Subject(s)
Choledocholithiasis/diagnosis , Common Bile Duct/abnormalities , Cystic Duct/abnormalities , Hepatic Duct, Common/abnormalities , Adult , Anatomic Variation , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy , Choledocholithiasis/surgery , Common Bile Duct/diagnostic imaging , Cystic Duct/diagnostic imaging , Hepatic Duct, Common/diagnostic imaging , Humans , MaleABSTRACT
The management of biliary disorders in patients with Roux-en-Y hepaticojejunostomy anastomosis is challenging and remains controversial. Our aim is to share our experiences of endoscopic treatment via a permanent access loop in 5 patients. Endoscopic treatment via a permanent access loop is an invaluable procedure for the management of stenotic hepaticojejunostomy anastomosis, anastomotic leakage, and hepatolithiasis. It may even be life-saving for some patients.
Subject(s)
Anastomosis, Roux-en-Y , Biliary Tract Diseases/surgery , Endoscopy, Digestive System/methods , Jejunostomy/methods , Liver/surgery , Adult , Aged , Anastomotic Leak/surgery , Biliary Tract Surgical Procedures/methods , Cholangitis/surgery , Female , Humans , Male , Middle Aged , Postoperative ComplicationsABSTRACT
The aim of this prospective study was to evaluate the results and the complications at a tertiary referral center which frequently uses precutting techniques for biliary cannulation. Four hundred seventy patients with naive papilla for whom biliary intervention was planned were included in the study. If the selective cannulation was not achieved after a few trials, precutting sphincterotomy was performed. The results were evaluated for the frequency, success, and complication rates of precutting. Precutting was performed on 238 (50.6%; 117 male, 121 female; mean age, 58.5 +/- 16.2 years) of 470 patients. Total success rate of endoscopic retrograde cholangiopancreatography (ERCP) was 99.2% (236/238). The rate of complications in patients with versus without precutting was 7 (2.9%) versus 3 (1.3%) for pancreatitis, 2 (0.8%) versus 1 (0.4%) for perforation, and 7 (2.9%) versus 3 (1.3%) for bleeding. The differences between the rates were not significant. Early precutting can be preferable in prolonged cannulation trials of therapeutic ERCP.
Subject(s)
Catheterization/methods , Cholangiopancreatography, Endoscopic Retrograde , Gallstones/diagnosis , Sphincterotomy, Endoscopic/methods , Aged , Cholangitis/etiology , Decision Making , Female , Humans , Jaundice/etiology , Male , Middle Aged , Pancreatic Neoplasms/diagnosis , Pancreatitis/etiology , Prospective Studies , Sphincterotomy, Endoscopic/adverse effects , Time FactorsABSTRACT
BACKGROUND: Pancreatic fistulas are managed primarily by conservative treatment. Surgery is performed in cases of conservative treatment failure. Endoscopic treatment is reported to be both effective and safe as an alternative treatment method. METHODS: A total of 26 patients underwent endoscopic treatment after failure of conservative treatment between January 2002 and November 2004. The mean time between the onset of fistula and the endoscopic retrograde cholangiopancreatography (ERCP) procedure was 95 days. The mean fistula output volume was 400 ml per day. Four patients had pancreatic ascites. The aim of the endoscopic treatment was to bypass the ductal disruption by placing stents or drains where the origin of fistulous tract could be identified, and to lower the pancreatic duct pressure by performing pancreatic sphincterotomy or by placing stents where the site of the leak could not be identified. RESULTS: Pancreatography could be performed in all the patients except one. Partial duct disruption occurred in 16 patients. All of the fistulas closed after the ductal disruption was bypassed. Pancreatic sphincterotomy or endoprothesis placement was effective for eight of the remaining nine patients in whom the ductal disruption originated from the tail of the pancreas and hence could not be bypassed. The overall success rate was 94% for the patients with partial duct disruption. Four patients had side branch leaks. All of them closed after placement of an endoprothesis. Fistulas closed in only one (20%) of the five patients with complete duct disruption. Pancreatic ascites resolved in two of the four patients after endoscopic treatment. No serious complications resulted from endoscopic treatment other than proximally migrated stents in two patients. CONCLUSIONS: Endoscopic treatment is an effective and safe method for patients with pancreatic fistulas unresponsive to conservative treatment. The success rate is very high, especially for patients with partial and side branch duct disruption.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Pancreatic Fistula/surgery , Sphincterotomy, Endoscopic , Adolescent , Adult , Aged , Drainage , Female , Humans , Male , Middle Aged , Pancreatic Fistula/diagnostic imaging , Prospective Studies , Stents , Treatment OutcomeSubject(s)
Cyanoacrylates/pharmacology , Endoscopy, Gastrointestinal/methods , Gastroenterostomy/adverse effects , Polypropylenes , Prosthesis Implantation/instrumentation , Stomach Neoplasms/surgery , Surgical Mesh , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications , ReoperationABSTRACT
Liver abscess is a quite rare complication in Crohn's disease. Early diagnosis and differentiation of pyogenic abscess from amoebic abscess are as important as the choosing of proper treatment in the management of liver abscess. Herein, 28-year-old man with Crohn's disease developing liver abscess is presented. He was treated with surgical drainage.
Subject(s)
Crohn Disease/complications , Liver Abscess/etiology , Adult , Drainage , Humans , Liver Abscess/diagnostic imaging , Liver Abscess/surgery , Male , Tomography, X-Ray ComputedSubject(s)
Bile , Pancreatic Ducts , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct , Female , Humans , Middle AgedSubject(s)
Common Bile Duct Neoplasms/surgery , Stents/adverse effects , Equipment Reuse , Humans , Male , Middle AgedSubject(s)
Developing Countries , Helicobacter Infections/epidemiology , Helicobacter pylori , Inflammatory Bowel Diseases/epidemiology , Adult , Cross-Sectional Studies , Female , Helicobacter Infections/diagnosis , Humans , Incidence , Inflammatory Bowel Diseases/diagnosis , Male , Middle Aged , Turkey/epidemiologyABSTRACT
Carbohydrate antigen CA19-9 is commonly used in the diagnosis of pancreatic and biliary malignancies. However, increases in its level in benign conditions such as acute cholangitis or pancreatitis have also been reported. A 79-year-old woman presented with cholangitis and a pancreatic pseudocyst while showing elevation of CA19-9 up to 35,500 U/mL. The patient was adequately treated and at two months' follow-up the CA19-9 level had returned to normal.
