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Hyponatremia is associated with more severe biliary disease

World Journal of Gastrointestinal Surgery 2020年第2期12卷 45-54页

作者： Michael John Zobel Lygia Stewart Department of Surgery University of California San FranciscoSan FranciscoCA 94143United States Department of Surgery San Francisco VA Medical CenterSan FranciscoCA 94121United States

BACKGROUND Sodium level is an important clinical predictor of complex biliary *** has been observed in conjunction with biliary disease,however the nature of this association remains *** To investigate the association between serum sodium and severe biliary *** Of 920 patients with gallstone disease treated at the SFVA Hospital from 1989-2019 were *** conducted multivariate analyses of correlation between sodium level and biliary disease severity,the presence/location of biliary bacteria,and other *** sodium level pre-intervention was ***,bile,and blood(as relevant)were *** severity was characterized:(1)None(no infectious manifestations);(2)Systemic inflammatory response syndrome;(3)Severe illness(gangrenous cholecystitis,cholangitis,necrotizing pancreatitis);and(4)Multiple organ dysfunction syndrome(bacteremia,hypotension,organ failure).Comorbidity was defined using the Charlson Comorbidity Index(CCI).RESULTS Decreased sodium level significantly correlated with worsening illness severity,ascending bacterial infection,gangrenous changes,elevated CCI score,increasing age,male sex,and *** multivariate analysis,all factors,except age,gender and glucose,independently correlated with sodium level and factors were *** This unique study is the first to explore,with such granularity,the relationship between biliary disease and *** prior studies have examined specific culture and clinical *** illustrates an inverse,independent correlation between illness severity and *** data demonstrate that sodium decreases as infection ascends from gallstone colonization to bactibilia to *** comorbidity and gangrenous changes also independently correlate with sodium on multivariate *** level is an important clinical indicator of disease severity for patients with biliary disease.

关键词： Hyponatremia biliary disease Cholecystitis Cholangitis Sodium Sepsis

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Three-dimensional visualization technology for guiding one-step percutaneous transhepatic cholangioscopic lithotripsy for the treatment of complex hepatolithiasis

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World Journal of Gastroenterology 2024年第28期30卷 3393-3402页

作者： Yong-Qing Ye Ya-Wen Cao Rong-Qi Li En-Ze Li Lei Yan Zhao-Wei Ding Jin-Ming Fan Ping Wang Yi-Xiang Wu Department of Hepatobiliary Surgery The Second People’s Hospital of FoshanFoshan 528000Guangdong ProvinceChina Department of Emergency Medicine Biomedical Innovation CenterThe Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhou 510655Guangdong ProvinceChina Department of Hepatobiliary Surgery Foshan Hospital of Traditional Chinese MedicineFoshan 528000Guangdong ProvinceChina Department of Hepatobiliary Surgery The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510282Guangdong ProvinceChina Department of Gastrointestinal Surgery The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510120Guangdong ProvinceChina

BACKGROUND biliary stone disease is a highly prevalent condition and a leading cause of hospitalization *** with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)*** This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for *** patients were divided into two groups:The 3D-PTOBF group and the PTOBF *** clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were *** Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)*** immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF *** complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF *** Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary *** perioperative and long-term outcomes are satisfactory for patients with complicated primary *** minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.

关键词： Hepatolithiasis One-step percutaneous transhepatic cholangioscopic lithotripsy biliary disease Three-dimensional visualization Clinical efficacy

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Management of pancreaticobiliary disease using a new intra-ductal endoscope:The Texas experience

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World Journal of Gastroenterology 2009年第11期15卷 1353-1358页

作者： Douglas S Fishman Paul R Tarnasky Sandeep N Patel Isaac Raijman Texas Children’s Hospital Section of Pediatric Gastroenterology and NutritionBaylor College of Medicine6621 Fannin StreetHoustonTX 77030United States Digestive Health Associates Methodist Pavilion II 221 West Colorado Blvd.DallasTX 75208-2359United States Division of Gastroenterology and Nutrition The University of Texas Health Science Center at San Antonio7703 Floyd Curl Drive San AntonioTX 78229-3900United States Digestive Associates of Houston 6620 Main Street.HoustonTX 77030United States

AIM:To evaluate a new single-operator mini-endoscope, Spyglass,for its performance,feasibility and safety in the management of pancreaticobiliary disease. METHODS:In a multicenter retrospective analysis of patients undergoing intraductal endoscopy,we evaluated 128 patients(71 men,mean age 57.6 years).Indications were therapeutic(TX)in 72(56%) and diagnostic(DX)in 56(44%). RESULTS:Peroral endoscopy was performed in 121 and percutaneous in *** indications included CBD stones in 41,PD stones in six,and biliary strictures in *** indications included abnormal LFT’s in 15, abnormal imaging in 38 and cholangiocarcinoma staging in *** of the stone(s)was considered good in 31,fair in six,and poor in four. Advancement of the electrohydraulic lithotripsy probe was not possible in three patients and proper targeting of the lesion was partial in four patients.A holmium laser was used successfully in three *** clearance was achieved in 37 patients after one procedure and in four patients after two *** of biliary strictures was modified in 20/29 and confirmed to be malignant in 10/*** the modified patients,no diagnosis was available in *** demonstrated malignancy in 8/17 and non-malignancy in *** pathology by imaging studies and abnormal LFT’s was modified in 43/63(66%).Staging of cholangiocarcinoma demonstrated multicentric cholangiocarcinoma in 2/*** was no morbidity associated with the use of Spyglass. CONCLUSION:Spyglass Spyscopeis a first generation, single operator miniature endoscope that can evaluate and treat various biliary and pancreatic tract diseases.

关键词： Intra-ductal endoscopy Choledochoscopy Cholangiopancreatoscopy Endoscopic retrogradecholangiopancreatography biliary disease Sclerosingcholangitis Cholangiocarcinoma Lithotripsy Pancreaticdisease Spyglass

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Role of stair-climbing test in predicting postoperativecardiopulmonary complications in elderly patients with biliarydiseases

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Frontiers of Medicine 2010年第1期4卷 77-81页

作者： Pei-Tu REN Bao-Chun LU Zhi-Liang CHEN Hong FU Department of Hepatobiliary Surgery Shaoxing People’s HospitalShaoxing 312000China

One hundred and twenty-six patients above 80 years old with biliary diseases undergoing operations in Shaoxing People’s Hospital from Jan.2002 to Jan.2007 were analyzed *** patients performed a preoperative stair-climbing test,and the risks for cardio-pulmonary complications were evaluated with pair-matching and linear correlations analysis between stair-climbing height(h)and left ventricular ejective factor(EF),forced vital capacity(FVC)and forced expiratory volume in one second(FEV1).There was a signiﬁcant difference in the incidence of cardiopulmonary complications among different stair-climbing ***-climbing heights were positively related with EF,FVC and *** suggests that the stair-climbing test is an effective and simple method for predicting cardiopulmonary complica-tions in elderly patients with biliary diseases.

关键词： biliary disease cardiopulmonary complica-tion stair-climbing test

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Application of endoscopic retrograde cholangiopancreatography in biliary-pancreatic diseases

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Chinese Medical Journal 2009年第24期122卷 2967-2972页

作者： HUANG Liu-ye LIU Yun-xiang WU Cheng-rong CUI Jun ZHANG Bo Department of Gastroenterology Yantai Yuhuangding HospitalAffiliated to Medical College of Qingdao University YantaiShandong 264000 China

Background Endoscopic retrograde cholangiopancreatography （ERCP） has been used increasingly for the treatment of choledocholithiasis, gallstone pancreatitis, and benign or malignant bile duct or pancreatic duct stenosis. The purpose of this study was to evaluate ERCP for the diagnosis and therapy of biliary-pancreatic diseases. Methods A total of 2075 patients who underwent diagnostic and therapeutic ERCP from June 2001 to March 2009 were analyzed retrospectively. Achievement and complication rates were calculated, and the therapeutic effect was observed. Results In all the 64 cases who underwent diagnostic ERCP, the procedure was successful, in 2011 cases therapeutic ERCP was performed, and the success rate was 94.6%. In the therapeutic ERCP cases, 1434 （93.0%） were successful among the 1542 cases of choledocholithiasis, and 422 （90.0%） of the 469 cases with benign or malignant bile duct or pancreatic duct stenosis, or acute obstructive suppurative cholangitis with stent placement or endoscopic nasobiliary drainage were successful. Fifty-nine （90.8%） cases of the 65 who underwent a pre-cut for pancreatic sphincterotomy were successful. Complication rate was 5.1% and the most frequent complication was acute pancreatitis （4.4%）. Conclusions ERCP is one of the major diagnostic and therapeutic methods for biliary-pancreatic disease. Therapeutic ERCP is a minimally invasive, safe and effective treatment method for various biliary-pancreatic diseases.

关键词： endoscopic retrograde cholangiopancreatography biliary disease pancreatic disease

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Portal biliopathy

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World Journal of Gastroenterology 2016年第35期22卷 7973-7982页

作者： mohammad s khuroo ajaz a rather naira s khuroo mehnaaz s khuroo Sher-I-Kashmir Institute of Medical Sciences Srinagar Kashmir 190010India Digestive diseases Centre Dr.Khuroo’s medical ClinicSrinagarKashmir 190010India Department of Surgery SKIMS Medical College and HospitalBeminaSrinagarKashmir 190010India Consultant Radiology Digestive Diseases CentreDr.Khuroo’s Medical ClinicSrinagarKashmir 190010India Department of Pathology Govt.Medical CollegeSrinagarKashmir 190001India

Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures(hepaticojejunostomy or choledechoduodenostomy).

关键词： biliary disease Extrahepatic portal venous obstruction Portal cavernoma Bile duct strictures Bile duct calculi

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Spontaneous gallbladder perforation,pericholecystic abscess and cholecystoduodenal fistula as the first manifestations of gallstone disease

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Hepatobiliary & Pancreatic diseases International 2009年第2期8卷 212-214页

作者： Vui Heng Chong Kian Soon Lim Varkey Vallickad Mathew Gastroenterology Unit Department of MedicineRaja Isteri Pengiran Anak Saleha(RIPAS)Hospital Gastroenterology Unit Department of RadiologyRaja Isteri Pengiran Anak Saleha(RIPAS)Hospital Gastroenterology Unit Department of SurgeryRaja Isteri Pengiran Anak Saleha(RIPAS)Hospital

BACKGROUND:Gallstone disease is common,and complications that are frequently encountered include acute cholecystitis and acute pancreatitis,but rarely gallbladder perforation. METHOD:Data were retrospectively collected from clinical case notes and a literature review is presented. RESULTS:A 72-year-old lady presented with spontaneous gallbladder perforation,pericholecystic abscess and cholecystoduodenal fistula as the first manifestations of gallstone *** was previously well and had no abdominal *** condition was successfully managed with initial antibiotic therapy followed by interval cholecystectomy and fistula repair. CONCLUSIONS:Our case highlighted some uncommon but severe complications which occurred simultaneously as the first manifestations of previously asymptomatic gallstone *** complications need to be considered in patients suspected of intra-abdominal sepsis,even when there are no characteristic symptoms.

关键词： acute cholecystitis biliary disease complication liver abscess

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Impact of previous cyst-enterostomy on patients' outcome following resection of bile duct cysts

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World Journal of Gastrointestinal Surgery 2016年第6期8卷 427-435页

作者： Mehdi Ouaissi Reza Kianmanesh Emilia Ragot Jacques Belghiti Pietro Majno Gennaro Nuzzo Remi Dubois Yann Revillon Daniel Cherqui Daniel Azoulay Christian Letoublon Frane is-Rene Pruvot Francois Paye Patrick Rat Karim Boudjema Adeline Roux Jean-Yves Mabrut Jean-François Gigot Department of General and Digestive Surgery La Timone Hospital13009 MarseilleFrance Department of Digestive and Endocrine Surgery Robert DebréHospital51090 ReimsFrance Department of HPB Surgery Beaujon Hospital92110 ClichyFrance Department of Digestive Surgery Geneva University Hospital1205 GenevaSwitzerland Department of HPB Surgery Gemelli University Hospital00168 RomaItaly Department of Pediatric Surgery Mother and Children Hospital69677 BronFrance Department of Pediatric Digestive Surgery Necker Hospital75175 ParisFrance Department of Digestive and HPB Surgery Paul Brousse Hospital94800 VillejuifFrance Department of Digestive and HPB Surgery Henri Mondor Hospital94000 CreteilFrance Department of Digestive Surgery Michallon Hospital38043 GrenobleFrance Department of Digestive surgery and Transplantation Claude Huriez Hospital59037 LilleFrance Department of Digestive Surgery Saint Antoine Hospital75012 ParisFrance Department of Digestive Surgery Dijon University Hospital21000 DijonFrance Department of HPB Surgery Pontchaillou Hospital35033 RennesFrance Pôle Information Médicale Evaluation Recherche Unitéde Recherche Clinique69317 LyonFrance Department of Digestive Surgery and Hepatic Transplantation La Croix-Rousse Hospital69317 LyonFrance Department of Abdominal Surgery and Transplantation Division of Hepato-biliary and Pancreatic Surgery Cliniques Universitaires Saint-Luc 1200 BrusselsBelgium

AIM:To analyze the impact of previous cyst-enterostomy of patients underwent congenital bile duct cysts(BDC)***:A multicenter European retrospective study between 1974 and 2011 were conducted by the French Surgical *** Todani subtypes I and IVb were *** imaging studies and operative and pathology reports underwent central *** with and without a previous history of cystenterostomy(CE)were ***:Among 243 patients with Todani types I and IVb BDC,16 had undergone previous CE(6.5%).Patients with a prior history of CE experienced a greater incidence of preoperative cholangitis(75%vs 22.9%,Pbiliary cancer(31.3%vs 6.2%,P=0.004)than patients without a prior *** morbidity(75%vs 33.5%;P<0.0008),severe complications(43.8%vs 11.9%;P=0.0026)and reoperation rates(37.5%vs 8.8%;P=0.0032)were also significantly greater in patients with previous CE,and their Mayo Risk Score,during a median follow-up of 37.5 mo(range:4-372 mo)indicated significantly more patients with fair and poor results(46.1%vs 15.6%;P=0.0136).CONCLUSION:This is the large series to show that previous CE is associated with poorer short-and longterm results after Todani types I and IVb BDC resection.

关键词： Bile duct cyst Congenital biliary disease Cyst-enterostomy Long-term outcome

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