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Still elusive: Developments in the accurate diagnosis of indeterminate biliary strictures
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作者 Lynn Affarah Philip Berry Sreelakshmi Kotha 《World Journal of Gastrointestinal Endoscopy》 2024年第6期297-304,共8页
Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pa... Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pathology.A positive histological diagnosis is always preferred prior to high risk hepatobiliary surgery,or to inform other types of therapy.Endoscopic retrograde cholangiopancreato-graphy with brushings has low sensitivity and despite significant improvements in instruments there is still an unacceptably high false negative rate.Other methods such as endoscopic ultrasound and cholangioscopy have improved diagnostic quality.In this review we explore the techniques available to aid accurate diagnosis of indeterminate biliary strictures and obtain accurate histology to facilitate clinical management. 展开更多
关键词 Indeterminate biliary stricture Benign biliary stricture Malignant biliary stricture Endoscopic retrograde cholangiopancreatography Endoscopic ultrasound Primary sclerosing cholangitis
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Diagnosis and Management of Biliary Strictures after Deceased-Donor Liver Transplantation Based on Clinical Practice
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作者 Jianqiang Chen Chengyou Du 《Surgical Science》 2024年第3期99-110,共12页
Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Bil... Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Biliary strictures following LT are divided into anastomotic strictures (AS) and non-anastomotic strictures (NAS). A Limitation of current published researches is that most studies aren’t based on clinical practice. The aim of this review is to summarize risk factors, clinical presentation, diagnosis and management in post-LT biliary strictures. 展开更多
关键词 biliary strictures Liver Transplantation Clinical Practice Anastomotic strictures Non-Anastomotic strictures
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Diagnosis of biliary strictures after liver transplantation:Which is the best tool? 被引量:32
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作者 Thomas Zoepf Evelyn J. Maldonado-Lopez +5 位作者 Philip Hilgard Alexander Dech■ne Massimo Malago Christoph E. Broelsch Joerg Schlaak Guido Gerken 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第19期2945-2948,共4页
AIM: To evaluate the diagnostic value of different indirect methods like biochemical parameters, ultrasound (US) analysis, CT-scan and MRI/MRCP in comparison with endoscopic retrograde cholangiography (ERC), for diagn... AIM: To evaluate the diagnostic value of different indirect methods like biochemical parameters, ultrasound (US) analysis, CT-scan and MRI/MRCP in comparison with endoscopic retrograde cholangiography (ERC), for diagnosis of biliary complications after liver transplantation. METHODS: In 75 patients after liver transplantation, who received ERC due to suspected biliary complications, the result of the cholangiography was compared to the results of indirect imaging methods performed prior to ERC. The cholangiography showed no biliary stenosis (NoST) in 25 patients, AST in 27 and ITBL in 23 patients. RESULTS: Biliary congestion as a result of AST was detected with a sensitivity of 68.4% in US analysis (specificity 91%), of 71% in MRI (specificity 25%) and of 40% in CT (specificity 57.1%). In ITBL, biliary congestion was detected with a sensitivity of 58.8% in the US, 88.9%in MRI and of 83.3% in CT. However, as anastomotic or ischemic stenoses were the underlying cause of biliary congestion, the sensitivity of detection was very low. InMRI detected the dominant stenosis at a correct localization in 22% and CT in 10%, while US failed completely. The biochemical parameters, showed no significant difference in bilirubin (median 5.7; 4,1; 2.5 mg/dL), alkaline phosphatase (median 360; 339; 527 U/L) or gamma glutamyl transferase (median 277; 220; 239 U/L) levels between NoST, AST and ITBL.CONCLUSION: Our data confirm that indirect imaging methods to date cannot replace direct cholangiography for diagnosis of post transplant biliary stenoses. However MRI may have the potential to complement or precede imaging by cholangiography. Optimized MRCP-processing might further improve the diagnostic impact of this method. 展开更多
关键词 ERCP Liver transplantation biliary strictures ENDOSCOPY THERAPY ULTRASOUND IMRCP diagnosis
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Current diagnosis and treatment of benign biliary stricturesafter living donor liver transplantation 被引量:19
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作者 Jae Hyuck Chang Inseok Lee +1 位作者 Myung-Gyu Choi Sok Won Han 《World Journal of Gastroenterology》 SCIE CAS 2016年第4期1593-1606,共14页
Despite advances in surgical techniques, benign biliary strictures after living donor liver transplantation(LDLT) remain a significant biliary complication and play an important role in graft and patient survival. Ben... Despite advances in surgical techniques, benign biliary strictures after living donor liver transplantation(LDLT) remain a significant biliary complication and play an important role in graft and patient survival. Benign biliary strictures after transplantation are classified into anastomotic or non-anastomotic strictures. These two types differ in presentation, outcome, and response to therapy. The leading causes of biliary strictures include impaired blood supply, technical errors during surgery, and biliary anomalies. Because patients usually have non-specific symptoms, a high index of suspicion should be maintained. Magnetic resonance cholangiography has gained widespread acceptance as a reliable noninvasive tool for detecting biliary complications. Endoscopy has played an increasingly prominent role in the diagnosis and treatment of biliary strictures after LDLT. Endoscopic management in LDLT recipients may be more challenging than in deceased donor liver transplantation patients because of the complex nature of the duct-to-duct reconstruction. Repeated aggressive endoscopic treatment with dilation and the placement of multiple plastic stents is considered the first-line treatment for biliary strictures. Percutaneous and surgical treatments are now reserved for patients for whom endoscopic management fails and for those with multiple, inaccessible intrahepatic strictures or Roux-en-Y anastomoses. Recent advances in enteroscopy enable treatment, even in these latter cases. Direct cholangioscopy, another advanced form of endoscopy, allows direct visualization of the inner wall of the biliary tree and is expected to facilitate stenting or stone extraction. Rendezvous techniques can be a good option when the endoscopic approach to the biliary stricture is unfeasible. These developments have resulted in almost all patients being managed by the endoscopic approach. 展开更多
关键词 biliary strictures Living donor liver transplantation Endoscopic RETROGRADE CHOLANGIOGRAPHY PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY biliarycomplication
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Biomarkers in bile-complementing advanced endoscopic imaging in the diagnosis of indeterminate biliary strictures 被引量:1
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作者 Vennisvasanth Lourdusamy Benjamin Tharian Udayakumar Navaneethan 《World Journal of Gastrointestinal Endoscopy》 CAS 2015年第4期308-317,共10页
Biliary strictures present a diagnostic challenge and a conundrum, particularly when an initial work up including abdominal imaging and endoscopic retrograde cholangiopancreatography based sampling are nondiagnostic. ... Biliary strictures present a diagnostic challenge and a conundrum, particularly when an initial work up including abdominal imaging and endoscopic retrograde cholangiopancreatography based sampling are nondiagnostic. Advances in endoscopic imaging have helped us diagnose these strictures better. However, even with modern technology, some strictures remain a diagnostic challenge. The proximity of bile fluid to the bile duct epithelia makes it an attractive option to investigate for bio-markers, which might be representative of the functions/abnormal changes taking place in the biliary system. A number of biomarkers in bile have been discovered recently in approaching biliary strictures with their potential future diagnostic utility, further supported by the immunohistochemical analysis of the resected tissue specimens. Novel biliary biomarkers especially carcinoembryonic cell adhesion molecule 6 and neutrophil gelatinase-associated lipocalin seem promising in differentiating malignant from benign biliary strictures. Recent developments in lipidomic profiling of bile are also very promising. Biliary biomarkers appear to complement endoscopic imaging in diagnosing malignant etiologies of biliary stricture. Future studies addressing these biomarkers need to be incorporated to the current endoscopic techniques to determine the best approach in determining the etiology of biliary strictures. 展开更多
关键词 BILE Pancreato-biliary MALIGNANCIES Biomarkers Cholangiocarcinoma Pancreatic CANCERS biliary strictures
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Clinical approach to indeterminate biliary strictures:Clinical presentation,diagnosis,and workup 被引量:1
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作者 Sujani Yadlapati Ramzi Mulki +3 位作者 Sergio A Sánchez-Luna Ali M Ahmed Kondal Rao Kyanam Kabir Baig Shajan Peter 《World Journal of Gastroenterology》 SCIE CAS 2023年第36期5198-5210,共13页
Despite advances in cross-sectional imaging and endoscopic technology,bile duct strictures remain a challenging clinical entity.It is crucial to make an early determination of benign or malignant nature of biliary str... Despite advances in cross-sectional imaging and endoscopic technology,bile duct strictures remain a challenging clinical entity.It is crucial to make an early determination of benign or malignant nature of biliary strictures.Early diagnosis not only helps with further management but also minimizes mortality and morbidity associated with delayed diagnosis.Conventional imaging and endoscopic techniques,particularly endoscopic retrograde cholangiopancreatography(ERCP)and tissue sampling techniques play a key in establishing a diagnosis.Indeterminate biliary strictures(IDBSs)have no definite mass on imaging or absolute histopathological diagnosis and often warrant utilization of multiple diagnostics to ascertain an etiology.In this review,we discuss possible etiologies,clinical presentation,diagnosis,and management of IDBSs.Based on available data and expert opinion,we depict an evidence based diagnostic algorithm for management of IDBSs.Areas of focus include use of traditional tissue sampling techniques such as ERCP with brush cytology,intraductal biopsies,fluorescence in situ hybridization and flow cytometry.We also describe the role of endoscopic ultrasound(EUS)-guided fine needle aspiration and biopsies,cholangioscopy,confocal laser endomicroscopy,and intraductal EUS in management of IDBSs. 展开更多
关键词 biliary strictures Indeterminate strictures biliary sampling CHOLANGIOSCOPY Benign strictures Malignant strictures Indeterminate biliary strictures
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Evaluation of novel slim biopsy forceps for diagnosis of biliary strictures: Single-institutional study of consecutive 360 cases(with video) 被引量:1
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作者 Kenjiro Yamamoto Takayoshi Tsuchiya +12 位作者 Takao Itoi Shujiro Tsuji Reina Tanaka Ryosuke Tonozuka Mitsuyoshi Honjo Shuntaro Mukai Kentaro Kamada Mitsuru Fujita Yasutsugu Asai Yukitoshi Matsunami Yuichi Nagakawa Hiroshi Yamaguchi Atsushi Sofuni 《World Journal of Gastroenterology》 SCIE CAS 2017年第35期6429-6436,共8页
AIM To evaluate the feasibility and reliability of endoscopic transpapillary bile duct biopsy for the diagnosis of biliary strictures.METHODS A total of 360 patients(241 men) who underwent endoscopic retrograde cholan... AIM To evaluate the feasibility and reliability of endoscopic transpapillary bile duct biopsy for the diagnosis of biliary strictures.METHODS A total of 360 patients(241 men) who underwent endoscopic retrograde cholangiopancreatography for biliary strictures with biopsy from April 2012 to March 2016 at Tokyo Medical University Hospital were retrospectively reviewed. This study was approved by our Institutional Review Board(No. 3516). Informed consent was obtained from all individual participants included in this study. The biopsy specimens were obtained using a novel slim biopsy forceps(Radial Jaw 4P, Boston Scientific, Boston, MA, United States).RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 69.6%, 100%, 100%, 59.1%, and 78.8%, respectively. The sensitivity was 75.6% in bile duct cancer, 64% in pancreatic cancer, 61.1% in gallbladder cancer, and 57.1% in metastasis. In bile duct cancer, a lower sensitivity was observed for perihilar bile duct stricture(68.7%) than for distal bile duct stricture(83.1%). In terms of the stricture lengths of pancreatic cancer, gallbladder cancer, and metastasis, a longer stenosis resulted in a better sensitivity. In particular, there was a significant difference between pancreatic cancer and gallbladder cancer(P < 0.05). One major complication was perforation of the extrahepatic bile duct with bile leakage. CONCLUSION Endoscopic transpapillary biopsy alone using novel slim biopsy forceps is feasible and reliable, but restrictive. Biopsy should be performed in consideration of the stricture level, stricture length, and cancer type. 展开更多
关键词 ENDOSCOPIC transpapillary BIOPSY BIOPSY forceps biliary stricturE BILE duct cancer ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY
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Biliary strictures complicating living donor liver transplantation:Problems,novel insights and solutions 被引量:16
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作者 Harshavardhan B Rao Arjun Prakash +1 位作者 Surendran Sudhindran Rama P Venu 《World Journal of Gastroenterology》 SCIE CAS 2018年第19期2061-2072,共12页
Biliary stricture complicating living donor liver transplantation(LDLT) is a relatively common complication, occurring in most transplant centres across the world. Cases of biliary strictures are more common in LDLT t... Biliary stricture complicating living donor liver transplantation(LDLT) is a relatively common complication, occurring in most transplant centres across the world. Cases of biliary strictures are more common in LDLT than in deceased donor liver transplantation. Endoscopic management is the mainstay for biliary strictures complicating LDLT and includes endoscopic retrograde cholangiography, sphincterotomy and stent placement(with or without balloon dilatation). The efficacy and safety profiles as well as outcomes of endoscopic management of biliary strictures complicating LDLT is an area that needs to be viewed in isolation, owing to its unique set of problems and attending complications; as such, it merits a tailored approach, which is yet to be well established. The diagnostic criteria applied to these strictures are not uniform and are over-reliant on imaging studies showing an anastomotic narrowing. It has to be kept in mind that in the setting of LDLT, a subjective anastomotic narrowing is present in most cases due to a mismatch in ductal diameters. However, whether this narrowing results in a functionally significant narrowing is a question that needs further study. In addition, wide variation in the endotherapy protocols practised in most centres makes it difficult to interpret the results and hampers our understanding of this topic. The outcome definition for endotherapy is also heterogenous and needs to be standardised to allow for comparison of data in this regard and establish a clinical practice guideline. There have been multiple studies in this area in the last 2 years, with novel findings that have provided solutions to some of these issues. This review endeavours to incorporate these new findings into the wider understanding of endotherapy for biliary strictures complicating LDLT, with specific emphasis on diagnosis of strictures in the LDLT setting, endotherapy protocols and outcome definitions. An attempt is made to present the best management options currently available as well as directions for future research in the area. 展开更多
关键词 biliary strictures Endoscopic management STENTING Self-expanding metal STENTS Living DONOR liver transplantation
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Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry 被引量:9
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作者 Ei Takahashi Mitsuharu Fukasawa +5 位作者 Tadashi Sato Shinichi Takano Makoto Kadokura Hiroko Shindo Yudai Yokota Nobuyuki Enomoto 《World Journal of Gastroenterology》 SCIE CAS 2015年第16期4946-4953,共8页
AIM:To identify criteria for predicting successful drainage of unresectable malignant hilar biliary strictures(UMHBS) because no ideal strategy currently exists.METHODS:We examined 78 patients with UMHBS who underwent... AIM:To identify criteria for predicting successful drainage of unresectable malignant hilar biliary strictures(UMHBS) because no ideal strategy currently exists.METHODS:We examined 78 patients with UMHBS who underwent biliary drainage.Drainage was considered effective when the serum bilirubin level decreased by ≥ 50% from the value before stent placement within 2 wk after drainage, without additional intervention.Complications that occurred within 7 d after stent placement were considered as early complications.Before drainage, the liver volume of each section(lateral and medial sections of the left liver and anterior and posterior sections of the right liver) was measured using computed tomography(CT) volumetry.Drained liver volume was calculated based on the volume of each liver section and the type of bile duct stricture(according to the Bismuth classification).Tumor volume, which was calculated by using CT volumetry, was excluded from the volume of each section.Receiver operating characteristic(ROC) analysis was performed to identify the optimal cutoff values for drained liver volume.In addition, factors associated with the effectiveness of drainage and early complications were evaluated.RESULTS:Multivariate analysis showed that drained liver volume [odds ratio(OR) = 2.92, 95%CI:1.648-5.197; P < 0.001] and impaired liver function(with decompensated liver cirrhosis)(OR = 0.06, 95%CI:0.009-0.426; P = 0.005) were independent factors contributing to the effectiveness of drainage.ROC analysis for effective drainage showed cutoff values of 33% of liver volume for patients with preserved liver function(with normal liver or compensated livercirrhosis)and 50%for patients with impaired liver function(with decompensated liver cirrhosis).The sensitivity and specificity of these cutoff values were82%and 80%for preserved liver function,and 100%and 67%for impaired liver function,respectively.Among patients who met these criteria,the rate of effective drainage among those with preserved liver function and impaired liver function was 90%and 80%,respectively.The rates of effective drainage in both groups were significantly higher than in those who did not fulfill these criteria(P<0.001 and P=0.02,respectively).Drainage-associated cholangitis occurred in 9 patients(12%).A smaller drained liver volume was associated with drainage-associated cholangitis(P<0.01).CONCLUSION:Liver volume drainage≥33%in patients with preserved liver function and≥50%in patients with impaired liver function correlates with effective biliary drainage in UMHBS. 展开更多
关键词 biliary drainage Computed tomographyvolumetry HILAR biliary stricturE Cholangiocarcinoma Liver function CHOLANGITIS
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Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders 被引量:25
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作者 Petko Karagyozov Irina Boeva Ivan Tishkov 《World Journal of Gastrointestinal Endoscopy》 CAS 2019年第1期31-40,共10页
Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an import... Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an important diagnostic and therapeutic tool leading to avoidance of aggressive and unnecessary surgery in many clinical scenarios. This paper focuses on the newly developed SpyGlass DS technology, its advantages, and the technique of single-operator cholangioscopy(SOC), biliary indications and possible adverse events. We also review the available literature; discuss the limitations and future expectations.Digital SOC(D-SOC) is a useful technique, which provides endoscopic imaging of the biliary tree, optical diagnosis, biopsy under direct vision and therapeutic interventions. The implementations are diagnostic and therapeutic. Diagnostic indications are indeterminate biliary strictures, unclear filling defects, staging of cholangiocarcinoma, staging of ampullary tumors(extension into the common bile duct), unclear bile duct dilation, exploring cystic lesions of the biliary tree,unexplained hemobilia, posttransplant biliary complications. Therapeutic indications are lithotripsy of difficult stones, retrieval of migrated stents, foreign body removal, guide wire placement, transpapillary gallbladder drainage and endoscopic tumor ablative therapy. Most studied and established indications are the diagnosis of indeterminate biliary stricture and intraductal lithotripsy of difficult stones. The adverse events are not different and more common compared to those of Endoscopic retrograde cholangiopancreatography(ERCP)alone. D-SOC is a safe and effective procedure, adjunct to the standard ERCP and the newly available digital technology overcomes many of the limitations of the previous generations of cholangioscopes. 展开更多
关键词 Per-oral CHOLANGIOSCOPY DIGITAL single-operator CHOLANGIOSCOPY Difficult stones Indeterminate strictures Endoscopic retrograde cholangiopancreatography biliary interventions
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Evaluation of fully covered self-expanding metal stents in benign biliary strictures and bile leaks 被引量:9
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作者 David Lalezari Inder Singh +1 位作者 Sofiya Reicher Viktor Ernst Eysselein 《World Journal of Gastrointestinal Endoscopy》 CAS 2013年第7期332-339,共8页
AIM: To investigate the use of fully covered metal stents in benign biliary strictures (BBS) and bile leaks. METHODS: We studied 17 patients, at Harbor-UCLA Medical center (Los Angeles), with BBS (n=12) and bile leaks... AIM: To investigate the use of fully covered metal stents in benign biliary strictures (BBS) and bile leaks. METHODS: We studied 17 patients, at Harbor-UCLA Medical center (Los Angeles), with BBS (n=12) and bile leaks (n=5) from July 2007 to February 2012 that had received placement of fully covered self-expanding metal stents (FCSEMs). Fourteen patients had endoscopic placement of VIABIL (Conmed, Utica, New York, United States) stents and three had Wallflex (Boston Scientific, Mass) stents. FCSEMS were 8 mm or 10 mm in diameter and 4 cm to 10 cm in length. Patients were followed at regular intervals to evaluate for symptoms and liver function tests. FCSEMS were removed after 4 or more weeks. Resolution of BBS and leak was documented cholangiographically following stent removal. Stent patency can be defined as adequate bile and contrast flow from the stent and into the ampulla during endoscopic retrograde cholangiopancreatography (ERCP) without clinical signs and/or symptoms of biliary obstruction. Criterion for bile leak resolution at ERCP is defined as absence of contrast extravasation from the common bile duct, cystic duct remanent, or gall blad-der fossa. Rate of complications such as migration, and instent occlusion were recorded. Failure of endoscopic therapy was defined as persistent biliary stenosis or continuous biliary leakage after 12 mo of stent placement. RESULTS: All 17 patients underwent successful FC- SEMS placement and removal. Etiologies of BBS included: cholecystectomies (n=8), cholelithiasis (n=2), hepatic artery compression (n=1), pancreatitis (n=2), and Whipple procedure (n=1). All bile leaks occurred following cholecystectomy. The anatomic location of BBS varied: distal common bile duct (n=7), common hepatic duct (n=1), hepaticojejunal anastomosis (n=2), right intrahepatic duct (n=1), and choledochoduo-denal anastomatic junction (n=1). All bile leaks were found to be at the cystic duct. Twelve of 17 patients had failed prior stent placement or exchange. Resolution of the biliary strictures and bile leaks was achieved in 16 of 17 patients (94%). The overall median stent time was 63 d (range 27-251 d). The median stent time for the BBS group and bile leak group was 62 ± 58 d (range 27-199 d) and 92 ± 81 d (range 48-251 d), respectively. All 17 patients underwent successful FCSEMS removal. Long term follow-up was obtained for a median of 575 d (range 28-1435 d). Complications occurred in 5 of 17 patients (29%) and included: migration (n=2), stent clogging (n=1), cholangitis (n=1), and sepsis with hepatic abscess (n=1). CONCLUSION: Placement of fully covered self-expanding metal stents may be used in the management of benign biliary strictures and bile leaks with a low rate of complications. 展开更多
关键词 BILE LEAKS Benign biliary stricturE Fully COVERED metal STENTS biliary disease
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Endoscopic therapy of benign biliary strictures 被引量:12
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作者 Joel R Judah Peter V Draganov 《World Journal of Gastroenterology》 SCIE CAS CSCD 2007年第26期3531-3539,共9页
Benign biliary strictures are being increasingly treated with endoscopic techniques. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. Surgery has been the traditiona... Benign biliary strictures are being increasingly treated with endoscopic techniques. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. Surgery has been the traditional treatment, but there is increasing desire for minimally invasive endoscopic therapy. At present, endoscopy has become the first line approach for the therapy of post- liver transplant anastomotic strictures and distal (Bismuth ! and I) post-operative strictures. Strictures related to chronic pancreatitis have proven more difficult to treat, and endoscopic therapy is reserved for patients who are not surgical candidates. The preferred endoscopic approach is aggressive treatment with gradual dilation of the stricture and insertion of multiple plastic stents. The use of uncovered self expandable metal stents should be discouraged due to poor long-term results. Treatment with covered metal stents or bioabsorbable stents warrants further evaluation. This area of therapeutic endoscopy provides an ongoing opportunity for fresh research and innovation. 展开更多
关键词 biliary stricture ENDOSCOPY biliary stent PANCREATITIS Liver transplant Anastomotic stricture
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Bilateral vs unilateral placement of metal stents for inoperable highgrade hilar biliary strictures: A systemic review and meta-analysis 被引量:6
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作者 Munish Ashat Sumant Arora +3 位作者 Jagpal S Klair Christopher A Childs Arvind R Murali Frederick C Johlin 《World Journal of Gastroenterology》 SCIE CAS 2019年第34期5210-5219,共10页
BACKGROUND Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction.No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral s... BACKGROUND Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction.No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting.AIM To assess the efficacy and safety of bilateral vs unilateral biliary drainage in inoperable malignant hilar obstruction.METHODS PubMed,Embase,Scopus,and Cochrane databases,as well as secondary sources(bibliographic review of selected articles and major GI proceedings),were searched through January 2019.The primary outcome was the re-intervention rate.Secondary outcomes were a technical success,early and late complications,and stent malfunction rate.Pooled odds ratio(OR)and 95%confidence interval(CI)were calculated for each outcome.RESULTS A total of 9 studies were included(2 prospective Randomized Controlled Study,5 retrospective studies,and 2 abstracts),involving 782 patients with malignant hilar obstruction.Bilateral stenting had significantly lower re-intervention rate compared with unilateral drainage(OR=0.59,95%CI:0.40-0.87,P=0.009).There was no difference in the technical success rate(OR=0.7,CI:0.42-1.17,P=0.17),early complication rate(OR=1.56,CI:0.31-7.75,P=0.59),late complication rate(OR=0.91,CI:0.58-1.41,P=0.56)and stent malfunction(OR=0.69,CI:0.42-1.12,P=0.14)between bilateral and unilateral stenting for malignant hilar biliary strictures.CONCLUSION Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures,with no significant difference in technical success,and early or late complication rates. 展开更多
关键词 Metal stent HILAR biliary stricturE Re-intervention RATE Technical success RATE
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Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic, gallbladder and biliary tract Lesions 被引量:7
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作者 Ghassan M Hammoud Ashraf Almashhrawi Jamal A Ibdah 《World Journal of Gastrointestinal Oncology》 SCIE CAS 2014年第11期420-429,共10页
Endoscopic ultrasound(EUS)-guided fine needle aspira-tion(FNA) of the liver is a safe procedure in the diag-nosis and staging of hepatobiliary malignancies with a minimal major complication rate. EUS-FNA is useful for... Endoscopic ultrasound(EUS)-guided fine needle aspira-tion(FNA) of the liver is a safe procedure in the diag-nosis and staging of hepatobiliary malignancies with a minimal major complication rate. EUS-FNA is useful for liver lesions poorly accessible to other imaging modali-ties of the liver. EUS-guided FNA of biliary neoplasia and malignant biliary stricture is superior to the con-ventional endoscopic brushing and biopsy. 展开更多
关键词 Endoscopic ultrasound Fine needle aspira-tion Hepatocellular carcinoma BILE duct stricturE Gall-bladder CHOLANGIOCARCINOMA biliary drainage
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Role of endoscopic retrograde cholangiopancreatography inthe management of benign biliary strictures:What's new? 被引量:6
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作者 Rosa Ferreira Rui Loureiro +4 位作者 Nuno Nunes António Alberto Santos Rui Maio Marília Cravo Maria AntóniaDuarte 《World Journal of Gastrointestinal Endoscopy》 CAS 2016年第4期220-231,共12页
Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cho... Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing. 展开更多
关键词 Benign biliary strictures BILE duct stricturE Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY STENTS Cholecystectomy Liver transplantation Primarysclerosing CHOLANGITIS Chronic pancreatitis
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Preoperative differential diagnosis between intrahepatic biliary cystadenoma and cystadenocarcinoma:A single-center experience 被引量:25
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作者 Fu-Bo Zhang Ai-Min Zhang +3 位作者 Zhi-Bin Zhang Xin Huang Xi-Tao Wang Jia-Hong Dong 《World Journal of Gastroenterology》 SCIE CAS 2014年第35期12595-12601,共7页
AIM: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma. METHODS: A retrospective analysis of patient data was performed, which... AIM: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma. METHODS: A retrospective analysis of patient data was performed, which included 21 cases of intrahepatic biliary cystadenoma and 25 cases of intrahepatic biliary cystadenocarcinoma diagnosed between April 2003 and April 2013 at the General Hospital of PLA. Potential patients were excluded whose diagnoses were not confirmed pathologically. Basic information (including patient age and gender), clinical manifestation, duration of symptoms, serum assay results (including tumor markers and the results of liver function tests), radiological features and pathological results were collected. All patients were followed up. RESULTS: Preoperative levels of cancer antigen 125 (12.51 +/- 9.31 vs 23.20 +/- 21.86, P < 0.05) and carbohydrate antigen 19-9 (22.56 +/- 26.30 vs 72.55 +/- 115.99, P < 0.05) were higher in the cystadenocarcinoma subgroup than in the cystadenoma subgroup. There were no statistically significant differences in age or gender between the two groups, or in pre- or post-operative levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin (TBIL), and direct bilirubin (DBIL) between the two groups. However, eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had elevated levels of TBIL and DBIL. There were three cases in the cystadenoma subgroup and six cases in the cystadenocarcinoma subgroup with postoperative complications. CONCLUSION: Preoperative differential diagnosis relies on the integration of information, including clinical symptoms, laboratory findings and imaging results. (C) 2014 Baishideng Publishing Group Inc. All rights reserved. 展开更多
关键词 Intrahepatic biliary cystadenoma Intrahepatic biliary cystadenocarcinoma Preoperative differential diagnosis
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Recent advances in the diagnosis and treatment of primary biliary cholangitis 被引量:18
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作者 Ying-Qiu Huang 《World Journal of Hepatology》 CAS 2016年第33期1419-1441,共23页
Primary biliary cholangitis(PBC), formerly referred toas primary biliary cirrhosis, is an infrequent progressive intrahepatic cholestatic autoimmune illness that can evolve into hepatic fibrosis, hepatic cirrhosis, he... Primary biliary cholangitis(PBC), formerly referred toas primary biliary cirrhosis, is an infrequent progressive intrahepatic cholestatic autoimmune illness that can evolve into hepatic fibrosis, hepatic cirrhosis, hepatic failure, and, in some cases, hepatocellular carcinoma. The disease itself is characterized by T-lymphocytemediated chronic non-suppurative destructive cholangitis and elevated serum levels of extremely specific antimitochondrial autoantibodies(AMAs). In this article, we will not only review epidemiology, risk factors, natural history, predictive scores, radiologic approaches(e.g., acoustic radiation force impulse imaging, vibration controlled transient elastography, and magnetic resonance elastography), clinical features, serological characteristics covering biochemical markers, immunoglobulins, infections markers, biomarkers, predictive fibrosis marker, specific antibodies(including AMAs such as AMA-M2), anti-nuclear autoantibodies [such as anti-multiple nuclear dot autoantibodies(anti-sp100, PML, NDP52, anti-sp140), anti-rim-like/membranous anti-nuclear autoantibodies(anti-gp210, anti-p62), anti-centromere autoantibodies, and some of the novel autoantibodies], histopathological characteristics of PBC, diagnostic advances, and antidiastole of PBC. Furthermore, this review emphasizes the recent advances in research of PBC in terms of therapies, including ursodeoxycholic acid, budesonide, methotrexate, obeticholic acid, cyclosporine A, fibrates such as bezafibrate and fenofibrate, rituximab, mesenchymal stem cells transplant, and hepatic transplant. Currently, hepatic transplant remains the only optimal choice with acknowledged treatment efficiency for end-stage PBC patients. 展开更多
关键词 Autoimmune liver diseases Primary biliary cholangitis Primary biliary cirrhosis diagnosis THERAPY
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Endoscopic ultrasonography can diagnose distal biliary strictures without a mass on computed tomography 被引量:5
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作者 Yasuyuki Saifuku Michiko Yamagata +8 位作者 Takero Koike Genyo Hitomi Kazunari Kanke Hidetaka Watanabe Toshimitsu Murohisa Masaya Tamano Makoto Iijima Keiichi Kubota Hideyuki Hiraishi 《World Journal of Gastroenterology》 SCIE CAS CSCD 2010年第2期237-244,共8页
AIM:To assess the diagnostic ability of endoscopic ultrasonography(EUS)for evaluating causes of dista biliary strictures shown on endoscopic retrograde chol angiopancreatography(ERCP)or magnetic resonance cholangiopan... AIM:To assess the diagnostic ability of endoscopic ultrasonography(EUS)for evaluating causes of dista biliary strictures shown on endoscopic retrograde chol angiopancreatography(ERCP)or magnetic resonance cholangiopancreatography(MRCP),even without iden tifiable mass on computed tomography(CT). METHODS:The diagnostic ability of EUS was retro spectively analyzed and compared with that of routine cytology(RC)and tumor markers in 34 patients with distal biliary strictures detected by ERCP or MRCP a Dokkyo Medical School Hospital from December 2005 to December 2008,without any adjacent mass or ec centric thickening of the bile duct on CT that could cause biliary strictures.Findings considered as benign strictures on EUS included preservation of the normasonographic layers of the bile duct wall,irrespective of the presence of a mass lesion.Other strictures were considered malignant.Final diagnosis of underlying diseases was made by pathological examination in 18 cases after surgical removal of the samples,and by clinical follow-up for>10 mo in 16 cases. RESULTS:Seventeen patients(50%)were finally di- agnosed with benign conditions,including 6"normal" subjects,while 17 patients(50%)were diagnosed with malignant disease.In terms of diagnostic ability,EUS showed 94.1%sensitivity,82.3%specificity,84.2% positive predictive value,93.3%negative predictive value(NPV)and 88.2%accuracy for identifying ma- lignant and benign strictures.EUS was more sensi- tive than RC(94.1%vs 62.5%,P=0.039).NPV was also better for EUS than for RC(93.3%vs 57.5%,P= 0.035).In addition,EUS provided significantly higher sensitivity than tumor markers using 100 U/mL as the cutoff level of carbohydrate antigen 19-9(94.1%vs 53%,P=0.017).On EUS,biliary stricture that was fi- nally diagnosed as malignant showed as a hypoechoic, irregular mass,with obstruction of the biliary duct and invasion to surrounding tissues. CONCLUSION:EUS can diagnose biliary strictures caused by malignant tumors that are undetectable on CT.Earlier detection by EUS would provide more therapeutic options for patients with early-stage pancreaticobiliary cancer. 展开更多
关键词 Computed tomography CYTOLOGY Endoscopic retrograde cholangiopancreatography Endoscopic ultrasound Indeterminate biliary stricture Magnetic resonance cholangiopancreatography Tumor marker
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Endoscopic diagnosis and treatment of biliary leak in patients following liver transplantation:a prospective clinical study 被引量:4
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作者 Liao, Jia-Zhi Zhao, Qiu +5 位作者 Qin, Hua Li, Rong-Xiang Hou, Wei Li, Pei-Yuan Liu, Nan-Zhi Li, De-Ming 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2007年第1期29-33,共5页
BACKGROUND: Orthotopic liver transplantation has been widely used in patients with end-stage liver disease within the last two decades. However, the prevalence of biliary complications after liver transplantation rema... BACKGROUND: Orthotopic liver transplantation has been widely used in patients with end-stage liver disease within the last two decades. However, the prevalence of biliary complications after liver transplantation remains high. The most common short-term biliary complication may be biliary leak. So, we examined 13 patients with biliary leak after liver transplantation, attempting to evaluate the role of endoscopic diagnosis and treatment of biliary leak and the incidence of bile duct stricture after healing of the leak. METHODS: Six cases of T-tube leak and seven cases of anastomosis leak complicating liver transplantation were enrolled in this prospective study. Six patients were treated by endoscopic plastic stent placement, two by nasobiliary catheter drainage, two by papillosphincterotomy, and three by nasobiliary catheter drainage combined with plastic stent placement. Some patients received growth hormone treatment. RESULTS: The bile leak resolution time was 10-35 days in 10 patients with complete documentation. The median time of leak resolution was 15.3 days. Four cases of anastomosis stricture, three cases of common hepatic duct and one case of multiple bile duct stenosis were detected by follow-up nasobiliary catheter cholangiography or endoscopic retrograde cholangiopancreatography. CONCLUSIONS: Endoscopic nasobiliary catheter or plastic stent placement is a safe and effective treatment for bile duct stricture occurring after bile leak resolution in most liver transplantation patients. Nasobiliary catheter combined with plastic stent placement may be the best choice for treating bile leak, because, theoretically, it may prevent the serious condition resulting from accidental nasobiliary catheter dislocation, and it may have prophylactic effects on upcoming bile duct stricture, although this should be further confirmed. 展开更多
关键词 liver transplantation biliary leak bile duct stricture endoscopic therapy endoscopic retrograde CHOLANGIOPANCREATOGRAPHY nasobiliary tube STENT
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Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis 被引量:6
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作者 Hiroshi Ohyama Rintaro Mikata +4 位作者 Takeshi Ishihara Yuji Sakai Harutoshi Sugiyama Shin Yasui Toshio Tsuyuguchi 《World Journal of Gastrointestinal Endoscopy》 CAS 2017年第1期12-18,共7页
AIMTo investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors. METHODSTen consecutive patients with stones in the pancreatic head an... AIMTo investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors. METHODSTen consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for &ge; 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared. RESULTSEndoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 &plusmn; 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 &plusmn; 1.8 mm vs 13.7 &plusmn; 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 &plusmn; 3.0 mm, incomplete group; 29.0 &plusmn; 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 &plusmn; 7.3 mo. CONCLUSIONSequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy. 展开更多
关键词 Chronic pancreatitis biliary stricture biliary stent Pancreatic stone ENDOSCOPY
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