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Meira-Júnior JD, Ramos-Aranda J, Carrillo-Vidales J, Velásquez-Coria ER, Mercado MA, Dominguez-Rosado I. BILE DUCT INJURY REPAIR IN A PATIENT WITH SITUS INVERSUS TOTALIS. Arq Bras Cir Dig 2024; 37:e1795. [PMID: 38511812 PMCID: PMC10949928 DOI: 10.1590/0102-672020240002e1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/30/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Bile duct injury (BDI) causes significant sequelae for the patient in terms of morbidity, mortality, and long-term quality of life, and should be managed in centers with expertise. Anatomical variants may contribute to a higher risk of BDI during cholecystectomy. AIMS To report a case of bile duct injury in a patient with situs inversus totalis. METHODS A 42-year-old female patient with a previous history of situs inversus totalis and a BDI was initially operated on simultaneously to the lesion ten years ago by a non-specialized surgeon. She was referred to a specialized center due to recurrent episodes of cholangitis and a cholestatic laboratory pattern. Cholangioresonance revealed a severe anastomotic stricture. Due to her young age and recurrent cholangitis, she was submitted to a redo hepaticojejunostomy with the Hepp-Couinaud technique. To the best of our knowledge, this is the first report of BDI repair in a patient with situs inversus totalis. RESULTS The previous hepaticojejunostomy was undone and remade with the Hepp-Couinaud technique high in the hilar plate with a wide opening in the hepatic confluence of the bile ducts towards the left hepatic duct. The previous Roux limb was maintained. Postoperative recovery was uneventful, the drain was removed on the seventh post-operative day, and the patient is now asymptomatic, with normal bilirubin and canalicular enzymes, and no further episodes of cholestasis or cholangitis. CONCLUSIONS Anatomical variants may increase the difficulty of both cholecystectomy and BDI repair. BDI repair should be performed in a specialized center by formal hepato-pancreato-biliary surgeons to assure a safe perioperative management and a good long-term outcome.
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Affiliation(s)
- José Donizeti Meira-Júnior
- Universidade de São Paulo, Digestive Surgery Division, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Javier Ramos-Aranda
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Javier Carrillo-Vidales
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Erik Rodrigo Velásquez-Coria
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Miguel Angel Mercado
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Ismael Dominguez-Rosado
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
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Mills K, Joseph A, Abioye A, Nguyen P, Beazer J, Amadi C, Bilal M, Pantangi P. Bile Duct Tumor as the Presenting Manifestation of Colon Cancer: A Case Report. Cureus 2023; 15:e46378. [PMID: 37927693 PMCID: PMC10620619 DOI: 10.7759/cureus.46378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Painless obstructive jaundice is a well-recognized clinical sign of hepatocellular pathology or obstruction of the biliary system. Bile duct tumors are a known etiology of painless obstructive jaundice. Here, we present a case of obstructive jaundice, which was initially thought be caused by cholangiocarcinoma based on computerized tomography imaging and endoscopic retrograde cholangiopancreatography but was later found to be hilar metastasis from an undiscovered colon cancer.
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Affiliation(s)
- Krystal Mills
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | - Allan Joseph
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Adedayo Abioye
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Phuong Nguyen
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Jabez Beazer
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Chima Amadi
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Muhammad Bilal
- Internal Medicine, Ascension St. Vincent's East Hospital, Birmingham, USA
| | - Pramod Pantangi
- Gastroenterology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Echeverri-Mejía C, Ríos-Orozco SU, Lozada-Martínez ID, Narvaez-Rojas AR. Alagille syndrome: an orphan disease in Colombia and summary of recent advances in treatment and survival - a case report. Ann Med Surg (Lond) 2023; 85:1231-1234. [PMID: 37113962 PMCID: PMC10129178 DOI: 10.1097/ms9.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/18/2023] [Indexed: 04/29/2023] Open
Abstract
Alagille syndrome has been described as a multisystemic clinical spectrum caused by an autosomal dominant genetic disorder. Although it is estimated that there is 1 case per 100 000 live births, the prognosis for survival and quality of life for these patients is varied but tends to be negative. In Colombia, this condition is considered an orphan disease with difficult management due to the lack of specialized centers that have all the medical specialties and subspecialties. Some reports state that no more than 30 cases have been published in this country. Materials and methods The authors report a case of a male baby who, at 8 days old, he was taken to the general practitioner's outpatient clinic for persistent jaundice. At 3 months of age, he was reviewed by the pediatric gastroenterology department, which requested liver and biliary tract scintigraphy, showing atresia of the biliary tract, hepatomegaly, and the absence of a gallbladder. Results Liver transplantation is the definitive solution. However, in low- and middle-income countries, where there are no well-established organ transplantation programs, the prognosis for these patients is presumed to be worse. Conclusion Alagille syndrome is a rare disease that requires an accurate and early diagnosis and timely multidisciplinary management to reduce the impact of multisystemic complications. It is necessary to advance in transplant programs in low- and middle-income countries, to provide a solution to cases where there are no other therapeutic alternatives, and to contribute to the quality of life of the affected patient.
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Affiliation(s)
| | | | - Ivan D. Lozada-Martínez
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
| | - Alexis R. Narvaez-Rojas
- International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
- Breast Surgical Oncology Division, DeWitt Daughtry Family Department of Surgery, Jackson Health System/University of Miami Miller School of Medicine, Miami, Florida
- Corresponding author. Address: International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, 663, Nicaragua. Tel number: +505 8565 9292. E-mail address: (A. Narvaez-Rojas)
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GONZÁLEZ-ARBOLEDA F, PIZARRO F, LINDNER C, CAQUEO F. THERAPEUTIC APPROACH OF COMPLICATED HYDATID DISEASE: ROLE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CHOLANGIOHYDATIDOSIS. Arq Bras Cir Dig 2023; 35:e1699. [PMID: 36629682 PMCID: PMC9831634 DOI: 10.1590/0102-672020220002e1699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/11/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hydatid disease, a parasitic infestation caused by Echinococcus granulosus larvae, is an infectious disease endemic in different areas, such as India, Australia, and South America. The liver is well known as the organ most commonly affected by hydatid disease and may present a wide variety of complications such as hepatothoracic hydatid transit, cyst superinfection, intra-abdominal dissemination, and communication of the biliary cyst with extravasation of parasitic material into the bile duct, also called cholangiohydatidosis. Humans are considered an intermediate host, exposed to these larvae by hand-to-mouth contamination of the feces of infected dogs. AIM This study aimed to highlight the role of endoscopic retrograde cholangiopancreatography in patients with acute cholangitis secondary to cholangiohydatidosis. METHODS Considering the imaging findings in a 36-year-old female patient with computed tomography and magnetic resonance imaging showing a complex cystic lesion in liver segment VI, with multiple internal vesicles and a wall defect cyst that communicates with the intrahepatic biliary tree, endoscopic biliary drainage was performed by endoscopic retrograde cholangiopancreatography with papillotomy, leading to the discharge of multiple obstructive cysts and hydatid sand from the main bile duct. RESULTS Clinical and laboratory findings improved after drainage, with hospital discharge under oral antiparasitic treatment before complete surgical resection of the hepatic hydatid cyst. CONCLUSIONS Endoscopic retrograde cholangiopancreatography is a safe and useful method for the treatment of biliary complications of hepatic hydatid disease and should be considered the first-line procedure for biliary drainage in cases of cholangiohydatid disease involving secondary acute cholangitis.
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Affiliation(s)
- Franz GONZÁLEZ-ARBOLEDA
- Regional Hospital, Digestive Surgery Department – Talca, Chile;,Catholic University of Maule, Faculty of Medicine – Talca, Chile
| | | | - Cristian LINDNER
- Regional Hospital, Digestive Surgery Department – Talca, Chile;,Regional Hospital, Radiology Department – Talca, Chile
| | - Fermín CAQUEO
- Regional Hospital, Digestive Surgery Department – Talca, Chile
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5
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Lee YN, Moon JH, Lee TH, Yoo HW, Yang JK, Cha SW, Cho YD, Park SH. Efficacy and safety of direct peroral cholangioscopy using a new multibending ultra-slim endoscope for the management of biliary diseases. J Hepatobiliary Pancreat Sci 2022; 29:1292-1299. [PMID: 35658104 DOI: 10.1002/jhbp.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/21/2022] [Accepted: 05/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE Compared with currently available duodenoscopy-assisted systems, direct peroral cholangioscopy (DPOC) using an ultra-slim endoscope is limited by technical difficulties. The multibending (MB) ultra-slim endoscope was introduced as a dedicated cholangioscope for DPOC to challenge the technical problem. We retrospectively analyzed the clinical utility of DPOC using an MB endoscope with free-hand insertion into the bile duct in patients with biliary diseases. METHODS A total of 145 patients who underwent DPOC using an MB endoscope were analyzed. The primary outcome was the technical success rate of DPOC using the free-hand insertion of the MB endoscope. The secondary outcomes were the technical success rates of DPOC-guided diagnostic and therapeutic interventions, the diagnostic accuracy of DPOC-guided target biopsy, and adverse events related to DPOC. RESULTS Free-hand biliary insertion of a MB endoscope for DPOC was technically successful in 133 patients (91.7%). DPOC-guided target biopsy was successful in 36 of 38 patients (94.7%) and had a diagnostic accuracy of 91.7% (95% confidence interval, 82.6-100). Sixty-nine therapeutic interventions were performed; technical success was achieved in 65 (94.2%). No severe adverse events were observed. CONCLUSIONS The MB ultra-slim endoscope was technically effective to perform a DPOC including various diagnosis and therapeutic interventions without device assistance. MB endoscope is considered to contribute to expanding a role of DPOC in diagnosis and treatment of diverse biliary tract diseases.
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Affiliation(s)
- Yun Nah Lee
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Jong Ho Moon
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Cheonan, Korea
| | - Hae Won Yoo
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Jae Kook Yang
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Cheonan, Korea
| | - Sang-Woo Cha
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Seoul, Korea
| | - Young Deok Cho
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Seoul, Korea
| | - Sang-Heum Park
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Cheonan, Korea
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Cirimele V, D'Amone G, Quattrocchi CC. A case of portal biliopathy in a young patient with portal cavernoma secondary to neonatal umbilical vein catheterization. Radiol Case Rep 2022; 18:463-466. [PMCID: PMC9691431 DOI: 10.1016/j.radcr.2022.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
Portal biliopathy (PB) refers to biliary obstruction caused by cavernous transformation of the portal vein (CTPV). CTPV occurs most frequently in patients with liver cirrhosis or malignancy. Less common causes include congenital malformations and neonatal umbilical vein cannulation. We present a case of portal biliopathy in a 28-year-old man with CTPV secondary to umbilical vein catheterization in neonatal age. The case illustrates portal biliopathy as a late complication of neonatal invasive procedures and highlights the importance of a multimodality imaging approach to achieve a prompt diagnosis.
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7
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Muacevic A, Adler JR, Choi C, Verma S. Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Subcapsular Hepatic Hematoma. Cureus 2022; 14:e31691. [PMID: 36561579 PMCID: PMC9767655 DOI: 10.7759/cureus.31691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 11/21/2022] Open
Abstract
Physicians need to recognize the potential complications of endoscopic retrograde cholangiopancreatography (ERCP), which are rare but can be serious. We describe a case of post-ERCP subcapsular hepatic hematoma (SHH). A 39-year-old man with a history of alcohol use, complicated by chronic pancreatitis and common bile duct (CBD) stricture, presented with right upper quadrant pain two weeks after the placement of a stent for CBD stricture. He was managed with pain control and antibiotics. SHH is a rare complication of ERCP. Hematomas can expand, resulting in significant anemia and liver function test (LFT) elevation, or can become infected. Patients with SHH must be carefully monitored in the post-ERCP setting.
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8
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Ozcan N, Riaz A, Kahriman G. Percutaneous Management of Biliary Stones. Semin Intervent Radiol 2021; 38:348-355. [PMID: 34393345 DOI: 10.1055/s-0041-1731373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Bile duct stone disease is the most common causes of nonmalignant bile duct obstructions. The range of common bile duct stone formation in patients with cholecystectomy is 3 to 14.7%. Hepatolithiasis, although endemic in some parts of the world, is a rare disease that is difficult to manage. Endoscopic intervention is accepted as the first-line management of common bile duct stones. However, when the bile duct cannot be cannulated for various reasons, the endoscopic procedure fails. In this circumstance, percutaneous approach is an alternative technique for the nonsurgical treatment of bile duct stones. This article reviews the indications, technique, outcomes, and complications of the percutaneous treatment of bile duct stone disease.
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Affiliation(s)
- Nevzat Ozcan
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Erciyes, Medical Faculty, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Ahsun Riaz
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Guven Kahriman
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Erciyes, Medical Faculty, Gevher Nesibe Hospital, Kayseri, Turkey
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9
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Barbaro F, Tringali A, Larghi A, Baldan A, Onder G, Familiari P, Boškoski I, Perri V, Costamagna G. Endoscopic management of non-anastomotic biliary strictures following liver transplantation: Long-term results from a single-center experience. Dig Endosc 2021; 33:849-857. [PMID: 33080081 DOI: 10.1111/den.13879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Studies on endoscopic treatment of non-anastomotic biliary strictures (NABS) following orthotopic liver transplantation (OLT) are scanty and with a short follow-up. The long-term results of endoscopic treatment with plastic stents of NABS following OLT were analyzed. METHODS Retrospective analysis of consecutive enrolled patients who underwent endoscopic treatment for NABS after OLT between 1997 and 2015. Endoscopic treatment success was defined as stricture resolution, without recurrence. RESULTS During the study period, 33 patients with NABS underwent endoscopic retrograde cholangiopancreatography (ERCP) in our center. A total of 68 ERCP were performed with a 4.4% of procedure-related adverse events. Mortality related to cholangitis secondary to endoscopic procedures was 12%. After median follow-up of 70.3 months from stents removal, NABS resolution was obtained in 12 out of 24 (50%) patients. Only one case of late NABS recurrence was observed which was successfully retreated endoscopically. According to our data analysis NABS occurring <12 months from OLT showed a worse prognosis (P < 0.04). CONCLUSIONS The follow-up of this study confirms that endoscopic treatment of NABS is unsatisfactory. However, patients who respond to endoscopic treatment maintain the response over time. Prompt treatment of acute cholangitis due to stents occlusion is advised in these patients to avoid high mortality rates.
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Affiliation(s)
- Federico Barbaro
- Digestive Endoscopy Unit, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Baldan
- Gastroenterology and Transplant Hepatology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Graziano Onder
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Familiari
- Digestive Endoscopy Unit, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
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Subhash A, Abadir A, Iskander JM, Tabibian JH. Applications, Limitations, and Expansion of Cholangioscopy in Clinical Practice. Gastroenterol Hepatol (N Y) 2021; 17:110-120. [PMID: 34035770 PMCID: PMC8132717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Peroral cholangioscopy (POC) provides minimally invasive, direct endoscopic visualization of the biliary ductal system for both diagnostic and therapeutic purposes. POC has benefited from a number of technologic advances since its first introduction several decades ago. These advances have led to improved utility and expanded functionality, making POC an integral part of managing various bile duct diseases and disorders. Over time, the clinical role of POC has expanded. Novel applications and capabilities are being increasingly appreciated and developed. This article provides an overview of the current state of POC, with a particular focus on digital single-operator cholangioscopy and its strengths, limitations, advances, and emerging applications.
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Affiliation(s)
- Amith Subhash
- Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Alexander Abadir
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John M. Iskander
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - James H. Tabibian
- Division of Gastroenterology, Olive View-UCLA Medical Center, Sylmar, California
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
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11
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Ramon Y Cajal Calvo J, Bello Franco C, Sesé Lacamara L, Costa Lorente M, Moreno Caballero L. [Bouveret syndrome: unusual cause of gallstone ileus]. ACTA ACUST UNITED AC 2020; 77:378-80. [PMID: 33351368 DOI: 10.31053/1853.0605.v77.n4.30300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/08/2020] [Indexed: 11/21/2022]
Abstract
Introduction Bouveret syndrome consists of an obstruction of the gastric outlet due to the impaction of a gallstone in the duodenal bulb after migration through a cholecystoduodenal fistula. Clinical Case Patient with diffuse colicky abdominal pain, diarrhea and yellowish vomiting. The imaging tests carried out reveal significant gastric and duodenal dilation with the presence of gas at the gallbladder level with the existence of a cholecystoduodenal fistula with a rounded intraluminal image in the proximal jejunum compatible with migrated lithiasis. The patient underwent emergency surgery through an enterotomy with removal of the calculus and its closure. Discussion: Discussion Bouveret's syndrome is a rare gallstone ileus condition that causes significant morbidity and mortality and often occurs in the elderly with significant comorbidities. Individual diagnosis and treatment strategies are required for optimal management and results, with endoscopic treatment or open surgery being the two treatments available for resolution of the condition. Conclusion Bouveret syndrome is a life-threatening condition with gastric outlet obstruction caused by large gallstones. In most cases, a CT scan is required for diagnosis, and although in some cases percutaneous and endoscopic treatments can be successful as first-line treatment, most patients require surgery to remove stones.
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12
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Rumsey S, Winders J, MacCormick AD. Diagnostic accuracy of Charcot's triad: a systematic review. ANZ J Surg 2017; 87:232-238. [PMID: 28213923 DOI: 10.1111/ans.13907] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/14/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Charcot's triad is a well-established diagnostic tool for acute cholangitis (AC). It has been recognized as an inaccurate test in clinical practice; however, its exact sensitivity and specificity remain unclear. This knowledge is key to informing the value of its continued clinical application. The objectives of this study are to calculate an estimate of the sensitivity and specificity of Charcot's triad based on published research and consider its applicability to clinical practice and medical education. METHODS Electronic database search for relevant literature and review of reference lists of the subsequent articles for additional resources. Two independent researchers located articles which were qualitatively and quantitatively reviewed. The overall sensitivity and specificity values across all studies were subsequently calculated. RESULTS The 16 articles included in the review varied widely in study design and the sensitivity of Charcot's triad was reported for AC. Across the included articles, there were 4288 patients studied. The overall sensitivity for Charcot's triad was calculated as 36.3%. The specificity was only analysed in three studies and had an overall value of 93.2%. Nine of the articles also investigated the sensitivity of Reynold's pentad which was consistently low with an overall value of 4.82%. The specificity of Reynold's pentad was not studied. CONCLUSION Charcot's triad has limited clinical utility as a diagnostic algorithm for AC. It is an effective rule-in test but a poor rule-out test and should be applied and taught accordingly. A more sensitive diagnostic tool is required to achieve superior outcomes for AC patients.
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Affiliation(s)
- Steva Rumsey
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Joel Winders
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Andrew D MacCormick
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Middlemore Hospital, Auckland, New Zealand
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Abstract
INTRODUCTION Primary biliary cirrhosis (PBC) is a chronic, cholestatic liver disease characterized histologically by lymphocytic cholangitis and intralobular bile duct destruction. It is a progressive disorder associated with increased mortality and decreased quality of life related to hepatic fibrosis, troublesome symptoms such as fatigue and pruritus, and ultimately endstage cirrhosis. PBC affects adults around the world, and therefore effective treatment of PBC and its associated symptoms constitute significant issues for patients and providers as well as on a public health level. The only approved pharmacotherapy for PBC to date is ursodeoxycholic acid (UDCA), a choleretic, hydrophilic bile acid which has been in clinical use for decades. UDCA is effective in a majority of patients with PBC, but nearly a third of patients are UDCA non-responders. Non-response to UDCA is associated with an increased risk of death or need for liver transplantation (LT). Whereas LT is an effective treatment, it engenders substantial cost and a risk of PBC recurrence, among other complications. Patients who are non-responders to UDCA or have highly symptomatic disease (e.g., intractable pruritus) are thus in critical need of novel therapeutic approaches, which are both safe and effective. AREAS COVERED In this review, we provide a synopsis regarding the safety and benefits of established and emerging pharmacotherapies for PBC and present viewpoints on how they may evolve over the next several years. EXPERT OPINION It is our belief that the pharmacoscope of PBC, as with other cholestatic liver diseases, is likely to see important advancements in the near future.
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Affiliation(s)
- James H Tabibian
- a 1 Mayo Clinic, Division of Gastroenterology and Hepatology , Rochester, MN, USA
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Walas MK, Skoczylas K, Gierbliński I. Errors and mistakes in the ultrasound diagnostics of the liver, gallbladder and bile ducts. J Ultrason 2012; 12:446-62. [PMID: 26673428 PMCID: PMC4603237 DOI: 10.15557/jou.2012.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 11/26/2012] [Accepted: 12/03/2012] [Indexed: 12/12/2022] Open
Abstract
Ultrasonography is the most widespread imaging technique used in the diagnostics of the pathologies concerning the organs in the abdominal cavity. Similarly to other diagnostic tools, errors may occur in ultrasound examinations. They generally result from inappropriate techniques, which do not conform to current standards, or erroneous interpretation of obtained images. A significant portion of mistakes is caused by inappropriate quality of the apparatus, the presence of sonographic imaging artifacts, unfavorable anatomic variants or improper preparation of the patient for the examination. This article focuses on the examiner-related errors. They concern the evaluation of the liver size, echostructure and arterial and venous vascularization as well as inappropriate interpretation of the liver anatomic variants and the vascular and ductal structures localized inside of it. Furthermore, the article presents typical mistakes made during the diagnosis of the most common gallbladder and bile duct diseases. It also includes helpful data concerning differential diagnostics of the described pathologies of the liver, gallbladder and bile ducts. The article indicates the most frequent sources of mistakes as well as false negative and false positive examples which result from these errors. What is more, the norms used in the liver, gallbladder and bile duct evaluations are presented as well as some helpful guidelines referring to the exam techniques and image interpretation, which allows for reducing the error-making risk. The article has been prepared on the basis of the report published in 2005 by the Polish experts in the field of ultrasonography and extended with the latest findings obtained from the pertinent literature.
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Affiliation(s)
- Maria Krystyna Walas
- Ośrodek USG i Diagnostyki Biopsyjnej, Katedra i Klinika Chorób Metabolicznych CMUJ, Kraków, Polska
| | - Krzysztof Skoczylas
- Klinika Gastroenterologii Onkologicznej, Centrum Onkologii - Instytut im. Marii Skłodowskiej-Curie, Warszawa, Polska
| | - Ireneusz Gierbliński
- Klinika Gastroenterologii Onkologicznej, Centrum Onkologii - Instytut im. Marii Skłodowskiej-Curie, Warszawa, Polska
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Tucker RM, Mack CL. Generation of a cholangiocyte-specific cDNA expression library for the identification of B and T cell autoantigens in murine biliary disease. Hepatol Res 2012; 42:502-7. [PMID: 22236071 PMCID: PMC3798039 DOI: 10.1111/j.1872-034x.2011.00951.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Several mouse models of inflammatory cholangiopathies exist, including biliary atresia, primary biliary cirrhosis, autoimmune hepatitis, and primary sclerosing cholangitis. In an ongoing effort to identify the target antigens of both infiltrating autoreactive T cells and serum autoantibodies, we aimed to generate a cholangiocyte-derived cDNA library capable of expressing a wide variety of proteins. METHODS mRNA was isolated from a normal mouse cholangiocyte cell line and reverse transcribed into cDNA. After initial cloning of the cDNA into a transfer vector (pDONR222), the entire library was shuttled into an Escherichia coli expression vector (pDEST160). RESULTS The library contains 2.3 × 10(6) independent clones and expresses proteins up to 100 kD in molecular weight. Using a variety of techniques, including western blot analysis, mass spectrometry of individual clones, and direct DNA sequencing of plasmids, a number of both ubiquitously expressed and cholangiocyte-specific proteins (e.g. cytokeratin 19) have been identified within. CONCLUSION A comprehensive mouse cholangiocyte cDNA expression library has been generated and is available for use as a source of multiple cholangiocyte-specific antigens for immunological studies. The library can be used to screen for specificity of T cell lines or hybridomas. Furthermore, this library has potential uses in SEREX analysis of autoantibody reactivity. The cholangiocyte-specific cDNA library is a powerful tool for the identification of target antigens in murine inflammatory cholangiopathies and is available as a shared resource.
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Affiliation(s)
| | - Cara L. Mack
- Department of Medicine, University of Colorado, Denver,Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital Colorado, Aurora, Colorado, USA
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Abstract
Primary sclerosing cholangitis (PSC) is a chronic, cholestatic, idiopathic liver disease characterized by fibro-obliterative inflammation of the hepatic bile ducts. In a clinically significant proportion of patients, PSC progresses to cirrhosis, end-stage liver disease, and in some cases, cholangiocarcinoma (CCA). The development of CCA in PSC is unpredictable, its surveillance and diagnosis complex, and its treatment options limited unless detected early. Herein we provide a focused review of the current literature regarding CCA surveillance in patients with PSC and discuss the diagnostic and management challenges that exist. Where evidence is limited, we present our perspective and approach as well as directions for future research.
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Affiliation(s)
- James H. Tabibian
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Keith D. Lindor
- Executive Vice Provost, Health Solutions, Arizona State University, P.O. Box 877805, Tempe, AZ 85287-7805, USA
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Satish J, Monica J, Dalbir K, Lovesh S. Management of spontaneous perforation of the bile duct in an infant in a semi-urban setup: a case report. Malays J Med Sci 2012; 19:73-75. [PMID: 22977379 PMCID: PMC3436493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 08/09/2011] [Indexed: 06/01/2023] Open
Abstract
Spontaneous perforation of the extrahepatic bile duct leading to biliary peritonitis is a rare occurrence once other causes of biliary peritonitis, such as trauma, choledochal cyst, stone diseases, and distal atresia of the bile duct, are ruled out. A 7-month-old male infant was brought to the hospital in critical condition with distension of the abdomen. He had a history of vomiting and diarrhoea, low-grade fever, and refusal to feed for 2 days. Signs of peritonitis were found upon examination. Due to the poor general condition of the patient, the case was taken up for laparotomy, and a diagnosis of spontaneous extrahepatic bile duct perforation was made intra-operatively. In the present case, the cause was idiopathic. An external drain was placed near the site of the leak for 2 weeks. The patient recovered well and was discharged on post-operative day 16. Disease awareness for correct pre-operative diagnosis and interventional planning is required to reduce mortality, morbidity, and complications in spontaneous perforation of the common bile duct.
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Affiliation(s)
- Jain Satish
- Aakash Hospital, Rishi Nagar, Hisar-125001, Haryana, India
| | - Jain Monica
- Aakash Hospital, Rishi Nagar, Hisar-125001, Haryana, India
| | - Kaur Dalbir
- Aakash Hospital, Rishi Nagar, Hisar-125001, Haryana, India
| | - Shukla Lovesh
- Aakash Hospital, Rishi Nagar, Hisar-125001, Haryana, India
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