Gallstone Disease: Common Questions and Answers.

In the United States, 10% to 15% of adults are affected by gallstones, and cholesterol gallstones are the most prevalent subtype. Risk factors for developing gallstone disease include female sex; older age; certain medications; and having type 2 diabetes mellitus, nonalcoholic fatty liver disease, obesity, rapid weight loss, or hemolytic anemia. Nearly 80% of gallstones are found incidentally and remain asymptomatic. When symptomatic, gallstone disease usually presents as sudden onset right upper quadrant or epigastric abdominal pain. Common complications of gallstones include cholecystitis, choledocholithiasis, gallstone pancreatitis, and ascending cholangitis. The Murphy sign is a specific physical examination finding for acute cholecystitis. Ultrasonography is the initial imaging choice for detecting gallstones and acute cholecystitis. A hepatobiliary iminodiacetic acid (HIDA) scan can be used to evaluate for cholecystitis in patients with negative or equivocal ultrasound findings. Magnetic resonance cholangiopancreatography (MRCP) is an accurate, noninvasive diagnostic test to identify choledocholithiasis, certain malignancies, and biliary obstruction. Nonsteroidal anti-inflammatory drugs are safe and effective in treating pain from acute cholecystitis and biliary colic. Laparoscopic cholecystectomy is the treatment of choice for most patients with biliary colic or acute cholecystitis. Ursodeoxycholic acid and chenodeoxycholic acid should not routinely be used to treat gallstone disease, but they can be used as a nonsurgical alternative for certain patients. Postcholecystectomy syndrome is a potential postoperative complication that presents with abdominal pain, bloating, and diarrhea. (Am Fam Physician. 2024;109(6):518-524.

Surgical Removal of a Huge Common Bile Duct Stone.

A 65-year-old woman was diagnosed with an 8 cm large common bile duct stone and multiple stones in both intrahepatic ducts because of abnormal liver function tests. After a multidisciplinary approach, surgical removal was considered, and primary closure after laparoscopic removal of the common bile duct stone was performed. The patient recovered without complications and was discharged on the fourth postoperative day. Endoscopic removal of common bile duct stones is the standard treatment, but surgical removal through laparoscopic common bile duct exploration is also a safe and effective treatment method for such huge gallstones.

Early prediction of gallstone disease with a machine learning-based method from bioimpedance and laboratory data.

Gallstone disease (GD) is a common gastrointestinal disease. Although traditional diagnostic techniques, such as ultrasonography, CT, and MRI, detect gallstones, they have some limitations, including high cost and potential inaccuracies in certain populations. This study proposes a machine learning-based prediction model for gallstone disease using bioimpedance and laboratory data. A dataset of 319 samples, comprising161 gallstone patients and 158 healthy controls, was curated. The dataset comprised 38 attributes of the participants, including age, weight, height, blood test results, and bioimpedance data, and it contributed to the literature on gallstones as a new dataset. State-of-the-art machine learning techniques were performed on the dataset to detect gallstones. The experimental results showed that vitamin D, C-reactive protein (CRP) level, total body water, and lean mass are crucial features, and the gradient boosting technique achieved the highest accuracy (85.42%) in predicting gallstones. The proposed technique offers a viable alternative to conventional imaging techniques for early prediction of gallstone disease.

Evaluation of the effectiveness and safety of single-operator cholangiopancreatoscopy with the SpyGlass™ system / Evaluación de la eficacia y seguridad de la colangiopancreatoscopia de un solo operador con el sistema SpyGlass®

Background and study aims The single-operator cholangiopancreatoscopy (SOCP) with the SpyGlass™ system is a endoscopy technique whose use has grown exponentially in recent years. The aims of this study were to evaluate the efficacy and safety of SOCP with SpyGlass™ and determine the factors related to the onset of adverse events (AEs). Patients and methods Retrospective study at a single tertiary institution with inclusion of all consecutive patients undergoing SOCP with SpyGlass™ from February-2009 to December-2021. No exclusion criteria were considered. A descriptive statistical analysis was performed. The factors associated with the existence of AE were analyzed using Chi-square and Student's t-test. Results A total of 95 cases were included. The most common indications were biliary strictures (BS) evaluation (66.3%) or treatment of difficult common bile duct stones (27.4%). Technical and clinical success was attained in 98.9%. Single-session stone clearance was obtained in 84%. The AE rate was 7.4%. To detect malignancy in BS, optical diagnosis presents a sensitivity and specificity of 100% and 91.2%, respectively; while histology results were 36.4% and 100% respectively. A previous endoscopic sphincterotomy was associated with a lower rate of AEs (2.4% vs 41.7%; p < 0.001). Conclusions SOCP with SpyGlass™ is a safe and effective technique to diagnose and treat pancreatobiliary pathology. The presence of sphincterotomy performed prior to the procedure could improve the technique's safety (AU)

Antecedentes y objetivos del estudio La colangiopancreatoscopia de un solo operador (SOCP) con el sistema SpyGlass® es una técnica endoscópica cuyo uso ha crecido exponencialmente durante los últimos años. Los objetivos de este estudio fueron evaluar la eficacia y seguridad de la SOPC con SpyGlass® y determinar los factores relacionados con la aparición de eventos adversos (EA). Pacientes y métodos Estudio retrospectivo realizado en un único centro terciario, con inclusión consecutiva de todos los pacientes sometidos a SOCP con SpyGlass® desde febrero de 2009 hasta diciembre de 2021. No hubo criterios de exclusión. Se realizó un análisis estadístico descriptivo. Los factores asociados a la aparición de EA se analizaron mediante χ2 y la prueba t de Student. Resultados Se incluyeron un total de 95 casos. Las indicaciones más frecuentes fueron la evaluación de estenosis biliares (EB) (66,3%) o el tratamiento de coledocolitiasis difícil (27,4%). El éxito técnico y clínico se logró en 98,9%. La extracción de todas las litiasis en una sola sesión se obtuvo en 84%. La tasa de EA fue de 7,4%. Para la detección de malignidad en EB, el diagnóstico óptico presenta una sensibilidad y especificidad de 100% y 91,2%, respectivamente; mientras que los resultados de la histología fueron 36,4 y 100%, respectivamente. La esfinterotomía endoscópica previa se asocia con una menor tasa de EA (2,4 vs. 41,7%; p < 0,001). Conclusiones La SOCP con SpyGlass® es una técnica segura y eficaz para diagnosticar y tratar la patología biliopancreática. La presencia de esfinterotomía previa al procedimiento podría mejorar la seguridad de la técnica (AU)

Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones.

BACKGROUND AND AIMS: Single-operator cholangioscopy (SOC) offer a diagnostic and therapeutic alternative with an improved optical resolution over conventional techniques; however, there are no standardized clinical practice guidelines for this technology. This evidence-based guideline from the Colombian Association of Digestive Endoscopy (ACED) intends to support patients, clinicians, and others in decisions about using in adults the SOC compared to endoscopic retrograde cholangiopancreatography (ERCP), to diagnose indeterminate biliary stricture and to manage difficult biliary stones. METHODS: ACED created a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. Universidad de los Andes and the Colombia Grading of Recommendations Assessment, Development and Evaluation (GRADE) Network supported the guideline-development process, updating and performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The GRADE approach was used, including GRADE Evidence-to-Decision frameworks. RESULTS: The panel agreed on one recommendation for adult patients with indeterminate biliary strictures and one for adult patients with difficult biliary stones when comparing SOC versus ERCP. CONCLUSION: For adult patients with indeterminate biliary strictures, the panel made a conditional recommendation for SOC with stricture pattern characterization over ERCP with brushing and/or biopsy for sensitivity, specificity, and procedure success rate outcomes. For the adult patients with difficult biliary stones the panel made conditional recommendation for SOC over ERCP with large-balloon dilation of papilla. Additional research is required on economic estimations of SOC and knowledge translation evaluations to implement SOC intervention in local contexts.

Obstrução duodenal por cálculo - síndrome de bouveret: um relato de caso / Duodenal obstruction by calculus - bouveret syndrome: a case report

Introdução: A Síndrome de Bouveret é uma complicação rara, causada por um cálculo biliar grande que obstrui o intestino por meio de uma fístula e tem como principais sintomas: náuseas, vômitos, dor abdominal e distensão. O diagnóstico é feito por meio de exames de imagem, o tratamento é desafiador e pode envolver cirurgia ou procedimentos endoscópicos. Tem morbimortalidade considerável, mas a falta de diretrizes padrão dificulta o diagnóstico e o tratamento. Objetivos: Apresentar um relato de caso de paciente com características fisiopatológicas e diagnóstico de Síndrome de Bouveret, discutir a sintomatologia clínica, diagnóstico, tratamento e o desfecho cirúrgico. Método: Relato de caso realizado por revisão de prontuário e exames de paciente com síndrome de Bouveret. Apresentação: Feminina, 62 anos, quadro clínico compatível com obstrução duodenal. Tomografia de abdômen: imagem ectópica radiopaca, distensão hidroaérea intestinal, sugerindo cálculo biliar, confirmada através de endoscopia digestiva alta. Submetida a gastrotomia, seguida de gastrorrafia, sem reparo da fístula colecistogástrica. Discussão: Síndrome de Bouveret é mais comum em idosos e mulheres com antecedentes de cálculos biliares grandes. O diagnóstico é feito por meio de exames de imagem, geralmente por tomografia computadorizada e o tratamento visa remover o cálculo e aliviar a obstrução intestinal de maneira menos invasiva possível. Por alto risco cirúrgico, o tratamento endoscópico por meio de métodos como retirada com cesta ou litotripsia é indicado, porém, requer múltiplos procedimentos e possui limitações. A abordagem cirúrgica pode ser realizada em um ou dois tempos, dependendo das condições do paciente. Conclusão: Exames de imagens aliados à clínica são essenciais para o diagnóstico e tratamento com gastrostomia e o reparo de fistula em dois tempos se mostra uma ótima opção

Introduction: Bouveret syndrome is a rare complication, caused by a large gallstone that obstructs the intestine through a fistula and has as main symptoms: nausea, vomiting, abdominal pain and distension. The diagnosis is made through imaging tests, the treatment is challenging and may involve surgery or endoscopic procedures. It has considerable morbidity and mortality, but the lack of standard guidelines makes diagnosis and treatment difficult. Objectives: To present a case report of a patient with pathophysiological characteristics and diagnosis of Bouveret syndrome, to discuss the clinical symptomatology, diagnosis, treatment and surgical outcome. Method: Case report performed by review of medical records and examinations of patients with Bouveret syndrome. Presentation: Female, 62 years old, clinical picture compatible with duodenal obstruction. Abdominal CT scan: radiopaque ectopic image, intestinal hydrorespiratory distension, suggesting gallstone, confirmed by upper digestive endoscopy. Submitted to gastrotomy, followed by gastrorraphy, without repair of the cholecystogastric fistula. Discussion: Bouveret syndrome is more common in the elderly and women with a history of large gallstones. The diagnosis is made through imaging tests, usually by computed tomography and the treatment aims to remove the stone and relieve intestinal obstruction in the least invasive way possible. Due to high surgical risk, endoscopic treatment through methods such as basket removal or lithotripsy is indicated, however, it requires multiple procedures and has limitations. The surgical approach can be performed in one or two times, depending on the patient's conditions. Conclusion: Imaging exams combined with the clinic are essential for diagnosis and treatment with gastrostomy and two-stage fistula repair is a great option

Introducción: El Síndrome de Bouveret es una complicación rara, causada por un gran cálculo biliar que obstruye el intestino a través de una fístula y tiene como síntomas principales: náuseas, vómitos, dolor abdominal y distensión. El diagnóstico se realiza a través de pruebas de imagen, el tratamiento es desafiante y puede involucrar cirugía o procedimientos endoscópicos. Tiene una morbilidad y mortalidad considerables, pero la falta de pautas estándar dificulta el diagnóstico y el tratamiento. Objetivos: Presentar un reporte de caso de un paciente con características fisiopatológicas y diagnóstico de Síndrome de Bouveret, discutir la sintomatología clínica, diagnóstico, tratamiento y resultado quirúrgico. Método: Reporte de caso realizado mediante revisión de historias clínicas y exámenes de un paciente con síndrome de Bouveret. Presentación: Mujer, 62 años, cuadro clínico compatible con obstrucción duodenal. Tomografía de abdomen: imagen ectópica radiopaca, distensión intestinal hidroaérea, sugestiva de cálculos biliares, confirmada por endoscopia digestiva alta. Sometido a gastrotomía, seguida de gastrorrafia, sin reparación de la fístula colecistogástrica. Discusión: El síndrome de Bouveret es más común en ancianos y mujeres con antecedentes de cálculos biliares grandes. El diagnóstico se realiza mediante pruebas de imagen, generalmente por tomografía computarizada, y el tratamiento tiene como objetivo eliminar el cálculo y aliviar la obstrucción intestinal de la forma menos invasiva posible. Debido al alto riesgo quirúrgico, está indicado el tratamiento endoscópico mediante métodos como la extracción con canastilla o la litotricia, sin embargo, requiere múltiples procedimientos y tiene limitaciones. El abordaje quirúrgico se puede realizar en una o dos etapas, dependiendo de las condiciones del paciente. Conclusión: Los exámenes de imagen combinados con la clínica son fundamentales para el diagnóstico y tratamiento con gastrostomía y la reparación de fístulas en dos tiempos demuestra ser una gran opción.

Quistes y hamartomas biliares, no siempre son asintomáticos / Biliary cysts and hamartomas are not always asymptomatic

In daily clinical practice, we can find consultation reasons and exploratoryfindings that can guide us to a certain pathology. However, to avoid mistakes,we must remember that there are fewer common diseases, which could leadto an unexpected final diagnosis.Hepatic cystic lesions are usually found incidentally, having a wide differentialdiagnosis. Among them are biliary cysts and hamartomas, rare lesions, butwith not inconsiderable importance, as we will see in the case that is exposedbelow. (AU)

En la práctica clínica habitual nos podemos encontrar motivos de consulta yhallazgos exploratorios que nos pueden guiar a una determinada patología.Sin embargo, para no caer en errores, debemos recordar que existen enfermedades menos habituales, que podrían llevarnos a un diagnóstico finalinesperado.Las lesiones quísticas hepáticas se hallan generalmente de forma incidental, teniendo un amplio diagnóstico diferencial. Entre ellas se encuentranlos quistes y hamartomas biliares, lesiones poco frecuentes, pero con unaimportancia no desdeñable, como veremos en el caso que se expone a continuación. (AU)

Direct cholangioscopy-guided stone extraction / Extracción de piedras guiada por colangioscopia directa

No disponible

Íleo biliar como causa de dolor abdominal en el paciente anciano / Gallstone ileus as a cause of abdominal pain in the elderly patient

El íleo biliar es una complicación rara y potencialmente grave de la colelitiasis. Se define como una obstrucción intestinal mecánica secundaria a la presencia de un cálculo biliar en la luz intestinal. La causa más frecuente es la impactación del cálculo en el íleon tras su paso a través de una fístula bilioentérica. Presenta una elevada morbimortalidad, debido principalmente a la dificultad y el retraso diagnóstico. Presentamos un estudio retrospectivo de 4 casos de íleo biliar tratados entre 2013 y 2017 en el Hospital Nuestra Señora del Prado. Se analizaron las características clínicas, las pruebas diagnósticas y el tratamiento quirúrgico realizado

Gallstone ileus is a rare and potentially serious complication of cholelithiasis. It is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone in the intestinal luz. The most frequent cause is impaction of the calculus in the ileum after passing through a bilioenteric fístula. It has a high morbidity and mortality rate, mainly due to the difficulty and delay in its diagnosis. A retrospective study is presented of 4 cases of gallstone ileus treated between 2013 and 2017 in the Hospital Nuestra Señora del Prado. An analysis was performed on the clinical characteristics, diagnostic tests, and surgical treatment

Acute calculous cholecystitis: a real-life management study in a tertiary teaching hospital

Aim: to describe the management of acute calculous cholecystitis in a tertiary teaching hospital and the outcomes obtained. Material and methods: a retrospective single tertiary center cohort study. Results: medical records of 487 patients were analyzed. The mean follow-up was 44.5 +/- 17.0 months. Treatment alternatives were cholecystectomy (64.3%), conservative treatment (23.0%), endoscopic retrograde cholangiopancreatography (17.4%), percutaneous cholecystostomy (10.7%) and endoscopic ultrasound-guided gallbladder drainage (0.8%). Most cholecystectomies were delayed (88.8%). Recurrences occurred in 38.2% of patients. Although cholecystectomy was the therapeutic approach with the lowest recurrence rate once performed, 44.6% of patients that underwent delayed surgery had pre-surgical recurrences. Conclusions: delayed cholecystectomy is still commonly performed, even though it is related with a high frequency of preoperative recurrences

No disponible

Colecistectomía: resultados de una década de experiencia / Cholecystectomy: results. a decade of experience

Introducción: La colecistectomía, sea a través de una incisión subcostal o videolaparoscópica es la intervención quirúrgica por excelencia para remover la vesícula biliar. El objetivo del estudio es presentar la experiencia acumulada en este tipo de cirugía a través de diez años, sus indicaciones, sus modalidades quirúrgicas, la relación con otras patologías así como las complicaciones de las técnicas empleadas. Metodología: Se incluyen todos los casos quirúrgicos de pacientes con enfermedad de la vesícula y vías biliares ingresados del 01 de enero del 2006 al 31 de diciembre del 2016 en el Departamento de Cirugía del Hospital San Vicente. Resultados: Del 2006 al 2016 se intervinieron 985 pacientes de los cuales, 888 (90.15%) corresponden al sexo femenino. La edad promedio fue de 41 años para ambos sexos, no mostrando diferencias 40.78 vs. 40.95. La colecistitis crónica fue la indicación pre operatoria en el 98.7% y su relación con hernia umbilical fue del 2.23%. La técnica quirúrgica abierta se realizó en 702 (70.27%) y la vía laparoscópica en 260 (26.40%). La tasa global de complicaciones fue del 2.33% (23 / 985 pacientes) siendo el sangrado el más observado en 12 pacientes (1.21%) y la lesión de la vía biliar en 5 (0.50%). Conclusiones: La afección de la vesícula sigue afectando principalmente al sexo femenino, su resolución es esencialmente quirúrgica y en la actualidad la colecistectomía video laparoscópica se considera la cirugía por excelencia, sin que ésta anule la vía abierta por múltiples factores. Es un procedimiento de baja morbilidad y en nuestra serie no se acompañó de mortalidad.

Background: Cholecystectomy, performed with open incision or laparoscopically, by excellence it is the surgery to remove the pathological gallbladder. The aim of this study is to present the experience gained in this type of surgery within ten years, showing indicatons, surgical modalites, and the relaton with other pathologies as well as complicatons of the techniques employed. Methods: All surgical cases of patents with diseased gallbladder and bile ducts are admited from January 01, 2006 to December 31, 2016 in the Department of Surgery of San Vicente Hospital. Results: 985 patents were included, 888 (90.15%) are female. Average age was 41 years old for both sexes, showing no diferences 40.78 vs. 40.95. Chronic Cholecystts was the main preoperatve diagnosis in 98.7%, and its relaton with an umbilical hernia was 2.23%. The open technique was performed on 702 patents (70.27%) and laparoscopic approach on 260 patents (26.40%). The overall complicaton rate was 2.33%. Hemorrhage was the most common in 12 patents (1.21%), and bile duct injury in 5 patents (0.50%). Conclusion: Gallbladder disease is stll more common in women. Treatment is essentally surgical and currently laparoscopic cholecystectomy is considered the standard of care. Cholecystectomy has a low incidence of morbidity and in this study there was no mortality

A New Paradigm in Gallstones Diseases and Marked Elevation of Transaminases: An Observational Study

ABSTRACT Background. In clinical practice, it is assumed that a severe rise in transaminases is caused by ischemic, viral or toxic hepatitis. Nevertheless, cases of biliary obstruction have increasingly been associated with significant hypertransaminemia. With this study, we sought to determine the true etiology of marked rise in transaminases levels, in the context of an emergency department. Material and methods. We retrospectively identified all patients admitted to the emergency unit at Centro Hospitalar e Universitário de Coimbra between 1st January 2010 and 31st December 2010, displaying an increase of at least one of the transaminases by more than 15 times. All patient records were analyzed in order to determine the cause of hypertransaminemia. Results. We analyzed 273 patients - 146 males, mean age 65.1 ± 19.4 years. The most frequently etiology found for marked hypertransaminemia was pancreaticobiliary acute disease (n = 142;39.4%), mostly lithiasic (n = 113;79.6%), followed by malignancy (n = 74;20.6%), ischemic hepatitis (n = 61;17.0%), acute primary hepatocellular disease (n = 50;13.9%) and muscle damage (n = 23;6.4%). We were not able to determine a diagnosis for 10 cases. There were 27 cases of recurrence in the lithiasic pancreaticobiliary pathology group. Recurrence was more frequent in the group of patients who had not been submitted to early cholecystectomy after the first episode of biliary obstruction (p = 0.014). The etiology of hypertransaminemia varied according to age, cholestasis and glutamic-pyruvic transaminase values. Conclusion. Pancreaticobiliary lithiasis is the main cause of marked hypertransaminemia. Hence, it must be considered when dealing with such situations. Not performing cholecystectomy early on, after the first episode of biliary obstruction, may lead to recurrence.

Síndrome de Bouveret: reporte de un caso / Bouveret Syndrome: case report

El síndrome de Bouveret es un tipo infrecuente de íleo biliar, caracterizado por el paso de un cálculo de la vesícula al intestino a través de una fístula colecistogastroduodenal produciendo obstrucción del tracto gastrointestinal. Se reportaron poco más de 200 casos en la literatura médica, con una mortalidad aproximada de un 25% y un pronóstico determinado por: comorbilidad, edad avanzada y retraso en el diagnóstico debido a su inespecificidad. Para el diagnóstico son útiles: radiografía simple, ecografía, tomografía computarizada, resonancia magnética y la endoscopía como medio más sensible que también es usado como forma terapéutica además de la cirugía. Se presenta el caso de una paciente de 49 años, que consultó por epigastralgia, nauseas, vómitos postprandiales, intolerancia alimentaria, en mal estado general, con diagnóstico de colecistitis aguda procediendo a colecistectomía abierta donde se evidencio un cálculo impactado en el trayecto de una fístula colecistogástrica correspondiente a un Síndrome de Bouveret.

Bouveret syndrome is a rare type of gallstone ileus, characterized by the step of calculating the gallbladder into the intestine through a fistula colecistogastroduodenal producing gastrointestinal tract obstruction. Just over 200 cases were reported in the medical literature, with an estimated mortality of 25% and a specific prognosis: comorbidity, advanced age and delay in diagnosis due to its specificity. For diagnostic they are useful: plain radiography, ultrasound, computed tomography, magnetic resonance and endoscopy as more sensitive means is also used as therapeutically addition to surgery. Patient 49, who complained epigastric pain, nausea, postprandial vomiting, food intolerance, poor general condition, diagnosed with acute cholecystitis proceeding to open cholecystectomy where impacted stone was evident in the way of a corresponding cholecystogastric fístula to Bouveret syndrome.

Lemmel's Syndrome, an Unusual Cause of Abdominal Pain and Jaundice by Impacted Intradiverticular Enterolith: Case Report

Duodenal diverticula are detected in up to 27% of patients undergoing upper gastrointestinal tract evaluation with periampullary diverticula (PAD) being the most common type. Although PAD usually do not cause symptoms, it can serve as a source of obstructive jaundice even when choledocholithiasis or tumor is not present. This duodenal diverticulum obstructive jaundice syndrome is called Lemmel's syndrome. An 81-yr-old woman came to the emergency room with obstructive jaundice and cholangitis. Abdominal CT scan revealed stony opacity on distal CBD with CBD dilatation. ERCP was performed to remove the stone. However, the stone was not located in the CBD but rather inside the PAD. After removal of the enterolith within the PAD, all her symptoms resolved. Recognition of this condition is important since misdiagnosis could lead to mismanagement and therapeutic delay. Lemmel's syndrome should always be included as one of the differential diagnosis of obstructive jaundice when PAD are present.

Aspectos atuais no manejo dos pacientes com íleo biliar / Current aspects in the management of patients with biliary obstruction

Íleo biliar é uma complicação rara da colelitíase que, quando não diagnosticada precocemente, pode cursar com altos índices de complicações. Apesar de infrequente, deve ser lembrado pelos médicos que trabalham em serviços de urgência. O tratamento é cirúrgico, podendo variar conforme o local de atendimento, o estado geral do paciente e a experiência da equipe.

Gallstone ileus is a rare complication of biliary lithiasis that, when not diagnosed early, can be associated with high complication rates. Although infrequent, this condition should be considered by physicians working in emergency departments. Treatment is mainly surgical and may vary by location of care, patient's general condition and experience of staff.

Rendimiento diagnóstico del marcador tumoral CA 19-9 en la diferenciación entre patología bilio-pancreática benigna y maligna / Accuracy of the tumor marker CA 19-9 in the differentiation of benign and malignant bilio-pancreatic diseases

Introduction: CA 19-9 has been identified as a derivative of sialic Lewis blood group A and is expressed in 95 percent of the population. Several studies have documented an overproduction of CA 19-9 in malignant pancreatic and biliary tree diseases. The objective of this study is to determine the accuracy of the tumor marker CA 19-9 differentiating benign and malignant bilio-pancreatic diseases. Material and Methods: diagnostic test study. We reviewed the records of all patients with malignant bilio-pancreatic diseases and benign biliary calculous diseases evaluated in Hospital Base Osorno between august 2007 and december 2011, with CA 19-9 as part of their study. Results: 71 patients met the inclusion criteria, 17 men and 54 women, with a mean age of 60.7 +/- 15.3 years old. Twenty nine (40.8 percent) cases were benign and 42 (59.2 percent) cases malignant. For a cutoff level of 37 U/ml the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to differentiate benign from malignant disease was 81 percent, 72.4 percent, 81 percent and 72.4 percent, respectively. For a cut off level of 130 U/ml specificity and PPV increased to 96.6 percent and 96.4 percent, respectively. Conclusions: the use of CA 19-9 is useful in the diagnosis of patients with suspected bilio-pancreatic malignant disease. The optimization of the normal published value can help to improve accuracy.

Introducción: El CA 19-9 se ha identificado como un derivado siálico del grupo sanguíneo Lewis A y se expresa en el 95 por ciento de la población. Numerosos estudios han documentado una sobreproducción de CA 19-9 en tumores malignos del árbol biliar y páncreas. El objetivo de este estudio es determinar la utilidad del marcador tumoral CA 19-9 en la diferenciación de patología bilio-pancreática benigna y maligna. Material y Métodos: estudio de pruebas diagnósticas. Se revisaron los antecedentes de todos los pacientes con patología bilio-pancreática maligna y enfermedad litiásica biliar benigna, evaluados en el Hospital Base de Osorno entre agosto de 2007 y diciembre de 2011, a los que se les haya solicitado CA 19-9 como parte de su estudio. Resultados: 71 pacientes cumplieron los criterios de inclusión, 17 hombres y 54 mujeres, con una media de 60,7 +/- 15,3 años de edad. Veintinueve (40,8 por ciento) casos correspondieron patología benigna y 42 (59,2 por ciento) casos a patología maligna. Para un valor de corte de 37 U/ml la sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN) para diferenciar enfermedad benigna de maligna fue de 81 por ciento, 72,4 por ciento, 81 por ciento y 72,4 por ciento, respectivamente. Para un valor de corte de 130 U/ ml la especificidad y el VPP aumentaron a 96,6 por ciento y 96,4 por ciento, respectivamente. Conclusiones: el uso del Ca 19-9 es útil en el proceso diagnóstico de pacientes con sospecha de patología bilio-pancreática maligna. La optimización de los valores sobre el valor de normalidad publicado puede ayudar a mejorar su rendimiento.

Refractory Bile Duct Stones Occurring at Hepaticoduodenostomy Site / 대한소화기학회지

No abstract available.

Acute Gallstone Pancreatitis Misdiagnosed as Acupuncture Induced Traumatic Pancreatitis / 대한소화기학회지

No abstract available.

A Case of Acute Cholecystitis after Colonoscopy / 대한소화기학회지

A 43-year-old man, who received total gastrectomy five years ago for advanced gastric cancer, underwent a screening colonoscopy and abdominal CT scan. Abdominal CT scan revealed no abnormal findings. Colonoscopy revealed polyps at the rectum, which were removed by polypectomy. The patient did not complain of abdominal pain or discomfort throughout the procedure. But, he developed right upper quadrant abdominal pain on the next day after colonoscopy. Abdominal CT scan revealed the distended gallbladder with mild wall thickening and suspicious sandy stones or sludge in the gallbladder. The patient underwent an open cholecystectomy. Pathology was compatible with acute cholecystitis. We should be aware of and consider cholecystitis in the differential diagnosis for patients with abdominal pain after colonoscopy.

Formación de cálculos biliares de colesterol: nuevos avances científicos / Cholesterol gallstone formation: new scientific advances

La investigación científica sobre la formación de cálculos biliares de colesterol, ha comprobado la participación de numerosos genes, entre los cuales se encuentran receptores nucleares y transportadores biliares. El desequilibrio fisicoquímico entre los lípidos biliares más importantes produce hipersecreción de colesterol en la bilis, una etapa necesaria para sobresaturar la vesícula biliar. Las sales biliares son insuficientes para solubilizar al colesterol en micelas mixtas, por lo que esta molécula se solubiliza, en su mayoría, dentro de liposomas (fosfolípidos y escasas sales biliares), y en ellos existe en alta concentración, que tiende a precipitar y a formar cristales, evento considerado como limitante para la formación de cálculos biliares. El desarrollo del cálculo puede acelerarse si existe hipersecreción de proteínas mucinas y escasa motilidad vesicular. La presente revisión tiene el objetivo de informar los nuevos aportes científicos sobre la formación de cálculos biliares de colesterol, analizando y discutiendo sus resultados enfocados a la búsqueda de tratamientos farmacológicos, porque la litiasis no tiene terapia eficaz y la colecistectomía es el método quirúrgico invasivo, cuando la enfermedad produce síntomas

Scientific research about cholesterol gallstone formation has shown the involvement of many genes, such as nuclear receptors and biliary transporters. Physicochemical imbalance of three major biliary lipids produces hypersecretion of cholesterol in bile, a key process for supersaturation of gallbladder. Bile salts are insufficient for solubilization of cholesterol in mixed micelles; therefore this molecule is solubilized mostly into liposome (phospholipids and few bile salts); there is a high concentration of cholesterol into liposomes, which leads to its precipitation and crystallization, the key factor for cholesterol gallstone formation. Development of gallstones might accelerated when there is hypersecretion of mucins and gallbladder hypomotility. The aim of this review is to inform about new scientific contributions of cholesterol gallstone formation, analyzing them to the investigation of possible pharmacological treatments, since it is a disease that has no effective treatment and the only cholecystectomy is an invasive surgical treatment for symptomatic gallstone