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Peribiliary glands (PBG) is a kind of microscopic structure around the intra-hepatic bile ducts and extrahepatic bile ducts. PBG not only participates in maintaining the normal physiological function of biliary epithelial tissue, but also plays an important role in its damage and repair process. Biliary tree stem/progenitor cells in PBG are important cell sources of biliary epithelial regeneration and repair. PBG and the surrounding peribiliary vascular plexus are key influencing factors for the occurrence of ischemic-type biliary lesions (ITBL) after liver transplantation. Based on relevant literatures and clinical practice, the authors summarize the function of PBG as well as its relationship with ITBL.
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@#Urethral strictures in females are very uncommon. In selected populations of women who underwent urodynamic studies for obstructive symptoms, female urethral strictures represent 4-13% of the causes of bladder outlet obstruction. Literature is limited regarding surgical treatment for near-obliterative urethral strictures in female patients. In this paper, the authors aimed to report a novel technique of double-faced inlay buccal mucosal graft (BMG) urethroplasty, first described by Joshi in 2020. This is a case of a 35-year-old female with progressively worsening lower urinary tract symptoms, several months after undergoing cesarean section despite multiple internal urethrotomies. Grafts were placed both the anterior and posterior urethral walls with noted good urine flow with mild lower urinary tract symptoms on follow-up after 6 months. The combined dorsal and ventral inlay BMG urethroplasty is a feasible technique with good results for female patients with urethral strictures. To the authors’ knowledge, this is the first-ever reported case, for this novel technique, in the Philippines.
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Biliary complications, especially the ischemic-type biliary lesions (ITBL), are the main causes of mortality and retransplantation for patients undergoing liver transplantation. In recent years, the application of marginal donor livers such as livers from donor of cardiac death and fatty liver leads to high incidence of ITBL. As a result, the treatment and prevention of ITBL after liver transplantation become a research hotspot. Based on the global research progress and the clinical experience of their liver transplantation center, the authors investigate the treatment and prevention of ITBL after liver transplantation in the donation after cardiac death era.
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Objective:To assess the efficacy, safety of adding intralesional compound betamethasone injection to EEBD to reduce restricture.Methods:77 patients, treated in The first people's hospital of YancHeng from January, 2015 to December, 2018, were randomized to receive EEPD combined with either compound betamethasone injection or placebo injection. A total of 2 ml of compound betamethasone injection or an identical volume of normal saline solution as a placebo was injected per site using a 23-gauge needle immediately after EEPD. Patients and treating physicians were blinded to the treatment. The primary endpoint was the number of dilations required to resolve the stricture、restricture-free survival、time required to resolve the stricture and adverse events.Results:During the 4-years study period, Finally , 74 patients , who were randomized to either the steroid group (37 cases) or placebo group (37 cases), comprised the per-protocol population .The median number of EEPD required to resolve strictures was 2.0( IQR 1.0-3.0) in the steroid group and 3.0 ( IQR 3.0-4.5) in the placebo group ( P<0.001). After 6 months of follow-up, 27.0% of patients who had received steroid injections remained recurrence free compared with 3.5% of those who had received saline injections( P<0.001). The median time of EEPD required to resolve the stricture was 88 days( IQR 0-98 days)in the steroid group and 131 days( IQR 97-157 days)in the placebo group( P<0.001). No adverse events occurred related to the EEPD or steroid injection occurred. Conclusion:Endoscopic esophageal probe dilation combined with compound betamethasone injection shows promising results for the prevention of stricture recurrence in patients of anastomotic strictures.
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Data of 7 patients with complex benign esophageal strictures (CBESs) who underwent endoscopic longitudinal incision combined with local injection of bleomycin were retrospectively reviewed at Air Force Medical Center from August 2018 to November 2019.The length of preoperative esophageal stenosis was 4-14 cm and the minimum diameter of esophageal stenosis was 0.2-0.4 cm in 7 cases. The procedure was successful for all 7 patients.No adverse events occurred during 5-14 months of follow-up period.Restenosis and dysphagia occurred in 5 cases.The interval between the first endoscopic treatment and the recurrence of esophageal stenosis was 30-120 days.Among the 5 cases of recurrence, 4 cases remained unobstructed after 2 treatments and 1 case remained unobstructed after 4 treatments. The dysphagia scores of 7 patients were graded from 0 to 1 by the end of follow-up. Endoscopic longitudinal incision combined with bleomycin therapy in treatment of CBESs is safe and effective.
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Corrosive oesophageal strictures are a common and debilitating condition in India. Patients generally have dysphagia, cachexia, drooling of saliva, aspiration pneumonitis, and lung abscess. Though endoscopic dilatations are done in cases of short segment strictures, surgical oesophageal by pass is the permanent solution for this condition. A 24 years female presented with complaints of dysphagia and cachexia, due to corrosive stricture. Patient had a history of poison ingestion 2 years back. Intra-operatively stricturous mucosa is excised and an iso peristaltic colonic loop by pass was carried out. Post operatively patient had a complication of anastomotic leak which was treated conservatively, excepting which patient is symptom free and gaining weight on a follow up period of 1 year. Ever since first described by Kelling and Vuillet in 1911 colonic interposition is mostly used around the globe for oesophageal bypass in both benign and malignant conditions. Stomach and jejunum are the other conduits that can be used. Iso peristaltic loop is mostly used to reduce the incidence of reflux. Right colon or transverse colon graft based on the mid colic artery or the left colic artery owing to the reliable blood supply and less diameter. This procedure has a high complication rate of around 27% most of which are due to the vascular comprise of the graft.
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0bjective To study the impact of aging on pancreatic atrophy,fibrosis and exocrine hy-pofunction in patients with post.ERCP pancreatitis(PEP)and its severity.Methods A retrospective study was conducted on 786 patients who underwent ERCP at the Affiliated Zhongshan Hospital of Dalian Universi-ty from June 201 1 to April 2018.Patients who were aged over 75 years were grouped into the elderly group while those aged less than 75 years were grouped into the younger group.The incidences and severity of post-ERCP pancreatitis in the two groups were analyzed.Results In the elderly group,there were 308 patients.The average age was(8 1.8±4.8)years.In the younger group,there were 478 patients.The average age was(57.7±12.0)years.The average operation time for the elderly group was(52.5±14.1)minutes,and that for the younger group was(50.7±14.9)minutes.There were no significant differences in opera-tion time and in the related factors between the two groups(P＞0.05).There was no significant difference in the rates of hyperamylasemia between the two groups(29.9％vs 30.1％,P＞0.05).The overall rate of PEP was 11.3％(89/786).In the elderly group,the rate of PEP was6.5％(20/308),which was signifi-cantly lower than that in the younger group(x2=11.765,P＜0.05).The rates of mild,moderate and severe PEP in the elderly group was significantly lower than those in the younger group(all P＜0.05).Hyperamylasemia and pancreatitis in the 2 groups were alleviated after conservative treatment.Conclusions Aging(≥75 years)resulted in pancreatic atrophy,fibrosis,exocrine hypofunction which had a protective effect on PEP.
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Benign biliary strictures are uncommon in children. Classically, these cases are managed surgically, however less invasive approaches with interventional radiology and or endoscopy may have similar results and improved safety profiles While benign biliary strictures have been described in literature on several occasions in young children, (most older than 1 year and once in an infant 3 months of age), all reported cases were managed surgically. We present two cases of benign biliary strictures in infants less than 6 months of age that were managed successfully with novel non-invasive procedures and a review of all current pediatric cases reported in the literature. Furthermore, we describe the use of a Rendezvous procedure, which has not been reported as a treatment approach for benign biliary strictures.
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Child , Humans , Infant , Infant, Newborn , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic , Endoscopy , Jaundice, Neonatal , Radiology, InterventionalABSTRACT
Children′s esophageal stenosis is mainly benign stenosis. Esophageal foreign bodies and corrosion are common causes of esophageal stenosis in children requiring emergency management. Endoscop￣ic treatment of esophageal stricture includes endoscopic balloon dilatation,endoscopic radial incision,medical treatement,endoscopic stenting and so on. According to the cause of the stenosis,the nature of the lesion and the morphological structure of the lesion,formulating appropriate endoscopic treatment strategy are important for therapeutic effect and reducing the incidence of complications.
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Biliary strictures are considered indeterminate when the initial radiologic evaluation and endoscopic retrograde cholangiopancreatography with brush cytology and/or forceps biopsy do not reveal diagnostic findings. Evaluation of these strictures is challenging and often requires a multidisciplinary approach and multiple procedures. Peroral cholangioscopy allows direct visualization of these lesions and targeted tissue acquisition using miniature biopsy forceps. In the past decade, there have been significant improvements in the field of cholangioscopy. These advances have allowed higher-quality image acquisition, easy setup, operation by a single operator, easy maneuverability, and excellent targeted tissue sampling performance. However, the interpretation of cholangioscopic visual findings remains challenging. In this review, we discuss the role of peroral cholangioscopy in the evaluation of indeterminate biliary strictures.
Subject(s)
Bile Duct Diseases , Bile Duct Neoplasms , Biopsy , Cholangiocarcinoma , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic , Surgical InstrumentsABSTRACT
Objective@#To study the impact of aging on pancreatic atrophy, fibrosis and exocrine hypofunction in patients with post-ERCP pancreatitis (PEP) and its severity.@*Methods@#A retrospective study was conducted on 786 patients who underwent ERCP at the Affiliated Zhongshan Hospital of Dalian University from June 2011 to April 2018. Patients who were aged over 75 years were grouped into the elderly group while those aged less than 75 years were grouped into the younger group. The incidences and severity of post-ERCP pancreatitis in the two groups were analyzed.@*Results@#In the elderly group, there were 308 patients. The average age was (81.8±4.8) years. In the younger group, there were 478 patients. The average age was (57.7±12.0) years. The average operation time for the elderly group was (52.5±14.1) minutes, and that for the younger group was (50.7±14.9) minutes. There were no significant differences in operation time and in the related factors between the two groups (P>0.05). There was no significant difference in the rates of hyperamylasemia between the two groups (29.9% vs 30.1%, P>0.05). The overall rate of PEP was 11.3% (89/786). In the elderly group, the rate of PEP was 6.5% (20/308), which was significantly lower than that in the younger group (χ2=11.765, P<0.05). The rates of mild, moderate and severe PEP in the elderly group was significantly lower than those in the younger group (all P<0.05). Hyperamylasemia and pancreatitis in the 2 groups were alleviated after conservative treatment.@*Conclusions@#Aging (≥75 years) resulted in pancreatic atrophy, fibrosis, exocrine hypofunction which had a protective effect on PEP.
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Corrosive injuries are common in developing countries. Acid ingestion is more common in developing countries when compared to alkali ingestion in developed countries. Ingestion may be accidental or suicidal. The nature of the corrosive ingested determines the extent of injury caused. Acidic injury commonly affects stomach than alkalis and it ranges from acute to chronic gastric injuries. In this article we discuss about the management of corrosive stricture of pylorus of stomach which was dealt by laparoscopy.
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Objective To explore the therapeutic effect of laparoscopic surgery for complicated ureteral strictures after Holmium laser lithotripsy.Methods There were 67 patients with ureteral stenosis after ureteroscopic lithotripsy or percutaneous nephrolithotomy Holmium laser lithotripsy from January 2009 to September 2017.There were 38 males and 29 females.The average age of patients was 37 years old(rang 21-62 years).47 cases were hospitalized because of osphyalgia,among whom 8 cases had fever.There were 19 cases of upper ureteral calculi postoperative stenosis,18 cases of middle ureteral calculi postoperative stenosis and 30 cases of lower ureteral calculi postoperative stenosis,17 cases of whom had complete atresia.6 patients had received twice Holmium laser lithotripsy.Two patients had received triple Holmium laser lithotripsy.In 67 cases,11 cases had received a ureteral stent placement to dilate the affected ureter.2 cases had received twice ureteral stent placements,two double-J tubes were placed in the two stage surgery.2 cases had received treatment of incision inside the ureteral stricture by ureteroscope,but symptoms recurred after removal of the double-J tube.There were 15 cases of mild hydronephrosis before surgery,moderate hydronephrosis in 27 cases,severe hydronephrosis in 25 cases.The depth of separation of the renal collecting system was (3.85 ± 0.58) cm,preoperative serum creatinine was 115μmol/L on average (range 46-258 μmol/L).The surgery was done by the abdominal pathway or posterior abdominal pathway.52 patients had ureteral stenosis resection plus ureter end anastomosis,15 patients had ureteral bladder replantation.Results All the patients had successful surgery.The operation time was 65-160 min,and the average operation time was 82 min;the intraoperative blood loss was about 20-300 ml,and the average blood loss was about 56 ml;Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic.The stent was removed after 2-3 months and patients were followed up for 5-24 months after removing the double-J tube,with an average of 12 months.The patients with osphyalgia were significantly relieved.The separation of the renal collecting system was reduced to(3.85 ± 0.58)cm,postoperative serum creatinine was 75.8 μmol/L on average (range 47-165 μmol/L).Renal function stop deterioration in 67 patients.Conclusion The operation of laparoscopic ureteral strictures resection plus ureter end anastomosis or ureteral bladder replantation after ureteral strictures due to the use of Holmium laser lithotripsy is the minimally invasive,safe and effective treatment.
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Liver transplantation has become the most effective treatment for end-stage liver diseases.Due to the shortage of organ,more and more extended criteria donors (ECD) grafts had been used,which expand the liver pool.However,a series of complications post transplantation were caused by ischemia,hypoxia,steatosis and so on.The non-anastomotic biliary strictures after liver transplantation is one of the major complications when the ECD donors was be used in clinic.The study on the protective effect of machine perfusion on liver donors is too numerous to list,and existing studies have found that MP can reduce the incidence of NAS after liver transplantation.This review provides an overview of the pathogenesis of NAS and the reduction incidence of NAS by MP.
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Objective To investigate the safety and efficacy of laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique in the treatment of ureteral strictures secondary to Holmium laser lithotripsy.Methods The clinical data of 26 cases of ureteral strictures secondary to Holmium laser lithotripsy performed by laparoscopic ureteroureterostomy from December 2013 to January 2016 in our hospital were analyzed retrospectively.The patients included 15 men and 11 women,with an average age of 39.5 years (range 24-71 years).The ureteral strictures secondary to holmium laser lithotripsy were found on average follow-up of 5.2 months (range 1-22 months).There were 12 cases of mild hydronephrosis before surgery,moderate hydronephrosis in 11 cases,severe hydronephrosis in 3 cases.Preoperative serum creatinine was 102.0 μ mol/L on average (range 53.3-201.4 μmol/L),and ureteral stenosis length was 15.0 mm on average (range 8.0-26.0 mm).The upper ureteral strictures in 6 cases,the middle strictures in 13 cases,and the lower strictures in 7 cases.Results All the operations were completed successfully without conversion to open and no intraoperative death.The average operation time was 121.4 min(range 90-155 min);the estimated blood loss was 92.3 ml (range 30-200 ml);the mean recovery time of gastrointestinal function after operation was 1.4 d(range 0.5-2.5 d);the mean hospital stay was 6.2 d(range 4-9 d)with indwelling double J;the Foley catheter was removed 14.5 d(range 12-16 d)postoperatively;the mean time of double J withdrawal was 76.3 d(range 61-86 d).Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic administration.Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management 5 days later.After a period of 11 to 22 months of follow-up,no patient had ureteric re-stenosis.Conclusions Laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopyassisted technique could accurately locate and cure the ureteral strictures.It might be safe and effective with short operation time,less injury and quick recovery.
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Objective To investigate the safety and efficacy of laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique in the treatment of ureteral strictures secondary to Holmium laser lithotripsy.Methods The clinical data of 26 cases of ureteral strictures secondary to Holmium laser lithotripsy performed by laparoscopic ureteroureterostomy from December 2013 to January 2016 in our hospital were analyzed retrospectively.The patients included 15 men and 11 women,with an average age of 39.5 years (range 24-71 years).The ureteral strictures secondary to holmium laser lithotripsy were found on average follow-up of 5.2 months (range 1-22 months).There were 12 cases of mild hydronephrosis before surgery,moderate hydronephrosis in 11 cases,severe hydronephrosis in 3 cases.Preoperative serum creatinine was 102.0 μ mol/L on average (range 53.3-201.4 μmol/L),and ureteral stenosis length was 15.0 mm on average (range 8.0-26.0 mm).The upper ureteral strictures in 6 cases,the middle strictures in 13 cases,and the lower strictures in 7 cases.Results All the operations were completed successfully without conversion to open and no intraoperative death.The average operation time was 121.4 min(range 90-155 min);the estimated blood loss was 92.3 ml (range 30-200 ml);the mean recovery time of gastrointestinal function after operation was 1.4 d(range 0.5-2.5 d);the mean hospital stay was 6.2 d(range 4-9 d)with indwelling double J;the Foley catheter was removed 14.5 d(range 12-16 d)postoperatively;the mean time of double J withdrawal was 76.3 d(range 61-86 d).Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic administration.Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management 5 days later.After a period of 11 to 22 months of follow-up,no patient had ureteric re-stenosis.Conclusions Laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopyassisted technique could accurately locate and cure the ureteral strictures.It might be safe and effective with short operation time,less injury and quick recovery.
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Objective To investigate the efficacy of ventral bladder mucosa onlay graft urethroplasty for the management of panurethral stricture.Methods From August of 2005 to July of 2013,11 cases of panurethral stricture were treated by ventral bladder mucosa onlay graft urethroplasty.The median age of the patients was 53 years (22-72 year),The median stricture length was 15 cm (12-18 cm).The patient was placed in the lithotomy position,Penile urethra was exposed by circumcoronal incision and degloving of skin,Bulbar urethra was exposed by inverted Y-shaped perineal incision.The strictured urethral segment was then opened ventrally in the midline up to at least 1 cm proximally into the healthy urethra.An appropriate size bladder mucosa graft was harvested,and was quilted to the splited urethra edge,the graft width was 1.5-2.0 cm.Two F10 fenestrated silicone catheters were left as urethral stents,a suprapupic cystostomy tube was left.The urethral stent was removed 4 weeks postoperatively.Follow-up was performed every 3 months for the first year,and annually thereafter.Success was defined as normal voiding with a maximum flow rates ≥ 15 ml/s,and the patients required no further instrumentation,including dilation or urethrotomy.Results The mean follow-up was 18 months (range,9-36 months),the overall success rate was 10/11.One patient developed urethral meatus stenosis 3 months postoperatively,and was managed by meatal dilatation.Conclusion Ventral bladder mucosa onlay graft urethroplasty can be used for the management of panurethral stricture,Bladder mucosa is an alternative substitution for complex urethral reconstruction.
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Objective To explore the therapeutic effect of endoscopic treatment for common bile duct stricture secondary to chronic pancreatitis.Methods The clinical data of 58 patients with common bile duct stricture secondary to chronic pancreatitis diagnosed between January 2007 and January 2014 were retrospectively analysed.Results A total of 58 patients with common bile duct stricture secondary to chronic pancreatitis underwent 157 endoscopic procedures with placement of 204 polyethylene stents.The mean time of stenting was 12.2 months(3-33 months).After treatment,stricture disappeared in 20 patients(34.5％),with a mean stenting period of 7.8 months(3-22 months).Treatment was successful in 37 patients(63.8％),with a mean stenting period of 9.5 months (3-22 months),and was incompletely successful in 12 patients (20.7％) with a mean stenting period of 19.8 months(12-33 months).Nine patients(15.5％) referred to surgery were considered a failure of endoscopic therapy.Conclusion The endoscopic treatment of common bile duct stricture due to pancreatic edema or pancreatic cyst is effective.Endoscopic treatment is a safe,effective and minimally invasive method for common bile duct stricture secondary to chronic pancreatitis,which can be the first option.
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<p><b>Objectives </b>: We examined effect of saireito for prevention and improvement of urethral strictures after transurethral resection of the prostate (TUR-P), also examining the utility of considering the saireito ‘pattern'.<br><b>Materials and Methods </b>: We evaluated 142 benign prostatic hyperplasia patients, and were randomly assigned to a saireito treatment group (3.0 gr. x 3 times per day 30 min. before meal, n = 70) and no treatment control group (n = 72).<br><b>Results </b>: 1) A statistically significant difference was observed in the occurrence of urethral stricture by saireito administration (p = 0.043, Chi-square test, Odds ratio : 0.12 [95% CI ; 0.01-0.95]. 2) For urethral strictures that occurred in the no treatment group, improvement of stricture in five cases was observed by saireito administration. 3) With either the appropriate administration or non-administration of saireito according to correct ‘pattern' diagnoses, the incidence of urethral stricture was significantly reduced (p = 0.042).<br><b>Discussion </b>: Administration of saireito after TUR-P is effective for preventing post-operative urethral stricture. It is also effective for confirmed strictures. Saireito administration is appropriate in patients with saireito ‘pattern' indications.</p>
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BACKGROUND/AIMS: Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. METHODS: Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wire-grasping method, forceps in the duodenum grasps a guide-wire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. RESULTS: In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). CONCLUSIONS: The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.