encuentran cambios fisiológicos del embarazo; enfermedad hepática preexistente, siendo las más comunes las enfermedades colestásicas (colangitis biliar primaria y colangitis esclerosante primaria), hepatitis autoinmune, enfermedad de Wilson, hepatitis virales crónicas, cirrosis establecida de cualquier etiología y paciente con historia de trasplante hepático; enfermedad hepática adquirida durante el embarazo, siendo las principales las hepatitis virales, la toxicidad inducida por medicamentos y la hepatolitiasis; hepatopatía relacionada con el embarazo, en la cual se encuentran 5 entidades principales: hiperémesis gravídica, colestasis intrahepática del embarazo, preeclampsia, síndrome HELLP e hígado graso del embarazo. La severidad de estas entidades tiene una amplia gama de presentaciones, desde la paciente que es completamente asintomática, hasta la falla hepática aguda e incluso la muerte. La gravedad del cuadro se asocia con una morbilidad y mortalidad significativas tanto para la madre como para el feto, lo cual hace que una evaluación rápida, diagnóstico certero y manejo apropiado por un equipo multidisciplinario (incluida obstetricia de alto riesgo, hepatología, gastroenterología y radiología intervencionista), en un servicio que tenga la posibilidad de ofrecer trasplante hepático, sean fundamentales para obtener buenos desenlaces.


Abstract Liver diseases develop in 3% to 5% of all gestations. Among the causes are: 1. Physiological changes of pregnancy. 2. Pre-existing liver diseases and conditions. The most common are cholestatic diseases such as primary biliary cholangitis and primary sclerosing cholangitis. Others include autoimmune hepatitis, Wilson's disease, chronic viral hepatitis, cirrhosis of any etiology and histories of liver transplantation. 3. Liver disease acquired during pregnancy, especially viral hepatitis, drug-induced toxicity and hepatolithiasis. 4. Pregnancy-related liver diseases including hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, preeclampsia, HELLP syndrome and fatty liver of pregnancy. Severity ranges from absence of symptoms to acute liver failure and even death. Severe cases have significant morbidity and mortality for both mother and fetus. These cases require rapid evaluation, accurate diagnosis and appropriate management by a multidisciplinary team including high-risk obstetrics, hepatology, gastroenterology and interventional radiology. Availability of liver transplantation is also important for obtaining good outcomes.


Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia , Pregnancy , Liver Transplantation , Hepatitis , Hyperemesis Gravidarum , Liver Cirrhosis, Biliary
7.
An. bras. dermatol ; 94(6): 710-712, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1054894

ABSTRACT

Abstract Although the association of multiple autoimmune diseases has already been widely described, no reports of the association between vitiligo, primary biliary cirrhosis and Sjogren's syndrome were retrieved in the SciELO and PubMed databases. The authors describe the case of a female patient who was diagnosed with primary biliary cirrhosis and Sjogren's syndrome at age 54. At age 58, she developed vitiligo restricted to the face, associated with significant impairment of self-esteem and quality of life. Antinuclear antibody was negative at the onset of the condition, but became positive after phototherapy initiation. In general, the occurrence of multiple autoimmune diseases in the same patient is known as a mosaic of autoimmunity. However, specific mechanisms appear to interconnect primary biliary cirrhosis and Sjogren's syndrome, such as PDC-E2-mediated generalized epithelitis.


Subject(s)
Humans , Female , Middle Aged , Vitiligo/complications , Sjogren's Syndrome/complications , Liver Cirrhosis, Biliary/complications , Vitiligo/pathology , Sjogren's Syndrome/pathology , Autoimmunity , Chronic Disease , Liver Cirrhosis, Biliary/pathology
8.
Arq. gastroenterol ; 56(3): 300-303, July-Sept. 2019. tab
Article in English | LILACS | ID: biblio-1038721

ABSTRACT

ABSTRACT BACKGROUND: Bile duct injury is a life-threatening complication that requires proper management to prevent the onset of negative outcomes. Patients may experience repeated episodes of cholangitis, secondary biliary cirrhosis, end-stage liver disease and death. OBJECTIVE: To report a single center experience in iatrogenic secondary liver transplantation after cholecystectomy and review the literature. METHODS: This was a retrospective single center study. Of the 1662 liver transplantation realized, 10 (0.60 %) were secondary to iatrogenic bile ducts injuries due cholecystectomies. Medical records of these patients were reviewed in this study. RESULTS: Nine of 10 patients were women; the median time in waiting list and between cholecystectomy and inclusion in waiting list was of 222 days and of 139.9 months, respectively. Cholecystectomy was performed by open approach in eight (80%) cases and by laparoscopic approach in two (20%) cases. The patients underwent an average of 3.5 surgeries and procedures before liver transplantation. Biliary reconstruction was realized with a Roux-en-Y hepaticojejunostomy in nine (90%) cases. Mean operative time was 447.2 minutes and the median red blood cell transfusion was 3.4 units per patient. Mortality in the first month was of 30%. CONCLUSION: Although the liver transplantation is an extreme treatment for an initially benign disease, it has its well-defined indications in treatment of bile duct injuries after cholecystectomy, either in acute or chronic scenario.


RESUMO CONTEXTO: A lesão da via biliar é uma complicação que pode ameaçar a vida e que requer manejo adequado para prevenir o aparecimento de desfechos negativos. Os pacientes podem apresentar episódios repetidos de colangite, cirrose biliar secundária, doença hepática terminal e até mesmo morte. OBJETIVO: Avaliar a experiência de um único centro em transplante hepático secundário a lesão iatrogênica de via biliar pós-colecistectomia e fazer uma revisão de literatura. MÉTODOS: Este foi um estudo retrospectivo de um único centro. Dos 1662 transplantes de fígado, 10 (0,60%) foram secundários a lesões iatrogênicas das vias biliares devido à colecistectomias. Os prontuários médicos desses pacientes foram revisados neste estudo. RESULTADOS: Nove dos dez pacientes eram mulheres; o tempo médio em lista de espera de transplante e entre colecistectomia e inclusão na lista de espera foi de 222 dias e de 139,9 meses, respectivamente. A colecistectomia foi realizada por abordagem aberta em oito (80%) casos e por abordagem laparoscópica em dois (20%) casos. Os pacientes foram submetidos a uma média de 3,5 cirurgias e procedimentos antes do transplante de fígado e a reconstrução biliar foi realizada com hepaticojejunostomia em Y-de-Roux em nove (90%) casos. O tempo operatório médio foi de 447,2 minutos e a média de transfusão de concentrados de hemácias foi de 3,4 unidades por paciente. Mortalidade no primeiro mês foi de 30%. CONCLUSÃO: Embora o transplante de fígado seja um tratamento extremo para uma doença inicialmente benigna, ele tem suas indicações bem definidas no tratamento de lesões biliares após colecistectomia, seja em um cenário agudo ou crônico.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Bile Ducts/injuries , Liver Transplantation , Cholecystectomy, Laparoscopic/adverse effects , Liver Cirrhosis, Biliary/surgery , Bile Ducts/surgery , Retrospective Studies , Iatrogenic Disease , Liver Cirrhosis, Biliary/etiology , Middle Aged
10.
Article in English | WPRIM | ID: wpr-763194

ABSTRACT

PURPOSE: Autoimmunity is an alternative etiology of gastric inflammation, the initiating event in the gastric carcinogenic cascade. This mechanism may be an increasingly important cause of gastric cancer with the waning prevalence of its primary etiologic factor, chronic Helicobacter pylori infection. MATERIALS AND METHODS: PubMed and EMBASE were searched up to September 2018. Autoimmunity and 96 specific manifestations were considered for associations with gastric cancer risk. Random effects analysis was used to calculate pooled relative risk estimates (RR) and 95% confidence intervals (CI). RESULTS: We found a total of 52 observational studies representing 30 different autoimmune diseases. Overall, the presence of an autoimmune condition was associated with a gastric cancer pooled RR of 1.37 (95% CI, 1.24 to 1.52). Among the 24 autoimmune conditions with two or more independent reports, nine were significantly associated with increased gastric cancer risk: dermatomyositis (RR, 3.69; 95% CI, 1.74 to 7.79), pernicious anemia (RR, 2.84; 95% CI, 2.30 to 3.50), Addison disease (RR, 2.11; 95% CI, 1.26 to 3.53), dermatitis herpetiformis (RR, 1.74; 95% CI, 1.02 to 2.97; n=3), IgG4-related disease (RR, 1.69; 95% CI, 1.00 to 2.87), primary biliary cirrhosis (RR, 1.64; 95% CI, 1.13 to 2.37), diabetes mellitus type 1 (RR, 1.41; 95% CI, 1.20 to 1.67), systemic lupus erythematosus (RR, 1.37; 95% CI, 1.01 to 1.84), and Graves disease (RR, 1.27; 95% CI, 1.06 to 1.52). CONCLUSION: Our analysis documents the wide range of autoimmune diseases associated with gastric cancer. These associations may reflect unreported links between these conditions and autoimmune gastritis. Further studies are warranted to investigate potential causal mechanisms.


Subject(s)
Addison Disease , Anemia, Pernicious , Autoimmune Diseases , Autoimmunity , Dermatitis Herpetiformis , Dermatomyositis , Diabetes Mellitus , Epidemiology , Gastritis , Graves Disease , Helicobacter pylori , Inflammation , Liver Cirrhosis, Biliary , Lupus Erythematosus, Systemic , Prevalence , Stomach Neoplasms
11.
Article in Chinese | WPRIM | ID: wpr-776010

ABSTRACT

To systematically evaluate the risks of cardiocerebral vascular events in patients with primary biliary cholangitis(PBC). Methods We carried out a Meta analysis by RevMan 5.3 software to investigate literatureon the risk of cardiocerebral vascular events in patients with PBC and controls. Results Compared with non-PBC controls,PBC patients had significantly higher risk of coronary events(=1.56,=0.0002);however,the risk of cerebrovascular events showed no significant difference between these two groups(=1.01,=0.94).Subgroup analysis demonstrated a significantly lower risk of transient ischemic attack or carotid stenosis in PBC patients(=0.63,=0.03);however,there was no significant difference in the risk of stroke(=1.11,=0.40). Conclusion Patients with PBC have an increased risk of coronary events but may have a lower risk of transient ischemic attack or carotid stenosis.


Subject(s)
Carotid Stenosis , Cholangitis , Coronary Disease , Humans , Ischemic Attack, Transient , Liver Cirrhosis, Biliary , Risk Factors , Stroke
12.
Rev. méd. Panamá ; 39(1): 25-27, 2019.
Article in Spanish | LILACS | ID: biblio-1102342

ABSTRACT

El síndrome de Reynolds, se define como cirrosis biliar primaria en pacientes con esclerodermia; este síndrome debe ser sospechado en aquellos pacientes que desarrollen un patrón colestásico. Se reporta una paciente con antecedente de esclerodermia que se presenta con ictericia, a quien se le confirma con estudios inmunológicos y biopsia hepática, el diagnóstico de cirrosis biliar prima­ ria (ahora se denomina colangitis biliar primaria). Se ordena ácido ursodesoxicólico 15mg/día.


Reynolds syndrome is defined as primary biliary cirrhosis in patients with scleroderma; this syndro­me should be suspected in those patients who develop a cholesteric pattern. We report a patient with scleroderma who presented with jaundice. After immunological and liver biopsy, a diagnosis of Primary Biliary Cholangiopathy (new name) was confirmed. Ursodeoxycholic acid 15mg / day was prescribed


Subject(s)
Humans , Female , Middle Aged , Scleroderma, Systemic , Liver Cirrhosis, Biliary/pathology , Ursodeoxycholic Acid/pharmacokinetics , Liver/pathology
13.
Gastroenterol. latinoam ; 30(2): 58-63, 2019. tab
Article in English | LILACS | ID: biblio-1103903

ABSTRACT

ANTECEDENTES: La colangitis biliar primaria (CBP) es una enfermedad hepática inflamatoria crónica colestásica de causa desconocida. Varios patógenos virales y bacterianos han sido propuestos como factores que podrían gatillar una respuesta inmune por mimetismo molecular, o directamente estar relacionados en la persistencia del daño biliar. Existen reportes controversiales respecto al rol de en la patogenia de CBP. OBJETIVOS: Investigar marcadores de infección de séricos y en hígado de pacientes con CBP. PACIENTES Y MÉTODOS: Veinte pacientes diagnosticados con CBP y 20 pacientes control con otras enfermedades hepáticas crónicas no colestásicas fueron estudiados. Se determinaron anticuerpos séricos anti- (IgG). Se realizó detección inmunohistoquímica de antígenos de en hígado. Se extrajo DNA de hígado para amplificación de la secuencia específica de rRNA 16S de por PCR. Fueron usados controles de amplificación de DNA bacteriano y humano. Los pacientes firmaron consentimiento informado. Se realizó un metaanálisis de la diferencia de riesgo de CBP en pacientes infectados por y en un grupo control. RESULTADOS: Los anticuerpos séricos fueron positivos en 30% de los pacientes con CBP y 50% de los controles (p = NS). Antígenos de no fueron detectados en tejido hepático de pacientes con CBP ni de controles. No se amplificó ADN bacteriano en ninguna de las muestras. El metaanálisis de la diferencia de riesgo mostró gran heterogeneidad de los estudios, por lo que no se realizó una estimación de diferencia de riesgo agrupada. DISCUSIÓN: No encontramos asociación entre infección por y CBP. En la evidencia actual, un estudio presenta resultados a favor de la asociación entre y CBP y tres estudios resultados en contra.,


Primary biliary cholangitis (PBC) is a chronic cholestatic inflammatory liver disease of unknown cause. Several viral and bacterial pathogens have been proposed as factors that could either trigger an immune response by molecular mimicry or directly be involved in the persistence of biliary damage. There are conflicting reports respecting the role of in the pathogenesis of PBC. To investigate markers of infection in serum and liver tissue from patients with PBC. Twenty patients with diagnosis of PBC and 20 control patients with other non-cholestatic chronic liver diseases were studied. Serum anti- antibodies (IgG) were determined. Liver tissue was available for immunohistochemistry detection of antigens. DNA was extracted from liver tissue and a specific sequence of 16S rRNA gene was amplified by CPR. Adequate controls of bacterial and human DNA amplification were used. Informed consent was obtained from patients. A meta-analysis of risk difference of PBC in Chlamydophila pneumoniae infected patients and in the control groupwas performed. Serum antibodies were positive in 30% of patients with PBC and 50% of controls (p = NS). antigens were not detected in liver tissue neither of patients with PBC nor controls. Bacterial DNA did not amplify in any of the samples, despite good amplification of internal and external controls. Risk difference meta-analysis showed high heterogeneity between studies. Therefore, we did not estimate a pooled risk difference. Our results do not support the association between infection and PBC. In the current literature only one study shows an association between and PBC, but other three studies do not support it.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Chlamydia Infections/diagnosis , Chlamydophila Infections/complications , Liver Cirrhosis, Biliary/diagnosis , Liver Cirrhosis, Biliary/microbiology , DNA, Bacterial , Immunoglobulin G , Immunohistochemistry , RNA, Ribosomal, 16S/analysis , Case-Control Studies , Polymerase Chain Reaction , Chlamydophila pneumoniae/genetics , Liver/microbiology , Liver Cirrhosis, Biliary/etiology
14.
Niger. j. surg. (Online) ; 25(1): 91-96, 2019. ilus
Article in English | AIM | ID: biblio-1267538

ABSTRACT

Background: Management of injuries sustained during cholecystectomy requires expertise and involves a patient who is troubled, usually drained of personal resources. There has been an increase in incidence with laparoscopic cholecystectomy. The standard surgical management done for major biliary injuries is Roux-en-Y Hepaticojejunostomy (R-en-Y HJ). Materials and Methods: Patients managed surgically for definitive management of biliary injuries in the form of R-en-Y HJ were included. Data were collected from prospectively maintained records and through outpatient follow-up. Demographic data, early and late surgical complications, long-term outcomes, and follow-up results were analyzed. Results: Among the 62 patients, 26 were males, with a mean age of 37.4 ± 13.5 years. A total of 24 patients presented with ongoing biliary fistula. The Strasberg­Bismuth type of injury included types E1 in 8 (13%), E2 in 31 (50%), E3 in 19 (30.6%), and E4 in four patients (6.4%). There were no postoperative mortality and morbidity in 27.4% of patients. Atrophy­hypertrophy complex was seen in four patients, vascular injury in six patients, and an internal fistulisation with duodenum in two patients. Presence of comorbidities (P = 0.05), male gender (P = 0.03), tobacco use (P = 0.04), low albumin (P = 0.016), and more proximal (E4-E1) type of injury (P = 0.008) were independent predictors of postoperative morbidity (P < 0.05). The mean duration of patient follow-up was 26.2 ± 21.1 months. Conclusion: Optimization of preoperative nutrition, avoidance of intraoperative blood transfusion, proper timing of repair, and tension-free R-en-Y HJ draining all the ducts which is done at an experienced hepatobiliary center provide the best outcome


Subject(s)
Cholecystectomy , India , Liver Cirrhosis, Biliary , Surgical Procedures, Operative
15.
Article in English | WPRIM | ID: wpr-760868

ABSTRACT

Progressive familial intrahepatic cholestasis (PFIC) is a group of severe genetic disorders, inherited in an autosomal recessive manner, causing cholestasis of hepatocellular origin, later progressing to biliary cirrhosis and liver failure. This is the first report of PFIC type 1 with novel compound heterozygous mutations in Korea. The patient was presented with intrahepatic cholestasis, a normal level of serum γ-glutamyl transferase, steatorrhea, and growth failure. Genetic testing of this patient revealed novel compound heterozygous mutations (p.Glu585Ter and p.Leu749Pro) in the ATP8B1 gene. After a liver transplantation at age 19 months, the patient developed severe post-transplant steatohepatitis.


Subject(s)
Child , Cholestasis , Cholestasis, Intrahepatic , Fatty Liver , Genetic Testing , Humans , Korea , Liver Cirrhosis, Biliary , Liver Failure , Liver Transplantation , Steatorrhea , Transferases
16.
J. bras. econ. saúde (Impr.) ; 10(1): 45-55, Abr. 2018.
Article in Portuguese | LILACS, ECOS | ID: biblio-884394

ABSTRACT

Objetivos: A colangite biliar primária (CBP) é uma doença hepática colestática, autoimune, inflamatória e crônica que, quando não tratada, evolui para cirrose e eventualmente insuficiência hepática em um período de 10 a 20 anos. Este estudo teve como objetivo avaliar o impacto em longo prazo do tratamento com ácido ursodesoxicólico (AUDC) em pacientes com CBP. Métodos: Uma revisão sistemática da literatura foi conduzida até maio de 2017. Os desfechos incluíram sobrevida livre de transplante (SLT) ou morte, sobrevida global (SG), taxa de mortalidade, taxa de transplantes e a taxa combinada de mortes e transplantes. A análise dos dados foi realizada por meio de um modelo de efeitos aleatórios, utilizando-se o método de DerSimonian e Laird. Resultados: Doze estudos foram incluídos na metanálise. O tratamento com AUDC apresentou aumento do tempo de SLT no acompanhamento em longo prazo a partir do quinto ano de tratamento, com resultados estatisticamente significativos para os anos de 5 e 10 (p < 0,01). Os resultados da metanálise das taxas de mortalidade, transplante e taxa combinada de mortalidade e transplante mostraram-se não significativos para os três desfechos apresentados. A inclusão dos estudos de braço comparador teórico alterou de maneira significativa os resultados da análise principal, tornando os resultados estatisticamente significativos a partir do terceiro ano de acompanhamento. Conclusões: AUDC é eficaz no aumento da SLT ou morte, com resultados estatisticamente significativos em 5 e 10 anos, quando os pacientes são tratados de maneira crônica.


Objectives: Primary biliary cholangitis (PBC) is an inflammatory and chronic autoimmune cholestatic liver disease that, when left untreated, progresses to cirrhosis and eventually liver failure in a period of 10 to 20 years. This study aimed to evaluate the long-term impact of treatment with ursodeoxycholic acid (UDCA) in patients with PBC. Methods: A systematic literature review was conducted until May 2017. The endpoints included transplant-free survival (TFS) or death, overall survival (OS), mortality rate, transplantation rates and the combined rate of deaths and transplants. Data analysis was performed using a random effects model with the DerSimonian and Laird method. Results: Twelve studies were included in the meta-analysis. Treatment with UDCA showed an increase in TFS time in the long-term follow up from the fifth year of treatment, with statistically significant results for the years 5 and 10 (p < 0.01). Meta-analysis results for mortality rates, transplantation and combined mortality and transplantation rates were not significant for the three outcomes presented. The inclusion of the theoretical comparator arm studies significantly altered the results of the main analysis, making the results statistically significant from the third year of follow-up. Conclusions: UDCA is effective in increasing TFS or death, with statistically significant results at 5 and 10 years, when patients are treated chronically


Subject(s)
Humans , Liver Cirrhosis, Biliary , Meta-Analysis , Ursodeoxycholic Acid
17.
S. Afr. j. surg. (Online) ; 56(1): 30-34, 2018. ilus
Article in English | AIM | ID: biblio-1271006

ABSTRACT

Background: The aim of this study was to determine the safety and clinical effectiveness of 10Fr plastic biliary stents compared to uncovered self-expanding metal stents (SEMS) for palliative treatment of patients with inoperable extra-hepatic malignant biliary obstruction in a public hospital in South Africa.Methods: From January 2009 to December 2013, 40 patients who were admitted to a tertiary academic centre because of distal malignant biliary obstruction were enrolled in a prospective randomized study. Patients were randomly assigned to receive an uncovered SEMS or a plastic stent deployed through the biliary stricture during endoscopic retrograde cholangiopancreatography (ERCP).Results: Patient survival time in the two groups did not differ significantly (median: SEMS ­ 114 days; plastic ­ 107 days). Stent failure was more common in the plastic stent group (7/19 vs. 1/21). The results became significant after 6 months of follow-up. There was no significant difference between the two groups in the incidence of serious adverse events.Conclusions: SEMS had a longer duration of patency than plastic stents, which recommends their use in the palliative treatment of patients with biliary obstruction due to distal malignant biliary obstruction


Subject(s)
Liver Cirrhosis, Biliary , Patients , South Africa
18.
Article in Korean | WPRIM | ID: wpr-714525

ABSTRACT

Intrahepatic duct (IHD) stone is the presence of calculi within the intrahepatic bile duct specifically located proximal to the confluence of the left and right hepatic ducts. This stone is characterized by its intractable nature and frequent recurrence, requiring multiple therapeutic interventions. Without proper treatment, biliary strictures and retained stones can lead to repeated episodes of cholangitis, liver abscesses, secondary biliary cirrhosis, portal hypertension, and death from sepsis or hepatic failure. The ultimate treatment goals for IHD stones are complete removal of the stone, the correction of the associated strictures, and the prevention of recurrent cholangitis. A surgical resection can satisfy the goal of treatment for hepatolithiasis, i.e., complete removal of the IHD stones, stricture, and the risk of cholangiocarcinogenesis. On the other hand, in some cases, such as bilateral IHD stones, surgery alone cannot achieve these goals. Therefore, the optimal treatments require a multidisciplinary approach, including endoscopic and radiologic interventional procedures before and/or after surgery. Percutaneous transhepatic cholangioscopic lithotomy (PTCS-L) is particularly suited for patients at poor surgical risk or who refuse surgery and those with previous biliary surgery or stones distributed in multiple segments. PTCS-L is relatively safe and effective for the treatment of IHD stones, and complete stone clearance is mandatory to reduce the sequelae of IHD stones. An IHD stricture is the main factor contributing to incomplete clearance and stone recurrence. Long-term follow-up is required because of the overall high recurrence rate of IHD stones and the association with cholangiocarcinoma.


Subject(s)
Bile Ducts, Intrahepatic , Calculi , Cholangiocarcinoma , Cholangitis , Constriction, Pathologic , Follow-Up Studies , Hand , Hepatectomy , Hepatic Duct, Common , Humans , Hypertension, Portal , Liver Abscess , Liver Cirrhosis, Biliary , Liver Failure , Recurrence , Sepsis
19.
Gut and Liver ; : 714-721, 2018.
Article in English | WPRIM | ID: wpr-718115

ABSTRACT

BACKGROUND/AIMS: Recently reported prognostic models for primary biliary cholangitis (PBC) have been shown to be effective in Western populations but have not been well-validated in Asian patients. This study aimed to compare the performance of prognostic models in Korean patients and to investigate whether inflammation-based scores can further help in prognosis prediction. METHODS: This study included 271 consecutive patients diagnosed with PBC in Korea. The following prognostic models were evaluated: the Barcelona model, the Paris-I/II model, the Rotterdam criteria, the GLOBE score and the UK-PBC score. The neutrophil-to-lymphocyte ratio (NLR) was analyzed with reference to its association with prognosis. RESULTS: For predicting liver transplant or death at the 5-year and 10-year follow-up examinations, the UK-PBC score (areas under the receiver operating characteristic curve [AUCs], 0.88 and 0.82) and GLOBE score (AUCs, 0.85 and 0.83) were significantly more accurate in predicting prognosis than the other scoring systems (all p 2.46) at baseline was an independent predictor of reduced transplant-free survival in the multivariate analysis (adjusted hazard ratio, 3.74; p < 0.01). When the NLR was applied to the prognostic models, it significantly differentiated the prognosis of patients. CONCLUSIONS: The UK-PBC and GLOBE scores showed good prognostic performance in Korean patients with PBC. In addition, a high NLR was associated with a poorer prognosis. Including the NLR in prognostic models may further help to stratify patients with PBC.


Subject(s)
Asians , Cholangitis , Follow-Up Studies , Humans , Korea , Liver , Liver Cirrhosis, Biliary , Multivariate Analysis , Prognosis , ROC Curve
20.
GED gastroenterol. endosc. dig ; 36(3): 77-82, Jul.-Set. 2017. ilus, tab
Article in Portuguese | LILACS | ID: biblio-876775

ABSTRACT

Introdução: a lesão iatrogênica de via biliar é uma grave complicação cirúrgica que pode ocorrer durante a realização de colecistectomia. Os pacientes portadores desse tipo de lesão podem evoluir com cirrose biliar secundária a despeito de múltiplos tratamentos cirúrgicos, sendo necessário o transplante hepático como a última opção para tratamento. Objetivo: analisar o perfil dos pacientes em um centro de referência no Nordeste do Brasil submetidos a transplante hepático por lesão iatrogênica de via biliar. Métodos: foram analisados retrospectivamente 730 prontuários na Unidade de Transplante de Fígado do Hospital Universitário Oswaldo Cruz, no período de 2001 até 2015, e selecionados os oito pacientes submetidos a transplante hepático por lesão iatrogênica de via biliar. Resultados: a idade variou entre 26 e 61 anos, sendo seis indivíduos do sexo feminino. A cirurgia inicial foi a colecistectomia aberta em sete casos e videolaparoscópia em um caso. Em uma oportunidade, a lesão foi identificada durante a colecistectomia. Os sintomas se assemelharam com os descritos na literatura, incluindo colangite de repetição. Quatro pacientes eram portadores de lesão E2 e três de lesão tipo E3 de Strasberg. Seis pacientes já haviam sido submetidos a abordagens cirúrgicas prévias e o tempo entre a lesão inicial e o transplante variou entre três (3) e vinte e seis anos (26). Todos os pacientes eram portadores de Cirrose Biliar Secundária e o tempo na lista de espera para transplante variou entre 111 e 1123 dias. O MELD teve uma média de 16. O transplante foi realizado por técnica convencional em seis casos e Piggyback em dois, sendo a reconstrução por hepaticojejunostomia realizada em todos. Um paciente necessitou de retransplante, evoluindo a óbito. Conclusão: transplante hepático por lesão iatrogênica de via biliar é mais comum naqueles pacientes que demoraram a ser encaminhados para centro de referência e que foram submetidos a múltiplos procedimentos prévios.


Background: iatrogenic bile duct injury is a serious surgical complication that may occur during cholecystectomy.Patients with this type of lesion may develop secondary biliary cirrhosis, despite multiple surgical treatments, requiring liver transplantation as the last measure. Aim: analyze the patients submitted to hepatic transplantation due to iatrogenic bile duct injury in a referral center in the Northeast of Brazil. Results: the age ranged from 26 to 61 years, with six females. The initial surgery was open cholecystectomy in seven cases and videolaparoscopic in one case. In one patient the lesion was identified during cholecystectomy. The symptoms resembled those described in the literature, including recurrent cholangitis. Four patients had E2 lesions and three E3 lesions from Strasberg. Six patients had undergone previous surgical approaches and the time between initial injury and transplantation ranged from three to twenty-six years. All patients had secondary Biliary Cirrhosis and the time on the transplant waiting list varied between 111 and 1123 days. The MELD had an average of 16. The transplantation was performed by conventional technique in six cases and Piggyback in two, and reconstruction by hepaticojejunostomy performed in all. One patient needed a re-transplant and the same patient died one year later. Conclusion: hepatic transplantation due to iatrogenic bile duct injury is more common in those patients who were delayed to be referred to a referral center and who underwent multiple previous surgical procedures.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Bile Ducts , Cholecystectomy , Cholecystectomy/adverse effects , Liver Transplantation , Cholecystectomy, Laparoscopic , Iatrogenic Disease , Liver Cirrhosis, Biliary , Medical Records , Retrospective Studies
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