ABSTRACT
OBJECTIVES: Biliary access refractory to conventional cannulation techniques is a challenging clinical scenario for most endoscopists. The endoscopic-percutaneous rendezvous technique is an optimal alternative with high success rates and low complication rates in expert hands, however its routine use in the West, mainly in Latin America, is still limited. The aim of our study was to evaluate the feasibility, efficacy and safety of endoscopic-percutaneous rendezvous in the management of difficult biliary tract in an endoscopic center in Peru. MATERIALS AND METHODS: Descriptive study - case series type that included 21 patients, with diagnosis of difficult bile duct, all treated by endoscopic-percutaneous rendezvous between July 2017 to July 2020. We evaluated: age, gender, number of previous failed endoscopic retrograde cholangiopancreatography, associated endoscopic findings, rate of successful cannulation, rate of successful resolution of difficult choledocholithiasis, adverse events and procedure-related mortality. RESULTS: The rate of successful cannulation was 100% (21/21). There were 12 cases (57.1%) of difficult choledocholithiasis of which there was a successful resolution rate of 91.6% (11/12). The overall adverse event rate was 4.7% (1/21), which was one case of post-sphincteroplasty gastrointestinal bleeding that was successfully resolved endoscopically only. CONCLUSIONS: Endoscopic-percutaneous rendezvous performed by expert hands is feasible, safe and clinically effective for the management of the difficult bile duct in Latin America.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Humans , Male , Female , Peru , Middle Aged , Aged , Cholangiopancreatography, Endoscopic Retrograde/methods , Choledocholithiasis/surgery , Feasibility Studies , Adult , Aged, 80 and over , Treatment Outcome , Catheterization/methods , Retrospective StudiesABSTRACT
Introduction: Cholangioscopy is a test that allows the evaluation of the biliary epithelium. It is used for diagnosis and management of biliary diseases. Objectives: Determine the success rate of complete removal of difficult stones with the use of laser lithotripsy through cholangioscopy as well as its complications. Determine the visual impression accuracy of bile duct injuries. Materials and methods: This is a prospective and descriptive study. We included 39 patients between July 2016 and July 2017 with diagnosis of difficult stones in the biliary tract and indeterminate stenosis of the biliary tract that were submitted to cholangioscopy. Results: Success rate of complete removal of difficult stones was 65.3%, there was one complication. Two laser sessions were required in 4 of the 17 patients who obtained complete removal of the stones. The visual impression accuracy of lesions in the bile duct to determine malignancy coincided in all cases with the final diagnosis of the patient. Conclusions: Laser lithotripsy allows a safe and effective treatment of the difficult stones of the bile duct. Precession of visual impression of lesions in the bile duct is very high.
Introducción: La colangioscopía es un examen que permite evaluar la luz biliar, el epitelio biliar y sirve para diagnóstico y manejo de enfermedades de la vía biliar. Objetivos: Determinar la tasa de éxito de remoción completa de cálculos difíciles con el uso de litotripcia con láser a través de la colangioscopía asi como las complicaciones de ésta. Determinar la precisión de impresión visual de lesiones de la vía bilar. Materiales y métodos: Estudio prospectivo, descriptivo. Se incluyeron a 39 pacientes entre Julio 2016 a Julio 2017 con diagnóstico de cálculo difícil en la vía biliar y estenosis indeterminada de la vía biliar que fueron sometidos a colangioscopía. Resultados: La tasa de éxito de remoción completa de cálculos difíciles fue de 65,3% con una complicación. Se requirió de dos sesiones con láser en 4 de los 17 pacientes que obtuvieron remoción completa de cálculos. La precisión de impresión visual de lesiones en la vía biliar para determinar malignidad coincidió en todos los casos con el diagnóstico final del paciente. Conclusiones: La colangioscopía con uso de litotripcia con láser permite un tratamiento seguro y eficaz en los cálculos difíciles de la vía biliar. La precesión de la impresión visual de lesiones en la vía biliar es muy alta.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cholelithiasis/surgery , Cholelithiasis/diagnosis , Endoscopy, Digestive System/methods , Sphincterotomy, Endoscopic , Lithotripsy, Laser , Peru , Biliary Tract/pathology , Prospective Studies , Constriction, Pathologic , Choledocholithiasis/surgery , Choledocholithiasis/diagnosis , Lasers, Solid-StateABSTRACT
INTRODUCTION: Cholangioscopy is a test that allows the evaluation of the biliary epithelium. It is used for diagnosis and management of biliary diseases. OBJECTIVES: Determine the success rate of complete removal of difficult stones with the use of laser lithotripsy through cholangioscopy as well as its complications. Determine the visual impression accuracy of bile duct injuries. MATERIALS AND METHODS: This is a prospective and descriptive study. We included 39 patients between July 2016 and July 2017 with diagnosis of difficult stones in the biliary tract and indeterminate stenosis of the biliary tract that were submitted to cholangioscopy. RESULTS: Success rate of complete removal of difficult stones was 65.3%, there was one complication. Two laser sessions were required in 4 of the 17 patients who obtained complete removal of the stones. The visual impression accuracy of lesions in the bile duct to determine malignancy coincided in all cases with the final diagnosis of the patient. CONCLUSIONS: Laser lithotripsy allows a safe and effective treatment of the difficult stones of the bile duct. Precession of visual impression of lesions in the bile duct is very high.
Subject(s)
Cholelithiasis/diagnosis , Cholelithiasis/surgery , Endoscopy, Digestive System/methods , Lithotripsy, Laser , Sphincterotomy, Endoscopic , Adult , Aged , Aged, 80 and over , Biliary Tract/pathology , Choledocholithiasis/diagnosis , Choledocholithiasis/surgery , Constriction, Pathologic , Female , Humans , Lasers, Solid-State , Male , Middle Aged , Peru , Prospective StudiesABSTRACT
Benign recurrent intrahepatic cholestasis (BRIC) is a rare form of intrahepatic cholestasis characterized by repeated self-limited episodes of severe pruritus and jaundice. Classically its natural evolution is benign, without progress to fibrosis or hepatic insufficiency; although, lastly were reported cases which progress to Progressive familial intrahepatic cholestasis (PFIC). This disease is characterized by progressive hepatic insufficiency and cirrhosis. We present the case of a 32 years old male patient who went to Gastroenterology Service of Arzobispo Loayza National Hospital by pruritus and jaundice. We reported this case for its infrequent presentation and because is an entity which should be considered within differential diagnosis of hepatic cholestasis diseases.
Subject(s)
Cholestasis, Intrahepatic/diagnosis , Adult , Cholestasis, Intrahepatic/genetics , Disease Progression , Humans , Male , RecurrenceABSTRACT
La Colestasis Intrahepatica Benigna Recurrente (CIBR) es una rara forma de colestasis intrahepatica caracterizada por episodios recurrentes y autolimitados de ictericia y prurito intensos. Clásicamente su evolución natural es benigna, sin progresión a fibrosis o insuficiencia hepática; sin embargo, últimamente se han reportado casos que progresan a Colestasis Intrahepatica Familiar Progresiva (CIFP), ésta última caracterizada porinsuficiencia hepática y cirrosis. Presentamos el caso de un paciente varón de 32 años que acude al Servicio de Gastroenterología del Hospital Nacional "Arzobispo Loayza",por ictericia y prurito. Lo reportamos por lo infrecuente de su presentación y por ser una entidad que debemos tener en cuenta en el diagnóstico diferencial de enfermedades hepáticas colestásicas.
Benign recurrent intrahepatic cholestasis (BRIC) is a rare form of intrahepatic cholestasischaracterized by repeated self-limited episodes of severe pruritus and jaundice. Classicallyits natural evolution is benign, without progress to fibrosis or hepatic insufficiency; although,lastly were reported cases which progress to Progressive familial intrahepatic cholestasis(PFIC). This disease is characterized by progressive hepatic insufficiency and cirrhosis.We present the case of a 32 years old male patient who went to Gastroenterology Serviceof Arzobispo Loayza National Hospital by pruritus and jaundice. We reported this case forits infrequent presentation and because is an entity which should be considered withindifferential diagnosis of hepatic cholestasis diseases.