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1.
World J Gastroenterol ; 25(40): 6107-6115, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31686766

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in pediatric patients with cholangiopancreatic diseases. AIM: To evaluate the efficacy, safety, and long-term follow-up results of ERCP in symptomatic pancreaticobiliary maljunction (PBM). METHODS: A multicenter, retrospective study was conducted on 75 pediatric patients who were diagnosed with PBM and underwent therapeutic ERCP at three endoscopy centers between January 2008 and March 2019. They were divided into four PBM groups based on the fluoroscopy in ERCP. Their clinical characteristics, specific ERCP procedures, adverse events, and long-term follow-up results were retrospectively reviewed. RESULTS: Totally, 112 ERCPs were performed on the 75 children with symptomatic PBM. Clinical manifestations included abdominal pain (62/75, 82.7%), vomiting (35/75, 46.7%), acholic stool (4/75, 5.3%), fever (3/75, 4.0%), acute pancreatitis (47/75, 62.7%), hyperbilirubinemia (13/75, 17.3%), and elevated liver enzymes (22/75, 29.3%). ERCP interventions included endoscopic sphincterotomy, endoscopic retrograde biliary or pancreatic drainage, stone extraction, etc. Procedure-related complications were observed in 12 patients and included post-ERCP pancreatitis (9/75, 12.0%), gastrointestinal bleeding (1/75, 1.3%), and infection (2/75, 2.7%). During a mean follow-up period of 46 mo (range: 2 to 134 mo), ERCP therapy alleviated the biliary obstruction and reduced the incidence of pancreatitis. The overall effective rate of ERCP therapy was 82.4%; seven patients (9.3%) were lost to follow-up, eight (11.8%) re-experienced pancreatitis, and eleven (16.2%) underwent radical surgery, known as prophylactic excision of the extrahepatic bile duct and hepaticojejunostomy. CONCLUSION: ERCP is a safe and effective treatment option to relieve biliary or pancreatic obstruction in symptomatic PBM, with the characteristics of minor trauma, fewer complications, and repeatability.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Má Junção Pancreaticobiliar/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Ductos Biliares/anormalidades , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/cirurgia , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/métodos , Feminino , Fluoroscopia , Seguimentos , Humanos , Lactente , Masculino , Ductos Pancreáticos/anormalidades , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia , Má Junção Pancreaticobiliar/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
3.
Braz J Med Biol Res ; 52(8): e8522, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31365696

RESUMO

Pancreaticobiliary maljunction (PBM) is associated with high risk of epithelial atypical growth and malignant transformation of the bile duct or gallbladder. However, overall changes in genetic expression have not been examined in children with PBM. Genome-wide expression was analyzed using peripheral blood samples from 10 children with PBM and 15 pediatric controls. Differentially expressed genes (DEGs) were identified using microarray. Bioinformatics analysis was conducted using Gene Ontology and KEGG analyses. The top 5 in the up-regulated genes in PBM were verified with qRT-PCR. Receiver operator characteristic curve analysis was conducted to evaluate the predictive accuracy of selected genes for PBM. The microarray experiments identified a total of 876 DEGs in PBM, among which 530 were up-regulated and the remaining 346 were down-regulated. Verification of the top 5 up-regulated genes (TYMS, MYBPC1, FUT1, XAGE2, and GREB1L) by qRT-PCR confirmed the up-regulation of MYBPC1 and FUT1. Receiver operating characteristic curve analysis suggested that FUT1 and MYBPC1 up-regulation could be used to predict PBM, with the area under the curve of 0.873 (95%CI=0.735-1.000) and 0.960 (95%CI=0.891-1.000), respectively. FUT1 and MYBPC1 were up-regulated in children with PBM, and could be used as potential biomarkers for PBM.


Assuntos
Ductos Biliares/anormalidades , Proteínas de Transporte/genética , Fucosiltransferases/genética , Perfilação da Expressão Gênica , Ductos Pancreáticos/anormalidades , Regulação para Cima/genética , Neoplasias dos Ductos Biliares/etiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Dilatação Patológica/complicações , Dilatação Patológica/congênito , Feminino , Neoplasias da Vesícula Biliar/etiologia , Humanos , Lactente , Masculino , Análise em Microsséries
5.
Hepatobiliary Pancreat Dis Int ; 18(4): 332-336, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31155429

RESUMO

BACKGROUND: Pancreas divisum is a congenital embryological disease caused by a lack of fusion between the ventral and dorsal pancreatic ducts in the early stages of embryogenesis. Recurrent acute pancreatitis, chronic pancreatitis or chronic abdominal pain are the main clinical syndromes at presentation and occur in only 5% of the patients with pancreas divisum. This review aimed to discuss diagnosis and treatment strategies in patients with symptomatic pancreas divisum. DATA SOURCES: We report a literature review from 1990 up to January 2018 to explore the various diagnostic modalities and surgical techniques and results reported in the surgical treatment of pancreas divisum. RESULTS: There are limited reports available on this topic in the literature. We analyzed and described the main indications in the treatment of pancreas divisum, focusing on surgical treatment and a discussion of the different approaches. Furthermore, we report the results from our experience in two cases of pancreas divisum treated by pancreatic head resection with segmental duodenectomy (the Nakao procedure). CONCLUSIONS: Pancreas divisum is a common pancreatic malformation in which only a few patients develop a symptomatic disease. Surgical treatment is needed in case of endoscopic drainage failure and in cases complicated with chronic pancreatitis and local complications. Many techniques, of greater or lesser complexity, have been proposed.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Anormalidades do Sistema Digestório/diagnóstico por imagem , Anormalidades do Sistema Digestório/cirurgia , Pancreatectomia , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia , Pancreaticoduodenectomia , Dor Abdominal/etiologia , Adulto , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Dor Crônica/etiologia , Anormalidades do Sistema Digestório/complicações , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/efeitos adversos , Ductos Pancreáticos/anormalidades , Pancreaticoduodenectomia/efeitos adversos , Pancreatite Crônica/etiologia , Recidiva , Resultado do Tratamento
7.
Histopathology ; 75(3): 365-375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30882917

RESUMO

AIMS: To investigate whether genetic or inflammatory pro-oncogenic factors are relevant to the increased risk of gallbladder cancers in patients with pancreaticobiliary maljunction (PBM). METHODS AND RESULTS: Mutations in KRAS exon 2 were examined by a highly sensitive, droplet digital PCR platform using surgically resected specimens of PBM-associated (n = 31) and non-associated gallbladder cancers (n = 49). The tissue expression of IL-6 and IL-33, which are suspected to promote biliary carcinogenesis, was analysed by quantitative real-time PCR and in-situ hybridisation. The incidence of KRAS mutations was similarly low in PBM-associated (five of 32 cases; 16%) and non-associated cancers (four of 49 cases; 8%) (P = 0.272). The tissue expression of IL-33 mRNA, but not IL-6 mRNA, was significantly higher in PBM-associated gallbladder cancers than in gallbladder cancers without PBM (P = 0.004). A similar degree of IL-33 overexpression was also observed in the background non-cancerous mucosa in cases of PBM-associated gallbladder cancers, and was significantly greater than that in PBM cases with cholecystitis alone (P < 0.001). The results of in-situ hybridisation indicated that the source of IL-33 production in PBM-associated carcinomas was the endothelium, cancer cells and non-neoplastic biliary epithelium. In a combined PBM-associated and non-associated cohort, IL-33 overexpression in gallbladder cancers correlated with less aggressive features (e.g. a lower pT stage and longer overall survival), similar to recently reported findings on large-duct cholangiocarcinomas. CONCLUSIONS: KRAS mutations do not appear to be associated with a high risk of malignancy in PBM, while IL-33 overexpression may provide a pro-oncogenic microenvironment in the gallbladder mucosa of patients with PBM.


Assuntos
Ducto Colédoco/anormalidades , Neoplasias da Vesícula Biliar/patologia , Interleucina-33/biossíntese , Ductos Pancreáticos/anormalidades , Idoso , Feminino , Neoplasias da Vesícula Biliar/genética , Neoplasias da Vesícula Biliar/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Proteínas Proto-Oncogênicas p21(ras)/genética , Regulação para Cima
8.
Nihon Shokakibyo Gakkai Zasshi ; 116(3): 241-248, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30853677

RESUMO

A 71-year-old female with non-dilated pancreaticobiliary maljunction (PBM) and gallbladder polypoid lesions underwent laparoscopic cholecystectomy. Histological examination of the polypoid lesions revealed gallbladder cancer. Five years after cholecystectomy, gradual dilatation of the main pancreatic duct (MPD) led to the identification of a papillary tumor growing in the MPD of the pancreatic head. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Pathological examination revealed a papillary tumor with focal invasion to the MPD. Immunohistochemically, the tumor cells were positive for MUC1 and MUC5AC and negative for MUC2. Therefore, the definitive diagnosis was pancreatobiliary-type intraductal papillary mucinous carcinoma. This case emphasizes the significance of surveillance for potential cancer of the pancreas as well as the biliary tract in patients with PBM.


Assuntos
Adenocarcinoma Mucinoso/cirurgia , Adenocarcinoma Papilar/cirurgia , Colecistectomia , Neoplasias da Vesícula Biliar/cirurgia , Ductos Pancreáticos/anormalidades , Idoso , Feminino , Humanos
10.
Digestion ; 100(3): 152-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30630169

RESUMO

BACKGROUND: Several guidelines recommend the risk-adapted monitoring of patients with chronic pancreatitis (CP). However, dedicated risk stratification is widely missing in CP. Elderly-CP (disease onset with 60 or more years of age) may represent a subgroup of CP subjects with a distinct course of disease. AIMS: We aimed to investigate the clinical presentation of elderly-CP, and if elderly-CP requires an adapted monitoring. METHODS: Seven hundred forty one patients with CP were analyzed in a multicenter (Mannheim/Germany, n = 537; Gießen/Germany, n = 100; Donetsk/Ukraine, n = 104), cross-sectional, retrospective study and classified according to the M-ANNHEIM classification. RESULTS: The frequency of elderly-CP was 20% (148/741). In comparison with non-elderly-CP, elderly-CP was less frequently caused by alcohol and nicotine dependency or genetic mutations. In contrast, the frequency of efferent duct abnormalities (p = 0.009, chi-square test) and idiopathic CP (p < 0.0001, chi-square test) increased significantly. The presence of multiple risk factors was found less frequently in elderly-CP than in non-elderly patients (p < 0.0001; chi-square test). Furthermore, elderly-CP was associated with increased rates of pseudocysts (p = 0.0002; chi-square test), endocrine insufficiency (p = 0.001; chi-square test), and the absence of pain (p = 0.04; chi-square test) in the first year of the disease. CONCLUSION: In elderly-CP, the course of disease significantly differs from non-elderly-CP. Therefore, individualized monitoring strategies for elderly-CP might be necessary.


Assuntos
Ilhotas Pancreáticas/patologia , Ductos Pancreáticos/anormalidades , Pseudocisto Pancreático/epidemiologia , Pancreatite Crônica/complicações , Fatores Etários , Idade de Início , Idoso , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Ilhotas Pancreáticas/metabolismo , Masculino , Pessoa de Meia-Idade , Pseudocisto Pancreático/etiologia , Pancreatite Crônica/etiologia , Pancreatite Crônica/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
14.
Rom J Intern Med ; 56(4): 233-242, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30521477

RESUMO

Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. The attention towards the PD has grown significantly since there are reports that this condition may cause acute relapsing pancreatitis, chronic pancreatitis and chronic abdominal pain syndrome. Furthermore, over the years, there have been multiple reports of PD associated with different types of tumors. There is evidence that PD can be associated with pancreatic tumors (up to 12.5% of cases). The golden standard for diagnosing PD is endoscopic retrograde cholangiopancreatography, but since it is an invasive procedure magnetic resonance cholangiopancreatography with secretin is a good alternative. In case the patient is symptomatic, endoscopic or surgical treatment should be performed. This review describes the key points of the pathophysiology, diagnostic modalities, risks of pancreatitis and tumors, as well as treatment options of PD.


Assuntos
Pancreatopatias/etiologia , Ductos Pancreáticos/anormalidades , Variação Anatômica , Humanos , Ductos Pancreáticos/diagnóstico por imagem , Fatores de Risco
15.
Gastrointest Endosc Clin N Am ; 28(4): 455-476, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30241638

RESUMO

Patients with recurrent acute pancreatitis (RAP) have few treatment options available to them to manage their symptoms or prevent progression to chronic pancreatitis. At present, endotherapy is typically pursued as a means to achieve symptom remission and reduce rates of recurrence, hospitalization, abdominal pain, narcotic use, and surgical intervention. However, evidence that endotherapy effectively alters the natural history of disease remains limited. This article reviews the recent literature on the efficacy of endoscopic intervention in the treatment RAP with a focus on high-quality prospective randomized controlled studies. Additional studies are needed to corroborate these findings.


Assuntos
Anormalidades Congênitas/terapia , Endoscopia do Sistema Digestório , Ductos Pancreáticos/anormalidades , Pancreatite/etiologia , Pancreatite/terapia , Disfunção do Esfíncter da Ampola Hepatopancreática/terapia , Esfinterotomia Endoscópica , Doença Aguda , Humanos , Recidiva , Disfunção do Esfíncter da Ampola Hepatopancreática/complicações
17.
BMC Surg ; 18(1): 50, 2018 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-30068344

RESUMO

BACKGROUND: The genesis of the "complex type" classification of pancreaticobiliary maljunction (PBM) is unclear, and the pancreaticobiliary anatomy is also varied according to each case. We encountered a patient with PBM and incomplete pancreatic divisum (PD). We herein discussed about the embryological etiology of pancreaticobiliary system predicted from PBM with incomplete PD. CASE PRESENTATION: A 67-year-old man was found to have a dilatation of the common bile duct (CBD) during a medical examination at 62 years of age. The dilatation of the CBD subsequently progressed, and he was admitted to our hospital for surgical treatment. Magnetic resonance cholangiopancreatography revealed a dilatation from the common hepatic duct to the middle bile duct with PBM. Endoscopic retrograde cholangiopancreatography from the papilla of Vater revealed the pancreatic main duct via the pancreatic branch duct, and PBM with dilatation of the CBD and incomplete PD were revealed. We performed an extrahepatic bile duct resection and hepaticojejunostomy because of high risk of malignant transformation. Taping and transection of the bile duct without dilatation on the pancreatic side were performed, and thereafter, two orifices of the common channel and ventral pancreatic duct were ligated. The level of amylase in the bile was 7217 IU/L, and a histological examination of the CBD showed an inflammatory change of CBD, not a malignant transformation. CONCLUSION: It is somewhat easy to identify the pancreatobiliary anatomy when the cause of embryology of both PBM and PD is thought to be an abnormal embryology of the ventral pancreas.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Ducto Colédoco/anormalidades , Pâncreas/anormalidades , Idoso , Bile/metabolismo , Ductos Biliares Extra-Hepáticos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Colangiopancreatografia por Ressonância Magnética/métodos , Ducto Hepático Comum/anormalidades , Humanos , Masculino , Ductos Pancreáticos/anormalidades
19.
Pan Afr Med J ; 29: 55, 2018.
Artigo em Francês | MEDLINE | ID: mdl-29875936

RESUMO

This study focused on endoscopic examination of a prominent papilla which showed two separate orifices revealing separate entrance of the main pancreatic duct and of the common bile duct (A). This was the most rare anatomoendoscopic variation, accounting for only 10% of retrograde cholangiopancreatographies using endoscopic approach (ERCP). However, it facilitated selective biliary catheterization (SBC) in our patient, as one might have expected. Papilla had a pseudo polypoid appearance and a biliary orifice (BO) at the right angle toward the duodenal wall; hence this was a more difficult approach than that via the pancreatic orifice (PO) which, on the other hand, required undesired pancreatic catheterization (B). As SBC was the approach we decided to adopt, the special techniques to consider in this particular case were: transpancreatic sphincterotomy (TPS) alone or TPS after implantation of a pancreatic stent (PS). We opted for the second technique (STP + PS) and we noticed that the implantation of a PS resulted in better BO visualization (C). We could perform SBC without recourse to TPS. In this specific case, as in other cases of difficult SBC in our practice, PS has proven effectiveness.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Ducto Colédoco/cirurgia , Ductos Pancreáticos/cirurgia , Stents , Cateterismo , Ducto Colédoco/anormalidades , Humanos , Ductos Pancreáticos/anormalidades , Esfinterotomia Endoscópica/métodos
20.
Diagn Interv Radiol ; 24(2): 72-76, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29757145

RESUMO

PURPOSE: We aimed to evaluate the frequency of bile duct branching pattern variations at the hepatic confluence in patients with pancreas divisum (PD). METHODS: A search was performed through the hospital database using the keyword "pancreas divisum" to identify patients. The magnetic resonance cholangiopancreatography (MRCP) images of 137 patients who were diagnosed with PD between August 2011 and November 2016 were retrospectively analyzed for the presence of bile duct variations. A control group of 137 patients without PD was established among patients investigated during the same period. Variations of the biliary tract were grouped into seven types according to the McSweeney et al. classification. RESULTS: Biliary tract variations were detected in 103 of a total of 274 patients. Fifty-eight PD patients (42.3%) and 45 control patients (32.8%) had bile duct variation at the hepatic confluence level. The patients with PD were more likely to have biliary tract variation compared with the control group; however, it was not statistically significant (P = 0.105). The most common variation in PD patients was type 3a variation (16.8%). CONCLUSION: MRCP studies showed atypical bile duct confluence pattern in nearly half of both PD patients and controls. There was no statistically significant difference in the frequency of anatomic variations at bile duct confluence in patients with PD versus those without PD. Derivation of these structures from different outpouchings in early embryological life may explain this insignificant difference.


Assuntos
Ductos Biliares/diagnóstico por imagem , Colangiopancreatografia por Ressonância Magnética/métodos , Pâncreas/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Doença Aguda , Adulto , Idoso , Ductos Biliares/anormalidades , Ductos Biliares/embriologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Ductos Pancreáticos/anormalidades , Ductos Pancreáticos/embriologia , Pancreatite/complicações , Pancreatite/diagnóstico por imagem , Pancreatite/patologia , Estudos Retrospectivos
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