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1.
Turk J Gastroenterol ; 33(9): 760-766, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36134551

RESUMO

BACKGROUND: The aim of this study was to determine the prevalence and factors associated with gallbladder stone in patients with predialysis chronic kidney disease. METHODS: This cross-sectional study retrospectively examined follow-up data of patients with chronic kidney disease between January 2015 and December 2020 at the Health Sciences University Antalya Training and Research Hospital who had undergone abdominal ultrasonography for any reason. Patients with gallbladder stone on abdominal ultrasonography and history of cholecystectomy due to gallbladder stone were identified as the gallstone group. The prevalence of gallbladder stone was determined according to disease stage. Patients with and without gallbladder stone were compared in terms of demographic and clinical characteristics and laboratory parameters that may be associated with the development of gallbladder stone. RESULTS: A total of 511 patients had chronic kidney disease (stages 3, 4, and 5 in 303 [59.3%], 176 [34.4%], and 32 [6.3%], respectively). The gallstone prevalence rates were 25.1%, 30.1%, and 46.9% in stage 3, 4, and 5 chronic kidney disease, respectively, and that in all the patients was 28.2% (95% CI: 24.3-32.3, P = .026). Logistic regression analysis revealed that increased age (odds ratio: 1.045; 95% CI: 1.027-1.063, P < .001) and decreased estimated glomerular filtration rate (odds ratio: 0.974; 95% CI: 0.956-0.991, P = .004) were associated with gallbladder stone. CONCLUSION: The prevalence of gallbladder stone was high in the predialysis patients with chronic kidney disease and increased with increasing disease stage. High age and low estimated glomerular filtration rate were associated with gallbladder stone formation.


Assuntos
Cálculos Biliares , Insuficiência Renal Crônica , Estudos Transversais , Vesícula Biliar , Cálculos Biliares/complicações , Cálculos Biliares/epidemiologia , Humanos , Prevalência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco
3.
Adv Surg ; 56(1): 37-48, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36096576

RESUMO

Intraoperative cholangiography (IOC) is an essential skill that surgeons need for the safe performance of cholecystectomy and intraoperative diagnosis and management of bile duct stones. Whether it should be performed routinely or selectively is an ongoing debate that goes back to the early days of laparoscopic cholecystectomy (LC). Benefits of IOC include ability to detect bile duct stones, recognition of aberrant anatomy, and, in some circumstances, mitigation of the risk of bile duct injury. In this review, key aspects of this debate, technical aspects of performing IOC, evidence regarding its benefits, and imaging alternatives to IOC during LC are presented.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares , Colangiografia/métodos , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos
4.
Arq Gastroenterol ; 59(3): 352-357, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36102431

RESUMO

BACKGROUND: Gallstones are the presence of bile clay in the gallbladder or bile ducts. The disease can be asymptomatic or symptomatic and can lead to complications and consequently a worse prognosis, such as acute cholecystitis, choledocholithiasis, cholangitis, and acute pancreatitis. The risk of complications increases after the first episode of biliary colic. OBJECTIVE: A clinical-epidemiological evaluation of patients admitted to a gastroenterology ward of a tertiary care hospital with gallstone-related complications. METHODS: We evaluated 158 patients admitted through discharge reports and medical records analysis from January 1, 2013, to February 24, 2021. RESULTS: The female sex was predominant (76.6%), and the mean age of patients was 51.6 years. Men were significantly older than women (P=0.005). Most (57.6%) had some comorbidity, the most frequent being systemic arterial hypertension, diabetes mellitus, and obesity. The mean hospitalization time was 24 days, significantly longer in men (P=0.046) but without a direct relationship with age (P=0.414). The most frequent complication was choledocholithiasis, and 55.7% of patients without previous cholecystectomy had a report of biliary colic before admission, on average 1.5 years previously. A history of a prior cholecystectomy was present in 17.1% of those evaluated. Abdominal ultrasonography followed by magnetic resonance cholangiography was the most frequently performed exam for diagnostic definition. Regarding therapeutic measures, endoscopic retrograde cholangiopancreatography was necessary for 47.3% of patients without previous cholecystectomy and 81.4% of patients who have already had a cholecystectomy. Among patients not yet cholecystectomized, 84% underwent the procedure before discharge. CONCLUSION: The female patients were predominant. Men were significantly older than women and had more extended hospital stays. The most frequent complication was choledocholithiasis, and around half of the patients reported previous biliary colic. endoscopic retrograde cholangiopancreatography has been necessary for the majority of the patients.


Assuntos
Coledocolitíase , Cólica , Cálculos Biliares , Pancreatite , Doença Aguda , Coledocolitíase/complicações , Coledocolitíase/epidemiologia , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/epidemiologia , Centros de Atenção Terciária
5.
Tokai J Exp Clin Med ; 47(3): 143-148, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36073287

RESUMO

OBJECTIVE: Endoscopic removal is recommended for common bile duct stones (CBDs). However, in patients with asymptomatic CBDs, follow-up without treatment may be recommended because of the increased complication risks associated with asymptomatic CBDs removal. The objective of our study was to investigate the efficacy and safety of CBDs removal in asymptomatic patients. METHODS: Consecutive patients with naive papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of CBDs from April 2016 to August 2020 were retrospectively analyzed. We compared the efficacy and safety of CBDs removal in asymptomatic and symptomatic patients. RESULTS: We enrolled 300 patients, 53 asymptomatic and 247 symptomatic patients. Endoscopic CBDs removal was successful in all patients, except one symptomatic patient. However, the complete stone removal rate in a single session was significantly higher in the asymptomatic group than that in the symptomatic group. ERCP-related complications did not differ between the asymptomatic and symptomatic patients. The incidence of post-ERCP pancreatitis was similar and liver cirrhosis was the only significant risk factor for pancreatitis. CONCLUSION: Complication risks associated with endoscopic CBDs removal was not significantly different between asymptomatic and symptomatic patients. Liver cirrhosis was a significant risk factor of ERCP-related pancreatitis.


Assuntos
Cálculos Biliares , Pancreatite , Ducto Colédoco , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Cirrose Hepática/complicações , Pancreatite/etiologia , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 101(35): e30312, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107600

RESUMO

INTRODUCTION: Therapeutic laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography (LA-ERCP) is a safe and effective technique for patient who are unable to receive endoscopic or percutaneous transhepatic treatment. This procedure shows a high overall success rate in managing pancreaticobiliary complications, comparable to that of ERCP. PATIENT CONCERNS: A 51-year-old man had abdominal pain for 2 days. The patient showed acute calculous cholecystitis and acute cholangitis with distal common bile duct (CBD) stones. We performed laparoscopic cholecystectomy and removed the distal CBD stones through CBD exploration.On the fourth day after the surgery, bile leakage was observed through the surgical drain. DIAGNOSIS: The patient was diagnosed with postoperative bile leakage based on clinical findings. INTERVENTIONS: The patient could not receive ERCP or percutaneous transhepatic biliary drainage because he had severe trismus and limb stiffness after suffering from poliomyelitis. So, we performed LA-ERCP, sphincterotomy, and biliary stent insertion. The fully covered self-expanding metal stent was implanted within the percutaneous gastrostomy site around, and 4 weeks later, the stent was removed during re-ERCP. OUTCOMES: The patient was discharged without any complications. There were no long-term complications noted during the 12-month follow-up. CONCLUSION/LESSONS: Staged LA-ERCP represents a practical strategy for managing bile leakage and offers a novel solution for patients for whom transoral and transhepatic approaches are unsuitable. As a result, clinicians must know techniques for gaining access to the biliary system, such as LA-ERCP.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Cálculos Biliares , Laparoscopia , Bile , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Colecistite Aguda/cirurgia , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
8.
Comput Math Methods Med ; 2022: 4805185, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36051000

RESUMO

Objective: To explore the value of MRI evaluation of indomethacin suppositories in the prevention of pancreatitis and hyperamylasemia in patients with common bile duct calculi after endoscopic retrograde cholangiopancreatography (ERCP) based on image denoising algorithm. Methods: A retrospective analysis in August 2020 to December 2021. Because of the common bile duct calculi hospitalized parallel ERCP operation, 89 cases of patients, according to the different postoperative treatments, were divided into group A (n = 44) and group B (n = 45), in which A set of separate application inhibits the pancreatic enzyme secretion after surgery drug treatment, and B group on the basis of group A linked with indole beauty Xinshuan treatment. The incidence of postoperative pancreatitis and hyperamylasemia was compared between the two groups. The levels of serum amylase were compared between the two groups. Patients in group B were diagnosed with pancreatitis by conventional MRI and MRI with denoising algorithm, respectively, and the imaging characteristics and diagnosis rate differences of the two methods were observed. ROC curve was drawn to evaluate the diagnostic efficacy of MRI denoising algorithm for postoperative pancreatitis and serum amylase level detection for hyperamylasemia. Results: The incidence of postoperative pancreatitis and hyperamylasemia in group B was significantly lower than that in group A (P < 0.05). There were 6 cases of postoperative pancreatitis in group B, 2 cases (33.33%) were diagnosed by conventional MRI, and 5 cases (83.33%) were diagnosed by MRI based on denoising algorithm. Although there was no significant difference in diagnosis rate between the two methods, the number of cases of pancreatitis diagnosed by MRI based on denoising algorithm was slightly higher than that by conventional MRI. Compared with conventional MRI images, MRI images with denoising algorithm showed that the number of cases with pancreatic swelling, the number of cases with pancreatic duct/bile duct dilation, and the number of cases with abdominal effusion were all high (all P < 0.05). ROC results showed that the area under the curve of MRI with denoising algorithm for the diagnosis of postoperative pancreatitis was 0.855, and the sensitivity was 89.40%. The specificity was 83.20%, and the area under the curve of serum amylase for postoperative hyperamylasemia was 0.893, the sensitivity was 89.80%, and the specificity was 85.20%, all of which had high diagnostic efficacy. Conclusion: MRI results of denoising algorithm suggest that indomethacin suppositories can effectively reduce the incidence of postoperative pancreatitis and hyperamylasemia after ERCP, which is worthy of clinical application.


Assuntos
Coledocolitíase , Cálculos Biliares , Hiperamilassemia , Pancreatite , Algoritmos , Amilases , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocolitíase/complicações , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Cálculos Biliares/complicações , Humanos , Hiperamilassemia/complicações , Hiperamilassemia/prevenção & controle , Indometacina/uso terapêutico , Imageamento por Ressonância Magnética , Pancreatite/diagnóstico por imagem , Pancreatite/etiologia , Pancreatite/prevenção & controle , Estudos Retrospectivos , Supositórios
9.
Front Cell Infect Microbiol ; 12: 938581, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36072225

RESUMO

Background: The optimal timing of enteral nutrition (EN) initiation in predicted severe acute gallstone pancreatitis (SAGP) and its influence on disease outcomes are not well known. Methods: We conducted a retrospective study of patients with predicted SAGP treated with endoscopic retrograde cholangiopancreatography and EN. The patients were classified into two groups according to the timing of EN initiation after admission: within 48 h, and more than 48 h. The primary outcome was in-hospital mortality. The secondary outcomes were length of hospital stay, need for intensive care admission, need for surgical intervention, improvements in blood test results after 7-10 days of EN, incidence of pancreatic necrosis and infection, and hospital care costs. The microbiological profiles of infectious complications were also evaluated. Results: Of the 98 patients, 31 and 67 started EN within 48 h, and more than 48 h after admission, respectively. Early EN was associated with a decrease in in-hospital mortality (0 vs. 11.9%; p=0.045), length of hospital stay (median:18 vs. 27 days; p=0.001), need for intensive care admission (3.2% vs. 20.9%; p=0.032), and hospital care costs (median:9,289 vs. 13,518 US$; p=0.007), compared to delayed EN. Moreover, early EN for 7-10 days had more beneficial effects on blood test results than delayed EN, including total protein (p=0.03) and CRP (p=0.006) levels. However, the need for surgical intervention and incidence of pancreatic necrosis did not differ between the two groups. In our study, Gram-negative bacteria were the main responsible pathogens (50.5%). Infection with multidrug-resistant organisms (MDRO) was found in 19.4% of the patients. The most common MDRO was MDR Enterococcus faecium. Early EN was not superior in reducing incidence of infected pancreatic necrosis, bacteremia, polymicrobial infection, or MDROs. Conclusions: In patients with predicted SAGP, early EN is associated with a decrease in in-hospital mortality, length of hospital stay, need of intensive care admission, and hospital care costs, compared to delayed EN. There are no significant benefits of early EN in reducing the rate of infection-related complications. Further studies with larger sample sizes are warranted.


Assuntos
Cálculos Biliares , Pancreatite Necrosante Aguda , Nutrição Enteral/efeitos adversos , Cálculos Biliares/complicações , Cálculos Biliares/terapia , Humanos , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/terapia , Estudos Retrospectivos
10.
Front Cell Infect Microbiol ; 12: 935927, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35982781

RESUMO

Background/Purpose: Currently, there are no effective tools to accurately assess acute biliary pancreatitis (ABP) risk in patients with gallstones. This study aimed to develop an ABP risk nomogram in patients with symptomatic gallstones. Methods: We conducted a retrospective nested case-control study and data on 816 conservatively treated patients with symptomatic gallstones admitted to The First Affiliated Hospital of Harbin Medical University between January 6, 2007 and January 22, 2016 were retrospectively collected. We conducted a propensity-score matched (PSM) analysis based on follow-up time in a ratio of 1:4 between ABP group (n=65) and non-ABP group (n=260). These matched patients were randomly divided into study cohort (n=229) and validation cohort (n=96) according to a ratio of 7:3. In the study cohort, independent risk factors for ABP occurrence identified using Cox regression were included in nomogram. Nomogram performance and discrimination were assessed using the concordance index (C-index), area under the curve (AUC), calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC). The model was also validated in the validation cohort. Results: Nomogram was based on 7 independent risk factors: age, diabetes history, gallbladder wall thickness, gallstone diameter, coexisting common bile duct (CBD) stones, direct bilirubin (DBIL), and white blood cell count (WBC). The C-index of nomogram was 0.888, and the 10-year AUCs of nomogram was 0.955. In the validation cohort, nomogram still had good discrimination (C-index, 0.857; 10-year AUC, 0.814). The calibration curve showed good homogeneity between the prediction by nomogram and the actual observation. DCA and CIC demonstrated that nomogram was clinically useful. Conclusions: The ABP risk nomogram incorporating 7 features is useful to predict ABP risk in symptomatic gallstone patients.


Assuntos
Cálculos Biliares , Pancreatite , Estudos de Casos e Controles , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico , Cálculos Biliares/terapia , Humanos , Nomogramas , Pancreatite/complicações , Pancreatite/diagnóstico , Estudos Retrospectivos
11.
J Coll Physicians Surg Pak ; 32(8): 991-995, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35932121

RESUMO

OBJECTIVE: To evaluate the anatomy of the extrahepatic bile duct and to reveal its importance in the formation of acute calculous cholecystitis (ACC). STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Department of General Surgery and Radiology, Kanuni Sultan Suleyman Training and Research Hospital of the University of Health Sciences, Turkey, between January 2016 and December 2021. METHODOLOGY: The data of the patients treated with ACC were analysed on MRCP by an experienced radiologist. The patients were divided into two groups; asymptomatic gallstones (AsGS, control group) and ACC. The cystic duct, common hepatic duct, and common bile duct lengths and variations in cystic duct opening were measured. Receiver operating characteristics (ROC) analysis was conducted to define a cut-off value and compared categorical results of the two groups by Mann-Whitney U test. RESULTS: One-hundred and seventy-three patients were analysed, one-hundred and seven were females, and 66 were males. The median age was 46 years in the AsGS group and 53 years in the ACC group. It was statistically significant that ACC had a higher median age value than AsGS (p=0.014). In the analysis of extrahepatic variations, cystic duct, common hepatic duct, and common bile duct length, were statistically longer in the calculous cholecystitis group (p<0.001, p=0.022, and p=0.019 respectively). ROC analysis was performed for cystic, common hepatic, and common bile duct length, respectively. Cut-off values ​​were 30.5 mm, 36.5 mm, and 42.5 mm. CONCLUSION: Extrahepatic bile duct variations are of critical importance in ACC surgery. In the data, as the cystic duct and common bile duct lengthens, the possibility of ACC increases. There is need for studies with larger samples. KEY WORDS: Acute calculous cholecystitis, Extrahepatic biliary tract, Anatomical variations, Cholelithiasis.


Assuntos
Ductos Biliares Extra-Hepáticos , Colecistite Aguda , Colecistite , Cálculos Biliares , Ductos Biliares Extra-Hepáticos/diagnóstico por imagem , Estudos de Casos e Controles , Colecistite/diagnóstico por imagem , Colecistite/cirurgia , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Ducto Cístico/diagnóstico por imagem , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
12.
BMC Gastroenterol ; 22(1): 371, 2022 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-35927715

RESUMO

BACKGROUND: International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis. METHOD: 1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery. RESULTS: 725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months. CONCLUSION: Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery. TRIAL REGISTRATION: Not applicable.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Colecistite , Cálculos Biliares , Colecistectomia/efeitos adversos , Colecistectomia/métodos , Colecistite/etiologia , Colecistite Aguda/epidemiologia , Colecistite Aguda/cirurgia , Comorbidade , Cálculos Biliares/complicações , Cálculos Biliares/epidemiologia , Cálculos Biliares/cirurgia , Humanos , Estudos Retrospectivos
13.
Diagn Interv Radiol ; 28(4): 352-358, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35950279

RESUMO

PURPOSE Patients with acute calculus cholecystitis and contraindications to cholecystectomy receive cholecystostomy drainage catheters, many of which remain in place until end of life. This study aims to assess safety, feasibility, and early clinical outcomes of percutaneous cholecystoscopy using the LithoVue endoscope, laser/mechanical cholelithotripsy, and mechanical cholelithotomy for management of symptomatic cholelithiasis. METHODS This was a single-institute retrospective analysis of 17 patients with acute calculus cholecystitis who had contraindications to cholecystectomy, underwent cholecystostomy catheter placement between 2015 and 2017, and stone removal between 2017 and 2018. The LithoVue 7.7- 9.5 F endoscope was used in combination with laser/mechanical cholelithotripsy, mechanical retrograde, and balloon-assisted anterograde cholelithotomy to remove gallstones and common bile duct stones. Surgical contraindications ranged from cardiopulmonary disease to morbid obesity to neoplastic processes. Timing and number of interventions, as well as technical and clinical successes, were assessed. RESULTS The median time interval from cholecystostomy catheter placement to cholelithotripsy was 58 days, after an average of 2 tube exchange procedures. Technical and clinical success were achieved in all patients (stone-free gallbladder and cholecystostomy tube removal). On average, three sessions of cholecystoscopy and laser and mechanical cholelithotripsy were required for complete gallstone extraction. The mean interval time between the first cholelithotripsy session and removal of cholecystostomy was 71.8±60.8 days. There were neither major nor minor procedure-related complications. CONCLUSION Percutaneous cholecystoscopy using the LithoVue endoscope, in combination with laser/ mechanical cholelithotripsy and mechanical cholelithotomy, is feasible, safe, well-tolerated, and was able to remove the cholecystostomy tube in the patients with contraindication to cholecystectomy.


Assuntos
Colecistite Aguda , Cálculos Biliares , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Estudos de Viabilidade , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Lasers , Estudos Retrospectivos , Resultado do Tratamento
14.
Contrast Media Mol Imaging ; 2022: 7737610, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35949700

RESUMO

To reveal the relationship between a group of preoperative biochemical indicators such as GGT, ALP, ALT, AST, TB, and DB and the occurrence of common bile duct stones in patients with negative results of magnetic resonance cholangiopancreatography, a retrospective diagnostic accuracy clinical test is conducted in this study. In order to reduce the missed diagnosis rate of choledocholithiasis and perform more accurate common bile duct exploration, 466 patients who underwent surgical treatment of cholelithiasis from January 2014 to December 2015 have been analyzed retrospectively. Firstly, the confounding factors are corrected through Binary Logistic regression. Then, the diagnostic efficacy of each indicator is measured by the ROC curve among different types of patients. In all patients, the top three individual indicators with the greatest AUC curve area for predicting common bile duct stones can be observed from the results of MRCP, γ-glutamyl transpeptidase, and alkaline phosphatase. Besides, the diagnostic efficiency of the comprehensive evaluation is higher than that of all individual indicators. For MRCP-negative patients, the top three largest AUC curve area of the diagnostic efficacy for choledocholithiasis were GGT, ALP, and DB. For patients who have a suspected diagnosis of secondary choledocholithiasis, the diagnostic efficacy of the combination of imaging results, biochemical indexes, common bile duct width, and other abnormal indicators for choledocholithiasis is much higher than that of the single abnormal biochemical indexes for the prediction of choledocholithiasis. For MRCP-negative patients, GGT, ALP, DB, and the width of common bile duct diameter are valuable for the prediction of common bile duct stones, and GGT is the most valuable diagnostic predictor.


Assuntos
Coledocolitíase , Cálculos Biliares , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangiopancreatografia por Ressonância Magnética , Coledocolitíase/complicações , Coledocolitíase/diagnóstico por imagem , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Humanos , Imageamento por Ressonância Magnética/métodos , Resultados Negativos , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
BMC Surg ; 22(1): 317, 2022 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-35978331

RESUMO

BACKGROUND: Laparoscopic cholecystectomy is a common surgical option for gallstone disease with minimal trauma and rapid recovery. Ascites is a relatively uncommon complication after laparoscopic cholecystectomy and is more frequently observed in patients with preoperative abnormal liver function. However, patients without underlying liver disease develop refractory ascites after laparoscopic cholecystectomy are rare. We report a case of massive ascites caused by lymphatic injury after laparoscopic cholecystectomy. CASE PRESENTATION: A 63-year-old woman complained of abdominal discomfort and distension at the twelfth day after a laparoscopic cholecystectomy for gallbladder stones. Subsequently, the patient developed spontaneous bacterial peritonitis and a decreased output of urine. Abdominal computed tomography (CT) identified abdominal effusion. The patient received abdominocentesis and the volume of slightly turbid yellow ascites averaged 1500-2000 ml per day. The results of laboratory analysis of ascitic fluid showed the following: serum-ascites albumin-gradient (SAAG), 11-12 g/L; albumin, 11-14 g/L; triglycerides, 0.91 mmol/L. After the diuretic therapy, repeated large-volume paracentesis with albumin supplementation, administration of antibiotics and renal vasodilating medications, the patient's symptoms did not relieve. Lymphoscintigraphy found a small amount of radioactive filling in the abdominal cavity. The patient finally received surgery with detection and ligation of the lymphatic leak. The ascites disappeared and the patient recovered well. CONCLUSIONS: For patients with atypical characteristics of chylous ascites, lymphoscintigraphy could help to localize and qualify the diagnosis. Surgical treatment could be considered when conservative treatment fails.


Assuntos
Colecistectomia Laparoscópica , Ascite Quilosa , Cálculos Biliares , Albuminas , Ascite/etiologia , Ascite/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Ascite Quilosa/diagnóstico , Ascite Quilosa/etiologia , Ascite Quilosa/terapia , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Pessoa de Meia-Idade
16.
J Am Coll Surg ; 235(3): 411-419, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35972159

RESUMO

BACKGROUND: Antimicrobial guidance for common bile duct stones during the perioperative period is limited. We sought to examine the effect of broad-spectrum (BS) vs narrow-spectrum (NS) antibiotics on surgical site infections (SSIs) in patients with common bile duct stones undergoing same-admission cholecystectomy. STUDY DESIGN: We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same-admission cholecystectomy for choledocholithiasis and/or acute biliary pancreatitis between 2016 and 2019. We excluded patients with cholangitis, perforated cholecystitis, and nonbiliary infections on admission. Patients were divided based on receipt of BS or NS antibiotics. Our primary outcome was the incidence of SSIs, and secondary outcomes included hospital length of stay, acute kidney injury (AKI), and 30-day readmission for SSI. RESULTS: The cohort had 891 patients: 51.7% (n= 461) received BS antibiotics and 48.3% (n = 430) received NS antibiotics. Overall antibiotic duration was longer in the BS group than in the NS group (6 vs 4 d, p = 0.01); however, there was no difference in rates of SSI (0.9% vs 0.5%, p = 0.7) or 30-day readmission for SSI (1.1% vs 1.2%, p = 1.0). Hospital length of stay was significantly longer in the BS group (p < 0.001) as were rates of AKI (5% vs 1.4%, p = 0.001). On multivariable regression, BS antibiotic use was a risk factor for AKI (adjusted odds ratio 2.8, 95% CI 1.16 to 7.82, p = 0.02). CONCLUSION: The incidence of SSI and 30-day readmission for SSI was similar between antibiotic groups. However, BS antibiotic use was associated with a longer hospitalization and greater likelihood of AKI.


Assuntos
Injúria Renal Aguda , Colecistectomia Laparoscópica , Cálculos Biliares , Pancreatite , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Antibacterianos/uso terapêutico , Ducto Colédoco , Cálculos Biliares/cirurgia , Humanos , Pancreatite/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia
17.
Scand J Surg ; 111(3): 11-30, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36000716

RESUMO

BACKGROUND AND OBJECTIVE: Gallstones are highly prevalent, and more than 9000 cholecystectomies are performed annually in Denmark. The aim of this guideline was to improve the clinical course of patients with gallstone disease including a subgroup of high-risk patients. Outcomes included reduction of complications, readmissions, and need for additional interventions in patients with uncomplicated gallstone disease, acute cholecystitis, and common bile duct stones (CBDS). METHODS: An interdisciplinary group of clinicians developed the guideline according to the GRADE methodology. Randomized controlled trials (RCTs) were primarily included. Non-RCTs were included if RCTs could not answer the clinical questions. Recommendations were strong or weak depending on effect estimates, quality of evidence, and patient preferences. RESULTS: For patients with acute cholecystitis, acute laparoscopic cholecystectomy is recommended (16 RCTs, strong recommendation). Gallbladder drainage may be used as an interval procedure before a delayed laparoscopic cholecystectomy in patients with temporary contraindications to surgery and severe acute cholecystitis (1 RCT and 1 non-RCT, weak recommendation). High-risk patients are suggested to undergo acute laparoscopic cholecystectomy instead of drainage (1 RCT and 1 non-RCT, weak recommendation). For patients with CBDS, a one-step procedure with simultaneous laparoscopic cholecystectomy and CBDS removal by laparoscopy or endoscopy is recommended (22 RCTs, strong recommendation). In high-risk patients with CBDS, laparoscopic cholecystectomy is suggested to be included in the treatment (6 RCTs, weak recommendation). For diagnosis of CBDS, the use of magnetic resonance imaging or endoscopic ultrasound prior to surgical treatment is recommended (8 RCTs, strong recommendation). For patients with uncomplicated symptomatic gallstone disease, observation is suggested as an alternative to laparoscopic cholecystectomy (2 RCTs, weak recommendation). CONCLUSIONS: Seven recommendations, four weak and three strong, for treating patients with symptomatic gallstone disease were developed. Studies for treatment of high-risk patients are few and more are needed. ENDORSEMENT: The Danish Surgical Society.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Cálculos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Colecistite Aguda/cirurgia , Dinamarca , Cálculos Biliares/complicações , Humanos
18.
Scand J Surg ; 111(3): 39-47, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36000728

RESUMO

BACKGROUND AND OBJECTIVE: Exposures of gallstones and treatments thereof in relation to development of cancer have not been explored before in long-term follow-up studies. Our objective was to determine whether symptomatic gallstones, cholecystectomy, or sphincterotomy were associated with development of upper gastrointestinal cancers. METHODS: This is a nationwide cohort study of persons born in Denmark 1930-1984 included from age 30 years with long-term follow-up (1977-2014). Exposures were hospital admissions with gallstones, cholecystectomy, and sphincterotomy. Time-varying covariates were included in analyses to allow the impact of exposures to change with time. Follow-up periods were 2-5 and > 5 years. Hazard ratios (HR) with 95% confidence intervals (CI) were reported. RESULTS: A total of 4,465,962 persons were followed. We found positive associations between sphincterotomy and biliary (>5 years HR 4.34, CI [2.17-8.70]), gallbladder (2-5 years HR 20.7, CI [8.55-50.1]), and pancreatic cancer (2-5 years HR 3.68, CI [2.09-6.49]). Cholecystectomy was positively associated with duodenal (2-5 years HR 2.94, CI [1.31-6.58]) and small bowel cancer (2-5 years HR 2.75, CI [1.56-4.87]). Inverse associations were seen for cholecystectomy and biliary (>5 years HR 0.60, CI [0.41-0.87]), pancreatic (>5 years HR 0.45 CI [0.35-0.57]), esophageal (>5 years HR 0.57, CI [0.43-0.74]), and gastric cancer (>5 years HR 0.68, CI [0.55-0.86]) and for gallstones and pancreatic cancer (>5 years HR 0.66, CI [0.47-0.93]). Gallstones were positively associated with gallbladder (>5 years HR 3.51, CI [2.02-6.10]) and small bowel cancer (2-5 years HR 3.21, CI [1.60-6.45]). CONCLUSIONS: A positive association between sphincterotomy and biliary cancer was identified. Cholecystectomy seems to be inversely associated with biliary, pancreatic, esophageal, and gastric cancer. Associations should be explored in similar large cohorts.


Assuntos
Neoplasias Colorretais , Cálculos Biliares , Neoplasias Gastrointestinais , Neoplasias Pancreáticas , Esfincterotomia , Neoplasias Gástricas , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Estudos de Coortes , Neoplasias Colorretais/cirurgia , Cálculos Biliares/complicações , Cálculos Biliares/epidemiologia , Cálculos Biliares/cirurgia , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Gastrointestinais/cirurgia , Humanos , Neoplasias Pancreáticas/cirurgia , Esfinterotomia Endoscópica , Neoplasias Gástricas/cirurgia
19.
Medicine (Baltimore) ; 101(28): e29851, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35839024

RESUMO

INTRODUCTION: A high percentage of patients with gallstones exhibit abnormalities in gallbladder emptying, and gallstones are often associated with gallbladder contraction. Interstitial cells of Cajal (ICC) in the gallbladder are involved in the generation and spreading of spontaneous contractions of the gallbladder. This study examined the relationship among the number of gallbladder ICC, gallbladder contractility, and gallstones. MATERIALS AND METHODS: Forty-six patients, who underwent cholecystectomy within 3 months of enduring a gallbladder ejection fraction scan, were enrolled in this study. ICC were identified using a microscope after immunohistochemical staining for CD117/c-kit. Five high-power field (magnification 400×) units were randomly assigned, and the number of ICC in the mucosal and muscular layers was counted. These counts were compared according to the sex, age, reason for cholecystectomy, presence of gallstone, presence of gallbladder polyp, gallbladder ejection fraction, and gallbladder size for each patient. RESULTS: The number of ICC in the mucosal layer was increased in the male participants (154.4 ± 73.9) compared with the female participants (107.3 ± 75.2); however, the ICC in the muscular layer was not different between the 2 groups. Additionally, the ICC in the mucosal and muscular layers did not differ according to age, cause of cholecystectomy, number of stones, stone character, stone diameter, or the presence of polyps. A larger gallbladder size was correlated with a decreased number of ICC in the muscular layer of the gallbladder. Additionally, when the number of gallbladder stones was increased, the number of ICC in the muscular layer of the gallbladder was decreased; however, there was no significant correlation between the number of ICC in the mucosal layer of the gallbladder and any of the following factors: age, GBEF, gallbladder size, stone number, or diameter. Furthermore, there was no significant correlation between the number of ICC in the muscular layer of the gallbladder, regardless of age, GBEF, and stone diameter. CONCLUSION: Although we were unable to achieve significant results regarding the relationship between GBEF and ICC, this is the first human study to reveal the relationship among ICC, gallbladder size, and the number of gallstones.


Assuntos
Cálculos Biliares , Células Intersticiais de Cajal , Colecistectomia , Feminino , Vesícula Biliar , Esvaziamento da Vesícula Biliar , Humanos , Masculino
20.
Chirurgia (Bucur) ; 117(3): 357-361, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35792546

RESUMO

Background: Laparoscopic cholecystectomy has become a routine procedure in abdominal surgery, a "gold standard" in the treatment of gallstones. Iatrogenic perforation of the gallbladder during a cholecystectomy is a possible incident, with numerous complications due to unidentified intraperitoneal gallstones during surgery. Pulmonary complications of laparoscopic cholecystectomy are extremely rare. Case report: This report presents the case of a 62-year-old female with post cholecystectomy subphrenic abscess and trans-diaphragmatic fistula in the middle pulmonary lobe. In this case, the pulmonary symptoms dominated the clinical picture and the initial complementary explorations indicated a strictly pulmonary condition. The initial evolution of the patient was towards worsening, and the subsequent explorations established the real diagnosis. Conclusion: Gallbladder perforations with accidental loss of gallstones should be recognized immediately and managed. In the development of a pulmonary abscess, we can take into account an intra-peritoneal condition as well.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares , Abscesso , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
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