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Response letter to “Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the outcomes?” with imaging aspects

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World Journal of Clinical Cases 2024年第5期12卷 1029-1032页

作者： Sonay Aydin Baris Irgul Department of Radiology Erzincan Binali Yildirim UniversityErzincan 24100Turkey

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

Imaging features of malignant vs stone-induced biliary obstruction:Aspects to consider

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World Journal of Clinical Cases 2024年第15期12卷 2678-2681页

作者： Cristian Lindner Department of Radiology Faculty of MedicineUniversity of ConcepciónConcepción 4030000Chile

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.

关键词： Malignant biliary obstruction choledocholithiasis Dilated bile ducts Magnetic resonance Multidetector computed tomography

Risk factors of recurrent choledocholithiasis following therapeutic endoscopic retrograde cholangiopancreatography

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Hepatobiliary & Pancreatic Diseases International 2023年第3期22卷 282-287页

作者： Lin Li Jing Wang Cheng-Cheng Tong Chi-Yi He Department of Gastroenterology The First Affiliated Hospital of Wannan Medical CollegeWuhu 241001China

Background:The risk factors for the recurrent choledocholithiasis after endoscopic retrograde cholangiopancreatography(ERCP)have not been well studied.The aim of this study was to explore the risk factors of recurrent choledocholithiasis.Methods:We carried out a retrospective analysis of data collected between January 1,2010 and January 1,2020.Univariate analysis and multivariate analysis were used to explore the independent risk factors of recurrent choledocholithiasis following therapeutic ERCP.Results:In total,598 patients were eventually selected for analysis,299 patients in the recurrent choledocholithiasis group and 299 patients in the control group.The overall rate of recurrent choledocholithiasis was 6.91%.Multivariate analysis showed that diabetes[odds ratio(OR)=3.677,95%confidence interval(CI):1.875-7.209;Pcholedocholithiasis.However,history of drinking(OR=0.183,95%CI:0.099-0.337;Pcholedocholithiasis.Conclusions:Patients with the abovementioned risk factors are more likely to have recurrent CBD stones.Patients who eat light food frequently and have a history of drinking are less likely to present with recurrent CBD calculi.

关键词： Recurrence choledocholithiasis Endoscopic retrograde cholangiopancreatography

choledocholithiasis caused by anatomical variation of cystic duct: A case report

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Laparoscopic, Endoscopic and Robotic Surgery 2022年第1期5卷 40-44页

作者： Meng Tong Yumeng Li Xuedi Sun Yingli Wang Shuai Yang Bocheng Zhang Feiyu Jia Lijun Peng Jinghua Liu Department of General Surgery Jinzhou Medical UniversityJinzhou 121001China Graduate Management Office Education and Teaching DepartmentLinyi People's HospitalLinyi 276000China Department of Gastroenterology Linyi People's HospitalLinyi 276000China Department of Hepatobiliary Surgery Linyi People's HospitalLinyi 276000China Minimally Invasive Institute of Digestive Surgery and Prof.Cai's Laboratory Linyi People's HospitalLinyi 276000China

Laparoscopic cholecystectomy(LC)has gradually become the first choice for the treatment of cholecystolithiasis in recent years.Iatrogenic bile duct injury(IBDI)is an important clinical problem in LC.The anatomical variation of the cystic duct increases the probability of IBDI and the difficulty of operation.We present a case of a 44-year-old male with a anatomical variation of the cystic duct complicated with cholecystolithiasis and choledocholithiasis,who successfully underwent choledocholithotomy,choledochoscopic exploration and T-tube drainage surgery.The patient recovered well and was discharged home on postoperative day 10.The T-tube was removed at 1 month postoperatively after cholangiography examination of no choledocholithiasis left.

关键词： Cholecystolithiasis choledocholithiasis Anatomical variation of cystic duct Laparoscopic cholecystectomy Choledocholithotomy

Microbiologic risk factors of recurrent choledocholithiasis postendoscopic sphincterotomy

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World Journal of Gastroenterology 2022年第12期28卷 1257-1271页

作者： Ying Li Wen-Hui Tan Jia-Chuan Wu Zhi-Xin Huang Yan-Yan Shang Biao Liang Jian-Hui Chen Rui Pang Xin-Qiang Xie Ju-Mei Zhang Yu Ding Liang Xue Mou-Tong Chen Juan Wang Qing-Ping Wu Guangdong Provincial Key Laboratory of Microbial Safety and Health Key Laboratory of Agricultural Microbiomics and Precision ApplicationMinistry of Agriculture and Rural AffairsState Key Laboratory of Applied Microbiology Southern ChinaInstitute of MicrobiologyGuangdong Academy of SciencesGuangzhou 510070Guangdong ProvinceChina Digestive Endoscopy Center Guangdong Second Provincial General HospitalGuangzhou 510000Guangdong ProvinceChina Division of Gastrointestinal Surgery Center The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510080Guangdong ProvinceChina

BACKGROUND choledocholithiasis is a severe disorder that affects a significant portion of the world’s population.Treatment using endoscopic sphincterotomy(EST)has become widespread;however,recurrence post-EST is relatively common.The bile microbiome has a profound influence on the recurrence of choledocholithiasis in patients after EST;however,the key pathogens and their functions in the biliary tract remain unclear.AIM To investigate the biliary microbial characteristics of patients with recurrent choledocholithiasis post-EST,using next-generation sequencing.METHODS This cohort study included 43 patients,who presented with choledocholithiasis at the Guangdong Second Provincial General Hospital between May and June 2020.The patients had undergone EST or endoscopic papillary balloon dilation and were followed up for over a year.They were divided into either the stable or recurrent groups.We collected bile samples and extracted microbial DNA for analysis through next-generation sequencing.Resulting sequences were analyzed for core microbiome and statistical differences between the diagnosis groups;they were examined using the Kyoto Encyclopedia of Genes and Genomes pathway hierarchy level using analysis of variance.Correlation between the key genera and metabolic pathways in bile,were analyzed using Pearson’s correlation test.RESULTS The results revealed distinct clustering of biliary microbiota in recurrent choledocholithiasis.Higher relative abundances(RAs)of Fusobacterium and Neisseria(56.61%±14.81%vs 3.47%±1.10%,8.95%±3.42%vs 0.69%±0.32%,respectively)and the absence of Lactobacillus were observed in the bile of patients with recurrent disease,compared to that in stable patients.Construction of a microbiological co-occurrence network revealed a mutual relationship among Fusobacterium,Neisseria,and Leptotrichia,and an antagonistic relationship among Lactobacillales,Fusobacteriales,and Clostridiales.Functional prediction of biliary microbiome revealed that the loss of transcription and metabolic abilities may lead

关键词： choledocholithiasis Biliary tract Microbiome Endoscopic sphincterotomy Recurrence Lactobacillus

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients:A technical review

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World Journal of Clinical Cases 2023年第9期11卷 1939-1950页

作者： Bo-Ya Chiu Shu-Hung Chuang Shih-Chang Chuang Kung-Kai Kuo School of Post-baccalaureate Medicine College of MedicineKaohsiung Medical UniversityKaohsiung 80708Taiwan Division of General and Digestive Surgery Department of SurgeryKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiung 80708Taiwan School of Medicine College of MedicineKaohsiung Medical UniversityKaohsiung 80708Taiwan

Situs inversus(SI)is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs.Since the 1990s,more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy.In these cases,the major problem is to overcome is the left-right condition for right-handed surgeons.Laparoscopic common bile duct exploration(LCBDE),an alternative to treat patients with bile duct stones,has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography.Recent updated meta-analyses revealed that a shorter postoperative hospital stay,fewer procedural interventions,cost-effectiveness,a higher stone clearance rate,and fewer perioperative complications are additional advantages of LCBDE.However,the technique is technically demanding,even for skilled laparoscopic surgeons.Conducting LCBDE in patients with difficult situations,such as SI,is more complex than usual.We herein review published SI patients with choledocholithiasis treated by LCBDE,including our own experience,and this paper focuses on the technical aspects.

关键词： choledocholithiasis Choledochotomy Laparoscopic common bile duct exploration Single incision Situs inversus Transcystic

Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis

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World Journal of Gastroenterology 2022年第16期28卷 1692-1704页

作者： Supisara Tintara Ishani Shah William Yakah Awais Ahmed Cristina S Sorrento Cinthana Kandasamy Steven D Freedman Darshan J Kothari Sunil G Sheth Department of Internal Medicine Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215United States Division of Gastroenterology&Hepatology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215United States Division of Gastroenterology Duke University Medical CenterDurhamNC 27710United States Division of Gastroenterology Durham VA Medical CenterDurhamNC 27705United States

BACKGROUND Acute gallstone pancreatitis(AGP) is the most common cause of acute pancreatitis(AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy(ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk and endoscopic retrograde cholangiopancreatography(ERCP) for patients at high risk of choledocholithiasis. In 2019, the ASGE guidelines were updated using more specific criteria to categorize individuals at high risk for choledocholithiasis. Neither ASGE guideline has been studied in AGP to determine the probability of having choledocholithiasis.AIM To determine compliance with ASGE guidelines, assess outcomes, and compare 2019 vs 2010 ASGE criteria for suspected choledocholithiasis in AGP.METHODS We conducted a retrospective cohort study of 882 patients admitted with AP to a single tertiary care center from 2008-2018. AP was diagnosed using revised Atlanta criteria and AGP was defined as the presence of gallstones on imaging or with cholestatic pattern of liver injury in the absence of another cause. Patients with chronic pancreatitis and pancreatic malignancy were excluded as were those who went directly to cholecystectomy prior to assessment for choledocholithiasis. Patients were assigned low, intermediate or high risk based on ASGE guidelines. Our primary outcomes of interest were the proportion of patients in the intermediate risk group undergoing magnetic resonance cholangiopancreatography(MRCP) first and the proportion of patients in the high risk group undergoing ERCP directly without preceding imaging. Secondary outcomes of interest included outcome differences based on if guidelines were not adhered to. We then evaluated the diagnostic accuracy of 2019 in comparison to the 2010 ASGE criteria for patients with suspected choledocholithiasis. We performed the t test or Wilcoxon rank sum test, as appropriate, to analyze if

关键词： American Society for Gastrointestinal Endoscopy guidelines choledocholithiasis Acute gallstone pancreatitis Endoscopic retrograde cholangiopancreatography Magnetic resonance cholangiopancreatography

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 305-317页

作者： Tharathorn Suwatthanarak Vitoon Chinswangwatanakul Asada Methasate Chainarong Phalanusitthepha Minoru Tanabe Keiichi Akita Thawatchai Akaraviputh Minimally Invasive Surgery Unit Department of SurgeryFaculty of Medicine Siriraj HospitalMahidol UniversityBangkok Noi 10700BangkokThailand Graduate School of Medical and Dental Sciences Tokyo Medical and Dental UniversityBunkyo 113-8519TokyoJapan Department of Hepatobiliary and Pancreatic Surgery Tokyo Medical and Dental UniversityBunkyo 113-8519TokyoJapan Department of Clinical Anatomy Tokyo Medical and Dental UniversityBunkyo 113-8519TokyoJapan

While endoscopic retrograde cholangiopancreatography(ERCP)remains the primary treatment modality for common bile duct stones(CBDS)or choledocho-lithiasis due to advancements in instruments,surgical intervention,known as common bile duct exploration(CBDE),is still necessary in cases of difficult CBDS,failed endoscopic treatment,or altered anatomy.Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes.This review elucidates relevant clinical anatomy,selection indications,and outcomes to enhance surgical understanding.The selection between trans-cystic(TC)vs trans-choledochal(TD)approaches is described,along with stone removal techniques and ductal closure.Detailed surgical techniques and strategies for both the TC and TD approaches,including instrument selection,is also provided.Additionally,this review comprehensively addresses operation-specific complications such as bile leakage,stricture,and entrapment,and focuses on preventive measures and treatment strategies.This review aims to optimize the management of CBDS through laparoscopic CBDE,with the goal of improving patient outcomes and minimizing risks.

关键词： choledocholithiasis Common bile duct stone Difficult common bile duct stone Common bile duct exploration Laparoscopic common bile duct exploration

Limited endoscopic sphincterotomy plus large balloon dilation for choledocholithiasis with periampullary diverticula

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World Journal of Gastroenterology 2010年第34期16卷 4335-4340页

作者： Hyung Wook Kim Dae Hwan Kang Cheol Woong Choi Jong Hwan Park Jin Ho Lee Min Dae Kim Il Doo Kim Ki Tae Yoon Mong Cho Ung Bae Jeon Suk Kim Chang Won Kim Jun Woo Lee Department of Internal Medicine Pusan National University School of Medicine and Medical Research Institute Pusan National University Yangsan Hospital Department of Radiology Pusan National University School of Medicine and Medical Research Institute Pusan National University Hospital

AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS: A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated. RESULTS: There were no significant differences between the PAD and the control groups in overall successful stone removal (94.5% vs 93.9%), stone removal in first session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%), and complications (11.0% vs 7.6%). Clinical outcomes were also similar between the types of PAD, but the rate of stone removal in first session and the number of sessions were significantly lower and more frequent, respectively, in type B PAD (papilla located near the diverticulum) than controls [23/38 (60.5%) vs 54/66 (81.8%), P = 0.021; and 1 (1-2) vs 1 (1-3), P = 0.037, respectively] and the frequency of pancreatitis was significantly higher in type A PAD (papilla located inside or in the margin of the diverticulum) than in controls (16.1% vs 3.0%, P = 0.047). CONCLUSION: Limited EST plus LBD was an effective and safe procedure for removing choledocholithiasis in patients with PAD. However, some types of PAD should be managed with caution.

关键词： Endoscopic sphincterotomy Large balloon dilation choledocholithiasis Periampullary diverticula