New classification system for indications for endoscopic retrograde cholangiopancreatography predicts diagnoses and adverse events.
CONCLUSIONS: An a-priori-based indication system for ERCP, which relies on pre-ERCP objective parameters, provides a more useful and scientific classification system than is available currently.
PMID: 28954557 [PubMed - as supplied by publisher] (Source: Scandinavian Journal of Gastroenterology)
Source: Scandinavian Journal of Gastroenterology - September 30, 2017 Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research
The Routine Use of Cholangiography for Laparoscopic Cholecystectomy in the Modern Era.
This study demonstrates that routine IOC is an effective method of detecting CBD stones and CBD injuries, resulting in improved patient outcomes and economic benefits for health services. We have also identified several predictive factors for CBD stones on IOC.
PMID: 28951654 [PubMed - in process] (Source: JSLS : Journal of the Society of Laparoendoscopic Surgeons)
Source: JSLS : Journal of the Society of Laparoendoscopic Surgeons - September 29, 2017 Category: Surgery Tags: JSLS Source Type: research
Can clinical factors predict the need for intervention after a positive intraoperative cholangiogram?
CONCLUSIONSElevated transaminases and sonographic biliary dilation have poor predictive values for choledocholithiasis. Thus, patients with a positive intraoperative cholangiogram may benefit from additional studies, such as endoscopic ultrasound or magnetic resonance cholangiopancreatography prior to ERCP. (Source: Journal of Digestive Diseases)
Source: Journal of Digestive Diseases - August 30, 2017 Category: Gastroenterology Authors: Mohammed Kaif, Deepak Agrawal, Jayaprakash Sreenarasimhaiah Tags: Original Article Source Type: research
The Prevalence of Hjortsjo Crook Sign of Right Posterior Sectional Bile Duct and Bile Duct Anatomy in ERCP.
CONCLUSION: Hjortsjo Crook Sign frequently presents in RPSBD variation types I, II, and IV in our patients.
PMID: 28785551 [PubMed - in process] (Source: Canadian Journal of Gastroenterology)
Source: Canadian Journal of Gastroenterology - August 10, 2017 Category: Gastroenterology Tags: Can J Gastroenterol Hepatol Source Type: research
Role of Hepatobiliary Scintigraphy and Preoperative Liver Biopsy for Exclusion of Biliary Atresia in Neonatal Cholestasis Syndrome
AbstractAll diagnostic algorithms for Neonatal Cholestasis Syndrome (NCS) focus on differentiating numerous medical causes from Biliary Atresia (BA). No preoperative diagnostic algorithm has 100% diagnostic accuracy for BA and yet, timely diagnosis is crucial to optimize surgical outcome. Markers for high index of clinical suspicion for BA are: a “usually” well thriving infant with conjugated hyperbilirubinemia, raised gamma glutamyl transpeptidase, persistently “acholic” stools, firm hepatomegaly with dysmorphic, hypoplastic gall bladder. In the presence of above ‘red flag’ signs, there has been much debate on...
Source: Indian Journal of Pediatrics - July 8, 2017 Category: Pediatrics Source Type: research
Gallbladder mucosal lesions associated with high biliary amylase irrespective of pancreaticobiliary maljunction
ConclusionPBR is associated with an increased frequency of gallbladder mucosal metaplasia, irrespective of the presence of PBM. Objectively identified reflux represents an additional indication for cholecystectomy but the long‐term consequences for extra‐hepatic biliary malignancy remain unknown and warrant further investigation. Methods of objectively identifying PBR pre‐operatively require further investigation. (Source: ANZ Journal of Surgery)
Source: ANZ Journal of Surgery - July 1, 2017 Category: Surgery Authors: Jason Free, Frank Wang, Nick Williams, Justin S. Gundara, Ralph F. Staerkle, Thomas J. Hugh, Jaswinder S. Samra Tags: Original Article Source Type: research
Intraoperative cholangiography during cholecystectomy among hospitalized medicare beneficiaries with non-neoplastic biliary disease
Conclusions IOC in patients with non-neoplastic biliary disease was associated with increased odds of CBD injury. This likely reflects its selective use in patients at higher risk of CBD injury or as a confirmatory test when an injury is suspected. Summary Common bile duct injury is a rare, but serious complication of cholecystectomy. This retrospective study examined the association between intraoperative cholangiography and common bile duct injury requiring surgical repair among hospitalized Medicare beneficiaries. Use of intraoperative cholangiogram was associated with increased incidence of common bile duct injury. (S...
Source: The American Journal of Surgery - June 23, 2017 Category: Surgery Source Type: research
Gangrenous cholecystitis: innovative laparoscopic techniques to facilitate subtotal fenestrating cholecystectomy when a critical view of safety cannot be achieved
ConclusionsIn the setting of severe inflammation, a number of procedural modifications can be incorporated to allow the surgeon to approach dissection of the gangrenous gallbladder using a flexible operative plan designed to optimize safe completion of this challenging procedure, with the expected improvement in surgical outcomes. (Source: Surgical Endoscopy)
Source: Surgical Endoscopy - June 8, 2017 Category: Surgery Source Type: research
A Technique to Define Extrahepatic Biliary Anatomy Using Robotic Near-Infrared Fluorescent Cholangiography
ConclusionNIFC using ICG is demonstrated as a useful technique to rapidly identify and aid in the visualization of extrahepatic biliary anatomy. Techniques that selectively utilize this technology specifically in difficult cases where the anatomy is unclear are demonstrated in order to obtain the critical view of safety. (Source: Journal of Gastrointestinal Surgery)
Source: Journal of Gastrointestinal Surgery - June 5, 2017 Category: Surgery Source Type: research
Can clinical factors predict the need for intervention after positive intraoperative cholangiogram?
ConclusionsApproximately half of patients with abnormal IOC had normal ERCP. Elevated transaminases and sonographic biliary dilation have poor predictive value for choledocholithiasis. Thus, patients with a positive IOC may benefit from additional studies such as EUS or MRCP prior to ERCP. (Source: Journal of Digestive Diseases)
Source: Journal of Digestive Diseases - May 26, 2017 Category: Gastroenterology Authors: Mohammed Kaif, Deepak Agrawal, Jayaprakash Sreenarasimhaiah Tags: Original article Source Type: research
An unusual case of jaundice: Biliary tumor thrombus in fibrolamellar hepatocellular carcinoma
Conclusion Preoperative surgical approach should consider CBD exploration on an individual basis for underlying obstructive biliary tumor thrombus. (Source: International Journal of Surgery Case Reports)
Source: International Journal of Surgery Case Reports - May 13, 2017 Category: Surgery Source Type: research
Damage to The Bile Ducts at Cholecystectomy
Six patients who incurred iatrogenic injury to the extrahepatic bile duct following elective cholecystectomy are described. All cases were diagnosed three weeks to one year after operation. In none of the patients was an operative cholangiogram performed during the original cholecystectomy to detect congenital biliary tree anomalies or obstruction. Possible risk factors contributing to such injuries were intraoperative bleeding, common bile duct exploration in patients with obstructive jaundice, and poor surgical assistance. Obesity was not found to be of significance since all six patients were thin. Iatrogenic bile duct ...
Source: Annals of Saudi Medicine - April 29, 2017 Category: Journals (General) Tags: ISSUE 4 Source Type: research
Tu1418 Prospective Evaluation of Digital Peroral Cholangioscopy for the Detection of Residual Biliary Stones That Are Missed With Conventional ERCP: an Interim Analysis
ERCP is considered the standard of care for removing stones in the bile duct utilizing a variety of conventional methods. After removal of stones from the bile duct, an occlusion cholangiogram is usually performed to confirm complete bile duct clearance. However, occlusion cholangiogram can miss residual stones in 11- 30% of cases - reportedly in the setting of a dilated bile duct, large stones, severe pneumobilia, and after lithotripsy. The primary goal of this prospective study is to assess if digital peroral cholangioscopy (POC) will enhance the diagnostic yield in the detection of residual biliary stones that are misse...
Source: Gastrointestinal Endoscopy - April 28, 2017 Category: Gastroenterology Authors: Divyesh V. Sejpal, Arvind J. Trindade, Lee Calvin, Larry S. Miller, Sumant Inamdar, Peter Stein, Benley George, Anil Vegesna Tags: Tuesday – ASGE poster Source Type: research
Tu1458 Occlusion Cholangiography Does Not Impact the Rate of Recurrent Choledocholithiasis in Patients Who Undergo ERCP With Stone Extraction
Choledocholithiasis is the most common indication for endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Occlusive cholangiography is commonly used to ensure that all stones are removed from the common bile duct (CBD); however, employment of this technique and documentation varies widely between practitioners. Currently there is no evidence to suggest occlusion cholangiography improves outcomes following ERCP. Furthermore, it is unclear whether endoscopists should pursue an alternative imaging modality in cases of cholangitis where an occlusion cholangiogram is a relative contraindication. (Source:...
Source: Gastrointestinal Endoscopy - April 28, 2017 Category: Gastroenterology Authors: Matthew J. Skinner, Christopher C. Thompson Tags: Tuesday – ASGE poster Source Type: research
An Atypical Presentation of Colorectal Adenocarcinoma
BY LOUISE VESANEN, MSC, & AHMED RAZZIUDIN, MDA 53-year-old woman was brought to the ED from a nursing home for hypotension and hypoxia. She appeared septic. Her blood pressure was 80/60 mm Hg, and she was pale, cyanotic, and jaundiced. The patient was nonverbal at baseline due to underlying cerebral palsy, so information about her present illness was provided by her nursing home. Recent records listed elevated alkaline phosphatase and gallstone finding on ultrasound. Physical exam demonstrated abdominal distension and tenderness on palpation of her right upper quadrant.Initial workup included CBC, CMP, blood g...
Source: The Case Files - April 26, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
