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Revista Espanola de Enfermedades... Dec 2020both percutaneous transhepatic cholangiography and drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) with SEMS implantation have been used for...
INTRODUCTION
both percutaneous transhepatic cholangiography and drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) with SEMS implantation have been used for unresectable hilar cholangiocarcinoma (HC) in the clinic for many years. However, which one is preferred is still unknown.
OBJECTIVE
to study the effects of biliary drainage of self-expanding metal stents (SEMS) implantation under PTCD or ERCP to treat HC.
METHODS
the clinical data of 82 patients with HC from January 2006 to January 2015 were recorded retrospectively. Patients were treated with biliary implantation of self-expanding metal stents (SEMS) under PTCD (PTCD group, 40 patients) or ERCP (ERCP group, 42 patients). Clinical data, including total bilirubin concentrations, complications and survival time were analyzed.
RESULTS
the remission of jaundice was similar in both groups (p > 0.05). The median survival time of the ERCP group and PTCD group were 237 d and 252 d respectively, with no significant differences (p > 0.05). The biliary infection rates under ERCP and PTCD procedure were 52.4 % and 20.0 % respectively, with a significant statistical difference (p < 0.05). For those HC patients of Bismuth III/IV, the infection rates under ERCP and PTCD procedure were 58.3 % and 14.3 %, respectively (p < 0.05).
CONCLUSIONS
both PTCD and ERCP with SEMS implantation were effective to prolong the survival time of HC patients. The biliary infection rates were higher in the ERCP group, especially for Bismuth III/IV HC patients.
Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Humans; Klatskin Tumor; Retrospective Studies; Stents
PubMed: 33118356
DOI: 10.17235/reed.2020.6937/2020 -
Australian Family Physician Dec 2004Gallstones are a common cause of abdominal pain. Gallstones are present in 20% of women and 8% of men, but might not cause symptoms. (Review)
Review
BACKGROUND
Gallstones are a common cause of abdominal pain. Gallstones are present in 20% of women and 8% of men, but might not cause symptoms.
OBJECTIVE
This article discusses the aetiology of biliary colic and related disorders. The differential diagnosis is examined and relevant investigations are outlined. Some less common aspects of this disease complex are described for context.
DISCUSSION
The only effective treatment for symptomatic gallstones is cholecystectomy, for which the laparoscopic approach is now the gold standard.
Topics: Biliary Tract Diseases; Cholangiography; Cholecystectomy, Laparoscopic; Colic; Diagnosis, Differential; Family Practice; Female; Gallstones; Humans; Irritable Bowel Syndrome; Male; Pancreatitis; Peptic Ulcer
PubMed: 15630917
DOI: No ID Found -
World Journal of Gastroenterology Sep 2021Laparoscopic cholecystectomy (LC) is one of the most frequently performed gastrointestinal surgeries worldwide. Bile duct injury (BDI) represents the most serious...
Laparoscopic cholecystectomy (LC) is one of the most frequently performed gastrointestinal surgeries worldwide. Bile duct injury (BDI) represents the most serious complication of LC, with an incidence of 0.3%-0.7%, resulting in significant perioperative morbidity and mortality, impaired quality of life, and high rates of subsequent medico-legal litigation. In most cases, the primary cause of BDI is the misinterpretation of biliary anatomy, leading to unexpected biliary lesions. Near-infrared fluorescent cholangiography is widely spreading in clinical practice to delineate biliary anatomy during LC in elective and emergency settings. The primary aim of this article was to perform an up-to-date overview of the evolution of this method 12 years after the first clinical application in 2009 and to highlight all advantages and current limitations according to the available scientific evidence.
Topics: Bile Duct Diseases; Cholangiography; Cholecystectomy, Laparoscopic; Coloring Agents; Humans; Quality of Life
PubMed: 34629815
DOI: 10.3748/wjg.v27.i36.5989 -
World Journal of Gastroenterology Jul 2015To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system. (Review)
Review
AIM
To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system.
METHODS
MEDLINE and PubMed searches were performed using the key words "fluorescent cholangiography", "fluorescent angiography", "intraoperative fluorescent imaging", and "laparoscopic cholecystectomy" in order to identify relevant articles published in English, French, German, and Italian during the years of 2009 to 2014. Reference lists from the articles were reviewed to identify additional pertinent articles. For studies published in languages other than those mentioned above, all available information was collected from their English abstracts. Retrieved manuscripts (case reports, reviews, and abstracts) concerning the application of fluorescent cholangiography were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. In contrast to classic meta-analyses, statistical analysis was performed where the outcome was calculated as the percentages of an event (without comparison) in pseudo-cohorts of observed patients.
RESULTS
A total of 16 studies were found that involved fluorescent cholangiography during standard laparoscopic cholecystectomies (n = 11), single-incision robotic cholecystectomies (n = 3), multiport robotic cholecystectomy (n = 1), and single-incision laparoscopic cholecystectomy (n = 1). Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of important biliary anatomy and could facilitate the prevention of bile duct injuries. The structures effectively identified before dissection of Calot's triangle included the cystic duct (CD), the common hepatic duct (CHD), the common bile duct (CBD), and the CD-CHD junction. A review of the literature revealed that the frequencies of detection of the extrahepatic biliary system ranged from 71.4% to 100% for the CD, 33.3% to 100% for the CHD, 50% to 100% for the CBD, and 25% to 100% for the CD-CHD junction. However, the frequency of visualization of the CD and the CBD were reduced in patients with a body mass index > 35 kg/m(2) relative to those with a body mass index < 35 kg/m(2) (91.0% and 64.0% vs 92.3% and 71.8%, respectively).
CONCLUSION
Fluorescent cholangiography is a safe procedure enabling real-time visualization of bile duct anatomy and may become standard practice to prevent bile duct injury during laparoscopic cholecystectomy.
Topics: Anatomic Landmarks; Bile Ducts; Cholangiography; Cholecystectomy, Laparoscopic; Fluorescent Dyes; Humans; Indocyanine Green; Intraoperative Care; Luminescent Measurements; Optical Imaging; Predictive Value of Tests; Risk Factors; Wounds and Injuries
PubMed: 26167088
DOI: 10.3748/wjg.v21.i25.7877 -
Surgery Dec 2022Published empirical data have increasingly suggested that using near-infrared fluorescence cholangiography during laparoscopic cholecystectomy markedly increases biliary...
BACKGROUND
Published empirical data have increasingly suggested that using near-infrared fluorescence cholangiography during laparoscopic cholecystectomy markedly increases biliary anatomy visualization. The technology is rapidly evolving, and different equipment and doses may be used. We aimed to identify areas of consensus and nonconsensus in the use of incisionless near-infrared fluorescent cholangiography during laparoscopic cholecystectomy.
METHODS
A 2-round Delphi survey was conducted among 28 international experts in minimally invasive surgery and near-infrared fluorescent cholangiography in 2020, during which respondents voted on 62 statements on patient preparation and contraindications (n = 12); on indocyanine green administration (n = 14); on potential advantages and uses of near-infrared fluorescent cholangiography (n = 18); comparing near-infrared fluorescent cholangiography with intraoperative x-ray cholangiography (n = 7); and on potential disadvantages of and required training for near-infrared fluorescent cholangiography (n = 11).
RESULTS
Expert consensus strongly supports near-infrared fluorescent cholangiography superiority over white light for the visualization of biliary structures and reduction of laparoscopic cholecystectomy risks. It also offers other advantages like enhancing anatomic visualization in obese patients and those with moderate to severe inflammation. Regarding indocyanine green administration, consensus was reached that dosing should be on a milligrams/kilogram basis, rather than as an absolute dose, and that doses >0.05 mg/kg are necessary. Although there is no consensus on the optimum preoperative timing of indocyanine green injections, the majority of participants consider it important to administer indocyanine green at least 45 minutes before the procedure to decrease the light intensity of the liver.
CONCLUSION
Near-infrared fluorescent cholangiography experts strongly agree on its effectiveness and safety during laparoscopic cholecystectomy and that it should be used routinely, but further research is necessary to establish optimum timing and doses for indocyanine green.
Topics: Humans; Indocyanine Green; Cholecystectomy, Laparoscopic; Cholangiography; Optical Imaging; Coloring Agents
PubMed: 36427926
DOI: 10.1016/j.surg.2022.07.012 -
Revue Medicale de Liege Jul 2022Cholelithiasis is rare in children and even more so in infants. We report the case of a 3-month-old patient with cholestatic jaundice secondary to an obstruction of the...
Cholelithiasis is rare in children and even more so in infants. We report the case of a 3-month-old patient with cholestatic jaundice secondary to an obstruction of the terminal portion of the bile duct. The treatment applied in this patient was a cholecystectomy with trans-cystic cholangiography and common bile duct clearance. The evolution was excellent. The current literature on biliary lithiasis in children and infants is poor in large cohort studies. The various treatments proposed, if necessary, include biliary lavage by percutaneous puncture, endoscopic retrograde cholangiopancreatography with sphincterotomy and laparoscopic or open cholecystectomy with intraoperative cholangiography. None of these procedures has shown superiority over the others. Therefore, no treatment algorithm is currently defined. Patients are treated on a case-by-case basis according to their symptoms, previous history and the level of expertise of each centre for these rare, difficult and specific procedures.
Topics: Child; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholelithiasis; Humans; Infant; Laparoscopy
PubMed: 35924500
DOI: No ID Found -
The Journal of Trauma and Acute Care... Feb 2017Percutaneous cholecystostomy (PC) is often performed for patients with acute cholecystitis who are at high risk for operative morbidity and mortality. However, the... (Comparative Study)
Comparative Study
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 cholangiography (RSC, n = 43) were compared to patients who had on-demand cholangiography (ODC, n = 41) triggered by recurrent biliary disease.
RESULTS
RSC and ODC groups were similar by severity of acute cholecystitis, presence of gallstones, systemic inflammatory response syndrome (SIRS) criteria at the time of PC, SIRS criteria 72 hours after PC, and hospital length of stay. Two patients in the ODC group developed clinical indications for cholangiography. All 44 RSC patients had cholangiography, and 67 total cholangiograms were performed in this group. Surveillance cholangiography identified six patients (14%) with cystic duct filling defect and seven patients (16%) with a common bile duct filling defect, all of whom were asymptomatic. Fifteen patients (35%) in the RSC group had 32 ERCP procedures; five patients (12%) in the ODC group had 7 ERCPs (p = 0.021). The ODC group had fewer days to drain removal (35 vs. 61, p < 0.001) and days to cholecystectomy (39 vs. 81, p = 0.005). Rates of recurrent cholecystitis, cholangitis, gallstone pancreatitis, drain removal, and cholecystectomy were similar between groups.
CONCLUSION
RSC after PC for acute cholecystitis identified biliary pathology in asymptomatic patients and propagated further testing, but did not provide clinical benefit. ODC was associated with earlier drain removal, earlier cholecystectomy, and decreased resource utilization.
LEVEL OF EVIDENCE
Prognostic study, level III; therapeutic study, level IV.
Topics: Aged; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholecystitis, Acute; Cholecystostomy; Comorbidity; Device Removal; Drainage; Florida; Humans; Length of Stay; Retrospective Studies; Severity of Illness Index; Systemic Inflammatory Response Syndrome
PubMed: 27893641
DOI: 10.1097/TA.0000000000001315 -
Abdominal Radiology (New York) Sep 2022Over 2500 percutaneous transhepatic cholangiography and biliary drainage (PTCD) procedures are yearly performed in the Netherlands. Most interventions are performed for... (Observational Study)
Observational Study
OBJECTIVES
Over 2500 percutaneous transhepatic cholangiography and biliary drainage (PTCD) procedures are yearly performed in the Netherlands. Most interventions are performed for treatment of biliary obstruction following unsuccessful endoscopic biliary cannulation. Our aim was to evaluate complication rates and risk factors for complications in PTCD patients after failed ERCP.
METHODS
We performed an observational study collecting data from a cohort that was subjected to PTCD during a 5-year period in one academic and four teaching hospitals. Primary objective was the development of infectious (sepsis, cholangitis, abscess, or cholecystitis) and non-infectious complications (bile leakage, severe hemorrhage, etc.) and mortality within 30 days of the procedure. Subsequently, risk factors for complications and mortality were analyzed with a multilevel logistic regression analysis.
RESULTS
A total of 331 patients underwent PTCD of whom 205 (61.9%) developed PTCD-related complications. Of the 224 patients without a pre-existent infection, 91 (40.6%) developed infectious complications, i.e., cholangitis in 26.3%, sepsis in 24.6%, abscess formation in 2.7%, and cholecystitis in 1.3%. Non-infectious complications developed in 114 of 331 patients (34.4%). 30-day mortality was 17.2% (N = 57). Risk factors for infectious complications included internal drainage and drain obstruction, while multiple re-interventions were a risk factor for non-infectious complications.
CONCLUSION
Both infectious and non-infectious complications are frequent after PTCD, most often due to biliary drain obstruction.
Topics: Abscess; Cholangiography; Cholangitis; Cholecystitis; Cholestasis; Drainage; Humans; Sepsis
PubMed: 34357434
DOI: 10.1007/s00261-021-03207-4 -
Surgical Endoscopy Oct 2022Decades of debate surround the use of intraoperative cholangiography (IOC) during cholecystectomy. To the present day, the role of IOC is controversial as regards... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Decades of debate surround the use of intraoperative cholangiography (IOC) during cholecystectomy. To the present day, the role of IOC is controversial as regards decreasing the rate of bile duct injury (BDI). We aimed to review and analyse the available literature on the benefits of IOC during cholecystectomy.
METHODS
A systematic literature search was performed until 19 October 2020 in five databases using the following search keys: cholangiogra* and cholecystectomy. The primary outcomes were BDI and retained stone rate. To investigate the differences between the groups (routine IOC vs selective IOC and IOC vs no IOC), we calculated weighted mean differences (WMD) for continuous outcomes and relative risks (RR) for dichotomous outcomes, with 95% confidence intervals (CI).
RESULTS
Of the 19,863 articles, 38 were selected and 32 were included in the quantitative synthesis. Routine IOC showed no superiority compared to selective IOC in decreasing BDI (RR = 0.91, 95% CI 0.66; 1.24). Comparing IOC and no IOC, no statistically significant differences were found in the case of BDI, retained stone rate, readmission rate, and length of hospital stay. We found an increased risk of conversion rate to open surgery in the no IOC group (RR = 0.64, CI 0.51; 0.78). The operation time was significantly longer in the IOC group compared to the no IOC group (WMD = 11.25 min, 95% CI 6.57; 15.93).
CONCLUSION
Our findings suggest that IOC may not be indicated in every case, however, the evidence is very uncertain. Further good quality research is required to address this question.
Topics: Bile Duct Diseases; Cholangiography; Cholecystectomy; Cholecystectomy, Laparoscopic; Humans; Intraoperative Care; Length of Stay
PubMed: 35794500
DOI: 10.1007/s00464-022-09267-x -
Seminars in Roentgenology Jul 1997
Review
Topics: Bile Ducts; Biliary Tract Diseases; Biliary Tract Neoplasms; Cholangiography; Humans; Liver Transplantation
PubMed: 9253066
DOI: 10.1016/s0037-198x(97)80003-x