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1.
Rev. colomb. gastroenterol ; 35(4): 527-532, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1156335

ABSTRACT

Resumen El tratamiento actual para la obstrucción biliar maligna es la derivación biliar no quirúrgica con propósito paliativo. La cirugía tiene indicaciones específicas en pacientes con patología maligna con propósito curativo. Sin embargo, la obstrucción duodenal y del conducto biliar intra o extrahepático no dilatado hace que esta cirugía y el procedimiento endoscópico guiado por ultrasonografía endoscópica (USE) sean difíciles de realizar. Presentamos nuestra experiencia con el primer caso en Colombia, un país latinoamericano del tercer mundo. Consistió en una colecistogastrostomía guiada por USE, a partir de la utilización de una endoprótesis luminal (Lumen-apposing metal stents, LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos) de 15 mm × 10 mm, en un paciente masculino con cáncer pancreático inoperable e invasión duodenal con conducto colédoco dilatado. La colecistogastrostomía guiada por USE podría ser considerada como una opción de más importancia para la descompresión biliar que el drenaje percutáneo, ya que es superior en términos de viabilidad técnica, seguridad y eficacia en casos específicos de estenosis ampular e invasión duodenal. Además, puede ser realizada en países del tercer mundo, cuando se cuenta con el entrenamiento y los instrumentos adecuados. La endoprótesis metálica totalmente recubierta, aplicada a luz (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos), es ideal para la colecistogastrostomía guiada por USE, a fin de minimizar complicaciones como fugas biliares. Se necesitan estudios comparativos adicionales para validar los beneficios de esta técnica.


Abstract The current treatment of malignant biliary obstruction is non-surgical biliary diversion with palliative intent. The surgery having specific indications in patients with malignant pathology with curative intent. However, duodenal obstruction and non-dilated intra- or extrahepatic bile duct make these surgical and endoscopic procedures guided by EUS difficult. We present our experience with the first case in Colombia, a third-world country in Latin America, of a cholecystogastrostomy guided by endoscopic ultrasound (EUS) in a patient with unresectable pancreatic cancer and duodenal invasion with dilated common bile duct using a luminal stent (LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) 15 mm × 10 mm. EUS-guided cholecystogastrostomy should be considered as an option for biliary decompression of greater importance than percutaneous drainage since it is superior in terms of technical feasibility, safety and efficacy in specific cases of ampullary stenosis and duodenal invasion. In addition, it can be done in third world countries when it has the appropriate training and implements. The fully covered metal stent applied to light (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) is ideal for EUS guided cholecystogastrostomy to minimize complications such as bile leakage. Additional comparative studies are needed to validate the benefits of this technique.


Subject(s)
Humans , Male , Aged , Pancreatic Neoplasms , Therapeutics , Bile Ducts, Extrahepatic , Common Bile Duct , Endosonography , Methods , Drainage , Efficacy , Decompression
2.
Article in English | WPRIM | ID: wpr-787233

ABSTRACT

Endobiliary radiofrequency ablation (RFA) is a procedure performed widely to induce locoregional tumor control by the transfer of thermal energy to the lesion and subsequent tumor necrosis. A 72-year-old male with a prior history of acute calculous cholangitis and perforated cholecystitis was admitted to the Kyungpook National University Hospital complaining of fever and nausea. He had an indwelling percutaneous transhepatic gallbladder drainage (PTGBD) catheter from the previous episode of perforated cholecystitis. An abdominal CT scan showed marked dilation of both the intrahepatic and extrahepatic bile ducts. Common bile duct cancer was confirmed histologically after an endobiliary biopsy. A surgical resection was considered to be the initial treatment option. During open surgery, multiple metastatic nodules were present in the small bowel mesentery and anterior abdominal wall. Resection of the tumor was not feasible, so endobiliary RFA was performed prior to biliary stenting. Cholecystectomy was required for the removal of the PTGBD catheter, but the surgical procedure could not be performed due to a cystic ductal invasion of the tumor. Instead, chemical ablation of the gallbladder (GB) with pure ethanol was performed to breakdown the GB mucosa. Palliative treatment for a biliary obstruction was achieved successfully using these procedures. In addition, a PTGBD catheter was removed successfully without significant side effects. As a result, an improvement in the patient's quality of life was accomplished.


Subject(s)
Abdominal Wall , Aged , Bile Ducts, Extrahepatic , Biopsy , Catheter Ablation , Catheters , Cholangiocarcinoma , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Cholecystectomy , Cholecystitis , Common Bile Duct , Cystic Duct , Drainage , Ethanol , Fever , Gallbladder , Humans , Male , Mesentery , Mucous Membrane , Nausea , Necrosis , Palliative Care , Quality of Life , Stents , Tomography, X-Ray Computed
3.
Clinical Endoscopy ; : 598-605, 2019.
Article in English | WPRIM | ID: wpr-785664

ABSTRACT

BACKGROUND/AIMS: For the treatment of malignant biliary obstruction, endoscopic retrograde biliary drainage (ERBD) has been widely accepted as a standard procedure. However, post-ERBD complications can affect the lives of patients. The purpose of this study was to identify the predictive factors for these complications, including the patient’s status, cancer status, and stent type.METHODS: This was a retrospective analysis conducted in a single tertiary hospital from January 2007 to July 2017. The following variables were evaluated: sex, age, body mass index, cancer type, history of pancreatitis, gallbladder stone, previous biliary stenting, precut papillotomy, stent type, contrast injection into the pancreatic duct or gallbladder, cystic duct invasion by the tumor, and occlusion of the cystic duct orifice by a metal stent.RESULTS: Multivariate analysis showed that contrast injection into the pancreatic duct was a risk factor for pancreatitis. Patients with a history of bile drainage showed a lower risk of pancreatitis. For cholecystitis, the analysis revealed contrast injection into the gallbladder and cystic duct invasion by the tumor as important predictive factors. Metal stents showed a greater risk of post-procedure pancreatitis than plastic stents, but did not affect the incidence of cholecystitis.CONCLUSIONS: Considering that contrast injection is the most important factor for both complications, a careful approach by the physician is essential in preventing the occurrence of any complications. Further, choosing the type of stent is an important factor for patients at a risk of post-procedure pancreatitis.


Subject(s)
Bile , Bile Ducts, Extrahepatic , Body Mass Index , Cholecystitis , Cystic Duct , Drainage , Gallbladder , Humans , Incidence , Multivariate Analysis , Pancreatic Ducts , Pancreatitis , Plastics , Retrospective Studies , Risk Factors , Stents , Tertiary Care Centers
4.
Article in English | WPRIM | ID: wpr-761773

ABSTRACT

Echinococcosis is a disease caused by the Echinococcus species that parasitizes in humans. Alveolar echinococcosis (AE) which is caused by Echinococcus multilocularis is harmful to humans. AE mainly occurs in the liver and can be transferred to retroperitoneal lymph nodes, lung, brain, bone, spleen and other organs through lymphatic and blood vessels. Cholangiocarcinoma can occur in the intrahepatic and extrahepatic bile ducts and is more common in the hilar. We reported a case of hilar bile duct alveolar echinococcosis which was originally misdiagnosed an cholangiocarcinoma.


Subject(s)
Bile Ducts , Bile Ducts, Extrahepatic , Bile , Blood Vessels , Brain , Cholangiocarcinoma , Echinococcosis , Echinococcus , Echinococcus multilocularis , Humans , Liver , Lung , Lymph Nodes , Spleen
5.
Gut and Liver ; : 104-113, 2019.
Article in English | WPRIM | ID: wpr-719361

ABSTRACT

BACKGROUND/AIMS: There have been no nationwide studies to investigate the trends in incidence and 5-year survival rates of intra- and extrahepatic bile duct cancers and gall-bladder cancer. Therefore, our study aimed to describe the incidence and 5-year survival rates of biliary tract cancers by subsites in South Korea. METHODS: A total of 86,134 patients with biliary tract cancers were selected from the National Health Information Database. Age-standardized incidence rates and annual percentage changes were calculated. Life-table methods and log-rank tests were used to determine the differences in survival rates. Cox-proportional hazard models were used to estimate the hazard ratio of the patients with biliary tract cancers. RESULTS: The incidence rate of intra-hepatic bile duct cancer decreased by 1.3% annually from 8.8 per 100,000 in 2006 to 7.8 per 100,000 in 2015. Extrahepatic bile duct cancer also showed a decreasing trend by 2.2% per year from 8.7 per 100,000 in 2006 to 6.7 per 100,000 in 2015. Gallbladder cancer showed the greatest decline, with an annual percentage change of 2.8% from 6.3 per 100,000 to 5.2 per 100,000 during the same period. The 5-year survival rates were 30.0% in gallbladder cancer, 27.8% in extrahepatic bile duct cancer, and 15.9% in intra-hepatic bile duct cancer. CONCLUSIONS: The overall incidence rates of intrahepatic and extrahepatic bile duct cancer and gallbladder cancer decreased from 2006 to 2015. Among biliary tract cancers, intrahepatic bile duct cancers exhibited the highest incidence rate and the worst survival rate.


Subject(s)
Bile Duct Neoplasms , Bile Ducts, Extrahepatic , Bile Ducts, Intrahepatic , Biliary Tract Neoplasms , Biliary Tract , Cholangiocarcinoma , Gallbladder Neoplasms , Humans , Incidence , Korea , Proportional Hazards Models , Survival Rate
6.
Gut and Liver ; : 617-627, 2019.
Article in English | WPRIM | ID: wpr-763888

ABSTRACT

Intraductal papillary neoplasms of the bile duct (IPNBs) are known to show various pathologic features and biological behaviors. Recently, two categories of IPNBs have been proposed based on their histologic similarities to pancreatic intraductal papillary mucinous neoplasms (IPMNs): type 1 IPNBs, which share many features with IPMNs; and type 2 IPNBs, which are variably different from IPMNs. The four IPNB subtypes were re-evaluated with respect to these two categories. Intestinal IPNBs showing a predominantly villous growth may correspond to type 1, while those showing papillay-tubular or papillay-villous growth correspond to type 2. Regarding gastric IPNB, those with regular foveolar structures with varying numbers of pyloric glands may correspond to type 1, while those with papillary-foveolar structures with gastric immunophenotypes and complicated structures may correspond to type 2. Pancreatobiliary IPNBs that show fine ramifying branching may be categorized as type 1, while others containing many complicated structures may be categorized as type 2. Oncocytic type, which displays solid growth or irregular papillary structures, may correspond to type 2, while papillary configurations with pseudostratified oncocytic lining cells correspond to type 1. Generally, type 1 IPNBs of any subtype develop in the intrahepatic bile ducts, while type 2 IPNBs develop in the extrahepatic bile duct. These findings suggest that IPNBs arising in the intrahepatic ducts are biliary counterparts of IPMNs, while those arising in the extrahepatic ducts display differences from prototypical IPMNs. The recognition of these two categories of IPNBs with reference to IPMNs and their anatomical location along the biliary tree may deepen our understanding of IPNBs.


Subject(s)
Bile Ducts , Bile Ducts, Extrahepatic , Bile Ducts, Intrahepatic , Bile , Biliary Tract , Cholangiocarcinoma , Gastric Mucosa , Mucins
7.
Article in English | WPRIM | ID: wpr-758928

ABSTRACT

This study was performed to evaluate the feasibility of ultrasound-guided computed tomography (CT) cholecystography and to establish an optimal protocol. In 8 healthy beagles, CT cholecystography was conducted using four contrast formulas; two dilution ratios (1:1 vs. 1:3) and two total volumes (8 mL vs. 16 mL) of 300 mgI/kg iohexol after ultrasound-guided percutaneous contrast injection into the gallbladder. CT images were obtained at 3, 10, and 30 min after injection and assessed qualitatively and quantitatively. For all contrast formulas, CT cholecystography showed the gallbladder and the intra- and extrahepatic bile ducts. The volume of the gallbladder and size of bile duct were significantly larger when using a volume of 16 mL iohexol than an 8 mL volume regardless of the dilution ratio. The distinction between the common bile duct and duodenum, the filling of the gallbladder, and the patency of bile duct were effectively assessed using a 16 mL volume of contrast agent with either dilution ratio. Beam-hardening artifacts deteriorated CT image quality for visualizing the biliary system when using the dilution ratio of 1:1. Patency of the bile tract could be easily evaluated using a curvilinear planar reconstruction. There was no significant difference in CT scan time among the different conditions. Minor leakage of contrast agent temporarily occurred after contrast injection in 30% of 32 sets of CT cholecystography. Ultrasound-guided percutaneous cholecystography can visualize both gallbladder and biliary tract with minimal artifacts using a contrast agent volume of 16 mL with a 1:3 dilution ratio.


Subject(s)
Animals , Artifacts , Bile , Bile Ducts , Bile Ducts, Extrahepatic , Biliary Tract , Cholecystography , Common Bile Duct , Contrast Media , Dogs , Duodenum , Gallbladder , Iohexol , Tomography, X-Ray Computed
8.
Article in English | WPRIM | ID: wpr-766011

ABSTRACT

We report a rare case of hilar squamous cell carcinoma. A 62-year-old Korean woman complaining of nausea was referred to our hospital. Her biliary computed tomography revealed a 28 mm-sized protruding solid mass in the proximal common bile duct. The patient underwent left hemihepatectomy with S1 segmentectomy and segmental excision of the common bile duct. Microscopically, the tumor was a moderately differentiated squamous cell carcinoma of the extrahepatic bile duct, without any component of adenocarcinoma or metaplastic portion in the biliary epithelium. Immunohistochemically, the tumor was positive for cytokeratin (CK) 5/6, CK19, p40, and p63. Squamous cell carcinoma of the extrahepatic bile duct is rare. To date, only 24 cases of biliary squamous cell carcinomas have been reported. Here, we provide a clinicopathologic review of previously reported extrahepatic bile duct squamous cell carcinomas.


Subject(s)
Adenocarcinoma , Bile Ducts, Extrahepatic , Carcinoma, Squamous Cell , Common Bile Duct , Drug Therapy , Epithelial Cells , Epithelium , Female , Hepatic Duct, Common , Humans , Keratins , Klatskin Tumor , Mastectomy, Segmental , Middle Aged , Nausea
9.
Int. j. morphol ; 37(1): 308-310, 2019. graf
Article in English | LILACS | ID: biblio-990043

ABSTRACT

SUMMARY: Given that the gallbladder and the biliary tract are subject to multiple anatomical variants, detailed knowledge of embryology and its anatomical variants is essential for the recognition of the surgical field when the gallbladder is removed laparoscopically or by laparotomy, even when radiology procedures are performed. During a necropsy procedure, when performing the dissection of the bile duct is a rare anatomical variant of the bile duct, in this case the cystic duct joins at the confluence of the right and left hepatic ducts giving an appearance of trident. This rare anatomical variant in the formation of common bile duct is found during the exploration of the bile duct during a necropsy procedure, it is clear that the wrong ligation of a common hepatic duct can cause a great morbi-mortality in the postsurgical of biliary surgery. This rare anatomical variant not previously described is put in consideration to the scientific community. Anatomical variants of the biliary tract are associated with high rates of morbidity and mortality, causing serious bile duct injuries. Only the surgical skill of the surgeon and his open mind to the possibilities of abnormalities make the performance of cholecystectomy a safe procedure.


RESUMEN: Dado que la vesícula biliar y el tracto biliar están sujetos a múltiples variantes anatómicas, el conocimiento detallado de la embriología y sus variantes anatómicas es esencial para el reconocimiento del campo quirúrgico cuando la vesícula biliar se extirpa laparoscópicamente o por laparotomía, incluso cuando se realizan procedimientos de radiología. Durante un procedimiento de necropsia, se realiza la disección del conducto biliar y se observa una variante anatómica inusual del conducto biliar; en este caso, el conducto cístico se une a la confluencia de los conductos hepáticos derecho e izquierdo dando una apariencia de tridente. Esta rara variante anatómica en la formación del conducto biliar común puede causar una gran morbimortalidad en la cirugía biliar asociado a una ligadura incorrecta. Esta extraña variante anatómica no descrita anteriormente se reporta a la comunidad científica, debido a que las variantes anatómicas del tracto biliar se asocian con altas tasas de morbilidad y mortalidad, al causar lesiones graves en el conducto biliar. Solo la habilidad quirúrgica del cirujano y su mente abierta a las posibilidades de variaciones anatómicas hacen que la realización de la colecistectomía sea un procedimiento seguro.


Subject(s)
Humans , Bile Ducts, Extrahepatic/anatomy & histology , Gallbladder/anatomy & histology , Liver/anatomy & histology , Cholecystectomy , Cystic Duct/anatomy & histology , Dissection , Anatomic Variation , Hepatic Duct, Common/anatomy & histology
10.
Rev. colomb. cir ; 34(2): 179-184, 20190000. fig
Article in Spanish | LILACS, COLNAL | ID: biblio-999219

ABSTRACT

La anastomosis hepático-yeyuno en Y de Roux se considera la técnica de elección para tratar lesiones quirúrgicas de la vía biliar, como su sección o resección. La pérdida de confluencia de los conductos hepáticos principales derecho e izquierdo es uno de los factores que incrementan la complejidad técnica durante el procedimiento y, en algunos de estos pacientes, se requiere una doble anastomosis hepático-yeyuno para garantizar resultados satisfactorios a largo plazo. Se describen los aspectos técnicos y los resultados posoperatorios del tratamiento quirúrgico empleado, con base en la intervención de una paciente con una lesión quirúrgica de la vía biliar y pérdida de la confluencia de los conductos hepáticos. La evolución de la paciente fue satisfactoria y se mantiene asintomática después de 12 meses de seguimiento. A pesar de ser una técnica compleja, la doble anastomosis hepático-yeyuno en Y de Roux resultó una opción segura de tratamiento en esta paciente


Roux-en-Y hepato-jejunostomy (RYHJ) is the technique of choice for the surgical treatment of bile duct injuries (BDI), such as section or resection. The loss of the hepatic confluence (LHC) increases the technical difficulties during the procedure and, in some of these patients, a doble-RYHJ is required to achieve a long term successful result. We report the technical aspects of the surgical technique as well as the results, based on the case of a young female patient with BDI and LHC. The patient shows a satisfactory evolution and remains asymptomatic during the 12 months of follow up. Double RYHJ, although technically demanding, resulted a safe option for treating this patient


Subject(s)
Humans , Bile Ducts, Extrahepatic , Anastomosis, Roux-en-Y , Biliary Tract Surgical Procedures , Intraoperative Complications
11.
Article in English | WPRIM | ID: wpr-718627

ABSTRACT

Primary neuroendocrine tumors originating from the extrahepatic bile duct are rare. Among these tumors, large cell neuroendocrine carcinomas (NECs) are extremely rare. A 59-year-old man was admitted to Sanggye Paik Hospital with jaundice that started 10 days previously. He had a history of laparoscopic cholecystectomy, which he had undergone 12 years previously due to chronic calculous cholecystitis. Laboratory data showed abnormally elevated levels of total bilirubin 15.3 mg/dL (normal 0.2–1.2 mg/dL), AST 200 IU (normal 0–40 IU), ALT 390 IU (normal 0–40 IU), and gamma-glutamyl transferase 1,288 U/L (normal 0–60 U/L). Serum CEA was normal, but CA 19-9 was elevated 5,863 U/mL (normal 0–37 U/mL). Abdominal CT revealed a 4.5 cm sized mass involving the common bile duct and liver hilum and dilatation of both intrahepatic ducts. Percutaneous transhepatic drainage in the left hepatic duct was performed for preoperative biliary drainage. The patient underwent radical common bile duct and Roux-en-Y hepaticojejunostomy for histopathological diagnosis and surgical excision. On histopathological examination, the tumor exhibited large cell NEC (mitotic index >20/10 high-power field, Ki-67 index >20%, CD56 [+], synaptophysin [+], chromogranin [+]). Adjuvant concurrent chemotherapy and radiotherapy were started because the tumor had invaded the proximal resection margin. No recurrence was detected at 10 months by follow-up CT.


Subject(s)
Bile Duct Neoplasms , Bile Ducts, Extrahepatic , Bilirubin , Carcinoma, Neuroendocrine , Cholecystectomy, Laparoscopic , Cholecystitis , Common Bile Duct , Diagnosis , Dilatation , Drainage , Drug Therapy , Follow-Up Studies , Hepatic Duct, Common , Humans , Jaundice , Liver , Middle Aged , Neuroendocrine Tumors , Radiotherapy , Recurrence , Synaptophysin , Tomography, X-Ray Computed , Transferases
12.
Article in English | WPRIM | ID: wpr-717606

ABSTRACT

BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a recently defined entity and its clinical characteristics and classifications have yet to be established. We aimed to clarify the clinical features of IPNB and determine the optimal morphological classification criteria. METHODS: From 2003 to 2016, 112 patients with IPNB who underwent surgery were included in the analysis. After pathologic reexamination by a specialized biliary-pancreas pathologist, previously suggested morphological and anatomical classifications were compared using the clinicopathologic characteristics of IPNB. RESULTS: In terms of histologic subtypes, most patients had the intestinal type (n = 53; 48.6%) or pancreatobiliary type (n = 33; 30.3%). The simple “modified anatomical classification” showed that extrahepatic IPNB comprised more of the intestinal type and tended to be removed by bile duct resection or pancreatoduodenectomy. Intrahepatic IPNB had an equally high proportion of intestinal and pancreatobiliary types and tended to be removed by hepatobiliary resection. Morphologic classifications and histologic subtypes had no effect on survival, whereas a positive resection margin (75.9% vs. 25.7%; P = 0.004) and lymph node metastasis (75.3% vs. 30.0%; P = 0.091) were associated with a poor five-year overall survival rate. In the multivariate analysis, a positive resection margin and perineural invasion were important risk factors for survival. CONCLUSION: IPNB showed better long-term outcomes after optimal surgical resection. The “modified anatomical classification” is simple and intuitive and can help to select a treatment strategy and establish the proper scope of the operation.


Subject(s)
Bile Duct Neoplasms , Bile Ducts , Bile Ducts, Extrahepatic , Bile Ducts, Intrahepatic , Bile , Cholangiocarcinoma , Classification , Humans , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Pancreaticoduodenectomy , Risk Factors , Survival Rate
14.
Article in Korean | WPRIM | ID: wpr-740660

ABSTRACT

A 6-year-old male who lived with a mother in a single-parent family was referred to the emergency room with multiple traumas. There was no specific finding on CT scan of the other hospital performed 55 days before admission. However, CT scan at the time of admission showed common bile duct (CBD) stenosis, proximal biliary dilatation and bile lake formation at the segment II and III. Endoscopic retrograde biliary drainage was performed, but the tube had slipped off spontaneously 36 days later, and follow-up CT scan showed aggravated proximal biliary dilatation above the stricture site. He underwent excision of the CBD including the stricture site, and the bile duct was reconstructed with Roux-en-Y hepaticojejunostomy. Pathologic report of the resected specimen revealed that the evidence of trauma as a cause of bile duct stricture. While non-iatrogenic extrahepatic biliary trauma is uncommon, a level of suspicion is necessary to identify injuries to the extrahepatic bile duct. The role of the physicians who treat the abused children should encompass being suspicious for potential abdominal injury as well as identifying visible injuries.


Subject(s)
Abdominal Injuries , Bile Ducts , Bile Ducts, Extrahepatic , Bile , Child , Child Abuse , Child , Common Bile Duct , Constriction, Pathologic , Dilatation , Drainage , Emergency Service, Hospital , Follow-Up Studies , Humans , Lakes , Male , Mothers , Multiple Trauma , Single-Parent Family , Tomography, X-Ray Computed , Wounds, Nonpenetrating
15.
Gut and Liver ; : 149-155, 2017.
Article in English | WPRIM | ID: wpr-85464

ABSTRACT

BACKGROUND/AIMS: There is no consensus for using endoscopic papillary large balloon dilation (EPLBD) in patients without dilatation of the lower part of the bile duct (DLBD). We evaluated the feasibility and safety of EPLBD for the removal of difficult bile duct stones (diameter ≥10 mm) in patients without DLBD. METHODS: We retrospectively reviewed the records of 209 patients who underwent EPLBD for the removal of bile duct stones from October 2009 to July 2014. Primary outcomes were the clearance rate and additional mechanical lithotripsy. Secondary outcomes were the incidence of complications and recurrence rate. RESULTS: Fifty-seven patients had DLBD (27.3%), and 152 did not have DLBD (72.7%). There were no significant differences in the overall success rate or the use of mechanical lithotripsy. Success rate during the first session and procedure time were better in the DLBD than the without-DLBD group (75.7% vs 66.7%, 48.1±23.0 minutes vs 58.4±31.7 minutes, respectively). As for complications, there were no significant differences in the incidence of pancreatitis, perforation or bleeding after endoscopic retrograde cholangiopancreatography. The recurrence rate did not differ significantly between the two groups. CONCLUSIONS: EPLBD is a useful and safe method for common bile duct stone removal in patients without DLBD.


Subject(s)
Bile Ducts , Bile Ducts, Extrahepatic , Bile , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct , Consensus , Dilatation , Hemorrhage , Humans , Incidence , Lithotripsy , Methods , Pancreatitis , Recurrence , Retrospective Studies
16.
MedUNAB ; 20(1): 54-62, 2017. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-878013

ABSTRACT

Introducción: El conducto subvesicular fue descrito por Hubert Luschka como pequeños ductos biliares derivados de la pared de la vesícula biliar. Algunos autores lo describen como un ducto que lleva el drenaje desde el parénquima hepático hasta la vesícula, otros utilizan el término describiéndolo como un conducto que drena desde el parénquima hepático hasta las vías biliares extrahepaticas. Se planteó una revisión bibliográfica de la descripción anatómica del epónimo conducto de Luschka y de la terminología anatómica propuesta conducto subvesicular o subvesical, dada su importancia clínica como causa de fuga biliar. Metodología: Se realizó una revisión bibliográfica en bases de datos y bibliotecas electrónicas. Con ventana de tiempo personalizada desde 2006 hasta 2016, se obtuvo un total de 82 artículos, posteriormente se realizó un resumen analítico especializado, seleccionando un total de 46. Resultados: No se encontró consenso en la descripción anatómica del epónimo, ni en la descripción de la terminología internacional. Las lesiones de la vía biliar durante la colecistectomía se presentan como una complicación poco frecuente (0.1 - 1.5%); sin embargo, tienen repercusiones en varios ámbitos y una morbi-mortalidad considerable. Conclusiones: Se evidenció discrepancia en la nomenclatura utilizada para la descripción de estos conductos, puesto que se denomina de manera indiscriminada como conducto de Luschka a todos los ductos biliares que se encuentran en la fosa biliar. La relevancia clínica radica en que es la segunda causa de fuga biliar iatrogénica y la asociación entre el conducto subvesical y carcinomas ductales. Aún se necesitan más estudios principalmente locales para identificar su incidencia y prevenir complicaciones...(AU)


Introduction: The duct was described by Hubert Luschka as small bile ducts derived from the wall of the gallbladder. Some authors describe it as a duct leading to drainage from the hepatic parenchyma to the gallbladder; others use the term to describe it as a conduit draining from the hepatic parenchyma to the extrahepatic bile ducts. This article presents a literature review of the anatomical description of the eponymous Luschka conduit and the proposed anatomical terminology subvesicular or subvesical conduit, given its clinical importance as a cause of biliary leakage. Methodology: A bibliographic review was carried out in databases and electronic libraries. With a customized time window from 2006 to 2016, obtaining a total of 62 articles, a specialized analytical summary was subsequently performed, selecting a total of 46. Results: No consensus was found in the anatomical description of the eponym, nor in the description of the International terminology. Lesions of the biliary tract during cholecystectomy present as a rare complication (0.1 - 1.5%) but have repercussions in several areas and considerable morbidity and mortality. Conclusions: There was a discrepancy in the nomenclature used for the description of these ducts. It is indiscriminately named as the luschka's conduit for all bile ducts found in the biliary fossa. The clinical relevance is that it is the second cause of iatrogenic biliary leakage and the association between the subvesical duct and ductal carcinomas. More local studies are still needed to identify its incidence and prevent complications...(AU)


Introdução: O ducto subvesicular foi descrito por Hubert Luschka como pequenos ductos biliares derivados da parede da vesícula biliar. Alguns autores descrevem isso como um ducto que leva a drenagem do parênquima hepático para a vesícula biliar, outros usam o termo para descrevê-lo como um canal que drena do parênquima hepático para os ductos biliars extra-hepáticos. Foi proposta uma revisão bibliográfica da descrição anatômica do canal epônimo de Luschka e da derivação anatômica proposta subvesicular ou subvesical, dada sua importância clínica como causa de vazamento biliar. Metodologia: foi realizada uma revisão bibliográfica em bancos de dados e bibliotecas eletrônicas. Com uma janela de tempo personalizada de 2006 a 2016, foi obtido um total de 82 artigos, seguido de um resumo analítico especializado, selecionando um total de 46. Resultados: Nenhum consenso foi encontrado na descrição anatômica do epônimo, nem na descrição da terminologia internacional. As lesões do trato biliar durante a colecistectomia apresentam-se como uma complicação rara (0.1 ­ 1.5%); no entanto, têm repercussões em várias áreas e considerável morbidade e mortalidade. Conclusões: houve uma discrepância na nomenclatura utilizada para a descrição desses ductos, uma vez que é indiscriminadamente referido como o canal de Luschka a todos os canais biliares encontrados na fossa biliar. A relevância clínica é que é a segunda causa de vazamento biliar hepático e a associação entre ducto subvesical e carcinomas ductais. Mais estudos locais ainda são necessários para identificar sua incidência e prevenir complicações...(AU)


Subject(s)
Humans , Bile Ducts , Biliary Tract , Bile Ducts, Extrahepatic , Bile Duct Diseases , Bile Duct Neoplasms , Biliary Tract Surgical Procedures
17.
Article in Chinese | WPRIM | ID: wpr-256582

ABSTRACT

<p><b>OBJECTIVE</b>To summarize the 23-year experience of laparoscopic biliary surgery in General Hospital of PLA and evaluate the application of laparoscopic surgery in the treatment of biliary diseases.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 11 419 consecutive patients with biliary diseases undergoing laparoscopic surgery from April, 1992 and December, 2014. The disease spectrum was compared between patients treated before December 31, 2003 and those treated after the time point.</p><p><b>RESULTS</b>The 11419 patients receiving laparoscopic surgery accounted for 56.3% of the total patients undergoing biliary surgeries during the 23 years, including 4701 male and 6718 female patients with a mean age of 50.9∓13.2 years (6-93 years). Most (80.83%) of the patients received laparoscopic surgery for gallbladder stones, and 12.53% patients had the operation for gallbladder polyps. The laparoscopic operation rate was 84.81% in patients with gallbladder stones and 34.91% in patients with extrahepatic bile duct stones, but remained low in patients with biliary carcinoma. In laparoscopic operations, laparoscopic cholecystectomy was the most frequent (96.18%) followed by operations for extrahepatic bile duct stones, in which primary suture accounted for 1.38%, traditional T tube drainage for 0.90% and laparoscopic transcystic duct exploration for 0.72%. For malignant tumors, laparoscopic technique was used mainly for the purpose of exploration (0.34%). The application of laparoscopic technique in biliary surgery tended to increase after the year 2004, especially for benign gallbladder diseases and extrahepatic bile duct stones (P<0.05).</p><p><b>CONCLUSION</b>Laparoscopic technique in biliary surgery is gradually replacing the traditional open operation and becomes the gold standard for the treatment of benign biliary diseases.</p>


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Bile Duct Neoplasms , General Surgery , Bile Ducts, Extrahepatic , Child , Cholecystectomy, Laparoscopic , Drainage , Female , Gallbladder Diseases , General Surgery , Gallstones , General Surgery , Humans , Laparoscopy , Male , Middle Aged , Retrospective Studies , Young Adult
18.
Article in English | WPRIM | ID: wpr-190321

ABSTRACT

Inspissated bile syndrome (IBS) is a rare condition in which thick intraluminal bile, including bile plugs, sludge, or stones, blocks the extrahepatic bile ducts in an infant. A 5-week-old female infant was admitted for evaluation of jaundice and acholic stool. Diagnostic tests, including ultrasound sonography, magnetic resonance cholangiopancreatography, and a hepatobiliary scan, were not conclusive. Although the diagnosis was unclear, the clinical and laboratory findings improved gradually on administration of urodeoxycholic acid and lipid emulsion containing omega-3 polyunsaturated fatty acids (PUFAs) for 3 weeks. However, a liver biopsy was suggestive of biliary atresia. This finding forced us to perform intraoperative cholangiography, which revealed a patent common bile duct with impacted thick bile. We performed normal saline irrigation and the symptom was improved, the final diagnosis was IBS. Thus, we herein report that IBS can be treated with omega-3 PUFAs as an alternative to surgical intervention.


Subject(s)
Bile Ducts, Extrahepatic , Bile , Biliary Atresia , Biopsy , Cholangiography , Cholangiopancreatography, Magnetic Resonance , Cholestasis , Common Bile Duct , Diagnosis , Diagnostic Tests, Routine , Fatty Acids, Omega-3 , Fatty Acids, Unsaturated , Female , Humans , Infant , Jaundice , Liver , Sewage , Ultrasonography
19.
Article in English | WPRIM | ID: wpr-220408

ABSTRACT

PURPOSE: There is still some debate on surgical procedures for hepatocellular carcinoma (HCC) patients with bile duct tumor thrombi (BDTT, Ueda type 3 or 4). What is adequate extent of liver resection for curative treatment? Is extrahepatic bile duct resection mandatory for cure? The aim of this study is to answer these questions. METHODS: Between February 1994 and December 2012, 877 consecutive HCC patients underwent hepatic resection at Ajou University Hospital. Thirty HCC patients (3.4%) with BDTT (Ueda type 3 or 4) were retrospective reviewed in this study. RESULTS: In total, 20 patients enrolled in this study were divided into 2 groups: patients who underwent hemihepatectomy with extrahepatic bile duct resection (group 1, n = 10) and with only removal of BDTT (group 2, n = 10). The 1-, 3- and 5-year overall survival rates were 75.0%, 50.0%, and 27.8%, respectively. The 1-, 3-, and 5-year survival rates of group 1 were 100.0%, 80.0%, and 45.7%, and those of group 2 were 50.0%, 20.0%, and 10.0%, respectively (P = 0.014). The 1-, 3-, and 5-year recurrences free survival rates of group 1 were 90.0%, 70.0%, and 42.0%, and those of group 2 were 36.0%, 36.0%, and 0%, respectively (P = 0.014). Thrombectomy and infiltrative growth type (Ig) were found as independent prognostic factors for recurrence free survival by multivariate analysis. Thrombectomy, Ig, and high indocyanine green retention rate at 15 minutes were found as independent prognostic factors for overall survival by multivariate analysis. CONCLUSION: We suggest that the appropriate surgical procedure for icteric HCC patients should be comprised of ipsilateral hemihepatectomy with caudate lobectomy and extrahepatic bile duct resection.


Subject(s)
Bile Ducts , Bile Ducts, Extrahepatic , Bile , Carcinoma, Hepatocellular , Cholestasis , Hepatectomy , Humans , Indocyanine Green , Liver , Multivariate Analysis , Recurrence , Retrospective Studies , Survival Rate , Thrombectomy
20.
Article in English | WPRIM | ID: wpr-72537

ABSTRACT

PURPOSE: This study analyzed the outcomes of patients with resected extrahepatic bile duct cancer (EHBDC) in order to clarify the role of adjuvant treatments in these patients. MATERIALS AND METHODS: A total of 336 patients with EHBDC who underwent curative resection between 2001 and 2010 were analyzed retrospectively. The treatment types were as follows: surgery alone (n=168), surgery with chemotherapy (CTx, n=90), surgery with radiotherapy (RT) alone (n=29), and surgery with chemoradiotherapy (CRT, n=49). RESULTS: The median follow-up period was 63 months. The 5-year rates of locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) for all patients were 56.5%, 59.7%, 36.6%, and 42.0%, respectively. In multivariate analysis, surgery with RT and CRT was a significant prognostic factor for LRFFS, and surgery with CTx was a significant prognostic factor for DMFS, and surgery with CTx, RT, and CRT was a significant prognostic factor for PFS (p < 0.05). Surgery with CTx and CRT showed association with superior OS (p < 0.05), and surgery with RT had marginal significance (p=0.078). In multivariate analysis of the R1 resection patients, surgery with CRT showed significant association with OS (p < 0.05). CONCLUSION: Adjuvant RT and CTx may be helpful in improving clinical outcomes of patients with resected EHBDC who have a high risk of disease recurrence, particularly R1 resection patients. Conduct of additional prospective, larger-scale studies will be required in order to confirm the benefit of adjuvant RT and CTx in these patients.


Subject(s)
Bile Ducts, Extrahepatic , Biliary Tract Neoplasms , Chemoradiotherapy , Cholangiocarcinoma , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Humans , Multivariate Analysis , Prospective Studies , Radiotherapy , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies , Treatment Outcome
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