Management of suspected common bile duct stones on cholangiogram during same-stay cholecystectomy for acute gallstone-related disease
Recent data have suggested that upfront cholecystectomy should be performed even in the presence of moderately abnormal liver function tests (LFTs). As a consequence, more common bile duct (CBD) stones are dis... (Source: BMC Surgery)
Source: BMC Surgery - April 17, 2017 Category: Surgery Authors: Sandra de Sousa, Olivier Tobler, Pouya Iranmanesh, Jean-Louis Frossard, Philippe Morel and Christian Toso Source Type: research
Diagnostic Accuracy of Laboratory Tests and Diagnostic Imaging in Detecting Biliary Strictures After Liver Transplantation
DiscussionThe diagnostic accuracy of liver enzymes and imaging modalities is modest in detecting post-LT biliary strictures and cannot be used solely to identify patients needing further workup. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - March 5, 2017 Category: Gastroenterology Source Type: research
Comparative performance of non-contrast MRI with HASTE vs. contrast-enhanced MRI/3D-MRCP for possible choledocholithiasis in hospitalized patients
ConclusionIn hospitalized patients with suspected choledocholithiasis, performance of non-contrast abdominal MRI with HASTE is similar to contrast-enhanced MRI with 3D-MRCP, offering potential for decreased scanning time and improved patient tolerability. (Source: Abdominal Imaging)
Source: Abdominal Imaging - February 1, 2017 Category: Radiology Source Type: research
Routine surveillance cholangiography after percutaneous cholecystostomy delays drain removal and cholecystectomy
Introduction: Percutaneous cholecystostomy (PC) is often performed for patients with acute cholecystitis who are at high risk for operative morbidity and mortality. However, the necessity for routine cholangiography after PC remains unclear. We hypothesized that routine surveillance cholangiography (RSC) after PC would provide no benefit compared to on-demand cholangiography (ODC) triggered by signs or symptoms of biliary pathology.
Methods: We performed a 3-year retrospective cohort analysis of patients managed with PC for acute cholecystitis at two tertiary care hospitals. Patients who had routine surveillance cholangio...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - January 24, 2017 Category: Orthopaedics Tags: Original Articles Source Type: research
The Role of Endoscopic Biliary Drainage without Sphincterotomy in Gallstone Patients with Cholangitis and Suspected Common Bile Duct Stones Not Detected by Cholangiogram or Intraductal Ultrasonography.
Conclusions: EBD using 5-F plastic stents without EST may be safe and effective for the management of cholangitis accompanied by gallstones in patients without CBD stones according to ERCP and IDUS.
PMID: 28104896 [PubMed - as supplied by publisher] (Source: Gut and Liver)
Source: Gut and Liver - January 22, 2017 Category: Gastroenterology Tags: Gut Liver Source Type: research
Protocol-Driven Management of Suspected Common Duct Stones
Common duct stones can be diagnosed by magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS)/ERCP, and intraoperative cholangiogram (IOC). In 2015, our group adopted a standard approach of preoperative EUS/ERCP followed by laparoscopic cholecystectomy for patients with an admission bilirubin>4.0 mg/dL. For bilirubin (Source: Journal of the American College of Surgeons)
Source: Journal of the American College of Surgeons - January 13, 2017 Category: Surgery Authors: Anthony Manning, Richard Frazee, Stephen Abernathy, Claire Isbell, Travis Isbell, Justin Regner, Yolanda Munoz-Maldonado, Randall Smith Tags: Southern surgical association article Source Type: research
Endoscopic Management of the Difficult Bile Duct Stones: A Single Tertiary Center Experience.
Conclusions. Periodic endobiliary stenting can be used as an effective treatment for patients with difficult stones. Sizes of the CBD and of the largest stone are independent risk factors that affect the success rate.
PMID: 27999591 [PubMed] (Source: Gastroenterology Research and Practice)
Source: Gastroenterology Research and Practice - December 23, 2016 Category: Gastroenterology Tags: Gastroenterol Res Pract Source Type: research
Percutaneous Hepaticojejunostomy Using a Radiofrequency Wire for Management of a Postoperative Bile Leak
We describe a case of a free bile duct leak following extended right hepatectomy and surgical hepaticojejunostomy treated with percutaneous transhepatic hepaticojejunostomy in which a radiofrequency guidewire was used to gain enteral access. A modified internal/external biliary catheter was left in place. The patient was enrolled in a benign biliary stricture protocol, and 8 months later, the catheter was removed following a normal cholangiogram and biliary manometric perfusion testing. At 3-month follow-up after catheter removal, the patient is asymptomatic with no clinical, biochemical, or radiographic evidence of bili...
Source: CardioVascular and Interventional Radiology - December 22, 2016 Category: Radiology Source Type: research
Utility of MRCP in Clinical Decision Making of Suspected Choledocholithiasis: An Institutional Analysis and Literature Review
Conclusions There is a significant difference in the laboratory evaluation and demographics of patients undergoing ERCP, MRCP, and laparoscopic cholecystectomy. MRCP was followed with a more invasive test a majority of the time. Since MRCP did not change the management of patients with suspected choledocholithiasis, its utility in this patient population should be questioned. Further research is needed to better define the pretest characteristics which would predict which patients do not need further intervention after MRCP as well as defining the most cost-effective strategy. (Source: The American Journal of Surgery)
Source: The American Journal of Surgery - November 30, 2016 Category: Surgery Source Type: research
Utility of MRCP in Clinical Decision Making of Suspected Choledocholithiasis: An Institutional Analysis and Literature Review
The ideal treatment algorithm for suspected choledocholithiasis is not yet well defined. Imaging options include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and intraoperative cholangiogram (IOC). MRCP is diagnostic, while the other two modalities can also be therapeutic. Each of these modalities for diagnosis and treatment carries its own set of risks, benefits, and institutional costs. We hypothesized that there would be a significant difference between the biochemical profiles and characteristics of patients who undergo ERCP vs. (Source: American Journal of Surgery)
Source: American Journal of Surgery - November 29, 2016 Category: Surgery Authors: Wesley R. Badger, Andrew J. Borgert, Kara J. Kallies, Shanu N. Kothari Source Type: research
Obstructive jaundice caused by hepatic torsion in an infant with congenital diaphragmatic hernia
We present a 2 months female infant who had respiratory distress and persistent jaundice since birth. Investigations suggested direct hyperbilirubinemia, right-sided diaphragmatic hernia with liver herniation in the thorax, and intra- and extrahepatic biliary dilatation. Laparotomy showed herniation of liver in the chest with hepatic torsion of about 180΀ causing obstruction of bile ducts. Liver torsion was corrected and liver relocated in the abdomen. An operative cholangiogram confirmed free passage of contrast to the intestine after correction of hepatic torsion. Repair of the diaphragmatic hernia was perfor...
Source: Journal of Indian Association of Pediatric Surgeons - November 24, 2016 Category: Surgery Authors: Iftikhar Ahmad Jan Basmah Al Hamoudi Abdulla AlJunaibi Abdelmatlub Ben Mussa Source Type: research
Diagnosis and Management of Postoperative Biliary Leaks
Semin intervent Radiol 2016; 33: 307-312 DOI: 10.1055/s-0036-1592324Postoperative biliary leaks have become more common in the past three decades since the development of laparoscopic biliary surgery. The role of the radiologist and interventional radiologist is important in the diagnosis and treatment of such complications, and can play an adjunctive role in the definitive surgical repair. Ultrasound, computed tomography, magnetic resonance cholangiopancreatography, nuclear medicine cholescintigraphy studies, and percutaneous transhepatic cholangiograms (PTC) are the various imaging modalities used for diagnosis. Interven...
Source: Seminars in Interventional Radiology - October 30, 2016 Category: Radiology Authors: Nikpour, Arian M. Knebel, R. Justin Cheng, Danny Tags: Review Article Source Type: research
Spontaneous passage of a large common bile duct stone during computed tomography
An asymptomatic 85-year-old man was referred to our hospital for the treatment of a common bile duct (CBD) stone. He had a history of distal gastrectomy and Roux-en-Y reconstruction for gastric cancer. Endoscopic retrograde cholangiopancreatography (ERCP) with a single-balloon enteroscope was performed. The cholangiogram revealed a CBD stone measuring 15mm in diameter (Fig. 1); however, stone extraction failed because of unsuccessful biliary cannulation. Precut sphincterotomy was not performed in this session, and therefore his papilla remained naive. (Source: Digestive and Liver Disease)
Source: Digestive and Liver Disease - October 5, 2016 Category: Gastroenterology Authors: Toji Murabayashi, Takahisa Ogawa, Kei Ito, Kaori Masu Tags: Image of the Month Source Type: research
Y-configured metallic stent combined with (125)I seed strands cavity brachytherapy for a patient with type IV Klatskin tumor.
We report a case in an inoperable patient with type IV Klatskin tumor treated by the use of a novel, two piece, Y-configured self-expandable metallic stent (SEMS) combined with two (125)I seed strands via bilateral approach. The placement of the Y-shaped SEMS was successful and resulted in adequate biliary drainage. After 2 months of intraluminal brachytherapy (ILBT), both (125)I seed strands and temporary drainage catheter were removed after patency of the expanded stents was confirmed by the cholangiogram. This technique was feasible and could be considered for the treatment of patients with Bismuth type IV Klatskin tumo...
Source: Journal of Contemporary Brachytherapy - September 22, 2016 Category: Cancer & Oncology Tags: J Contemp Brachytherapy Source Type: research
