Migration of a biliary stent causing duodenal perforation and biliary peritonitis

Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.

Role of ERCP in the era of laparoscopic cholecystectomy for the evaluation of choledocholithiasis in sickle cell anemia

AIM:To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in patients with sickle cell anemia (SCA) in the era of laparoscopic cholecystectomy (LC). METHODS:Two hundred and twenty four patients (144 male,80 female; mean age,22.4 years; range,5-70 years) with SCA underwent ERCP as part of their evaluation for cholestatic jaundice (CJ). The indications for ERCP were:CJ only in 97,CJ and dilated bile ducts on ultrasound in 103,and CJ and common bile duct (CBD) stones on ultrasound in 42. RESULTS:In total,CBD stones were found in 88 (39.3%) patients and there was evidence of recent stone passage in 16. Fifteen were post-LC patients. These had endoscopic sphincterotomy and stone extraction. The remaining 73 had endoscopic sphincterotomy and stone extraction followed by LC without an intraoperative cholangiogram.CONCLUSION:In patients with SCA and cholelithiasis,ERCP is valuable whether preoperative or postoperative,and in none was there a need to perform intraoperative cholangiography. Sequential endoscopic sphincterotomy and stone extraction followed by LC is beneficial in these patients. Endoscopic sphincterotomy may also prove to be useful in these patients as it may prevent the future development of biliary sludge and bile duct stones.

Sickle cell cholangiopathy:An endoscopic retrograde cholangiopancreatography evaluation

AIM:To evaluate the role of endoscopic retrograde cholangiopancreatography(ERCP) in patients with sickle cell disease(SCD) .METHODS:Two hundred and twenty four SCD patients with cholestatic jaundice(CJ) had ERCP.The indications for ERCP were based on clinical and biochemical evidence of CJ and ultrasound findings.RESULTS:Two hundred and forty ERCPs were performed.The indications for ERCP were:CJ only in 79,CJ and dilated bile ducts without stones in 103,and CJ and bile duct stones in 42.For those with CJ only,ERCP was normal in 42(53.2%) ,and 13(16.5%) had dilated bile ducts without an obstructive cause.In the remaining 22,there were bile duct stones with or without dilation.For those with CJ,dilated bile ducts and no stones,ERCP was normal in 17(16.5%) ,and 28(27.2%) had dilated bile ducts without an obstructive cause.In the remaining 58,there were bile ducts stones with or without dilation.For those with CJ and bile duct stones,ERCP was normal in two(4.8%) ,and 14(33.3%) had dilated bile ducts without an obstructive cause.In the remaining 26,there were bile duct stones with or without dilatation.CONCLUSION:Considering the high frequency of biliary sludge and bile duct stones in SCD,endoscopic sphincterotomy might prove helpful in these patients.

Safety of pegylated interferon and ribavirin therapy for chronic hepatitis C in patients with sickle cell anemia

AIM:To evaluate the safety and efficacy of combined pegylated interferon and ribavirin for the treatment of chronic hepatitis C(HCV)in patients with sickle cell anemia(SCA). METHODS:Fifty-two patients with SCA and HCV were treated over a period of 7 years from June 2002 to July 2009.Their medical records were reviewed for:age at treatment,sex,body mass index,Hb level at the start of therapy and on follow-up,hemoglobin electrophoresis,liver function tests,G6PD level,LDH, bilirubin,HCV-RNA viral load,HCV genotype,liver biopsy,duration of treatment,and side effects.All were treated with pegylated interferon and a standard dose of ribavirin.The treatment was continued for 24 wk for those with genotype 2 and 3 and for 48 wk for those with genotype 1 and 4. RESULTS:Fifty-two patients(30 females and 22 males) were treated.Their mean age was 29.5 years(range 15-54 years).HCV genotype was determined in 48 and 15 had liver biopsy.Their mean pre-treatment HCV-RNA viral load was 986330 IU/mL(range 12762-3329282 IU/mL).The liver biopsy showed gradeⅠin 6 and gradeⅡin 9 and stageⅠin 13 and stageⅡin 2.Only 8 were receiving hydroxyurea at the time of treatment.All tolerated the treatment well and none experienced a decrease in their Hb which required blood transfusion pre,during or after therapy.There were no hematological side effects attributable to ribavirin at the usual recommended dose.Thirty-seven(71.2%)achieved SVR at 6 mo after the end of treatment.The remaining 15 were non-responders.Two of them showed an ETR but had a relapse.The remaining 13 had a relatively significant HCV-RNA viral load with a mean HCV-RNA viral load of 1829741.2 IU/mL(900000-3329282 IU/mL) and eight of them had HCV genotype 1,four had HCV genotype 4,and one had HCV genotype 5. CONCLUSION:Patients with SCA and HCV can be treated with pegylated interferon and ribavirin at the usual recommended dose.This is even so in those who are not receiving hydroxyurea.The treatment is safe and effective and the response rate is comparable to those without SCA.