ABSTRACT
BACKGROUND/AIMS: Results from studies evaluating needle-knife papillotomy are conflicting. The aim of this retrospective study was to assess the safety and efficacy of needle-knife papillotomy as a precut procedure to achieve biliary access during ERCP. METHODOLOGY: During a period of seven years, ERCP was performed 938 times. During this time, needle-knife papillotomy was carried out in 68 patients, with complete follow-up obtained in all patients. The follow-up concentrated on the safety and efficacy of the procedure and short-term complications. RESULTS: Cannulation of the common bile duct was successful immediately after needle-knife papillotomy in 44 patients (66%), during a second ERCP in 18 patients (26%), and in a third ERCP in 2 patients (3%) achieving a total cannulation rate of 94%. There were no needle-knife papillotomy related deaths. Complications included bleeding in 5 patients (7%), and pancreatitis in 3 patients (4%). All complications were managed conservatively. CONCLUSIONS: Our experience indicates that needle-knife papillotomy is a versatile, effective and safe technique of gaining biliary access in patients in whom deep cannulation proves impossible and biliary access is considered essential.
Subject(s)
Choledocholithiasis/surgery , Common Bile Duct/pathology , Common Bile Duct/surgery , Sphincterotomy, Endoscopic/methods , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
This report describes two patients who developed jaundice within two weeks of receiving an amoxycillin-clavulanate potassium combination. Causes of jaundice, other than drug administration, were excluded. The patients' jaundice and clinical symptoms did not respond to stopping the drug. Ursodeoxycholic acid (750 mg/day) led to a prompt and sustained improvement in their hyperbilirubinaemia and symptoms such as pruritus and fatigue. These cases suggest that ursodeoxycholic acid may be an effective treatment for drug-associated cholestasis.
Subject(s)
Amoxicillin-Potassium Clavulanate Combination/adverse effects , Cholagogues and Choleretics/therapeutic use , Cholestasis, Intrahepatic/drug therapy , Drug Therapy, Combination/adverse effects , Ursodeoxycholic Acid/therapeutic use , Aged , Aged, 80 and over , Biopsy , Cholestasis, Intrahepatic/chemically induced , Cholestasis, Intrahepatic/pathology , Humans , Liver/pathology , Male , PrognosisSubject(s)
Bile Duct Diseases/etiology , Breast Neoplasms/complications , Carcinoma, Lobular/complications , Dermatomyositis/etiology , Paraneoplastic Syndromes/etiology , Adult , Chemotherapy, Adjuvant , Dilatation, Pathologic/etiology , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Mastectomy, Radical , Tomography, X-Ray ComputedSubject(s)
Adenocarcinoma/diagnosis , Pancreatic Neoplasms/diagnosis , Pancreatitis/diagnosis , Acute Disease , Adenocarcinoma/diagnostic imaging , Diagnosis, Differential , Fatal Outcome , Female , Humans , Middle Aged , Pancreatic Neoplasms/diagnostic imaging , Pancreatitis/diagnostic imaging , Recurrence , Tomography, X-Ray ComputedABSTRACT
A 51-year-old woman developed jaundice while taking tenoxicam. A full evaluation, including ultrasound, computed tomography, endoscopic cholangiography and liver biopsy, confirmed the diagnosis of mixed hepatic injury. The patient's jaundice and all other liver function abnormalities normalized 1 month after she discontinued taking tenoxicam. This is the first case report of mixed hepatic injury, confirmed with biopsy, associated with tenoxicam. Tenoxicam should be considered as a potential cause of hepatic injury when other more common aetiologies have been excluded.
