-
Revista de Gastroenterologia de Mexico... 2019
Topics: Autoimmune Diseases; Cohort Studies; Humans; Liver Cirrhosis, Biliary; Mexico
PubMed: 30541671
DOI: 10.1016/j.rgmx.2018.07.005 -
Orphanet Journal of Rare Diseases Jul 2006Biliary atresia (BA) is a rare disease characterised by a biliary obstruction of unknown origin that presents in the neonatal period. It is the most frequent surgical... (Review)
Review
Biliary atresia (BA) is a rare disease characterised by a biliary obstruction of unknown origin that presents in the neonatal period. It is the most frequent surgical cause of cholestatic jaundice in this age group. BA occurs in approximately 1/18,000 live births in Western Europe. In the world, the reported incidence varies from 5/100,000 to 32/100,000 live births, and is highest in Asia and the Pacific region. Females are affected slightly more often than males. The common histopathological picture is one of inflammatory damage to the intra- and extrahepatic bile ducts with sclerosis and narrowing or even obliteration of the biliary tree. Untreated, this condition leads to cirrhosis and death within the first years of life. BA is not known to be a hereditary condition. No primary medical treatment is relevant for the management of BA. Once BA suspected, surgical intervention (Kasai portoenterostomy) should be performed as soon as possible as operations performed early in life is more likely to be successful. Liver transplantation may be needed later if the Kasai operation fails to restore the biliary flow or if cirrhotic complications occur. At present, approximately 90% of BA patients survive and the majority have normal quality of life.
Topics: Biliary Atresia; Biliary Tract; Biliary Tract Surgical Procedures; Cholestasis; Female; Humans; Infant, Newborn; Liver Transplantation; Male
PubMed: 16872500
DOI: 10.1186/1750-1172-1-28 -
Experimental Biology and Medicine... Jan 2018Autoimmunity is a consequence of both genetic and environmental factors, occurring in genetically susceptible hosts with environmental triggers. While genome-wide... (Review)
Review
Autoimmunity is a consequence of both genetic and environmental factors, occurring in genetically susceptible hosts with environmental triggers. While genome-wide association studies have revealed a number of susceptible genes contributing to etiology, the environmental triggers remain poorly understood. Primary biliary cholangitis, formally known as primary biliary cirrhosis, is considered a model autoimmune disease for which our group has extensively evaluated environmental factors involved in its etiology. Bacterial infection and xenobiotics have been proposed as candidate environmental factors that may explain tolerance breakdown and production of primary biliary cholangitis-specific antimitochondrial autoantibodies. Large-scale case-control studies have consistently detected an association of primary biliary cholangitis with urinary tract infections caused by Escherichia coli, as E. coli PDC-E2 is molecularly similar to human PDC-E2, the immunodominant target of AMAs. Another bacterium of interest is Novosphingobium aromaticivorans, a ubiquitous xenobiotic-metabolizing bacterium that produces lipoylated proteins, which are highly reactive with sera from primary biliary cholangitis patients. Regarding xenobiotics, case-control studies have suggested that frequent use of nail polish is associated with an increased susceptibility to primary biliary cholangitis. We found that 2-octynamide, the conjugate derived from 2-octynoic acid present in cosmetics, lipsticks, and some chewing gums, was unique in both its quantitative structure-activity relationship analysis and reactivity with primary biliary cholangitis sera. 2-nonyamide is another xenobiotic that also has the optimal chemical structure for xenobiotic modification of the PDC-E2 epitope, as demonstrated by the enhanced epitope recognition with AMA-positive PBC sera. Moreover, we found that C57BL/6 mice immunized with 2-octynoic acid-BSA possess many of the features characteristic to primary biliary cholangitis. Impact statement Autoimmunity is believed to develop in genetically susceptible hosts with triggers from the environment. Researchers have recently demonstrated that bacteria and xenobiotics commonly present in our environment are potential triggers of tolerance breakdown against autoantigens and autoimmunity, particularly in primary biliary cholangitis (PBC). The link between xenobiotics and PBC has been further confirmed with the establishment of PBC model mice by immunizing mice with xenobiotics.
Topics: Animals; Cosmetics; Disease Models, Animal; Environmental Exposure; Escherichia coli; Genome-Wide Association Study; Gram-Negative Bacterial Infections; Humans; Liver Cirrhosis, Biliary; Mice, Inbred C57BL; Sphingomonadaceae; Urinary Tract Infections; Xenobiotics
PubMed: 29307284
DOI: 10.1177/1535370217748893 -
World Journal of Gastroenterology Feb 2012Endoscopic ultrasound (EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary... (Review)
Review
Endoscopic ultrasound (EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-guided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and techniques. EUS-guided biliary drainage is an attractive option because of its minimally invasive, single step procedure which provides internal biliary decompression. Multiple investigators have reported high success and low complication rates. Unfortunately, high quality prospective data are still lacking. We provide detailed review of the use of EUS for biliary drainage from the perspective of practicing endoscopists with specific focus on the technical aspects of the procedure.
Topics: Biliary Tract Diseases; Drainage; Endosonography; Humans; Stents
PubMed: 22363114
DOI: 10.3748/wjg.v18.i6.491 -
Liver Research Dec 2018The terms biliary sludge and cholesterol microlithiasis (hereafter referred to as microlithiasis) were originated from different diagnostic techniques and may represent...
The terms biliary sludge and cholesterol microlithiasis (hereafter referred to as microlithiasis) were originated from different diagnostic techniques and may represent different stages of cholesterol gallstone disease. Although the pathogenesis of biliary sludge and microlithiasis may be similar, microlithiasis could be preceded by biliary sludge, followed by persistent precipitation and aggregation of solid cholesterol crystals, and eventually, gallstone formation. Many clinical conditions are clearly associated with the formation of biliary sludge and microlithiasis, including total parenteral nutrition, rapid weight loss, pregnancy, organ transplantation, administration of certain medications, and a variety of acute and chronic illnesses. Numerous studies have demonstrated complete resolution of biliary sludge in approximately 40% of patients, a cyclic pattern of disappearing and reappearing in about 40%, and progression to gallstones in nearly 20%. Although only a minority of patients with ultrasonographic demonstration of biliary sludge develop gallstones, it is still a matter of controversy whether microlithiasis could eventually evolve to cholesterol gallstones. Biliary sludge and microlithiasis are asymptomatic in the vast majority of patients; however, they can cause biliary colic, acute cholecystitis, and acute pancreatitis. Biliary sludge and microlithiasis are most often diagnosed ultrasonographically and bile microscopy is considered the gold standard for their diagnosis. Specific measures to prevent the development of biliary sludge are not practical or cost-effective in the general population. Laparoscopic cholecystectomy offers the most definitive therapy on biliary sludge. Endoscopic sphincterotomy or surgical intervention is effective for microlithiasis-induced pancreatitis. Ursodeoxycholic acid can effectively prevent the recurrence of solid cholesterol crystals and significantly reduce the risk of recurrent pancreatitis.
PubMed: 34367716
DOI: 10.1016/j.livres.2018.10.001 -
Outcome of stenting in biliary and pancreatic benign and malignant diseases: A comprehensive review.World Journal of Gastroenterology Aug 2015Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are... (Review)
Review
Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct and may also be used to treat biliary or pancreatic leaks, pancreatic fluid collections and to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. In this review, relevant literature search and expert opinions have been used to evaluate the outcome of stenting in biliary and pancreatic benign and malignant diseases.
Topics: Biliary Tract Diseases; Biliary Tract Neoplasms; Cholangiopancreatography, Endoscopic Retrograde; Humans; Metals; Pancreatic Diseases; Pancreatic Neoplasms; Plastics; Prosthesis Design; Stents; Treatment Outcome
PubMed: 26290631
DOI: 10.3748/wjg.v21.i30.9038 -
Mediators of Inflammation 2010Biliary innate immunity is involved in the pathogenesis of cholangiopathies in patients with primary biliary cirrhosis (PBC) and biliary atresia. Biliary epithelial... (Review)
Review
Biliary innate immunity is involved in the pathogenesis of cholangiopathies in patients with primary biliary cirrhosis (PBC) and biliary atresia. Biliary epithelial cells possess an innate immune system consisting of the Toll-like receptor (TLR) family and recognize pathogen-associated molecular patterns (PAMPs). Tolerance to bacterial PAMPs such as lipopolysaccharides is also important to maintain homeostasis in the biliary tree, but tolerance to double-stranded RNA (dsRNA) is not found. In PBC, CD4-positive Th17 cells characterized by the secretion of IL-17 are implicated in the chronic inflammation of bile ducts and the presence of Th17 cells around bile ducts is causally associated with the biliary innate immune responses to PAMPs. Moreover, a negative regulator of intracellular TLR signaling, peroxisome proliferator-activated receptor-gamma (PPARgamma), is involved in the pathogenesis of cholangitis. Immunosuppression using PPARgamma ligands may help to attenuate the bile duct damage in PBC patients. In biliary atresia characterized by a progressive, inflammatory, and sclerosing cholangiopathy, dsRNA viruses are speculated to be an etiological agent and to directly induce enhanced biliary apoptosis via the expression of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL). Moreover, the epithelial-mesenchymal transition (EMT) of biliary epithelial cells is also evoked by the biliary innate immune response to dsRNA.
Topics: Animals; Antigens, Bacterial; Biliary Atresia; Biliary Tract; Cholangitis; Cytokines; Defensins; Epithelial-Mesenchymal Transition; Gallstones; Humans; Immunity, Innate; Liver Cirrhosis, Biliary; PPAR gamma; Th17 Cells; Toll-Like Receptors
PubMed: 20798866
DOI: 10.1155/2010/373878 -
Seminars in Interventional Radiology Dec 2016Therapeutic access to the biliary system is generally limited to endoscopic or percutaneous approaches. A variety of percutaneous transhepatic biliary interventions are... (Review)
Review
Therapeutic access to the biliary system is generally limited to endoscopic or percutaneous approaches. A variety of percutaneous transhepatic biliary interventions are applicable for the diagnosis and treatment of biliary system pathologies, the majority of which may be performed in conjunction with one another. The backbone of nearly all of these interventions is percutaneous transhepatic cholangiography for opacification of the biliary tree, after which any number of therapeutic or diagnostic modalities may be pursued. We describe an overview of the instrumentation and technical approaches for several fundamental interventional procedures, including percutaneous transhepatic cholangiography and internal/external biliary drainage, endobiliary biopsy techniques, cholangioscopy, cholangioplasty and biliary stenting, biliary stone extraction, and intraluminal brachytherapy.
PubMed: 27904247
DOI: 10.1055/s-0036-1592327 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2020Biliary fistula is one of the most common complications of liver and biliary tract surgeries. Endoscopic retrograde cholangiopancreatography (ERCP) is used for the...
BACKGROUND
Biliary fistula is one of the most common complications of liver and biliary tract surgeries. Endoscopic retrograde cholangiopancreatography (ERCP) is used for the diagnosis and treatment of biliary fistulas. In this study, we aimed to analyze the contribution of ERCP in this regard.
METHODS
Patients who underwent ERCP for biliary fistulas following liver and biliary tract surgery between January 2012 and December 2017 were included in this study. The demographic characteristics of the patient, surgical procedure, localization of the biliary fistula, classification of biliary duct injury, and success of ERCP were retrospectively evaluated.
RESULTS
In total, 90 patients (37 male and 53 female) with a diagnosis of biliary fistula underwent ERCP. Common biliary duct (CBD) cannulation was achieved in 87 patients using ERCP. In five patients, the proximal part of the biliary tract was not visualized, and complete injury of CBD was considered. In ERCP, contrast extravasation was detected in the cystic duct in 44 patients: CBD, eight patients; liver bed, four patients; hepatic duct bifurcation, two patients; the right hepatic canal, seven patients; and the left hepatic canal, two patients.
CONCLUSION
ERCP is an effective method for the diagnosis and treatment of biliary diseases. The diagnosis and treatment of postoperative biliary fistulas with ERCP reduces surgery cost, morbidity, and mortality.
Topics: Biliary Fistula; Cholangiopancreatography, Endoscopic Retrograde; Humans; Postoperative Complications; Retrospective Studies
PubMed: 31942742
DOI: 10.14744/tjtes.2019.63667 -
The British Journal of Radiology Jul 2012Recent developments in imaging technology have enabled CT and MR cholangiopancreatography (MRCP) to provide minimally invasive alternatives to endoscopic retrograde... (Comparative Study)
Comparative Study Review
Recent developments in imaging technology have enabled CT and MR cholangiopancreatography (MRCP) to provide minimally invasive alternatives to endoscopic retrograde cholangiopancreatography for the pre- and post-operative assessment of biliary disease. This article describes anatomical variants of the biliary tree with surgical significance, followed by comparison of CT and MR cholangiographies. Drip infusion cholangiography with CT (DIC-CT) enables high-resolution three-dimensional anatomical representation of very small bile ducts (e.g. aberrant branches, the caudate branch and the cystic duct), which are potential causes of surgical complications. The disadvantages of DIC-CT include the possibility of adverse reactions to biliary contrast media and insufficient depiction of bile ducts caused by liver dysfunction or obstructive jaundice. Conventional MRCP is a standard, non-invasive method for evaluating the biliary tree. MRCP provides useful information, especially regarding the extrahepatic bile ducts and dilated intrahepatic bile ducts. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRCP may facilitate the evaluation of biliary structure and excretory function. Understanding the characteristics of each type of cholangiography is important to ensure sufficient perioperative evaluation of the biliary system.
Topics: Adult; Aged; Biliary Tract; Biliary Tract Diseases; Biliary Tract Neoplasms; Cholangiography; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Perioperative Care; Radiographic Image Enhancement; Risk Assessment; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 22422383
DOI: 10.1259/bjr/21209407