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Müller T, Braden B. Ultrasound-Guided Interventions in the Biliary System. Diagnostics (Basel) 2024; 14:403. [PMID: 38396442 PMCID: PMC10887796 DOI: 10.3390/diagnostics14040403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Ultrasound guidance in biliary interventions has become the standard tool to facilitate percutaneous biliary drainage as well as percutaneous gall bladder drainage. Monitoring of the needle tip whilst penetrating the tissue in real time using ultrasound allows precise manoeuvres and exact targeting without radiation exposure. Without the need for fluoroscopy, ultrasound-guided drainage procedures can be performed bedside as a sometimes life-saving procedure in patients with severe cholangitis/cholecystitis when they are critically ill in intensive care units and cannot be transported to a fluoroscopy suite. This article describes the current data background and guidelines and focuses on specific sonographic aspects of both the procedures of percutaneous biliary drainage and gallbladder drainage.
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Affiliation(s)
- Thomas Müller
- Medizinische Klinik II, St. Josefs-Hospital, Beethovenstraße 20, 65189 Wiesbaden, Germany
| | - Barbara Braden
- Medizinische Klinik B, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Hosokawa I, Takayashiki T, Ohtsuka M. Fusion imaging of real-time ultrasonography and computed-tomography-assisted puncture of the bile duct of segment 6 for Bismuth-Corlette type IV perihilar cholangiocarcinoma. Asian J Surg 2023; 46:907-908. [PMID: 35963681 DOI: 10.1016/j.asjsur.2022.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/15/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Isamu Hosokawa
- Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Tsukasa Takayashiki
- Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Singh J, Tripathy TP, Patel R, Chandel K. Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience. Indian J Crit Care Med 2023; 27:16-21. [PMID: 36756467 PMCID: PMC9886041 DOI: 10.5005/jp-journals-10071-24379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/18/2022] [Indexed: 01/02/2023] Open
Abstract
Background and aim Severe cholangitis secondary to biliary obstruction carries high mortality unless biliary drainage is performed urgently. Owing to various patient-related and logistical issues, bedside biliary drainage is considered a salvage therapeutic option. This study aims to evaluate the safety and efficacy of ultrasonography (USG)-guided biliary drainage at the bedside in patients with severe cholangitis admitted to the intensive care unit (ICU). Materials and methods A total of 20 patients with severe cholangitis admitted to ICU who underwent bedside percutaneous transhepatic biliary drainage (PTBD) under USG guidance were retrospectively evaluated. Clinical outcomes, details about the PTBD procedure, and complications were recorded and analyzed. Results Among 20 patients, 13 were male and 7 were female with a mean age of 50.5 years. The most common cause of biliary obstruction was gall bladder malignancy (45%, n = 9) followed by cholangiocarcinoma (25%, n = 5). Left- and right-sided PTBD was performed in 40% (n = 8) and 35% (n = 7) patients, respectively, while 25% (n = 5) of patients underwent bilateral PTBD. The technical success rate was 100%. A total of 65% (n = 13) of patients were discharged from ICU upon improvement while the remaining 35% (n = 7) died despite bedside PTBD. None of the patients had any major procedure-related complications. Conclusions Ultrsound-guided bedside PTBD seems to be a safe and effective option in critically ill patients with severe cholangitis when shifting of patients is not feasible. How to cite this article Singh J, Tripathy TP, Patel R, Chandel K. Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience. Indian J Crit Care Med 2023;27(1):16-21.
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Affiliation(s)
- Jitender Singh
- Department of Interventional Radiology, Shanti Mukand Hospital, New Delhi, India
| | - Tara Prasad Tripathy
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India,Tara Prasad Tripathy, Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, Phone: +91 8575827990, e-mail:
| | - Ranjan Patel
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Karamvir Chandel
- Department of Radiology, AIIMS, Bilaspur, Himachal Pradesh, India
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Takamoto T. Improvement and development in anatomical hepatectomy for hepatocellular carcinoma. Hepatobiliary Surg Nutr 2021; 10:545-547. [PMID: 34430540 DOI: 10.21037/hbsn-21-247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Takeshi Takamoto
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Ábrahám S, Tóth I, Benkő R, Matuz M, Kovács G, Morvay Z, Nagy A, Ottlakán A, Czakó L, Szepes Z, Váczi D, Négyessy A, Paszt A, Simonka Z, Petri A, Lázár G. Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years' experience at a tertiary care centre. Surg Endosc 2021; 36:2850-2860. [PMID: 34415432 PMCID: PMC9001534 DOI: 10.1007/s00464-021-08573-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022]
Abstract
Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.
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Affiliation(s)
- Szabolcs Ábrahám
- Department of Surgery, University of Szeged, Szeged, Hungary. .,Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Centre, Semmelweis u. 8., 6725, Szeged, Hungary.
| | - Illés Tóth
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary.,Central Pharmacy and Emergency Care Department, University of Szeged, Szeged, Hungary.,Central Pharmacy Department, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary.,Central Pharmacy and Emergency Care Department, University of Szeged, Szeged, Hungary
| | | | - Zita Morvay
- Radiology Department, University of Szeged, Szeged, Hungary
| | - András Nagy
- Radiology Department, University of Szeged, Szeged, Hungary
| | - Aurél Ottlakán
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | | | - András Négyessy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Zsolt Simonka
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - András Petri
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
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Takada T, Takikawa H, Sawada N, Higuchi R, Nagamachi Y, Isaji S, Yoshida M, Yamamoto M. Cholangio-venous reflux of biliary contents through paracellular pathways between hepatocytes in patients with acute cholangitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:508-514. [PMID: 33720522 DOI: 10.1002/jhbp.937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND We re-analyzed data on cholangio-venous reflux from a clinical study conducted prospectively on 22 patients in 1974. METHOD Direct cholangiography was performed with indocyanine green (ICG) mixed into UrographinR under monitoring of intrabiliary pressure, and the participants were allocated to three groups according to whether ICG leakage into the blood, signs of infection, or both, were present. RESULTS The intrabiliary pressure of six patients negative for both ICG leakage and signs of infection was approximately 19.5 (median, [range 18-22]) cmH2 O. In contrast, for the five patients positive for ICG leakage but negative for signs of infection, the intrabiliary pressure was higher (median 32.0 [range 27-41) cmH2 O]. The 11 patients positive for both ICG leakage and signs of infection had the highest intrabiliary pressure (median 48.0 [range 33-77] cmH2 O). Our analyses revealed that, as the intrabiliary pressure increased, the status of ICG leakage and signs of infection appeared in a stepwise fashion. CONCLUSION Our findings suggest that the tight junctions sealing the bile canaliculi deteriorated with increasing intrabiliary pressure, resulting in reflux of the biliary contents into the vascular system via paracellular pathways between hepatocytes.
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Affiliation(s)
- Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hajime Takikawa
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Norimasa Sawada
- Second Department of Pathology, Sapporo Medical University, Sapporo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yukiko Nagamachi
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Isaji
- Department of Hepatobiliary Pancreatic Surgery and Transplantation, Mie University, Mie, Japan
| | - Masahiro Yoshida
- Department of Hepatobiliary Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Ichikawa, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Safety and effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage: a multicenter experience. J Ultrasound 2019; 22:437-445. [PMID: 31368040 DOI: 10.1007/s40477-019-00399-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023] Open
Abstract
AIMS Aim of this study is to describe a multicenter experience on percutaneous transhepatic biliary drainage (PTBD) performed with ultrasound-guidance to access the biliary tree, focusing on safety, effectiveness and radiation dose exposure; differences between right- and left-sided approaches have been also evaluated. METHODS This is a multicenter prospective single-arm observational study conducted on patients affected by biliary tree stenosis/occlusion with jaundice and endoscopically inaccessible. The procedures have been performed puncturing the biliary system under US guidance and crossing the stenosis/occlusion under fluoroscopy. Beam-on time and X-ray dose have been evaluated. RESULTS 117 patients affected by biliary tree stenosis/occlusion not manageable with an endoscopic approach have been included in this analysis. The biliary stenosis/occlusion was malignant in 90.8% and benign in 9.2%. Technical success, considered as positioning of a drainage tube into the biliary tree, was 100%. Overall clinical success, considered as decrease in total bilirubin level after a single procedure, was 95.7%. The overall mean number of liver punctures to catheterize the biliary tree was 1.57. The mean total beam-on time was 570.4 s; the mean dose-area product was 37.25 Gy cm2. No statistical significant differences were observed in terms of technical and dosimetry results according to right-sided and left-sided procedures. Complications rate recorded up to 30 days follow-up was 10.8%, all of minor grades. CONCLUSIONS In this series US guidance to access the biliary tree for PTBD was a safe and effective technique with an acceptable low-grade complications rate; the reported radiation dose is low.
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Wagner A, Mayr C, Kiesslich T, Berr F, Friesenbichler P, Wolkersdörfer GW. Reduced complication rates of percutaneous transhepatic biliary drainage with ultrasound guidance. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:400-407. [PMID: 28251661 DOI: 10.1002/jcu.22461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/30/2016] [Accepted: 01/07/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND We aimed to analyze the benefits of adding ultrasound (US) guidance to the standard fluoroscopically assisted percutaneous transhepatic biliary drainage (F-PTBD). We also performed a systematic literature review of success and complication rates of US-PTBD in a wide field of indications. METHODS We evaluated a total of 81 US-PTBDs carried out in our institution, 74% of which were part of the management of malignancy. In addition, we compared our results with those of a total of 5,272 procedures (3,779 F-PTBD and 1,493 US-PTBD) reported in the literature. RESULTS US-PTBD was technically successful in 94% of attempts with a mean of 2.2 needle passes. Procedural success was achieved in 86% of cases. There were no procedure-related deaths or severe complications. Minor complications were catheter dislodgement (15%) as well as one case each of a porto-biliary fistula, hematoma, and biloma. A systematic review of the literature also showed that US-PTBD has a similar technical success rate to F-PTBD but lower median rates of severe early complications (0% versus 8%) and procedural death (0% versus 1%). CONCLUSIONS Given our results and our review of the literature, US-PTBD is as effective as F-PTBD and has significantly lower complication rates. US-PTBD should be preferred to F-PTBD. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:400-407, 2017.
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Affiliation(s)
- Andrej Wagner
- Department of Internal Medicine I, Paracelsus Medical University/Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Christian Mayr
- Department of Internal Medicine I, Paracelsus Medical University/Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
- Laboratory for Tumour Biology and Experimental Therapies, Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
| | - Tobias Kiesslich
- Department of Internal Medicine I, Paracelsus Medical University/Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
- Laboratory for Tumour Biology and Experimental Therapies, Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
| | - Frieder Berr
- Department of Internal Medicine I, Paracelsus Medical University/Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | | | - Gernot W Wolkersdörfer
- Department of Internal Medicine I, Paracelsus Medical University/Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
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Kinoshita M, Shirono R, Takechi K, Yonekura H, Iwamoto S, Shinya T, Takao S, Harada M. The Usefulness of Virtual Fluoroscopic Preprocedural Planning During Percutaneous Transhepatic Biliary Drainage. Cardiovasc Intervent Radiol 2017; 40:894-901. [PMID: 28127630 DOI: 10.1007/s00270-017-1581-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To retrospectively evaluate the usefulness of virtual fluoroscopic preprocedural planning (VFPP) in the percutaneous transhepatic biliary drainage (PTBD) procedure. MATERIALS AND METHODS Twenty-two patients who were treated by PTBD were included in this study. Twelve patients were treated using PTBD intraoperative referencing coronal computed tomography (CT) images (i.e., coronal CT group), and ten patients were treated using PTBD intraoperative referencing VFPP images (i.e., VFPP group). To analyze the effect of the intraoperative referencing VFPP image, the VFPP group was retrospectively compared with the coronal CT group. RESULTS The characteristics of both patient groups were not statistically significantly different. There were no significant differences in the targeted bile duct, diameter and depth of the target bile, breath-holding ability, number of targeted bile duct puncture attempts, change in the targeted bile duct, and exchange of the drainage catheter. However, the X-ray fluoroscopy time and the procedure time were significantly shorter in the VFPP group than in the coronal CT group (196 vs. 334 s, P < 0.05; and 16.0 vs. 27.2 min, P < 0.05). CONCLUSION Intraoperative referencing using the VFPP imaging in PTBD intuitively can be a useful tool for better localization of the guidewire in the bile duct and thereby shorten the X-ray fluoroscopy time and procedure time while minimizing radiation exposure and complications.
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Affiliation(s)
- Mitsuhiro Kinoshita
- Department of Radiology (Diagnostic Radiology), Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan.
| | - Ryozo Shirono
- Department of Radiology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Katsuya Takechi
- Department of Radiology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Hironobu Yonekura
- Department of Radiological Technology, Tokushima Red Cross Hospital, 103 Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Seiji Iwamoto
- Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, Tokushima, 770-8509, Japan
| | - Takayoshi Shinya
- Department of Radiology (Diagnostic Radiology), Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Shoichiro Takao
- Department of Diagnostic Radiology, Tokushima University Graduate School of Health Science, 3-18-15, Kuramoto-cho, Tokushima City, Tokushima, 770-8509, Japan
| | - Masafumi Harada
- Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima City, Tokushima, 770-8509, Japan
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Hamada T, Yasunaga H, Nakai Y, Isayama H, Horiguchi H, Fushimi K, Koike K. Severe bleeding after percutaneous transhepatic drainage of the biliary system: effect of antithrombotic agents--analysis of 34 606 cases from a Japanese nationwide administrative database. Radiology 2014; 274:605-13. [PMID: 25203133 DOI: 10.1148/radiol.14140293] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the relationship between antithrombotic agents (antiplatelet agents and anticoagulants) and severe bleeding after percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction, or cholecystostomy for acute cholecystitis. MATERIALS AND METHODS This retrospective study was institutional review board-approved, and patient consent was waived. Between July 2007 and March 2012, 34 606 patients who underwent PTBD (23 375 patients) or cholecystostomy (11 231 patients) were identified in the Diagnosis Procedure Combination database covering 1119 Japanese hospitals. The association between oral administration of antithrombotic agents prior to the procedure and severe bleeding was evaluated, with adjustment for other potential risk factors, such as age, chronic renal failure, liver cirrhosis, and procedure type. Users of antithrombotic agents were categorized as the continuation group, when they took these agents on the procedure day, or as the discontinuation group, when none were taken. Severe bleeding was defined as bleeding which required red blood cell transfusion or transcatheter arterial embolization within 3 days of the procedure. Univariate and multivariate logistic regression models fitted with generalized estimating equations were performed to evaluate the effect of antithrombotic agents on the bleeding complication. RESULTS Overall, 780 of 34 606 patients (2.3%) experienced severe bleeding. In the multivariate model, continuation of antiplatelet agents was significantly associated with severe bleeding versus nonuse (odds ratio [OR], 1.87; 95% confidence interval [CI]: 1.14, 3.05; P = .013), whereas discontinuation of antiplatelet agents showed no association (OR, 0.92; 95% CI: 0.70, 1.20; P = .517). The effect of neither continuation nor discontinuation of anticoagulants on severe bleeding was significant. Other significant risk factors for bleeding included older age, chronic renal failure, liver cirrhosis, academic hospital, and PTBD. CONCLUSION The continuation of antiplatelet agents can increase severe bleeding after percutaneous transhepatic drainage, whereas the effect of continuation of anticoagulants was inconclusive.
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Affiliation(s)
- Tsuyoshi Hamada
- From the Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan (T.H., Y.N., H.I., K.K.); Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan (H.Y.); Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan (H.H.); and Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan (K.F.)
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Furusawa N, Kobayashi A, Yokoyama T, Shimizu A, Motoyama H, Miyagawa SI. Surgical Treatment of 144 Cases of Hilar Cholangiocarcinoma Without Liver-Related Mortality. World J Surg 2013; 38:1164-76. [DOI: 10.1007/s00268-013-2394-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Miyazaki M, Shibuya K, Tokue H, Tsushima Y. Percutaneous transhepatic biliary drainage assisted by real-time virtual sonography: a retrospective study. BMC Gastroenterol 2013; 13:127. [PMID: 23941632 PMCID: PMC3751649 DOI: 10.1186/1471-230x-13-127] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 08/13/2013] [Indexed: 01/20/2023] Open
Abstract
Background Real-time virtual sonography (RVS) is a diagnostic imaging support system that can synchronize with ultrasound images in conjunction with computed tomography or magnetic resonance images using magnetic navigation system. RVS has been applied in clinical practice to perform such procedures as radiofrequency ablation and biopsy; however, the application of RVS for percutaneous transhepatic biliary drainage (PTBD) is rare. Methods Between 2007 and 2012, RVS-assisted PTBD was performed for 30 patients (19 males and 11 females; age range, 41 to 89 years; mean age, 66.9 years) with obstructive jaundice. The targeted bile duct was determined using the RVS system before the procedure. The intervention was considered to be successful when the targeted bile duct was punctured and the drainage catheter was placed in the bile duct. Complications were evaluated according to the Society of Interventional Radiology Clinical Practice Guidelines. Results A total of 37 interventions were performed for 30 patients. The interventions were successful in 35 (95%) of 37 interventions. The targeted bile ducts were: B3 (n = 24), B5 (n = 7), B8 (n = 3), B6 (n = 1), and the anterior (n = 1) and posterior (n = 1) branches of the right bile duct. The mean targeted bile duct diameter was 4.9 mm (1.9 to 8.2 mm). PTBD was able to be accomplished in all patients because the non-targeted bile ducts were successfully punctured alternatively. No major complications were observed in relation to the interventional procedure. Conclusions RVS-assisted PTBD is a feasible and safe procedure. Accurate puncture of targeted bile ducts can be achieved using this method.
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Kobayashi A, Miwa S, Nakata T, Miyagawa S. Disease recurrence patterns after R0 resection of hilar cholangiocarcinoma. Br J Surg 2009; 97:56-64. [PMID: 19937985 DOI: 10.1002/bjs.6788] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is little information regarding the clinical behaviour of hilar cholangiocarcinoma after curative resection. METHODS A retrospective study was undertaken of 79 consecutive patients with hilar cholangiocarcinoma who had undergone major hepatectomy (three or more Couinaud segments) concomitant with caudate lobectomy, and had negative resection margins. Sites of initial disease recurrence were classified as locoregional (porta hepatis) or distant (intrahepatic, peritoneal, para-aortic lymph nodal or extra-abdominal). Univariable and multivariable analyses were performed to determine the factors potentially related to recurrence. RESULTS Disease recurrence was observed in 42 (53 per cent) of the 79 patients. Cumulative recurrence rates at 3 and 4 years after surgery were 52 and 56 per cent respectively. Locoregional recurrence alone was observed in eight (10 per cent) and distant metastasis in 34 (43 per cent) of the 79 patients after R0 resection. Positive nodal involvement and high International Union Against Cancer tumour (T) stage were independent prognostic factors associated with distant metastasis. CONCLUSION Distant metastases are more common than locoregional recurrence after R0 resection for hilar cholangiocarcinoma, and associated with nodal involvement and high T stage.
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Affiliation(s)
- A Kobayashi
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
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Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 2003. [PMID: 12832969 DOI: 10.1097/00000658-200307000-00011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the feasibility of an aggressive surgical approach incorporating major hepatic resection after biliary drainage and preoperative portal vein embolization for patients with hilar bile duct cancer. SUMMARY BACKGROUND DATA Although many surgeons have emphasized the importance of major hepatectomy in terms of curative resection for patients with hilar bile duct cancer, this procedure results in a high incidence of postoperative morbidity and mortality in patients with cholestasis-induced impaired liver function. METHODS A retrospective cohort study was conducted in 140 patients with hilar bile duct cancer treated from 1990 through 2001. Resectional surgery was performed in 79 patients, 69 of whom underwent major hepatic resection. Thirteen patients underwent concomitant pancreaticoduodenectomy. Preoperative biliary drainage was carried out in all 65 patients who had obstructive jaundice. Portal vein embolization was conducted in 41 of 51 patients undergoing extended right hepatectomy. Short- and long-term outcomes were evaluated. RESULTS No patient experienced postoperative liver failure (maximum total bilirubin level, 5.4 mg/dL). The in-hospital mortality rate was 1.3% (1 in 79, resulting from cerebral infarction). A histologically negative resection margin was obtained more frequently when the scheduled extended hepatic resection was conducted (75% vs 44%, P = 0.0178). The estimated 5-year survival rate was 40% when histologically negative resection margins were obtained, but only 6% if the margins were positive. Multivariate analysis identified the resection margin and nodal status as independent factors predictive of survival. CONCLUSIONS Extensive resection, mainly extended right hemihepatectomy, after biliary drainage and preoperative portal vein embolization, when necessary, for patients with hilar bile duct cancer can be performed safely and is more likely to result in histologically negative margins than other resection methods.
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Lee SH, Hahn ST, Hahn HJ, Cho KJ. Single-wall puncture: a new technique for percutaneous transhepatic biliary drainage. AJR Am J Roentgenol 2003; 181:717-9. [PMID: 12933466 DOI: 10.2214/ajr.181.3.1810717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study is to evaluate the safety and utility of a new single-wall puncture technique for percutaneous transhepatic biliary drainage in comparison with the conventional double-wall puncture technique. CONCLUSION Our results suggest that the single-wall puncture technique is a useful method for percutaneous transhepatic biliary drainage and may be safer than the conventional double-wall puncture technique.
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Affiliation(s)
- Sang H Lee
- Department of Radiology, St. Mary's Hospital, The Catholic University of Korea, 62, Youido-dong, Yongdungpo-gu, Seoul 150-010, Korea
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16
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Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa SI. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 2003; 238:84-92. [PMID: 12832969 PMCID: PMC1422661 DOI: 10.1097/01.sla.0000074984.83031.02] [Citation(s) in RCA: 221] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the feasibility of an aggressive surgical approach incorporating major hepatic resection after biliary drainage and preoperative portal vein embolization for patients with hilar bile duct cancer. SUMMARY BACKGROUND DATA Although many surgeons have emphasized the importance of major hepatectomy in terms of curative resection for patients with hilar bile duct cancer, this procedure results in a high incidence of postoperative morbidity and mortality in patients with cholestasis-induced impaired liver function. METHODS A retrospective cohort study was conducted in 140 patients with hilar bile duct cancer treated from 1990 through 2001. Resectional surgery was performed in 79 patients, 69 of whom underwent major hepatic resection. Thirteen patients underwent concomitant pancreaticoduodenectomy. Preoperative biliary drainage was carried out in all 65 patients who had obstructive jaundice. Portal vein embolization was conducted in 41 of 51 patients undergoing extended right hepatectomy. Short- and long-term outcomes were evaluated. RESULTS No patient experienced postoperative liver failure (maximum total bilirubin level, 5.4 mg/dL). The in-hospital mortality rate was 1.3% (1 in 79, resulting from cerebral infarction). A histologically negative resection margin was obtained more frequently when the scheduled extended hepatic resection was conducted (75% vs 44%, P = 0.0178). The estimated 5-year survival rate was 40% when histologically negative resection margins were obtained, but only 6% if the margins were positive. Multivariate analysis identified the resection margin and nodal status as independent factors predictive of survival. CONCLUSIONS Extensive resection, mainly extended right hemihepatectomy, after biliary drainage and preoperative portal vein embolization, when necessary, for patients with hilar bile duct cancer can be performed safely and is more likely to result in histologically negative margins than other resection methods.
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Affiliation(s)
- Seiji Kawasaki
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
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17
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Shimada H, Endo I, Sugita M, Masunari H, Fujii Y, Tanaka K, Sekido H, Togo S. Is parenchyma-preserving hepatectomy a noble option in the surgical treatment for high-risk patients with hilar bile duct cancer? Langenbecks Arch Surg 2003; 388:33-41. [PMID: 12690478 DOI: 10.1007/s00423-003-0358-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2002] [Accepted: 01/28/2003] [Indexed: 10/25/2022]
Abstract
BACKGROUND The essential minimum of hepatic segmentectomy combined with caudate lobectomy (parenchyma-preserving hepatectomy) has been recommended particularly for high-risk patients with hilar bile duct cancer to minimize the risk of postoperative liver failure. This quality control study investigated whether parenchyma-preserving hepatectomy is a "noble option" in the surgical treatment of hilar bile duct cancer. PATIENTS AND METHODS A total of 53 patients with hilar bile duct cancer underwent surgical resection. These patients were retrospectively classified into a major hepatectomy group (major Hx, n=30), a parenchyma-preserving hepatectomy group (preserving Hx, n=11), and a hilar bile duct resection group (HBDR, n=12). A preserving Hx consisted of caudate lobectomy, either alone (n=3), or combined with resection of segment 4 (S4, n=4), or S58 (n=3) or S458 (n=1). The preserving Hx was used for high-risk patients in whom tumor tissue was diagnosed to be Bismuth type I and II by preoperative selective percutaneous transhepatic cholangiography. RESULTS The mean numbers of hepatico-jejunostomies were 2.8, 4.8, and 4.6 in the respective groups. Mortality rates including hospital death were 13.3%, 0%, and 0% respectively. Morbidity rates were 46.7%, 54.5%, and 33.3%. The preserving Hx group encountered no liver failure (T.Bil>10 mg/dl, encephalopathy) but acquired hyperbilirubinemia (T.Bil>5 mg/dl), pulmonary insufficiency and other complications at the same frequency as in the major Hx group. The survival rates in the three groups were 35.6%, 52.5%, and 48.6% at 3 years and 25.2%, 14.9%, and 24.3% at 5 years respectively. Curability rates (R0 to R1+2) were 76.7%, 54.5% and 50.0%, respectively. Preserving Hx tended to result in higher frequencies of positive transmural margins (e.g., cancer cells remaining around the right hepatic artery or the portal vein). CONCLUSIONS Preserving hepatectomy for high-risk patients should be limited strictly to patients who do not have tumors which are not invading adjacent organs (e.g., T2) nor a segmental duct and are confined longitudinally to the right or the left.
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Affiliation(s)
- Hiroshi Shimada
- Department of Surgery II, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
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Tamada K, Tomiyama T, Ohashi A, Wada S, Miyata T, Satoh Y, Higashizawa T, Gotoh Y, Ido K, Sugano K. Access for percutaneous transhepatic cholangioscopy in patients with nondilated bile ducts using nasobiliary catheter cholangiography and oblique fluoroscopy. Gastrointest Endosc 2000; 52:765-9. [PMID: 11115914 DOI: 10.1067/mge.2000.109807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Percutaneous transhepatic biliary drainage is required for percutaneous transhepatic cholangioscopy. However, puncture of nondilated bile ducts under ultrasonographic guidance is difficult. METHODS In 10 patients with no ultrasonographic evidence of intrahepatic bile duct dilatation, percutaneous transhepatic biliary drainage was performed under fluoroscopic guidance using cholangiography obtained via a nasobiliary drainage catheter. Direct puncture was performed by means of a left ventral approach using oblique C-arm fluoroscopy. RESULTS Bile duct puncture was successful in all patients. There were no procedure-related complications. Subsequent cholangioscopy was successful in all patients. CONCLUSIONS Direct puncture using nasobiliary drainage cholangiography and oblique fluoroscopy is a useful method when cholangioscopy is necessary in patients with nondilated bile ducts.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
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19
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Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg 1999; 230:663-71. [PMID: 10561090 PMCID: PMC1420920 DOI: 10.1097/00000658-199911000-00008] [Citation(s) in RCA: 282] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the long-term outcome of aggressive surgery incorporating hepatic resection and systematic nodal dissection for advanced carcinoma involving the hepatic hilus. SUMMARY BACKGROUND DATA Few long-term results are available regarding radical surgery incorporating major hepatectomy and nodal dissection. METHODS A retrospective analysis was undertaken in 107 patients with carcinoma involving the hepatic hilus treated between 1980 and 1997. Resectional surgery was performed in 65 patients, 52 of whom underwent major hepatectomies. The effects of clinical and pathologic factors were assessed by univariate and multivariate analyses. RESULTS Sixty percent of the patients with resectional surgery had stage IVA or IVB disease, and 92.3% of them underwent major hepatectomies. No in-hospital deaths were encountered in the 35 most recent resections, whereas there were six deaths in the early period. Resectional surgery was associated with a survival benefit, especially when resection margins were free from cancerous infiltration. The estimated 5-year survival rate after resection, including all deaths, was 34.8%; this was 51.6% when the margins were clear. Nodal involvement was documented in 44.6% of the resections. However, patients with metastases limited to the regional nodes showed a survival rate similar to that in patients without nodal involvement. Significant predictive factors for survival after resection were extension to the gallbladder, nodal status, resectional margins, histologic type, and gender. CONCLUSIONS The combination of major hepatectomy with systematic nodal dissection gave a good chance of prolonged survival for patients with carcinoma involving the hepatic hilus, even when the disease was advanced. Less-extensive procedures were also beneficial for less-advanced disease if clear resectional margins were secured.
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Affiliation(s)
- T Kosuge
- Department of Surgery, National Cancer Center Hospital, Tokyo, Japan
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Nagino M, Nimura Y, Kamiya J, Kondo S, Kanai M, Miyachi M, Yamamoto H, Hayakawa N. Preoperative management of hilar cholangiocarcinoma. ACTA ACUST UNITED AC 1995. [DOI: 10.1007/bf02350901] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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21
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Sukigara M, Taguchi Y, Watanabe T, Koshizuka S, Koyama I, Omoto R. Percutaneous transhepatic biliary drainage guided by color Doppler echography. ABDOMINAL IMAGING 1994; 19:147-9. [PMID: 8199547 DOI: 10.1007/bf00203490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Percutaneous transhepatic biliary drainage (PTBD) guided by color Doppler echography was performed on nine patients. By color Doppler echography, the segmental and subsegmental branches of both the portal vein and the hepatic artery could be identified and discriminated from the bile ducts because of their color flow mapping. We could select the safe pathway of needle advance, which did not injure the vessels. Thus, complication of bleeding did not occur in any of the patients. Color Doppler echography seems a very useful and safe method for the guidance of PTBD.
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Affiliation(s)
- M Sukigara
- First Department of Surgery, Saitama Medical School, Japan
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22
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Tsai CC, Mo LR, Yang CT, Yeh YH, Yueh SK, Hwang MH. Bilateral hepatic duct decompression via a single percutaneous tract using a 'mother-baby' drainage catheter. Eur J Radiol 1994; 18:6-11. [PMID: 8168585 DOI: 10.1016/0720-048x(94)90354-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Decompression of the right and left hepatic ducts using a 'mother-baby' self-made drainage system via a single percutaneous tract was performed successfully in 15 of 21 patients with benign (n = 4) and malignant (= 17) hilar obstruction. The 'mother-baby' drainage system was composed of an 18 F catheter placed through the right hepatic duct into the distal common bile duct which was designated as the 'mother' catheter, while a second 10 F baby catheter was placed through the first catheter into the left hepatic ducts. This was achieved by a three-stage procedure: (1) percutaneous transhepatic biliary drainage; (2) balloon dilatation of the tract; and (3) intubation of the contralateral hepatic duct and placement of the 'mother-baby' drainage catheters. The mean interval of stent clogging was 5 months, with a range of 2-9 months. In 12 malignant cases, average survival time was 9.8 months. The technique avoided a second percutaneous hepatic puncture in centrally obstructing lesions and afforded bilateral biliary decompression.
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Affiliation(s)
- C C Tsai
- Department of Radiology, Tainan Municipal Hospital, Taiwan, ROC
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23
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Hwang MH, Tsai CC, Mo LR, Yang CT, Yeh YH, Yau MP, Yueh SK. Percutaneous choledochoscopic biliary tract stone removal: experience in 645 consecutive patients. Eur J Radiol 1993; 17:184-90. [PMID: 8293746 DOI: 10.1016/0720-048x(93)90101-r] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Our experience in non-operative retrieval of biliary tract stones through PTCS (percutaneous transhepatic cholangioscopy, n = 103) and POC (post-operative choledochoscopy, n = 542) plus the use of Dormia basket and EHL (electrohydraulic lithotripsy) is presented. The results of transhepatic and T-tube routes are compared, with emphasis on the technical difficulties encountered. The success rates were 96% and 97% in POC and PTCS, respectively. No mortality was related to these procedures. Intrahepatic duct angulation and stricture were the factors most often responsible for failure. Postoperative choledochoscopic stone removal is safe and the method of choice for retained biliary tract calculi, while PTCS is highly indicated for those high-risk patients with or without previous biliary surgery. POC and PTCS have, therefore, their own indications and differ in their clinical applications.
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Affiliation(s)
- M H Hwang
- Department of Surgery, Show Chwan Memorial Hospital, Chang Hwa, Taiwan, ROC
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24
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Ho CS, Yeung EY. The management of problematic biliary calculi. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1992; 6:355-81. [PMID: 1392094 DOI: 10.1016/0950-3528(92)90009-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Recent advances in modern medical technology have significantly reduced the number of patients with 'problematic calculi'. When a patient does present with a difficult bile duct stone, various non-surgical treatment options are now available. In experienced hands, with healthy or high-risk patients, percutaneous treatment is as safe and as efficacious as endoscopy or surgery. Since it does not require general anaesthesia, and patients recover much more quickly than after surgery, the percutaneous approach is preferred when endoscopy fails to achieve ductal clearance. Surgery is indicated for patients with lesions requiring surgical removal or correction, but seldom for removal of biliary calculi alone.
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25
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Kosuge T, Beppu T, Iwasaki S, Itoh T, Idezuki Y. Bile acid profile and decrement rate of serum total bilirubin after biliary drainage. GASTROENTEROLOGIA JAPONICA 1990; 25:732-8. [PMID: 2279635 DOI: 10.1007/bf02779188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Non-esterified (non-sulfated and non-glucuronidated) bile acid profile in the serum and bile was assessed using mass fragmentation spectrometry in relation to the decrement rate of the serum total bilirubin after relief of the biliary obstruction by external biliary drainage in fourteen patients. Biliary excretion of the total bile acid was decreased and the serum ratio of cholic to cenodeoxycholic acid was low in the patients with refractory jaundice. An unusual bile acid, 3 beta,7 alpha-dihydroxy-5 beta-cholan-24-oic acid, was detected in the sera of all patients early after biliary drainage. Disappearance of this bile acid from the serum was delayed in refractory jaundice. These findings suggested that extremely prolonged jaundice after biliary drainage resulted from profound liver cell damage secondary to biliary obstruction.
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Affiliation(s)
- T Kosuge
- Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan
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26
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Das K, Kochhar R, Mehta SK, Suri S. A modified technique of ultrasonically guided percutaneous transhepatic biliary drainage. Surg Endosc 1989; 3:191-4. [PMID: 2482990 DOI: 10.1007/bf02171544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Ultrasonically guided percutaneous transhepatic biliary drainage was performed for palliative treatment in 31 patients and for pre-operative drainage in 21. The drainage was performed through a right intercostal approach with the ultrasound transducer placed in the midclavicular line without use of any specialized adaptor. No major complications were encountered. The main advantages of ultrasound guided drainage were (1) the rapidness of the procedure, (2) the negligible risk of puncturing blood vessels, and (3) the minimal exposure to radiation.
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Affiliation(s)
- K Das
- Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kim DG, Song SH, Jang HC, Kim JG, Ahn HS, Ahn DS, Kim JS, Han YM. Percutaneous transcatheteral biliary biopsy (PTBB)--a report of two cases. Korean J Intern Med 1989; 4:160-4. [PMID: 2486846 PMCID: PMC4534989 DOI: 10.3904/kjim.1989.4.2.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In two patients with obstructive jaundice, percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD) were performed. During PTBD, the percutaneous transcatheteral biliary biopsy (PTBB) with the biopsy forceps of the gastrofiberscope was performed through the biliary stent catheter. Biopsy specimens were successfully obtained and histopathologic findings were satisfactory in both cases.
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28
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Yanagisawa J, Ichimiya H, Kuwano N, Nakayama F. The role of preoperative biliary decompression in the treatment of bile duct cancer. World J Surg 1988; 12:33-8. [PMID: 3344583 DOI: 10.1007/bf01658483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Laméris JS, Stoker J, Dees J, Nix GA, Van Blankenstein M, Jeekel J. Non-surgical palliative treatment of patients with malignant biliary obstruction--the place of endoscopic and percutaneous drainage. Clin Radiol 1987; 38:603-8. [PMID: 2446814 DOI: 10.1016/s0009-9260(87)80336-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Non-surgical methods to treat patients with inoperable malignant biliary obstruction are endoscopic retrograde biliary drainage and ultrasound guided percutaneous transhepatic biliary drainage. During a 2 year evaluation a total of 144 patients were admitted with malignant biliary obstruction: 93 with a mid- or distal common bile duct stenosis; 51 patients with a perihilar stenosis. Endoscopic biliary drainage was performed in 123 patients and ultrasound guided percutaneous biliary drainage in 57 patients. An effect on jaundice was seen in more patients after percutaneous biliary drainage (91%) than with endoscopic biliary drainage (70%). However with the percutaneous method only 63% of patients were drained internally. The site of the stenosis seemed to be an important factor. In patients with perihilar obstruction early complications after endoscopic biliary drainage occurred in 41% of drained patients compared with 3% procedure-related and 28% catheter-related complications with ultrasound guided drainage. A major complication of the endoscopic method in perihilar disease was cholangitis due to inadequate drainage.
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Affiliation(s)
- J S Laméris
- Department of Radiology, University Hospital Dijkzigt, Rotterdam
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Abstract
Primary liver cancer, particularly HCC, is increasing in certain countries, notably Japan. Although hepatitis B virus has been etiologically linked to hepatocarcinogenesis and integration of its DNA into hepatocyte chromosomal DNA has been emphasized, other etiologic factors seem to have an interplay with virus infection. Histopathology of HCC has geographic variations. An expanding encapsulated HCC is most common in Japan, whereas it is nearly nonexistent in the West; such regional differences can only be explained by differences in the major etiologic factors. Early detection of HCC is now possible with ultrasound examination combined with AFP measurement, and this strategy has been executed with success in the Far East where HCC is endemic among cirrhotics. The speed of tumor growth can be measured with accuracy by ultrasound examination. Preneoplastic or early lesions of HCC in a cirrhotic liver seem to be adenomatous hyperplastic nodules or foci, and the conventional histological criteria for malignant liver cells do not seem applicable to such lesions. Although advanced cirrhosis is a real deterrent for hepatic surgery, hepatic resection affords a better survival compared with any nonsurgical therapeutic modality. Transcatheter arterial embolization is one of the current preferences of the hepatologist for inoperable patients. Lastly, a new staging scheme has been proposed for the assessment of prognosis and for comparison of efficacy of various therapeutic modalities.
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Ultrasound and CT-Guided Percutaneous Interventiona Procedures of the Abdomen. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1986. [DOI: 10.1177/875647938600200204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Percutaneous interventional procedures have played an increasingly important role in patient management. This is primarily due to the application of diagnostic ultrasound and computerized tomography as imaging modalities to provide accurate guidance for these procedures. The purpose of this article is to review the use of ultrasound and computerized tomography in biopsies and in drainage procedures of the abdomen.
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Laméris JS, Obertop H, Jeekel J. Biliary drainage by ultrasound-guided puncture of the left hepatic duct. Clin Radiol 1985; 36:269-74. [PMID: 2998680 DOI: 10.1016/s0009-9260(85)80058-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Percutaneous transhepatic biliary drainage under ultrasonic guidance was performed in 38 patients with obstructive jaundice due to malignancy (49 intubations). The method was used for palliation in 33 patients and for pre-operative drainage because of cholangitis in five patients. Puncture of the left lobar ducts was the method of choice (35 patients). Only in cases of poor visualisation of the left biliary ducts was right-sided drainage performed (three patients). Combined left- and right-sided drainage was necessary in nine patients. All attempts with ultrasound-guided punctures were successful. There were no complications related to the punctures. Delayed complications were cholangitis (10 patients) and bleeding (one patient). The advantages of the method compared with conventional percutaneous transhepatic biliary drainage and the advantages of the left liver lobe drainage are outlined.
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Takikawa H, Beppu T, Seyama Y. Profiles of bile acids and their glucuronide and sulphate conjugates in the serum, urine and bile from patients undergoing bile drainage. Gut 1985; 26:38-42. [PMID: 3965365 PMCID: PMC1432397 DOI: 10.1136/gut.26.1.38] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Bile acid profiles in serum, urine, and bile from patients undergoing bile drainage and the changes of serum bile acids after bile drainage were studied. Bile acids were separated into non-glucuronidate-non-sulphate, glucuronidated, and sulphated fractions and were measured by mass fragmentography using conjugates of deuterium labelled bile acids as internal standards. Glucuronidated and sulphated bile acids contribute 14-32% and 16-44% of serum bile acids, 4-11% and 61-82% of urine bile acids and 0.2-1% and 0.3-2% of biliary bile acids respectively. After bile drainage the concentration of serum non-glucuronidated-non-sulphated bile acids decreased more rapidly than glucuronidated and sulphated bile acids. There was little biliary excretion of the glucuronidated and sulphated bile acids. Such conjugation appears to have a role in facilitating bile acid excretion by the urinary route.
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Makuuchi M, Yamazaki S, Hasegawa H, Bandai Y, Ito T, Watanabe G. Ultrasonically guided cholangiography and bile drainage. ULTRASOUND IN MEDICINE & BIOLOGY 1984; 10:617-623. [PMID: 6531822 DOI: 10.1016/0301-5629(84)90076-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Ultrasonically guided percutaneous transhepatic cholangiography (UG-PTC), bile drainage (UG-PTBD) and gallbladder drainage procedure (UG-PTGBD), developed by us, were performed in 47, 183 and 36 patients, respectively. In 47 patients UG-PTC was successfully performed 51 times without complications. By UG-PTBD 220 intubations were carried out successfully and four attempts failed (1.8%). The main complication was that the catheter slipped out from the bile duct. It was experienced 27 times (12.3%) in 23 patients (12.4%) from two to 47 days after intubation. UG-PTGBD was successfully performed 36 times. Bleeding from the catheter was experienced in four patients. However, other complications such as cholascos were not experienced. Due to the development of ultrasonic diagnosis and the UG-PTBD procedure, the indications for percutaneous transhepatic cholangiography (PTC) are now limited. For differentiation of jaundice, ultrasonic examination takes over from PTC. For preparation of PTBD, thin needle cholangiography is no longer necessary because UG-PTBD is a single-step procedure without the need for cholangiography. Therefore, the indication for PTC is limited to patients with partial dilatation of intrahepatic bile ducts without jaundice, for example when only the left hepatic duct is dilated due to hepatolithiasis.
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Rubin JM, Dohrmann GJ. A cannula for use in ultrasonically guided biopsies of the brain. Technical note. J Neurosurg 1983; 59:905-7. [PMID: 6619947 DOI: 10.3171/jns.1983.59.5.0905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The authors describe a cannula that has been modified to improve its visibility during ultrasonically guided biopsies of the brain. To enhance the echogenicity of the tip of the cannula, six parallel rings, 0.25 to 0.30 mm deep and 0.40 to 0.50 mm apart, were etched into the tip of the cannula. The cannula was also lengthened to approximately 19 cm to permit its unencumbered passage through any biopsy guidance device that may be employed. Detailing the precise location of the tip of the biopsy cannula is most important. The tip of this modified probe is much more echogenic and hence more easily seen ultrasonically than it would be otherwise, both in vivo and in vitro. This modified cannula is useful in any ultrasonically guided intracranial biopsy procedure.
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Afschrift M, Nachtegaele P, Voet D, Noens L, Van Hove W, van der Straeten M, Verdonk G. Puncture of thoracic lesions under sonographic guidance. Thorax 1982; 37:503-6. [PMID: 7135290 PMCID: PMC459355 DOI: 10.1136/thx.37.7.503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Thirty-six punctures of thoracic lesions have been performed with a compound B-scanner or a real-time linear-array scanner for guidance. Twenty-three fluid collections were punctured and aspiration biopsies were performed on 13 echogenic lesions. All the punctures were successful at the first attempt. No complications occurred. The results confirm the usefulness of sonography for guiding punctures of thoracic fluid effusions and solid masses. Usually a static B-scanner is sufficient, but when masses are small or surrounded by vital structures puncture may be controlled by a real-time scanner.
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Weyman PJ, Evens RG. Percutaneous transhepatic biliary drainage in the management of biliary obstruction. Curr Probl Diagn Radiol 1982; 11:1-55. [PMID: 7116914 DOI: 10.1016/0363-0188(82)90018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Reid MH, Phillips HE. The role of computed tomography and ultrasound imaging in biliary tract disease. Surg Clin North Am 1981; 61:787-825. [PMID: 7025293 DOI: 10.1016/s0039-6109(16)42481-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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