-
Journal of Clinical Gastroenterology Jul 2023Indications for endoscopic placement of endoluminal and transluminal stents have greatly expanded over time. Endoscopic stent placement is now a well-established... (Review)
Review
Indications for endoscopic placement of endoluminal and transluminal stents have greatly expanded over time. Endoscopic stent placement is now a well-established approach for the treatment of benign and malignant biliary and pancreatic diseases (ie, obstructive jaundice, intra-abdominal fluid collections, chronic pancreatitis etc.). Ongoing refinement of technical approaches and development of novel stents is increasing the applicability and success of pancreatico-biliary stenting. In this review, we discuss the important developments in the field of pancreatico-biliary stenting, with a specific focus on endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-associated developments.
Topics: Humans; Jaundice, Obstructive; Endosonography; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Stents; Cholestasis; Ultrasonography, Interventional
PubMed: 36040964
DOI: 10.1097/MCG.0000000000001760 -
Journal of Gastrointestinal Surgery :... Jan 2023To characterize the prognostic implication of jaundice and preoperative biliary drainage on postoperative outcomes among patients with gallbladder cancer (GBC)...
OBJECTIVES
To characterize the prognostic implication of jaundice and preoperative biliary drainage on postoperative outcomes among patients with gallbladder cancer (GBC) undergoing surgical resection.
METHODS
Patients who underwent surgical resection of GBC identified from a multicenter database between January 2000 and December 2019 were retrospectively analyzed. Data on clinical and pathological details, as well as short- and long-term overall survival (OS), were obtained and compared among patients with and without preoperative jaundice and biliary drainage.
RESULTS
Among 449 patients with GBC, median and 1-, 3-, and 5-year OS were 17.4 months, 63.7%, 28.4%, and 22.1%, respectively. Patients who presented with preoperative jaundice (n = 100, 22.3%) were more likely to have advanced disease, a lower incidence of R0 resection (29.0% vs. 69.1%, p < 0.001), as well as a higher incidence of postoperative liver failure (4% vs. 0, p = 0.002), and worse long-term survival versus patients without jaundice (median OS, 10.4 vs. 27.1 months, p < 0.001). Preoperative biliary drainage was performed for the majority of jaundiced patients (77.0%) and was associated with decreased risk of postoperative liver failure (1.3% vs. 13.0%, p = 0.041); preoperative biliary drainage failed to improve long-term survival (median OS, 10.2 months vs. 12.0 months, p = 0.679). On multivariable analysis, R0 resection (17.5 vs. 7.6 months, p < 0.001) and adjuvant therapy (15.6 vs. 6.6 months, p = 0.027) were associated with improved long-term survival among jaundiced patients.
CONCLUSIONS
While preoperative biliary drainage of jaundiced GBC patients decreased the risk of postoperative liver failure, it did not impact long-term outcomes. Rather, preoperative jaundice was associated with a lower chance at R0 resection and worse long-term survival.
Topics: Humans; Retrospective Studies; Gallbladder Neoplasms; Jaundice; Postoperative Complications; Drainage; Liver Failure
PubMed: 36376722
DOI: 10.1007/s11605-022-05523-6 -
Duodecim; Laaketieteellinen... 2016Jaundice is a common cause for seeking medical attention at an emergency department. The doctor on call should be able to recognize patients whose jaundice requires... (Review)
Review
Jaundice is a common cause for seeking medical attention at an emergency department. The doctor on call should be able to recognize patients whose jaundice requires emergency investigations and treatment in specialized care. Most patients can be treated electively on an urgent referral. Ultrasound scan of the liver will in most cases clarify whether a liver disease or a biliary tract obstruction is in question, and whether the patient should be referred to an internist or a surgeon.
Topics: Emergency Service, Hospital; Humans; Jaundice; Referral and Consultation
PubMed: 29188946
DOI: No ID Found -
Journal of the Royal Naval Medical... 2017Obstructive jaundice is a clinical condition that indicates the possibility of a significant underlying disease process. This clinical review considers the... (Review)
Review
Obstructive jaundice is a clinical condition that indicates the possibility of a significant underlying disease process. This clinical review considers the pathophysiology, investigation and management of patients with obstructive jaundice and considers the particular challenges that medical personnel may face when deployed away from the United Kingdom (UK). It aims to give guidance with regard to the short- and long-term investigation and management of such patients.
Topics: Humans; Jaundice, Obstructive; Military Personnel; Risk Factors; United Kingdom
PubMed: 30088740
DOI: No ID Found -
Khirurgiia 2023To analyze the indications, technical features and results of percutaneous cholecystostomy.
OBJECTIVE
To analyze the indications, technical features and results of percutaneous cholecystostomy.
MATERIAL AND METHODS
A retrospective single-center study of the results of percutaneous cholecystostomy over 13-year period was carried out. The indications for surgery, technical features and outcomes were studied.
RESULTS
The indications for percutaneous cholecystostomy were acute cholecystitis in 40 (63.5%) cases and obstructive jaundice in 23 (36.5%) cases. In acute cholecystitis, cholecystectomy was denied due to severe acute and decompensated chronic diseases. In case of obstructive jaundice, cholecystostomy was preferred if other methods of biliary decompression were impossible. Drainage with locking thread was used in 44 (69.8%) patients. A total of 13 (21.3%) cases of drainage migration were noted. Incidence of migration of catheters with locking threads was 13.6%, without locking threads - 41.2% (=0.033). Subsequent cholecystectomy was performed in 10 (15.9%) patients. In case of obstructive jaundice, cholecystostomy did not lead to destructive cholecystitis in any case. Six patients with acute cholecystitis had progressive gallbladder destruction. Overall postoperative in-hospital mortality was 36.5% (=23). Mortality in the group of acute cholecystitis was 32.5% (=13), in the group of obstructive jaundice - 43.5% (=10). Mortality was higher in acute cholecystitis Grade III (75.0%) compared to Grade II (21.9%; =0.008).
CONCLUSION
Cholecystostomy is a rare (reserve) intervention. Locking thread significantly reduces the incidence of migration of cholecystostomy catheter. Progressive gallbladder destruction required cholecystectomy in 15% of cases. Treatment of patients with acute cholecystitis depends on physical status and comorbidities.
Topics: Humans; Cholecystostomy; Retrospective Studies; Jaundice, Obstructive; Mobile Health Units; Cholecystitis, Acute; Treatment Outcome
PubMed: 36583492
DOI: 10.17116/hirurgia202301139 -
International Journal of Surgery... Nov 2014The aim of this systematic review and meta-analysis was to determine if adjunct steroids affect jaundice-free, cholangitis, and survival rates after Kasai... (Meta-Analysis)
Meta-Analysis Review
AIM
The aim of this systematic review and meta-analysis was to determine if adjunct steroids affect jaundice-free, cholangitis, and survival rates after Kasai portoenterostomy.
METHODS
The literature was searched using the following terms: biliary atresia, portoenterostomy, steroids, glucocorticoids, dexamethasone, prednisolone, and hydrocortisone. The primary outcome was the jaundice-free rate. Secondary outcomes were cholangitis and survival rates.
RESULTS
Ten studies were included in the systematic review and 8 in the meta-analyses. Steroid treatment regimens were inconsistent between studies. The pooled odds ratio (OR) for the jaundice-free rate did not significantly favor steroid over non-steroid treatment (1.95; 95% confidence interval [CI]: 0.91-4.11; P = 0.087), nor did the pooled OR for the cholangitis rate (0.75; 95% CI: 0.48-1.17; P = 0.202). Overall survival ranged from 58 to 95% in the steroid group and from 36 to 96% in the control group. Native liver survival ranged from 30 to 56% in the steroid group and from 31 to 48% in the control group. The survival data were not suitable for meta-analysis.
CONCLUSIONS
Although these results imply that adjunct steroids after Kasai portoenterostomy for BA may not improve jaundice-free or cholangitis rates, the quality of available evidence is limited and therefore not definitive. Additional high quality studies are needed.
Topics: Biliary Atresia; Cholangitis; Dexamethasone; Glucocorticoids; Humans; Hydrocortisone; Jaundice; Portoenterostomy, Hepatic; Postoperative Care; Prednisolone; Survival Rate
PubMed: 25224699
DOI: 10.1016/j.ijsu.2014.08.407 -
American Journal of Otolaryngology 2022While jaundice is frequently described in the sclera and skin, there are few reports of true vocal fold jaundice in patients with high bilirubin, and no reports by...
OBJECTIVES
While jaundice is frequently described in the sclera and skin, there are few reports of true vocal fold jaundice in patients with high bilirubin, and no reports by otolaryngologists in the literature. Here we describe a case of a patient with bilateral true vocal fold jaundice and discuss the potential pathogenesis and implications of this finding.
METHODS
A 29-year-old man with history of Dubin-Johnson Syndrome presented with cough and difficulty breathing and was incidentally found to have persistent yellow discoloration of the true vocal folds bilaterally.
RESULTS
Videolaryngoscopic exam demonstrated bilateral true vocal fold yellow discoloration with sparing of nearby laryngeal structures on initial presentation and follow-up exam. Direct and total bilirubin levels were found to be elevated.
CONCLUSION
A patient with benign Dubin-Johnson Syndrome and elevated total and direct bilirubin was incidentally found to have bilateral vocal fold jaundice. Jaundice and the presence of bilirubin do not appear to cause harm to the function or health of the true vocal folds and may be related to the high concentration of elastin present in the true vocal folds.
Topics: Adult; Bilirubin; Humans; Jaundice; Jaundice, Chronic Idiopathic; Liver Function Tests; Male; Vocal Cords
PubMed: 35417838
DOI: 10.1016/j.amjoto.2022.103456 -
Epidemiology and Infection Jan 2018Historical enquiry into diseases with morbidity or mortality predilections for particular demographic groups can permit clarification of their emergence, endemicity, and... (Review)
Review
Historical enquiry into diseases with morbidity or mortality predilections for particular demographic groups can permit clarification of their emergence, endemicity, and epidemicity. During community-wide outbreaks of hepatitis A in the pre-vaccine era, clinical attack rates were higher among juveniles rather than adults. In community-wide hepatitis E outbreaks, past and present, mortality rates have been most pronounced among pregnant women. Examination for these characteristic predilections in reports of jaundice outbreaks in the USA traces the emergence of hepatitis A and also of hepatitis E to the closing three decades of the 19th century. Thereafter, outbreaks of hepatitis A burgeoned, whereas those of hepatitis E abated. There were, in addition, community-wide outbreaks that bore features of neither hepatitis A nor E; they occurred before the 1870s. The American Civil War antedated that period. If hepatitis A had yet to establish endemicity, then it would not underlie the jaundice epidemic that was widespread during the war. Such an assessment may be revised, however, with the discovery of more extant outbreak reports.
Topics: Disease Outbreaks; Hepatitis A; Hepatitis E; History, 19th Century; History, 20th Century; Humans; Jaundice; Military Personnel; United States
PubMed: 29254514
DOI: 10.1017/S0950268817002837 -
The American Journal of Tropical... Dec 2018In the absence of a civil registration system, a house-to-house survey is often used to estimate cause-specific mortality in low- and middle-income countries. However,...
In the absence of a civil registration system, a house-to-house survey is often used to estimate cause-specific mortality in low- and middle-income countries. However, house-to-house surveys are resource and time intensive. We applied a low-cost community knowledge approach to identify maternal deaths from any cause and jaundice-associated deaths among persons aged ≥ 14 years, and stillbirths and neonatal deaths in mothers with jaundice during pregnancy in five rural communities in Bangladesh. We estimated the method's sensitivity and cost savings compared with a house-to-house survey. In the five communities with a total of 125,570 population, we identified 13 maternal deaths, 60 deaths among persons aged ≥ 14 years associated with jaundice, five neonatal deaths, and four stillbirths born to a mother with jaundice during pregnancy over the 3-year period before the survey using the community knowledge approach. The sensitivity of community knowledge method in identifying target deaths ranged from 80% for neonatal deaths to 100% for stillbirths and maternal deaths. The community knowledge approach required 36% of the staff time to undertake compared with the house-to-house survey. The community knowledge approach was less expensive but highly sensitive in identifying maternal and jaundice-associated mortality, as well as all-cause adult mortality in rural settings in Bangladesh. This method can be applied in rural settings of other low- and middle-income countries and, in conjunction with hospital-based hepatitis diagnoses, used to monitor the impact of programs to reduce the burden of cause-specific hepatitis mortality, a current World Health Organization priority.
Topics: Adolescent; Adult; Bangladesh; Cause of Death; Community Participation; Family Characteristics; Female; Health Knowledge, Attitudes, Practice; Health Surveys; Hepatitis; Humans; Incidence; Infant; Infant Mortality; Jaundice; Male; Maternal Death; Pregnancy; Rural Population; Stillbirth
PubMed: 30298803
DOI: 10.4269/ajtmh.17-0974 -
RoFo : Fortschritte Auf Dem Gebiete Der... Jul 2018
Topics: Adult; Carcinoma, Papillary; Diagnosis, Differential; Humans; Jaundice; Magnetic Resonance Imaging; Male; Pancreatic Cyst; Pancreatic Neoplasms; Pancreaticojejunostomy; Tomography, X-Ray Computed
PubMed: 29415298
DOI: 10.1055/s-0044-101262