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1.
Rev. gastroenterol. Perú ; 43(4)oct. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1536368

ABSTRACT

La colangiopatía portal hace referencia a anomalías colangiográficas que se producen en pacientes con cavernomatosis portal, siendo progresiva, cursando con enfermedad biliar sintomática y anomalías graves de las vías biliares. Y, representa una complicación infrecuente de la hipertensión portal. Se describe el caso de un hombre de 53 años, con historia de larga data de hipertensión portal nocirrótica y cavernomatosis portal, quien presentó un episodio de enfermedad biliar obstructiva sintomática, y en estudios se documentó tejido fibrótico de extensión periportal ascendente con compresión extrínseca del colédoco distal y dilatación de la vía biliar extra e intrahepática. Por lo que se procedió a colangiopancreatografía retrógrada endoscópica, realizándose tratamiento paliativo, con papilotomía pequeña y colocación de endoprótesis biliar plástica, siendo exitoso por ausencia de complicaciones procedimentales, y mejoría clínica y parámetros bioquímicos. Finalmente, recibiendo de alta con indicación de seguimiento prioritario para recambios periódicos de endoprótesis biliares, y valoración por hepatología. La colangiopatía portal es una entidad rara que debe sospecharse en sujetos con hipertensión portal de origen no-cirrótico, con hallazgos imagenológicos de estenosis, angulaciones o dilataciones segmentarias, su tratamiento debe ser individualizado, y la terapia endoscópica es de elección en enfermedad biliar sintomática.


Portal cholangiopathy refers to cholangiographic abnormalities occurring in patients with portal cavernomatosis, being progressive, presenting with symptomatic biliary disease and severe biliary tract abnormalities. And, it represents an infrequent complication of portal hypertension. We describe the case of a 53-year-old man with a long history of non-cirrhotic portal hypertension and portal cavernomatosis, who presented an episode of symptomatic obstructive biliary disease, and studies documented fibrotic tissue of ascending periportal extension with extrinsic compression of the distal common bile duct and dilatation of the extra and intrahepatic biliary tract. Therefore, endoscopic retrograde cholangiopancreatography was performed, and palliative treatment with small papillotomy and placement of a plastic biliary endoprosthesis was successful due to the absence of procedural complications, and clinical improvement and biochemical parameters. Finally, the patient was discharged with indication of priority follow-up for periodic replacement of biliary stents, and evaluation by hepatology. Portal cholangiopathy is a rare entity that should be suspected in subjects with portal hypertension of non-cirrhotic origin, with imaging findings of stenosis, angulations or segmental dilatations, its treatment should be individualized, and endoscopic therapy is of choice in symptomatic biliary disease.

2.
Journal of Clinical Hepatology ; (12): 1126-1133, 2023.
Article in Chinese | WPRIM | ID: wpr-973202

ABSTRACT

Objective To investigate the effect of Yinchenhao decoction on renal oxidative stress injury in rats with obstructive jaundice and its association with the regulation of the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and nuclear translocation. Methods A total of 32 male Sprague-Dawley rats were randomly divided into sham-operation group (S group), model group (O group), low-dose Yinchenhao decoction group (LY group), and high-dose Yinchenhao decoction group (HY group), with 8 rats in each group. For the rats in the S group, the upper common bile duct was isolated without ligation, and for those in the other groups, double ligation of the middle and upper 1/3 of the common bile duct was performed to establish a model of obstructive jaundice. After 7 days, the rats in the LY group and the HY group were given Yinchenhao decoction by gavage at a dose of 6.3 and 18.9 mL/kg, respectively, while those in the S and O groups were given an equal volume of distilled water by gavage every day for 7 consecutive days, and the rats were treated on day 14. ELISA was used to measure the serum levels of total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), blood urea nitrogen (BUN), and creatinine (Cr); spectrophotometry was used to measure the activity of the oxidative stress factors superoxide dismutase (SOD) and malondialdehyde (MDA) in renal tissue; quantitative real- time PCR and Western blotting were used to measure the mRNA and protein expression levels of Nrf2, Kelch-like ECH-associated protein 1 (Keap1), and NAD(P)H quinone dehydrogenase 1 (NQO1) in renal tissue; immunohistochemistry was used to measure observe the nuclear translocation of Nrf2 protein in renal tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t -test was used for further pairwise comparison within groups. Results Compared with the S group, the O group had significant increases in the levels of TBil, DBil, ALT、GGT, BUN, and Cr, a significant reduction in the activity of SOD, and a significant increase in the level of MDA (all P 0.05). Compared with the S group, the O group had a significant reduction in the positive rate of Nrf2 in cell nucleus in renal tissue ( P < 0.05), and compared with the O group, the LY group and the HY group had a significant increase in the positive rate of Nrf2 in cell nucleus ( P < 0.05). Conclusion Yinchenhao decoction can effectively alleviate renal injury caused by obstructive jaundice, possibly by upregulating the protein expression of Nrf2 in renal tissue and regulating the nuclear translocation of Nrf2 protein, so as to mediate the protein expression of downstream NQO1, regulate oxidative stress response caused by obstructive jaundice, and thereby alleviate renal injury in rats.

3.
Article in Chinese | WPRIM | ID: wpr-1024155

ABSTRACT

Objective:To investigate the efficacy of endoscopic retrograde cholangiopancreatography in the treatment of Child-Pugh C cirrhosis complicated by obstructive jaundice and its effects on liver function and infection indexes.Methods:The clinical data of 86 patients with Child-Pugh C cirrhosis complicated by obstructive jaundice who received treatment in the Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, from June 2017 to June 2022 were retrospectively analyzed. These patients were divided into an observation group ( n = 56) and a control group ( n = 30) according to different treatment methods. Patients in the observation group underwent endoscopic retrograde cholangiopancreatography and those in the control group received conservative drug treatment. After 14 days of treatment, clinical efficacy was compared between the two groups. The changes in liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptide (GGT)] and infection indicators [white blood cell count (WBC), procalcitonin (PCT), and C-reactive protein (CRP)] were compared between the two groups before and after treatment. The incidence of postoperative complications was compared between the two groups. At 6 months after treatment, the prognosis was compared between the two groups. Results:The total response rate in the observation group was 98.21% (55/56), which was significantly higher than 60.00% (18/30) in the control group ( Z = 23.43, P < 0.001). Before treatment, serum ALT, AST, GGT levels in the control group were (294.53 ± 45.19) U/L, (286.62 ± 17.15) U/L, and (304.53 ± 12.34) U/L, respectively, and they were (96.25 ± 16.7) U/L, (113.25 ± 8.56) U/L, (122.25 ± 9.24) U/L after 14 days of treatment. Before treatment, serum ALT, AST, and GGT levels in the observation group were (352.36 ± 70.23) U/L, (303.31 ± 12.12) U/L, and (368.36 ± 10.23) U/L, respectively, and they were (108.65 ± 12.38) U/L, (95.65 ± 6.54) U/L, and (85.66 ± 7.28) U/L, respectively, after 14 days of treatment. After treatment, serum ALT, AST, and GGT levels in each group were significantly decreased compared with those before treatment (observation group t = 22.54, 49.54, 64.76; control group t = 25.57, 112.83, 168.48, all P < 0.05). After treatment, the amplitude of decrease in serum ALT, AST, and GGT levels in the observation group were significantly greater than those in the control group ( t = 2.27, 3.18, 4.61, all P < 0.05). After treatment, PCT, CRP, and WBC in each group were significantly decreased compared with those before treatment (observation group: t = 11.68, 11.46, 5.42, control group: t = 20.39, 18.69, 19.02, all P < 0.05). After treatment, the amplitude of decrease in serum PCT, CRP, and WBC in the observation group were significantly greater than those in the control group ( t = 5.14, 1.67, and 2.11, all P < 0.05). Within 14 days after treatment, there were two cases of acute pancreatitis, one case of hyperamylasemia, and one case of transient biliary bleeding in the observation group. There was one case of acute pancreatitis in the control group. The incidence of complications in the observation group was slightly, but not significantly, higher than that in the control group ( P > 0.05). After treatment, 12 patients (40.00%) in the control group experienced worsening jaundice, and additional endoscopic retrograde cholangiopancreatography salvage treatment was given. After treatment, total bilirubin level decreased by > 50%, reaching the standard of significant efficacy. At 6 months after treatment, stent obstruction occurred in two patients, which was effectively treated by replacement. There were no deaths in each group during the follow-up period. Conclusion:Implantation of a nasobiliary duct or a biliary duct stent during endoscopic retrograde cholangiopancreatography is more effective at treating yelloxemia in patients with Child-Pugh C cirrhosis complicated by obstructive jaundice than medication. The former method can effectively relieve obstructive jaundice, smooth drainage, improve liver function, reduce infection, and be relatively safe.

4.
Article in Chinese | WPRIM | ID: wpr-993344

ABSTRACT

Malignant obstructive jaundice is caused by direct invasion or compression of the biliary tract by malignant tumors of the bile duct, pancreas and other systems. Patients are often accompanied by symptoms such as malnutrition, low immune function, and organ damage. The treatments of active preoperative biliary drainage and reasonable reinfusion combined with enteral nutrition can help improve the safety of patients during the perioperative period, reduce postoperative complications, and improve the life quality of patients. This article reviewed the research progress of preoperative biliary drainage, bile recycling methods and precautions in patients with malignant obstructive jaundice, aiming to provide reference for clinical diagnosis and treatment practice.

5.
Article in Chinese | WPRIM | ID: wpr-958279

ABSTRACT

Objective:To compare the clinical effect of three indwelling methods of plastic biliary stent on relieving obstructive jaundice caused by unresectable hilar cholangiocarcinoma.Methods:A retrospective study was performed on data of 61 patients with obstructive jaundice caused by unresectable hilar cholangiocarcinoma from April 2014 to December 2020 in Cancer Hospital, Chinese Academy of Medical Sciences. Plastic biliary stent placement was used to relieve jaundice, including 18 cases of intragastric indwelling at the end of biliary stent, 31 cases of duodenal papilla indwelling at the end of biliary stent, and 12 cases of horizontal portion of duodenum indwelling at the end of biliary stent. Incidence of fever within 2 weeks, perioperative mortality, 90-day obstruction rate, and median stent patency period were followed up and the results were analyzed.Results:The incidence of fever within 2 weeks of the three groups were significantly different [66.7% (12/18), 58.1% (18/31) and 16.7% (2/12), χ2=7.30, P=0.026]. There were no statistically differences in the perioperative mortality [0 (0/16), 3.2% (1/31) and 0 (0/10), χ2=1.09, P=1.000], 90-day obstruction rate [52.9% (9/17), 48.3% (14/29) and 40.0% (4/10), χ2=1.91, P=0.589], or median stent patency period (66.0 d, 91.5 d and 94.0 d, Z=4.96, P=0.084) among three groups. Conclusion:Patients with biliary plastic stents with ends placed at the horizontal portion of the duodenum show lower incidence of fever within two weeks after implantation, and similar median stent patency period, 90-day obstruction rate and perioperative mortality compared with intragastric indwelling and duodenal papilla indwelling groups. Therefore, biliary plastic stents with ends placed at the horizontal portion of the duodenum should be recommended as the preferred procedure.

6.
Article in Chinese | WPRIM | ID: wpr-932747

ABSTRACT

Objective:To investigate the effect of autophagy on liver injury with obstructive jaundice in Sprague-Dawley (SD) rats and its underlying mechanism.Methods:Thirty-five healthy male SD rats, SPF grade, aged 6-8 weeks, weighting 200-300 g, were divided into 5 groups with 7 rats in each group, including sham group (simple free common bile duct, without ligation, intraperitoneal injection of normal saline), obstructive jaundice (OJ) group (established by common bile duct ligation, intraperitoneal injection of normal saline), OJ group with 3-MA, OJ group with Rapamycin, and OJ group with 3-MA and VX-765. Morphological changes in liver tissues were analyzed with HE staining. Expression of autophagy-related protein Atg5 was detected by immunohistochemistry staining. Liver function was analyzed by automatic biochemical instrument and the level of serum interleukin (IL)-18 was detected using ELISA assay. Protein levels of autophagy related-proteins and endoplasmic reticulum stressed (ERs)-related apoptosis proteins were detected by Western Blot.Results:The relative expression of autophagy related protein Atg5 in OJ group was significantly higher than that in sham group [(5.0±1.0) vs. (2.8±1.3), t=-3.00, P<0.05]. Compared with sham group, the activity of autophagy was enhanced and the protein levels of Caspase-1/p-65 and IL-18 were significantly increased in OJ group. At the same time, apoptosis was induced by activating ERs. In OJ group, the autophagy inducer 3-MA improved the expression levels of Caspase-1/p-65 and IL-18, and aggravate liver injury. While after applying the autophagy agonist Rapamycin in OJ rat models, the expression of Caspase-1/p-65 and IL-18 was repressed and liver damage was also reduced. In addition, in rat OJ groups with 3-MA, inhibition of Caspase-1 by VX-765 could down regulate the expression of Caspase-1/p-65 and IL-18, and protect against liver injury. Conclusions:Both ERs related apoptosis and autophagy were activated after ligation of common bile duct. Besides, activation of autophagy could reduce OJ-induced liver injury in SD rats by inhibiting the Caspase-1/p-65 inflammatory pathway.

7.
Zhonghua Nei Ke Za Zhi ; (12): 82-85, 2022.
Article in Chinese | WPRIM | ID: wpr-933435

ABSTRACT

Objective:To explore the risk factors and preventive strategies of pancreatitis after percutaneous transhepatic biliary drainage (PTBD) in patients with pancreatic cancer and obstructive jaundice.Methods:A total of 241 patients were retrospectively analyzed from May 2001 to October 2014 in Tianjin Medical University Cancer Institute and Hospital. The possibly correlated 9 factors were analyzed, including gender, age, hemoglobin level, total bilirubin level, degree of pancreatic duct dilatation, degree of pancreatic atrophy, degree of biliary stenosis, the pancreatic duct visualization, and drainage mode.Results:Univariate analysis suggested that pancreatic duct dilatation, pancreatic atrophy, visualized pancreatic duct and drainage mode were associated with the incidence of pancreatitis after PTBD ( P<0.05). Logistic regression analysis showed that visualization of pancreatic duct ( OR=6.33) was a risk factor for pancreatitis, while pancreatic duct dilatation ( OR=0.14), pancreatic atrophy ( OR=0.12) and external drainage ( OR=0.11) were protective factors for pancreatitis. Conclusion:In pateints with pancreatic cancer and obstructive jaundice, pancreatic duct dilatation and pancreatic atrophy predict low risk of pancreatitis after PTBD,while intraoperative pancreatic duct visualization and internal or external drainage may increase the incidence of postoperative pancreatitis.

8.
International Journal of Surgery ; (12): 10-15,F3, 2022.
Article in Chinese | WPRIM | ID: wpr-929961

ABSTRACT

Objective:To investigate the risk factor analysis and model prediction of bleeding after endoscopic retrograde cholangiopancreatography in patients with malignant obstructive jaundice (MOJ).Methods:A retrospective analysis was performed on 302 patients with MOJ treated with ERCP who were treated in the No. 363 Hospital Affiliated to Southwest Medical University from January 2015 to June 2021. The general clinical data of the patients were collected, and the biochemical indicators of the pancreatic and bile ducts were detected. The patients were followed up after discharge, and the patients were divided into a bleeding group ( n=47) and a control group ( n=255) according to whether the follow-up patients were bleeding after ERCP. Compared the general and clinical data of the two groups of patients, including age, gender, platelet count, presence of bile duct stones, acute cholangitis, acute pancreatitis, number of stones, intraoperative bleeding, pancreatic cancer, cholangiocarcinoma, large stone diameter, stone incarceration, duodenal papillary diverticulum, and pre-surgical incision. The measurement data that obey the normal distribution were represented by the mean±standard deviation ( ± s), and the two independent sample t test was used for the comparison between groups; the data that do not conform to the normal distribution were represented by M ( Q1, Q3), and the comparison between groups was used Mann-Whitney U test. The comparison of enumeration data between groups adopted chi-square test. Logistic multivariate regression was used to analyze the independent risk factors of postoperative bleeding after ERCP, and a nomogram prediction model was established and verified according to the independent risk factors of postoperative bleeding. Results:The two groups of patients were compared in age, gender, platelet count, bile duct stones, acute cholangitis, acute pancreatitis, the number of stones, intraoperative bleeding and other aspects, the difference was not statistically significant ( P>0.05). The percentages of pancreatic cancer, cholangiocarcinoma, large stone diameter, stone incarceration, duodenal papillary diverticulum, and surgical pre-incision in the bleeding group were 12.77%, 17.02%, 19.15%, 51.06%, 59.57%, and 14.89%, respectively. , the percentages of the control group were 3.92%, 5.10%, 9.02%, 19.22%, 17.65%, and 5.88%, and the difference was statistically significant between the two groups ( P<0.05). Taking postoperative bleeding as the dependent variable, and using the indicators with statistical differences in univariate analysis as independent variables, multivariate Logistic regression analysis showed that the patient had pancreatic cancer ( OR=1.838, 95% CI: 1.524-4.613, P=0.041), cholangiocarcinoma ( OR=2.548, 95% CI: 1.870-5.116, P=0.015), stone incarceration ( OR=3.078, 95% CI: 2.374-6.012, P<0.001), duodenum Intestinal papillary diverticula ( OR=1.140, 95% CI: 1.045-1.628, P<0.001), surgical pre-incision ( OR=1.640, 95% CI: 1.321-1.928, P<0.001) were associated with postoperative bleeding in MOJ patients after ERCP independent risk factors. The predictive ability of duodenal papillary diverticulum was the highest; the predictive ability of stone incarceration and cholangiocarcinoma was the second, and there was no significant difference between them; the predictive ability of pancreatic cancer, stone diameter, and pre-incision on bleeding after ERCP in MOJ patients smaller. Pancreatic cancer, cholangiocarcinoma, large stone diameter, stone incarceration, duodenal papillary diverticulum, and pre-incision scores were 42, 63, 28, 65, 76, and 34 points respectively, and the total score was 308 points corresponding to the nomogram model. The predictive power of the nomogram was 61.6%, and overall, the nomogram had good predictive performance. Harrell concordance index analysis and ROC curve were used to evaluate the model discrimination, the C-index calculation result was 0.826 (95% CI: 0.771-0.847), the ROC curve AUC was 0.843 (95% CI: 0.801-0.884), and the ROC prediction The value and the calculation result of C-index are relatively close. The model discrimination is applied in this study and has a certain prediction effect. The nomogram model in the Calibration curve predicted the probability of postoperative bleeding after ERCP in MOJ patients with high consistency with the actual probability. Conclusion:ERCP is safe and feasible for most patients with MOJ, but for patients with pancreatic cancer, bile duct cancer, large stone diameter, stone incarceration, and duodenal papillary diverticulum, it should be performed with caution, and preoperative incision should be avoided, to reduce the risk of postoperative bleeding. In addition, the nomogram model has a strong predictive ability in predicting bleeding after ERCP in patients with MOJ, which is worthy of reference in clinical research.

9.
Article in Chinese | WPRIM | ID: wpr-910573

ABSTRACT

Objective:To investigate the expression of intestinal alkaline phosphatase (IAP) in intestinal mucosa with bile deficiency and the effect of bile on the expression of IAP in intestinal epithelial Caco-2 cell model.Methods:Thirty healthy male SD rats were randomly divided into control group (Ctrl, n=10), external drainage group (ED, n=10) and obstructive jaundice group (OJ, n=10). Ileum specimens were collected on the 7th day after modeling. Western blot and immunohistochemical staining were used to determine the expression of IAP in rat intestinal mucosa. Different concentrations of human bile were used to treat on Caco-2 cells, and Western blot was used to detect the changes in IAP expression in Caco-2 cells. Results:Rat models were successfully established. The expression level of IAP in the intestinal mucosa of ED group [(9.19±1.67)%] was significantly lower than that of the Ctrl group [(15.09±0.61)%, P<0.05]; the expression of IAP in the intestinal mucosa of OJ group [(6.86±1.07)%] was significantly lower than that of the Ctrl group ( P<0.05). Through in vitro cell experiments, expression of IAP in Caco-2 cells was increased in a time and dose-dependent manner when treated with human bile. Conclusions:Bile deficiency in the intestine can cause inhibition of IAP in the intestinal mucosa. Bile can promote the expression of IAP in intestinal mucosal epithelial cells.

10.
Cancer Research and Clinic ; (6): 844-847, 2021.
Article in Chinese | WPRIM | ID: wpr-912979

ABSTRACT

Objective:To explore the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) biliary stent implantation in patients with unresectable malignant biliary stricture (MBS) and the influencing factors of overall survival.Methods:The clinical data of 346 patients who underwent ERCP biliary stent implantation due to MBS from May 2013 to October 2016 in Xijing Digestive Disease Hospital of Air Force Military Medical University, Shanxi Bethune Hospital and Mengchao Hepatobiliary Hospital of Fujian Medical University were retrospectively analyzed, and the efficacy, complications and risk factors affecting overall survival were also analyzed.Results:After ERCP biliary stent implantation, the levels of total bilirubin, γ-glutamyl transpeptidase, alkaline phosphatase and alanine aminotransferase were lower than those before surgery (all P < 0.01). The incidence of infection after operation was 14.7% (51/346), and the incidence of biliary infection was 13.0% (45/346). The incidence of post-ERCP pancreatitis (PEP) was 4.6% (16/346). The median survival time after ERCP was 131.0 d (70.3 d, 246.5 d). Multivariate Cox regression analysis showed that the independent risk factors affecting the overall survival patients included the hilar bile duct stenosis ( HR = 1.85, 95% CI 1.44-2.38, P < 0.01), preoperative bilirubin level exceeding the upper limit of normal level by 5 times ( HR = 1.75, 95% CI 1.30-2.36, P < 0.01), carbohydrate antigen 199 level exceeding the upper limit of normal level by 10 times ( HR = 1.27, 95% CI 1.00-1.61, P = 0.050), vascular and organ metastasis ( HR = 1.32, 95% CI 1.04-1.69, P = 0.023), and the poor jaundice decreasing level ( HR = 1.37, 95% CI 1.02-1.85, P = 0.037) . Conclusions:The ERCP biliary stent implantation is a safe and effective therapy for MBS. ERCP biliary stent implantation MBS patients with hilar bile duct stenosis, preoperative bilirubin levels more than 5 times of the upper limit of normal level, carbohydrate antigen 199 levels more than 10 times of the upper limit of normal level, vascular and organ metastasis, and poor jaundice decreasing level may have poor overall survival.

11.
Article in Chinese | WPRIM | ID: wpr-1016199

ABSTRACT

Background: Autoimmune pancreatitis (AIP) is a chronic pancreatitis associated with immune factors. IgG4-related sclerosing cholangitis (IgG4-SC) is a common extrapancreatic manifestation of AIP, however, its optimal treatment still needs to be clarified. Aims: To summarize the experience in the clinical diagnosis and treatment of AIP, especially IgG4-SC. Methods: Twenty-five patients with AIP admitted from the First Affiliated Hospital of Nanchang University between January 2015 and May 2021 were recruited, and a retrospective analysis was conducted on the clinical symptoms, laboratory and imaging findings, pathological results, as well as the treatment regimens and clinical outcomes. Results: All the patients were diagnosed as type 1 AIP (84.0% male, mean age 63.5 years). Obstructive jaundice (56.0%) and epigastric pain (44.0%) were the main clinical symptoms. The main imaging findings were diffuse enlargement of the pancreas, capsule-like rim, and distal biliary stricture associated with intra- and extra-hepatic duct dilation. The serum IgG4 elevated significantly. In 14 patients with IgG4-SC, the total bilirubin was between 1-2 upper limit of normal (ULN) in 3 cases, between 2-5 ULN in 3 cases, and > 5×ULN in 8 cases. Fifteen (83.3%) patients obtained pathological diagnosis by endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA). Six IgG4-SC patients were treated with steroids alone, and 6 received biliary stenting with or without steroids, no differences in liver function tests were existed between the two groups prior to treatment (all P> 0.05). Liver function tests in most of these patients were normalized after treatment. Conclusions: AIP is a rare disease in clinical practice, and is more frequently seen in elderly male patients. Biliary involvement (IgG4-SC) is common and often presents initially as obstructive jaundice, which can be effectively managed with steroids alone, without the need for biliary stenting.

12.
Journal of Clinical Hepatology ; (12): 863-867, 2021.
Article in Chinese | WPRIM | ID: wpr-875896

ABSTRACT

ObjectiveTo investigate the clinical effect and safety of endoscopic nasobiliary drainage (ENBD) versus endoscopic biliary stenting (EBS) in preoperative biliary drainage for low-level malignant obstructive jaundice. MethodsChinese and English databases were searched for control studies on the clinical effect of ENBD versus EBS in preoperative biliary drainage for low-level malignant obstructive jaundice published up to August 2020. After quality assessment and data extraction were performed for the studies included, RevMan 53 software was used to perform the meta-analysis. ENBD and EBS were compared in terms of incidence rates of preoperative cholangitis and preoperative pancreatitis, stent dysfunction rate, overall incidence rate of complications before and after surgery, and rate of postoperative pancreatic leakage. ResultsSix studies involving 1182 patients were included. The meta-analysis showed that there were no significant differences between the ENBD group and the EBS group in incidence rate of preoperative pancreatitis (odds ratio [OR]=0.66, 95% confidence interval [CI]: 0.44-0.99, P=0.05), stent dysfunction rate (OR=1.14, 95% CI: 0.56-2.31, P=0.72), and overall incidence rate of complications before and after surgery (OR=0.69, 95% CI: 0.41-1.15, P=0.15). Compared with the EBS group, the ENBD group had significant reductions in incidence rate of preoperative cholangitis (OR=0.34, 95% CI: 0.23-0.50, P<0.000 01) and rate of postoperative pancreatic leakage (OR=0.53, 95% CI: 0.32-0.88, P=0.01). ConclusionPreoperative biliary drainage with ENBD is superior to EBS in patients with well-diagnosed low-level malignant obstructive jaundice. More large multicenter randomized controlled trials are needed in the future to verify this conclusion.

13.
Article in Chinese | WPRIM | ID: wpr-932721

ABSTRACT

Objective:To systematically evaluate the clinical effect of biliary stent combined with intra-biliary radiofrequency ablation and stent alone in the treatment of malignant obstructive jaundice.Methods:The PubMed, Cochrane library, Embase, HowNet, Wanfang, Weipu were systematically searched, the search time was up to February 2021. To collect and compare the clinical efficacy studies of combined intra-biliary radiofrequency ablation in the treatment of patients with malignant obstructive jaundice before biliary stent placement. After literature screening, data extraction and quality assessment conducted by two independent reviewers. Meta-analysis was performed with the patients' 1-year survival rate, 6-month patency rate after biliary stent operation, and comparative changes in postoperative complications as the main outcome indicators.Results:Finally, 9 studies were included, comprising 2 randomized controlled studies (RCT) and 7 retrospective studies, involving a total of 443 patients, with 211 cases in the biliary stent combined with intra-biliary radiofrequency ablation group and 232 cases in the stent alone group. The results of meta-analysis showed that in two joint groups compared with the stent alone group, in overall analysis, the rate of re-obstruction of the biliary tract decreased 6 months after stenting ( OR=0.24, 95% CI: 0.13-0.42) and 1-year survival rate increased ( OR=3.79, 95% CI: 2.08-6.90), the differences are statistically significant ( P<0.001), there was no statistical difference in the complications ( P=0.13). In ERCP group, the rate of re-obstruction of the biliary tract decreased 6 months after stenting ( OR=0.21, 95% CI: 0.08-0.55), and the 1-year survival rate significant increase ( OR=3.63, 95% CI: 1.76-7.48), the differences are statistically significant ( P<0.01). In PTCD group, the rate of re-obstruction of the biliary tract decreased 6 months after stenting ( OR=0.25, 95% CI: 0.12-0.51), and the 1-year survival rate significant increase ( OR=4.13, 95% CI: 1.42-12.03), the differences are statistically significant ( P<0.01). Conclusion:Compared with the stent-only group, the combined group is safe and effective in treating malignant obstructive jaundice.

14.
Arch. méd. Camaguey ; 24(3): e6798, mayo.-jun. 2020. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1124184

ABSTRACT

RESUMEN Fundamento: el duodeno corresponde a la segunda localización, con más frecuencia se presentan en los divertículos gastrointestinales después del colon. El síndrome de Lemmel también conocido como ictericia obstructiva intermitente, presencia de divertículos duodenales próximos a la papila de Váter podría favorecer al desarrollo de enfermedades pancreatobiliares. Objetivo: presentar el caso de una adulta mayor con ictericia en mucosa y piel intermitente asociada con episodios febriles no cuantificados y dolor en hipocondrio derecho. Presentación del caso: paciente de 67 años de edad, femenina, con un síndrome ictérico obstructivo, sin presencia de coledocolitiasis u otra alteración del árbol biliar distinta a la presencia de un divertículo duodenal. Por esta sintomatología es remitido a consulta de Gastroenterología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey. Conclusiones: el síndrome de Lemmel es una enfermedad poco frecuente que debe tenerse en cuenta como causa de ictericia obstructiva.


ABTRACT Background: the duodenum corresponds to the second location where the gastrointestinal diverticula are most frequently presented after the colon. Lemmel's syndrome, also known as intermittent obstructive jaundice, presence of duodenal diverticula near the papilla of Vater could favor the development of pancreatic biliary diseases. Objective: to present the case of an older adult with jaundice in mucosa and intermittent skin associated with febrile episodes not quantified and pain in the right hypochondrium. Case report: a 67-year-old female patient with an obstructive jaundice syndrome, without the presence of choledocholithiasis or other alteration of the biliary tree other than the presence of a duodenal diverticulum. For this symptomatology is referred to Gastroenterology consultation. Conclusions: Lemmel's syndrome is a rare pathology that must be taken into account as a cause of obstructive jaundice.

15.
Journal of Clinical Hepatology ; (12): 847-849, 2020.
Article in Chinese | WPRIM | ID: wpr-819190

ABSTRACT

ObjectiveTo investigate the clinical value of ultrasound-guided real-time percutaneous transhepatic-cholangial or transhepatic-cholecyst drainage (PTCD) in the treatment of patients with acute obstructive cholangitis in primary hospitals. MethodsA retrospective analysis was performed for the clinical data of 38 patients with acute obstructive cholangitis who underwent ultrasound-guided real-time PTCD in Tengchong People’s Hospital from February 2012 to June 2018, and among these patients, 4 had malignant biliary obstruction and cholangitis and 34 had acute obstructive suppurative cholangitis caused by hepatolithiasis. ResultsOf all patients, 30 underwent puncture of the bile duct in the right lobe of liver, 6 underwent puncture of the bile duct in the left lobe of liver, and 2 underwent puncture of the gallbladder. The success rate of first-time needle insertion was 91.2% (35/38), and the overall success rate of puncture was 100%. There were no complications such as massive hemorrhage, biliary peritonitis, and biliary-vascular fistula. At 2 weeks after surgery, 89.5% (34/38) of the patients had a bilirubin level reduced by ≥1/2, and 32 patients (84.2%) had a level of alanine aminotransferase reduced to normal. As for the 34 patients with hepatolithiasis, second-stage surgeries including bile duct exploration/cholecystolithotomy and hepatic lobectomy were performed after the infection was under control, or they were referred to superior hospitals with tube indwelling for further treatment. The 4 patients with neoplastic bile duct obstruction were referred to superior hospitals with tube indwelling, among whom 3 underwent radical surgery and 1 underwent biliary stent placement via the former deep blind fistula. ConclusionUltrasound-guided real-time PTCD can be used as an effective, simple, and safe biliary drainage technique for the early treatment of acute biliary obstruction in primary hospitals. This technique has a high success rate and low requirements for medical equipment, and therefore, it holds promise for clinical application in primary hospitals after related technical procedures are standardized.

16.
Rev. gastroenterol. Perú ; 39(4): 378-380, oct.-dic 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1144627

ABSTRACT

Los neuromas del conducto biliar se desarrollan a partir de las fibras nerviosas simpáticas y parasimpáticas que envuelven la pared de la vía biliar. Mujer de 44 años de edad con antecedente de colecistectomía convencional seis meses previos al ingreso acude a emergencia por ictericia obstructiva de 15 días de evolución. En los estudios de imagen impresiona la presencia de una masa a nivel de las vías biliares considerándose el diagnostico de una neoplasia maligna. Por los antecedentes, ausencia de marcadores tumorales se decide realizar una biopsia percutánea sin resultados concluyente, realizándose posteriormente una intervención quirúrgica con estudio anatomo-patológico compatible con neuroma de amputación de vía biliar. El neuroma de amputación a nivel de la vía biliar es un tumor infrecuente. Puede manifestarse clínicamente como una ictericia obstructiva y suele simular a un tumor maligno de las vías biliares. El manejo quirúrgico es el tratamiento definitivo.


Neuromas of the bile duct develop from the sympathetic and parasympathetic nerve fibers that surround the wall of the bile duct. A 44-year-old woman with a history of conventional cholecystectomy six months prior to hospital admission attended emergency due to obstructive jaundice that lasted 15 days. In the imaging studies, the presence of a mass at the level of the bile ducts is considered, considering the diagnosis of a malignant neoplasm. Due to the antecedents, the absence of tumor markers, it was decided to perform a percutaneous biopsy without conclusive results, performing later a surgical intervention with anatomopathological study compatible with neuroma of biliary tract amputation. The amputation neuroma at the level of the bile duct is an infrequent tumor. It can manifest clinically as obstructive jaundice and usually simulates a malignant tumor of the bile ducts. Surgical management is the definitive treatment.


Subject(s)
Adult , Female , Humans , Postoperative Complications , Cholecystectomy/adverse effects , Common Bile Duct Neoplasms/complications , Jaundice, Obstructive/etiology , Neuroma/complications , Postoperative Complications/pathology , Common Bile Duct Neoplasms/pathology , Neuroma/pathology
17.
Radiol. bras ; Radiol. bras;52(4): 222-228, July-Aug. 2019. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1020315

ABSTRACT

Abstract Objective: To evaluate the accuracy of percutaneous transhepatic biliary biopsy (PTBB) in patients with suspected biliary obstruction. Materials and methods: This was a retrospective analysis of 18 patients with obstructive jaundice who underwent PTBB. In each patient, three to ten fragments were collected from the lesion. The final diagnosis was confirmed in the pathology report. We also reviewed analyses of the results of laboratory tests performed before the procedure, as well as the Bismuth classification, clinical outcome, complications occurring during the procedure, access route, and materials used. Results: Technical success was achieved in 100% of the PTBB procedures. Among the 18 patients clinically diagnosed with bile duct stenosis, the pathological analysis confirmed that diagnosis in 17. In one case, the pathological findings were considered false-negative. The predominant tumor was cholangiocarcinoma (seen in 50% of the cases). Sixteen of the procedures (88.9%) were performed without complications. Transient hemobilia occurred in one case, and cholangitis occurred in another. Conclusion: PTBB is a safe, viable, simple technique with a high rate of true-positive results for the definitive diagnosis of obstructive jaundice.


Resumo Objetivo: Avaliar a precisão diagnóstica da colangiobiópsia trans-hepática percutânea (CBTP) em pacientes com suspeita de obstrução biliar. Materiais e Métodos: Análise retrospectiva de 18 pacientes apresentando icterícia obstrutiva foram submetidos a CBTP. Em cada paciente, 3 a 10 fragmentos foram coletados da lesão. O diagnóstico final foi confirmado por relatório anatomopatológico. Adicionalmente, foram registrados a análise laboratorial antes do procedimento, a classificação de Bismuth, o desfecho clínico, as intercorrências durante o procedimento, a via de acesso e os materiais utilizados. Resultados: A CBTP apresentou sucesso técnico em 100% dos casos. Dos 18 pacientes clinicamente diagnosticados com estenose biliar, 17 receberam diagnóstico patológico positivo. Em um caso os achados patológicos foram considerados falso-negativos. O colangiocarcinoma foi a neoplasia predominante (50%). Dezesseis (88,9%) procedimentos foram realizados sem intercorrências. Hemobilia transitória ocorreu em um caso e colangite em outro caso isolado. Conclusão: A CBTP é uma técnica segura, viável e simples, com alta taxa de verdadeiro-positivos para o diagnóstico definitivo de causas de icterícia obstrutiva.

18.
Article in Chinese | WPRIM | ID: wpr-861432

ABSTRACT

Objective: To investigate the diagnostic value of 18F-FDG PET/CT combined with MR cholangiopancreatography (MRCP) multimodal imaging in diagnosis of malignant and benign obstructive jaundice. Methods Totally 57 biliary obstruction patients were enrolled and divided into malignant obstruction group (n=31) and benign obstruction group (n=26). The diagnostic efficacy of 18F-FDG PET/CT, MRCP and multimodal imaging of obstructive jaundice were analyzed and compared. Results In malignant obstruction group, moderate to severe biliary expansion accounted for 41.94% (13/31), while in the benign obstruction group, the rate was 3.85% (1/26), and the difference between the two groups was statistically significant (P=0.047). The maximum standard uptake value (SUVmax) of malignant obstruction group (10.54±6.69) was significantly higher than that of the benign obstruction group (3.78±1.68; P0.05), while compared with MRCP, the differences in sensitivity and accuracy were statistically significant (P=0.002, 0.002), the difference in specificity was not statistically significant (P=0.463). Compared with final results, the Kappa coefficients of multimodality imaging, 18F-FDG PET/CT and MRCP were 0.858, 0.752 and 0.375, respectively. Conclusion 18F-FDG PET/CT combined with MRCP multimodal imaging is helpful to improvement of the diagnostic accuracy of obstructive jaundice, which has important guiding significance for diagnosis and clinical treatment decision-making.

19.
Article in Chinese | WPRIM | ID: wpr-862131

ABSTRACT

Objective: To investigate the early efficacy and impact factors of biliary stent in treatment of malignant obstructive jaundice (MOJ). Methods: Clinical data of 232 patients with MOJ who underwent percutaneous transhepatic cholangial drainage (PTCD) and biliary stent implantation were analyzed retrospectively. The early postoperative outcomes were evaluated, and the impact factors of early postoperative outcomes were analyzed using univariate analysis and Logistic regression. Results: All 232 patients were successfully treated with PTCD and biliary stent implantation, and the drainage was performed. Among 232 patients, the treatment were markedly effective in 149 cases, effective in 36 cases, whereas ineffective in 47 cases at early postoperative stage, and the total effective rate was 79.74% (185/232). Univariate analysis showed that tumor type, obstruction level, length of obstruction, Child-Pugh grading, ascites, intrahepatic lesions, distant metastasis, tumor size, blood platelet (PLT), CA125 and postoperative biliary tract infection were important factors influencing early efficacy (all P<0.05). Logistic regression showed that Child-Pugh grading, PLT, CA125 and postoperative biliary tract infection were independent risk factors for early efficacy (all P<0.05). Conclusion: Biliary stent implantation has certain value in improving liver function and treating jaundice in patients with MOJ. Child-Pugh grading, PLT, CA125 and postoperative biliary tract infection are independent risk factors for early postoperative outcomes.

20.
Article in Chinese | WPRIM | ID: wpr-745360

ABSTRACT

Objective To study the therapeutic effects of EUS-guided biliary drainage (EUS-BD) using a nitinol fully covered self-expandable metal stents in patients with malignant obstructive jaundice after failed ERCP.Methods From January 2016 to January 2018,all patients with malignant obstructive jaundice who failed ERCP underwent EUS-guided biliary drainage using nitinol fully covered self-expandable metal stent at Affiliated Hangzhou First People' s Hospital,Zhejiang University School of Medicine.The operation success rate,liver functional recovery time,complication rate,length of hospital stay and survival time were observed.Results Of 36 patients who underwent EUS-guided biliary drainage,34 were successfully performed,with 19 through the stomach,and 15 through the duodenum.The operation success rate was 94.4% (34/36).The liver functional recovery time of the 34 patients were 25.8 ±.6.5 days.One patient developed hemobilia and one cholangitis,both improved after conservative treatment.The total complication rate was 5.6% (2/36).The hospital stay and survival time were 21.5 ± 4.7 days and 220.5 ± 54.8 days,respectively.Conclusion EUS-BD using nitinol fully covered self-expandable metal stents was a feasible and effective treatment in patients with malignant biliary obstruction after failed ERCP.

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