ABSTRACT
Bile leaks arise from various causes such as trauma, complications after hepatobiliary surgery, and intrahepatic malignancies or their associated liver-directed treatments. Bile leaks can result in significant morbidity and mortality. Delayed diagnosis is not uncommon due to nonspecific manifestations; therefore, a high clinical suspicion is needed. A multidisciplinary approach for treatment of biliary leaks with prompt referral to tertiary care centers with experienced hepatobiliary surgeons, advanced endoscopists, and interventional radiologists is needed to address these challenging complications. Management of biliary leaks can range from conservative management to open surgical repair. Minimally invasive procedures play a crucial role in biliary leak treatment, and the interventional radiologist can help guide appropriate management on the basis of a clear understanding of the pathophysiology of biliary leaks and a current knowledge of the armamentarium of treatment options. In most cases, a simple diversion of bile to decompress the biliary system may prove effective. However, persistent and high-output biliary leaks require delineation of the source with tailored treatment options to control the leak. This may be done by additional diversions, occluding the source, reestablishing connections, or using a combination of therapies to bridge to more definitive surgical interventions. The authors describe the different treatment options and emphasize the role of interventional radiology. ©RSNA, 2024.
Subject(s)
Postoperative Complications , Humans , Postoperative Complications/diagnostic imaging , Postoperative Complications/therapy , Biliary Tract Diseases/diagnostic imaging , Biliary Tract Diseases/therapy , Anastomotic Leak/diagnostic imaging , Anastomotic Leak/therapy , Patient Care TeamABSTRACT
INTRODUCTION: Biliary stents are used to optimize ductal patency and enable bile flow in the management of obstruction or injury related to biliary tract tumors, strictures, stones, or leaks. Although direct therapeutic applications of biliary stents are less well developed, stents can be used to deliver drugs, radioisotopes, and photodynamic therapy. AREAS COVERED: This report provides an in-depth overview of the clinical indications, and therapeutic utility of biliary stents. Unique considerations for the design of biliary stents are described. The properties and functionalities of materials used for stents such as metal alloys, plastic polymers, or biodegradable materials are described, and opportunities for design of future stents are outlined. Current and potential applications of stents for therapeutic applications for biliary tract diseases are described. EXPERT OPINION: Therapeutic biliary stents could be used to minimize inflammation, prevent stricture formation, reduce infections, or provide localized anti-cancer therapy for biliary tract cancers. Stents could be transformed into therapeutic platforms using advanced materials, 3D printing, nanotechnology, and artificial intelligence. Whilst clinical study and validation will be required for adoption, future advances in stent design and materials are expected to expand the use of therapeutic biliary stents for the treatment of biliary tract disorders.
Subject(s)
Stents , Humans , Biliary Tract Diseases/therapySubject(s)
Biliary Tract Diseases , Cholangiopancreatography, Endoscopic Retrograde , Consensus , Pancreatic Diseases , Humans , Cholangiopancreatography, Endoscopic Retrograde/methods , Child , Pancreatic Diseases/diagnosis , Pancreatic Diseases/therapy , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/therapy , China , Pediatrics/standardsABSTRACT
BACKGROUND AND AIM: Rapidly aging societies have become a major issue worldwide including Japan. This study aimed to elucidate relative changes in the characteristics of inpatients in Japan related to this issue. METHODS: A total of 23 835 Japanese inpatients treated from 2010 to 2021 were enrolled (2010-2013, period I; 2014-2017, period II; 2018-2021, period III). Changes in clinical features were retrospectively analyzed based on ICD-10 diagnosis data. RESULTS: The percentage of patients aged over 75 years increased over time (period I, 38.0%; II, 39.5%, III, 41.4%). Emergency admissions comprised 27.5% of all in period I, which increased to 43.2% in period II and again to 44.5% in period III (P < 0.001). In period I, gastrointestinal disease, liver disease, pancreatic-biliary disease, and other disease types were noted in 47.4%, 29.5%, 19.2%, and 3.9%, respectively, while those values were 44.0%, 18.0%, 33.9%, and 4.1%, respectively, in period III (P < 0.001). The frequency of liver disease decreased by approximately 0.6-fold from periods I to III, while that of biliary-pancreatic disease increased by approximately 1.8-fold during that time. Both percentage and actual numbers of patients with biliary-pancreatic disease increased during the examined periods. Analysis of changes in the proportion of organs affected by malignancy during periods I, II, and III showed a marked increase in cases of biliary-pancreatic malignancy (11.6%, 19.5%, 26.6%, respectively) (P < 0.001). CONCLUSION: In association with the rapidly aging Japanese society, there has been an increasing frequency of biliary-pancreatic disease cases requiring hospitalization for treatment in the west Japan region of Shikoku.
Subject(s)
Gastroenterology , Inpatients , Humans , Japan/epidemiology , Aged , Retrospective Studies , Male , Inpatients/statistics & numerical data , Female , Gastroenterology/statistics & numerical data , Gastroenterology/trends , Aged, 80 and over , Middle Aged , Aging , Liver Diseases/epidemiology , Liver Diseases/therapy , Liver Diseases/diagnosis , Biliary Tract Diseases/epidemiology , Biliary Tract Diseases/therapy , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/therapy , Gastrointestinal Diseases/diagnosis , Hospitalization/statistics & numerical data , Time Factors , Age Factors , Adult , Pancreatic Diseases/epidemiology , Pancreatic Diseases/therapyABSTRACT
The progress of endoscopic diagnosis and treatment for inflammatory diseases of the biliary tract and pancreas have been remarkable. Endoscopic ultrasonography (EUS) and EUS-elastography are used for the diagnosis of early chronic pancreatitis and evaluation of endocrine and exocrine function in chronic pancreatitis. Notably, extracorporeal shock wave lithotripsy and electrohydraulic shock wave lithotripsy have improved the endoscopic stone removal rate in patients for whom pancreatic stone removal is difficult. Studies have reported the use of self-expanding metal stents for stent placement for pancreatic duct stenosis and EUS-guided pancreatic drainage for refractory pancreatic duct strictures. Furthermore, EUS-guided drainage using a double-pigtailed plastic stent has been performed for the management of symptomatic pancreatic fluid collection after acute pancreatitis. Recently, lumen-apposing metal stents have led to advances in the treatment of walled-off necrosis after acute pancreatitis. EUS-guided biliary drainage is an alternative to refractory endoscopic biliary drainage and percutaneous transhepatic biliary drainage for the treatment of acute cholangitis. The placement of an inside stent followed by switching to uncovered self-expanding metal stents in difficult-to-treat cases has been proposed for acute cholangitis by malignant biliary obstruction. Endoscopic transpapillary gallbladder drainage is an alternative to percutaneous transhepatic gallbladder drainage for severe and some cases of moderate acute cholecystitis. EUS-guided gallbladder drainage has been reported as an alternative to percutaneous transhepatic gallbladder drainage and endoscopic transpapillary gallbladder drainage. However, it is important to understand the advantages and disadvantages of each drainage method and select the optimal drainage method for each case.
Subject(s)
Endosonography , Humans , Endosonography/methods , Biliary Tract Diseases/surgery , Biliary Tract Diseases/therapy , Biliary Tract Diseases/diagnostic imaging , Biliary Tract Diseases/diagnosis , Drainage/methods , Endoscopy, Digestive System/methods , Stents , Pancreatic Diseases/therapy , Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/surgery , Pancreatitis/therapyABSTRACT
OBJECTIVES: No study has explored whether availability of endoscopic retrograde cholangiopancreatography (ERCP) is adequate and equitable across US children's hospitals. We hypothesized that ERCP availability and utilization differs by geography and patient factors. METHODS: Healthcare encounter data from 2009 to 2019 on children with pancreatic and biliary diseases from the Pediatric Health Information System were analyzed. ERCP availability was defined as treatment at a hospital that performed pediatric ERCP during the year of service. RESULTS: From 2009 to 2019, 37,946 children (88,420 encounters) had a potential pancreatic or biliary indication for ERCP; 7066 ERCPs were performed. The commonest pancreatic diagnoses leading to ERCP were chronic (47.2%) and acute pancreatitis (43.2%); biliary diagnoses were calculus (68.3%) and obstruction (14.8%). No ERCP was available for 25.0% of pancreatic encounters and 8.1% of biliary encounters. In multivariable analysis, children with public insurance, rural residence, or of Black race were less likely to have pancreatic ERCP availability; those with rural residence or Asian race were less likely to have biliary ERCP availability. Black children or those with public insurance were less likely to undergo pancreatic ERCP where available. Among encounters for calculus or obstruction, those of Black race or admitted to hospitals in the West were less likely to undergo ERCP when available. CONCLUSIONS: One-in-four children with pancreatic disorders and one-in-12 with biliary disorders may have limited access to ERCP. We identified racial and geographic disparities in availability and utilization of ERCP. Further studies are needed to understand these differences to ensure equitable care.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Health Services Accessibility , Hospitals, Pediatric , Humans , Cholangiopancreatography, Endoscopic Retrograde/statistics & numerical data , Child , Hospitals, Pediatric/statistics & numerical data , Male , Female , United States , Health Services Accessibility/statistics & numerical data , Child, Preschool , Adolescent , Infant , Pancreatic Diseases/therapy , Pancreatic Diseases/surgery , Healthcare Disparities/statistics & numerical data , Biliary Tract Diseases/therapy , Retrospective StudiesABSTRACT
Liver transplantation is a technically demanding surgical procedure with known complications, and the optimal approach to addressing vascular and biliary complications requires a coordinated effort between surgical and interventional radiology teams. Vascular complications involving the hepatic artery, portal vein, or hepatic veins can be characterized by their mechanism, chronicity, and timing of presentation. These factors help determine whether the optimal therapeutic approach is surgical or endovascular. Very early presentation in the perioperative period favors surgical revision, while later presentation is best addressed endovascularly. Biliary complications can be categorized as leaks or strictures, and coordinated surgical, endoscopic, and percutaneous management is needed to address these types of complications. Through advances in technique and the management of complications, outcomes after liver transplantation continue to improve.
Subject(s)
Biliary Tract Diseases , Liver Transplantation , Humans , Liver Transplantation/adverse effects , Biliary Tract Diseases/therapy , Hepatic Artery , Portal Vein/diagnostic imaging , Portal Vein/surgery , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology , Postoperative Complications/therapy , Retrospective StudiesABSTRACT
Liver transplantation (LT) is the only curative therapy in patients with end-stage liver disease. Long-term survival is excellent, yet LT recipients are at risk of significant complications. Biliary complications are an important source of morbidity after LT, with an estimated incidence of 5%-32%. Post-LT biliary complications include strictures (anastomotic and non-anastomotic), bile leaks, stones, and sphincter of Oddi dysfunction. Prompt recognition and management is critical as these complications are associated with mortality rates up to 20% and retransplantation rates up to 13%. This review aims to summarise our current understanding of risk factors, natural history, diagnostic testing, and treatment options for post-transplant biliary complications.
Subject(s)
Biliary Tract Diseases , Biliary Tract , Liver Transplantation , Transplants , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/etiology , Biliary Tract Diseases/therapy , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Humans , Liver Transplantation/adverse effectsABSTRACT
The history of ascariasis is very old. It is endemic in various parts of Bangladesh. Hepatobiliary ascariasis is a well-known complication of the intestinal ascariasis. Although cosmopolitan, it predominantly affects people in Asia, Africa, and South America. This was a prospective observational study conducted from July to December 2014 to explore the short term outcome of therapeutic ERCP in the treatment of biliary ascariasis in a tertiary care hospital of Bangladesh. A total of 60 cases of biliary ascariasis were selected conveniently in this study. Data were collected by face-to-face interviews and observation with the help of data sheet. Data were checked for quality control and analyzed by computer using SPSS software. The mean±SD age of the patients was 30.96±7.66 years. All the patients were aged between 17 and 55 years and predominantly affect women in the 3rd and 4th decades. The most common presentation was upper abdominal pain in 47(83.32%) of the patients. Ultrasound was the diagnostic tool of choice, where biliary ascariasis was found in 40(66.7%) of patients. ERCP is reserved mainly for therapeutic purposes and found successful in 57(95%) of the patients.
Subject(s)
Ascariasis , Biliary Tract Diseases , Adolescent , Adult , Ascariasis/diagnostic imaging , Ascariasis/therapy , Bangladesh , Biliary Tract Diseases/diagnostic imaging , Biliary Tract Diseases/therapy , Cholangiopancreatography, Endoscopic Retrograde , Female , Humans , Middle Aged , Tertiary Care Centers , Young AdultABSTRACT
BACKGROUND: Complementary to percutaneous intra-abdominal drainage, percutaneous transhepatic biliary drainage (PTBD) might ameliorate healing of pancreatic fistula and biliary leakage after pancreatoduodenectomy by diversion of bile from the site of leakage. This study evaluated technical and clinical outcomes of PTBD for this indication. METHODS: All patients undergoing PTBD for leakage after pancreatoduodenectomy were retrospectively evaluated in two tertiary pancreatic centers (2014-2019). Technical success was defined as external biliary drainage. Clinical success was defined as discharge with a resolved leak, without additional surgical interventions for anastomotic leakage other than percutaneous intra-abdominal drainage. RESULTS: Following 822 pancreatoduodenectomies, 65 patients (8%) underwent PTBD. Indications were leakage of the pancreaticojejunostomy (n = 25; 38%), hepaticojejunostomy (n = 15; 23%) and of both (n = 25; 38%). PTBD was technically successful in 64 patients (98%) with drain revision in 40 patients (63%). Clinical success occurred in 60 patients (94%). Leakage resolved after median 33 days (IQR 21-60). PTBD related complications occurred in 23 patients (35%), including cholangitis (n = 14; 21%), hemobilia (n = 7; 11%) and PTBD related bleeding requiring re-intervention (n = 4; 6%). In hospital mortality was 3% (n = 2). CONCLUSION: Although drain revisions and complications are common, PTBD is highly feasible and appears to be effective in the treatment of biliopancreatic leakage after pancreatoduodenectomy.
Subject(s)
Biliary Tract Diseases , Biliary Tract Surgical Procedures , Biliary Tract Diseases/therapy , Biliary Tract Surgical Procedures/adverse effects , Drainage/adverse effects , Humans , Pancreaticoduodenectomy/adverse effects , Retrospective StudiesABSTRACT
RATIONALE: Plastic endobiliary stents, after endoscopic retrograde cholangiopancreatography, can get spontaneously dislocated from the common bile duct and migrate intothe distal bowel. Most migrated biliary stents are removed with the passing of stool. However, migrated biliary stents can cause bowel perforation, albeit rarely, and surgical intervention may be required. Recently, we observed a colonic diverticular perforation caused by a migrated biliary stent, and we have reported this case with a review of the literature. PATIENTS CONCERNS: A 74-year-old man presented with severe right lower quadrant pain after biliary stent insertion 1month ago. DIAGNOSES: Abdominal computed tomography revealed perforation of the proximal ascending colon by the migrated biliary stent, combined with localized peritonitis. INTERVENTIONS: Emergency diagnostic laparoscopic examination revealed penetration of the proximal ascending colon by the plastic biliary stent, and right hemicolectomy was performed. OUTCOMES: On pathological examination, colonic diverticular perforation by the biliary stent was confirmed. The patient was discharged without any additional complications. LESSONS: Endoscopic retrograde cholangiopancreatography endoscopists must always be cautious of the possibility of stent migration in patients with biliary stents in situ. In cases of biliary stent dislocation from the common bile duct in asymptomatic patients, follow-up with serial, plain abdominal radiographs, and physical examination is needed until confirmation of spontaneous passage through stool. In symptomatic cases suggesting peritonitis, abdominal computed tomography scan confirmation is needed, and early intervention should be considered.
Subject(s)
Biliary Tract Diseases/therapy , Cholangiopancreatography, Endoscopic Retrograde , Diverticulum, Colon , Intestinal Perforation , Peritonitis , Stents , Aged , Biliary Tract Diseases/complications , Biliary Tract Diseases/surgery , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Diverticulum, Colon/complications , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/etiology , Male , Peritonitis/diagnosis , Peritonitis/etiology , Stents/adverse effectsABSTRACT
ABSTRACT: Biliary complications (BC) especially stenosis and strictures are the most common complications after orthotropic liver transplantation (OLT) procedure in adult recipients. The intention of this study was analyzed BC in 273 patients after OLT for the last 4 years in our department.Retrospective study of 273 patients underwent cadaveric donor liver transplantation between January 2014 and December 2017. Most of them (nâ=â268) have anastomosed bile duct in end to end, rest of them (nâ=â5) underwent hepaticojejunostomy. Statistical analysis was performed using Fischer exact test and Student t test. A P value <.05 was considered significant.BC were developed in 48/273 transplants (17.6%). The most frequent was biliary stricture (nâ=â42, 87.5%) followed by bile leak (nâ=â4, 8.3%) and choledocholitiasis (nâ=â2, 4.2%). Treatment was usually using endoscopic retrograde cholangiopancreatography. Recipients with hypotension during and after OLT treated by norepinephrine have a higher index of BC.Self-expanding metal stents implantation seems to be more effective than repeated balloon dilatation of anastomotic strictures with subsequent plastic biliary stent placement and associated with similar complication rate. Good fluid management against inotropic therapy may reduce risk of BC.
Subject(s)
Biliary Tract Diseases/etiology , Liver Transplantation/adverse effects , Adolescent , Adult , Aged , Biliary Tract Diseases/pathology , Biliary Tract Diseases/therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Self Expandable Metallic Stents , Young AdultABSTRACT
The application of artificial intelligence (AI) in medicine has increased rapidly with respect to tasks including disease detection/diagnosis, risk stratification, and prognosis prediction. With recent advances in computing power and algorithms, AI has shown promise in taking advantage of vast electronic health data and imaging studies to supplement clinicians. Machine learning and deep learning are the most widely used AI methodologies for medical research and have been applied in pancreatobiliary diseases for which diagnosis and treatment selection are often complicated and require joint consideration of data from multiple sources. The aim of this review is to provide a concise introduction of the major AI methodologies and the current landscape of AI research in pancreatobiliary diseases.
Subject(s)
Artificial Intelligence , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/therapy , Pancreatic Diseases/diagnosis , Pancreatic Diseases/therapy , Deep Learning , Electronic Health Records , Forecasting , Humans , Machine Learning , Prognosis , Risk AssessmentSubject(s)
Biliary Tract Diseases/therapy , Carcinoma, Hepatocellular/therapy , Chylothorax/therapy , Embolization, Therapeutic/instrumentation , Esophageal and Gastric Varices/therapy , Liver Neoplasms/therapy , Adult , Aged , Biliary Tract Diseases/diagnostic imaging , Chylothorax/diagnostic imaging , Equipment Design , Esophageal and Gastric Varices/diagnostic imaging , Humans , Liver Neoplasms/diagnostic imaging , Male , Middle Aged , Portasystemic Shunt, Transjugular Intrahepatic , Thoracic Duct/diagnostic imaging , Treatment OutcomeABSTRACT
Besides the adverse effects associated with endoscopic retrograde cholangiopancreatography (ERCP), indirect visualization of the biliopancreatic system through fluoroscopy has limited its diagnostic and therapeutic efficacy. Direct visualization through cholangiopancreatoscopy may overcome this limitation and allow the resolution of many dilemmas related to the diagnostic and therapeutic drawbacks of ERCP. Herein, we discuss the current indications of single-operator cholangioscopy (SOC) concerning the diagnostic interventions within the biliopancreatic system. The current role of SOC in the diagnosis of pancreatobiliary stenosis, primary sclerosing cholangitis, intraductal papillary mucinous neoplasm, and pre-surgical mapping of neoplastic lesions were reviewed. There is growing data in the literature supporting the early implementation of SOC in the diagnostic algorithm of pancreatobiliary diseases. In selected cases, this could prevent diagnostic delay and reduce the risks and costs related to repeated ERCPs. This potential characterizes SOC as safety and cost-effective.
Subject(s)
Biliary Tract Diseases/pathology , Cholangiopancreatography, Endoscopic Retrograde , Pancreatic Diseases/pathology , Biliary Tract Diseases/therapy , Humans , Pancreatic Diseases/therapy , Predictive Value of Tests , Prognosis , Reproducibility of ResultsABSTRACT
Liver and biliary pathology in the neonate are rare and include a broad range of structural, neoplastic, infectious, genetic, and metabolic diseases. While most conditions present postnatally, antenatal detection is increasing given recent advances in antenatal imaging capabilities. In certain structural or obstructive liver diseases, antenatal detection now proves essential to help guide treatment and prevent morbidity. We review the epidemiology, pathophysiology, common antenatal diagnostic findings, and recommendations for surgical liver and biliary pathology in the neonate.
Subject(s)
Biliary Tract Diseases/diagnosis , Fetal Diseases/diagnosis , Infant, Newborn, Diseases/diagnosis , Liver Diseases/diagnosis , Prenatal Diagnosis , Biliary Tract Diseases/epidemiology , Biliary Tract Diseases/pathology , Biliary Tract Diseases/therapy , Female , Fetal Diseases/epidemiology , Fetal Diseases/pathology , Fetal Diseases/therapy , Humans , Infant, Newborn , Infant, Newborn, Diseases/epidemiology , Infant, Newborn, Diseases/pathology , Infant, Newborn, Diseases/therapy , Liver Diseases/epidemiology , Liver Diseases/pathology , Liver Diseases/therapy , PregnancySubject(s)
Betacoronavirus , Biliary Tract Diseases , Cholangiopancreatography, Endoscopic Retrograde/standards , Coronavirus Infections/prevention & control , Endosonography/standards , Infection Control/standards , Pancreatic Diseases , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Biliary Tract Diseases/complications , Biliary Tract Diseases/diagnostic imaging , Biliary Tract Diseases/therapy , COVID-19 , Cholangiopancreatography, Endoscopic Retrograde/methods , Coronavirus Infections/complications , Coronavirus Infections/transmission , Endosonography/methods , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Informed Consent/standards , Pancreatic Diseases/complications , Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , SARS-CoV-2 , United StatesSubject(s)
Coronavirus Infections , Digestive System Diseases/therapy , Gastroenterology , Hospital Units , Pandemics , Pneumonia, Viral , Aged , Aged, 80 and over , Ambulatory Care , Betacoronavirus , Biliary Tract Diseases/epidemiology , Biliary Tract Diseases/therapy , COVID-19 , Digestive System Diseases/epidemiology , Digestive System Neoplasms/epidemiology , Digestive System Neoplasms/therapy , Emergency Service, Hospital , Female , Gastrointestinal Hemorrhage/epidemiology , Gastrointestinal Hemorrhage/therapy , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Italy/epidemiology , Liver Diseases/epidemiology , Liver Diseases/therapy , Male , Middle Aged , Pancreatic Diseases/epidemiology , Pancreatic Diseases/therapy , Patient Transfer , Referral and Consultation , SARS-CoV-2 , Severity of Illness IndexABSTRACT
BACKGROUND: Biliary diseases are common digestive system disorders which may combine with biliary tract infection such as cholecystitis or cholangitis. Thus, rapid identification of the bacteria and their antibiotic susceptibility profiles are crucial for reducing the mortality of patients with biliary tract infection. AIM: To identify bacterial species and antibiotic susceptibility for antibacterial therapy and analyze bile cultivation risk factors for increasing detection rates. METHODS: This retrospective study was conducted from July 2008 to July 2017. In total, 1339 bile samples which were collected during therapeutic endoscopic retrograde cholangiopan-creatography or percutaneous transhepatic cholangiodrainage or other biliary surgeries or biliary drainage were obtained to characterize pathogen spectra, antibiotic susceptibility, and clinical features. Clinical data including age, sex, comorbidities, clinical symptoms, protopathies, and history of biliary tract diseases and surgeries were collated from hospital medical records. Species identification and initial drug susceptibility were further identiï¬ed by biochemical characterization using the VITEK 2 Compact test. RESULTS: Positive microbiological findings were observed in 738 samples. The most frequently encountered strains were gram-negative bacteria (74.94%), including Escherichia coli (37.78%), Pseudomonas aeruginosa (8.96%), and Klebsiella pneumoniae (10.29%). Bile bacteria were largely sensitive to carbapenems, piperacillin/tazobactam, and gentamicin. Gram-negative strains had low susceptibility to ceftriaxone, quinolones and ampicillin. Almost the same micro-organisms were present in patients with malignant and benign diseases. The number of samples with Klebsiella pneumoniae in the bile culture were significantly different between patients with malignant and benign diseases (55 vs 30; P = 0.019). Age (P < 0.001), fever (P < 0.001), history of biliary tract diseases and surgeries (both P < 0.001), benign disease (P = 0.002), and the comorbidity chronic renal insufficiency (P = 0.007) affected the positive rates of the bile samples. CONCLUSION: Gram-negative bacteria were the most commonly isolated biliary bacteria. We determined the major factors associated with positive detection rates. Microbiological analysis of bile samples allowed accurate antibiotic treatments.
Subject(s)
Anti-Bacterial Agents/pharmacology , Bile/microbiology , Biliary Tract Diseases/diagnosis , Fever/epidemiology , Renal Insufficiency, Chronic/epidemiology , Age Factors , Aged , Anti-Bacterial Agents/therapeutic use , Bacterial Typing Techniques , Biliary Tract Diseases/complications , Biliary Tract Diseases/microbiology , Biliary Tract Diseases/therapy , Cholangiopancreatography, Endoscopic Retrograde , Comorbidity , Drainage , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Female , Fever/microbiology , Fever/therapy , Humans , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/isolation & purification , Male , Microbial Sensitivity Tests , Middle Aged , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/isolation & purification , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND AND OBJECTIVE: Acute pancreatitis is one of the most common gastrointestinal conditions requiring hospitalization. Even though its presentation during pregnancy is uncommon, it is a medical challenge. Currently, no studies compare the clinical outcomes between pregnant patients with acute pancreatitis and nonpregnant patients with acute pancreatitis. Our aim was to compare the characteristics and clinical outcomes of pregnant and nonpregnant women with acute pancreatitis. METHODS: We conducted a retrospective study that included all patients admitted to our hospital with acute pancreatitis over a 10-year period. Demographics, general characteristics, and clinical outcomes were evaluated and compared between pregnant and nonpregnant women with acute pancreatitis, at a ratio of 1:5. RESULTS: Over 10 years, 27 pregnant patients with acute pancreatitis were treated. Etiology was biliary in 96% and hypertriglyceridemia was the cause in 3.4% (1 patient). The mean patient age was 26.2 years (range 15-36 years). The main cause of acute pancreatitis was biliary disease (96%). Patients in the study group were in their first, second, or third trimester of pregnancy, at 7.4%, 33.3%, and 59.3%, respectively. In the comparison of pregnant versus nonpregnant patients with acute pancreatitis, there were no differences in age, hospital stay (7.37 vs. 10.8, P=.814), severity (severe 3.7% vs. 16.7%, P=.79), local complications (0% vs. 1.9%, P=.476), or mortality (0% vs. 1.9%, P=.476). CONCLUSIONS: The clinical evolution of both groups with biliary acute pancreatitis was similar, with low morbidity and mortality.