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Preoperative biliary drainage (PBD) is an important part of preoperative management of patients with hilar cholangiocarcinoma which could reduce serum total bilirubin,remove jaundice,improve liver function,and reduce the mortality and morbidity.Although PBD is widely used in biliary surgery now,there are still several controversial issues in clinical applications about the indication of PBD,the best way of PBD,implantation metastasis of PBD and so on.With the development of medical image and surgical technology,we had a better understanding of PBD now.This review summarizes the recent scenario and current advancement about the above-mentioned controversy.
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Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2％).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.
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Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2％).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.
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Objective To discuss which drainage method is more efficient in treatment of choledocholithiasis with obstructive jaundice. Methods Compared the difference of serum total bilirubin,direct bilirubin, the variation of serum total bilirubin and direct bilirubin before and after drainage and daily biliary drainage by endoscopic nasobil-iary drainage (ENBD) and endoscopic nasobiliary drainage with continuous negative-pressure suction after three days. Results The daily biliary drainage about the patients by ENBD with continuous negative-pressure suction is much more effective than the patients by ENBD. The serum total bilirubin and direct bilirubin about the patients by ENBD with continuous negative-pressure suction is less than the patients by ENBD after three days. The variation of serum total bilirubin and direct bilirubin before and after drainage about the patients by ENBD with continuous neg-ative-pressure suction is more than the patients by ENBD. Conclusion The ENBD with continuous negative-pres-sure suction is more effective for choledocholithiasis with obstructive jaundice.
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Objective To evaluate the curative efficacy of endoscopic retrograde cholangiopancreatography (ERCP) on bile leaks after orthotopic liver transplantation (OLT). Methods Data of 12 cases, hospitalized in our hospital from March 2013 to February 2016, with bile leaks after OLT confirmed by magnetic resonance imaging of the pancreas (MRCP) or ERCP were retrospectively analyzed . The curative efficacy of ERCP was evaluated including clinical symptoms of bile leaks and complications, occurrence time and location, diagnosis and treatment process and efficacy. Results In this study, 12 cases were male patients, with the average age of 49.75 ± 8.55 (age from 35 to 62 years old). Among them 11 cases were successfully treated by endoscopic nasobiliary drainage (ENBD), and the success rate of endoscopical therapy was 91.7%, the curative rate of bile leaks was 91.7%(11/12). No ERCP related serious complications and death were found in patients. Nine cases combined with biliary strictures and/or biliary duct stone/bile plug were performed endoscopic sphinctrotomy (EST) during the first time of ERCP, and accepted further ERCP treatment after 2 weeks when the bile leaks were healed. All patients with ENBD were carried out well except one case. Conclusion ERCP is a safe and effective minimally invasive treatment method for different types of bile leaks after OLT.
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Objective To investigate the regulation of metabolic characteristics of metronidazole and tinidazole in human bile,and provide a theoretic basis for physician selecting antibiotic rationally when biliary tract was infected.Methods Samples of hman bile were obtained by ERCP plus ENBD,contents of metronidazole and tinidazole were simultaneously measured by HPLC method in the human bile and plasma.Results 0 25 hour after metronidazole and tinidazole were given through iv,contents of two antibiotics had reached the effective bactericida.Concentraction,content of tinidazole in the bile was relatively stable,but its C max was lower as compared with the metronidazole,contents of the two antibiotics in bile were continuously higher than those of the effective bactericidal in 24 hours,and after 16 hours and re-raise was observed in contents of the two antibiotics in bile.Conclusion As maintaining a higher concentration level for long time in the bile by iv,metronidazole and tinidazole were recommended in the patients with an infection in biliary truct.
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Objective To evaluate the efficacy of laparoscopic and open operation combined with endoscopic nasobiliary drainage(ENBD) in the management of choledocholith. Methods 44 cases treated by laparoscopic common bile duct exploration (LCBDE) and 34 ones by open common bile duct exploration(OCBDE) combined with ENBD and primary suture of common bile duct were retrospectively analyzed from January 1997 to July 2001. Results All cases were operated on successfully. The clearance rate of stones was 100%(78/78). No postoperative complications such as bile leakage, hemobilia, cholangitis, etc occurred. Postoperative hospital stay was (6 2?1 3)days in group LCBDE and (7 4?2 1)days in group OCBDE. 57 cases had been followed up for (1～4 5)years with an average of 2 6 years, and ultrasoundgraphy showed no bile duct stricture and recurrent stones. Conclusions LCBDE or OCBDE combined with ENBD and primary suture of common bile duct is safe and reliable.
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Objective To evaluate the effect of early endoscopic treatment for patients with severe acute biliary pancreatitis.Methods Ninety patients with severe acute biliary pancreatitis were divided into three groups: Thirty patients underwent early endoscopic treatment(group A),30 patients underwent expectant treatment(group B) and 30 patients receive surgical treatment(group C),respectively.complications and safety were evaluated.Results The symptoms and signs disappeared in all 30 cases after early endoscopic treatment.All the 30 patients(100%) of endoscopic treatment(group A) were cured which significantly better than the other groups(group B 83.3% and group C 93.3%,respectively).Conclusions Early endoscopic treatment relieves the orifice obstruction of biliary and pancreatic ducts,decreases the pressure of biliary and pancreatic ducts,it is safe,mini-invasive and highly effective for the treatment of severe acute biliary pancreatitis.
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A 5-year-old male patient was admitted due to fever, and right upper abdominal pain for 2 weeks. He showed severe right upper quadrant tenderness on palpation, hepatomegaly 5 cm below the right costal margin, no mass, and no splenomegaly. On biochemical studies, ALT was 380IU/ml, AST 462IU/ml, alkaline phosphatase 1,069IU/ml, GTP 239IU/ml, and total bilirubin 2.1mg/dl. Endoscopic retrograde cholangiopancreatography (ERCP) showed cylindrical dilatations of CBD and cystic dilatations with strictures of extrahepatic and both bilateral intrahepatic bile ducts (choledochal cyst type IVa) with multiple stones in the CBD and extra- and intrahepatic bile ducts. Endoscopic sphincterotomy (EST) and stone extraction with basket and balloon were performed successfully. The bile was severely purulent and the stones were pigment stones. Klebsiella pneumoniae were dominantly grown on bile culture. An endoscopic nasobiliary drainage (ENBD) tube was inserted to treat biliary sepsis. The bile ducts were irrigated with tobramycin-mixed normal saline twice a day for 2 week, when ALT, AST, total bilirubin and liver size were normalized and no more bacteria was grown on bile culture. The clinical symptoms were improved just after the therapeutic ERCP. There was no side effect by ERCP, EST and ENBD.
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Child, Preschool , Humans , Male , Abdominal Pain , Alkaline Phosphatase , Bacteria , Bile , Bile Ducts , Bile Ducts, Intrahepatic , Bilirubin , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Choledochal Cyst , Choledocholithiasis , Constriction, Pathologic , Dilatation , Drainage , Fever , Guanosine Triphosphate , Hepatomegaly , Klebsiella pneumoniae , Liver , Palpation , Sepsis , Sphincterotomy, Endoscopic , SplenomegalyABSTRACT
BACKGROUND/AIMS: Acute suppurative cholangitis is associated with significant mortality. It is best managed by drainage of biliary tree such as endoscopic, percutaneous or surgical, We evaluated the role of emergency endoscopic nasobiliary drainage(ENBD) in the acute suppurative cholangitis. METHODS: For 55 patients with acute calculous cholangitis, who did not respond to conservative management and the stone could not be removed from bile duct by endoscopic papillotomy due to poor condition or bleeding tendency, ENBD tube(7.5Fr) was inserted at proximal side of obstruction. ENBD was done at 39.4 hours (mean) after arrival to hospital. RESULTS: ENBD was successful in all patients (100%). All patients responded with striking improvement of the abdominal pain, fever and stabilized vital signs within 3 days. After patients conditions were stabilized clinically, common bile duct stones were removed successfully by endoscopic sphincterotomy or surgery. No patients died of acute suppurative cholangitis. CONCLUSION: These results show that ENBD is a simple, safe, and effective measure for the initial control of acute suppurative cholangitis due to cholelithiasis.
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Humans , Abdominal Pain , Bile Ducts , Biliary Tract , Cholangitis , Cholelithiasis , Common Bile Duct , Drainage , Emergencies , Fever , Hemorrhage , Mortality , Sphincterotomy, Endoscopic , Strikes, Employee , Vital SignsABSTRACT
ERCP may provide more definite diagnosis, preoperative guidance, and endoscopic therapy in many children with known and suspected disorders of the pancreas or biliary tract. To our knowledge, there has been rare case of ERCP in children and no reported case of ERCP performed in inf~int less than 2 years old in Korea. We report a case of KRCP performed in 26 month old girl who was admitted to evaluate jaundice. We diagnosed CBD stones and choledochal cyst, Todani type III containiaig stones by ERCP. After endoscopic sphincterotomy(EST), removal of stones, and endoscopic nasobiliary drainage(END) her bilirubin level normalized about 2 months later.
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Child , Child, Preschool , Female , Humans , Infant , Biliary Tract , Bilirubin , Cholangiopancreatography, Endoscopic Retrograde , Choledochal Cyst , Diagnosis , Jaundice , Korea , Pancreas , Sphincterotomy, EndoscopicABSTRACT
0.05).Conclusions This study shows that in severe acute biliary pancreatitis patiens with biliary tract obstruction, emergency endoscopic therapy should be performed within 48 hours from the onset of symptoms; patients with mild acute biliary pancreatitis shoud also undergo prompt endoscopic therapy after ineffective conservative management or appearance of symptoms of acute biliary tract infection.
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Endoscopic nasobiliary drainage(ENBD) has been developed as a safe and effective noninvasive biliary drainage method for initial decompression in the benign or malignant biliary obstruction, dissolution of biliary stones by injection of litholytic agents through the tube, and proper causative diagnosis of biliary obstruction by cytologic, bacteriologic and parasite investigation of drained bile. Generally, endoscopic sphicterotomy (EST) is performed before the insertion of an ENBD tube in order to make the procedure easy and to prevent acute pancreatitis that may develop by compression of the pancreatic orifice of the inserted tube. Nevertheless, in some cases EST is difficult to perform or should not be performed due to their coagulopathy. In such cases, ENBD without EST may be necessary. To evaluate the safety, successfullness and effectiveness of ENBD without EST, ENBD without EST using 5, 6 or 7 Fr pigtail tubes were performed in 81 cases(49 malignant, 32 benign). ENBD without EST was successfully performed in 78 out of 81 cases(96.3%). This effectiveness for decompression of bile duct, evaluated by decreasing total bilirubin values, was good in 66 out of 73 casee (90. 2%). The complications of this procedure were noted in 6 out of 78 cases(7. 7%). e. g. cholangitis in 3, migration of ENBD tube in 2, acute pancreatitis in 1 case. Particularly, regardless of our concern that ENBD without EST may develop acute pancreatitis acute panereatitis was noted in only one case. In conclusion, ENBD without EST is a safe and effective method which can be applied to the cases who have benign or malignant obstructive jaundice.