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1.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370996

RESUMO

An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode of acute cholecystitis complicated by a perforated gallbladder for which she had declined surgery 5 years prior. Radiological imaging confirmed a large gallstone impacted in the first part of the duodenum with gross gastric outlet obstruction and pneumobilia, confirming the diagnosis of Bouveret syndrome, an often overlooked and rare variant of gallstone ileus. Following an unsuccessful oesophagogastroduodenoscopy for stone retrieval, she underwent a laparotomy and gastrotomy with a successful outcome and discharged from hospital 4 weeks following the procedure.


Assuntos
Obstrução Duodenal/diagnóstico , Cálculos Biliares/complicações , Obstrução da Saída Gástrica/diagnóstico , Íleus/diagnóstico , Idoso de 80 Anos ou mais , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Endoscopia do Sistema Digestório , Feminino , Vesícula Biliar/diagnóstico por imagem , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Íleus/etiologia , Íleus/cirurgia , Estômago/diagnóstico por imagem , Estômago/cirurgia , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
3.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 55(3): 169-172, mayo-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196165

RESUMO

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


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Cálculos Biliares/diagnóstico , Doenças do Íleo/cirurgia , Obstrução Intestinal/etiologia , Doenças do Íleo/complicações , Cálculos Biliares/complicações , Tomografia Computadorizada por Raios X , Ultrassonografia , Dor Abdominal/etiologia
4.
BMC Surg ; 20(1): 92, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375832

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is essential for managing biliary and pancreatic disorders. Infection is the most morbid complication of ERCP and among the most common causes of ERCP-related death. CASE PRESENTATION: A 69-year-old man presented with right upper quadrant abdominal pain, obstructive jaundice and abnormal liver function tests. Ultrasound revealed cholelithiasis without bile duct dilation. After receiving intravenous antibiotics for acute cholecystitis, the patient was discharged. Two weeks later, an endoscopic ultrasound demonstrated gallstones and CBD dilation of up to 6.4 mm with 2 filling defects. An ERCP was performed with a papillotomy and stone extraction. Twenty-four hours post-ERCP the patient developed a fever, chills, bilirubinemia and elevated liver function tests. Ascending cholangitis was empirically treated using Ceftriaxone and Metronidazole. However, the patient remained febrile, with a diffusely tender abdomen and elevated inflammatory markers. A CT revealed a very small hypodense lesion in the seventh liver segment. Extended-spectrum beta-lactamase positive Klebsiella Pneumonia and Enterococcus Hirae were identified, and the antibiotics were switched to Imipenem and Cilastatin. The hypodense lesion in the liver increased to 1.85 cm and a new hypodense lesion was seen in the right psoas. At day 10 post-ERCP, the patient started having low back pain and difficulty walking. MRI revealed L4-L5 discitis with a large epidural abscess, spanning L1-S1 and compressing the spinal cord. Decompressive laminectomy of L5 was done and Klebsiella pneumonia was identified. Due to continued drainage from the wound, high fever, we performed a total body CT which revealed increased liver and iliopsoas abscess. Decompressive laminectomy was expanded to include L2-L4 and multiple irrigations were done. Gentamycin and Vancomycin containing polymethylmethacrylate beads were implanted locally and drainage catheters were placed before wound closure. Multidisciplinary panel discussion was performed, and it was decided to continue with a non invasive approach . CONCLUSIONS: Early recognition of complications and individualized therapy by a multi-disciplined team is important for managing post-ERCP septic complications. Particular attention should be given to adequate coverage by empiric antibiotics.


Assuntos
Abscesso/etiologia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangite/diagnóstico , Idoso , Endossonografia , Cálculos Biliares/diagnóstico , Humanos , Icterícia Obstrutiva/etiologia , Imagem por Ressonância Magnética , Masculino , Ultrassonografia
5.
Dtsch Arztebl Int ; 117(9): 148-158, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32234195

RESUMO

BACKGROUND: Gallstone disease affects up to 20% of the European population, and cholelithiasis is the most common reason for hospitalization in gastroenterology. METHODS: This review is based on pertinent publications retrieved by a selective search of the literature, including the German clinical practice guidelines on the diagnosis and treatment of gallstones and corresponding guidelines from abroad. RESULTS: Regular physical activity and an appropriate diet are the most important measures for the prevention of gallstone disease. Transcutaneous ultrasonography is the paramount method of diagnosing gallstones. Endoscopic retrograde cholangiography should only be carried out as part of a planned therapeutic intervention; endosonography beforehand lessens the number of endoscopic retrograde cholangiographies that need to be performed. Cholecystectomy is indicated for patients with symptomatic gallstones or sludge. This should be performed laparoscopically with a four-trocar technique, if possible. Routine perioperative antibiotic prophylaxis is not necessary. Cholecystectomy can be performed in any trimester of pregnancy, if urgently indicated. Acute cholecystitis is an indication for early laparoscopic cholecystectomy within 24 hours of admission to hospital. After successful endoscopic clearance of the biliary pathway, patients who also have cholelithiasis should undergo laparoscopic cholecystectomy within 72 hours. CONCLUSION: The timing of treatment for gallstone disease is an essential determinant of therapeutic success.


Assuntos
Cálculos Biliares/terapia , Cálculos Biliares/diagnóstico , Humanos , Guias de Prática Clínica como Assunto , Fatores de Tempo , Resultado do Tratamento
8.
Afr Health Sci ; 20(1): 383-391, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33402926

RESUMO

Background: Gallstone disease (GSD) is the most prevalent medical condition in the pancreatobiliary system. The burden of GSD and its complications are major public health issues globally. It is a common cause of surgical intervention, contributing substantially to health care costs. Most patients are asymptomatic, however 20% become symptomatic after 10 years. Its prevalence differs among populations and remains unknown in Uganda. Objective: To determine the prevalence and risk factors of GSD in patients undergoing abdominal ultrasonography at Mulago hospital, Uganda. Methods: This was a cross-sectional study at the Department of Radiology in Mulago hospital. Convenient sampling was used to recruit individuals having an abdominal ultrasound scan. Questionnaires were used to assess risk factors, and an abdominal exam was performed for individuals with gallstones to assess symptomatology. Results: The prevalence of GSD was 22%. Statistically significant factors associated with GSD were a history of hormonal contraceptive use OR 3.2 (1.88-5.41) and a history of previous biliary symptoms OR 2.9 (1.68-4.91). Ninety-four percent of individuals with gallstones had epigastric/right upper quadrant pain. Conclusion: The prevalence of GSD is high in Mulago hospital; use of hormonal contraceptives and a previous history of biliary symptoms were significant risk factors for GSD in this study. Majority of patients with GSD were symptomatic with epigastric pain as the cardinal symptom. We recommend a countrywide screening program using abdominal ultrasonography to determine the prevalence of GSD in the general population. There is need to study further the risk of hormonal contraceptive use and GSD. Women on these contraceptives should be informed of the potential risk, and offered alternative options where feasible.


Assuntos
Dor Abdominal/diagnóstico por imagem , Cálculos Biliares/diagnóstico , Cálculos Biliares/epidemiologia , Ultrassonografia/métodos , Dor Abdominal/etiologia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Estudos Transversais , Feminino , Cálculos Biliares/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Inquéritos e Questionários , Uganda/epidemiologia , Adulto Jovem
9.
Surg Laparosc Endosc Percutan Tech ; 29(6): 503-508, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31800398

RESUMO

PURPOSE: Few authors have studied applying the laparoscopic approach in patients with previous upper abdominal operations, but no comparison has been made between laparoscopic and open approaches in patients with previous upper abdominal operations. This article aims to introduce surgical techniques and details in treatment to surgeons specialized in minimally invasive surgery. MATERIALS AND METHODS: From January 2010 to January 2018, 460 eligible patients were divided into 3 groups and analyzed retrospectively. Group A: patients with a history of upper abdominal operations who underwent laparoscopy (n=124); group B: patients without a history of upper abdominal operations who underwent laparoscopy (n=140); and group C: patients with a history of upper abdominal operations who underwent an open operation (n=196). Group A was the experimental group; groups B and C served as the control groups. RESULTS: No significant difference was found between groups A and B. Significant differences were found between groups A and C in estimated blood loss (258.3±67.2 vs. 424.7±103.7 mL, P<0.001), postoperative hospitalization (5.7±2.3 vs. 10.2±3.1 d, P<0.001), and postoperative complications (16.1% vs. 42.9%, P=0.013). The final rate of stones clearance was 100% in 3 groups. The total rate of stone recurrence was 7.8%. CONCLUSIONS: Laparoscopy with certain surgical techniques was feasible, effective, and advantageous for patients with previous upper abdominal operations by experienced surgeons. It is necessary for surgeons to have advanced skills and surgical techniques to achieve a successful laparoscopy.


Assuntos
Abdome/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/métodos , Ducto Colédoco/cirurgia , Cálculos Biliares/cirurgia , Ducto Colédoco/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Seguimentos , Cálculos Biliares/diagnóstico , Humanos , Laparoscopia , Laparotomia , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
10.
Scand J Gastroenterol ; 54(10): 1269-1273, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31553628

RESUMO

Objective: Hepatitis E virus (HEV) genotype 3 is endemic in Northern Europe and despite a high seroprevalence of anti-HEV IgG antibodies among blood donors (≈17%), few clinical cases are notified in Sweden. Low awareness of hepatitis E and its possible symptoms may contribute to this discrepancy. The aim of this study was to investigate the prevalence of acute HEV infection among hospital admitted patients with abdominal pain and elevated liver enzymes.Materials and methods: During 2016-2017, 148 adult patients with serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > twice normal levels were prospectively enrolled at surgical wards at three Swedish hospitals. Serum samples were analyzed for HEV RNA as well as anti-HEV IgM and IgG, and medical records were reviewed.Results: Six (6/148, 4.1%) patients were HEV infected confirmed by detectable HEV RNA, but only one of these patients had detectable anti-HEV antibodies. Four of the HEV infected patients were diagnosed with gallstone-related disease: three with biliary pancreatitis and one with biliary colic. The remaining two were diagnosed with bowel obstruction and pancreatic malignancy. Four HEV strains were typed by sequencing to genotype 3.Conclusions: This study identified acute HEV3 infection in 4% of the patients with elevated liver enzymes admitted to a surgical ward. HEV infection was not the solitary disease leading to hospitalization, instead it was found to be associated with other surgical conditions such as gallstone-related disease including biliary pancreatitis. Additionally, HEV RNA might be the preferential diagnostic tool for detecting ongoing HEV infection.


Assuntos
Cólica/virologia , Cálculos Biliares/virologia , Genótipo , Vírus da Hepatite E/genética , Hepatite E/diagnóstico , Pancreatite/virologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cólica/diagnóstico , Feminino , Seguimentos , Cálculos Biliares/diagnóstico , Hepatite E/complicações , Hepatite E/epidemiologia , Hepatite E/virologia , Vírus da Hepatite E/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Prevalência , Estudos Prospectivos , RNA Viral/análise , Suécia , Adulto Jovem
11.
Medicina (Kaunas) ; 55(9)2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31533295

RESUMO

Background: Gallstone or biliary ileus is a late complication of gallstone disease. It accounts for 1%-4% of all bowel obstructions and is more common in elderly patients. The preferred treatment option is to mechanically remove the impacted stones. It is done surgically using open or laparoscopic approach and rarely, when stones are impacted in the colon, endoscopically. In this paper we present five consecutive cases of gallstone ileus and describe possible diagnostic and minimally invasive treatment options. Case presentation: During a five-month period a total of five patients were treated for gallstone ileus. All patients were female and from 48 to 87 years of age. Symptoms were not specific and common for all small bowel obstructions. Upon admission the patients also had unspecific laboratory findings-neutrophilic leukocytosis and various C-reactive protein concentrations, ranging from 8 to 347 mg/L. According to the hospital protocol, all patients initially underwent an abdominal ultrasound, which was inconclusive, and therefore every patient additionally had a CT scan with intravenous contrast. After these two diagnostic modalities one patient still did not have the definitive gallstone ileus diagnosis, as the ectopic stone was not visible. Four patients in our case series were treated using minimally invasive methods: in one case the stone was removed endoscopically, and laparoscopically in the other three. Treatment outcomes were good in four cases as the patients fully recovered, however one patient suffered a massive cerebral infarction after the operation and passed away. Conclusions: Gallstone ileus is a rare and difficult-to-diagnose condition. Management of these patients in every case should be individualized, as there are many options, each with their own advantages and disadvantages. We show that minimally invasive treatment such as colonoscopy or laparoscopy is possible in these cases.


Assuntos
Cálculos Biliares/complicações , Íleus/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Cálculos Biliares/diagnóstico , Cálculos Biliares/terapia , Humanos , Íleus/diagnóstico , Íleus/terapia , Laparoscopia/métodos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
12.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31473637

RESUMO

Gallstone ileus and small bowel diverticulosis are uncommon pathologies. However, the simultaneous presentation of both in this patient provided a diagnostic puzzle for the surgical and radiological teams at our institution. The imaging also demonstrated several typical features for the pathologies in question. Ultimately the management of the patient was not compromised by the diagnostic dilemma, but the imaging findings represent a useful learning opportunity for all radiologists and general surgeons.


Assuntos
Dor Abdominal/diagnóstico , Cálculos Biliares/diagnóstico , Hérnia Inguinal/diagnóstico , Íleus/diagnóstico , Enteropatias/diagnóstico , Dor Abdominal/etiologia , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Enfisema/complicações , Enfisema/diagnóstico , Cálculos Biliares/complicações , Hérnia Inguinal/complicações , Humanos , Íleus/complicações , Enteropatias/complicações , Masculino
13.
Rev. esp. enferm. dig ; 111(9): 667-671, sept. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-190349

RESUMO

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


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Colecistectomia/métodos , Colecistite/cirurgia , Cálculos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Atenção Terciária à Saúde/métodos , Estudos Retrospectivos , Doença Aguda , Colecistite/diagnóstico , Cálculos Biliares/diagnóstico , Resultado do Tratamento , Recidiva
14.
BMC Gastroenterol ; 19(1): 135, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349795

RESUMO

BACKGROUND: This study aims to evaluate the efficacy and safety of detecting and removing residual common bile duct stones (CBDS) using direct peroralcholangioscopy (DPOC) after performing endoscopic retrograde cholangiopancreatography (ERCP) for stone retrieval. METHODS: From January 5, 2017 to December 27, 2017, a total of 164 cases of choledocholithiasis were treated by ERCP for stone retrieval. According to the inclusion and exclusion criteria, the remaining 79 cases (39 males; mean age: 63.3 years old, range: 52-79 years old) were enrolled in the present study. The maximum transverse stone diameter was 6-15 mm (12.7 ± 4.2 mm), as determined by ERCP. Furthermore, there were 57 cases of multiple stones (number of stones: two in 41 cases, three in nine cases, and ≥ 4 in seven cases), 13 cases of post-mechanical lithotripsy, and nine cases of broken stones. RESULTS: The overall success rate of DPOC was 94.9% (75/79). Furthermore, 18.7%(14/75) of cases were directly inserted, 72%(54/75) of cases required guide wire assistance, and 9.3%(7/75) of cases were successfully inserted with overtube assistance. The average insertion time was 7-17 min (4.9 ± 2.9 min). Residual stones were detected in 19 cases (25.3%), and all of which were < 5 mm in diameter. Moreover, five cases of formed stones were removed by basket and balloon catheter, while the remaining cases were cleaned after irrigation and suction. There were no serious complications. CONCLUSION: DPOC is safe and effective for both the detection and removal of residual CBDS after conventional ERCP.


Assuntos
Coledocolitíase/diagnóstico , Coledocolitíase/cirurgia , Endoscopia do Sistema Digestório , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Surg Endosc ; 33(9): 3050-3055, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31321534

RESUMO

BACKGROUND AND AIMS: Cholelithiasis is the most common biliary tract disorder. Surgery is the treatment of choice for symptomatic gallstones. Aims of this study were to investigate the feasibility and short-term safety of a new endoscopic procedure with a specially designed Nitinol gallbladder stent for blockage of gallstone migration, the Shai™ Stent. The Shai stent is designed to enable free bile flow, which will be supposed to prevent recurrent attacks. METHODS: The Shai™ Stent was inserted into the gallbladder during a standard ERCP procedure using a conventional metal stent delivery system. The aim of the present study was to investigate the feasibility and safety of insertion and deployment and removal of the stent into the gallbladder of pigs. In addition, the short-term safety of the stent was evaluated. RESULTS: Fifteen stents were placed in the gallbladder of 15 pigs. Mean procedure time was 25 min (15-37). The maximum follow-up before sacrifice was 42 days. The stent in 1 pig had migrated at the 42 days follow-up but there were no macroscopic changes in its gallbladder or other organs. The stent remained in place in the remaining 12 pigs at autopsy, and the gallbladder and bile ducts were macroscopically normal. Stent removal was easily done in two pigs immediately after placement. CONCLUSIONS: Correct placement and removal of the Shai™ Stent in the gallbladder is safe and feasible in pigs. Further clinical trials are warranted to confirm these results and to effectively evaluate the capability of this stent as an innovative biotechnology to block gallstones from migration and impaction.


Assuntos
Ductos Biliares/cirurgia , Cálculos Biliares/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Stents , Animais , Colangiopancreatografia Retrógrada Endoscópica/métodos , Modelos Animais de Doenças , Estudos de Viabilidade , Seguimentos , Cálculos Biliares/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Desenho de Prótese , Estudos Retrospectivos , Suínos , Fatores de Tempo
16.
BMJ Open ; 9(7): e025551, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31289058

RESUMO

INTRODUCTION: According to the literature, early cholecystectomy is necessary to avoid complications related to gallstones after an initial episode of acute biliary pancreatitis (ABP). A randomised, controlled multicentre trial (the PONCHO trial) revealed that in the case of gallstone-induced pancreatitis, early cholecystectomy was safe in patients with mild gallstone pancreatitis and reduced the risk of recurrent gallstone-related complications, as compared with interval cholecystectomy. We hypothesise that carrying out a sphincterotomy (ES) allows us to delay cholecystectomy, thus making it logistically easier to perform and potentially increasing the efficacy and safety of the procedure. METHODS/DESIGN: EMILY is a prospective, randomised, controlled multicentre trial. All patients with mild ABP, who underwent ES during the index admission or in the medical history will be informed to take part in EMILY study. The patients will be randomised into two groups: (1) early cholecystectomy (within 6 days after discharge) and (2) patients with delayed (interval) cholecystectomy (between 45 and 60 days after discharge). During a 12-month period, 93 patients will be enrolled from participating clinics. The primary endpoint is a composite endpoint of mortality and recurrent acute biliary events (that is, recurrent ABP, acute cholecystitis, uncomplicated biliary colic and cholangitis). The secondary endpoints are organ failure, biliary leakage, technical difficulty of the cholecystectomy, surgical and other complications. ETHICS AND DISSEMINATION: The trial has been registered internationally ISRCTN 10667869, and approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (EKU/2018/12176-5). TRIAL REGISTRATION NUMBER: ISCRTN 10667869; Pre-results.


Assuntos
Colecistite Aguda/diagnóstico , Cálculos Biliares/diagnóstico , Pancreatite/diagnóstico , Esfinterotomia Endoscópica , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Colecistite Aguda/complicações , Feminino , Cálculos Biliares/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Pancreatite/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Esfinterotomia Endoscópica/métodos , Fatores de Tempo
17.
Endoscopy ; 51(10): 922-929, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31250408

RESUMO

BACKGROUND: Peroral cholangioscopy (POCS) can be useful for difficult bile duct stone clearance. Large prospective multinational data on POCS-guided lithotripsy for clearing difficult bile duct stones in a single session of endoscopic retrograde cholangiopancreatography (ERCP) are missing. METHODS: Patients with difficult bile duct stones (defined as one or more of: largest stone diameter ≥ 15 mm, failed prior attempt at stone clearance, impacted, multiple, hepatic duct location, or located above a stricture) were enrolled at 17 centers in 10 countries. The principal endpoint was stone clearance in a single ERCP procedure using POCS. RESULTS : 156 patients underwent 174 sessions of POCS-guided electrohydraulic or laser lithotripsy. Stone clearance had failed in a previous ERCP using traditional techniques in 124/156 patients (80 %), while 32 /156 patients (21 %) were referred directly to POCS-guided therapy based on preprocedural assessment of the difficulty of stone clearance. In 101/156 patients (65 %), there were impacted stones. POCS-guided stone clearance was achieved in a single POCS procedure in 125 /156 patients (80 %, 95 % confidence interval [CI] 73 % - 86 %), and was significantly more likely for stones ≤ 30 mm compared with > 30 mm (odds ratio 7.9, 95 %CI 2.4 - 26.2; P = 0.002). Serious adverse events occurred in 3/156 patients (1.9 %, 95 %CI 0.4 % - 5.5 %), and included pancreatitis, perforation due to laser lithotripsy, and cholangitis (n = 1 each), all resolved within 1 week. CONCLUSION: POCS-guided lithotripsy is highly effective for clearance of difficult bile duct stones in a single procedure and successfully salvages most prior treatment failures. It may also be considered first-line therapy for patients with difficult choledocholithiasis to avoid serial procedures.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Cálculos Biliares/cirurgia , Litotripsia/métodos , Cirurgia Endoscópica por Orifício Natural , Idoso , Feminino , Cálculos Biliares/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento
18.
Am J Gastroenterol ; 114(8): 1322-1342, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31205135

RESUMO

INTRODUCTION: Detailed recommendations and guidelines for acute pancreatitis (AP) management currently exist. However, quality indicators (QIs) are required to measure performance in health care. The goal of the Acute Pancreatitis Task Force on Quality was to formally develop QIs for the management of patients with known or suspected AP using a modified version of the RAND/UCLA Appropriateness Methodology. METHODS: A multidisciplinary expert panel composed of physicians (gastroenterologists, hospitalists, and surgeons) who are acknowledged leaders in their specialties and who represent geographic and practice setting diversity was convened. A literature review was conducted, and a list of proposed QIs was developed. In 3 rounds, panelists reviewed literature, modified QIs, and rated them on the basis of scientific evidence, bias, interpretability, validity, necessity, and proposed performance targets. RESULTS: Supporting literature and a list of 71 proposed QIs across 10 AP domains (Diagnosis, Etiology, Initial Assessment and Risk Stratification, etc.) were sent to the expert panel to review and independently rate in round 1 (95% of panelists participated). Based on a round 2 face-to-face discussion of QIs (75% participation), 41 QIs were classified as valid. During round 3 (90% participation), panelists rated the 41 valid QIs for necessity and proposed performance thresholds. The final classification determined that 40 QIs were both valid and necessary. DISCUSSION: Hospitals and providers managing patients with known or suspected AP should ensure that patients receive high-quality care and desired outcomes according to current evidence-based best practices. This physician-led initiative formally developed 40 QIs and performance threshold targets for AP management. Validated QIs provide a dependable quantitative framework for health systems to monitor the quality of care provided to patients with known or suspected AP.


Assuntos
Pancreatite/diagnóstico , Pancreatite/terapia , Indicadores de Qualidade em Assistência à Saúde , Comitês Consultivos , Analgésicos/uso terapêutico , Antibacterianos/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Consenso , Técnica Delfos , Gerenciamento Clínico , Drenagem , Hidratação , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico , Cálculos Biliares/terapia , Gastroenterologistas , Médicos Hospitalares , Humanos , Apoio Nutricional , Manejo da Dor , Pancreatite/etiologia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/etiologia , Pancreatite Necrosante Aguda/terapia , Reprodutibilidade dos Testes , Medição de Risco , Cirurgiões
19.
Postgrad Med J ; 95(1124): 328-333, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31123175

RESUMO

Acute pancreatitis (AP) accounts for over 230 000 US and 28 000 UK hospital admissions annually. Abdominal pain is the most common presenting symptom in AP but may not reflect severity. The clinical challenge is identifying the 20% of patients in whom AP will be severe. We summarise the common aetiologies, the risk stratification strategies including the simplified Bedside Index for Severity in Acute Pancreatitis, acute management approaches in the initial presentation setting, conditions for using advance imaging and opinions on antibiotic use. Some warning signs of impending complications are also discussed.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Nutrição Enteral , Hidratação , Pancreatite/terapia , Dor Abdominal/etiologia , Doença Aguda , Amilases/metabolismo , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico , Humanos , Lipase/metabolismo , Pancreatite/diagnóstico , Pancreatite/etiologia , Pancreatite Alcoólica/diagnóstico , Pancreatite Alcoólica/terapia , Índice de Gravidade de Doença
20.
Int J Lab Hematol ; 41 Suppl 1: 95-101, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31069991

RESUMO

Hereditary hemolytic anemia (HHA) is a group of genetically and phenotypically heterogeneous disorders characterized by premature destruction of red blood cells (RBCs) with clinical manifestations ranging from asymptomatic to marked hemolytic anemia. There are three main categories of HHA: (a) RBC membrane defects; (b) hemoglobinopathies/thalassemias; and (c) RBC enzyme deficiencies. Hyperbilirubinemia is a frequent consequence of hemolytic anemia and can lead to bilirubin-associated neurotoxicity in neonates and to jaundice, and formation of gall stones in adults. Hyperbilirubinemia can also be caused by impaired bilirubin conjugation due to polymorphisms and mutations in genes involved in bilirubin metabolism (eg, UGT1A1). Neonates with HHA and co-inherited variants impairing bilirubin conjugation are at increased risk of bilirubin-associated toxicity. Prior to the advent of next-generation sequencing (NGS), molecular diagnosis of these disorders was limited to targeted single gene Sanger sequencing. However, NGS is making its way into the standard diagnostic workup of complex and multigene disorders like HHA. This review will focus on the molecular updates of HHA with particular focus on the neonatal and pediatric population.


Assuntos
Anemia Hemolítica Congênita , Hiperbilirrubinemia Neonatal , Adulto , Anemia Hemolítica Congênita/sangue , Anemia Hemolítica Congênita/diagnóstico , Anemia Hemolítica Congênita/genética , Membrana Eritrocítica/genética , Membrana Eritrocítica/metabolismo , Feminino , Cálculos Biliares/sangue , Cálculos Biliares/diagnóstico , Cálculos Biliares/genética , Glucuronosiltransferase/genética , Glucuronosiltransferase/metabolismo , Humanos , Hiperbilirrubinemia/sangue , Hiperbilirrubinemia/diagnóstico , Hiperbilirrubinemia/genética , Hiperbilirrubinemia Neonatal/sangue , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/genética , Recém-Nascido , Masculino , Mutação , Patologia Molecular
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