[Peculiarities of performance of endoscopic transpapillary interventions in the early period after cholecystectomy]

The peculiarities of performance of endoscopic transpapillary interventions (ETI) during the early period after cholecystectomy were studied up. There were examined 1788 patients, aged from 18 to 90 yrs old, in whom postcholecystectomy syndrome was diagnosed. Emergent interventions were performed in 780 (43.6%) patients (main group). Into the comparison group 1008 (56.4%) patients were included, who were admitted to the hospital in 0.5-552 (Me 36) months after cholecystectomy conduction. The indications to perform the urgent endoscopic intervention were excessive transdrainage biliary output (more than 350 ml a day) from a subhepatic indignation (in 442 patients) and the obturation jaundice presence (in 338). Using ETI the cause of biliary obstruction in the early postoperative period was established in 93.5% of patients. Miniinvasive methods were applied in 82.2% patients of the main group and in 93.4%--of the comparison group.

[Clinico-morphological characteristics of major duodenal papilla benign neoformations of patients with postcholecystectomy syndrome]

The article is devoted to a problem of diagnosis and treatment of postcholecystectomy syndrome caused by benign neoformations of the major duodenal papilla. The material of study was formed by 76 patients; among them 53 ones had isolated benign neoformations of the major duodenal papilla. The medical-diagnostic algorithm applied by authors for the examination of patients with postcholecystectomy syndrome is presented. It's been defined, that benign neoformations of the major duodenal papilla take an essential place in the structure of postcholecystectomy syndrome and make 13.5% of the reasons of its occurrence. Thus, the most widespread morphological substratum of these benign neoformations is the hyperplastic polyp.

[Morphological features and esophago-gastroduodenal zone microbiocenose in patients with syndrome postcholecystectomic syndrome]

Endoscopical and histological features of oesophagogastroduodenal zone, parameters of pH-metry and electrogastroenterography, qualitative and quantitative characteristics of microbiocenosis were studied in 80 female persons with postcholecystectomy syndrome more then a year after cholecystectomy. In the presence of duodenogastral reflux the most natural is the combination of distal oesophagitis, antral atrophic gastritis and duodenitis, accompanied with low level of gastric acidity, gastric hypokinesis and duodenal dyskinesis, dysbacteriosis of mucosal microflora with its quantitative increase and appearance of bacteria with expressed pathogenicity non-typical for this biotope. These data should be taken into consideration for determination of pre- and postoperative treatment tactics for patients with gallstones.

[Rationale for the allocation of clinical variants of the postcholecystectomical syndrome associated with bacterial overgrowth in the small intestine]

The article presents the literature data concerning the pathogenesis and clinical manifestations as postcholecystectomical syndrome and syndrome of bacterial overgrowth in the small intestine (ARIS). Was provided information on the microflora of the small intestine and factors affecting its formation. It is shown that the main clinical manifestations of ARIS influenced by intestinal motility disorders, the processes of intestinal digestion and absorption. Are also given own results, which allowed to justify the selection of a clinical variant postcholecystectomical syndrome associated with bacterial overgrowth in the small intestine.

Inflammatory polyps in common bile duct caused by T-tube

We describe two patients who formed inflammatory polyps at the side holes of T-tubes. It seems advisable to remove T-tubes as soon as it is appropriate. New designs and materials may also help avert these lesions.

[Post-cholecystectomy syndrome: hepatobiliary scintigraphy and cholangiopancreatography with magnetic resonance in 5 consecutive patients. Comparison of results and integrated diagnosis]

PURPOSE

To investigate the clinical effectiveness of combined hepatobiliary scintigraphy (HBS) and MR-cholangiopancreatography (MRCP) studies in the postcholecystectomy syndrome.

MATERIAL AND METHODS

June 1997, to February 1998, we examined with HBS and MRCP five women, three of them submitted to surgical and two to laparoscopic cholecystectomy. All patients had biliary pain but no changes in cholestasis and liver function blood parameters. After at least 4 hours' fasting HBS was performed dynamically, for one hour, injecting a 185 MBq 99mTc-mebrofenin bolus i.v. A fatty meal was given at the end of the basal test and serial static images were acquired till complete biliary washout.

RESULTS

MRCP was normal in one case while in the others it showed biliary tree dilation, severe stricture of the distal common bile duct (CBD) and marked enlargement of the remnant cystic duct (RCD), which lodged a 6-mm stone in one patient. Pancreatic ducts were regular. HBS showed delayed biliary transit in all patients, which was however completed within 3 hours of injection, favored by the fatty meal. The RCD was not injected in three cases. Finally, HBS detected an early liver dysfunction in three cases.

DISCUSSION

HBS and MRCP allow to evaluate the biliary tree function and anatomy, respectively, adding further data on liver function and pancreatic duct morphology. We detected associated functional and organic biliary alterations which were the likely cause of postcholecystectomy pain, such as severe spasm in Oddi's sphincter, nonpatent enlarged RCD and RCD stones. Moreover, HBS detected an early liver dysfunction in three cases. In conclusion, combined HBS and MRCP studies make a noninvasive, simple and accurate diagnostic approach in postcholecystectomy syndrome and for the screening of patients needing prompt surgical treatment.

Helicobacter pylori infection increases following cholecystectomy

Cholecystectomy is frequently linked with duodenogastric reflux and gastritis but its effect on Helicobacter Pylori (H pylori) infection has not been examined. In a prospective study, twenty two patients with documented cholelithiasis underwent upper gastrointestinal endoscopy and biopsy and 24hr dual channel pH monitoring prior to cholecystectomy and again at 3-6 months post-operatively. The antral biopsies were histologically assessed for H pylori and gastritis and awarded an alkaline reflux score. The number of patients with H pylori infection increased from 7 (32%) preoperatively to 15 (68%) post-cholecystectomy (p < 0.05). Cholecystectomy was also associated with an increase in the incidence of gastritis from 7 to 15 (p < 0.05). The increase in H pylori infection rate occurred in association with an increase in the percentage time gastric pH > 4 in the supine position, from 9.6 (2.2) to 22.2 (4.8) percent, (p < 0.01). The median chemical gastritis score, however, did not change significantly following surgery [8(3-11) vs 7(3-11)]. Seven patients remained symptomatic following cholecystectomy all of whom were H pylori positive and had gastritis. H pylori can survive in the alkaline environment which follows cholecystectomy and may contribute to the post-cholecystectomy syndrome.