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Results of Surgical Management of Malignant Obstruction of the Common Bile Duct in Yaoundé
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作者 Eric Patrick Savom Gaël Tsanga Nomo +5 位作者 Richard II Mbele Mahamat Yannick Ekani Boukar Cédric Paterson Atangana Fred Dikongue Dikongue Guy Aristide Bang Arthur Essomba 《Surgical Science》 2024年第4期265-277,共13页
Introduction: In Cameroon, surgery remains the only approach in malignant obstructions of the common bile duct (MOCBD) even in palliative situations. The aim of this work was to describe the modalities of surgical tre... Introduction: In Cameroon, surgery remains the only approach in malignant obstructions of the common bile duct (MOCBD) even in palliative situations. The aim of this work was to describe the modalities of surgical treatment of MOCBD, evaluate the results and detect the factors associated with postoperative morbidity and mortality. Patients and Methods: We conducted an analytical observational study, with retrospective data collection from the files of patients operated upon for MOCBD. This was done in four referral hospitals in the city of Yaoundé for a 42-month period spanning from January 1, 2020 to June 30, 2023. Demographic data, clinical presentation, surgical data, and 30-day postoperative outcomes were collected. Results: We collected 71 files. The sex ratio was 1.4 and the mean age was 56 ± 11 years. Fifty-three (53) patients (74.6%) were overweight or obese and 10 patients (14.1%) were hypertensive. A clinical cholestasis syndrome was present in 69 patients (97.2%). Fifty-five (55) patients (77.5%) had a cancer of the head of the pancreas, 8 patients (11.3%) had an extra-hepatic cholangiocarcinoma and 8 patients (11.3%) had an ampullary adenocarcinoma. Eight (8) resections (11.3%) with curative intent had been carried out and in 63 cases (88.7%), surgery was palliative. Postoperative morbidity was 55.7%, influenced by advanced WHO stage (p = 0.02). Postoperative mortality was 25.7%, associated with a high ASA score (p = 0.01). Conclusion: Pancreatic head cancer is the main etiology of malignant obstructions of the common bile duct in Cameroon. Surgical treatment is most often palliative. Postoperative morbidity and mortality are high, influenced by high WHO and ASA scores. 展开更多
关键词 Malignant obstruction Common bile duct Palliative treatment MORBIDITY MORTALITY
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Bedside score predicting retained common bile duct stone in acute biliary pancreatitis
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作者 Tawfik Khoury Anas Kadah +2 位作者 Mahmud Mahamid Amir Mari Wisam Sbeit 《World Journal of Clinical Cases》 SCIE 2020年第8期1414-1423,共10页
BACKGROUND Retained common bile duct(CBD) stone after an acute episode of biliary pancreatitis is of paramount importance since stone extraction is mandatory.AIM To generate a simple non-invasive score to predict the ... BACKGROUND Retained common bile duct(CBD) stone after an acute episode of biliary pancreatitis is of paramount importance since stone extraction is mandatory.AIM To generate a simple non-invasive score to predict the presence of CBD stone in patients with biliary pancreatitis.METHODS We performed a retrospective study including patients with a diagnosis of biliary pancreatitis. One hundred and fifty-four patients were included. Thirty-three patients(21.5%) were diagnosed with CBD stone by endoscopic ultrasound(US).RESULTS In univariate analysis, age(OR: 1.048, P = 0.0004), aspartate transaminase(OR:1.002, P = 0.0015), alkaline phosphatase(OR: 1.005, P = 0.0005), gamma-glutamyl transferase(OR: 1.003, P = 0.0002) and CBD width by US(OR: 1.187, P = 0.0445)were associated with CBD stone. In multivariate analysis, three parameters were identified to predict CBD stone;age(OR: 1.062, P = 0.0005), gamma-glutamyl transferase level(OR: 1.003, P = 0.0003) and dilated CBD(OR: 3.685, P = 0.027),with area under the curve of 0.8433. We developed a diagnostic score that included the three significant parameters on multivariate analysis, with assignment of weights for each variable according to the co-efficient estimate. A score that ranges from 51.28 to 73.7 has a very high specificity(90%-100%) for CBD stones, while a low score that ranges from 9.16 to 41.04 has a high sensitivity(82%-100%). By performing internal validation, the negative predictive value of the low score group was 93%.CONCLUSION We recommend incorporating this score as an aid for stratifying patients with acute biliary pancreatitis into low or high probability for the presence of CBD stone. 展开更多
关键词 STONES Common bile duct Predictors biliary pancreatitis
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Response letter to “Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the outcomes?” with imaging aspects 被引量:1
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作者 Sonay Aydin Baris Irgul 《World Journal of Clinical Cases》 SCIE 2024年第5期1029-1032,共4页
Radiological imaging findings may contribute to the differentiation of malignant biliary obstruction from choledocholithiasis in the etiology of acute cholangitis.
关键词 Malignant biliary obstruction CHOLEDOCHOLITHIASIS Acute cholangitis Dilated bile ducts Magnetic resonance cholangiopancreatography Endoscopic retrograde cholangiopancreatography
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Imaging features of malignant vs stone-induced biliary obstruction:Aspects to consider
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作者 Cristian Lindner 《World Journal of Clinical Cases》 SCIE 2024年第15期2678-2681,共4页
Radiological studies play a crucial role in the evaluation of patients with biliary duct obstruction,allowing for the guidance of clinical diagnosis towards a malignant or stone-induced etiology through the recognitio... Radiological studies play a crucial role in the evaluation of patients with biliary duct obstruction,allowing for the guidance of clinical diagnosis towards a malignant or stone-induced etiology through the recognition of relevant imaging features,which must be continuously revisited given their prognostic significance.This article aims to emphasize the importance of recognizing crucial imaging aspects of malignant and stone-induced biliary obstruction. 展开更多
关键词 Malignant biliary obstruction CHOLEDOCHOLITHIASIS Dilated bile ducts Magnetic resonance Multidetector computed tomography
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Effectiveness of a new approach to minimally invasive surgery in palliative treatment of patients with distal malignant biliary obstruction 被引量:1
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作者 Yaroslav M Susak Leonid L Markulan +3 位作者 Serhii M Lobanov Roman Y Palitsya Mariia P Rudyk Larysa M Skivka 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第4期698-711,共14页
BACKGROUND Palliative endoscopic biliary drainage is the primary treatment option for the management of patients with jaundice which results from distal malignant biliary obstruction(DMBO).In this group of patients,de... BACKGROUND Palliative endoscopic biliary drainage is the primary treatment option for the management of patients with jaundice which results from distal malignant biliary obstruction(DMBO).In this group of patients,decompression of the bile duct(BD)allows for pain reduction,symptom relief,chemotherapy administration,improved quality of life,and increased survival rate.To reduce the unfavorable effects of BD decompression,minimally invasive surgical techniques require continuous improvement.AIM To develop a technique for internal-external biliary-jejunal drainage(IEBJD)and assess its effectiveness in comparison to other minimally invasive procedures in the palliative treatment of patients with DMBO.METHODS A retrospective analysis of prospectively collected data was performed,which included 134 patients with DMBO who underwent palliative BD decompression.Biliary-jejunal drainage was developed to divert bile from the BD directly into the initial loops of the small intestine to prevent duodeno-biliary reflux.IEBJD was carried out using percutaneous transhepatic access.Percutaneous transhepatic biliary drainage(PTBD),endoscopic retrograde biliary stenting(ERBS),and internal-external transpapillary biliary drainage (IETBD) were used for the treatment of studypatients. Endpoints of the study were the clinical success of the procedure, the frequency andnature of complications, and the cumulative survival rate.RESULTSThere were no significant differences in the frequency of minor complications between the studygroups. Significant complications occurred in 5 (17.2%) patients in the IEBJD group, in 16 (64.0%)in the ERBS group, in 9 (47.4%) in the IETBD group, and in 12 (17.4%) in the PTBD group.Cholangitis was the most common severe complication. In the IEBJD group, the course ofcholangitis was characterized by a delayed onset and shorter duration as compared to other studygroups. The cumulative survival rate of patients who underwent IEBJD was 2.6 times higher incomparison to those of the PTBD and IETBD groups and 20% higher in comparison to that of theERBS group.CONCLUSIONIEBJD has advantages over other minimally invasive BD decompression techniques and can berecommended for the palliative treatment of patients with DMBO. 展开更多
关键词 Distal malignant biliary obstruction obstructive jaundice bile duct decompression Palliative endoscopic biliary drainage Internal-external biliary-jejunal drainage
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Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis,a novel technique for malignant obstruction:A case report and review of literature
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作者 Gurjiwan Singh Virk Nour A Parsa +2 位作者 Juan Tejada Muhammad Sohail Mansoor Sven Hida 《World Journal of Gastrointestinal Endoscopy》 CAS 2018年第9期219-224,共6页
For patients suffering from both biliary and duodenal obstruction,endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the treatment of choice.ERCP through an already existing duodenal prosthes... For patients suffering from both biliary and duodenal obstruction,endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the treatment of choice.ERCP through an already existing duodenal prosthesis is an uncommon procedure and furthermore no studies have reported installing a covered metal stent onto an already existing bare metal stent in the common bile duct(CBD).We describe a rare case of a stent-in-stent dilatation of the CBD through an already existing self-expanding metal stent in the second part of duodenum for the patient presenting with jaundice in setting of biliary and duodenal obstruction from pancreatic adenocarcinoma.The biliary obstruction was relieved with a decrease in bilirubin levels post-stenting. 展开更多
关键词 Bare METAL STENT Endoscopic retrograde CHOLANGIOpancreatOGRAPHY Common bile duct Selfexpanding METAL STENT JAUNDICE biliary obstruction Gastric outlet obstruction
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Randomized trial in malignant biliary obstruction:Plastic vs partially covered metal stents 被引量:7
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作者 Peter L Moses Khalid M AlNaamani +6 位作者 Alan N Barkun Stuart R Gordon Roger D Mitty M Stanley Branch Thomas E Kowalski Myriam Martel Viviane Adam 《World Journal of Gastroenterology》 SCIE CAS 2013年第46期8638-8646,共9页
AIM:To compare efficacy and complications of par-tially covered self-expandable metal stent(pcSEMS)to plastic stent(PS)in patients treated for malignant,infrahilar biliary obstruction.METHODS:Multicenter prospective r... AIM:To compare efficacy and complications of par-tially covered self-expandable metal stent(pcSEMS)to plastic stent(PS)in patients treated for malignant,infrahilar biliary obstruction.METHODS:Multicenter prospective randomized clinical trial with treatment allocation to a pcWallstent(SEMS)or a 10 French PS.Palliative patients aged≥18,for infrahilar malignant biliary obstruction and a Karnofsky performance scale index>60%from 6 participating North American university centers.Primary endpoint was time to stent failure,with secondary outcomes of death,adverse events,Karnofsky performance score and short-form-36 scale administered on a three-monthly basis for up to 2 years.Survival analyses were performed for stent failure and death,with Cox proportional hazards regression models to determine significant predictive characteristics.RESULTS:Eighty-five patients were accrued over 37mo,42 were randomized to the SEMS group and 83patients were available for analyses.Time to stent failure was 385.3±52.5 d in the SEMS and 153.3±19.8 d in the PS group,P=0.006.Time to death did not differ between groups(192.3±23.4 d for SEMS vs211.5±28.0 d for PS,P=0.70).The only significant predictor was treatment allocation,relating to the time to stent failure(P=0.01).Amongst other measured outcomes,only cholangitis differed,being more common in the PS group(4.9%vs 24.5%,P=0.029).The small number of patients in follow-up limits longitudinal assessments of performance and quality of life.From an initially planned 120 patients,only 85 patients were recruited.CONCLUSION:Partially covered SEMS result in a longer duration till stent failure without increased complication rates,yet without accompanying measurable benefits in survival,performance,or quality of life. 展开更多
关键词 Randomized biliary obstruction STENT PLASTIC Metal PALLIATIVE Common bile duct
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New 14-mm diameter Niti-S biliary uncovered metal stent for unresectable distal biliary malignant obstruction 被引量:5
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作者 Masataka Kikuyama Naofumi Shirane +3 位作者 Shinya Kawaguchi Shuzou Terada Tsuyoshi Mukai Ken Sugimoto 《World Journal of Gastrointestinal Endoscopy》 CAS 2018年第1期16-22,共7页
AIM To investigate whether an uncovered self-expandable metal stent(UCSEMS) with a large diameter could prevent recurrent biliary obstruction(RBO).METHODS Thirty-eight patients with malignant biliary obstruction under... AIM To investigate whether an uncovered self-expandable metal stent(UCSEMS) with a large diameter could prevent recurrent biliary obstruction(RBO).METHODS Thirty-eight patients with malignant biliary obstruction underwent treatment with an UCSEMS with a 14-mm diameter(Niti-S 14). Retrospectively, we evaluated technical and functional success rate, RBO rate, time to RBO, survival time, and adverse events in these patients.RESULTS Stent placement success and functional success were achieved in all patients. Two patients(5.3%) had RBO due to tumor ingrowth or overgrowth. The median time to RBO was 190(range, 164-215) d. The median survival time was 120(range, 18-502) d. The 6-mo non-RBO rate was 91%. Other adverse events other than RBO occurred as follows: Acute cholecystitis, post-ERCP pancreatitis, hemobilia, and fever without exacerbation of liver injury, and liver abscess in 4(10.3%), 3(7.9%), 2(5.3%), 1(2.6%), and 1(2.6%), respectively. Migration of the stents was not observed.CONCLUSION Niti-S 14 is considered to be a preferable metal stent because of a low rate of RBO with no migration. 展开更多
关键词 Metal stent Malignant biliary obstruction pancreatic CANCER Migration pancreatitis bile duct CANCER OVERGROWTH Recurrent biliary obstruction INGROWTH Adverse event
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Duodenoscopy in treatment of acute gallstone pancreatitis 被引量:8
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作者 Ming-Qing Zhou Neng-Ping Li Ren-Da Lu the Department of Surgery, Central Hospital of Zhabei District, Shanghai 200070, China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2002年第4期608-610,共3页
Objective: To probe the potential use of duodenosco- py in the diagnosis and treatment of acute gallstone pancreatitis (GP). Methods: Fourty-five patients with acute GP were randomly divided into endoscopic retrograde... Objective: To probe the potential use of duodenosco- py in the diagnosis and treatment of acute gallstone pancreatitis (GP). Methods: Fourty-five patients with acute GP were randomly divided into endoscopic retrograde cholan- giopancreatography (ERCP) group (n=20) and non-ERCP group (n=25). Each group was subdivi- ded into mild and severe groups according to A- PACHE Ⅱ scores. They were given supportive treat- ment combined with traditional Chinese medicine. The patients in the ERCP group received ERCP within 24 hours after admission. If there were stones in the common bile duct with stenosis of the inferior extremity or ampulla, endoscopic sphincterotomy (ES) was performed to extract the stones by basket. If no calculi were identified or multiple stones were large, endoscopic naso-biliary drainage (ENBD) was carried out. Results: The incidence of complication, length of hospitalization and cost were markedly lower in pa- tients with severe acute GP in the ERCP group than those in the non-ERCP group (P<0.05), in contrast to the 2 mild subgroups of the ERCP and non-ERCP groups (P>0.05). Conclusion: It is feasible, effective and safe to apply duodenoseopy in the treatment of severe acute GP. 展开更多
关键词 pancreatitis DUODENOSCOPY endoscopic retrograde cholangiopancreatography endoscopic sphincterotomy endoscopic naso-biliary drainage common bile duct calculi
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Endoscopic ultrasound guided biliary and pancreatic duct interventions 被引量:1
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作者 David Prichard Michael F Byrne 《World Journal of Gastrointestinal Endoscopy》 CAS 2014年第11期513-524,共12页
When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(E... When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(ESCP), percutaneous radiological therapy or surgery can be considered. Small case series reporting the initial experience with ESCP have been superseded by comprehensive reports of large cohorts. Although these reports are predominantly retrospective, they demonstrate that endoscopic ultrasound(EUS) guided biliary and pancreatic interventions are associated with high levels of technical and clinical success. The proce-dural complication rates are lower than those seen with percutaneous therapy or surgery. This article describes and discusses data published in the last five years relat-ing to EUS-guided biliary and pancreatic intervention. 展开更多
关键词 ENDOSCOPIC ultrasound ENDOSCOPIC retro-grade cholangio-pancreatography Percutaneous tran-shepatic CHOLANGIOGRAPHY bile duct biliary drainage pancreatIC duct pancreatIC drainage
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Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes? 被引量:2
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作者 Yung-Kuan Tsou Yi-Tse Su +1 位作者 Cheng-Hui Lin Nai-Jen Liu 《World Journal of Clinical Cases》 SCIE 2023年第29期6984-6994,共11页
BACKGROUND Whether clinical outcomes of acute cholangitis(AC)vary by etiology is unclear.AIM To compare outcomes in AC caused by malignant biliary obstruction(MBO)and common bile duct stones(CBDS).METHODS This retrosp... BACKGROUND Whether clinical outcomes of acute cholangitis(AC)vary by etiology is unclear.AIM To compare outcomes in AC caused by malignant biliary obstruction(MBO)and common bile duct stones(CBDS).METHODS This retrospective study included 516 patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)due to AC caused by MBO(MBO group,n=56)and CBDS(CBDS group,n=460).Clinical and laboratory parameters were compared between the groups.Propensity score matching(PSM)created 55 matched pairs.Confounders used in the PSM analysis were age,sex,time to ERCP,and technical success of ERCP.The primary outcome comparison was 30-d mortality.The secondary outcome comparisons were intensive care unit(ICU)admission rate,length of hospital stay(LOHS),and 30-d readmission rate.RESULTS Compared with the CBDS group,the MBO group had significantly lower body temperature,percentage of abnormal white blood cell counts,and serum levels of aspartate aminotransferase,alanine aminotransferase,and creatinine.Body temperature,percent abnormal white blood cell count,and serum aspartate aminotransferase levels remained significantly lower in the MBO group in the PSM analysis.Platelet count,prothrombin time/international normalized ratio,and serum levels of alkaline phosphatase and total bilirubin were significantly higher in the MBO group.The MBO group had a significantly higher percentage of severe AC(33.9%vs 22.0%,P=0.045)and received ERCP later(median,92.5 h vs 47.4 h,P<0.001).However,the two differences were not found in the PSM analysis.The 30-d mortality(5.4%vs 0.7%,P=0.019),ICU admission rates(12.5%vs 4.8%,P=0.028),30-d readmission rates(23.2%vs 8.0%,P<0.001),and LOHS(median,16.5 d vs 7.0 d,P<0.001)were significantly higher or longer in the MBO group.However,only LOHS remained significant in the PSM analysis.Multivariate analysis revealed that time to ERCP and multiple organ dysfunction were independent factors associated with 30-d mortality.CONCLUSION MBO patients underwent ERCP later and thus had a worse prognosis than CBDS patients.Therefore,clinicians should remain vigilant in MBO patients with clinically suspected AC,and perform ERCP for biliary drainage as soon as possible. 展开更多
关键词 Malignant biliary obstruction Common bile duct stones Endoscopic retrograde cholangiopancreatography Acute cholangitis MORTALITY ETIOLOGY
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One-step palliative treatment method for obstructive jaundice caused by unresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent 被引量:29
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作者 Hiroshi Yoshida Yasuhiro Mamada +10 位作者 Nobuhiko Taniai Yoshiaki Mizuguchi Tetsuya Shimizu Shigeki Yokomuro Takayuki Aimoto Yoshiharu Nakamura Eiji Uchida Yasuo Arima Manabu Watanabe Eiichi Uchida Takashi Tajiri 《World Journal of Gastroenterology》 SCIE CAS CSCD 2006年第15期2423-2426,共4页
AIM: To describe a simple one-step method involving percutaneous transhepatic insertion of an expandable metal stent (EMS) used in the treatment of obstructive jaundice caused by unresectable malignancies. METHODS... AIM: To describe a simple one-step method involving percutaneous transhepatic insertion of an expandable metal stent (EMS) used in the treatment of obstructive jaundice caused by unresectable malignancies. METHODS: Fourteen patients diagnosed with obstructive jaundice due to unresectable malignancies were included in the study. The malignancies in these patients were a result of very advanced carcinoma or old age. Percutaneous transhepatic cholangiography was performed under ultrasonographic guidance. After a catheter with an inner metallic guide was advanced into the duodenum, an EMS was placed in the common bile duct, between a point 1 cm beyond the papilla of Vater and the entrance to the hepatic hilum. In cases where it was difficult to span the distance using just a single EMS, an additional stent was positioned. A drainage catheter was left in place to act as a hemostat. The catheter was removed after resolution of cholestasis and stent patency was confirmed 2 or 3 d post-procedure. RESULTS: One-step insertion of the EMS was achieved in all patients with a procedure mean time of 24.4 min. Out of the patients who required 2 EMS, 4 needed a procedure time exceeding 30 min. The mean time for removal of the catheter post-procedure was 2.3 d. All patients died of malignancy with a mean follow-up time of 7.8 mo. No stent-related complication or stent obstruction was encountered. CONCLUSIONS: One-step percutaneous transhepaticinsertion of EMS is a simple procedure for resolving biliary obstruction and can effectively improve the patient's quality of life. 展开更多
关键词 Expandable metallic stent bile duct carcinoma Gall bladder carcinoma pancreatic carcinoma Gastric carcinoma obstructive jaundice
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Role of endoscopic ultrasound in idiopathic pancreatitis 被引量:14
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作者 Piyush Somani Tagore Sunkara Malay Sharma 《World Journal of Gastroenterology》 SCIE CAS 2017年第38期6952-6961,共10页
Recurrent acute pancreatitis(RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is cl... Recurrent acute pancreatitis(RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP(IRAP). Idiopathic acute pancreatitis(IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. Endoscopic ultrasound(EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed. 展开更多
关键词 Endoscopic ultrasound pancreatitis ERCP MRCP USG CT Idiopathic recurrent pancreatitis ASCARIASIS pancreatic cancer biliary sludge GALLSTONES MICROLITHIASIS Common bile duct stones
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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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Complications of common bile duct stones: A risk factors analysis 被引量:4
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作者 Dong Jun Oh Ji Hyung Nam +1 位作者 Dong Kee Jang Jun Kyu Lee 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2021年第4期361-365,共5页
Background: The latest guidelines recommended that common bile duct stones(CBDSs) should be removed, preferably endoscopically, regardless of the presence of symptoms or complications. However, the removal of CBDSs ma... Background: The latest guidelines recommended that common bile duct stones(CBDSs) should be removed, preferably endoscopically, regardless of the presence of symptoms or complications. However, the removal of CBDSs may not be feasible in very old patients or those with co-morbidities. In these cases, it is important to understand the risk factors for the development of CBDSs-related complications to decide whether or not to treat high-risk patients. Herein, we aimed to identify the risk factors for the development of complications after the diagnosis of CBDSs. Methods: The medical records of patients with CBDSs between October 2005 and September 2019 were retrospectively analyzed. All patients with radiologically-diagnosed CBDSs, including those who received treatment and those who did not, were analyzed. Results: A total of 634 patients were included and 95(15.0%) patients had CBDS-related complications during the mean follow-up period of 32.6 months. Forty-four(6.9%) high-risk patients remained asymptomatic and did not receive treatment during the follow-up period. In multivariate analyses, size of CBDSs ≥ 5 mm and no treatment within 30 days were independent risk factors for the development of complications. The spontaneous passage of CBDSs was proved radiologically in 9 out of 81(11.1%) patients within 30 days. Conclusions: It is recommended treating CBDSs within 30 days from the diagnosis, even in high-risk patients, especially if the size is larger than 5 mm. 展开更多
关键词 Common bile duct stone Risk factors obstructive jaundice pancreatitis CHOLANGITIS
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Surgical treatment of patients with intermediate-terminal pancreatic cancer 被引量:3
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作者 Yu-Bin Liu Liang Huang Zhi-Yong Xian Zhi-Xiang Jian Jin-Rui Ou Zi-Xian Liu 《World Journal of Gastroenterology》 SCIE CAS CSCD 2006年第5期765-767,共3页
AIM: To investigate the surgical treatment of patients with intermediate-terminal pancreatic cancer. METHODS: A retrospective analysis was made of the clinical data of 163 patients with intermediate-terminal pancrea... AIM: To investigate the surgical treatment of patients with intermediate-terminal pancreatic cancer. METHODS: A retrospective analysis was made of the clinical data of 163 patients with intermediate-terminal pancreatic cancer who were surgically treated between August 1994 and August 2003. RESULTS: A total of 149 patients underwent palliative surgery. The mortality rate of those who underwent cholecystojejunostomy alone was 14.2%, the icterus or cholangitis recurrence rate was 61.9% with an average survival period of 7.1 too. The mortality rate for those who received hepatic duct-jejunostomy (HDJS) was 5.7%, the icterus or cholangitis recurrence rate was 6.8% with an average survival period of 7.1 too. But 31.8% of the patients developed duodenum obstruction within 6 mo after the surgery, six of seven patients with severe pain were given peri-abdominal aorta injection with absolute alcohol and their pain was alleviated. The other patients underwent percutaneous transhepatic cholangial drainage (PTCD) and their icterus index returned to normal level within 40 d with an average survival period of 7.5 mo. CONCLUSION: Roux-en-y HDJS combined with prophylactic gastrojejunostomy is recommended for patients with intermediate-terminal pancreatic cancer, and biliary prosthesis can partly relieve biliary obstruction in a short term. 展开更多
关键词 pancreatic cancer bile duct conduction Gastrointestinal conduction biliary prosthesis
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Surgery in biliary lithiasis: from the traditional “open” approach to laparoscopy and the“rendezvous” technique 被引量:18
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作者 Giuseppe Tarantino Paolo Magistri +3 位作者 Roberto Ballarin Giacomo Assirati Antonio Di Cataldo Fabrizio Di Benedetto 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2017年第6期595-601,共7页
BACKGROUND:According to the current literature, biliary lithiasis is a worldwide-diffused condition that affects almost 20% of the general population. The rate of common bile duct stones(CBDS) in patients with symptom... BACKGROUND:According to the current literature, biliary lithiasis is a worldwide-diffused condition that affects almost 20% of the general population. The rate of common bile duct stones(CBDS) in patients with symptomatic cholelithiasis is estimated to be 10% to 33%, depending on patient’s age.Compared to stones in the gallbladder, the natural history of secondary CBDS is still not completely understood. It is not clear whether an asymptomatic choledocholithiasis requires treatment or not. For many years, open cholecystectomy with choledochotomy and/or surgical sphincterotomy and cleaning of the bile duct were the gold standard to treat both pathologies. Development of both endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic surgery,together with improvements in diagnostic procedures, influenced new approaches to the management of CBDS in association with gallstones.DATA SOURCES:We decided to systematically review the literature in order to identify all the current therapeutic options for CBDS. A systematic literature search was performed independently by two authors using Pub Med, EMBASE, Scopus and the Cochrane Library Central.RESULTS:The therapeutic approach nowadays varies greatly according to the availability of experience and expertise in each center, and includes open or laparoscopic common bile duct exploration, various combinations of laparoscopic cholecystectomy and ERCP and combined laparoendoscopic rendezvous.CONCLUSIONS:Although ERCP followed by laparoscopic cholecystectomy is currently preferred in the majority of hospitals worldwide, the optimal treatment for concomitant gallstones and CBDS is still under debate, and greatly varies among different centers. 展开更多
关键词 biliary obstruction bile duct stones GALLSTONES endoscopic retrograde cholangiopancreatography laparoscopic cholecystectomy
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Endoscopic ultrasound-guided biliary drainage 被引量:7
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作者 Disaya Chavalitdhamrong Peter V Draganov 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第6期491-497,共7页
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 ... 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).EUSguided 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. 展开更多
关键词 bile duct biliary obstruction biliary drainage Endoscopic ultrasound Endoscopic ultrasound-guidedbiliary drainage
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Clinical characteristics of intrahepatic biliary papilloma:A case report 被引量:2
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作者 Dan Yi Li-Jing Zhao +2 位作者 Xiao-Bo Ding Tai-Wei Wang Song-Yang Liu 《World Journal of Clinical Cases》 SCIE 2021年第13期3185-3193,共9页
BACKGROUND Intrahepatic bile duct papilloma(IPNB)is a rare benign tumour from the bile duct epithelium and has a high malignant transformation rate.Early radical resection can obviously improve the prognosis of patien... BACKGROUND Intrahepatic bile duct papilloma(IPNB)is a rare benign tumour from the bile duct epithelium and has a high malignant transformation rate.Early radical resection can obviously improve the prognosis of patients,but it is difficult to be sure of the diagnosis of IPNB before operating.CASE SUMMARY This study included 28 patients with intraductal papilloma admitted to the First Hospital of Jilin University from January 2010 to November 2020 and recorded their clinical manifestations,imaging features,complications and prognosis.There were 12 males and 16 females with an average age of 61.36±8.03 years.Most patients had symptoms of biliary obstruction.Biliary dilatation and cystic mass could be seen on imaging.After surgery,IPNB was diagnosed by pathology.CONCLUSION IPNB is a rare benign tumour in the bile duct.Early diagnosis and timely R0 resection can improve the prognosis of IPNB. 展开更多
关键词 Intrahepatic bile duct Papillary tumour biliary obstruction Mural nodules Case report
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Endoscopic ultrasound-guided biliary drainage-current status and future perspectives 被引量:3
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作者 Petko Ivanov Karagyozov Ivan Tishkov +1 位作者 Irina Boeva Kiril Draganov 《World Journal of Gastrointestinal Endoscopy》 2021年第12期607-618,共12页
Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duode... Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duodenal diverticulum,ampullary neoplastic infiltration or surgically altered anatomy.In these cases percutaneous biliary drainage(PTBD)is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices.A large amount of data is already collected that proves its efficacy,safety and ability to replace PTBD in cases of ERCP failure.It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future.Several EUS-BD techniques are developed EUS-guided transmural stenting,antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy.EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure.The lack of training,absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure,which is related to life-threatening adverse events.Developing training models,dedicated devices and guidelines hopefully will make EUS-BD easier,safer and well accepted in the future.This paper focuses on the technical aspects of the different EUS-BD procedures,available literature data,advantages,negative aspects and the future perspectives of these modalities. 展开更多
关键词 Endoscopic ultrasound-guided biliary drainage Malignant bile duct obstruction Endoscopic ultrasound-guided hepaticogastrostomy Endoscopic ultrasoundguided rendezvous technique Endoscopic ultrasound-guided choledochoduodenostomy Endoscopic ultrasound-guided antegrade stenting Endoscopic retrograde cholangiopancreatography
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