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1.
Medicine (Baltimore) ; 99(11): e19545, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176109

RESUMO

To compare the diagnostic performance of percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography for the pathological assessment of suspected malignant bile duct stricture, using brush cytology and forceps biopsy.The study group comprised 79 consecutive patients who underwent pathological assessment for suspected malignant biliary stricture, 38 of whom underwent percutaneous transhepatic cholangiography (group A) and the other 41 underwent endoscopic retrograde cholangiography (group B). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. A subset analysis was performed to determine the effect of location and pathological type of the stricture on diagnostic performance, and complications were analyzed.The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.7%, 100%, 100%, 66.7%, and 89.5%, respectively, in group A, and 77.1%, 100%, 100%, 42.9%, and 80.4%, respectively, in group B. For hilar biliary strictures, the sensitivity and accuracy were superior in group A than in group B. Mild complications (transient c and bile leakage) were identified in 7 cases in each group, all resolved spontaneously within 3 to 5 days.Both brush cytology and forceps biopsy performed during percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography provided good diagnostic sensitivity and accuracy. Therefore, both diagnostic approaches can play an important role in planning therapeutic strategy. However, for strictures located at the hilum, pathology sampling via percutaneous transhepatic cholangiography is preferable to endoscopic retrograde cholangiography, as it provides higher sensitivity and accuracy.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/diagnóstico , Colangiografia , Idoso , Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/patologia , Colangiopancreatografia Retrógrada Endoscópica , Constrição Patológica/diagnóstico , Feminino , Humanos , Masculino , Sensibilidade e Especificidade
2.
Medicine (Baltimore) ; 99(3): e18855, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011505

RESUMO

RATIONALE: Prolonged cholestasis is a rare complication associated with endoscopic retrograde cholangiopancreatography (ERCP). PATIENT CONCERNS: A 68-year-old man who presented with worsening cholestasis after ERCP for the removal of a common bile duct stone. DIAGNOSIS: Total bilirubin increased up to 35.2 mg/dL after the 21st day post-ERCP. A percutaneous liver biopsy was performed and drug-related cholestasis was suspected as occurring as a result of the contrast agent. INTERVENTIONS: Oral ursodeoxycholic acid and cholestyramine were prescribed to the patient. OUTCOMES: By the 7th week post-ERCP, the patient's symptoms and markers of physiological health began to resolve. The bilirubin returned to normal levels on the 106th day post-ERCP. We reviewed the literature for studies of 9 patients with jaundice more than 30 days post-ERCP, the peak of total serum bilirubin occurred on 16th ±â€Š7th days and the recovery followed after mean time of 54th ±â€Š22th days. LESSONS: Although the cholestasis was prolonged, the outcome was favorable after medical therapy. There were no long-term consequences for the patient.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colestase/induzido quimicamente , Meios de Contraste/efeitos adversos , Idoso , Colagogos e Coleréticos/uso terapêutico , Colestase/tratamento farmacológico , Resina de Colestiramina/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Ácido Ursodesoxicólico/uso terapêutico
5.
Artigo em Japonês | MEDLINE | ID: mdl-31956187

RESUMO

It is important to reduce the dose received by medical staffs. The purpose of this study was to evaluate the effect of protective curtain and the property of small optically stimulated luminescence (OSL) dosimeters used for ambient dose measurement in fluoroscopy. The property of small OSL dosimeters was investigated in terms of uniformity, changing fluoroscopy time and polymethyl methacrylate (PMMA) thickness, and angular dependence. Paper pipes were assembled in glid shape and ambient dose was investigated by using small OSL dosimeters that were put on them with and without protective curtain. Air kerma was investigated by small OSL dosimeters that were put on a head phantom at the position of eyes. Dose response of small OSL dosimeters was independent of fluoroscopy time and PMMA thickness, so it is appropriate to measure ambient dose by small OSL dosimeters. In relation to ambient dose, there was significant difference with and without protective curtain (p<0.001, paired-t-test). These air kerma on the head phantom were reduced to approximately 20% by attaching protective curtain. In order to reduce the dose received by operators, it is desirable to use protective curtain.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Doses de Radiação , Exposição à Radiação , Proteção Radiológica , Humanos , Equipamentos de Proteção
6.
Khirurgiia (Mosk) ; (1): 33-39, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994497

RESUMO

OBJECTIVE: To evaluate the results of stenting of the main pancreatic duct for acute post-manipulation pancreatitis. MATERIAL AND METHODS: There were 946 transpapillary interventions within 5-year period. Various risk factors of this complication and the role of stenting of the main pancreatic duct for prevention of acute post-manipulation pancreatitis were analyzed for the same period. Complication was predicted only in some cases. There were 10 patients with unpredicted acute pancreatitis for this period. In all cases, an attempt of stenting of the main pancreatic duct was made in the first hours after development of complication. Stenting was successful in 7 cases. Technical success of operation was 70%. Stenting was followed by clinical improvement and pain relief. RESULTS: The course of acute post-manipulation pancreatitis is milder in patients who underwent pancreatic stenting. There were no cases of purulent-necrotic complications in these patients (n=7). At the same time, 2 cases of pancreatic necrosis were observed in the control group. One patient died among those who did not undergo stenting of the pancreatic duct. CONCLUSION: Stenting of the main pancreatic duct is effective in patients with acute post-manipulation pancreatitis. The course of acute post-manipulation pancreatitis is milder in patients who underwent pancreatic stenting. Significant clinical improvement is observed the next day after stenting. Stenting of the pancreatic duct should be carefully considered early after development of complication.


Assuntos
Ductos Pancreáticos/cirurgia , Pancreatite/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Humanos , Pancreatite/etiologia , Implantação de Prótese , Stents , Fatores de Tempo
7.
Medicine (Baltimore) ; 99(1): e18536, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895789

RESUMO

It remains challenging for endoscopists to manage pancreaticobiliary diseases in patients with ectopic papilla of Vater by endoscopic retrograde cholangiopancreatography (ERCP). The present study sought to evaluate the efficacy and safety of ERCP for this issue.Consecutive patients with ectopic papilla of Vater who underwent initial ERCP due to pancreaticobiliary diseases were retrospectively analyzed.One hundred seven patients with ectopic papilla of Vater were included. The success rate of cannulation was 83.2%. Endoscopic sphincterotomy, endoscopic papillary balloon dilation, and mechanical lithotripsy were performed in 12 (11.2%), 25 (23.4%), and 1 (0.9%) patients, respectively. The technical success rate was 83.2%; of these, endoscopic nasobiliary drainage, endoscopic retrograde biliary drainage, endoscopic retrograde pancreatic drainage, and stone extraction was conducted in 61 (57.0%), 17 (15.9%), 5 (4.7%), and 45 (42.1%) patients, respectively. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis were risk factors for stone extraction inability. Adverse events occurred in 20 (18.7%) patients, including post-ERCP pancreatitis (3.7%), hyperamylasemia (12.1%), and infection of biliary tract (2.8%); all of the adverse events were mild and alleviated by conventional therapies.ERCP is an appropriate choice for pancreaticobiliary diseases in patients with ectopic papilla of Vater due to its high efficacy and safety. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis increase difficulties for stone extraction.


Assuntos
Ampola Hepatopancreática , Doenças Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coristoma/cirurgia , Duodenopatias/cirurgia , Pancreatopatias/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Br J Radiol ; 93(1108): 20191046, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31971831

RESUMO

OBJECTIVE: To study the outcome of salvage percutaneous transhepatic biliary drainage (PTBD) in complex and technically challenging post-liver transplant (LT) biliary complications and analyse the reason for failure of endoscopic retrograde cholangiopancreatography (ERCP). METHODS AND MATERIALS: Hospital data were searched for all LT patients with biliary complications requiring salvage PTBD (upon failure of ERCP) from January 2010 to May 2017. Patients who underwent primary PTBD were excluded. Patients clinical and biochemical parameters were analysed for clinical, biochemical and imaging response, stent-free survival and the reason for ERCP failure. RESULTS: Salvage PTBD was performed in 32 patients with post-LT biliary stricture/bile leak presenting with deranged liver function in 12 (37.5%), cholangitis in 12 (37.5%) and cholangitis with cholangitic abscess in remaining 8 (25%) patients. Of 32 patients, 20 (62.5%) already had plastic biliary stent placed by ERCP, while in remaining (n = 12, 37.5%) a wire could not be negotiated across stricture by ERCP. These patients were found to have long/tortuous stricture (n = 18, 56.3%) and multiple duct disconnection at anastomosis (n = 14, 43.7%). Immediate as well as sustained (persisting for a year or more) clinical and biochemical improvement was seen in 26 (81.3%) patients, while failure of resolution of sepsis and death occurred in remaining 6 (18.8%). CONCLUSION: Salvage PTBD is an effective treatment in difficult-to-treat post-LT biliary strictures with deranged liver functions with or without cholangitis/cholangitic abscess. It can reduce graft loss with improved clinical outcome. Post-LT ductal anatomy at anastomosis is important to decide the appropriate approach (ERCP/PTBD). ADVANCES IN KNOWLEDGE: (1). PTBD as a salvage procedure in difficult anatomy or upon failure of ERCP-based intervention is effective and a good alternative strategy. (2). Postoperative surgical anatomy (type & length of stricture, number of ductanastomosis, location and graft-recipient duct alignment) is the key factor indeciding the appropriate therapeutic procedure.


Assuntos
Colangite/terapia , Colestase/terapia , Drenagem/métodos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/terapia , Terapia de Salvação/métodos , Abscesso/terapia , Adulto , Fístula Anastomótica/terapia , Colangiopancreatografia Retrógrada Endoscópica , Constrição Patológica/terapia , Drenagem/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Terapia de Salvação/estatística & dados numéricos , Stents/estatística & dados numéricos
9.
Chirurg ; 91(1): 29-36, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31691143

RESUMO

Bile leakage and postoperative bile duct strictures or anastomotic stenosis after bilioenteric anastomosis are complex surgical complications, which are associated with increased morbidity and mortality. Detailed diagnostics and sophisticated decision-making is always requiered. Complex liver surgery (redo procedures, nonanatomic resections, etc.) and surgery involving the liver hilum or exposure of the intraparenchymal Glissonean sheath are risk factors for postoperative bile leakage. Bile leakage is defined as a bilirubin concentration at least three times greater than the serum bilirubin measured in an abdominal drainage on or after the third postoperative day or as the need for radiologic intervention because of biliary collection or relaparotomy for bile peritonitis. Therapeutic strategies for bile leakage comprise conservative watch and wait, interventional procedures (endoscopic or percutaneous biliary drainage) and relaparotomy and are selected based on the postoperative onset, output volume and anatomic localization of the bile leak. Conservative treatment and interventional procedures show a high success rate and should therefore be considered as the treatment of choice in most cases. In contrast to bile leakage, bile duct strictures and anastomotic stenosis are rarely observed after surgery and can usually be treated by interventional procedures. This review article discusses situation-dependent specific treatment of postoperative bile leakage as well as bile duct strictures and anastomotic stenosis in detail.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar , Colestase , Transplante de Fígado , Complicações Pós-Operatórias , Ductos Biliares , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Humanos , Estudos Retrospectivos
10.
Chirurg ; 91(1): 18-22, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31712829

RESUMO

Bile duct injuries can occur after abdominal trauma, postoperatively after cholecystectomy, liver resection or liver transplantation and also as a complication of endoscopic retrograde cholangiopancreatography (ERCP). The clinical appearance of bile duct injuries is highly variable and depends primarily on the underlying cause. In addition to the high perioperative morbidity, following successful initial complication management, bile duct injuries can lead to significant long-term complications. The treatment requires close interdisciplinary cooperation between surgery, interventional gastroenterology and interventional radiology. The treatment of bile duct injuries depends primarily on the time of diagnosis (intraoperative/postoperative) as well as the extent of the injury and is discussed in this review.


Assuntos
Traumatismos Abdominais , Ductos Biliares , Colecistectomia Laparoscópica , Transplante de Fígado , Traumatismos Abdominais/cirurgia , Ductos Biliares/lesões , Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Humanos
11.
Gut ; 69(1): 52-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30971436

RESUMO

OBJECTIVE: Despite improvements in imaging, serum CA19-9 and pathological evaluation, differentiating between benign and malignant bile duct strictures remains a diagnostic conundrum. Recent developments in next-generation sequencing (NGS) have opened new opportunities for early detection and management of cancers but, to date, have not been rigorously applied to biliary specimens. DESIGN: We prospectively evaluated a 28-gene NGS panel (BiliSeq) using endoscopic retrograde cholangiopancreatography-obtained biliary specimens from patients with bile duct strictures. The diagnostic performance of serum CA19-9, pathological evaluation and BiliSeq was assessed on 252 patients (57 trainings and 195 validations) with 346 biliary specimens. RESULTS: The sensitivity and specificity of BiliSeq for malignant strictures was 73% and 100%, respectively. In comparison, an elevated serum CA19-9 and pathological evaluation had sensitivities of 76% and 48%, and specificities of 69% and 99%, respectively. The combination of BiliSeq and pathological evaluation increased the sensitivity to 83% and maintained a specificity of 99%. BiliSeq improved the sensitivity of pathological evaluation for malignancy from 35% to 77% for biliary brushings and from 52% to 83% for biliary biopsies. Among patients with primary sclerosing cholangitis (PSC), BiliSeq had an 83% sensitivity as compared with pathological evaluation with an 8% sensitivity. Therapeutically relevant genomic alterations were identified in 20 (8%) patients. Two patients with ERBB2-amplified cholangiocarcinoma received a trastuzumab-based regimen and had measurable clinicoradiographic response. CONCLUSIONS: The combination of BiliSeq and pathological evaluation of biliary specimens increased the detection of malignant strictures, particularly in patients with PSC. Additionally, BiliSeq identified alterations that may stratify patients for specific anticancer therapies.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/genética , Neoplasias dos Ductos Biliares/patologia , Doenças Biliares/diagnóstico , Doenças Biliares/genética , Doenças Biliares/patologia , Biomarcadores Tumorais/sangue , Antígeno CA-19-9/sangue , Constrição Patológica/diagnóstico , Constrição Patológica/genética , Diagnóstico Diferencial , Feminino , Humanos , Cirrose Hepática Biliar/diagnóstico , Cirrose Hepática Biliar/genética , Cirrose Hepática Biliar/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Manejo de Espécimes/métodos , Adulto Jovem
14.
Z Gastroenterol ; 58(2): 152-159, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31863426

RESUMO

Patients with indeterminate biliary stricture frequently pose a challenge in the clinical management. Patients with malignant and potentially resectable diseases should be treated surgically as soon as possible. On the other hand, in patients with benign diseases which might be cured with medial treatment, surgery should be avoided. This review shall provide a concise overview on the diagnostic yield of currently available endoscopic methods as well as describe methods of potential relevance in the future.


Assuntos
Ductos Biliares/patologia , Colangiopancreatografia Retrógrada Endoscópica , Colestase/terapia , Constrição Patológica , Colestase/etiologia , Drenagem , Humanos
15.
Niger J Clin Pract ; 22(12): 1680-1684, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793474

RESUMO

Background: Using a relaxant agent before an endoscopic retrograde cholangiopancreatography (ERCP) might reduce complications. Study Aims: We aimed to investigate the relaxant effects of proton pump inhibitors (PPIs) on sheep sphincter of Oddi (SO) and the mechanisms that might take part in this relaxant effect. Patients and Methods: The sheep SO was mounted in an organ bath filled with Krebs-Ringer bicarbonate solution under 1.5 g tension and the relaxant effects of PPIs were evaluated in the tissues precontracted by carbachol (10-6 mol/l). The relaxant responses to the PPIs were tested in the presence of various blockers to enlighten the underlying mechanism by the PPIs. Results: The PPIs exerted relaxant responses in a concentration-dependent manner in the sheep SO (P < 0.05). Esomeprazole produced the strongest relaxation. The administration of atropine, indomethacin, L-NAME, methylene blue, clotrimazole, glibenclamide, and 4-aminopyridine into the organ baths did not change the relaxations induced by PPIs in vitro (P> 0.05). On the other hand, Ca+2-activated potassium channel blocker tetraethylammonium (TEA) reduced the relaxation responses created by PPIs (P < 0.05). Conclusions: The present study suggests that PPIs create relaxation on SO partially via Ca+2-activated potassium channels. PPIs, especially esomeprazole, may be beneficial during the ERCP procedure. Further clinical studies are needed to confirm our results.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Relaxamento Muscular/efeitos dos fármacos , Inibidores da Bomba de Prótons , Esfíncter da Ampola Hepatopancreática/efeitos dos fármacos , 4-Aminopiridina/farmacologia , Animais , Glibureto/farmacologia , Masculino , Relaxamento Muscular/fisiologia , NG-Nitroarginina Metil Éster/farmacologia , Ovinos , Esfíncter da Ampola Hepatopancreática/fisiopatologia
17.
Bratisl Lek Listy ; 120(12): 908-911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31855049

RESUMO

Familial adenomatous polyposis (FAP) is an inherited autosomal dominant disorder. Extracolonic manifestations are seen quite often. As prophylactic colectomy has become a standard care in FAP patients, the concerns over the development of associated extracolonic malignancies have become more prevalent. The authors report a case of a patient with the history of subtotal colectomy because of FAP with the development of adenocarcinoma of papilla of Vater twenty-six years later. A radical procedure in form of proximal pancreaticoduodenectomy was indicated. Variable endoscopic surveillance protocols and treatment strategies have been proposed concerning the management of duodenal and periampullary lesions. In case of periampullary malignancies, the radical surgical resection offers the only chance for cure and the only option that may safeguard the long­term survival (Fig. 2, Ref. 30). Keywords: ampulla of Vater, bile duct, obstructive jaundice, pancreatoduodenectomy, periampullary tumors.


Assuntos
Ampola Hepatopancreática/diagnóstico por imagem , Ampola Hepatopancreática/cirurgia , Colectomia/efeitos adversos , Colectomia/métodos , Neoplasias do Colo/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Pancreaticoduodenectomia/métodos , Polipose Adenomatosa do Colo/complicações , Ampola Hepatopancreática/patologia , Colangiopancreatografia Retrógrada Endoscópica , Neoplasias do Colo/complicações , Neoplasias do Ducto Colédoco/complicações , Neoplasias do Ducto Colédoco/patologia , Neoplasias Duodenais , Humanos , Icterícia Obstrutiva/etiologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Khirurgiia (Mosk) ; (11): 37-41, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714528

RESUMO

OBJECTIVE: To develop a rational surgical strategy for acute biliary pancreatitis and its complications. MATERIAL AND METHODS: A 10-year follow-up enrolled 378 patients with acute biliary pancreatitis. Mild pancreatitis was diagnosed in 304 (80%) patients, moderate and severe course - in 74 (20%). Almost all patients with mild acute biliary pancreatitis underwent surgery within 3-7 days after the attack resolution. Patients with severe biliary pancreatitis had general and local complications that required differentiated treatment strategy. CONCLUSION: Strangulation of the calculus in the major duodenal papilla requires emergency endoscopic papillosphincterotomy. Choledocholithiasis, cholangitis and obstructive jaundice in acute biliary pancreatitis are indications for endoscopic papillosphincterotomy. Cholecystectomy should be performed after resolution of inflammatory changes in the gallbladder and pancreas in patients with severe biliary pancreatitis.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colelitíase/cirurgia , Pancreatite/cirurgia , Doença Aguda , Colelitíase/diagnóstico , Colelitíase/etiologia , Seguimentos , Humanos , Pancreatite/etiologia
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