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Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children

World Journal of Gastroenterology 2010年第4期16卷 490-495页

作者： Joo Young Jang Chong Hyun Yoon Kyung Mo Kim Department of Pediatrics Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoul 138-736South Korea Department of Pediatrics Ajou University School of MedicineSuwon 443-721South Korea Department of Pediatric Radiology Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoul 138-736South Korea Department of Pediatrics Asan Medical Center Children’s HospitalUniversity of Ulsan College of MedicineSeoul 138-736South Korea

AIM:To assess the indications,findings,therapeutic procedures,safety,and complications of endoscopic retrograde cholangiopancreatography(ERCP) performed in Korean ***:The demographic characteristics,indications for ERCP,findings,therapeutic procedures,and complications of 122 pediatric patients who underwent 245 ERCPs in the Asan Medical Center between June 1994 and March 2008 were ***:The mean age of the 122 patients was 8.0 ± 4.2 *** were biliary pathology in 78(64.0%),pancreatic pathology in 43(35.2%),and chronic abdominal pain in *** indications included choledochal cysts in 40,choledocholithiasis in 24,suspected sclerosing cholangitis in 8,trauma in 2,and other conditions in *** indications includedacute pancreatitis in 7,acute recurrent pancreatitis in 11,chronic pancreatitis in 20,trauma in 3,and pancreatic mass in *** the 245 ERCPs,success rate was 98.4% and 190(77.6%) were for therapeutic purposes,including endoscopic nasal drainage(51.8%),biliary sphincterotomy(38.0%),pancreatic sphincterotomy(23.3%),stent insertion(15.1%),stone extraction(18.8%),and balloon dilatation(11.0%).Complications were postERCP pancreatitis in 16(6.5%),ileus in 23(9.4%),hemorrhage in 2(0.8%),perforation in 2(0.8%),sepsis in 1(0.4%),and impacted basket in 1(0.4%).There were no procedure-related deaths,and most complications improved under supportive ***:This study showed that there is a high incidence of choledochal cyst and diagnostic and therapeutic ERCP for the management of various biliary and pancreatic diseases was safe and effective in Korean children.

关键词： Endoscopic retrograde cholangiopancreatography Pancreatic diseases biliary tract diseases Choledochal cyst Pancreatitis Pediatrics

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Empirical antibiotic treatment with piperacillin-tazobactam in Patients with microbiologically-documented biliary tract infections

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World Journal of Gastroenterology 2004年第15期10卷 2281-2283页

作者： Gabrio Bassotti Fabio Chistolini Francis Sietchiping-Nzepa Giuseppe de Roberto Antonio Morelli Gastrointestinal and Hepatology Section Department of Clinical and Experimental MedicineUniversity of PerugiaItaly

AIM: To report our experience with empiric antimicrobial monotherapy (piperacillin/tazobactam, of which no data are available in such specific circumstances) in microbiologically-documented infections in patients with benign and malignant conditions of the biliary ***: Twenty-three patients, 10 with benign and 13 with malignant conditions affecting the biliary tree and microbiologically-documented infections were recruited and the efficacy of empirical antibiotic therapy was ***: The two groups featured similar demographic and clinical data. Overall, the infective episodes were most due to Gram negative agents, more than 60% of such episodes (mostly in malignant conditions) were preceded by invasive instrumental maneuvers. Empirical antibiotic therapy with a single agent (piperacillin/tazobactam) was effective in more than 80% of cases. No deaths were reported following infections. CONCLUSION: An empiric therapeutic approach with piperacillin/tazobactam is highly effective in biliary tract infections due to benign or malignant conditions.

关键词： Adult Aged Aged, 80 and over Anti-Bacterial Agents biliary tract diseases biliary tract Neoplasms Drug Combinations Empirical Research Female Humans Infection Male Middle Aged Penicillanic Acid derivatives Piperacillin

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Experiences relating to management of biliary tract complications following liver transplantation in 96 cases

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Chinese Medical Journal 2002年第10期115卷 1533-1537页

作者：周光文蔡伟耀李宏为朱岳 John J.Fung 上海第二医科大学附属瑞金医院外科上海200025 Thomas E. Starzl Transplant Institute Pittsburgh PA 15213 USA

OBJECTIVE: To investigate best diagnosing methods and therapy for patients with biliary tract complications after liver transplantation and analyze related factors. METHODS: A review was made of data collected from 96 patients, and confirmed by retrospective case notes examination. RESULTS: A total of 94 patients (97 grafts) survived more than 2 days after transplantation; of whom, 92 had an end-to-end biliary anastomosis with a T tube. The average follow-up was 5.8 months (range: 0.3 - 10.2 months). Among the 94 patients, eight (8.5%, 8/94) had complications: leakage during T-tube removal (2 patients), leakage at an earlier stage (2), simultaneous stricture and leak (2) and just stricture (2). Six patients with biliary tract complications had predisposing factors including hepatic artery stenosis (2 patients, including one hepatic artery stenosis combined with severe rejection, hepatic artery thrombosis (3), and donor-recipient bile duct mismatch (1). There was no difference in cold ischemic time. With hepatic artery thrombosis and/or stenosis > 50%, five patients were re-transplanted; without hepatic artery thrombosis and/or stenosis 50%, re-transplantation is needed as early as possible.

关键词： Adult biliary tract diseases Female Humans Liver Transplantation Male Middle Aged Postoperative Complications Reoperation Retrospective Studies

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Pancreaticobiliary reflux in patients with a normal pancreaticobiliary junction:Pathologic implications

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World Journal of Gastroenterology 2011年第8期17卷 953-962页

作者： Marcelo A Beltrán Department of Surgery La Serena Hospital

Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and its pathologic implications has experienced tremendous progress during the last few *** editorial reviews the current knowledge on this condition and its pathological implications on gallbladder *** following aspects were def ined appropriate for discussion:(1) Evidence of carcinogenesis associated with pancreaticobiliary reflux;(2) Evidence of pancreaticobiliary reflux in normal pancreaticobiliary junction;and(3) Evidence of sphincter of Oddi(SO) dysfunction as a cause of pancreaticobiliary reflux in normal pancreaticobiliary *** articles reviewed were selected and classif ied according to f ive levels of evidence:Level-this *** an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and its clinical significance,the current evidence does not fully support what has been *** with evidence level Ι have not been *** is a fascinating subject of study,and if finally supported by evidence level Ι,the importance of this condition will constitute a major breakthrough in biliary pathology.

关键词： biliary tract diseases biliary tract motilitydisorders Pancreaticobiliary junction Pancreaticobili-ary reflux Sphincter of Oddi

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Biochemical and radiological predictors of malignant biliary strictures

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World Journal of Gastroenterology 2004年第10期10卷 1504-1507页

作者： Ibrahim A.AI-Mofleh Abdulrahman M.Aljebreen Saleh M.AlAmri Rashed S.AJ-Rashed Faleh Z.Al-Faleh Hussein M.AJ-Freihi Ayman A.Abdo Arthur C.Isnani Gastroenterology Division department of Medicine (38)King Khalid University HospitalRiyadhKingdom of Saudi Arabia King Khalid University Hospital College of Medicine and Research Center (74)PO Box 2925Riyadh 11461Kingdom of Saudi Arabia

AIM: Differentiation of benign biliary strictures (BBS) from malignant biliary strictures (MBS) remains difficult despite improvement in imaging and endoscopic techniques. The aim of this study was to identify the clinical, biochemical and or radiological predictors of malignant biliary ***: We retrospectively reviewed all charts of patients who had biliary strictures (BS) on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous cholangiography (PTC) in case of unsuccessful ERCP from March 1998 to August 2002. Patient characteristics, clinical features, biochemical, radiological and biopsy results were all recorded. Stricture etiology was determined based on cytology,biopsy or clinical follow-up. A receiver operator characteristic (ROC) curve was constructed to determine the optimal laboratory diagnostic criterion threshold in predicting ***: One hundred twenty six patients with biliary strictures were enrolled, of which 72 were malignant. The mean age for BBS was 53 years compared to 62.4 years for MBS (P=0.0006). Distal bile duct stricture was mainly due to a malignant process 48.6% vs 9% (P=0.001). Alkaline phosphates and AST levels were more significantly elevated in MBS (P=0.0002). ROC curve showed that a bilirubin level of 84 μmol/L or more was the most predictive of MBS with a sensitivity of 98.6%, specificity of 59.3% and a positive likelihood ratio of 2.42 (95% CI=0.649-0.810). Proximal biliary dilatation was more frequently encountered in MBS compared to BBS, 73.8% vs39.5% (P=0.0001). Majority of BBS (87%) and MBS (78%) were managed ***: A serum bilirubin level of 84 μmol/L or greater is the best predictor of MBS. Older age, proximal biliary dilatation, higher levels of bilirubin, alkaline phosphatase, ALT and AST are all associated with MBS. ERCP is necessary to diagnose and treat benign and malignant biliary strictures.

关键词： biliary tract diseases biliary tract Neoplasms Constriction, Pathologic Predictive Value of Tests Age Factors Bilirubin Cholangiography Cholangiopancreatography, Endoscopic Retrograde Humans Middle Aged ROC Curve Retrospective Studies Sensitivity and Specificity

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Diagnostic role of secretin-enhanced MRCP in patients with unsuccessful ERCP

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World Journal of Gastroenterology 2004年第20期10卷 3034-3038页

作者： László Czakó Tamás Takács Zita Morvay László Csernay János Lonovics First Department of Medicine University of SzegedSzegedHungary International Medical Center SzegedHungary

AIM:To evaluate the value of MR cholangiopancreatography (MRCP)in patients in whom endoscopic retrograde cholangiopancreatography(ERCP)was unsuccessfully performed by experts in a tertiary center. METHODS:From January 2000 to June 2003,22 patients fulfilled the inclusion *** indications for ERCP were obstructive jaundice(n=9),abnormal liver enzymes(n=8), suspected chronic pancreatitis(n=2),recurrent acute pancreatitis(n=2),or suspected pancreatic cancer(n=1). The reasons for the ERCP failure were the postsurgical anatomy(n=7),duodenal stenosis(n=3),duodenal diverticulum(n=2),and technical failure(n=10).MRCP images were evaluated before and 5 and 10 rain after i.v. administration of 0.5 IU/kg secretin. RESULTS:The MRCP images were diagnosed in all 21 *** patients gave normal MR findings and required no further *** revealed abnormalities(primary sclerosing cholangitis,chronic pancreatitis,cholangitis,cholecystolithiasis or common bile duct dilation)in 20 patients,who were followed up *** patients subsequently underwent laparotomy(hepaticojejunostomy in consequence of common bile duct stenosis caused by unresectable pancreatic cancer;hepaticotomy+Kehr drainage because of insufficient biliary-enteric anastomosis;choledochoj- ejunostomy,gastrojejunostomy and cysto-Wirsungo gastrostomy because of chronic pancreatitis,or choledochojejunostomy because of common bile duct stenosis caused by chronic pancreatitis).Three patients participated in therapeutic percutaneous transhepatic *** indications were choledocholithiasis with choledochojejunostomy,insufficient biliary-enteric anastomosis,or cholangiocarcinoma. CONCLUSION:MRCP can assist the diagnosis and management of patients in whom ERCP is not possible.

关键词： Adult Aged Aged, 80 and over biliary tract diseases Cholangiography Cholangiopancreatography, Endoscopic Retrograde Diagnosis, Differential Female Humans Jaundice, Obstructive Magnetic Resonance Imaging Male Middle Aged Pancreatitis Prospective Studies Research Support, Non-U.S. Gov't Secretin Sensitivity and Specificity

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Pyogenic liver abscess: Differences in etiology and treatment in Southeast Asia and Central Europe

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World Journal of Gastroenterology 2010年第20期16卷 2458-2462页

作者： Herwig Cerwenka Department of Surgery Medical University of GrazA-8036 GrazAustria

Knowledge of etiology and timely treatment of underlying causes,when possible,play an important role in the successful therapy of patients with pyogenic liver abscess (PLA).Recent publications from Central Europe and Southeast Asia hint at considerable differences in *** this article,we aim to elaborate these differences and their therapeutic *** from some special types of PLA that are comparable in Southeast Asia and Central Europe (such as posttraumatic or postprocedural PLA),there are clear differences in the microbiological spectrum,which implies different risk factors and disease *** pneumoniae (***) PLA is predominantly seen in Southeast Asia,whereas,in Central Europe,PLA is typically caused by Escherichia coli,Streptococcus or Staphylococcus,and these patients are more likely to be older and to have a biliary abnormality or *** patients are more likely to have diabetes *** of septic spread is crucial in *** patients,whereas treatment of the underlying diseases is decisive in many Central European PLA patients.

关键词： Liver abscess Klebsiella pneumoniae biliary tract diseases Drainage Antibiotics

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Management of occluded self-expanding biliary metal stents in malignant biliary disease

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Hepatobiliary & Pancreatic diseases International 2018年第1期17卷 49-54页

作者： Simon Nennstiel Isolde Tschurtschenthaler Bruno Neu Hana Algül Monther Bajbouj Roland M. Schmid Stefan von Delius Andreas Weber Klinik und Poliklinik fur Innere Medizin Ⅱ Klinikum rechts der Isar der Technischen Universitar Manchen Ismaninger Straβe 22 Munich 81675 Germany Medizinische Klinik II Krankenhaus Landshut-Achdorf Academic Teaching Hospital Technische Universitar Munchen Achdorferweg 3 Landshut 84036Germany

Background: Occlusion of self-expanding metal stents(SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of ***: Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS,management strategies, stent patency, subsequent interventions, survival time and case ***: A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency(88 vs. 143 days, P = 0.069), median survival time(95 vs. 192 days, P = 0.116), median subsequent intervention rate(53.4% vs. 40.0%, P = 0.501)and median case charge(€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months,significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS(93.3% vs. 57.1%, P = 0.037).Conclusions: In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management

关键词： Self-expanding metal stents biliary tract neoplasms Endoscopic retrograde cholangiopancreatography biliary tract diseases Complications

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Prospective evaluation of the short access cholangioscopy for stone clearance and evaluation of indeterminate strictures

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Hepatobiliary & Pancreatic diseases International 2017年第1期16卷 96-103页

作者： Athanasios D Sioulas Muhammad A El-Masry Stefan Groth Guido Schachschal Mario Anders Thomas Rosch Ulrike Denzer Department of Interdisciplinary Endoscopy University Hospital Hamburg-Eppendorf MartinistraBe 52 20246 Hamburg Germany Division of Gastroenterology Department of Internal Medicine Assiut University Hospital Al Walideyah Al Qebleyah Qesm Than Asyut Assiut Governorate Egypt

BACKGROUND： Peroral cholangioscopy facilitates diagnosis and therapy of biliary disorders. This study prospectively evaluated a new short access cholangioscopy. METHODS： Consecutive patients were included as follows： difficult stones （group 1） underwent cholangioscopy with electrohydraulic lithotripsy and indeterminate biliary strictures （group 2） were evaluated with macroscopic assessment and cholangioscopy guided biopsy sampling. We evaluated the complete stone clearance rate （group 1） and diagnostic accu- racy （group 2）. Follow-up was performed over a median of 13 and I6 months, respectively. RESULTS： Group 1 （n=21）： complete stone clearance defined as lack of stones in cholangiography and stone removal dur- ing cholangioscopy was achieved in 15 （71.4%） patients. Clini- cal stone clearance defined as lack of symptoms, laboratory abnormalities and hospital visits during follow-up, irrespec- tive of stone clearance was evident in 17 （81.0%） patients. One serious adverse event occurred （bile duct perforation）. Group 2 （n=28）： malignancy was confirmed in 15 patients. Sensitiv- ity, specificity and diagnostic accuracy of cholangioscopy were 85.7%, 75.0% and 80.7%, respectively. Sensitivity, specificity and diagnostic accuracy of biopsies were 54.5%, 100.0% and 72.2%, respectively. No serious adverse events occurred, and one patient was lost to ***： The novel system enabled complex stone treatment and biliary stricture diagnosis. Cholangioscopy outperformed direct biopsy regarding characterization of in- determinate strictures.

关键词： biliary tract diseases novel cholangioscopy feasibility

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Managing malignant biliary obstruction in pancreas cancer: Choosing the appropriate strategy

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World Journal of Gastroenterology 2014年第28期20卷 9345-9353页

作者： Brian R Boulay Mayur Parepally Division of Gastroenterology and Hepatology University of Illinois Hospital and Health Sciences System

Most patients with pancreatic cancer develop malignant biliary *** of obstruction is generally indicated to relieve symptoms and improve morbidity and ***-line therapy consists of endoscopic biliary stent *** data comparing plastic stents to self-expanding metallic stents(SEMS)has shown improved patency with *** decision of whether to treat obstruction and the means for doing so depends on the clinical *** patients with resectable disease,preoperative biliary decompression is only indicated when surgery will be delayed or complications of jaundice *** patients with locally advanced disease,self-expanding metal stents are superior to plastic stents for long-term *** patients with advanced disease,the choice of metallic or plastic stent depends on life *** endoscopic stent placement fails,percutaneous or surgical treatments are *** therapy or surgical approach can be used to treat concomitant duodenal and biliary obstruction.

关键词： Pancreatic neoplasms Cholestasis Extrahepatic Stents biliary tract diseases

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