ABSTRACT
Acute biliary infection is one of the common causes of acute abdomen, easily causes severe infection and even death. The reasonable treatment of the acute phase is very important. The sudden outbreak of corona virus disease (COVID-19) has posed severe challenges to the country's economic and social life, and has also led to an extreme shortage of medical resources. The diagnosis and treatment of acute biliary infections disease also face challenges. In order to control the epidemic of infectious diseases, we write this article from the perspective of prevention and controlling of COVID-19, referring to the Tokyo Guidelines 2018 to express our views on the diagnosis and treatment strategies for acute biliary infection, hoping to do our best to prevent and control the epidemic of COVID-19.
ABSTRACT
Objective To investigate the risk factors for post-ERCP complications. Methods Data of the patients who underwent ERCP in the First Affiliated Hospital of Nanchang University from 1 January 2011 to 31 December 2013 were retrospectively analyzed. Post-ERCP complications were analyzed by univariate and multivariate analyses. Results A total of 277 patients out of 1 951 developed complications, 101(5.18%)pancreatitis, 54(2.77%)hyperamylasemia(not including pancreatitis), 134(6.87%) biliary infection,8(0.41%)hemorrhage,1(0.05%)obstruction and 1(0.05%)perforation.Multivariate analyses showed cholangiocarcinoma(P=0.002,OR=2.39, 95% CI:1.38-4.14), long operation time(>60 min)(P=0.020,OR=3.77,95%CI:1.23-11.53)and endoscopic sphincterotomy(EST)(P=0.008, OR=2.56,95% CI:1.28-5.14)and entrance of guidewire to pancreatic duct(P=0.012,OR=1.43, 95%CI:1.08-1.87)were independent risk factors for PEP. Cholangiocarcinoma(P<0.01, OR=2.93, 95%CI:1.88-4.56),multiple times of ERCP during the period of hospitalization(P<0.01, OR=2.53, 95%CI:1.63-3.93)were independent risk factors for post-cholangitis. However, EST(P=0.03, OR=0.65,95%CI:0.44-0.97)and antibiotics prophylaxis after ERCP(P=0.03, OR=0.64, 95% CI:0.39-0.95)were protective factors for post-cholangitis. ConclusionCholangiocarcinoma, endoscopic sphincterotomy, long operation time(> 60 min)and entrance of guidewire to pancreatic duct were independent risk factors for PEP. Cholangiocarcinoma and multiple ERCP during the period of hospitalization are independent risk factors for post-cholangitis.EST and antibiotics prophylaxis after ERCP might reduce the occurrence of cholangitis.
ABSTRACT
Resumen El diagnóstico de las colangiopatías obstructivas por endosonografía biliopancreática (EUS, por sus siglas en inglés) se ha estudiado en profundidad, y existe un extenso reconocimiento de su papel para el diagnóstico de coledocolitiasis, tumores de la encrucijada biliopancreática y síndromes de compresión extrínseca de la vía biliar. La colangitis, la complicación más frecuente de la obstrucción biliar y responsable de gran parte de su morbimortalidad, no se ha relacionado en forma suficiente con los hallazgos endosonográficos. Nuestro estudio buscó definir la validez diagnóstica de la endosonografía en los pacientes con colangitis aguda con el fin de limitar la morbimortalidad del retraso diagnóstico. Se realizó un estudio descriptivo, analizando las historias clínicas de pacientes sometidos a endosonografía biliopancreática, por ictericia obstructiva de cualquier etiología, y quienes posteriormente fueron llevados a colangiopancreatografía retrógrada endoscópica (CPRE) para manejo de obstrucción biliar. Comparamos los hallazgos endosonográficos compatibles con colangitis aguda (engrosamiento de la vía biliar de 1,5 mm o más, presencia de halo pericolangítico de al menos 1,5 cm de longitud y presencia de contenido de ecogenicidad mixta en el interior de la vía biliar) con el drenaje purulento durante la CPRE. Se encontró una alta frecuencia de estos hallazgos en los pacientes con colangitis, y el engrosamiento de las paredes de la vía biliar fue el más común, en el 92,6% de los casos, seguido por la presencia de halo pericolangítico en el 59,3% de los casos y contenido ductal en el 66,7% de los casos. Igualmente, se encontró asociación ascendente de las frecuencias con grado de severidad de la colangitis. Resulta recomendable realizar estudios con un mayor poder estadístico que permitan validar nuestros resultados para una futura inclusión de la EUS en el algoritmo diagnóstico de las guías de práctica clínica en colangitis aguda.
Abstract Diagnosis of obstructive cholangiopathy with biliopancreatic endosonography (BUS) has been extensively studied, and its role in the diagnosis of choledocholithiasis, biliopancreatic junction tumors and extrinsic biliary compression syndromes is widely recognized. Endosonographic diagnosis of cholangitis, a more frequent complication of biliary obstruction which is responsible for much of its morbidity and mortality, has not been sufficiently studied. Our study's objective is to define the diagnostic validity of endosonography for patients with acute cholangitis in order to limit morbidity and mortality due to diagnostic delay. This is a descriptive study that analyzes clinical histories of patients who underwent biliopancreatic endosonography because of obstructive jaundice of any etiology and who later underwent endoscopic retrograde cholangiopancreatography (ERCP) to manage biliary obstruction. We compared endosonographic findings compatible with acute cholangitis: thickening of the bile duct of 1.5 mm or more, periportal halo sign of at least 1.5 cm in length, mixed echogenicity of bile duct content, and purulent drainage during ERCP. Patients with cholangitis most frequently presented thickened gallbladders (92.6% of cases) periportal halo signs (59.3% of cases) and mixed echogenicity of bile duct content (66.7% of cases). We also found an ascending association of frequencies with the degree of severity of cholangitis. Studies with greater statistical power are needed for validation of our results and for future inclusion of EUS in the diagnostic algorithm for clinical practice guidelines in cases of acute cholangitis.
Subject(s)
Cholangitis , Endosonography , Cholestasis , Radiotherapy, Image-GuidedABSTRACT
Objective To study biliary excretion of ceftriaxone sodium in humans. Methods Twelve biliary calculi patients were infused with a single dose of 2.0g ceftriaxone half an hour before operation and the common bile duct bile and gallbladder bile samples were coUected in the operations. The bile drug concentrations were assayed by HPLC. Results The results of clinical study on the bile drug showed that the concentrations (C) of ceftriaxone in common bile duct and gallbladder were (264.43±166.46) μg/ml and (85.39 ±48.16) μg/ml, respectively. Conclusion Ceftriaxone reaches high concentrations in humans' bile, and it could be chosen as a good antibiotics for the treament of biliary infection.
ABSTRACT
Objective To compare the prevent effect of biliary retrograde infection in the uncut and cut Roux-en-Y cholecystojejunostomy. Methods Sixteen Begle dogs were divided into two groups randomly. One group was performed with the uncut Roux-en-Y cholecystojejunostomy(the uncut group) and the other was performed with the cut Roux-en-Y cholecystojejunostomy (the cut group). The categories of bacterium in the the Roux limb before and twelve weeks after operation, and the biliary duct pressure of the anastomotic stoma were detected. The changes of the categories of bacterium before and after operation, the categories of bacterium and the biliary duct pressure after operation in two groups were analyzed. Results The isolating rate of G-aerobic bacteria and anaerobic bacteria was 37.50% and 6.25% before operation; in the uncut group, the isolating rate was 62.50%, 12.50%,with no significance difference comparing to preoperation(p＝0.390、1.000). In the uncut group the isolating rate was 87.50%, 75.00%after operation, with significance difference comparing to preoperation (p＝0.033、0.001).The isolating rate of anaerobic bacteria after operation in the cut group is higher than the uncut group,the difference is significance (p＝0.041). And the biliary duct pressure in the cut group is higher than the uncut group(p<0.001).Conclusion The uncut Roux-en-Y cholecystojejunostomy was more effective in prevent biliary retrograde infection.
ABSTRACT
Objective To study the expression of lipopolysaccharide(LPS) receptor,CD14 in the liver tissue during acute biliary infection and its relation with production of cytokines.Methods Rat models of acute biliary infection were established by ligating the choledochus and injecting Escherichia coli O111∶B4 into the duct.The expressions of CD14 protein and mRNA in liver tissue,the plasma levels of endotoxin,TNF-? and IL-6,and phagocytosis activity of Kupffer cells(KCs) were assayed at 0,3,6,12 and 24 h after operation.Ultrastructural changes in KCs were observed by electron microscopy.Results With the course prolonging in acute biliary infection,the plasma endotoxin level was progressively increased,KCs were activated and the levels of TNF-? and IL-6 markedly were increased,while the CD14 expression obviously increased at mRNA and protein levels.Conclusion The CD14 expression is gradually increased in liver tissue during acute biliary infection.KCs are activated and releasing more and more cytokines.It might be one of the important mechanisms of that KCs improve inflammatory response during the infection.
ABSTRACT
Objective To study the management for haemobilia from the intrahepatic biliary duct due to the biliary tract infection.Methods Selective hepatic angiography, cholangiography,fib erotic choledochscope were used to confirm the pathology and diagnosis in 11 cases. Partial liver resection, transcatheter mobilization,common bile duct exploration and T-tube drainage were performed respectively.Results Of the 11 patients,3 treated by transcatheter,2 by left external lobectomy,6 by common bile duct exploration and T-tube drainage.Definitive control of the bleeding was achieved in all the patients.No complications were observed.10 of the patients are alive and well at follow-up for 2 years.Conclusions The treatment of choice depends on the underlying pathology of haemobilia,location diagnosis and the patient's general condition. The therapeutic principle is effective for hepatic haemobilia resulting from the billiard infection.
ABSTRACT
Objective To investigate the expression and significance of human TREM-1 mRNA in patients with (biliary) infection. Methods Peripheral blood of 32 patients with biliary infection and 7 healthy volunteers were (collected). TREM-1 mRNA was determined by semi-quantitative RT-PCR. TNF-? was determined by ELISA method. Results The values of TREM-1/?-actin of control group was 0.48?0.072, while those of biliary infection group in 1d, 2d, 3d, 7d were 0.93?0.070,0.90?0.060,0.82?0.092,0.66?0.062 respectively (P
ABSTRACT
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.