Experiencia colangioscopia peroral monoperador (SPYGLASS) en patología biliar en un centro privado de tercer nivel en Venezuela / Experience colangioscopia peroral single operator (SPYGLASS) in biliary pathology in a center deprived of the third level in Venezuela.

Spyglass es un colangioscopio peroral mono operador desechable que ha estado disponible desde principios de 2007 para patología biliar. Objetivo: Demostrar la experiencia en Venezuela usando sistema Spyglass en pacientes con patología biliar. Pacientes y Métodos: Estudio prospectivo (febrero2012-mayo2015), Policlínica Metropolitana.50 spyglass fueron realizados, representando 7,7% del volumen de CPRE biliares en el mismo período (50/650). Se incluyeron 46 pacientes (45 hombres, 1 mujer), edad media 62,6 años (24-92 años). Indicaciones: coledocolitiasis (20), estenosis (23), tumor (2), descarte Neo entre 2 prótesis (1), prótesis trans stent (1). Un mono operador a través de un duodenoscopio terapéutico realizó colangioscopia spyglass. Sedación por anestesiología en quirófano y antibiótico profiláctico fue administrada. Resultados: Spyglass fue realizada en 46 pacientes (50 procedimientos).Hallazgos: litiasis (20 pacientes), estenosis benigna (10), estenosis maligna (13), colangitis esclerosante (1), prótesis trans stent (1). De los pacientes con litiasis, el clearance ductal posterior a litotripsia holmiun láser se logró en el 85% después de una sesión, y el 15 % en un segundo intento.Spyglass confirmó el diagnóstico de malignidad en 13/21 (62%), el diagnóstico se estableció por combinación de características visuales y biopsias directas.En 7/21 (33,33%) cambio diagnóstico: benigno (6), colangitis esclerosante (1) y en uno no se pudo establecer diagnóstico. La sospecha de benignidad se confirmó en 3/4 pacientes. Pancreatitis, microperforación retroperitoneal y fístula pancreática se reportó en un paciente (2,17%) resuelto con tratamiento médico y quirúrgico. Conclusiones: Spyglass es una técnica útil en estenosis sospechosa de benignidad o malignidad, difirió el diagnóstico, modificando la conducta. Es una técnica adyuvante de la CPRE en el manejo de cálculos.

Spyglass is a disposable peroral cholangioscope monoperator that has been available since early 2007 for biliary disease. Objective: To demonstrate the experience in Venezuela using Spyglass system in patients with biliary disease. Patients and Methods: Prospective study (february2012-may2015), Polyclinic Metropolitana.50 spyglass were performed, representing 7.7% of the volume of bile ERCP in the same period (50/650). 46 patients (45 males, 1 female), mean age 62.6 years (24-92 years) were included. Indications: choledocholithiasis (20), stenosis (23), tumor (2), dicard neo between two prothesis (1), trans prosthesis stent (1) .A monoperator through a therapeutic duodenoscope made cholangioscopy spyglass. Sedation for anesthesiology and prophylactic antibiotic was administered. Results: Spyglass was performed in 46 patients (50 procedures) .Findings: lithiasis (20 patients), benign stricture (10), malignant stricture (13), sclerosing cholangitis (1), trans prosthesis stent (1). Of patients with stone disease, ductal clearance holmium laser after lithotripsy was achieved in 85% after a session, and 15% in a second attempt.Spyglass confirmed the diagnosis of malignancy in 13/21 (62%), the diagnosis was established by combination of visual features and directs biopsies.En 7/21 (33.33%) change diagnosis: benign (6), sclerosing cholangitis (1) and one diagnosis could not be established. The suspicion was confirmed benignity in 3/4 patients. Pancreatitis, retroperitoneal microperforation and pancreatic fistula was reported in one patient (2.17%) resolved with medical and surgical treatment. Conclusions: Spyglass is a useful technique for suspected benign or malignant stricture, diagnosis differed modifying behavior. Spyglass is a useful adjuvant to ERCP in the management of difficult stone disease.

Effect of nalfurafi ne hydrochloride on the basal pressure of the sphincter of Oddi in anesthetized rabbits.

Background: Opioid analgesics, which are classifi ed as μ-opioid receptor agonists, are known to induce spasms or contraction of the sphincter of Oddi (SO), thereby inducing or exacerbating biliary diseases such as biliary obstruction, gallbladder dysfunction, cholelithiasis, pancreatitis, biliary dyskinesia, cholangitis, and cholecystitis. However, effects of κ-opioid receptor agonists on SO contraction have not been clarifi ed. In the present study, we investigated the effect of nalfurafi ne hydrochloride (nalfurafi ne), (E)-N-[17-(cyclopropylmethyl)-4,5α-epoxy-3,14-dihydroxymorphinan-6β-yl]-3- (furan-3-yl)-N-methylprop-2-enamide monohydrochloride, a selective κ-opioid receptor agonist, on spontaneous contraction of rabbit SO. Methods: SO contraction was measured using manometry in anesthetized rabbits. Rabbits were anesthetized with intravenous administration of 25 mg/kg sodium pentobarbital. An open tip catheter was inserted into the common bile duct toward the SO ampullae. Saline was perfused through the lumen of the open tip catheter at a constant rate of 6 ml/hr using a syringe pump. Nalfurafi ne, morphine, and pentazocine were intravenously (i.v.) administered and perfusion pressure was recorded. Results: Morphine (0.3 mg/kg, i.v.) and pentazocine (3 mg/kg, i.v.) were found to increase SO perfusion pressure, suggesting that these opioid analgesics may cause SO contraction. In contrast, nalfurafi ne (0.2 μg/kg, i.v.) decreased the perfusion pressure, indicating that this κ-opioid receptor agonist suppresses SO contraction. Conclusions: These fi ndings suggest that nalfurafi ne is unlikely to induce or exacerbate biliary diseases and may be safely used in patients with these disorders.

Clinical characteristics and the cause analysis of acute relapsing pancreatitis / 重庆医学

Objective To discuss the pathogenesis and clinical characteristics of acute relapsing pancreatitis .Methods The clini-cal data and relevant data of 274 acute pancreatitis cases from January 2010 to and December 2012 were analyzed ,of which one group of 231 cases were first onset and the other group of 43 cases were relapsing .Results The probability of relapse of acute pan-creatitis were highest from 1 month to half a year after first onset (20 cases ,accounting for 46 .51% );biliary factors were the major causes of first onset and relapse cases ,where the relapsing group was higher than first onset group ,with statistical significance (P 0 .05);there was no significant difference between the occurrence rate of severe pancreatitis and the occurrence rate of surgeries and deaths .Conclusion Biliary diseases and hyperlipidemia are closely related with the relapse of acute pancreatitis .

Cisto de colédoco com apresentação em idade adulta / Choledochal cyst presenting in adulthood

Cistos biliares são ectasias ductais congênitas envolvendo um segmento ou toda árvore biliar intra- e/ou extra-hepática, comuns na infância, mas de diagnóstico raro na idade adulta. O objetivo do presente trabalho é de relatar o caso de um paciente adulto diagnosticado com cisto gigante de colédoco durante investigação para dor abdominal (AU)

Biliary cysts are congenital ductal ectasias involving a segment or the entire intra- and/or extrahepatic biliary tree, common in childhood, but of uncommon diagnosis in adulthood. The aim of this study is to report the case of an adult patient diagnosed with giant choledochal cyst during investigation for abdominal pain (AU)

Pediatric liver transplantation / 中华消化外科杂志

Pediatric liver transplantation has long been developed in the western world.Currently,favorable outcomes after liver transplantation have been achieved in pediatric recipients and the postoperative 5-year survival rate reached 80％ in western transplantation centers.In the mainland China,pediatric liver transplantation started quite recently and there is still a big gap compared with western centers.In addition,there is unbalanced development between adult and pediatric recipients due to surgical difficulties and undesirable outcomes following pediatric liver transplantation.The operation methods of pediatric liver transplantation include whole liver transplantation,reduced-size liver transplantation,living donor liver transplantation and split liver transplantation.Perioperative complications of pediatric liver transplantation mainly include portal vein thrombosis,hepatic artery thrombosis,intra-abdominal bleeding,infections,rejection,bile leakage and biliary strictures.While the long-term complications are infections,post-transplantation lymphoproliferative disorders,acute and chronic rejections caused by poor compliance with immunosuppressive therapy.Perioperative complications have been reduced recently thanks to improvement of surgical techniques.With the highly-prolonged survival period,long-term postoperative complications have been playing a significant role in recipients' survival rates.Management of long-term follow-up and compliance has been the next focus of pediatric liver transplantation.

A study of the relationship between pathological anatomy of pancreaticobiliary maljunction and pancreatic and biliary diseases / 中华肝胆外科杂志

The widespread availability of multi-detector spiral CT and its post processing techniques,and MRI,provide us with important tools to carry out anatomical studies on pancreaticobiliary maljunction (PBM).Determining the relationship between PBM and biliary diseases contributes not only to a better understanding of pathogenesis and pathological process of biliary diseases,but it also provides evidence for prophylactic treatment.The present study reviewed the definition,classification,pathological anatomy of PBM,relationship between PBM and pancreaticobiliary diseases,and clinical treatments of PBM.

Effects of intravenous fluid restriction on complications after biliary surgery / 中华消化外科杂志

Objective To investigate the effects of intravenous fluid restriction on complications after biliary surgery.Methods The clinical data of 168 patients who received biliary surgery at the Nanjing General Hospital of Nanjing Military Command from October 2006 to March 2008 were prospectively analyzed.All patients were randomly divided into test group(85 patients received fluid restriction treatment)and control group(83 patients received conventional treatment)by the sealed envelope method.The difference in the fluid volume between the 2groups was observed.Differences in systemic complication rate,local complication rate,general complication rate,time to bowl movement,length of hospital stay and mortality between the 2 groups were compared.All data were analyzed using the chi-square test,t test,Fisher exact test,Results The median total volumes of fluid in test group and control group were 1450 ml and 2420 ml,respectively,with significant difference between the 2 groups (t=-5.067,P0.05).Conclusion Fluid restriction reduces the complication rate,shortens the length of hospital stay and accelerates recovery after biliary operation.

Una presentación inusual de compromiso hepático en telangiectasia hemorrágica hereditaria: enfermedad biliar / An unusual presentation of liver involvement in hereditary hemorrhagic telangiectasia biliary disease

Telangiectasia Hemorrágica Hereditaria es un desorden autosómico dominante sub reconocido y relativamente común caracterizado por lesiones angiodisplásicas que afectan múltiples órganos, entre ellos el hígado. Reportamos el caso de una mujer de 76 años de edad con historia de dolor en el tercio inferior del hemitórax derecho, presencia de tenues telangiectasias en pulpejos de dedos de manos, labios y lengua además de dolor a la palpación del hipocondrio derecho; la ecografía abdominal inicial de esta paciente fue compatible con dilatación de la vía biliar intrahepática. La paciente cumple el criterio diagnóstico de Curacao para Telangiectasia Hemorrágica Hereditaria. La presencia de malformaciones arteriovenosas en hígado fue confirmada por ECO-DOPPLER y Tomografía Espiral Multicorte.

Hereditary Hemorrhagic Telangiectasia is a relatively common, under-recognized autosomal dominant disorder characterized by angiodysplastic lesions that affect multiple organs, like liver. This is a case of a 76 years old woman with history of pain in the lower third of right hemithorax, presence of tiny telangiectases in fingers, lips and tongue, in additionto pain on palpation of right hypochondrium; the initial abdominal ultrasound assessment showed biliary intrahepatic dilation. Patient meets The Diagnostic Criteria of Curacao for Hereditary Hemorrhagic Telangiectasia. The presence of liver arteriovenous malformations was confirmed by DOPPLER-ECHO and CT scan.

Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis and the risk of developing malignancies: a large prospective study / Prevalencia de colangitis esclerosante primaria en pacientes con colitis ulcerosa y el riesgo de desarrollar malignidades: un extenso estudio prospectivo

Background/aim: primary sclerosing cholangitis (PSC) is associated with ulcerative colitis (UC) and seems to be a risk factor for colon cancer. However, taking into account that no data are available in South American population, we analyzed the prevalence of PSC in 1.333 patients with UC and the risk for developing colon cancer. Material: patients with persistent increases of alkaline phosphatase were studied by cholangiography and liver biopsy. To assess the risk of colon cancer, each patient with PSC and UC was matched with two control patients with UC without PSC of the same age, gender, extent and duration of UC. Results: the whole prevalence of PSC was 2.9% (39 patients) reaching 6.2% in extensive colitis. Seven (18 %) out of 39 patients with PSC developed colorectal carcinoma compared with 2 out of 78 (2.6%) in the control group (p=0.006). The cumulative risk of colorectal carcinoma was 11% and 18% after 10 and 20 years in the PSC group compared with 2% and 7% in the control group, respectively (p=0.002). Conclusion: this is the first prospective study performed in Latin America showing that the prevalence of PSC in patients with UC is similar to that reported in the Anglo-Saxon population. Patients with UC and PSC have a high risk of colorectal cancer.

Introducción/objetivos: la colangitis esclerosante primaria (CEP) se asocia a colitis ulcerosa (CU) y parece ser un factor de riesgo para cáncer de colon. Sin embargo, teniendo en cuenta que no existen datos disponibles en población de Sudamérica, nosotros analizamos la prevalencia de CEP en 1.333 pacientes con CU y el riesgo de desarrollar cáncer de colon. Material: los pacientes con fosfatasa alcalina persistentemente elevada fueron estudiados con colangiografía y biopsia hepática. Para determinar el riesgo de cáncer de colon cada paciente con CEP y CU fueron apareados con dos pacientes controles con CU sin CEP de la misma edad, sexo, extensión y duración de la CU. Resultados: la prevalencia total de CEP fue de 2.9% (39 pacientes), alcanzando una prevalencia del 6.2% en colitis extensa. Siete (18%) de 39 pacientes con CEP desarrollaron cáncer colorectal comparado con 2 de 78 en el grupo control (p=0.006). El riesgo acumulado de cáncer colorectal fue 11 y 18% después de 10 y 20 años en el grupo con CEP comparado con 2 y 7% en el grupo control, respectivamente (p=0.002). Conclusión: este es el primer estudio prospectivo realizado en Latinoamérica mostrando que la prevalencia de CEP en pacientes con CU es similar a la reportada en población anglosajona. Los pacientes con CU y CEP tienen un alto riesgo de cáncer colorectal.

Clinical analysis of implantation of the biliary stent for treatment of 131 cases of biliary obstruction / 中国实用内科杂志

Objective To study the feasibility and effect of implantation of the biliary stent for treatment of biliary obstruction.Methods A retrospective analysis of the diagnostic and therapeutic procedure was done in 131 cases of the inpatients from Apr.2006 to Feb.2007.The 131 patients with biliary obstruction underwent successfully 138 cases/times implantation of biliary stent.The results of recession of jaudince and the rate of complication were evaluated.Results All patients were implanted biliary stent successfully.The serum total bilirubin,direct bilirubin,alkaline phosphatase,?-glutamyl transpeptidase decreased obviously in three days,and the difference was remarkable.The main complication was infection of biliary tract and pancreatitis.Conclusion Implantation of biliary stent is an effective management for biliary obstruction,especially for patients who have lost the chance of operation.

Gastroduodenal Lesion Accompanied in Obstructive Biliary Disease / 대한소화기내시경학회지

BACKGROUND AND AIMS: Various gastric and duodenal lesions with gastrofiberscopy were observed in patients with obstructive biliary disease. METHODS: A clinical analysis of the endoscopic findings was carried out on 88 patients with obstructive biliary disease, from February 1994 to January 1998, in the department of Internal Medicine, Chungnam National University Hospital. RESULTS: 1) In the 88 patients, sex distribution showed predominance in the males (47/41) and most of the cases involved those in their 60's. 2) The obstructive biliary diseases were included, common bile duct stones (53.4%), common bile duct cancer (18.2%), pancreatic cancer (18.2%), Klatskin tumor (4.5%) and common hepatic duct cancer (3.4%). 3) The gastroduodenal lesions involved in the obstructive biliary diseases were, erosive gastritis (22.7%), duodenal ulcer (8.0%), gastric ulcer (5.7%), and acute duodenitis (3.4%) in orders. CONCLUSIONS: Significant upper gastrointestinal lesions were found in obstructive biliary disease.

Clinical Application of Peroral Cholangioscopy in Biliary Diseases / 대한소화기내시경학회지

BACKGROUND: Peroral cholangioscopy (PCS) was usually conducted for a differential diagnosis in cases which were difficult to diagnose on a routine endoscopic retrograde cholangiogram (ERC) or during fragmentation of a large bile duct stone with electrohydraulic lithotripsy. This study was conducted to evaluate the clinical utility of a PCS in biliary diseases. METHOD: We retrospectively reviewed the clinical records of 31 patients in whom a PCS was performed to evaluate various biliary diseases from July 1991 to Aug. 1996. RESULT: A peroral cholangioscope was successfully inserted into the bile duct in 90.3% (28/31) of the patients. The underlying diseases included bile duct stones (11 cases), bile duct cancer (9 cases), benign bile duct strictures (2 cases), benign bile duct turnors (2 cases), biliary cystadenocarcinoma (2 cases), emboli of the HCC in the bile duct(1 case), and common bile duct polyposis (1 case). Most PCSs were performed for the differential diagnosis between benign and malignant bile duct strictures or obstructions (14 cases) and fragmentation of large bile duct stone with electrohydraulic lithotripsy (10 cases). Overall, the success rate was 78.6% (22/28) in achieving the purpose 88.9% (16/18) in diagnostic aim and 60.0% (6/10) in therapeutic aim. Complications from the PCS occurred in 4 cases (14.3%). Cholangitis and acute pancreatitis was found in 1 case and asymptomatic hyperamylasemia were discovered in 2 cases. CONCLUSION: PCS plays a major role in confirming difficult cases to diagnose using on ERC and fragment to remove large cornmon bile duct stones.

CT Findings of the Clonorchiasis Alteration in Intrahepatic Bile Duct and Essential Liver / 实用放射学杂志

Objective To study CT findings of the intrahepatic bile duct and essential liver.Methods The clinical and CT material of the 113 cases of clonorchiasis were collected.The dilatation of Ⅱ,Ⅲ lever of intrahepatic bile duct were classified.Results 24 cases were slight degree dilated of the Ⅱ,Ⅲ lever bile duct,22 cases were light degree,31 cases were middle degree,36 cases were heavy degree.The light degree dilation of intrahepatic bile duct were found in whose clinical symptom and sign were not clear and obvious.The mid and heavy degree dilation of intrahepatic bile duct were found in those who has got abdominal pain,cold and fever,jaundice and complication.It was not relative between the calculus and dilation of intrahepatic bile duct.Dilation of intrahepatic bile duct with small piece of low density in liver essence accompany was found in 5 cases.Conclusion It would be the clonorchiasis if the minority small bile duct near liver membrane were dilated.Clinical symptom and sign are related to the dilative bile duct.CT findings of the small piece of low density essential liver and dilation of intrahepatic bile duct could be consider the inflammtory granuloma in the essential liver in clonorchiasis.

Antibiotics Usage in Liver Surgery Department:A Investigation and Analysis / 中华医院感染学杂志

OBJECTIVE To explore the rational antibiotics usage in hepato-biliary department.METHODS The antibiotics used in liver surgery department were investigated and evaluated according to the standards.RESULTS Totally 235 patients (88.01%) among 267 patients from 2005 to 2007 were used antibiotics,of which 18.30% for therapy,81.70% for prophylaxis and from them 83.40% were for systemic use. The specimens from 35 patients among 235 patients with liver disease,were sent to do antibiotic susceptibility test. Most of the patiants were given therapy by experience.CONCLUSIONS The administration department in the hospital should enhance its work by forming institutions and standards,and inspecting regularly to guarantee the safety of antibiotics usage.

Endoscopic sphincterotomy in the management of pancreaticobiliary disease / 重庆医科大学学报

Objective:Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (EST) are well accepted as the procedure of choice for diagnostic and therapeutic purposes of pancreaticobiliary disease. The aim of this study is to investigate the curative effect and complication of pancreaticobiliary disease managed by therapeutic ERCP. Methods: A total of 59 patients with common bile duct stone,acute obstructive suppurative cholangitis,malignant bile duct obstruction, acute or chronic pancreatitis,and sphincter of Oddi dysfunction. Each case was confirmed by ultrasonographic examination, diagnostic ERCP and blood amylase test. All patients underwent therapeutic ERCP such as EST, stone extraction and drainage. Results :Of the 59 patients, 16 patients with acute obstructive suppurative cholangitis and severe acute pancreatitis underwent urgent management of endoscopic intervention, stone extraction and endoscopic nasobiliary drainage. The remaining 43 patients underwent diagnostic ERCP,followed by therapeutic ERCP in cases of documented bile duct stone,sphincter of Oddi dysfunciton,or chronic pancreatitis. The success rate of endoscopic procedure was 100% ,and the complication rate was 6. 8% ,without mortality. Conclusion : In patients with pancreaticobiliary disease , therapeutic ERCP provides adequate management and is associated with low complication rates.