RESUMEN
BACKGROUND: Intraoperative laparoscopic ultrasonography (LUS) or intraoperative cholangiography (IOC) can be used for visualisation of the biliary tract during laparoscopic cholecystectomy. The aim of this systematic review was to compare use of LUS with IOC. METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched (last update: April 2024). PICO: P = patients undergoing intraoperative imaging of the biliary tree during laparoscopic cholecystectomy for gallstone disease; I = intervention: LUS; C = comparison: IOC; O = outcomes: mortality, bile duct injury, retained gallstone, conversion to open cholecystectomy, procedural failure, operation time including imaging time. Included articles were critically appraised using checklists. Conclusions were based on studies without major risk of bias. Meta-analyses were performed using random effects models. Certainty of evidence was assessed according to GRADE. RESULTS: Sixteen non-randomised studies met the PICO. Two before/after studies (594 versus 807 patients) contributed to conclusions regarding mortality (no events; very low certainty evidence), bile duct injury (1 versus 0 events; very low certainty evidence), retained gallstone (2 versus 2 events; very low certainty evidence), and conversion to open cholecystectomy (6 versus 21 events; risk ratio: 0.38 (95% confidence interval: 0.15-0.95); I2 = 0%; low certainty evidence). Seven additional studies, using intra-individual comparisons, contributed to conclusions regarding procedural failure; risk ratio: 1.12 (95% confidence interval: 0.70-1.78; I2 = 83%; very low certainty evidence). No studies reported operation time. Mean imaging time for LUS and IOC, reported in 12 studies, was 4.8â10.2 versus 10.9â17.9 min (mean difference: - 7.8 min (95% confidence interval: - 9.3 to - 6.3); I2 = 95%; moderate certainty evidence). CONCLUSION: It is uncertain whether there is any difference in mortality/bile duct injury/retained gallstone using LUS compared with IOC, but LUS may be associated with fewer conversions to open cholecystectomy and is probably associated with shorter imaging time.
Asunto(s)
Colangiografía , Colecistectomía Laparoscópica , Cálculos Biliares , Humanos , Colangiografía/efectos adversos , Colangiografía/métodos , Colecistectomía Laparoscópica/métodos , Colecistectomía Laparoscópica/efectos adversos , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/mortalidad , Cálculos Biliares/cirugía , Cuidados Intraoperatorios/efectos adversos , Cuidados Intraoperatorios/métodos , Tempo Operativo , Medición de Riesgo/métodos , Ultrasonografía/efectos adversos , Ultrasonografía/métodosRESUMEN
Other than rejection, hepatic artery and portal vein thrombosis are the most common complications in the immediate postoperative period with hepatic arterial thrombosis more common and more devastating. Hepatic artery stenosis is more common 1 month after transplantation, whereas portal and hepatic vein stenosis is more often seen as a late complication. Ultrasound is the first-line imaging examination to diagnose vascular complications with contrast-enhanced CT useful if ultrasound findings are equivocal. MR cholangiography is often most helpful in diagnosing bile leaks, biliary strictures, and biliary stones.
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Enfermedades de las Vías Biliares , Trasplante de Hígado , Trombosis , Humanos , Trasplante de Hígado/efectos adversos , Constricción Patológica/complicaciones , Colangiografía/efectos adversos , Trombosis/complicaciones , Complicaciones Posoperatorias/diagnóstico por imagen , HígadoRESUMEN
BACKGROUND: A variety of transhepatic percutaneous biliary procedures are appropriate for the treatment of pathologies of the biliary system. OBJECTIVES: The aim of this article is to describe best practices for performing percutaneous transhepatic cholangiography with placement of a biliary drain (PTCD), percutaneous transhepatic removal of bile duct stones, percutaneous stenting of the bile ducts, and percutaneous treatment of postoperative bilioma. MATERIALS AND METHODS: The authors reviewed existing literature on relevant current recommendations and presented them based on their own facility's approach. RESULTS: Biliary interventions are mostly aimed at treating some form of cholestasis of benign or malignant etiology. The technical success rate is up to 90%. CONCLUSION: Percutaneous biliary interventions are safe and effective procedures in the treatment of pathologies of the biliary system, preferably used when endoscopic access is not possible due to anatomical conditions.
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Colestasis , Drenaje , Humanos , Drenaje/efectos adversos , Drenaje/métodos , Conductos Biliares , Colangiografía/efectos adversos , Colestasis/diagnóstico por imagen , Colestasis/etiología , Colestasis/cirugía , Endoscopía/efectos adversosRESUMEN
BACKGROUND: Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure that involves inserting a needle into the biliary tree, followed by the immediate insertion of a catheter. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a novel technique that allows BD by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract. AIM: To compare the technical aspects and outcomes of percutaneous transhepatic BD (PTBD) and EUS-BD. METHODS: Different databases, including PubMed, Embase, clinicaltrials.gov, the Cochrane library, Scopus, and Google Scholar, were searched according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing PTBD and EUS-BD. RESULTS: Among the six studies that fulfilled the inclusion criteria, PTBD patients underwent significantly more reinterventions (4.9 vs 1.3), experienced more postprocedural pain (4.1 vs 1.9), and experienced more late adverse events (53.8% vs 6.6%) than EUS-BD patients. There was a significant reduction in the total bilirubin levels in both the groups (16.4-3.3 µmol/L and 17.2-3.8 µmol/L for EUS-BD and PTBD, respectively; P = 0.002) at the 7-d follow-up. There were no significant differences observed in the complication rates between PTBD and EUS-BD (3.3 vs 3.8). PTBD was associated with a higher adverse event rate than EUS-BD in all the procedures, including reinterventions (80.4% vs 15.7%, respectively) and a higher index procedure (39.2% vs 18.2%, respectively). CONCLUSION: The findings of this systematic review revealed that EUS-BD is linked with a higher rate of effective BD and a more manageable procedure-related adverse event profile than PTBD. These findings highlight the evidence for successful EUS-BD implementation.
Asunto(s)
Colestasis , Humanos , Bilirrubina , Colangiografía/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colestasis/diagnóstico por imagen , Colestasis/etiología , Colestasis/cirugía , Drenaje/efectos adversos , Drenaje/métodos , Endosonografía/efectos adversos , Endosonografía/métodos , Ultrasonografía Intervencional/efectos adversosRESUMEN
Percutaneous biliary interventions (PBIs) are commonly performed by interventional radiologists for a variety of clinical indications including biliary infections, strictures, leaks, and postoperative complications. PBIs have high technical and clinical success rates and are relatively safe when compared with more invasive surgical techniques. Percutaneous transhepatic cholangiography and percutaneous biliary drainage play an essential role in the management of common posthepatobiliary complications including biliary strictures and leaks. Percutaneous biliary endoscopy can be used for direct visualization of the biliary tree and a variety of interventions including tissue biopsy, lithotripsy, stone removal, as well as stent placement and removal.
Asunto(s)
Sistema Biliar , Colestasis , Colangiografía/efectos adversos , Colangiografía/métodos , Colestasis/etiología , Colestasis/cirugía , Constricción Patológica , Drenaje/métodos , Humanos , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Bile duct injury and conversion-to-open-surgery rates remain unacceptably high during laparoscopic and robotic cholecystectomy. In a recently published randomized clinical trial, using near-infrared fluorescent cholangiography with indocyanine green intraoperatively markedly enhanced biliary-structure visualization. Our systematic literature review compares bile duct injury and conversion-to-open-surgery rates in patients undergoing laparoscopic or robotic cholecystectomy with versus without near-infrared fluorescent cholangiography. METHODS: A thorough PubMed search was conducted to identify randomized clinical trials and nonrandomized clinical trials with ≥100 patients. Because all near-infrared fluorescent cholangiography studies were published since 2013, only studies without near-infrared fluorescent cholangiography published since 2013 were included for comparison. Incidence estimates, weighted and unweighted for study size, were adjusted for acute versus chronic cholecystitis, and for robotic versus laparoscopic cholecystectomy and are reported as events/10,000 patients. All studies were assessed for bias risk and high-risk studies excluded. RESULTS: In total, 4,990 abstracts were reviewed, identifying 5 near-infrared fluorescent cholangiography studies (3 laparoscopic cholecystectomy/2 robotic cholecystectomy; n = 1,603) and 11 not near-infrared fluorescent cholangiography studies (5 laparoscopic cholecystectomy/4 robotic cholecystectomy/2 both; n = 5,070) for analysis. Overall weighted rates for bile duct injury and conversion were 6 and 16/10,000 in near-infrared fluorescent cholangiography patients versus 25 and 271/10,000 in patients without near-infrared fluorescent cholangiography. Among patients undergoing laparoscopic cholecystectomy, bile duct injuries, and conversion rates among near-infrared fluorescent cholangiography versus patients without near-infrared fluorescent cholangiography were 0 and 23/10,000 versus 32 and 255/10,000, respectively. Bile duct injury rates were low with robotic cholecystectomy with and without near-infrared fluorescent cholangiography (12 and 8/10,000), but there was a marked reduction in conversions with near-infrared fluorescent cholangiography (12 vs 322/10,000). CONCLUSION: Although large comparative trials remain necessary, preliminary analysis suggests that using near-infrared fluorescent cholangiography with indocyanine green intraoperatively sizably decreases bile duct injury and conversion-to-open-surgery rates relative to cholecystectomy under white light alone.
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Enfermedades de los Conductos Biliares/etiología , Colangiografía , Colecistectomía Laparoscópica , Colecistectomía/métodos , Conversión a Cirugía Abierta , Verde de Indocianina , Procedimientos Quirúrgicos Robotizados , Enfermedades de los Conductos Biliares/epidemiología , Colangiografía/efectos adversos , Colangiografía/métodos , Colecistectomía/efectos adversos , Colecistectomía Laparoscópica/métodos , Ensayos Clínicos como Asunto , Humanos , Incidencia , Sesgo de Publicación , Procedimientos Quirúrgicos Robotizados/métodosRESUMEN
Endoscopic retrograde cholangiopancreatography is an invasive endoscopic procedure done more often for therapeutic rather than diagnostic purposes. There are various complications of this procedure like pancreatitis, cholangitis, hemorrhage, perforation and other rare adverse events. In this case report, we discuss a case of a 40 years female who was referred to our center for endoscopic retrograde cholangiography. After the procedure she complained of bilateral loss of vision which was an unknown complication to us. But after looking back to literature we found two such case reports attributed to isolated bilateral lateral geniculate body infarct.
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Colangitis , Pancreatitis , Colangiografía/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangitis/etiología , Femenino , Hemorragia/etiología , Humanos , Pancreatitis/etiologíaRESUMEN
BACKGROUND: Endoscopic biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is the most common form of palliation for malignant hilar obstruction. However, ERCP in such cases is associated with a risk of cholangitis. The incidence of post-ERCP cholangitis is particularly high in Bismuth type IV hilar obstruction, and this risk is further increased when the contrast injected for cholangiography is not drained. The present study aims to compare the incidence of cholangitis associated with the use of a contrast agent, air and CO2 for cholangiography in type IV hilar biliary lesions. METHODS: The clinical data of consecutive 70 patients with type IV hilar obstruction, who underwent ERCP from October 2013 to November 2017, were retrospectively analyzed. These patients were divided into three groups based on the agent used for cholangiography: group A, contrast (n = 22); group B, air (n = 18); group C, CO2 (n = 30). These three methods of cholangiography were chronologically separated. Prior to the ERCP, MRCP was obtained from all patients to guide the endoscopic intervention. RESULTS: At baseline, there was no significant difference in terms of the patient's age, gender, symptoms and liver function tests among the three groups (P > 0.05). The complication rates were significantly higher in group A than in groups B and C (63.6% vs. 26.7 and 27.8%, P < 0.05). The incidence of post-ERCP cholangitis was significantly higher in group A (P < 0.05), while the incidence of post-ERCP pancreatitis and bleeding were similar in the three groups. After the ERCP, the mean hospital stay was shorter in groups B and C, when compared to group A (P < 0.05). However, there was no significant difference in the 30-day mortality rate among the three groups (P > 0.05). Furthermore, there was no significant difference between groups B and C in terms of primary end points. CONCLUSION: CO2 or air cholangiography during ERCP for type IV hilar obstruction is associated with reduced risk of post-ERCP cholangitis, when compared to conventional contrast agents.
Asunto(s)
Dióxido de Carbono/efectos adversos , Colangiografía/efectos adversos , Colangitis/epidemiología , Medios de Contraste/efectos adversos , Neumorradiografía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Neoplasias de los Conductos Biliares/cirugía , Colangiografía/métodos , Colangitis/etiología , Femenino , Humanos , Incidencia , Tumor de Klatskin/cirugía , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Neumorradiografía/métodos , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A 72-year-old female patient who was admitted for ischaemic stroke had developed ascending cholangitis. Percutaneous transhepatic cholangiogram was performed to drain the infected bile, but this was complicated by haemorrhagic shock and hepatic haematoma. Mesenteric angiogram showed right hepatic artery (RHA) pseudoaneurysm which was embolised, there by stopping her bleeding. RHA is normally located posterior to common bile duct (CBD). An uncommon location of RHA is anterior to CBD, which can lead to haemorrhagic complications during percutaneous cholangiogram.
Asunto(s)
Aneurisma Falso/etiología , Colangiografía/efectos adversos , Colangitis/cirugía , Arteria Hepática/patología , Anciano , Conducto Colédoco/patología , Embolización Terapéutica , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/patología , Arteria Hepática/diagnóstico por imagen , Humanos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND There are 2 main methods of bile duct division in harvesting left lateral segment of a living donor: 1) by intraoperative cholangiography through cystic duct with cholecystectomy, or 2) by direct vision with preoperative magnetic resonance cholangiopancreatography. Here, we present a new approach to cholangiography by using the bile duct stump of the fourth liver segment (B4 stump) to achieve left lateral segmentectomy in pediatric living donor liver transplantation. MATERIAL AND METHODS This was a prospective study of 221 living donors who had undergone intraoperative cholangiography via the B4 stump in the course of left lateral segmentectomy. We collected and analyzed the clinical data, including the success rate of cholangiography by catheterizing the B4 stump; the associated time cost; the classification of the donor liver's biliary anatomy; the number of bile duct orifices on the graft side; and postoperative complications involving the biliary tract. RESULTS We were successful in catheterizing B4 stumps in all 221 patients. The mean time cost of these procedures was 7.21±3.62 minutes. Variations in the confluence of the right and left lobes were found in 58 patients (26.24%). Overall, sludge was detected in 18 cases (8.14%), gallstones were found in 3 patients (1.36%), and a polypoid gallbladder lesion was found in 1 patient (0.45%). There were 11 cases (4.98%) of bile leakage; no biliary strictures were found in the donors. CONCLUSIONS Intraoperative cholangiography via the B4 stump is an alternative procedure for living donors who undergoes left lateral segmentectomy.
Asunto(s)
Colangiografía/métodos , Hepatectomía/métodos , Trasplante de Hígado/métodos , Donadores Vivos , Recolección de Tejidos y Órganos/métodos , Adulto , Conductos Biliares/anatomía & histología , Conductos Biliares/diagnóstico por imagen , Conductos Biliares/cirugía , Cateterismo/efectos adversos , Cateterismo/métodos , Niño , Colangiografía/efectos adversos , Selección de Donante , Femenino , Hepatectomía/efectos adversos , Humanos , Periodo Intraoperatorio , Hígado/anatomía & histología , Hígado/diagnóstico por imagen , Hígado/cirugía , Trasplante de Hígado/efectos adversos , Masculino , Tempo Operativo , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Recolección de Tejidos y Órganos/efectos adversosRESUMEN
The different methods in differentiating biliary atresia (BA) from non-BA-related cholestasis were evaluated in order to provide a practical basis for a rapid, early and accurate differential diagnosis of the diseases. 396 infants with cholestatic jaundice were studied prospectively during the period of May 2007 to June 2011. The liver function in all subjects was tested. All cases underwent abdominal ultrasonography and duodenal fluid examination. Most cases were subjected to hepatobiliary scintigraphy, magnetic resonance cholangiopancreatography (MRCP) and a percutaneous liver biopsy. The diagnosis of BA was finally made by cholangiography or histopathologic examination. The accuracy, sensitivity, specificity and predictive values of these various methods were compared. 178 patients (108 males and 70 females with a mean age of 58±30 days) were diagnosed as having BA. 218 patients (136 males and 82 females with a mean age of 61 ±24 days) were diagnosed as having non-BA etiologies of cholestasis jaundice during the follow-up period in which jaundice faded after treatment with medical therapy. For diagnosis of BA, clinical evaluation, hepatomegaly, stool color, serum gamma-glutamyltranspeptidase (GGT), duodenal juice color, bile acid in duodenal juice, ultrasonography (gallbladder), ultrasonography (griangular cord or strip-apparent hyperechoic foci), hepatobiliary scintigraphy, MRCP, liver biopsy had an accuracy of 76.0%, 51.8%, 84.3%, 70.0%, 92.4%, 98.0%, 90.4%, 67.2%, 85.3%, 83.2% and 96.6%, a sensitivity of 83.1%, 87.6%, 96.1%, 73.7%, 90.4%, 100%, 92.7%, 27.5%, 100%, 89.0% and 97.4%, a specificity of 70.2%, 77.5%, 74.8%, 67.0%, 94.0%, 96.3%, 88.5%, 99.5%, 73.3%, 75.4% and 94.3%, a positive predictive value of 69.0%, 72.6%, 75.7%, 64.6%, 92.5%, 95.7%, 86.8%, 98.0%, 75.4%, 82.6% and 98.0%, and a negative predictive value of 83.6%, 8.5%, 95.9%, 75.7%, 92.3%, 100%, 84.2%, 93.7%, 100%, 84.0% and 92.6%, respectively. It was concluded that all the differential diagnosis methods are useful. The test for duodenal drainage and elements is fast and accurate. It is helpful in the differential diagnosis of BA and non-BA etiologies of cholestasis. It shows good practical value clinically.
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Atresia Biliar/diagnóstico por imagen , Colestasis/diagnóstico por imagen , Ictericia Neonatal/diagnóstico por imagen , Ácidos y Sales Biliares/análisis , Atresia Biliar/sangre , Atresia Biliar/complicaciones , Atresia Biliar/patología , Biomarcadores/análisis , Biomarcadores/sangre , Colangiografía/efectos adversos , Colangiografía/normas , Pancreatocolangiografía por Resonancia Magnética/efectos adversos , Pancreatocolangiografía por Resonancia Magnética/normas , Colestasis/sangre , Colestasis/etiología , Colestasis/patología , Diagnóstico Diferencial , Heces/química , Femenino , Humanos , Lactante , Recién Nacido , Ictericia Neonatal/sangre , Ictericia Neonatal/etiología , Ictericia Neonatal/patología , Hígado/diagnóstico por imagen , Hígado/patología , Masculino , Sensibilidad y Especificidad , Ultrasonografía/efectos adversos , Ultrasonografía/normasRESUMEN
AIM: To assess the role of laparoscopic ultrasound (LUS) as a substitute for intraoperative cholangiography (IOC) during cholecystectomy. METHODS: We present a MEDLINE and PubMed literature search, having used the key-words "laparoscopic intraoperative ultrasound" and "laparoscopic cholecystectomy". All relevant English language publications from 2000 to 2016 were identified, with data extracted for the role of LUS in the anatomical delineation of the biliary tract, detection of common bile duct stones (CBDS), prevention or early detection of biliary duct injury (BDI), and incidental findings during laparoscopic cholecystectomy. Data for the role of LUS vs IOC in complex situations (i.e., inflammatory disease/fibrosis) were specifically analyzed. RESULTS: We report data from eighteen reports, 13 prospective non-randomized trials, 5 retrospective trials, and two meta-analyses assessing diagnostic accuracy, with one analysis also assessing costs, duration of the examination, and anatomical mapping. Overall, LUS was shown to provide highly sensitive mapping of the extra-pancreatic biliary anatomy in 92%-100% of patients, with more difficulty encountered in delineation of the intra-pancreatic segment of the biliary tract (73.8%-98%). Identification of vascular and biliary variations has been documented in two studies. Although inflammatory disease hampered accuracy, LUS was still advantageous vs IOC in patients with obscured anatomy. LUS can be performed before any dissection and repeated at will to guide the surgeon especially when hilar mapping is difficult due to fibrosis and inflammation. In two studies LUS prevented conversion in 91% of patients with difficult scenarios. Considering CBDS detection, LUS sensitivity and specificity were 76%-100% and 96.2%-100%, respectively. LUS allowed the diagnosis/treatment of incidental findings of adjacent organs. No valuable data for BDI prevention or detection could be retrieved, even if no BDI was documented in the reports analyzed. Literature analysis proved LUS as a safe, quick, non-irradiating, cost-effective technique, which is comparatively well known although largely under-utilized, probably due to the perception of a difficult learning curve. CONCLUSION: We highlight the advantages and limitations of laparoscopic ultrasound during cholecystectomy, and underline its value in difficult scenarios when the anatomy is obscured.
Asunto(s)
Colangiografía/métodos , Colecistectomía Laparoscópica/métodos , Colecistitis/diagnóstico por imagen , Conducto Colédoco/diagnóstico por imagen , Endosonografía/métodos , Cálculos Biliares/diagnóstico , Laparoscopía/métodos , Colangiografía/efectos adversos , Colangiografía/economía , Colecistectomía Laparoscópica/economía , Colecistitis/etiología , Colecistitis/cirugía , Ensayos Clínicos como Asunto , Conducto Colédoco/patología , Conducto Colédoco/cirugía , Conversión a Cirugía Abierta/estadística & datos numéricos , Análisis Costo-Beneficio , Endosonografía/efectos adversos , Endosonografía/economía , Estudios de Factibilidad , Fibrosis , Cálculos Biliares/complicaciones , Cálculos Biliares/cirugía , Humanos , Laparoscopía/efectos adversos , Laparoscopía/economía , Tempo Operativo , Estudios Prospectivos , Estudios Retrospectivos , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
BACKGROUND: Prior studies of Medicare beneficiaries with both neoplastic and non-neoplastic indications for cholecystectomy demonstrated a reduced risk of common bile duct (CBD) injury when intraoperative cholangiography (IOC) was used. We sought to determine the association between IOC and CBD injury during inpatient cholecystectomy for non-neoplastic biliary disease and compare survival among those with or without CBD injury. METHODS: Retrospective study of patients ≥66 who underwent inpatient cholecystectomy (2005-2010) for gallstones, cholecystitis, cholangitis, or gallbladder obstruction. The association between IOC and CBD injury was analyzed using multivariable logistic regression and survival after cholecystectomy was analyzed using multivariable Cox regression. RESULTS: Among 472,367 patients who underwent cholecystectomy, 0.3% had a CBD injury. IOC was associated with increased CBD injury (adjusted OR 1.41[1.27-1.57]). CBD injury was associated with increased hazards of death (adjusted HR 1.37[1.25-1.51]). CONCLUSIONS: IOC in patients with non-neoplastic biliary disease was associated with increased odds of CBD injury. This likely reflects its selective use in patients at higher risk of CBD injury or as a confirmatory test when an injury is suspected.
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Enfermedades de las Vías Biliares/cirugía , Colangiografía/efectos adversos , Colecistectomía , Conducto Colédoco/lesiones , Cuidados Intraoperatorios/efectos adversos , Anciano , Anciano de 80 o más Años , Enfermedades de las Vías Biliares/mortalidad , Colecistectomía/mortalidad , Femenino , Humanos , Enfermedad Iatrogénica , Masculino , Medicare , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Estados UnidosRESUMEN
BACKGROUND: Intraoperative cholangiography (IOC) may detect residual stones in the common bile duct (CBD) after acute biliary pancreatitis (ABP). The aim of the present study is to analyze the utility of IOC in detecting residual stones in patients undergoing cholecystectomy for ABP and if complications are related with this procedure. METHODS: Demographic and clinical factors were assessed in patients with mild ABP who underwent IOC during laparoscopic cholecystectomy. Factors assessed included preoperative size of the CBD on ultrasonography, presence of stones in the gallbladder and the CBD, and IOC results. For the statistical analysis, χ2 or Fisher's exact tests to compare proportions and the nonparametric Mann-Whitney U test for analysis of values with abnormal distribution were used. RESULTS: The study included 113 patients, 82 males (72.6%) and 31 females (27.4%), of mean age 46.9 ± 14.7 years (range 18-86 years). All preoperative laboratory indicators were elevated. The group of the patients with stones in the CBD diagnosed by IOC was divided in patients with diameters <0.8 mm and with diameters ≥0.8 mm of the CBD diagnosed preoperatively with ultrasound. The laboratory tests do not demonstrate difference statistically significative between these two groups. The group of the patients without stones in the CBD diagnosed by IOC was also divided in patients with diameters <0.8 mm and with diameters ≥0.8 mm of the CBD. Also in these two groups, the statistical analysis of the laboratory tests does not demonstrate significative difference. Most procedures were performed by specialists (64.6%), and all patients underwent IOC. IOC showed stones in 84/113 patients (74.3%). A comparison of patients with and without stones at IOC showed similar mean times from hospitalization to surgery (5.9 days [range 2-12 days] vs. 6.1 days [range 2-23 days]), from surgery until hospital discharge (2.0 days [range 0-4 days] vs. 2.2 days [range 0-11 days]), and overall length of stay (7.9 days [range 3-19 days] vs. 8.3 days [range 3-23 days]) (P > 0.001). CONCLUSIONS: IOC is useful to diagnose residual CBD stones, without increasing complications related to the procedure itself.
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Conductos Biliares/anomalías , Colangiografía/normas , Cálculos Biliares/diagnóstico , Pancreatitis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Conductos Biliares/fisiopatología , Colangiografía/efectos adversos , Colangiografía/métodos , Femenino , Cálculos Biliares/complicaciones , Cálculos Biliares/cirugía , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Endoscopic ultrasound fine needle aspiration (EUS-FNA) and percutaneous transhepatic cholangiographic endobiliary forceps biopsy (PTC-EFB) are valid procedures for histological assessment of proximal biliary strictures (PBS), but their performances have never been compared. This study aimed to compare the diagnostic performance of these two techniques. METHOD: The diagnostic performances of EUS-FNA and PTC-EFB were compared in a retrospective cohort of patients assessed for PBS from 2011 to 2015 at a single tertiary centre. An inverse probability of treatment weighting (IPTW) was performed to adjust for covariate imbalance. RESULTS: A total of 102 EUS-FNAs and 75 PTC-EFBs (performed in 137 patients) were compared. Patients in the PTC-EFB group had higher preoperative bilirubin (243 versus 169 µmol/l, p = 0.005) and a higher incidence of malignancy (87% versus 67%, p = 0.008). Both techniques showed specificity and positive predictive value of 100%, and similar sensitivity (69% versus 75%, p = 0.45), negative predictive value (58% versus 38%, p = 0.15) and accuracy (78% versus 79%, p = 1.00). After IPTW, the diagnostic performance of the two techniques remained similar. CONCLUSION: Compared to EUS-FNA, PTC-EFB provides similar sensitivity, negative predictive value and accuracy. It should therefore be considered as the preferred tissue-sampling procedure, if biliary drainage is indicated.
Asunto(s)
Conductos Biliares/patología , Colangiografía , Colestasis/patología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Biopsia Guiada por Imagen/instrumentación , Biopsia Guiada por Imagen/métodos , Instrumentos Quirúrgicos , Anciano , Colangiografía/efectos adversos , Constricción Patológica , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/efectos adversos , Inglaterra , Diseño de Equipo , Femenino , Humanos , Biopsia Guiada por Imagen/efectos adversos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Centros de Atención TerciariaAsunto(s)
Colestasis/diagnóstico por imagen , Colestasis/cirugía , Drenaje/efectos adversos , Drenaje/métodos , Cálculos Biliares/etiología , Cirugía Asistida por Computador/efectos adversos , Anciano , Colangiografía/efectos adversos , Colangiografía/instrumentación , Colestasis/complicaciones , Remoción de Dispositivos , Femenino , Cálculos Biliares/diagnóstico por imagen , Humanos , Cirugía Asistida por Computador/instrumentación , Resultado del TratamientoRESUMEN
Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures (hepaticojejunostomy or choledechoduodenostomy).
Asunto(s)
Sistema Biliar/patología , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colestasis/metabolismo , Vena Porta/patología , Conductos Biliares/patología , Colangiografía/efectos adversos , Colangitis/complicaciones , Colestasis/etiología , Enfermedades de la Vesícula Biliar/complicaciones , Humanos , Hipertensión Portal/diagnóstico , Isquemia , Hígado/cirugía , Presión Portal , Vena Porta/cirugía , Derivación Portosistémica Quirúrgica , Stents/efectos adversosRESUMEN
La fasciolasis, en su fase crónica, puede causar un íctero obstructivo biliar por lo que el diagnóstico se confunde frecuentemente con litiasis de vía biliar principal. Se reportó el caso de una paciente con sospecha de colelitiasis, a la que se le realizó colangiopancreatoiografía retrógrada endoscópica. Durante el proceder se encontró un espécimen de Fasciola hepatica. A pesar que se han reportado en la literatura varios casos de esta trematodosis diagnosticados mediante técnica imagenológica, en Cuba son escasos estos reportes(AU)
Fasciolosis, in its chronic phase, can cause biliary obstructive jaundice so the diagnosis is frequently confused with bile duct calculi. This is case report of a patient diagnosed with cholelithiasis who underwent endoscopic retrograde cholangiopancreatography (CPRE) and during the procedure, fasciola hepatica was found. Despite the cases reported in literature, in Cuba, there are few cases that have been diagnosed trematodoses by imagenological technique.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Fasciola hepatica , Colangiografía/efectos adversos , Radiografía AbdominalRESUMEN
BACKGROUND: Primary intrahepatic lithiasis is defined by the presence of gallstones at the level of cystic dilatations of the intrahepatic biliary tree. Liver resection is considered the treatment of choice, with the purpose of removing stones and atrophic parenchyma, also reducing the risk of cholangiocarcinoma. However, in consequence of the considerable incidence of infectious complications, postoperative morbidity remains high. The current study was designed to evaluate the impact of preoperative bacterial colonization of the bile ducts on postoperative outcome. METHODS: The clinical records of 73 patients treated with liver resection were reviewed and clinical data, operative procedures, results of bile cultures, and postoperative outcomes were examined. RESULTS: Left hepatectomy (38 patients) and left lateral sectionectomy (19 patients) were the most frequently performed procedures. Overall morbidity was 38.3 %. A total of 133 microorganisms were isolated from bile. Multivariate analysis identified previous endoscopic or percutaneous cholangiography (p = 0.043) and preoperative cholangitis (p = 0.003) as the only two independent risk factors for postoperative infectious complications. CONCLUSIONS: Postoperative morbidity was strictly related to the preoperative biliary infection. An effective control of infections should be always pursued before liver resection for intrahepatic stones and an aggressive treatment of early signs of sepsis should be strongly emphasized.
Asunto(s)
Conductos Biliares Intrahepáticos/microbiología , Bilis/microbiología , Cálculos Biliares/cirugía , Hepatectomía/efectos adversos , Infecciones/etiología , Adulto , Anciano , Colangiografía/efectos adversos , Colangitis/complicaciones , Colangitis/microbiología , Endoscopía del Sistema Digestivo/efectos adversos , Femenino , Hepatectomía/métodos , Humanos , Infecciones/microbiología , Litiasis/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: There are few reports on the short- and long-term follow-up of endoscopic retrograde cholangiography (ERC) in adult patients with hepaticojejunostomy (HJS) stricture after living-donor liver transplantation (LDLT). METHODS: Nine LDLT recipients underwent ERC with the use of double-balloon endoscopy (DBE) for HJS stricture at Nagoya University Hospital. We assessed the rate of reaching biliary anastomosis, procedure success rate, procedure duration, complications, improvement in liver function test results, and biliary anastomosis patency. RESULTS: In total, 19 ERC procedures with the use of DBE were performed for 9 adult LDLT recipients with HJS stricture from June 2006 to September 2014. Balloon dilation with the use of DBE was successfully performed in 5 of the 9 patients during the 1st procedure. Of the 4 patients in whom DBE-ERC failed to be completed, 3 patients underwent 2nd procedures successfully. Liver function test results were significantly improved in the successful cases. Four patients underwent 2nd DBE-ERC for stricture recurrence at a mean time of 2.3 years after the 1st successful procedure. Of those, 2 patients required 3rd procedures for stricture recurrence after the 2nd procedure. CONCLUSIONS: DBE-ERC is promising as a treatment for HJS stricture in adult LDLT recipients in the short term. However, the DBE-ERC procedure may have a considerable risk of restenosis.