Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.836
Filtrar
1.
Khirurgiia (Mosk) ; (5): 70-75, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500692

RESUMO

One of significant achievements of modern endoscopy is development of retrograde biliary stenting for obstructive jaundice. This method ensured widespread application of endoscopic decompression in the treatment of patients with malignant biliary obstruction as preparation before radical surgery and final palliative care. Endoscopic retrograde transpapillary stenting firmly took its place together with antegrade and percutaneous stenting. There are certain advantages of this technique including minimally invasiveness and favorable quality of life. However, this approach is associated with some drawbacks associated with stent occlusion and difficult correction of this complication. The maximum diameter of the plastic stent (PS) is determined by the width of the working channel of the duodenoscope. In this regard, self-expandable metal stents (SEMS) were developed to increase the diameter of bile drainage channel. SEMS are associated with prolonged function. However, there is another problem. It is a germination of SEMS followed by impossible removal of the stent for its subsequent replacement. A further step in development of endoscopic biliary stents was the use of special SEMS coating to exclude tumor or granulation ingrowth. The problem of biliary stent occlusion remains relevant despite some improvement of stenting results. Mechanisms of occlusion of biliary stents and prevention of these events are discussed in this review.


Assuntos
Colestase/cirurgia , Neoplasias do Sistema Digestório/complicações , Endoscopia do Sistema Digestório , Icterícia Obstrutiva/cirurgia , Stents/efeitos adversos , Colestase/etiologia , Descompressão Cirúrgica/instrumentação , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/instrumentação , Endoscopia do Sistema Digestório/métodos , Humanos , Icterícia Obstrutiva/etiologia , Cuidados Paliativos
2.
Chirurgia (Bucur) ; 115(2): 252-260, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369730

RESUMO

Biliary atresia is the most frequent cause for neonatal obstructive cholestasis. Hepatoportoenterostomy (HPE) is the only method allowing survival until liver transplantation. For a maximum rate of success, the HPE procedure has to be performed within the 60 days of life. We aimed to create an experimental model for relieving obstructive cholestasis. In 20 Wistar rats selective bile duct obstruction was induced by the microsurgical ligature of the bile ducts corresponding to the median and left lateral liver lobes. After four weeks surgical re-intervention was carried out and HPE was performed microsurgically on the hilum of the median and left lateral liver lobes. One week after HPE, the integrity of the anastomosis and the hepatic changes were assessed. The survival rate throughout the study was 90%. The surgical re-intervention revealed hepatic-hilum adhesions, with fibrosis. Microscopically, an initial fibrogenic repair was identified, equivalent of moderate cholestasis. After the HPE, there was no bile leak from the anastomosis and no biliary peritonitis. The evolution was marked by a reduction in food intake. The experimental model we propose for the HPE is reliable by using microsurgical techniques. Based on it, one can study the changes induced by the bile duct obstruction.


Assuntos
Atresia Biliar/cirurgia , Colestase/cirurgia , Portoenterostomia Hepática/métodos , Animais , Atresia Biliar/complicações , Colestase/etiologia , Modelos Animais de Doenças , Humanos , Recém-Nascido , Microcirurgia , Ratos , Ratos Wistar , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(6): e19099, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028435

RESUMO

We determined the clinical effectiveness and long-term outcomes in patients with distal biliary obstruction (DBO) secondary to pancreatic carcinoma (PC) who were treated by self-expanded metallic stent (SEMS) insertion with or without high-intensity focused ultrasound (HIFU) ablation.From January 2014 to December 2018, consecutive patients with DBO secondary to PC underwent SEMS insertion with or without HIFU ablation in our center. The long-term outcomes were compared between the 2 groups.During the included period, 75 patients underwent SEMS insertion with (n = 34) or without (n = 41) HIFU ablation in our center. SEMS insertion was successfully performed in all patients. Liver function was significantly improved after SEMS insertion in both groups. An average of 2.9 HIFU treatment sessions per patient were performed. Twenty patients (stent + HIFU group: 7; stent-only group: 13) experienced stent dysfunction (P = .278). The clinical response rate to HIFU ablation was 79.4%. The median stent patency was significantly longer in the stent with HIFU group than in the stent-only group (175 vs 118 days, P = .005). The median survival was significantly longer in the stent with HIFU group compared with the stent-only group (211 versus 136 days, P = .004). An Eastern Cooperative Oncology Group (ECOG) Performance Status of 3 (hazard ratio: 0.300; P = .002) and subsequent HIFU ablation (hazard ratio: 0.508; P = .005) were associated with prolonged survival.HIFU ablation following stent insertion can prolong the stent patency and survival for patients with DBO secondary to PC.


Assuntos
Colestase/etiologia , Ablação por Ultrassom Focalizado de Alta Intensidade , Neoplasias Pancreáticas/complicações , Implantação de Prótese , Stents , Idoso , Colestase/cirurgia , Feminino , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Modelos de Riscos Proporcionais , Implantação de Prótese/métodos , Estudos Retrospectivos , Análise de Sobrevida
4.
Medicine (Baltimore) ; 99(3): e18718, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011448

RESUMO

BACKGROUND AND AIM: Biliary obstruction can impair the effectiveness of neo-adjuvant chemotherapy. This study was designed to compare biliary stenting with covered self-expandable metal stents (FCSEMS) and plastic stents (PS) in patients with biliary obstruction caused by borderline resectable pancreatic cancer (BRPC) who were undergoing neo-adjuvant chemotherapy during preoperative biliary drainage. METHODS: This single-center, comparative, randomized, superiority study was designed to compare FCSEMS with PS for drainage of biliary obstruction of BRPC. Twenty two eligible patients providing informed consent will be randomized 1:1 by computer to either FCSEMS or PS for endoscopic retrograde biliary drainage (ERBD). All subsequent clinical interventions, including crossover to alternative procedures, will be at the discretion of the treating physician based on standard clinical care. The primary outcomes will be the rates and causes of stent dysfunction during preoperative biliary drainage. Other outcomes include time required for ERBD, adverse events related to ERBD, period from ERBD to surgery, percentage of patients able to undergo surgery, operation time, intraoperative bleeding volume, postoperative adverse events, and postoperative hospitalization. Subjects, treating clinicians, and outcome assessors will not be blinded to assignment. DISCUSSION: This study is intended to determine whether FCSEMS or PS is the better biliary stent for ERBD for management of patients with biliary obstruction of BRPC, a common clinical dilemma that has not yet been investigated in randomized trials. TRIALS REGISTRATION: UMIN-CTR, Identifier: UMIN000030473. Registered July 10, 2017, Wakayama Medical University Hospital.


Assuntos
Colestase/etiologia , Colestase/cirurgia , Neoplasias Pancreáticas/complicações , Stents , Procedimentos Cirúrgicos do Sistema Biliar , Quimioterapia Adjuvante , Humanos , Neoplasias Pancreáticas/terapia , Plásticos , Cuidados Pré-Operatórios , Estudos Prospectivos , Projetos de Pesquisa , Stents Metálicos Autoexpansíveis , Método Simples-Cego
5.
Br J Radiol ; 93(1108): 20190637, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31778313

RESUMO

OBJECTIVES: To retrospectively evaluate the safety and efficacy of transcatheter arterial embolization (TAE) for delayed arterial bleeding secondary to percutaneous self-expandable metallic stent (SEMS) placement in patients with malignant biliary obstruction (MBO). METHODS: From January 1997 to September 2017, 1858 patients underwent percutaneous SEMS placement for MBO at a single tertiary referral center. Among them, 19 patients (mean age, 70.2 [range, 52-82] years; 13 men) presented with delayed SEMS-associated arterial bleeding and underwent TAE. RESULTS: The incidence of delayed arterial bleeding was 1.0% (19/1858) after SEMS placement, with a median time interval of 225 days (range, 22-2296). Digital subtraction angiography (DSA) showed pseudoaneurysm alone close to the stent mesh (n = 10), pseudoaneurysm close to the stent mesh with contrast extravasation to the duodenum (n = 3), pseudoaneurysm close to the stent mesh with arteriobiliary fistula (n = 1), in-stent pseudoaneurysm alone (n = 4) and in-stent pseudoaneurysm with arteriobiliary fistula (n = 1). Bleeding was stopped after the embolization in all patients. Overall clinical success rate was 94.7% (18/19). One patient with recurrent bleeding was successfully treated with a second embolization. Overall 30-day mortality rate was 26.3% (5/19). A major procedure-related complication was acute hepatic failure in one hilar bile duct cancer patient (5.3%), which was associated with an obliterated portal vein. CONCLUSION: TAE is safe and effective for the treatment of delayed arterial bleeding after percutaneous SEMS placement for MBO. ADVANCES IN KNOWLEDGE: This study demonstrated TAE is safe and effective for arterial bleeding after SEMS placement after MBO through the largest case series so far.


Assuntos
Falso Aneurisma/terapia , Colestase/cirurgia , Embolização Terapêutica/métodos , Hemorragia Pós-Operatória/terapia , Stents Metálicos Autoexpansíveis/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Angiografia Digital , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/terapia , Colestase/etiologia , Embolização Terapêutica/efeitos adversos , Feminino , Hemorragia Gastrointestinal , Hematemese/diagnóstico por imagem , Hematemese/terapia , Hemobilia/diagnóstico por imagem , Hemobilia/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/terapia
6.
Chirurg ; 91(1): 11-17, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31705282

RESUMO

BACKGROUND: Benign biliary diseases comprise entities, which present with very similar pathognomonic symptoms despite fundamental etiological differences. Obstructions of intrahepatic and extrahepatic bile ducts due to stones, tumors or parasites as well as stenoses and cystic alterations belong to the group of benign biliary diseases. OBJECTIVE: This article provides a systematic overview of the indications and differential treatment of benign biliary diseases with special emphasis on the surgical treatment. MATERIAL AND METHODS: The presented recommendations are in accordance with national and international guidelines, current scientific papers and expert opinions. RESULTS: Essentially the surgical options for benign biliary diseases consist of revision, reconstruction through bilioenteric anastomosis, resection and complete organ replacement in the sense of liver transplantation. The location of the affected segment of the biliary tree, the symptoms, the progress of the disease and suspected malignancy essentially determine the level of escalation in the described treatment level scheme. CONCLUSION: The treatment of benign biliary diseases is complex and requires achievement of unimpaired, unobstructed bile drainage. It serves the purpose of resolving cholestasis and thereby avoiding recurrent cholangitis and long-term complications, such as biliary cirrhosis and malignant transformation; however, in some cases of premalignant lesions of the bile ducts the strategy resembles cancer surgery, including resection of the affected tissue.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar , Colangite , Colestase , Ductos Biliares/cirurgia , Ductos Biliares Extra-Hepáticos/cirurgia , Colangite/cirurgia , Colestase/cirurgia , Drenagem , Humanos
7.
Eur Radiol ; 30(1): 175-185, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31385047

RESUMO

OBJECTIVE: To investigate whether covered stents show a higher efficacy than uncovered stents in percutaneous treatment of malignant hilar biliary obstruction. METHODS: Patients with obstructive jaundice caused by an unresectable hilar malignancy were included after failed endoscopic intervention in a prospective randomized trial comparing expanded polytetrafluoroethylene and fluorinated ethylene propylene (ePTFE-FEP)-covered nitinol stents with uncovered nitinol stents. Exclusion criteria were as follows: primary tumors existing more than 3 months, a biliodigestive anastomosis, previous stenting, and a Karnofsky score of less than 50. Safety, clinical success, and adjuvant chemotherapy were compared as well as occlusion rate, patency, and survival. RESULTS: A total of 120 patients were included. One patient was post hoc excluded. Fourteen patients who died within 7 days and one patient without patency data were excluded from patency analysis. Serious adverse events (p = 0.4), 30-day mortality (p = 0.5), and clinical success (p = 0.8) were equivalent for both stent groups. Twenty-one out of 61 (34%) patients in the covered and 24/58 (41%) in the uncovered stent groups received adjuvant chemotherapy (p = 0.5). Occlusion rate was 54% (27/50) in the covered stent group and 57% (31/54) in the uncovered stent group (p = 0.8). Median patency was 229 days (95% CI 113-345) for covered stents and 130 days (95% CI 75-185) for uncovered stents (p = 0.1). Median survival in patients with covered stents was 79 days (95% CI 52-106) and with uncovered stents 92 days (95% CI 60-124) (p = 0.3). CONCLUSION: In malignant hilar biliary obstruction, there is no evidence that ePTFE-FEP-covered stents are superior to uncovered stents in terms of safety, clinical success, adjuvant chemotherapy, patency, or survival. KEY POINTS: • Percutaneous palliation of hilar biliary obstruction is feasible with both uncovered and covered stents. • Clinical success in terms of bilirubin decrease and adjuvant chemotherapy is achievable with both stents. • Thirty-day mortality is considerable when stenting is also offered to patients with a low performance status.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Colestase/cirurgia , Icterícia Obstrutiva/cirurgia , Neoplasias Hepáticas/terapia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Colestase/etiologia , Colestase/mortalidade , Materiais Revestidos Biocompatíveis/uso terapêutico , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Politetrafluoretileno/análogos & derivados , Estudos Prospectivos , Stents/efeitos adversos
8.
World J Gastroenterol ; 25(41): 6238-6247, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31749594

RESUMO

BACKGROUND: Jaundice or preoperative cholestasis (PC) are typical symptoms of pancreatic masses. Approximately 50% of patients undergo preoperative biliary drainage (PBD) placement. PBD is a common cause of bacterobilia (BB) and is a known surgical site infection risk factor. An adjustment of preoperative antibiotic prophylaxis (PAP) may be reasonable according to the profile of BB. For this, we examined the microbiological findings in routine series of patients. AIM: To investigate the incidence and profile of biliary bacterial colonization in patients undergoing pancreatic head resections. METHODS: In the period from January 2009 to December 2015, 285 consecutive pancreatic head resections were performed. Indications for surgery were malignancy (71%), chronic pancreatitis (18%), and others (11%). A PBD was in 51% and PC was in 42%. The standard PAP was ampicillin/sulbactam. Intraoperatively, a smear was taken from the hepatic duct. An analysis of the isolated species and resistograms was performed. Patients were categorized according to the presence or absence of PC (PC+/PC-) and PBD (PBD+/PBD-) into four groups. Antibiotic efficiency was analyzed for standard PAP and possible alternatives. RESULTS: BB was present in 150 patients (53%). BB was significantly more frequent in PBD+ (n =120) than in PBD- (n = 30), P < 0.01. BB was present both in patients with PC and without PC: (PBD-/PC-: 18%, PBD-/PC+: 30%, PBD+/PC-: 88%, PBD+/PC+: 80%). BB was more frequent in malignancy (56%) than in chronic pancreatitis (45%). PBD, however, was the only independent risk factor in multivariate analysis. In total, 357 pathogens (342 bacteria and 15 fungi) were detected. The five most common groups (n = 256, 74.8%) were Enterococcus spp. (28.4%), Streptococcus spp. (16.9%), Klebsiella spp. (12.6%), Escherichia coli (10.5%), and Enterobacter spp. (6.4%). A polymicrobial BB (PBD+: 77% vs PBD-: 40%, P < 0.01) and a more frequent detection of Enterococcus (P < 0.05) was significantly associated with PBD+. In PBD+, the efficiency of imipenem and piperacillin/tazobactam was significantly higher than that of the standard PAP (P < 0.01). CONCLUSION: PBD-/PC- and PBD-/PC+ were associated with a low rate of BB, while PBD+ was always associated with a high rate of BB. In PBD+ patients, BB was polymicrobial and more often associated with Enterococcus. In PBD+, the spectrum of potential bacteria may not be covered by standard PAP. A more potent alternative for prophylactic application, however, was not found.


Assuntos
Antibioticoprofilaxia , Bile/microbiologia , Drenagem/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Antibacterianos/uso terapêutico , Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colestase/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Humanos , Icterícia Obstrutiva/etiologia , Análise Multivariada , Pancreatectomia/efeitos adversos , Pancreatite/cirurgia , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/prevenção & controle
9.
Croat Med J ; 60(5): 397-404, 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31686453

RESUMO

AIM: To assess the effectiveness and outcome of repeated percutaneous transhepatic balloon dilatation combined with targeted intramucosal corticosteroid injection in patients with benign biliary stricture. METHODS: This single-center pilot study, conducted between February 2014 and June 2016, involved five patients with benign biliary stricture (4 men and 1 woman, mean age 58.2 years). The study included only patients in whom previous surgical or/and non-surgical treatments failed or could not be performed due to patients' medical history and local status. RESULTS: We successfully developed an alternative treatment for patients with benign biliary stricture and performed it without side effects. There were no major complications, and the only one minor complication was cholangitis. In the median follow-up period of 30.24 months (range 14.5 to 44.6 months), no re-occlusion was detected. The disease-free survival, calculated after excluding the first patient (who died of heart attack), was 34.175 months. CONCLUSION: Percutaneous transhepatic corticosteroid injection combined with balloon dilatation could provide an alternative method for the treatment of benign biliary strictures that is effective in the long term and results in positive outcomes.


Assuntos
Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Colestase/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
10.
Arq Bras Cir Dig ; 32(3): e1454, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644674

RESUMO

BACKGROUND: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. AIM: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. METHODS: : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. RESULTS: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. CONCLUSION: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.


Assuntos
Perda Sanguínea Cirúrgica , Colestase/cirurgia , Drenagem/efeitos adversos , Hemostasia , Complicações Intraoperatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateteres , Colestase/sangue , Estudos Transversais , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Punções , Fatores de Risco , Adulto Jovem
11.
Am Surg ; 85(9): 1025-1027, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638518

RESUMO

From 1991 to 2013, Mississippi was without liver transplant services. In 2013, a new liver transplant program was established at the University of Mississippi Medical Center. Here, we describe our experience with the first 150 transplants over a 4.5-year period. This study is a review of 147 patients who underwent the first 150 liver transplants at the University of Mississippi Medical Center between March 5, 2013, and January 4, 2018. There were no exclusion criteria for this study. Donor, recipient, and outcome variables were analyzed. Recipients were 46% female and 74% white. Age at the time of transplant was 57 [IQR 49-63]. BMI at transplant was 30 [IQR 25-35]. Thirty per cent of transplants were for alcoholic cirrhosis, 25% non-alcoholic steatohepatitis, 24% hepatitis C, and 12% cholestatic. Mean model for end-stage liver disease (MELD) at the time of transplant was 20 [95% confidence interval 19-21] and MELD-Na was 22 [95% confidence interval 20-23]. One-year patient- and graft survival were 89% and 87%, respectively, which were as expected based on Scientific Registry of Transplant Recipient reports after risk adjustment. The data published here verifies it is possible to establish a new liver transplant center in an underserved area previously lacking comprehensive liver care and to achieve results similar to other high-volume centers across the country.


Assuntos
Centros Médicos Acadêmicos , Transplante de Fígado , Índice de Massa Corporal , Colestase/cirurgia , Fígado Gorduroso/cirurgia , Feminino , Sobrevivência de Enxerto , Hepatite C/cirurgia , Humanos , Tempo de Internação , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/normas , Masculino , Pessoa de Meia-Idade , Mississippi , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias , Desenvolvimento de Programas , Reoperação
12.
World J Gastroenterol ; 25(34): 5210-5219, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31558868

RESUMO

BACKGROUND: Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction. No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting. AIM: To assess the efficacy and safety of bilateral vs unilateral biliary drainage in inoperable malignant hilar obstruction. METHODS: PubMed, Embase, Scopus, and Cochrane databases, as well as secondary sources (bibliographic review of selected articles and major GI proceedings), were searched through January 2019. The primary outcome was the re-intervention rate. Secondary outcomes were a technical success, early and late complications, and stent malfunction rate. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated for each outcome. RESULTS: A total of 9 studies were included (2 prospective Randomized Controlled Study, 5 retrospective studies, and 2 abstracts), involving 782 patients with malignant hilar obstruction. Bilateral stenting had significantly lower re-intervention rate compared with unilateral drainage (OR = 0.59, 95%CI: 0.40-0.87, P = 0.009). There was no difference in the technical success rate (OR = 0.7, CI: 0.42-1.17, P = 0.17), early complication rate (OR = 1.56, CI: 0.31-7.75, P = 0.59), late complication rate (OR = 0.91, CI: 0.58-1.41, P = 0.56) and stent malfunction (OR = 0.69, CI: 0.42-1.12, P = 0.14) between bilateral and unilateral stenting for malignant hilar biliary strictures. CONCLUSION: Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures, with no significant difference in technical success, and early or late complication rates.


Assuntos
Neoplasias dos Ductos Biliares/complicações , Colestase/cirurgia , Drenagem/métodos , Tumor de Klatskin/complicações , Cuidados Paliativos/métodos , Neoplasias dos Ductos Biliares/cirurgia , Colestase/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Drenagem/efeitos adversos , Drenagem/instrumentação , Ducto Hepático Comum/patologia , Ducto Hepático Comum/cirurgia , Humanos , Tumor de Klatskin/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
14.
Jpn J Radiol ; 37(10): 719-726, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31486969

RESUMO

PURPOSE: To evaluate and compare the clinical outcomes between percutaneous gallbladder drainage (PGBD) and percutaneous gallbladder aspiration (PGBA) for acute cholecystitis after biliary stenting for malignant biliary obstruction. MATERIALS AND METHODS: Twenty-six and 14 patients underwent PGBD and PGBA, respectively, for acute cholecystitis after biliary stenting for malignant obstruction. The technical success rate, clinical effectiveness, and safety were compared between the 2 groups. RESULTS: Technical success was achieved in all patients. Clinical effectiveness rate was significantly higher in the PGBD group than in the PGBA group [100% (26/26) vs. 57% (8/14), p < 0.01]. In the PGBA group, clinical effectiveness rate was significantly lower in patients with tumor involvement of the cystic duct [13% (1/8) with involvement vs. 83% (5/6) without involvement, p = 0.03]. There were no deaths related to the procedure or acute cholecystitis aggravation. Pleural effusion and biliary peritonitis occurred in 1 patient each after PGBD and intra-abdominal bleeding occurred in 1 patient after PGBA as complications requiring treatment. CONCLUSION: Although PGBD was a more effective treatment for acute cholecystitis after biliary stenting for malignant obstruction, PGBA may be a less invasive option for high-risk patients without tumor involvement of the cystic duct.


Assuntos
Colecistite Aguda/terapia , Colestase/cirurgia , Stents/efeitos adversos , Idoso , Colecistite Aguda/etiologia , Drenagem , Feminino , Vesícula Biliar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sucção , Resultado do Tratamento
15.
Cardiovasc Intervent Radiol ; 42(12): 1751-1759, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31482338

RESUMO

PURPOSE: To develop, validate, and compare early warning models of the 30-day mortality risk for patients with malignant biliary obstruction (MBO) undergoing percutaneous transhepatic biliary stent placement (PTBS). MATERIALS AND METHODS: Between January 2013 and October 2018, this multicenter retrospective study included 299 patients with MBOs who underwent PTBS. The training set consisted of 166 patients from four cohorts, and another two independent cohorts were allocated as external validation sets A and B with 75 patients and 58 patients, respectively. A logistic model and an artificial neural network (ANN) model were developed to predict the risk of 30-day mortality after PTBS. The predictive performance of these two models was validated internally and externally. RESULTS: The ANN model had higher values of area under the curve than the logistic model in the training set (0.819 vs 0.797), especially in the validation sets A (0.802 vs 0.714) and B (0.732 vs 0.568). Both models had high accuracy in the three sets (75.9-83.1%). Along with a high specificity, the ANN model improved the sensitivity. The net reclassification improvement and integrated discrimination improvement also demonstrated that the ANN model led to improvements in predictive ability compared with the logistic model. CONCLUSIONS: Early warning models were proposed to predict the risk of 30-day mortality after PTBS in patients with MBO. The ANN model has higher accuracy and better generalizability than the logistic model.


Assuntos
Neoplasias do Sistema Biliar/complicações , Colestase/etiologia , Colestase/mortalidade , Modelos Estatísticos , Neoplasias Pancreáticas/complicações , Stents , Idoso , Idoso de 80 Anos ou mais , Sistema Biliar/patologia , Neoplasias do Sistema Biliar/mortalidade , Colestase/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco
16.
Transplant Proc ; 51(7): 2469-2472, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405740

RESUMO

OBJECTIVES: Although endoscopic management is considered as the first-line treatment for biliary strictures, it may be challenging in living donor liver transplant recipients due to the complex nature of duct-to-duct reconstruction. In this study we present the use of a pigtail drainage catheter as a biliary stent to treat biliary strictures after a living donor liver transplant. METHODS: Twenty-seven patients with biliary strictures were treated with our novel technique. In this technique, a pigtail catheter was trimmed into 3 parts (proximal, middle, and distal portions). A suture string was passed through the distal hole of the middle portion, which was then reversed and used as a stent while the proximal portion was used as a pusher. Following balloon dilation of the stenotic segment, the distal, reversed middle, and proximal portions were loaded over the guidewire. After proper placement of the stent, the retractor suture string, pusher, and guidewire were removed. The stent was removed during the third or fourth month of placement through endoscopic retrograde cholangiopancreatography (ERCP) in all patients. RESULTS: No significant complications developed during the procedure or follow-up period. Ten patients required re-stenting by ERCP during the same session. The mean follow-up period was 2 years. Cholestase enzymes and bilirubin levels were within normal limits in all patients during follow-up. CONCLUSION: Stents derived from drainage catheter facilitate treatment of biliary strictures in patients not eligible for the retrograde approach. This stent is cheap, easy to implement, can be easily removed by ERCP, and re-stenting can be applicable in retrograde if needed.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cateteres , Colestase/etiologia , Colestase/cirurgia , Transplante de Fígado/efeitos adversos , Adulto , Idoso , Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Cateterismo/métodos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Stents
17.
Turk J Gastroenterol ; 30(8): 714-721, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31418416

RESUMO

BACKGROUND/AIMS: For distal malignant biliary obstruction (MBO), a percutaneous metal stent is usually inserted by the transpapillary method. However, stent-related complications and recurrent biliary obstruction following transpapillary stent placement are concerns, and survival analysis of patients with distal MBO has rarely been done. MATERIALS AND METHODS: From January 2012 to March 2016, 104 patients underwent transpapillary uncovered metal stent placement for distal MBO at our institution. Clinical success, complications, recurrent biliary obstruction rates, and predictors of survival were analyzed. RESULTS: Of the total 104 patients, clinical success after stent insertion was achieved in 93 patients (90.3%). Major complications were observed in 24 patients (23.1%), which were as follows: cholangitis in 19 patients; pancreatitis in four patients; and biloma in one patient. Recurrent biliary occlusion was observed in 28 patients (26.9%). The median overall survival period was 162 days. The 3-, 6-, and 12-month overall survival rates after stent insertion were 64.4%, 41.3%, and 10.6%, respectively. Results of multivariate analysis indicated that metastatic carcinoma compared with ampullary carcinoma (HR=3.82; 95% CI, 1.30-11.24; p=0.015) and longer biliary stricture (HR=1.04; 95% CI, 1.02-1.06; p<0.001) were independent risk factors for worse survival after metal stent insertion. CONCLUSION: Transpapillary stent placement was found to be effective with acceptable complication rates for treating distal MBO. Primary tumor and length of biliary stricture were found to be statistically significant independent prognostic factors for survival.


Assuntos
Neoplasias dos Ductos Biliares/complicações , Procedimentos Cirúrgicos do Sistema Biliar/mortalidade , Colestase/cirurgia , Stents Metálicos Autoexpansíveis , Idoso , Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Colestase/etiologia , Colestase/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
18.
Surgery ; 166(6): 1004-1010, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31466857

RESUMO

BACKGROUND: The effects of the time interval from preoperative biliary drainage to pancreaticoduodenectomy on morbidity and mortality have not been established, but a recent multicenter study found that an interval greater than 4 weeks resulted in fewer major complications. We investigated whether delaying pancreaticoduodenectomy after preoperative biliary drainage led to improved postoperative morbidity and mortality. METHODS: Patients who underwent elective open pancreaticoduodenectomy between January 2009 and December 2016 were retrospectively analyzed. They were divided into a short duration group (time interval to surgery <4 weeks) and a delaying surgery group (time interval to surgery ≥4 weeks). An unstented control group (no stent group) was added. Perioperative characteristics and surgical outcomes were compared. RESULTS: Of 603 patients who underwent pancreaticoduodenectomy, 183 (30.3%) had preoperative biliary drainage, 110 patients (18.2%) in the short duration group and 73 (12.1%) in the delaying surgery group. The median interval between preoperative biliary drainage and pancreaticoduodenectomy was 3 weeks (interquartile range, 2-3) for the former group and 6 weeks (interquartile range, 5-7) for the latter. With the exception of wound infection, which was significantly higher in the short duration group than in the controls (8.2% vs 1.7%, P = .002) but not significantly increased compared with the delaying surgery group (8.2% vs 4.1%, P = .368), other complications were comparable among the 3 groups. Subgroup analyses in the intermediate- and high-risk cohort based on either original or alternative Fistula Risk Score showed similar outcomes. Univariate and multivariate analyses showed that short stent duration and female sex were independent factors associated with wound infection. CONCLUSION: A time interval between preoperative biliary drainage and resection greater than 4 weeks does not have a negative impact on short-term surgical outcomes. This finding indicates the relative safety of postponing surgery, if necessary, for preoperative treatment, optimization, or preparation.


Assuntos
Colestase/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Neoplasias Pancreáticas/terapia , Pancreaticoduodenectomia/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Sistema Biliar , Colestase/etiologia , Drenagem/instrumentação , Drenagem/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia/estatística & dados numéricos , Cuidados Pré-Operatórios/instrumentação , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis , Infecção da Ferida Cirúrgica/etiologia , Fatores de Tempo , Resultado do Tratamento
19.
J Pak Med Assoc ; 69(8): 1099-1102, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431760

RESUMO

OBJECTIVE: To evaluate the entire spectrum of endoscopic retrograde cholangiopancreatography procedure including site of stent migration, techniques of stent retrieval, success and complications. METHODS: The retrospective study was conducted at Dr Ruth Pfau Civil Hospital Karachi, and comprised data from January 2010 to January 2017of patients who underwent endoscopic retrograde cholangiopancreatography for the retrieval of stent migrated in the common bile duct, pancreatic duct or pancreatic pseudocyst or were found to have migrated stent during either stent removal or exchange and where attempts were made to remove the stent. A team of expert endoscopists had performed all the procedures. SPSS 17 was used for statistical analysis. RESULTS: There were 5700 procedures performed on 4800 patients. Pancreato-biliary stenting was done in 1229(21.56%) patients; 745(60.61%) with benign conditions and 484(39.38%) with malignant. Stent migration was found in 51(4.14%) patients; 30(58.8%) males and 21(41.2%) females. In terms of clinical presentation, right upper quadrant pain was the most common 9(17.6%). Technical success was achieved in all (100%) cases, with firstprocedure success in 45(88.2%). There was no complication or procedure-related mortality. CONCLUSIONS: In patients with stent migration, endoscopic retrograde cholangiopancreatography was found to be a safe and effective modality for stent retrieval.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Ducto Colédoco , Remoção de Dispositivo/métodos , Ductos Pancreáticos , Pseudocisto Pancreático , Falha de Prótese , Stents , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Coledocolitíase/cirurgia , Colestase/cirurgia , Constrição Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/prevenção & controle , Pancreatite Crônica/cirurgia , Plásticos , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
20.
World J Surg Oncol ; 17(1): 116, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277666

RESUMO

BACKGROUND AND AIM: Endoscopic biliary drainage (EBD) and percutaneous biliary drainage (PTBD) are the two main strategies of preoperative biliary drainage (PBD) for resectable malignant biliary obstruction (MBO) worldwide, but which is better remains unclear. Seeding metastasis (SM) has been reported repeatedly in the recent decade, although it is rarely taken into consideration in the choice of PBD. Hence, a systematic review was badly warranted to evaluate the incidence of SM between PTBD and EBD in the preoperative treatment of MBO. METHODS: PubMed, MEDLINE, the Cochrane Library, and Web of Science were used to identify any potentially eligible studies comparing the incidence of SM between EBD and PTBD from Nov 1990 to Mar 2018. The effect size was determined by odds ratio (OR) with 95% confidence interval (CI). RESULTS: Ten studies were enrolled in this study, including 1379 cases in the EBD group and 1085 cases in the PTBD group. Results showed that the incidence of SM in the EBD group was significantly lower than that in the PTBD group (10.5% vs. 22.0%, OR = 0.35, 95% CI 0.23~0.53). Subgroup analysis stratified by the definition of SM showed that the pooled ORs for peritoneal metastasis and tube-related SM between EBD and PTBD were 0.42 (95% CI 0.31~0.57) and 0.17 (95% CI 0.10~0.29), respectively. Subgroup analysis stratified by the location of MBO showed that the pooled ORs for the incidence of SM between EBD and PTBD for perihilar cholangiocarcinoma, distal cholangiocarcinoma, and pancreatic cancer were 0.27 (95% CI 0.13~0.56), 0.32 (95% CI 0.17~0.60), and 0.27 (95% CI 0.19~0.40), respectively. CONCLUSION: EBD should be the optimal PBD for MBO considering the SM, but it deserved further validation.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/patologia , Inoculação de Neoplasia , Neoplasias Pancreáticas/patologia , Cuidados Pré-Operatórios/métodos , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/complicações , Colangiocarcinoma/cirurgia , Colestase/etiologia , Colestase/cirurgia , Drenagem/métodos , Endoscopia/métodos , Humanos , Incidência , Invasividade Neoplásica/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/cirurgia , Prognóstico , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA