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1.
BMC Gastroenterol ; 21(1): 202, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952187

RESUMO

BACKGROUND: Transpapillary biliary drainage in ERCP is an established method for symptomatic treatment of patients with unresectable malignant biliary obstruction. Percutaneous transhepatic biliary drainage frequently remains the treatment of choice when the transpapillary approach proves ineffective. Recently, EUS-guided extra-anatomical anastomoses of bile ducts to the gastrointestinal tract have been reported as an alternative to percutaneous biliary drainage. To assess the usefulness of extra-anatomical intrahepatic biliary duct anastomoses to the gastrointestinal tract as endotherapy for unresectable malignant biliary obstruction and to determine factors affecting the efficacy of treatment. METHODS: A prospective analysis of the treatment results of all patients with unresectable biliary obstruction treated with EUS-guided hepaticogastrostomy at our institution in the years 2016-2019. RESULTS: Transmural intrahepatic biliary drainage (EUS-guided hepaticogastrostomy) was performed due to the ineffectiveness of ERCP in 53 patients (38 males, 15 females; mean age 74.66 [56-89] years) with unresectable biliary obstruction. Technical success of EUS-guided hepaticogastrostomy was achieved in 52/53 (98.11%) patients. Complications of endoscopic treatment were observed in 10/53 (18.87%) patients. Clinical success of EUS-guided hepaticogastrostomy was achieved in 46/53 (86.79%) patients. Bismuth type II-IV cholangiocarcinoma, hepatic metastases, ascites, suppurative cholangitis, and high blood bilirubin levels exceeding 30 mg/dL were independent factors for increased complications and inefficacy of EUS-guided hepaticogastrostomy. CONCLUSIONS: In the event of transpapillary biliary drainage proving ineffective, extra-anatomical anastomoses of intrahepatic bile ducts to the gastrointestinal tract provide an effective method for the treatment of patients with malignant biliary obstruction.


Assuntos
Neoplasias dos Ductos Biliares , Colestase , Idoso , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Colestase/etiologia , Colestase/cirurgia , Drenagem , Endossonografia , Feminino , Humanos , Masculino , Estudos Prospectivos , Stents , Ultrassonografia de Intervenção
2.
BMC Gastroenterol ; 21(1): 175, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865307

RESUMO

BACKGROUND: There is a lack of studies regarding the optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in patients with cholangitis caused by distal malignant biliary obstruction (MBO). This study aims to investigate the optimal timing of ERCP in patients with acute cholangitis associated with distal MBO with a naïve papilla. METHODS: A total of 421 patients with acute cholangitis, associated with distal MBO, were enrolled for this study. An urgent ERCP was defined as being an ERCP performed within 24 h following emergency room (ER) arrival, and early ERCP was defined as an ERCP performed between 24 and 48 h following ER arrival. We evaluated both 30-day and 180-day mortality as primary outcomes, according to the timing of the ERCP. RESULTS: The urgent ERCP group showed the lowest 30-day mortality rate (2.2%), as compared to the early and delayed ERCP groups (4.3% and 13.5%) (P < 0.001). The 180-day mortality rate was lowest in the urgent ERCP group, followed by early ERCP and delayed ERCP groups (39.4%, 44.8%, 60.8%; P = 0.006). A subgroup analysis showed that in both the primary distal MBO group, as well as in the moderate-to-severe cholangitis group, the urgent ERCP had significantly improved in both 30-day and 180-day mortality rates. However, in the secondary MBO and mild cholangitis groups, the difference in mortality rate between urgent, early, and delayed ERCP groups was not significant. CONCLUSIONS: In patients with acute cholangitis associated with distal MBO, urgent ERCP might be helpful in improving the prognosis, especially in patients with primary distal MBO or moderate-to-severe cholangitis.


Assuntos
Neoplasias do Sistema Biliar/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangite/cirurgia , Colestase/patologia , Doença Aguda , Idoso , Neoplasias do Sistema Biliar/patologia , Colangite/etiologia , Colestase/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
BMJ Case Rep ; 14(4)2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858881

RESUMO

The development and refinement of endoscopic stenting techniques in recent years have made endoscopic treatment an important part of palliative care for irresectable malignant disease in the gastrointestinal tract. We present the case of a 82-year-old man with biliary obstruction and duodenal stenosis on the basis of disseminated pancreatic cancer. He was bothered by jaundice and reduced oral intake. This is typically alleviated using stents; however, the placement of a duodenal stent can limit the possibility of subsequent placement of a biliary stent. This therapeutic challenge was solved using a combination of lumen-apposing metal stents (LAMS) and self-expanding uncovered metal stents (SEMS). LAMS is a relatively novel type of stent intended for endoscopic ultrasonography-guided placement. First, we placed a SEMS in the duodenum, a LAMS was subsequently placed through the mesh of the duodenal SEMS, alleviating the biliary system. The patient was able to resume oral intake and his jaundice subsided.


Assuntos
Colestase , Obstrução Duodenal , Idoso de 80 Anos ou mais , Colestase/etiologia , Colestase/cirurgia , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Duodeno/cirurgia , Endossonografia , Humanos , Masculino , Cuidados Paliativos , Estudos Retrospectivos , Stents , Resultado do Tratamento
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(1): 47-52, 2021 Jan 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33678636

RESUMO

OBJECTIVES: A variety of causes can lead to cholestasis, however, cholestasis caused by Graves' disease is usually overlooked clinically. Here we analyze the clinical characteristics of Graves' disease associated cholestasis so as to have a better understanding for the disease. METHODS: We retrospectively collected 13 inpatients' data who suffered from the Graves' disease associated cholestasis in the Department of Infectious Disease of Xiangya Hospital from January 2000 to December 2018. The characteristics of the patients' age, gender, liver function, thyroid function, coagulation function, the special cardiac examination, treatment, and follow-up data were analyzed. RESULTS: Thirteen patients, including 10 males and 3 females with the age range from 33 to 55 (median 43) years old presented cholestasis, pruritus, and hypermetabolic symptoms. The levels of total bilirubin (TBIL), direct bilirubin (DBIL), glutamic-pyruvic transferase, glutamic-oxaloacetic transferase, alkaline phosphosphatase, and gamma glutamyl transpeptidase were 170.4-976.7 (median 388.8) µmol/L, 93.2-418.1 (median 199.2) µmol/L, 25.1-182.1 (median 106.4) U/L, 38.2-265.7 (median 59.7) U/L, 105.3-332.0 (median 184.5) U/L, and 20.7-345.1 (median 47.6) U/L, respectively. The levels of free triiodothyronine (FT3), free thyroxine (FT4), and thyrotrophin receptor antibody were 4.1-50.0 (median 21.6) pmol/L, 30.4-100.0 (median 87.9) pmol/L, and 4.2-40 (median 19.8) U/mL, respectively. All patients' coagulation function, heart size, and ejection fraction (EF) value were normal. After anti-thyroid treatment, the levels of FT3, FT4, and TBIL decreased. Through telephone interview, we were able to know that after 6 months of anti-thyroid treatment, the level of FT3, FT4, and TBIL in these patients returned to normal, and the itch symptom disappeared completely. CONCLUSIONS: Graves' disease can cause cholestasis, with the low incidence. The symptoms of cholestasis can be improved or even eradicated with the cure of the Graves' disease. The cholestasis may be idiopathic. For patients with cholestasis and hyperthyroidism, Graves' disease should be considered for differential diagnosis.


Assuntos
Colestase , Doença de Graves , Adulto , Colestase/etiologia , Feminino , Doença de Graves/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Testes de Função Tireóidea , Tiroxina , Tri-Iodotironina
6.
BMC Gastroenterol ; 21(1): 118, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33711954

RESUMO

BACKGROUND: Investigators from different parts of the world are calling for a re-evaluation of the role of liver biopsy (LB) in the evaluation of infantile cholestasis (IC), especially in the light of emerging non-invasive diagnostic technologies. Therefore, this retrospective single-center study was conducted to determine the impact of LB on the diagnosis and management of IC in a cohort from Arabs. METHODS: From 2007 until 2019, 533 cases of IC were referred for evaluation. All infants who underwent LB were included in the study. We categorized the yield of LB into: (1) defined specific diagnosis; (2) excluded an important diagnosis. A single pathologist reviewed and made the histology report. RESULTS: 122 LB specimens met the inclusion criteria. The main indication for LB was a high suspicion of biliary atresia (BA) [high gamma-glutamyl transferase (GGT) cholestasis and pale stool] in 46 cases (37.8%). Liver biopsy had sensitivity of 86.4%, specificity (66.7%), PPV (70.4%), NPV (84.2%) in diagnosing BA. LB had a direct impact on clinical management in 52 cases (42.6%): (1) The true diagnosis was suggested by LB in 36 cases; (2) LB excluded BA and avoided intraoperative cholangiogram in 16 cases with high suspicion of BA. Among the 76 cases with low suspicion of BA, LB suggested the true diagnosis or helped to initiate specific management in 8 cases only (10.5%). In contrast, molecular testing confirmed the diagnosis in 48 (63%). CONCLUSION: LB continues to be an important tool in the workup of cases with a high suspicion of BA. The low yield of LB in cases with low suspicion of BA calls for a re-evaluation of its role in these cases in whom early incorporation of cholestasis sequencing gene  panels can have a better diagnostic yield.


Assuntos
Árabes , Colestase , Biópsia , Colestase/diagnóstico , Colestase/etiologia , Diagnóstico Diferencial , Humanos , Lactente , Fígado , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 100(12): e25268, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761729

RESUMO

INTRODUCTION: In patients with malignant distal bile duct obstruction and normal gastrointestinal anatomy, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is indicated when endoscopic retrograde cholangiopancreatography (ERCP) fails. The ERCP drainage route passes through the tumor, whereas the EUS-CDS route does not. Therefore, EUS-CDS is expected to have a longer stent patency than ERCP. However, for first-line biliary drainage, it remains unclear whether EUS-CDS or ERCP is superior in terms of stent patency. To reduce the frequency of highly adverse events (AEs) such as bile peritonitis or stent migration following EUS-CDS, we developed an antimigration metal stent with a thin delivery system for tract dilatation. This study is designed to assess whether EUS-CDS with this novel stent is superior to ERCP with a traditional metal stent in terms of stent patency when the two techniques are used for first-line drainage of malignant distal biliary obstruction. METHODS/DESIGN: This study is a multicenter single-blinded randomized controlled trial (RCT) involving 95 patients in four tertiary centers. Patients with malignant distal biliary obstruction that is unresectable or presents a very high surgical risk and who pass the inclusion and exclusion criteria will be randomized to EUS-CDS or ERCP in a 1:1 proportion. The primary endpoint is the stent patency rate 180 days after stent insertion. Secondary outcomes include the rates of technical success, clinical success, technical success in cases not requiring fistulous-tract dilation (only EUS-CDS group), procedure-related AEs, re-intervention success, patients receiving post-drainage chemotherapy, procedure time, and overall survival time. DISCUSSION: If EUS-CDS is superior to ERCP in terms of stent patency and safety for the first-line drainage of malignant distal biliary obstruction, it is expected that the first-line drainage method will be changed from ERCP to EUS-CDS, and that interruption of chemotherapy due to stent dysfunction can be avoided. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000041343. Registered on August 6, 2020. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047201Version number: 1.2, December 7, 2020.


Assuntos
Neoplasias dos Ductos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Coledocostomia , Colestase , Endossonografia/métodos , Peritonite , Complicações Pós-Operatórias , Stents , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/patologia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocostomia/efeitos adversos , Coledocostomia/instrumentação , Coledocostomia/métodos , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/cirurgia , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Peritonite/etiologia , Peritonite/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Falha de Prótese , Cirurgia Assistida por Computador/métodos
8.
Nutrients ; 13(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33557154

RESUMO

Total parenteral nutrition (TPN) is a life-saving intervention for infants that are unable to feed by mouth. Infants that remain on TPN for extended periods of time are at risk for the development of liver injury in the form of parenteral nutrition associated cholestasis (PNAC). Current research suggests the lipid component of TPN is a factor in the development of PNAC. Most notably, the fatty acid composition, vitamin E concentration, and presence of phytosterols are believed key mediators of lipid emulsion driven PNAC development. New emulsions comprised of fish oil and medium chain triglycerides show promise for reducing the incidence of PNAC in infants. In this review we will cover the current clinical studies on the benefit of fish oil and medium chain triglyceride containing lipid emulsions on the development of PNAC, the current constituents of lipid emulsions that may modulate the prevalence of PNAC, and potential new supplements to TPN to further reduce the incidence of PNAC.


Assuntos
Colestase/etiologia , Emulsões Gordurosas Intravenosas/administração & dosagem , Emulsões Gordurosas Intravenosas/efeitos adversos , Hepatopatias/etiologia , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/métodos , Humanos , Recém-Nascido
9.
Medicine (Baltimore) ; 100(3): e23938, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545967

RESUMO

ABSTRACT: This study was designed as a means of comparing the clinical efficacy and long-term outcomes of covered vs bare stent insertion as a treatment for distal malignant biliary obstruction (DMBO) caused by primary common biliary cancer (PCBC).This retrospective study was designed using data collected between January 2012 and December 2019 to assess the short- and long-term outcomes in patients with DMBO caused by PCBC treated by inserting either bare or covered stents were compared.Ninety two patients with DMBO caused by PCBC were divided between bare (n = 51) or covered (n = 41) stent groups. Technical success rates in both groups were 100%. Clinical success of bare vs covered stent use were 96.1% and 97.6% (P = 1.00). Stent dysfunction was seen in 17 and 6 patients in the bare and covered stent groups, respectively (P = .04). The median stent patency for bare and covered stents was 177 and 195 days, respectively (P = .51). The median survival was 188 and 200 days in the bare and covered stent groups, respectively (P = .85).For patients with DMBO caused by PCBC, using bare vs covered stents yields similar clinical efficacy and long term outcomes.


Assuntos
Colestase/etiologia , Neoplasias do Ducto Colédoco/cirurgia , Stents/classificação , Stents/normas , Idoso , Idoso de 80 Anos ou mais , Colestase/fisiopatologia , Feminino , Eliminação Hepatobiliar , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Implantação de Prótese/métodos , Implantação de Prótese/normas , Implantação de Prótese/estatística & dados numéricos , Estudos Retrospectivos , Stents/estatística & dados numéricos , Resultado do Tratamento
10.
BMC Gastroenterol ; 21(1): 28, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441096

RESUMO

BACKGROUND: Only a few reports have assessed the effectiveness of endoscopic biliary drainage (EBD) in hepatocellular carcinoma (HCC) patients with obstructive jaundice and liver dysfunction. METHODS: This was a retrospective study based on the clinical databases from the Okayama University Hospital and 10 affiliated hospitals. All patients received EBD for jaundice or liver dysfunction. The indication for EBD was aggravation of jaundice or liver dysfunction with intrahepatic bile duct (IHBD) dilation. The technical and clinical success rate, complications, factors associated with clinical failure, and survival duration were evaluated. RESULTS: A total of 107 patients were enrolled in this study. Technical success was achieved in 105 of 107 patients (98.1%). Clinical success was achieved in 85 of 105 patients (81%). Complications related to endoscopic retrograde cholangiography (ERC) occurred in 3 (2.8%) patients. Child-Pugh class C (odds ratio 3.90, 95% confidence interval [CI] 1.47-10.4, p = 0.0046) was the only factor associated with clinical failure, irrespective of successful drainage. The median survival duration was significantly longer in patients with clinical success than in those without clinical success (5.0 months vs. 0.93 months; hazard ratio [HR] 3.2, 95% CI 1.87-5.37). HCC Stage I/II/III (HR 0.57, CI 0.34-0.95, p = 0.032), absence of portal thrombosis (HR 0.52, CI 0.32-0.85, p = 0.0099), and clinical success (HR 0.39, CI 0.21-0.70, p = 0.0018) were significant factors associated with a long survival. CONCLUSIONS: EBD for obstructive jaundice and liver dysfunction in patients with HCC can be performed safely with a high technical success rate. Clinical success can improve the survival duration, even in patients expected to have a poor prognosis. TRIAL REGISTRATION: Retrospectively registered.


Assuntos
Carcinoma Hepatocelular , Colestase , Icterícia Obstrutiva , Neoplasias Hepáticas , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colestase/etiologia , Colestase/terapia , Drenagem , Humanos , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/terapia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/terapia , Estudos Retrospectivos , Resultado do Tratamento
11.
J Infect Chemother ; 27(2): 390-392, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33402301

RESUMO

Favipiravir is an antiviral drug that is expected to have a therapeutic effect on SARS-CoV2 infection. Teratogenicity and hyperuricemia are known as the main side effects of favipiravir, but little is known about other side effects. This report describes a case of cholestatic liver injury induced by favipiravir. A 73-year-old Japanese with a history of alcoholic hepatitis was infected with SARS-CoV2. Drug therapy was instituted with lopinavir/ritonavir combined with interferon ß-1b. However, his condition worsened despite additional support with continuous hemodiafiltration and veno-venous extracorporeal membrane oxygenation. We suspected complications of bacterial pneumonia and started favipiravir in addition to antimicrobial therapy. Favipiravir was administered at 6000 mg/day on the first day and 2400 mg/day for the second and subsequent days for 14 days. After the initiation of antibiotics, transaminase and total bilirubin were elevated, suggesting a transient cholestasic liver dysfunction. The liver dysfunction in this case may have been triggered by antibacterial treatment, and high dose of favipiravir may have promoted the deterioration of liver function. Monitoring of liver function is vital and close attention should be paid when using favipiravir at high doses or in patients with impaired liver function.


Assuntos
Amidas/efeitos adversos , Antivirais/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Colestase/etiologia , Pirazinas/efeitos adversos , Idoso , Amidas/uso terapêutico , Antivirais/uso terapêutico , Quimioterapia Combinada , Oxigenação por Membrana Extracorpórea , Humanos , Lopinavir/uso terapêutico , Masculino , Pirazinas/uso terapêutico , Ritonavir/uso terapêutico
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(1): 94-100, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33461259

RESUMO

Intestinal failure (IF) is defined as the critical reduction of functional intestines below the minimum needed to absorb nutrients and fluids, so that intravenous supplementation with parenteral nutrition (PN) is required to maintain health and/or growth. Although the benefits are evident, patients receiving PN can suffer from serious cholestasis due to lack of enteral feeding and small intestinal bacterial overgrowth (SIBO). One such complication that may arise is intestinal failure-associated liver disease (IFALD). Evidences from recent studies suggest that alterations in the intestinal microbiota, as well as intraluminal bile acid driven signaling, may play a critical role in both hepatic and intestinal injury. Since Marshall first proposed the concept of the gut-liver axis in 1998, the role of gut-liver axis disorders in the development of IFALD has received considerable attention. The conversation between gut and liver is the key to maintain liver metabolism and intestinal homeostasis, which influences each other and is reciprocal causation. However, as a "forgotten organ" , intestinal microbiota on the pathogenesis of IFALD has not been well reflected. As such, we propose, for the first time, the concept of gut-microbiota-liver axis to emphasize the importance of intestinal microbiota in the interaction of gut-liver axis. Analysis and research on gut-microbiota-liver axis will be of great significance for understanding the pathogenesis of IFALD and improving the prevention and treatment measures.


Assuntos
Microbioma Gastrointestinal , Enteropatias , Hepatopatias , Fígado/fisiopatologia , Nutrição Parenteral/efeitos adversos , Síndrome do Intestino Curto/fisiopatologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/fisiopatologia , Ácidos e Sais Biliares/fisiologia , Colestase/etiologia , Colestase/microbiologia , Colestase/fisiopatologia , Nutrição Enteral , Microbioma Gastrointestinal/fisiologia , Humanos , Enteropatias/etiologia , Enteropatias/microbiologia , Enteropatias/fisiopatologia , Intestinos/microbiologia , Intestinos/fisiologia , Intestinos/fisiopatologia , Fígado/microbiologia , Fígado/fisiologia , Hepatopatias/etiologia , Hepatopatias/microbiologia , Hepatopatias/fisiopatologia , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/dietoterapia , Transdução de Sinais
14.
J Postgrad Med ; 66(4): 209-211, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33037167

RESUMO

Cavernomatous transformation of the portal vein, seen in extrahepatic portal venous obstruction (EHPVO), can cause impingement or ischemic insult on bile ducts manifesting as "portal cavernoma cholangiopathy" (PCC). Bile duct wall calcification in portal biliopathy is a rare occurrence and has not been reported in the literature to the best of our knowledge. We report a 59-year-old male, a known case of EHPVO, who had undergone laparoscopic cholecystectomy, splenectomy, and splenorenal shunt in the past. The patient had now presented to us in view of recurrent episodes of cholangitis for which a bilioenteric bypass was planned. Intraoperatively, dilated and densely thickened bile ducts with multiple pericholedochal collaterals were noted. Incision of common hepatic duct and left hepatic duct showed completely calcified ductal wall with no visible healthy mucosa. Calcifications were removed partially from the bile duct walls near choledochotomy site. With the anticipation of futile benefit from bilioenteric bypass, Roux-en-Y HJ was abandoned. Hepaticoduodenostomy was done to prevent bile leak from choledochotomy site.


Assuntos
Ductos Biliares/cirurgia , Colangite/diagnóstico , Colestase/etiologia , Doenças do Ducto Colédoco/etiologia , Hipertensão Portal/complicações , Icterícia/etiologia , Ductos Biliares/diagnóstico por imagem , Coledocostomia , Colestase/diagnóstico por imagem , Doenças do Ducto Colédoco/diagnóstico por imagem , Humanos , Hipertensão Portal/cirurgia , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(27): e21111, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629744

RESUMO

RATIONALE: Intermittent combined pancreaticobiliary obstruction may lead to multiple episodes of ascending cholangitis and pancreatitis, usually due to choledocholithiasis or periampullary mass. However, one of the rare causes is periampullary or juxtapapillary duodenal diverticulum. Although duodenal diverticula are relatively common in the general population, the overwhelming majority are asymptomatic. Duodenal diverticula can cause combined pancreaticobiliary obstruction through multiple mechanisms such as stasis-induced primary choledocholithiasis, stasis-induced intradiverticular enterolith, or longstanding diverticulitis, causing stenosing fibrosing papillitis or a combination of more than one of these mechanisms. Herein, I report a case of Lemmel syndrome due to a combination of multiple mechanisms and review the available literature on the epidemiology, pathogenesis, clinical presentation, diagnostic work-up, and management of juxtapapillary duodenal diverticulum. PATIENT CONCERNS: Multiple episodes of abdominal pain, jaundice, anorexia, fever, and significant unintentional weight loss. DIAGNOSES AND INTERVENTIONS: Primary choledocholithiasis, recurrent ascending cholangitis, recurrent acute pancreatitis, and pancreatic atrophy due to giant juxtapapillary duodenal diverticulum, with unsuccessful endoscopic retrograde cholangiopancreatography that was completely resolved after open transduodenal sphincteroplasty and septoplasty, transampullary and transcystic common bile duct exploration and stone extraction, and duodenal diverticular inversion. OUTCOME: Complete resolution of combined pancreaticobiliary obstruction without recurrence for 2 years after surgery. LESSONS: Surgeons should be aware of such rare syndromes to avoid misdiagnosis and delayed or inappropriate management. Furthermore, they should understand the different available operative options for cases that are refractory to endoscopic approach.


Assuntos
Colangite/complicações , Divertículo/complicações , Icterícia/etiologia , Pancreatite/complicações , Dor Abdominal/etiologia , Atrofia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Coledocolitíase/complicações , Colestase/etiologia , Colestase/patologia , Diverticulite/complicações , Divertículo/patologia , Divertículo/cirurgia , Neoplasias Duodenais/patologia , Feminino , Humanos , Indonésia/etnologia , Pancreatopatias/patologia , Recidiva , Esfincterotomia Transduodenal/métodos , Resultado do Tratamento , Adulto Jovem
19.
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
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