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Seminars in Interventional Radiology Aug 2021Noninvasive imaging is a crucial and initial step in the diagnostic algorithm of patients with suspected biliary pathology and directs the subsequent diagnostic and... (Review)
Review
Noninvasive imaging is a crucial and initial step in the diagnostic algorithm of patients with suspected biliary pathology and directs the subsequent diagnostic and therapeutic workup, including the endoluminal and percutaneous biliary interventions. This article reviews the current noninvasive imaging methods for the evaluation of biliary system and further discusses their roles in the diagnostic workup of different biliary disease.
PubMed: 34393336
DOI: 10.1055/s-0041-1731268 -
Viszeralmedizin Jun 2015The biliary system is in continuous contact with the complex microbiota of the intestine. Microbial products have recently been proposed as potential triggers for... (Review)
Review
BACKGROUND
The biliary system is in continuous contact with the complex microbiota of the intestine. Microbial products have recently been proposed as potential triggers for biliary diseases.
METHODS
The aim of this review is to provide a summary of the current knowledge regarding the role of the biliary and intestinal microbiome in biliary inflammatory diseases.
RESULTS
Previously, it was suggested that the healthy biliary system is a sterile organ, while acute cholangitis and cholecystitis may occur from ascending infections. Although non-inflammatory biliary colonization by certain bacteria such as Salmonella spp. has been already recognized since several decades, human and animal studies indicated only very recently that the gallbladder harbors a complex microbiota also under non-pathologic conditions. Novel findings suggested that - similar to the situation in the intestine - the biliary mucosa features a chemical, mechanical, and immunological barrier, ensuring immunological tolerance against commensals. However, microbial triggers might influence acute and chronic inflammatory disease of the biliary system and the whole liver.
CONCLUSION
Although yet undefined, dysbiosis of the biliary or intestinal microbiota rather than a single microorganism may influence disease progression.
PubMed: 26468308
DOI: 10.1159/000431071 -
Mayo Clinic Proceedings Jan 1998Extrahepatic biliary atresia is an obliterative cholangiopathy that involves all or part of the extrahepatic biliary tree and, in many cases, the intrahepatic bile... (Review)
Review
Extrahepatic biliary atresia is an obliterative cholangiopathy that involves all or part of the extrahepatic biliary tree and, in many cases, the intrahepatic bile ducts. In the United States, from 400 to 600 new cases of biliary atresia are encountered annually. The diagnosis is usually suggested by the persistence of jaundice for 6 weeks or more after birth. Several factors have been considered for the pathogenesis of extrahepatic biliary atresia, including viral infection, metabolic insults, and abnormalities in bile duct morphogenesis. Although selected patients benefit from prompt diagnosis and Kasai portoenterostomy surgical intervention within the first 60 days of life, many ultimately require liver transplantation because of portal hypertension, recurrent cholangitis, and cirrhosis.
Topics: Bile Ducts, Extrahepatic; Biliary Atresia; Diagnosis, Differential; Humans; Liver
PubMed: 9443685
DOI: 10.1016/S0025-6196(11)63625-2 -
Journal of Nuclear Medicine : Official... Jun 2014Cholescintigraphy with (99m)Tc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to... (Review)
Review
Cholescintigraphy with (99m)Tc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide.
Topics: Biliary Tract; Biliary Tract Diseases; False Positive Reactions; Humans; Liver; Radionuclide Imaging; Reference Standards
PubMed: 24744445
DOI: 10.2967/jnumed.113.131490 -
Frontiers in Immunology 2022The biliary system is comprised of cholangiocytes and plays an important role in maintaining liver function. Under normal conditions, cholangiocytes remain in the... (Review)
Review
The biliary system is comprised of cholangiocytes and plays an important role in maintaining liver function. Under normal conditions, cholangiocytes remain in the stationary phase and maintain a very low turnover rate. However, the robust biliary repair is initiated in disease conditions, and different repair mechanisms can be activated depending on the pathological changes. During biliary disease, immune cells including monocytes, lymphocytes, neutrophils, and mast cells are recruited to the liver. The cellular interactions between cholangiocytes and these recruited immune cells as well as hepatic resident immune cells, including Kupffer cells, determine disease outcomes. However, the role of immune cells in the initiation, regulation, and suspension of biliary repair remains elusive. The cellular processes of cholangiocyte proliferation, progenitor cell differentiation, and hepatocyte-cholangiocyte transdifferentiation during biliary diseases are reviewed to manifest the underlying mechanism of biliary repair. Furthermore, the potential role of immune cells in crucial biliary repair mechanisms is highlighted. The mechanisms of biliary repair in immune-mediated cholangiopathies, inherited cholangiopathies, obstructive cholangiopathies, and cholangiocarcinoma are also summarized. Additionally, novel techniques that could clarify the underlying mechanisms of biliary repair are displayed. Collectively, this review aims to deepen the understanding of the mechanisms of biliary repair and contributes potential novel therapeutic methods for treating biliary diseases.
Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Biliary Tract; Cholangiocarcinoma; Humans; Liver
PubMed: 35432349
DOI: 10.3389/fimmu.2022.866040 -
British Journal of Hospital Medicine... Mar 2022Recent years have seen major advances in our understanding of primary biliary cholangitis, with the condition now renamed to reflect the majority of patients who do not... (Review)
Review
Recent years have seen major advances in our understanding of primary biliary cholangitis, with the condition now renamed to reflect the majority of patients who do not have cirrhosis. Data from large multicentre studies have greatly increased our knowledge of the natural history of primary biliary cholangitis, making the identification of higher risk patients clearer and facilitating the development of new medications. Recent guidelines have emphasised the importance of risk stratification, targeted treatment of symptoms and early prioritisation for second line therapies. The review summarises recent major developments in our understanding of primary biliary cholangitis and its management.
Topics: Humans; Liver Cirrhosis; Liver Cirrhosis, Biliary
PubMed: 35377202
DOI: 10.12968/hmed.2021.0450 -
Transplant International : Official... 2022In recent years, significant progress has been made in the field of liver machine perfusion. Many large transplant centers have implemented machine perfusion strategies... (Review)
Review
In recent years, significant progress has been made in the field of liver machine perfusion. Many large transplant centers have implemented machine perfusion strategies in their clinical routine. Normothermic machine perfusion (NMP) is primarily used to determine the quality of extended criteria donor (ECD) organs and for logistical reasons. The vast majority of studies, which assessed the viability of perfused grafts, focused on hepatocellular injury. However, biliary complications are still a leading cause of post-transplant morbidity and the need for re-transplantation. To evaluate the extent of biliary injury during NMP, reliable criteria that consider cholangiocellular damage are needed. In this review, different approaches to assess damage to the biliary tree and the current literature on the possible effects of NMP on the biliary system and biliary injury have been summarized. Additionally, it provides an overview of novel biomarkers and therapeutic strategies that are currently being investigated. Although expectations of NMP to adequately assess biliary injury are high, scant literature is available. There are several biomarkers that can be measured in bile that have been associated with outcomes after transplantation, mainly including pH and electrolytes. However, proper validation of those and other novel markers and investigation of the pathophysiological effect of NMP on the biliary tree is still warranted.
Topics: Biliary Tract; Biomarkers; Humans; Liver; Liver Transplantation; Organ Preservation; Perfusion
PubMed: 35707635
DOI: 10.3389/ti.2022.10398 -
Chirurgia (Bucharest, Romania : 1990) Dec 2021Spontaneous biliary-enteric fistula (SBEF) is an abnormal communication between the biliary tree and the gastrointestinal tract which develops as a result of biliary or... (Review)
Review
Spontaneous biliary-enteric fistula (SBEF) is an abnormal communication between the biliary tree and the gastrointestinal tract which develops as a result of biliary or gastrointestinal disease. Iatrogenic fistulas, due to surgery or instrumental exploration, are not included in this definition. R. Colombo, in 1559, was the first to describe SBEF as an occasional finding during an autopsy. In almost 90% of cases the cause of SBEF is chronic recurrent cholelithiasis. Less common causes are penetrating peptic ulcers and neoplastic infiltration from the biliary or gastrointestinal tract. The most common type of SBEF is cholecystoduodenal fistula and the least common is choledochoduodenal fistula. There are various complications associated with SBEF but often these are not promptly recognized by patients or physicians and diagnosis and treatment may be delayed for years. The most important complication, which can be considered pathognomonic for SBEF, is gallstone ileus which manifests clinically as acute or chronic mechanical intestinal obstruction. Gallstone ileus, a rather rare complication of a rather common pathology, biliary lithiasis, is found in 0.000015% of hospitalized patients but in 0.0003% of surgical patients. It is mainly found in women over the age of 65, with a male to-female ratio of 1:5. There are various forms of occlusion, related to the sites of gallstone impaction, with various clinical characteristics and degrees of severity. These include Bouveret syndrome ( 10% of cases) with impaction in duodenum or pylorus, and the more common Barnard's syndrome (5-75% of cases) in which the site of impaction is in the terminal ileum right before Bauhin's valve. For diagnosis, the radiological signs which make up Riglerâ??s triad or tetrad, are essential, and are best visible on magnetic resonance. The the gold standard is contrast-enhanced computed tomography scan. Regarding the surgical management, one-stage simple enterolithotomy is reserved for the oldest patients and the most severe cases. Nowadays, is performed more and more frequently by laparoscopy. In more favorable cases radical treatment of the occlusion, the biliary lithiasis and the SBEF is recommended, either as a one-stage procedure or in two stages with the second procedure performed after few weeks.
Topics: Biliary Fistula; Female; Gallstones; Humans; Intestinal Obstruction; Intestine, Small; Male; Treatment Outcome
PubMed: 35274609
DOI: No ID Found -
World Journal of Gastroenterology May 2013Biliary tract complications are the most common complications after liver transplantation. These complications are encountered more commonly as a result of increased... (Review)
Review
Biliary tract complications are the most common complications after liver transplantation. These complications are encountered more commonly as a result of increased number of liver transplantations and the prolonged survival of transplant patients. Biliary complications remain a major source of morbidity in liver transplant patients, with an incidence of 5%-32%. Post liver transplantation biliary complications include strictures (anastomotic and non-anastomotic), leaks, stones, sphincter of Oddi dysfunction, and recurrence of primary biliary disease such as primary sclerosing cholangitis and primary biliary cirrhosis. The risk of occurrence of a specific biliary complication is related to the type of biliary reconstruction performed at the time of liver transplantation. In this article we seek to review the major biliary complications and their relation to the type of biliary reconstruction performed at the time of liver tranplantation.
Topics: Biliary Tract Diseases; Cholangiopancreatography, Endoscopic Retrograde; Humans; Liver Transplantation; Reoperation; Risk Factors; Treatment Outcome
PubMed: 23704818
DOI: 10.3748/wjg.v19.i19.2841 -
Clinical Endoscopy Nov 2021The diagnosis of biliary strictures in clinical practice can be challenging. Discriminating between benign and malignant biliary strictures is important to prevent the... (Review)
Review
The diagnosis of biliary strictures in clinical practice can be challenging. Discriminating between benign and malignant biliary strictures is important to prevent the morbidity and mortality associated with incorrect diagnoses. Missing a malignant biliary stricture may delay surgery, resulting in poor prognostic outcomes. Conversely, it has been demonstrated that approximately 20% of patients who undergo surgery for suspected biliary malignancies have a benign etiology on histopathology. Traditional tissue sampling using endoscopic retrograde cholangiography does not always produce a definitive diagnosis, with a considerable proportion of cases remaining as indeterminate biliary strictures. Recent advances in endoscopic techniques have the potential to improve the diagnostic and prognostic accuracy of biliary strictures.
PubMed: 34038998
DOI: 10.5946/ce.2021.048