Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging – a case series
ConclusionTraditionally patients presenting with suspicion of choledocholithiasis undergo preoperative MRCP/EUS and/or ERCP prior to eventual LC. We propose an alternative, more streamlined, pathway of treatment without requiring preoperative cholangiography, applicable to both elective and emergency patients.
Conclusion: EUS is a useful and safe tool in the pediatric population with pancreatobiliary diseases.
Conclusion EDGE was the most cost-effective modality in post-RYGB anatomy for treatment of pancreaticobiliary diseases compared with DAE-ERCP and LA-ERCP. Sensitivity analysis demonstrated that this conclusion was robust to changes in important model parameters. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | Full text
ConclusionTransgastric laparoscopy-assisted ERCP is a feasible procedure with low complication rates and is used in treating patients with altered RYGB anatomy who present with biliary tract disorders. The use of transgastric laparoscopy-assisted ERCP allows endoscopic treatment and cholecystectomy to be performed in a single setting.
Endoscopic ultrasound-directed transgastric ERCP (EDGE) is an alternative to enteroscopy- and laparoscopy-assisted ERCP in patients with RYGB anatomy. It allows for direct access via lumen-apposing metal stents (LAMS) to the excluded stomach, followed by ERCP across the gastro-gastric (GG) stent. Although short-term results are promising with technical success in the majority of cases, the long-term outcomes are not known. Specifically, the rate of persistent GG fistula (GGF) is unknown.
ConclusionsGATE appears to be a safe and effective procedure and may be considered the preferred approach to ERCP in patients with RYGB anatomy at centers with LAMS experience. The procedure offers more definitive and higher range of ERCP interventions compared to traditional methods and is associated with fewer adverse events. Improvements in strategies and methods with the GATE technique may reduce risks and improve outcomes.
arlak E Abstract BACKGROUND/AIMS: Several studies recommend prompt laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. However, histopathological alterations in the gallbladder during this time interval and the role played by ERCP in causing these changes have not been sufficiently elucidated. To compare early period LCs with delayed LCs following common bile duct stone extraction via ERCP with regard to operation time, hospitalization period, conversion to open cholecystectomy rate, morbidity, mortality, and histopathological alterations in th...
Conclusions: This study suggests that the EDGE procedure has similar technical success and adverse events compared with LA-ERCP with the benefit of significantly shorter procedure times and hospital stay. EDGE may offer a minimally invasive, effective option, with less resource utilization, and without significant weight gain.
Purpose of review The present review describes the current and evolving techniques available in approaching endoscopic retrograde cholangiopancreatography (ERCP) for patients with Roux-en-Y gastric bypass (RYGB) anatomy. Recent findings Recent studies have demonstrated that device-assisted enteroscopy (DAE) approaches have high failures rates when performing ERCP, but are currently considered the first-line approach for patients with RYGB anatomy because of lower costs and risks compared to surgery. In contrast, laparoscopicy-assisted-ERCP (LA-ERCP) exhibits high technical success rates but carries surgical risks and ...
We report a 35-year-old female presenting with chronic symptoms consistent with biliary colic and an equivocal US reported as cholelithiasis. She underwent laparoscopy during which the absence of the gallbladder was noted. Postoperative MRCP confirmed the diagnosis of GA. PMID: 30258310 [PubMed - in process]
Condition: Choledocholithiasis Interventions: Procedure: endoscopic ultrasound; Procedure: intraoperative cholangiography; Procedure: ERCP; Device: Ultrasound endoscope Sponsor: Vilnius University Enrolling by invitation