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1

Common bile duct compression by an abdominal aortic aneurysm: an unusual cause of biliary tract dilatation.  

PubMed

Extra-hepatic bile duct compression is encountered commonly among patients with pancreatic disease, primary sclerosing cholangitis, and cholangiocarcinoma. However, in an elderly lady with predominantly cholestatic liver test abnormalities, magnetic resonance cholangiopancreatography (MRCP) demonstrated a large abdominal aortic aneurysm that was causing extra-hepatic bile duct compression and concomitant proximal bile duct dilatation. This unusual and uncommon finding was almost certainly the explanation for her liver test dysfunction. This report draws attention to the increasing role for MRCP as an accurate, but non-invasive means of appraisal of the pancreatico-biliary tree. In addition, an unusual and uncommon cause of extra-hepatic bile duct compression is discussed. PMID:12169986

Smith, Alastair D; Mohammed, Faiyaz; Watson, Gillian M T; Howlett, David C

2002-07-01

2

Natural history of unexplained biliary dilation  

Microsoft Academic Search

IntroductionWith the increasing use and availability of MRCP imaging incidental duct dilation is common. There are no guidelines as to how these patients should be investigated or followed. We sought to retrospectively identify a cohort of patients with biliary dilation on MRCP and assess the incidence of sinister pathology.MethodsLocal MRCP database was searched to identify patients with biliary dilation. Data

N M Kelly; B Tharian; T C K Tham

2011-01-01

3

Progressive balloon dilatation following hepaticojejunostomy improves outcome of bile duct stricture after iatrogenic biliary injury  

PubMed Central

Background Iatrogenic biliary stricture (IBS) is a disastrous complication of cholecystectomy. Although the endoscopic treatments are well accepted as initial attempts for IBS, surgical hepaticojejunostomy (HJ) is often necessary for a considerable proportion of patients. However, the anastomotic stricture after HJ also occurs. Methods In the present study, a new procedure, progressive balloon dilation following HJ (HJPBD), was designed and utilized in the IBS treatment. We retrospectively compared HJPBD with the traditional HJ in term of the outcomes when used for IBS treatment. Results Between January 1997 and December 2009, 112 patients with IBS attributed to cholecystectomy enrolled in our hospital were treated with surgical reconstruction with either HJ (n=58) or HJPBD (n=54). Of the 58 patients in HJ group, 48 patients (82.8%) had a successful outcome, while 52 out of 54 patients (96.3%) in HJPBD group achieved success. The successful surgical reconstruction rates were significantly different between these two groups, with a further improved outcome in patient undergone progressive balloon dilation following HJ. Additionally, 8 of the 10 failure cases in HJ group were successfully rescued by HJPBD procedure. Conclusions Our findings suggest that the new procedure of HJPBD could be successfully applied to IBS patients, and significantly improve the outcome of IBS reconstruction.

2013-01-01

4

Cystic dilatation of the cystic duct: a type 6 biliary cyst.  

PubMed

Choledochal cysts of the cystic duct are extremely unusual and only single case reports are documented in the literature. The widely used Todani classification does not include such type of lesions. We present a case of a young girl with a cystic duct choledochal cyst diagnosed preoperatively and confirmed intraoperatively. Due to the site and mass effect of the cyst, excision of the lesion included a part of bile duct. Reconstruction was achieved by Roux-en-Y hepaticojejunostomy. While such lesions are extremely rare, they do occur and need to be recognized as a separate entity in the Todani classification. PMID:24426660

Shah, Omar Javed; Shera, Altaf; Shah, Parveen; Robbani, Irfan

2013-06-01

5

Association of extrahepatic bile duct duplication with pancreaticobiliary maljunction and congenital biliary dilatation in children: a case report and literature review.  

PubMed

We herein report a case of cystic-type congenital biliary dilatation (CBD) in whom an extremely rare anomalous duplication of the common bile duct and pancreaticobiliary maljunction were diagnosed intraoperatively by meticulous surgical manipulations via conventional open surgery. By performing a dissection at the outer epicholedochal layer of the cyst, a thin cord-like structure shown to be the distal part of the common bile duct was identified. A further exploration revealed that the most distal (extra- and intrapancreatic) part of the common bile duct was duplicated, and each branch of the duct was connected to the main and accessory pancreatic ducts. The experience with our case and a literature review showed that extrahepatic bile duct duplication is generally associated with pancreaticobiliary maljunction and CBD. We conclude that an extremely careful exploration with delicate and meticulous surgical manipulation is essential to identify these morphological anomalies and prevent intraoperative and postoperative complications of CBD, such as pancreatic duct injury or pancreatitis. PMID:22825653

Tahara, Kazunori; Ishimaru, Yuki; Fujino, Junko; Suzuki, Makoto; Hatanaka, Masahiro; Igarashi, Akihiro; Ikeda, Hitoshi

2013-07-01

6

Cholangitis associated with cystic dilatation of the intrahepatic bile ducts after antireflux valve construction in biliary atresia  

Microsoft Academic Search

An intussusception-type antireflux valve (ARV) has been introduced to prevent postoperative ascending cholangitis in the\\u000a management of biliary atresia (BA). We investigated the characteristics of cholangitis in the management of BA using the ARV\\u000a in 38 patients who had undergone an operation at our institution; 29 underwent ARV construction at the same time as portenterostomy\\u000a (PEO) or hepaticojejunostomy. One patient

H. Komuro; S. Makino; T. Momoya; Y. Uehara; K. Tahara; M. Momoi

2001-01-01

7

[Treatment of congenital dilatation of the bile ducts. Apropos of 3 cases].  

PubMed

Congenital dilatation of the bile duct is an uncommon lesion requiring surgical treatment. Complete excision of the diseased bile duct prevents development of carcinoma of the bile duct. We report three cases of congenital dilatation of the biliary three, each illustrating a particular aspect of the therapeutic strategy. One patient had an unusual anomaly of the pancreaticobiliary junction that required pancreaticoduodenectomy. Another patient developed carcinoma of the bile duct 15 years after an internal derivation of a choledochal cyst. The last patient had dilatations of the common and intrahepatic bile ducts associated with congenital hepatic fibrosis. PMID:9772995

Berger, A; Roger, V; Wind, P; Chevallier, J M; Cugnenc, P H

1997-12-01

8

A rare cause of dilated bile duct incidentally detected on imaging.  

PubMed

Adenomas involving the extrahepatic bile ducts are rare benign tumours of the biliary tract. Given the asymptomatic nature of these tumours and the natural progression of biliary adenoma to carcinoma including cholangiocarcinoma, early detection is challenging. We present a case of an octogenarian woman with a remote history of gallstones who initially presented to the gastroenterology office for an incidental finding of biliary dilation, and whose subsequent imagings and biopsy suggested common bile adenoma. However, the patient was deemed a poor surgical candidate for pancreaticoduodenectomy, and unfortunately represented 5?months later with findings suggesting cholangiocarcinoma. This case provides a unique opportunity to study the natural progression of biliary adenoma to cholangiocarcinoma. PMID:24859557

Loh, Kah Poh; Nautsch, Deborah; Desilets, David; Mehendiratta, Vaibhav

2014-01-01

9

Surgical treatment of congenital biliary duct cyst  

PubMed Central

Background It is acknowledged that total cyst excision is a safe and ideal surgical treatment for congenital biliary duct cyst, compared to simple internal drainage. The aim of this study was to determine the optimal operation occasion and the effect of laparoscopy on congenital biliary duct cyst based upon total cyst excision. Methods From January 2002 to January 2011, 217 patients were admitted to Southwest Hospital for congenital biliary duct cyst. To determine the optimal surgery occasion, we divided these subjects into three groups, the infant group (age ? 3 years), the immaturity group (3 < age ? 18 years), and the maturity group (age > 18 years), and then evaluated the feasibility, risk and long-term outcome after surgery in the three groups. To analyze the effect of laparoscopic technique on congenital biliary duct cyst, we divided the patients into the laparoscopy and the open surgery groups. Results Among the three groups, the morbidity from cholangiolithiasis before surgical treatment had obvious discrepancy (p < 0.05) (lowest in the infant group), and intraoperative blood loss also had apparent diversity (p < 0.05). Furthermore, long-term outcomes (secondary cholangiolithiasis, stoma stenosis and cholangiocarcinoma) showed no significant difference between different groups (p > 0.05). Similarly, no significant discrepancy was observed in the morbidity from postoperative complications or long-term postoperative complications (p > 0.05) between the laparoscopic and the open surgery groups. Conclusions We conclude that total cyst excision should be performed as early as possible. The optimal treatment occasion is the infant period, and laparoscopic resection may be a new safe and feasible minimally invasive surgery for this disease.

2012-01-01

10

"Mustache sign" due to Stensen duct dilation.  

PubMed

An 80-year-old woman presented with a 5-year history of painless swellings of the left and right cheeks. The degree of swelling did not change with mastication. On palpation, the cheeks were soft, well defined, and movable. Compression and massage of the swollen areas caused increased salivary discharge from the orifices of the Stensen ducts. Three-dimensional computed tomography showed well-bordered, 15- to 20-mm wide, bilateral, tube-like dilatations of the ducts. The ductal origin of the swellings was explained to the patient, but she refused invasive procedures, thus no sialogram or surgical procedure was performed. We describe the clinical and radiographic features of a case of bilateral, congenital Stensen duct dilatation with bilateral swelling of the cheeks. PMID:24209996

Yoruk, O; K?l?c, K; Kantarc?, M

2013-12-01

11

The impact of duct-to-duct interaction on the hex duct dilation  

SciTech Connect

Dilation of the hex duct is an important factor in the operational lifetime of fuel subassemblies in liquid metal fast reactors. It is caused primarily by the irradiation-enhanced creep and void swelling of the hex duct material. Excessive dilation may jeopardize subassembly removal from the core or cause a subassembly storage problem where the grid size of the storage basket is limited. Dilation of the hex duct in Experimental Breeder Reactor II (EBR-II) limits useful lifetime because of these storage basket limitations. It is, therefore, important to understand the hex duct dilation behavior to guide the design and in-core management of fuel subassemblies in a way that excessive duct deformation can be avoided. To investigate the dilation phenomena, finite-element models of the hex duct have been developed. The inelastic analyses were performed using the structural analysis code, ANSYS. Both Type 316 and D9 austenitic stainless steel ducts are considered. The calculated dilations are in good agreement with profilometry measurements made after irradiation. The analysis indicates that subassembly interaction is an important parameter in addition to neutron fluence and temperature in determining hex duct dilation. 5 refs.

Lee, M.J.; Chang, L.K.; Lahm, C.E.; Porter, D.L.

1992-01-01

12

Biliary ascariasis: an uncommon cause for recurrent biliary colic after biliary sphincterotomy and common bile duct stone removal.  

PubMed

Endoscopic retrograde cholangiography is the most commonly used technique for removal of common bile duct stones. Biliary sphincterotomy during the procedure facilitates stone retrieval from the common bile duct. However, sphincterotomy ablates the normal biliary sphincter mechanism. This facilitates duodeno-biliary reflex and can result in inward migration of luminal parasite into the biliary system. In areas where ascariasis is endemic there is an increased risk of biliary ascariasis in postbiliary sphincterotomy patients. We report an unusual case where a patient presented with recurrent biliary colic after cholecystectomy and common bile duct stone extraction and was diagnosed to have biliary ascariasis with the help of endoscopic ultrasound examination of the biliary system. PMID:24407145

Thandassery, Ragesh Babu; Jha, Ashish Kumar; Goenka, Mahesh Kumar

2014-04-01

13

Dilated common duct sign. A potential indicator of a sphincter of Oddi dyskinesia  

SciTech Connect

The cholescintigraphic findings of a Sphincter of Oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the Sphincter of Oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. It was postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the Sphincter of Oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a Sphincter of Oddi dyskinesia.

DeRidder, P.; Fink-Bennett, D.

1984-05-01

14

A Rare Anomaly of Biliary System: MRCP Evidence of a Cystic Duct Cyst  

PubMed Central

Cystic duct cysts are a rare congenital anomaly. While the other bile duct cysts (choledochus and the intrahepatic bile ducts) are classified according to the classification described by Tadoni, there is no classification method described by the cystic duct cysts, although it is claimed that the cystic duct cysts may constitute a new “Type 6” category. Only a limited number of patients with cystic duct cysts have been reported in the literature. The diagnosis is usually made in the neonatal period or during childhood. The clinical symptoms are nonspecific and usually include pain in the right upper quadrant and jaundice. The condition may also present with biliary colic, cholangitis, cholelithiasis, or pancreatitis. In our case, the abdominal ultrasonography (US) performed on a 6-year-old female patient who presented with pain in the right upper quadrant pointed out an anechoic cyst at the neck of the gall bladder. Based on the magnetic resonance cholangiopancreatography (MRCP) results, a cystic dilatation was diagnosed in the cystic duct. The aim of this case-report presentation was to discuss the US and MRCP findings of the cystic dilatation of cystic duct, which is an extremely rare condition, in the light of the literature information.

Goya, Cemil; Arslan, Mehmet Serif; Hamidi, Cihad; Kuday, Suzan; Okur, Mehmet Hanifi; Aydogdu, Bahattin

2014-01-01

15

A Rare Anomaly of Biliary System: MRCP Evidence of a Cystic Duct Cyst.  

PubMed

Cystic duct cysts are a rare congenital anomaly. While the other bile duct cysts (choledochus and the intrahepatic bile ducts) are classified according to the classification described by Tadoni, there is no classification method described by the cystic duct cysts, although it is claimed that the cystic duct cysts may constitute a new "Type 6" category. Only a limited number of patients with cystic duct cysts have been reported in the literature. The diagnosis is usually made in the neonatal period or during childhood. The clinical symptoms are nonspecific and usually include pain in the right upper quadrant and jaundice. The condition may also present with biliary colic, cholangitis, cholelithiasis, or pancreatitis. In our case, the abdominal ultrasonography (US) performed on a 6-year-old female patient who presented with pain in the right upper quadrant pointed out an anechoic cyst at the neck of the gall bladder. Based on the magnetic resonance cholangiopancreatography (MRCP) results, a cystic dilatation was diagnosed in the cystic duct. The aim of this case-report presentation was to discuss the US and MRCP findings of the cystic dilatation of cystic duct, which is an extremely rare condition, in the light of the literature information. PMID:24987540

Goya, Cemil; Arslan, Mehmet Serif; Yavuz, Alpaslan; Hamidi, Cihad; Kuday, Suzan; Okur, Mehmet Hanifi; Aydogdu, Bahattin

2014-01-01

16

Laparoscopic transcystic duct balloon dilatation of the sphincter of Oddi  

Microsoft Academic Search

Balloon dilatation of the sphincter of Oddi has been performed via a laparoscopic transcystic duct technique. Small common duct stones and stone debris have been successfully lavaged into the duodenum in 17 of 20 cases (85%) by this method. Postoperative hyperamylasemia was noted in four patients. Mild clinical pancreatitis was observed in three patients (15%). Further evaluation of this technique

B. J. Carroll; E. H. Phillips; M. Chandra; M. Fallas

1993-01-01

17

Laparoscopic correction of biliary duct stenosis in choledochal cyst  

Microsoft Academic Search

Background\\/PurposesLaparoscopy has been widely accepted as a technique for the excision of choledochal cyst, but there has been little experience using it as a therapeutic modality for hepatic duct stenosis. The aim of this study is to present our experiences in laparoscopic excision of biliary stenosis and Roux-en-Y reconstruction for patients with choledochal cysts.

Long Li; Shu-li Liu; Wen-Ying Hou; Long Cui; Xue-Lai Liu; Zhang Jun; Huang Liu-Ming; Liu Gang; Naved Alizai Kamal

2008-01-01

18

A pilot proof-of-concept study of a modified device for one-step endoscopic ultrasound-guided biliary drainage in a new experimental biliary dilatation animal model  

PubMed Central

AIM: To evaluate the technical feasibility of a modified tapered metal tip and low profile introducer for one-step endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) in a new experimental biliary dilatation porcine model. METHODS: A novel dedicated device for one-step EUS-guided biliary drainage system (DEUS) introducer has size 3F tapered catheter with size 4F metal tip for simple puncture of the intestinal wall and liver parenchyma without graded dilation. A self-expandable metal stent, consisting of both uncovered and nitinol-covered portions, was preloaded into DEUS introducer. After establishment of a biliary dilatation model using endoscopic hemoclips or band ligation with argon plasma coagulation in 9 mini-pigs, EUS-BD using a DEUS was performed following 19-G needle puncture without the use of fistula dilation devices. RESULTS: One-step EUS-BD was technically successful in seven pigs [7/9 (77.8%) as intention to treat] without the aid of devices for fistula dilation from the high body of stomach or far distal esophagus to the intrahepatic (n = 2) or common hepatic (n = 5) duct. Primary technical failure occurred in two cases that did not show adequate biliary dilatation. In seven pigs with a successful bile duct dilatation, the technical success rate was 100% (7/7 as per protocol). Median procedure time from confirmation of the dilated bile duct to successful placement of a metallic stent was 10 min (IQR; 8.9-18.1). There were no immediate procedure-related complications. CONCLUSION: Modified tapered metal tip and low profile introducer may be technically feasible for one-step EUS-BD in experimental porcine model.

Lee, Tae Hoon; Choi, Jun Hyuck; Lee, Sang Soo; Cho, Hyun Deuk; Seo, Dong Wan; Park, Sang-Heum; Lee, Sung Koo; Kim, Myung-Hwan; Park, Do Hyun

2014-01-01

19

DILATE: A 2-D Structural Program for the Dilation Response of Hexagonal Ducts.  

National Technical Information Service (NTIS)

An analytical method is introduced for determining the dilation of hexagonal ducts in fast reactors. The method, which is valid for temperatures where creep is linearly dependent on stress, was implemented in a fast-running computer called DILATE. A bench...

D. P. Chan

1980-01-01

20

Paucity of biliary ducts: A rare etiology of neonatal cholestasis  

PubMed Central

We report a case of a newborn with cholestasis that was diagnosed as nonsyndromic Alagille syndrome. The main feature of the disease is a paucity of biliary ducts. There are two known types of the disease: the syndromic type which is associated with other congenital defects and the nonsyndromic type without other anomalies detected at birth. We describe the case and discuss its clinical and radiologic findings. We also discuss the various etiologies of cholestasis that are included in the differential diagnosis.

Figiel, Steven Cornell; Franco, Arie; Pucar, Darko; Lewis, Kristopher Neal; Lee, Jeffrey Roberts

2012-01-01

21

Internal pancreatic stent causing irreversible dilatation of pancreatic duct.  

PubMed

A 28-year-old woman underwent a pylorus preserving Whipple procedure for pancreatic serous cystadenoma located on the head of the pancreas. During the operation, an internal stent (7F silastic catheter, 9 cm in length) was placed within the pancreatic duct in the area of pancreaticojejunal end-to-end Dunking type anastomosis to prevent development of fistula. The stent was positioned so that one third of its length would lie into the pancreatic duct, and it was anchored to the periductal pancreatic tissue with only one rapidly absorbable chromic suture. Leakage from the anastomosis was not observed, and she was discharged without any complaint. Early postoperative abdominal CT examination revealed that the stent was retained within the normal caliber pancreatic duct (Fig. 1a). Six months after the operation, she began to complain to epigastric pain triggered by the meals. The laboratory analysis was normal, particularly liver biochemical tests and serum amylase. The internal pancreatic stent within the dilated pancreatic duct was detected by an additional CT examination (Fig. 1b). The stent was removed endoscopically at the third attempt. The pain was resolved after its removal. Control CT examination which was taken at the 18th month after removal of the stent showed dilatation of the pancreatic duct (Fig. 2a). The patient remained free of any complaint, although regressed pancreatic duct dilatation has persisted over 4 years of follow-up (Fig. 2b). PMID:24799775

Hasbahceci, Mustafa; Erol, Cengiz

2014-02-01

22

DILATE: a 2-d structural program for the dilation response of hexagonal ducts  

SciTech Connect

An analytical method is introduced for determining the dilation of hexagonal ducts in fast reactors. The method, which is valid for temperatures where creep is linearly dependent on stress, was implemented in a fast-running computer called DILATE. A bench-mark program is presented, which shows the results of the DILATE program in close agreement with the results of the finite element program MARC-CDC. User instructions for the DILATE program are described in detail and a listing of the program is included.

Chan, D.P.

1980-02-01

23

Alterations of nucleolar organizer regions of smooth muscle cells in bile duct following biliary ligation in rat.  

PubMed

Clinical experience indicates that bile duct dilatation is often associated with patients presenting with cholestasis. The purpose of this study is to propose a hypothesis that such a biliary dilatation, resulting from extra-hepatic obstruction, partially contributes to the rapidly occurring hypertrophy and hyperplasia of the smooth muscle cells in the bile duct; and that such an alteration could possibly lead to the development of neoplastic tissue. Twenty seven male Wistar rats were divided into 4 groups: Control Group (n = 7) with sham operation, Day 4 Group (n = 6) with common bile duct ligated for 4 days, Day 7 Group (n = 7) with common bile duct ligated for 7 days, and Day 14 Group (n = 7) with common bile duct ligated for 14 days. Complete extrahepatic biliary obstruction was induced in Wistar rats by distal ligation of the common bile duct (CBD). The CBD specimens were stained by H & E and argyrophilic techniques (AgNOR method), and the smooth muscle cells were identified and studied with light microscopy and an image analyzer. To determine maximum width of cell size, the widths of smooth muscle cells were found to be 2.82 +/- 0.07 microns, 3.05 +/- 0.06 microns, 4.53 +/- 0.10 microns, and 4.89 +/- 0.12 microns (Mean +/- S.E.) for the Control Group, Day 4 Group, Day 7 Group and Day 14 Group, respectively.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7853425

Shih, R H; Ker, C G

1994-12-01

24

Cystic Dilatation of the Parotid Duct of a Goat  

PubMed Central

Cystic dilatation of the parotid duct of a goat was diagnosed by exploratory surgery and analysis of cyst contents. The cyst and its associated salivary gland were surgically removed. This case is compared with the more common salivary mucocele. ImagesFigure 1.

Slocombe, R. F.

1980-01-01

25

Common bile duct dilatations in asymptomatic neonates: incidence and prognosis.  

PubMed

Background. This retrospective study reviewed 213 asymptomatic neonates with common bile duct (CBD) dilatations diagnosed via ultrasound to evaluate their incidence and outcomes. Materials and Methods. From August 2001 to July 2010, 18,230 abdominal ultrasound scans were performed as newborn screening. There were 213 (1.17%) cases of CBD dilatation. Dilatation of neonatal CBD was defined when its diameter was ?2?mm. The neonates' birth history, CBD size, and follow-up results were analyzed. Results. In the 213 infants, four cystic dilatations (1.88%, 4/213) that were eventually diagnosed as choledochal cysts (CC). Among 209 neonates with fusiform dilatations (size 2.0-6.7?mm), 77 had ultrasound follow-up and 87% of them resolved spontaneously which were diagnosed as transient CBD dilatation (TCBDD). Eighty percent of TCBDDs resolved within 6 months. Patients with initial CBD size ?3?mm had significantly lower resolution rate and neonates whose mothers are older than 35 years took longer time to resolve. Conclusion. The incidence of CBD dilatation in asymptomatic neonates was 1.17%. Eighty percent of TCBDDs resolved within 6 months. Regular ultrasound follow-up every 6 months may be appropriate for asymptomatic neonates with fusiform CBD dilatations to ensure resolution or progression. PMID:24772168

Lin, Shun-Feng; Lee, Hung-Chang; Yeung, Chun-Yan; Jiang, Chuen-Bin; Chan, Wai-Tao

2014-01-01

26

Common Bile Duct Dilatations in Asymptomatic Neonates: Incidence and Prognosis  

PubMed Central

Background. This retrospective study reviewed 213 asymptomatic neonates with common bile duct (CBD) dilatations diagnosed via ultrasound to evaluate their incidence and outcomes. Materials and Methods. From August 2001 to July 2010, 18,230 abdominal ultrasound scans were performed as newborn screening. There were 213 (1.17%) cases of CBD dilatation. Dilatation of neonatal CBD was defined when its diameter was ?2?mm. The neonates' birth history, CBD size, and follow-up results were analyzed. Results. In the 213 infants, four cystic dilatations (1.88%, 4/213) that were eventually diagnosed as choledochal cysts (CC). Among 209 neonates with fusiform dilatations (size 2.0–6.7?mm), 77 had ultrasound follow-up and 87% of them resolved spontaneously which were diagnosed as transient CBD dilatation (TCBDD). Eighty percent of TCBDDs resolved within 6 months. Patients with initial CBD size ?3?mm had significantly lower resolution rate and neonates whose mothers are older than 35 years took longer time to resolve. Conclusion. The incidence of CBD dilatation in asymptomatic neonates was 1.17%. Eighty percent of TCBDDs resolved within 6 months. Regular ultrasound follow-up every 6 months may be appropriate for asymptomatic neonates with fusiform CBD dilatations to ensure resolution or progression.

Yeung, Chun-Yan; Jiang, Chuen-Bin; Chan, Wai-Tao

2014-01-01

27

Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy  

Microsoft Academic Search

Background: Endoscopic biliary sphincterotomy (EST) is a well-established procedure for bile duct stone extraction. Bile duct stones can be classified as primary or secondary. However, few data are available on the recurrence of primary and secondary bile duct stones after EST. Therefore risk factors for the recurrence of primary bile duct stones after EST were prospectively studied. Methods: Between 1991

Dong Il Kim; Myung-Hwan Kim; Sung Koo Lee; Dang Wan Seo; Won Boem Choi; Sang Soo Lee; Hyun Ju Park; Yeon-Ho Joo; Kyo Sang Yoo; Hong Ja Kim; Young Il Min

2001-01-01

28

Paucity of biliary ducts: A rare etiology of neonatal cholestasis.  

PubMed

We report a case of a newborn with cholestasis that was diagnosed as nonsyndromic Alagille syndrome. The main feature of the disease is a paucity of biliary ducts. There are two known types of the disease: the syndromic type which is associated with other congenital defects and the nonsyndromic type without other anomalies detected at birth. We describe the case and discuss its clinical and radiologic findings. We also discuss the various etiologies of cholestasis that are included in the differential diagnosis. PMID:22690284

Figiel, Steven Cornell; Franco, Arie; Pucar, Darko; Lewis, Kristopher Neal; Lee, Jeffrey Roberts

2012-02-01

29

Retained common bile duct stones after endoscopic sphincterotomy: temporary and longterm treatment with biliary stenting.  

PubMed Central

Basket extraction after endoscopic sphincterotomy failed to clear the bile ducts immediately in 85 (30%) of 283 consecutive patients with common bile duct stones. Temporary biliary drainage was established by the insertion of a single 7 Fr double pigtail stent before further planned endoscopic attempts at stone removal. In 84 patients (21 male: 63 female, mean age 77 years) this measure relieved biliary obstruction, mean serum bilirubin falling from 101 to 18 umol/l by the time of the second endoscopic retrograde cholangiopancreatography. Six patients died from non-biliary causes with temporary stents in situ. Common bile duct stone extraction was achieved endoscopically in 50 of the remaining 79 patients after a mean of 4.3 months (range 1-12), 34 (68%) requiring only one further procedure. Three patients were referred for biliary surgery. Single stents were also effective for longterm biliary drainage in the remaining 26 elderly patients with unextractable stones. The main biliary complication of stenting was 13 episodes of cholangitis but all except one responded to medical treatment and early stent exchange. If common bile duct stones remain after endoscopic sphincterotomy, a single 7 Fr double pigtail stent is effective and safe for temporary biliary drainage before further endoscopic attempts at duct clearance and for longterm biliary drainage especially in the old and frail.

Maxton, D G; Tweedle, D E; Martin, D F

1995-01-01

30

Unilocular Extrahepatic Biliary Cystadenoma Mimicking Choledochal Cyst: A Case Report  

PubMed Central

We report here on a case of extrahepatic biliary cystadenoma arising from the common hepatic duct. A 42-year-old woman was evaluated by us to find the cause of her jaundice. Ultrasonography and CT showed a cystic dilatation of the common hepatic duct and also marked dilatation of the intrahepatic duct. Direct cholangiography demonstrated a large filling defect between the left hepatic duct and the common hepatic duct; dilatation of the intrahepatic duct was also demonstrated. Following excision of the cystic mass, it was pathologically confirmed as a unilocular biliary mucinous cystadenoma arising from the common hepatic duct.

Park, Ju-Hyun; Kim, Hyoung Jung; Ko, Young Tae; Lim, Joo Won; Yang, Moon-Ho

2004-01-01

31

Large bile duct stones treated by endoscopic biliary drainage.  

PubMed

One hundred five patients with obstructive jaundice and cholangitis (49 patients), referred for diagnostic endoscopy, were found to have inextractable bile duct stones. Median age was 76 years and three quarters were more than 72 years of age. Insertion of an endoprosthesis with or without a sphincterotomy relieved jaundice in 94% and settled cholangitis in 90%. Antibiotic cover during the procedure seems essential inasmuch as pyrexia and septicemia occurred in 6 of 57 cases where it was not given. One case was lethal. Another patient died of acute pancreatitis. The patients were old. One quarter died before the follow-up, 1 to 5 years after the initial intervention. The results indicate that the combination of endoscopic sphincterotomy, insertion of an endoprosthesis, and, if feasible, stone extraction on a later occasion when the acute phase of the illness had subsided brought the disease sufficiently under control among three quarters of the patients with large common duct stones or stenoses in the biliary tract. One quarter of the patients were treated surgically. This was accomplished without mortality, but morbidity was not negligible. A policy with a surgical approach restricted to selected cases with persistent symptoms in spite of sufficient endoscopic drainage is recommended. PMID:2911804

Kiil, J; Kruse, A; Rokkjaer, M

1989-01-01

32

[Monoca silicone intubation of the lacrimal ducts after retrograde dilatation].  

PubMed

The causes of stenosis in the area of the nasolacrimal duct in adults are extremely variable. In general, the symptoms may vary, but most cases exhibit a common factor of circumstances in the prestenotic area which favor recurring inflammation. The treatment of these disorders is limited to either a conservative therapeutic approach to control inflammation, or surgically invasive measures. By using balloon catheters, which are usually applied in PTCA (percutaneous transluminal coronary angioplasty), dilatation of the relative postsaccal stenosis is obtained with the assistance of radiography. An exact diagnosis by means of various testing methods, including digital dacryocystography for the detailed localization and documentation of any pathological changes, is decisive for success. Only in cases of incomplete, postsaccal stenosis is retrograde balloon dilation of the distal nasolacrimal duct incated. The guide wire, designed for the PTCA balloon catheter set, is introduced via the canaliculus to the nasal cavity antegradely and caught with a thin hook and pulled from the naris. This is done under visual control using an image converter. The balloon catheter is retrogradely threaded over the guide wire. The balloon is then placed at the site of the pathological stenosis under X-ray control and dilated with high pressure. To assure permeability of the system, a monocanalicular silicone intubation has to be made immediately following this procedure. This procedure has been performed successfully on six patients; Follow-up time ranged from 6 to 22 months. The initial results are encouraging and sustain hope that this minimally invasive, interdisciplinary technique represents a new alternative in the treatment of incomplete, postsaccal lacrimal stenosis. PMID:7719075

Kuchar, A; Huber, E; Steinkogler, F J; Karnel, F

1995-02-01

33

Benign retropneumoperitoneum developed after endoscopic sphincterotomy and large balloon dilation of biliary sphincter for removal of large biliary stones: a case report  

PubMed Central

Biliary endoscopic sphincterotomy (ES) followed by biliary orifice dilation (BOD) with large-diameter balloons (> 12 mm) is a relative new technique for extraction of large biliary stones. However, the safety and the potential complications of this combined technique are not known yet. We present a patient who developed benign retroperitoneum after ES plus BOD with large-diameter balloon for removal of a large biliary stone, which was successfully treated conservatively. To the best of our knowledge this is the first report of such a complication after introduction of this method to clinical practice.

Katsinelos, Panagiotis; Chatzimavroudis, Grigoris; Pilpilidis, Ioannis; Zavos, Christos; Lazaraki, Georgia; Tzilves, Dimitris; Paroutoglou, George; Kountouras, Jannis

2008-01-01

34

Benign retropneumoperitoneum developed after endoscopic sphincterotomy and large balloon dilation of biliary sphincter for removal of large biliary stones: a case report.  

PubMed

Biliary endoscopic sphincterotomy (ES) followed by biliary orifice dilation (BOD) with large-diameter balloons (> 12 mm) is a relative new technique for extraction of large biliary stones. However, the safety and the potential complications of this combined technique are not known yet. We present a patient who developed benign retroperitoneum after ES plus BOD with large-diameter balloon for removal of a large biliary stone, which was successfully treated conservatively. To the best of our knowledge this is the first report of such a complication after introduction of this method to clinical practice. PMID:18957073

Katsinelos, Panagiotis; Chatzimavroudis, Grigoris; Pilpilidis, Ioannis; Zavos, Christos; Lazaraki, Georgia; Tzilves, Dimitris; Paroutoglou, George; Kountouras, Jannis

2008-01-01

35

Biliary drainage of the common bile duct with an enteral metal stent  

Microsoft Academic Search

In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of five metal stents for a distal common bile duct (CBD) stenosis. All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla. A profoundly dilated CBD with sludge and

Irene M Dek; Elzen van den B. D. J; P. Fockens; E. A. J. Rauws

2009-01-01

36

Biliary Dilatation: Differentiation of Benign from Malignant Causes— Value of Adding Conventional MR Imaging to MR Cholangiopancreatography1  

Microsoft Academic Search

PURPOSE: To determine the value of conventional T1- and T2-weighted images and gadolinium-enhanced dynamic magnetic resonance (MR) images as a supplement to MR cholangiopancreatographic (MRCP) images in differentiation of benign from malignant causes of biliary dilatation. MATERIALS AND METHODS: MR studies in 62 patients with biliary dilatation with proved causes included conventional T1- and less heavily T2-weighted images, as well

Myeong-Jin Kim; Donald G. Mitchell; Katsuyoshi Ito; Eric K. Outwater

37

Which Is the Better Treatment for the Removal of Large Biliary Stones? Endoscopic Papillary Large Balloon Dilation versus Endoscopic Sphincterotomy  

PubMed Central

Background/Aims We evaluated the efficacy and cost-effectiveness of endoscopic papillary large balloon dilation (EPLBD) for large common bile duct (CBD) stone removal compared with endoscopic sphincterotomy (EST). Methods A total of 1,580 patients who underwent endoscopic CBD stone extraction between January 2001 and July 2010 were reviewed. The following inclusion criteria were applied: choledocholithiasis treated by EPLBD with minor EST or EST with mechanical lithotripsy; and follow-up >9 months after treatment. Results Forty-nine patients with EPLBD and 41 with EST were compared. There was no significant difference in the complication rates and stone recurrence rates between the two groups. However, significantly more endoscopic retrograde cholangiopancreatography (ERCP) sessions were required in the EST group to achieve the complete removal of stones (1.7 times vs 1.3 times; p=0.03). The mean cost required for complete stone removal per patient was significantly higher in the EST group compared to the EPLBD group (USD $1,644 vs $1,225, respectively; p=0.04). Dilated CBD was the only significant factor associated with recurrent biliary stones (relative risk, 1.09; 95% confidence interval, 1.02 to 1.17; p=0.02). Conclusions EPLBD is the better treatment (compared to EST) for removing large CBD stones because EPLBD requires fewer ERCP sessions and is less expensive.

Paik, Woo Hyun; Ryu, Ji Kon; Park, Jin Myung; Song, Byeong Jun; Kim, Jaihwan; Park, Joo Kyung; Kim, Yong-Tae

2014-01-01

38

Duct-to-duct reconstruction in liver transplantation for primary sclerosing cholangitis is associated with fewer biliary complications in comparison with hepaticojejunostomy.  

PubMed

There is no consensus on the preferred type of biliary reconstruction for patients undergoing orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC). The aim of this study was to compare long-term outcomes after OLT for PSC using either duct-to-duct anastomosis or Roux-en-Y hepaticojejunostomy for biliary reconstruction. In a consecutive series of 98 adult patients undergoing OLT for PSC, 45 underwent duct-to-duct reconstruction, and 53 underwent Roux-en-Y biliary reconstruction. The median follow-up was 8.2 years (interquartile range?=?3.9-14.5 years). The outcomes of the 2 groups were compared. There were no significant differences in patient demographics or general surgical variables between the groups. The overall patient and graft survival rates were similar for the 2 groups. The incidence of biliary strictures and biliary leakage within the first year after transplantation did not differ between the 2 groups. However, significantly more patients in the Roux-en-Y group suffered at least 1 episode of cholangitis within the first year (9% in the duct-to-duct group versus 25% in the Roux-en-Y group, P?=?0.04). In addition, Roux-en-Y reconstruction was associated with a significantly higher rate of late-onset (>1 year after transplantation) nonanastomotic biliary strictures (NAS) in comparison with duct-to-duct reconstruction (24% versus 7% at 5 years and 30% versus 7% at 10 years, P?=?0.01). In conclusion, duct-to-duct biliary reconstruction in patients with PSC is associated with lower rates of posttransplant cholangitis and late-onset NAS in comparison with Roux-en-Y hepaticojejunostomy. If technically and anatomically feasible, duct-to-duct anastomosis can be performed safely in patients undergoing OLT for PSC. PMID:24458730

Sutton, Michael E; Bense, Rico D; Lisman, Ton; van der Jagt, Eric J; van den Berg, Aad P; Porte, Robert J

2014-04-01

39

[Transient dilatation of intra- and extra-hepatic bile ducts. A case].  

PubMed

A case of transient dilatation of intra and extrahepatic bile ducts in the course of an infectious disease is described in a three-year-old girl. The ultrasonic bile duct abnormalities disappeared after three months. The mechanism involved remains uncertain; the hypothesis of a transient inflammatory obstruction is evoked. PMID:1963934

Trabelsi, M; Chabchoub, A; Hammou-Jeddi, A; Hammami, A; Bennaceur, B

1990-01-01

40

Resection of hepaticocystic duct which is a rare anomaly of the extrahepatic biliary system: a case report  

PubMed Central

Introduction There are several variations in the morphologic characteristics of the extrahepatic biliary system. A hepaticocystic duct is one of the rare variations. Case presentation A 69-year-old Asian man underwent a cholecystectomy for cholelithiasis. His cystic duct was not detected during surgery. An intraoperative cholangiography revealed that his common hepatic ducts drained directly into the neck of his gallbladder. There was no common bile duct, as evidenced by the union of the common hepatic and cystic ducts. Conclusion Knowledge of anomalies related to the extrahepatic biliary system is important for decreasing the severe morbidity and mortality that may result from a failure to recognize the anomaly.

2013-01-01

41

[Injuries of the ducts in surgery of the biliary tract].  

PubMed

The authors analysed 92 reconstructive and restorative operations on the biliary tract injured at a high level during emergency operations. Such complications occur most frequently when the surgeon is insufficiently experienced or due to unavailability or incomplete use of the radiological method of intraoperative diagnostics. The expediency of reinfusion of the lost bile into the gastrointestinal tract in the diagnosis of injury to the biliary tract is pointed out. It is emphasized that patients must be transferred early to a specialized medical establishment for a reconstructive operation. The creation of hepato-digestive anastomoses on a transhepatic drain produces better results than the other drainage methods. In the group of 92 patients 77 recovered and 15 died in different periods after the operation. PMID:7474710

Vecherko, V N; Minin, V V; Khatsko, V V; Shatalov, V F; Shatalov, A D

1995-01-01

42

Choledochoduodenostomy as the biliary-enteric bypass of choice for benign and malignant distal common bile duct strictures.  

PubMed

Choledochoduodenostomy (including hepaticoduodenostomy) for common bile duct (CBD) strictures has been underused because of concerns regarding postoperative duodenal fistula and cholangitis attending the so-called "sump syndrome." An institutional retrospective review of 55 consecutive choledochoduodenostomy procedures for CBD strictures from 1995 to 2011 was performed to examine its suitability as the biliary-enteric bypass procedure of choice. There were 30 male (55%) and 25 female (45%) patients with a mean age of 49 years (range, 13 to 73 years). Thirty-seven (67%) patients had benign CBD strictures and 18 (33%) had unresectable periampullary adenocarcinomas. Forty-nine (89%) underwent choledochoduodenostomy and six (11%) underwent hepaticoduodenostomy. There were no 30-day postoperative deaths, anastomotic leaks, or intra-abdominal abscesses. Five patients (9%) sustained Clavien Grade III or IV complications. Over a mean long-term follow-up of 29 months (range, 1 to 162 months), there was one anastomotic stricture successfully managed by endoscopic dilation and temporary stenting. Liver function tests in all other patients returned to and remained within normal limits. We conclude that choledochoduodenostomy is the preferred biliary-enteric bypass for both benign and malignant distal CBD strictures because of its ease, safety, and durability. Persistent fears of duodenal fistula and the "sump syndrome" are not warranted by the empiric data and should be abandoned. PMID:24160798

Luu, Carrie; Lee, Byrne; Stabile, Bruce E

2013-10-01

43

Biliary dilatation and duodenal intussusception secondary to enteric duplication cyst: MDCT diagnosis.  

PubMed

Enteric duplication cysts are rare congenital anomalies that may occur anywhere along the gastrointestinal tract, most commonly involving the small bowel. The distal ileum, jejunum, and duodenum are affected in descending order of frequency. We describe a case of biliary dilatation and duodenal intussusception caused by an enteric duplication cyst in an adult patient. To our knowledge, there are no other reported cases of this entity in an adult in the English literature. Multidetector computed tomography (MDCT) findings are emphasized, and the value of multiplanar reformation (MPR) in forming a correct preoperative differential diagnosis is discussed. PMID:18414910

Morley, Nicholas P; Pyrros, Ayis T; Yaghmai, Vahid; Miller, Frank H; Nikolaidis, Paul

2009-05-01

44

Laparoscopic treatment for common bile duct stones by transcystic papilla balloon dilatation technique  

Microsoft Academic Search

.   The laparoscopic transcystic common bile duct (CBD) approach is becoming increasingly more refined as an ideal technique\\u000a to deal with gallbladder stones (GBS) and common bile duct stones (CBDS) during a single operation. Our method, transcystic\\u000a CBD exploration and papilla balloon dilatation (PBD), is an easier, safer, and less invasive technique than the transcystic\\u000a approaches that have previously been

S. Fujisaki; T. Nezu; H. Miyake; T. Oida; R. Tomita; S. Amano; M. Fukuzawa

1999-01-01

45

Overlapping of Primary Biliary Cirrhosis and Small Duct Primary Sclerosing Cholangitis: First Case Report  

PubMed Central

Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are both autoimmune cholestatic liver disease and the association of these two conditions in the same patient is very rare. We report the case of a female patient presenting with a cholestatic liver disease and a panel of autoantibodies specific for PBC, including antibodies to mitochondrial E2-pyruvate dehydrogenase, gp-210 and Sp-100. Beside these findings, the liver biopsy revealed concentric fibrosis of small biliary ducts and the magnetic resonance cholangiography presented no abnormal findings. Diagnosis of small duct PSC/PBC overlapping was done. No description of this association was found in the literature. Clinical and serological features of this unusual finding are discussed.

Oliveira, Elze Maria Gomes; Oliveira, Patricia Marinho; Becker, Vitoria; Dellavance, Alessandra; Andrade, Luis Eduardo Coelho; Lanzoni, Valeria; Silva, Antonio Eduardo Benedito; Ferraz, Maria Lucia Gomes

2012-01-01

46

[Clinical signs, diagnosis and surgical treatment of extrahepatic biliary duct tumors].  

PubMed

Experience of surgical treatment of 271 patients the extrahepatic biliary ducts tumor for the 1992-1999 yrs period is presented. Indirect signs of extrahepatic biliary ducts tumor were revealed in 84% of observations. Depending on the tumor localization the trustworthiness of the endoscopic retrograde pancreatocholangiography method had constituted from 79.8 to 96.4%. Correct diagnosis was established before the operation in 94.3% of patients. Radical operation was done in 93 (34.3%) of patients, including 22 with proximal localization of tumor, 13--with central one, 10--distal, 48--terminal. Palliative operation was performed in 178 patients, in 76 of them biliodigestive anastomosis was done. Total postoperative mortality was 14.8%. PMID:11688258

Shalimov, A A; Kopchak, V M; Dronov, A I; Todurov, I M; Diachenko, V V; Duvalko, A V; Khomiak, I V; Vasil'ev, O V

2001-06-01

47

Balloon Catheter Dilation and Nasolacrimal Intubation for Treatment of Nasolacrimal Duct Obstruction Following a Failed Probing  

PubMed Central

Objective To compare the outcome of balloon catheter dilation and nasolacrimal intubation as treatments for congenital nasolacrimal duct obstruction (NLDO) after a failed probing in children less than 4 years of age Methods We conducted a prospective, non-randomized multicenter study which enrolled 159 children aged 6 to <48 months who had a history of a single failed nasolacrimal duct probing and had at least one of the following clinical signs of NLDO present: epiphora, mucous discharge and/or increased tear lake. One hundred ninety-nine eyes underwent either balloon catheter nasolacrimal duct dilation or nasolacrimal duct intubation. Treatment success was defined as no epiphora, mucous discharge or increased tear lake present at the outcome visit six months after surgery. Results Treatment success was reported in 65 of 84 eyes (77%, 95% CI = 65% to 85%) in the balloon group compared with 72 of 88 eyes (84%, 95% CI = 74% to 91%) eyes in the intubation group (risk ratio for success for intubation vs. balloon = 1.08, 95% CI = 0.95 to 1.22). Conclusions Balloon catheter dilation and nasolacrimal duct intubation each alleviate the clinical signs of persistent nasolacrimal duct obstruction in a similar proportion of patients.

2009-01-01

48

The effect of biliary stenting on difficult common bile duct stones  

PubMed Central

Introduction If common bile duct (CBD) stones (choledocholithiasis) are left untreated, they may cause increases in morbidity and mortality due to several conditions. Aim In this study, using transient biliary stenting following the failure of an initial endoscopic retrograde cholangiopancreatography (ERCP) session, we aimed to show the effects of making the CBD stones smaller and easier to remove in the following session. Material and methods In 156 of 1300 (12%) patients with CBD stones, who underwent balloon screening and/or basket lithotripsy following ERCP and CBD cannulation, it was not possible to remove the stones in the first session. Of these 156 patients, 64 (4.9%) were further followed and tested following transient biliary stenting. Results In the last ERCP following biliary stenting, the maximum stone sizes and stone indices were decreased in 54 (83%) patients and stone fragmentation was observed in 46 (72%) patients. Complete and incomplete removal was obtained in 40 (62.5%) and 24 (37.5%) patients, respectively. Conclusions Biliary stenting, fragmentation and the reduction in the size of difficult common bile duct stones caused by the first session of ERCP may increase the chance of success in the next session of ERCP.

Arabul, Mahmut; Celik, Mustafa; Alper, Emrah; Unsal, Belk?s

2014-01-01

49

Primary lacrimal sac rhinosporidiosis with grossly dilated sac and nasolacrimal duct.  

PubMed

Rhinosporidiosis is a chronic infection of the mucous membranes of the upper respiratory tract. The authors report a case of primary lacrimal sac rhinosporidiosis with a grossly dilated sac and nasolacrimal duct as seen on CT dacryocystography. Despite a chronic infection of 12 years' duration, there was no involvement of conjunctiva, nasal, or nasopharyngeal mucosa. PMID:19454941

Pushker, Neelam; Kashyap, Seema; Bajaj, Mandeep S; Meel, Rachna; Sood, Archana; Sharma, Sanjay; Konkal, Venkatesh L

2009-01-01

50

Microcatheter Use for Difficult Percutaneous Biliary Procedures  

SciTech Connect

Percutaneous biliary drainage procedures in patients with nondilated ducts are demanding, resulting in lower success rates than in patients with bile duct dilatation. Pertinent clinical settings include patients with iatrogenic bile leaks, diffuse cholangiocarcinomas, and sclerosing cholangitis. We describe a method to facilitate these procedures with the combined use of a 2.7-Fr microcatheter and a 0.018-in. hydrophilic wire.

Brountzos, Elias N., E-mail: ebrountz@med.uoa.gr; Kelekis, Alexis D.; Ptohis, Nikolaos; Kotsioumba, Ioanna [Athens University Medical School, Attikon University Hospital, Second Department of Radiology (Greece); Misiakos, Evangelos [Athens University, Medical School, Attikon University Hospital, Third Department of Surgery (Greece); Perros, George [Athens University, Medical School, Attikon University Hospital, Fourth Department of Surgery (Greece); Gouliamos, Athanasios D. [Athens University Medical School, Attikon University Hospital, Second Department of Radiology (Greece)

2008-09-15

51

Medical treatment of biliary duct stones: effect of ursodeoxycholic acid administration.  

PubMed Central

Twenty-eight patients with radiolucent biliary duct stones without cholangitis and jaundice were randomly allocated into two treatment groups receiving ursodeoxycholic acid 12 mg/kg (group A) or placebo (group B) in three daily doses for 24 months. In group A stones disappeared completely in seven patients and partially in one; placebo administration had no effect on stone size and three patients of group B (only one of group A) went to surgery for complications. Ursodeoxycholic acid treatment did not adversely affect liver function tests, and alkaline phosphatase decreased. Abdominal and biliary colics also became less frequent in the first six months of therapy in group A, but not in the placebo group. The bile was supersaturated with cholesterol in both groups, but decreased significantly only in patients receiving ursodeoxycholic acid even though the lithogenic index remained high. Cholesterol saturation of bile does not seem to be the only factor determining the dissolution of biliary duct stones which sometimes contain cholesterol as the main component.

Salvioli, G; Salati, R; Lugli, R; Zanni, C

1983-01-01

52

[Echinococcosis of intra- and extrahepatic bile ducts. Report of a case at the Central Military Hospital].  

PubMed

We present a woman 34 years old with echinococcosis of intra and extra hepatic biliary ducts including gallbladder. We found alive cysts, dead cysts and fragments of germinative membranes of a complicated cyst in left lobe (I - II) with clinical findings of obstructive jaundice; pain; cholecystitis and great dilation of biliary ducts. We performed left lobectomy, exploration of biliary ducts, transduodenal sphincteroplasty, cholecystectomy. We haven't had complications. We present ultrasound images of the pathologic pieces. PMID:12170290

Correa Tineo, S; Marroquin Vals, H; Pinto Paz, M; Culqui Lévano, C; Salinas Alva, E

2001-01-01

53

Covered Metal Stenting for Malignant Lower Biliary Stricture with Pancreatic Duct Obstruction: Is Endoscopic Sphincterotomy Needed?  

PubMed Central

Aims. To evaluate the need for endoscopic sphincterotomy (EST) before covered self-expandable metal stent (CSEMS) deployment for malignant lower biliary stricture with pancreatic duct obstruction. Methods. This study included 79 patients who underwent CSEMS deployment for unresectable malignant lower biliary stricture with pancreatic duct obstruction. Treatment outcomes and complications were compared between 38 patients with EST before CSEMS deployment (EST group) and 41 without EST (non-EST group). Results. The technical success rates were 100% in both the EST and the non-EST group. The incidence of pancreatitis was 2.6% in the EST, and 2.4% in the non-EST group (P = 0.51). The incidences of overall complications were 18.4% and 14.6%, respectively, (P = 0.65). Within the non-EST groups, the incidence of pancreatitis was 0% in patients with fully covered stent deployment and 3.6% in those with partially covered stent deployment (P = 0.69). In the multivariate analysis, younger age (P = 0.003, OR 12) and nonpancreatic cancer (P = 0.001, OR 24) were significant risk factors for overall complications after CSEMS deployment. EST was not identified as a risk factor. Conclusions. EST did not reduce the incidence of pancreatitis after CSEMS deployment in patients of unresectable distal malignant obstruction with pancreatic duct obstruction.

Nakahara, Kazunari; Okuse, Chiaki; Suetani, Keigo; Michikawa, Yosuke; Kobayashi, Shinjiro; Otsubo, Takehito; Itoh, Fumio

2013-01-01

54

Biliary drainage of the common bile duct with an enteral metal stent.  

PubMed

In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of five metal stents for a distal common bile duct (CBD) stenosis. All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla. A profoundly dilated CBD with sludge and concrements was seen. To ensure adequate bile drainage an enteral metal stent was inserted in the CBD. This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances. We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD, placement of an enteral metal stent in the CBD could be considered, especially in patients who are unfit for surgery. PMID:19452591

Dek, Irene M; van den Elzen, Bram D J; Fockens, Paul; Rauws, Erik A J

2009-05-21

55

Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? A prospective randomized controlled trial  

Microsoft Academic Search

Background  Although pancreatic duct guidewire placement (P-GW) for achieving selective biliary cannulation is reported to be effective\\u000a in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) is difficult, this technique entails a possible\\u000a increased risk of post-ERCP pancreatitis. We conducted a prospective randomized controlled trial to evaluate the prophylactic\\u000a effect of pancreatic duct stenting on the frequency of post-ERCP pancreatitis in patients

Kei Ito; Naotaka Fujita; Yutaka Noda; Go Kobayashi; Takashi Obana; Jun Horaguchi; Osamu Takasawa; Shinsuke Koshita; Yoshihide Kanno; Takahisa Ogawa

2010-01-01

56

Decompression of malignant biliary obstruction by duodenoscopic intubation of bile duct.  

PubMed Central

Interest is increasing in non-operative methods of relieving malignant obstruction of the bile duct, and drainage tubes and prostheses may be placed in the bile duct via the percutaneous transhepatic route. Two cases are described, however, in which a duodenoscope was used and the approach was via the papilla of Vater. This method allows temporary or permanent drainage tubes to be placed through malignant strictures. This endoscopic approach is less invasive and should be safer than that by the transhepatic route; furthermore, removing and replacing a blocked endoprosthesis should be easier. Further study is needed, as the procedure is technically more difficult and its role in managing biliary strictures has yet to be defined. Images FIG 1 FIG 2 FIG 3 FIG 4

Laurence, B H; Cotton, P B

1980-01-01

57

[Transient dilatation of the intra- and extra-hepatic bile ducts. A new aspect of bile duct involvement in scarlet fever].  

PubMed

An extra- and intra-hepatic bile duct dilatation has been observed in a child in the course of scarlet fever. Manifestations of cholestasis, cytolysis and inflammation were present. Pruritus disappeared within 2 months, biological abnormalities within 3 months and ultrasonic bile duct abnormalities between 3 and 6 months, with a follow-up of 9 months. This case report suggests a relationship between a transitory obstruction, possibly toxic in origin, of the bile ducts and the scarlet fever. PMID:3284506

Hermier, M; Pouillaude, J M; Bouvier, R; Foasso, M F; Descos, B; Loras-Duclaux, I

1988-01-01

58

Proximal bile duct tumors: surgical management with silastic transhepatic biliary stents.  

PubMed Central

Over a nine-year period, 27 patients with proximal biliary tumors were operated upon. In ten of the 27 patients (37%) tumor resection including the hepatic bifurcation was possible, and bilateral hepaticojejunostomies were performed using silastic transhepatic biliary stents. In the remaining 17 patients the tumor was partially resected, dilated, or bypassed, and reconstruction to a Roux-en-Y-jejunal loop was carried out using silastic transhepatic biliary stents. Hospital mortality for those patients undergoing resection was zero, and for the entire group 4% (1/27). The mean bilirubin on admission was 13.2 mg/dl and after discharge fell to a mean of 1.5 mg/dl. Mean survival for the entire group is 18 months with 11 patients still alive. Mean survival for the first nine patients undergoing resection is 21 months with seven patients still alive (one for over 5 years). The 15 patients dying following discharge survived for a mean of 14 months. Images Fig. 1. Fig. 2. Fig. 3.

Cameron, J L; Broe, P; Zuidema, G D

1982-01-01

59

[An unusual complication of hepatocellular carcinoma: the pleuro-biliary fistula].  

PubMed

A patient with hepatocellular carcinoma had fever, cough, dyspnea. The analysis and the transcatheter arterial chemoembolization (TACE) showed leucocytosis, cholestasis and pleural viscous fluid with bilirubin. The patient was stabilized and two chest tube were placed. Abdomen CT demonstrated dilated bile duct and pleuro-biliary fistula: dilated bile duct, necrosis and portal thrombus were predictive for TACE-induced pleuro-biliary fistula. PMID:19350800

Tirotta, Daniela; Durante, Vittorio

2009-02-01

60

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone  

PubMed Central

Background/Aims Between endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared. Methods Medical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD ?11 mm and follow-up longer than 6 months were included. Results There were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135°, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum. Conclusions Late complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

Kim, Ka Young; Kim, Ho Gak; Kim, Byeong Suk; Jung, Jin Tae; Kwon, Joong Goo; Kim, Eun Young; Lee, Chang Hyeong

2013-01-01

61

The Ballooning Time in Endoscopic Papillary Balloon Dilation for the Treatment of Bile Duct Stones  

PubMed Central

Background/Aims Endoscopic papillary balloon dilation (EPBD) is a safe and effective method for the treatment of choledocholithiasis, but previous studies have rarely reported the appropriate ballooning time (BT). We prospectively evaluated the safety and efficacy of EPBD according to BT in patients undergoing bile duct stone removal. Methods Seventy consecutive patients with bile duct stones were randomly assigned to receive EPBD with either conventional (n = 35, 60 seconds) or short (n = 35, 20 seconds) BT. Results EPBD alone achieved complete bile duct clearance in 67 patients (long BT, n = 33, 94.3%; short BT, n = 34, 97.1%; p = 0.808). We also found no significant difference in the rate of complete duct clearance, including procedures that used mechanical lithotripsy, between the long and short BT groups (97.1% vs. 100%; p = 0.811). Mild pancreatitis was noted in four (11.4%) patients in the long BT group and two (5.7%) patients in the short BT group, but this incidence was not significantly different. Conclusions The study showed that EPBD using both 20-sec and 60-sec BTs is safe and effective for the treatment of bile duct stones. Short and long BTs produced comparable outcomes.

Bang, Byoung Wook; Jeong, Seok; Lee, Jung Il; Lee, Jin-Woo; Kwon, Kye Sook; Kim, Hyung Gil; Shin, Yong Woon; Kim, Young Soo

2010-01-01

62

Rupture of Hepatocellular Carcinoma into the Biliary System with Resulting Bile Duct Thrombi: Report of Two Cases  

Microsoft Academic Search

We report two cases of hepatocellular carcinoma revealed by jaundice and the presence of free-floating tumoural fragments within the biliary system. Two men (one of 64 and one of 73) presented with isolated jaundice. The results from ultrasound, CT and MRI were suggestive of a cholangiocarcinoma. Surgical intervention demonstrated bile duct thrombi from the primary tumour causing obstructive jaundice.

P. Bigot; G. M. Buchanan; A. Hamy; C. Teyssedou; P. Pessaux; J. P. Arnaud

2007-01-01

63

One-Step Transpapillary Balloon Dilation under Cap-Fitted Endoscopy without a Preceding Sphincterotomy for the Removal of Bile Duct Stones in Billroth II Gastrectomy  

PubMed Central

Background/Aims Endoscopic sphincterotomy may be limited in Billroth II gastrectomy because of difficulty in orientating the duodenoscope and sphincterotome as a result of altered anatomy. This study was planned to investigate the efficacy and safety of endoscopic transpapillary large balloon dilation (EPBD) without preceding sphincterotomy for removal of large CBD stones in Billroth II gastrectomy. Methods Between March 2010 and February 2011, one-step EPBD under cap-fitted forward-viewing endoscopy was performed in patients who had undergone Billroth II gastrectomy at two tertiary referral centers. Main outcome measurements were successful duct clearance and EPBD-related complications. Results Successful access to major duodenal papilla was performed in 13 patients, but successful selective CBD cannulation was achieved in 12 patients (92.3%). Median maximum transverse stone size was 11.5 mm (10 to 14 mm). The mean number of stones was 2 (1-5). The median CBD diameter was 15 mm (12 to 19 mm). Mean procedure time from successful biliary access to complete stone removal was 17.8 min. Complete duct clearance was achieved in all patients. Four patients (33.3%) needed one more session of ERCP for removal of remnant stones. Asymptomatic hyperamylasemia in two patients and minor bleeding in another occurred. Conclusions Without preceding sphincterotomy, one-step EPBD (?10 mm) under cap-fitted forward-viewing endoscopy may be safe and effective for the removal of large stones (?10 mm) with CBD dilatation in Billroth II gastrectomy.

Hwang, Jae Chul; Choi, Hyun Jong; Moon, Jong Ho; Cho, Young Deok; Yoo, Byung Moo; Park, Sang-Heum; Kim, Jin Hong; Kim, Sun-Joo

2012-01-01

64

Endosonography-guided cholangiopancreatography as a salvage drainage procedure for obstructed biliary and pancreatic ducts  

PubMed Central

Endoscopic ultrasound allows transmural access to the bile or pancreatic ducts and subsequent contrast injection to provide ductal drainage under fluoroscopy using endoscopic retrograde cholangiopancreatography (ERCP)-based techniques. Differing patient specifics and operator techniques result in six possible variant approaches to this procedure, known as endosonography-guided cholangiopancreatography (ESCP). ESCP has been in clinical use for a decade now, with over 300 cases reported. It has become established as a salvage procedure after failed ERCP in the palliation of malignant biliary obstruction. Its role in the management of clinically severe chronic/relapsing pancreatitis remains under scrutiny. This review aims to clarify the concepts underlying the use of ESCP and to provide technical tips and a detailed step-by-step procedural description.

Perez-Miranda, Manuel; de la Serna, Carlos; Diez-Redondo, Pilar; Vila, Juan J

2010-01-01

65

Endoscopic papillary balloon dilation for bile duct stone removal in patients 60 years old or younger  

Microsoft Academic Search

Background  The aim of this study was to evaluate short- and long-term outcomes in relatively young patients (?60 years old) who underwent\\u000a endoscopic papillary balloon dilation (EPBD) for bile duct stone removal.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Immediate and long-term outcomes were evaluated in 311 patients who were 60 years old or younger at the time of EPBD. The\\u000a stone recurrence rate was compared among four groups stratified

Takeshi Tsujino; Haruhiko Yoshida; Hiroyuki Isayama; Yukiko Ito; Yoko Yashima; Hiroshi Yagioka; Hirofumi Kogure; Takashi Sasaki; Toshihiko Arizumi; Osamu Togawa; Saburo Matsubara; Yousuke Nakai; Naoki Sasahira; Kenji Hirano; Minoru Tada; Takao Kawabe; Masao Omata; Kazuhiko Koike

2010-01-01

66

Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions  

Microsoft Academic Search

Background  Bile duct injury (BDI) is a dreaded complication of cholecystectomy, often caused by misinterpretation of biliary anatomy.\\u000a To prevent BDI, techniques have been developed for intraoperative assessment of bile duct anatomy. This article reviews the\\u000a evidence for the different techniques and discusses their strengths and weaknesses in terms of efficacy, ease, and cost-effectiveness.\\u000a \\u000a \\u000a \\u000a \\u000a Method  PubMed was searched from January 1980 through

K. Tim Buddingh; Vincent B. Nieuwenhuijs; Lianne van Buuren; Jan B. F. Hulscher; Johannes S. de Jong; Gooitzen M. van Dam

2011-01-01

67

Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones  

PubMed Central

Background Lethal pancreatitis has been reported after treatment for common bile duct stones using small endoscopic papillary balloon dilation. Methods We retrospectively evaluated the safety and efficacy of using large balloon dilation alone without the use of sphincterotomy for the treatment of large common bile duct stones in Kaohsiung Veterans General Hospital. Success rate of stone clearance, procedure-related adverse events and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded. Results A total of 247 patients were reviewed in the current study. The mean age of the patients was 71.2 years. Most of them had comorbidities. Mean stone size was 16.4 mm. Among the patients, 132 (53.4%) had an intact gallbladder and 121 (49%) had a juxtapapillary diverticulum. The mean size of dilating balloon used was 13.2 mm. The mean duration of the dilating procedure was 4.7 min. There were 39 (15.8%) patients required the help of mechanical lithotripsy while retrieving the stones. The final success rate of complete retrieval of stones was 92.7%. The rate of pancreatic duct enhancement was 26.7% (66/247). There were 3 (1.2%) adverse events and 6 (2.4%) intra-procedure bleeding incidents. All patients recovered completely after conservative and endoscopic treatment respectively, and no procedure-related mortality was noted. 172 patients had a follow-up duration of more than 6 months and among these, 25 patients had recurrent common bile duct stones. It was significantly correlated to the common bile duct size (p = 0.036) Conclusions Endoscopic papillary large balloon dilation alone is simple, safe, and effective in dealing with large common bile duct stones in relatively aged and debilitated patients.

2011-01-01

68

Microcatheter use for difficult percutaneous biliary procedures.  

PubMed

Percutaneous biliary drainage procedures in patients with nondilated ducts are demanding, resulting in lower success rates than in patients with bile duct dilatation. Pertinent clinical settings include patients with iatrogenic bile leaks, diffuse cholangiocarcinomas, and sclerosing cholangitis. We describe a method to facilitate these procedures with the combined use of a 2.7-Fr microcatheter and a 0.018-in. hydrophilic wire. PMID:18320271

Brountzos, Elias N; Kelekis, Alexis D; Ptohis, Nikolaos; Kotsioumba, Ioanna; Misiakos, Evangelos; Perros, George; Gouliamos, Athanasios D

2008-01-01

69

[A case of intraductal mucinous neoplasms with the whole main pancreatic duct dilation treated via segment pancreatectomy].  

PubMed

The patient was a 77-year-old woman. She was diagnosed as intraducal papillary mucinous neoplasms (IPMN). She refused an operation for 3 years. After all, a nodule in the main pancreatic duct was pointed out, she agreed and was referred to us. Her past history showed pacemaker implantation for third-degree atrioventricular block, and no impaired glucose tolerance. Abdominal CT showed a dilated whole pancreatic duct and a multilocular cystic tumor. Endoscopic retrograde pancreatography showed a marked dilation of the main pancreatic duct. We diagnosed as main duct IPMN. Intraoperative US showed no nodule in pancreatic duct, and there was no suspicious lesion of invasive cancer. We performed segmental pancreatectomy between the left side of common bile duct and the pancreas tail. The tumor was resected with clear margins. Both cut-ends of the main pancreatic duct were anastomosed to a jejunal loop. The postoperative course was excellent. She was discharged on day 16. The glycemic control was good, she needed no treatment for diabetes. Total pancreatectomy has many problems such as insulin and pancreatic polypeptide deficiency, hypoglycemia, malabsorption, diarrhea and liver dysfunction. We avoided total pancreatectomy so that her quality of life was maintained. Still a careful follow -up is required. PMID:22202412

Yamaura, Tadayoshi; Sakamoto, Hirohiko; Amikura, Katsumi; Tanaka, Yoichi; Oba, Hanako; Kurosumi, Masafumi

2011-11-01

70

Primary biliary cirrhosis  

MedlinePLUS

Primary biliary cirrhosis is irritation and swelling (inflammation) of the bile ducts of the liver, which blocks ... ducts in the liver is not known. However, primary biliary cirrhosis is an autoimmune disorder. That means ...

71

Biliary Atresia Revisited  

Microsoft Academic Search

Extrahepatic biliary atresia (EHBA) is an inflammatory fibrosing process affecting the extrahepatic and intrahepatic biliary tree resulting in fibrous obliteration of the extrahepatic biliary tract, ductopenia of intrahepatic bile ducts, and biliary cirrhosis. EHBA is divided into a correctable and a noncorrectable type with focal patency of the otherwise atretic biliary tree in the former and no patency of the

Ellen Kahn

2004-01-01

72

Dilated common bile duct and deranged liver function tests associated with ketamine use in two HIV-positive MSM.  

PubMed

We report here the first two cases of hepatobiliary pathology in HIV-positive men following recreational use of ketamine: >1?g/day over a 12-month period while on ritonavir-based antiretroviral therapy. Presentation in each case was acute with nausea, vomiting and epigastric pain. Alanine aminotransferase was raised at 3.2× and 10.1?×?upper limit of normal and alkaline phosphatase was raised at 1.7× and 2.5?×?ULN for cases 1 and 2, respectively. Magnetic resonance cholangiopancreatography showed dilatation of the common bile duct; case 1, 18?mm and case 2, 14?mm with no ductal obstruction on endoscopic retrograde cholangiopancreatography. The symptoms resolved, common bile duct dilatation and liver function improved on discontinuation of ketamine use. Time to development of symptoms is shorter than reported in HIV-negative cases (12 months vs. 4 years) which may be explained by an interaction between ketamine and ritonavir. PMID:23970577

Zhou, Judith; Shaw, Simon G; Gilleece, Yvonne

2013-08-01

73

A giant retention cyst of the pancreas (cystic dilatation of dorsal pancreatic duct) associated with pancreas divisum  

Microsoft Academic Search

  We describe a rare case of pancreas divisum associated with a giant retention cyst (cystic dilatation of the dorsal pancreatic\\u000a duct), presumably formed following obstruction of the minor papilla. The patient was treated by pancreatico(cysto)jejunostomy.\\u000a A 50-year-old man was admitted with complaints of increasing upper abdominal distension and body weight loss. There was no\\u000a previous history of pancreatitis, gallstones, drinking,

Zenichi Morise; Kazuo Yamafuji; Tadao Tsuji; Atsunori Asami; Kaoru Takeshima; Noritaka Hayashi; Hideo Baba; Fumiko Yoshida; Yuta Abe; Yasuyuki Tokura

2002-01-01

74

Pancreato-biliary Endoscopic Ultrasound in Opium Addicts Presenting with Abdominal Pain  

PubMed Central

Objective: Asymptomatic dilatation of bile duct and symptomatic sphincter of Oddi dysfunction have been reported in opium addicts. Except one case report, there is no report in the literature on endoscopic ultrasound (EUS) study of pancreato-biliary system in opium addicts. The aim of the present study was to report the EUS features of pancreato-biliary system in opium addicts presenting with abdominal pain. Patients and Methods: A total of 15 opium addicts presenting with upper abdominal pain and dilated common bile duct (CBD) and or pancreatic duct (PD) on abdominal ultrasound were included in this study. EUS findings of pancreato-biliary system were analyzed in these patients. Results: All the 15 patients were males (mean age 53.3 years) presented with upper abdominal pain. Mean duration of opium addiction was 20.1 years. On EUS CBD was dilated in all the patients while PD was dilated in six patients. Gall bladder, liver and pancreatic parenchyma was normal in all these patients. Surface area of papilla of Vater (SPV) was increased in 12 patients. Conclusion: Opium addiction causes obstruction at ampulla and produces dilatation of bile duct and PD. Bile duct dilatation was seen in all the patients while PD dilatation was seen in few patients. Increase in SPV was a peculiar finding and appears to be as a result of direct effect of opium on ampulla.

Sharma, Shyam Sundar; Ram, Seva; Maharshi, Sudhir; Shankar, Vijay; Katiyar, Prashant; Jhajharia, Ashok; Sardava, Vimal; Bhardwaj, Hemendra

2013-01-01

75

Endoscopic papillary balloon dilation for difficult common bile duct stones: Our experience  

PubMed Central

AIM: To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) performed for common bile duct (CBD) stones. METHODS: From a computer database, we retrospectively analyzed the data relating to EBD performed in patients at the gastrointestinal unit of the Sandro Pertini Hospital of Rome (small center with low case volume) who underwent endoscopic retrograde cholangiopancreatography (ERCP) for CBD from January 1, 2010 to February 29, 2012. All patients had a proven diagnosis of CBD stones studied with echography, RMN-cholangiography and, when necessary, with computed tomography of the abdomen (for example, in cases with pace-makers). Prophylactic therapies, with gabexate mesilate 24 h before the procedure and with an antibiotic (ceftriaxone 2 g) 1 h before, were administered in all patients. The duodenum was intubated with a side-viewing endoscope under deep sedation with intravenous midazolam and propofol. The patients were placed in the supine position in almost all cases. EBD of the ampulla was performed under endoscopic and fluoroscopic guidance with a balloon through the scope (Hercules, wireguided balloon®, Cook Ireland Ltd. and CRE®, Microvasive, Boston Scientific Co., Natick, MA, United States). RESULTS: A total of 14 patients (9 female, 5 male; mean age of 73 years; range 57-82 years) were enrolled in the study, in whom a total of 15 EBDs were performed. All patients underwent minor endoscopic sphincterotomy (ES) prior to the EBD. The size of balloon insufflation depended on stone size and CBD dilation and this was performed until it reached 16 mm in diameter. EBD was performed under endoscopic and fluoroscopic guidance. The balloon was gradually filled with diluted contrast agent and was maintained inflated in position for 45 to 60 s before deflation and removal. The need for precutting the major papilla was 21.4%. In one patient (an 81-year-old), EBD was performed in a Billroth II. Periampullary diverticula were found only in a 74-year-old female. The adverse event related to the procedures (ERCP + ES) was only an intra procedural bleeding (6.6%) that occurred after ES and was treated immediately with adrenaline sclerotherapy. No postoperative complications were reported. CONCLUSION: With the current endoscopic techniques, very few patients with choledocholithiasis require surgery. EBD is an efficacious and safe procedure.

Zippi, Maddalena; De Felici, Isabella; Pica, Roberta; Traversa, Giampiero; Occhigrossi, Giuseppe

2013-01-01

76

Endoscopic papillary large balloon dilation for the removal of bile duct stones.  

PubMed

Endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) has been widely used as the alternative to EST along with endoscopic mechanical lithotripsy (EML) for the removal of large or difficult bile duct stones. Furthermore, EPLBD without EST was recently introduced as its simplified alternative technique. Thus, we systematically searched PubMed, Medline, the Cochrane Library and EMBASE, and analyzed all gathered data of EPLBD with and without EST, respectively, by using a single standardized definition, reviewing relevant literatures, published between 2003 and June 2013, where it was performed with large-diameter balloons (12-20 mm). The outcomes, including the initial success rate, the rate of needs for EML, and the overall success rate, and adverse events were assessed in each and compared between both of two procedures: "EPLBD with EST" and "EPLBD without EST". A total of 2511 procedures from 30 published articles were included in EPLBD with EST, while a total of 413 procedures from 3 published articles were included in EPLBD without EST. In the results of outcomes, the overall success rate was 96.5% in EPLBD with EST and 97.2% in EPLBD without EST, showing no significant difference between both of them. The initial success rate (84.0% vs 76.2%, P < 0.001) and the success rate of EPLBD without EML (83.2% vs 76.7%, P = 0.001) was significantly higher, while the rate of use of EML was significantly lower (14.1% vs 21.6%, P < 0.001), in EPLBD with EST. The rate of overall adverse events, pancreatitis, bleeding, perforation, other adverse events, surgery for adverse events, and fatal adverse events were 8.3%, 2.4%, 3.6%, 0.6%, 1.7%, 0.2% and 0.2% in EPLBD with EST and 7.0%, 3.9%, 1.9%, 0.5%, 0.7%, 0% and 0% in EPLBD without EST, respectively, showing no significant difference between both of them. In conclusion, recent accumulated results of EPLBD with or even without EST suggest that it is a safe and effective procedure for the removal of large or difficult bile duct stones without any additional risk of severe adverse events, when performed under appropriate guidelines. PMID:24379575

Kim, Jin Hong; Yang, Min Jae; Hwang, Jae Chul; Yoo, Byung Moo

2013-12-14

77

Endoscopic papillary large balloon dilation for the removal of bile duct stones  

PubMed Central

Endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) has been widely used as the alternative to EST along with endoscopic mechanical lithotripsy (EML) for the removal of large or difficult bile duct stones. Furthermore, EPLBD without EST was recently introduced as its simplified alternative technique. Thus, we systematically searched PubMed, Medline, the Cochrane Library and EMBASE, and analyzed all gathered data of EPLBD with and without EST, respectively, by using a single standardized definition, reviewing relevant literatures, published between 2003 and June 2013, where it was performed with large-diameter balloons (12-20 mm). The outcomes, including the initial success rate, the rate of needs for EML, and the overall success rate, and adverse events were assessed in each and compared between both of two procedures: “EPLBD with EST” and “EPLBD without EST”. A total of 2511 procedures from 30 published articles were included in EPLBD with EST, while a total of 413 procedures from 3 published articles were included in EPLBD without EST. In the results of outcomes, the overall success rate was 96.5% in EPLBD with EST and 97.2% in EPLBD without EST, showing no significant difference between both of them. The initial success rate (84.0% vs 76.2%, P < 0.001) and the success rate of EPLBD without EML (83.2% vs 76.7%, P = 0.001) was significantly higher, while the rate of use of EML was significantly lower (14.1% vs 21.6%, P < 0.001), in EPLBD with EST. The rate of overall adverse events, pancreatitis, bleeding, perforation, other adverse events, surgery for adverse events, and fatal adverse events were 8.3%, 2.4%, 3.6%, 0.6%, 1.7%, 0.2% and 0.2% in EPLBD with EST and 7.0%, 3.9%, 1.9%, 0.5%, 0.7%, 0% and 0% in EPLBD without EST, respectively, showing no significant difference between both of them. In conclusion, recent accumulated results of EPLBD with or even without EST suggest that it is a safe and effective procedure for the removal of large or difficult bile duct stones without any additional risk of severe adverse events, when performed under appropriate guidelines.

Kim, Jin Hong; Yang, Min Jae; Hwang, Jae Chul; Yoo, Byung Moo

2013-01-01

78

Endoscopic management of a major bile duct stricture from surgical clips following laparoscopic hemicolectomy.  

PubMed

Benign postoperative bile duct strictures are usually complications of cholecystectomies. However, development of obstructive jaundice and biliary stricture as a result of surgical clips after laparoscopic right hemicolectomy is rare and has not been reported in the literature. We present a case of a 64-year-old woman who presented with sudden onset jaundice and abdominal pain, 1 week following right hemicolectomy. Laboratory reports suggested obstructive jaundice. Subsequent imaging studies showed biliary dilation of both intrahepatic and extrahepatic ducts with no evidence of bile duct stones. The endoscopic retrograde cholangiopancreatography (ERCP) showed an abrupt, complete obstruction of the common bile duct at the level of the surgical clips. The bile duct stricture formed at the site of surgical clips improved significantly after serial incremental biliary dilations with successive placement of increasing number of endoprostheses side-by-side at repeat ERCP sessions. PMID:23446047

Singh, Shailendra; Aoun, Elie; Thakkar, Shyam

2013-01-01

79

Endoscopic large-balloon dilation alone versus endoscopic sphincterotomy plus large-balloon dilation for the treatment of large bile duct stones  

PubMed Central

Background Endoscopic sphincterotomy (EST) combined with large-balloon dilation (LBD) has been proposed as an alternative to manage large bile duct stones. However, recent reports indicate that LBD without EST may be safe and effective in this setting. Methods One hundred thirty-one patients with large common bile duct (CBD) stones 12 mm in size or larger underwent LBD alone (n?=?62) or EST plus LBD (n?=?69) for lithotripsy. The therapeutic outcome and complications were reviewed and compared. Results There were no differences between the two groups with regard to age, size and number of stones, or bile duct diameter. The LBD alone group (mean age, 70.4 years) and the EST plus LBD group (mean age, 68.2 years) had similar outcomes in terms of overall successful stone removal (96.8% vs. 95.7%, P?=?0.738) and complete stone removal without the need for mechanical lithotripsy (80.6% vs. 73.9%, P?=?0.360). Complications in the LBD alone and EST plus LBD groups were as follows: pancreatitis (6.5% vs. 4.3%, P?=?0.593), impaction of basket and stone (0% vs. 1.4%, P?=?0.341), and perforation (0% vs. 1.4%, P?=?0.341). Conclusions LBD alone may be a simple, safe, and effective alternative to EST plus LBD in relatively aged patients with large CBD stones, and it can simplify the procedure compared with EST plus LBD.

2013-01-01

80

Genetic alterations and growth pattern in biliary duct carcinomas: loss of heterozygosity at chromosome 5q bears a close relation with polypoid growth  

Microsoft Academic Search

Biliary duct carcinomas (BDCs) are relatively rare and the carcinogenic mechanisms underlying their induction are poorly understood. There are two growth patterns, polypoid and non-polypoid infiltrative type, but little information is available concerning the relation between growth pattern and genetic alterations. A comparative study was therefore conducted to clarify if differences in genetic changes, including loss of heterozygosity (LOH) at

E Hidaka; A Yanagisawa; M Seki; T Setoguchi; Y Kato

2001-01-01

81

Biliary tree stem/progenitor cells in glands of extrahepatic and intraheptic bile ducts: an anatomical in situ study yielding evidence of maturational lineages  

PubMed Central

Stem/progenitors have been identified intrahepatically in the canals of Hering and extrahepatically in glands of the biliary tree. Glands of the biliary tree (peribiliary glands) are tubulo-alveolar glands with mucinous and serous acini, located deep within intrahepatic and extrahepatic bile ducts. We have shown that biliary tree stem/progenitors (BTSCs) are multipotent, giving rise in vitro and in vivo to hepatocytes, cholangiocytes or pancreatic islets. Cells with the phenotype of BTSCs are located at the bottom of the peribiliary glands near the fibromuscular layer. They are phenotypically heterogeneous, expressing transcription factors as well as surface and cytoplasmic markers for stem/progenitors of liver (e.g. SOX9/17), pancreas (e.g. PDX1) and endoderm (e.g. SOX17, EpCAM, NCAM, CXCR4, Lgr5, OCT4) but not for mature markers (e.g. albumin, secretin receptor or insulin). Subpopulations co-expressing liver and pancreatic markers (e.g. PDX1+/SOX17+) are EpCAM+/?, and are assumed to be the most primitive of the BTSC subpopulations. Their descendants undergo a maturational lineage process from the interior to the surface of ducts and vary in the mature cells generated: pancreatic cells in hepatopancreatic ducts, liver cells in large intrahepatic bile ducts, and bile duct cells along most of the biliary tree. We hypothesize that there is ongoing organogenesis throughout life, with BTSCs giving rise to hepatic stem cells in the canals of Hering and to committed progenitors within the pancreas. The BTSCs are likely to be central to normal tissue turnover and injury repair and to be key elements in the pathophysiology of liver, pancreas and biliary tree diseases, including oncogenesis.

Carpino, Guido; Cardinale, Vincenzo; Onori, Paolo; Franchitto, Antonio; Berloco, Pasquale Bartolomeo; Rossi, Massimo; Wang, Yunfang; Semeraro, Rossella; Anceschi, Maurizio; Brunelli, Roberto; Alvaro, Domenico; Reid, Lola M; Gaudio, Eugenio

2012-01-01

82

Role of contrast enhanced ultrasound in the assessment of biliary duct disease.  

PubMed

The introduction of microbubble contrast agents (CA), which act as blood pool tracers, has overcome the limitations of conventional B-Mode, colour or power Doppler ultrasound, enabling the display of parenchymal microvasculature. Initially, the use of CA was accepted for hepatic lesions. In the following years, experts have expanded recommendations, as a result of the method's efficiency in extrahepatic applications. In this article we review the methodology and the application of contrast-enhanced ultrasound (CEUS) in the evaluation of biliary pathology. This new imaging tool allows a non invasive differential diagnosis of biliary lesions and a clearer delineation of the tumoral process. PMID:24567924

Spârchez, Zeno; Radu, Pompilia

2014-03-01

83

Biliary cystadenoma  

PubMed Central

The diagnosis of cystadenoma is rare, even more so when located in the extrahepatic bile duct. Unspecific clinical signs may lead this pathology to be misdiagnosed. The need for pathological anatomy in order to distinguish cystadenomas from simple biliary cysts is crucial. The most usual treatment nowadays is resection of the bile duct, together with cholecystectomy and Roux-en-Y reconstruction.

Bartolome, Miguel A Hernandez; Ruiz, Sagrario Fuerte; Romero, Israel Manzanedo; Lojo, Beatriz Ramos; Prieto, Ignacio Rodriguez; Alvira, Luis Gimenez; Carreno, Rosario Granados; Esteban, Manuel Limones

2009-01-01

84

Biliary Colic  

MedlinePLUS

... liver and stored in the gallbladder. When you eat a meal, bile passes from the gallbladder through the cystic duct and the common bile duct into the small intestine, where it mixes with partially digested food. Gallstones are the most common reason for biliary colic. If a gallstone blocks either ...

85

Glutathione status in liver and plasma during development of biliary cirrhosis after bile duct ligation  

Microsoft Academic Search

We do not know much about the changes that occur in reduced (GSH) and oxidized (GSSG) glutathione in the development of liver cirrhosis. Therefore, we investigated the glutathione redox system during development of liver cirrhosis after bile-duct ligation in rats. We compared the GSH and GSSG content of liver and plasma between bile-duct-ligated rats and sham-operated controls 6 and 24

Edmund Purucker; Ron Winograd; Elke Roeb; Siegfried Matern

1998-01-01

86

Spontaneous Biliary Peritonitis in Children  

PubMed Central

Pediatric Spontaneous Bile duct perforation is a rare clinical condition with only around 150 cases reported worldwide. Early management gives excellent prognosis but the condition often presents a diagnostic dilemma. Hepato-biliary Technetium-99m-iminodiacetic acid scintiscan is the diagnostic investigation of choice but its availability in third world countries is limited. We present two cases of spontaneous biliary peritonitis in children, which were diagnosed without scintiscanning. The first case was a one-and -a half-year-old child, who was diagnosed with biliary peritonitis without pneumoperitoneum by a combination of Ultrasound (USG), Contrast enhanced computed tomography (CECT), and Magnetic Resonance Imaging (MRI). The child underwent USG-guided drainage and subsequent cholecystectomy with hepatico-jejunostomy. The second child also had biliary peritonitis without pneumoperitoneum, which was initially suspected on USG. CECT revealed dilated gall bladder and fluid collection in sub-hepatic space and pelvis. Abdominal paracentesis revealed presence of bile. The child responded to conservative therapy. Both are doing well on two-year follow-up. In a patient with jaundice, biliary tract abnormalities and/or free fluid, either generalized or localized to peri-cholecystic/sub-hepatic space on USG/CT/MRI, in the absence of pneumoperitoneum, suggest a diagnosis of biliary perforation even in the absence of scintiscanning.

Kohli, Supreethi; Singhal, Anu; Arora, Anita; Singhal, Sanjeev

2013-01-01

87

Cystic Duct Remnant Syndrome  

PubMed Central

Post-cholecystectomy syndrome (PCS) is a common manifestation in patients with cholecystectomy. The patients exhibit a heterogeneous group of symptoms, such as upper abdominal pain, vomiting, gastrointestinal disorders, jaundice, and dyspepsia. Choledocholithiasis, biliary dyskinesia, and dilation of cystic duct remnants are common causes of these symptoms. The symptoms can recur after a symptom-free period following cholecystectomy or they can persist after surgery. Ultrasonography, computed tomography (CT), and magnetic resonance imaging scan, which are non-invasive methods of imaging, have a high sensitivity in detecting the causes of PCS. We report a case of an 84-year-old lady who came to the Ultrasound Department with recurrent episodes of abdominal pain following cholecystectomy. The gray-scale sonography showed a dilated cystic structure, which was confirmed as the duct remnant in follow-up contrast-enhanced CT.

Perera, Eranga; Bhatt, Shweta; Dogra, Vikram S.

2011-01-01

88

Large balloon dilation post endoscopic sphincterotomy in removal of difficult common bile duct stones: A literature review  

PubMed Central

Endoscopic sphincterotomy (ES) is the standard therapy in common bile duct (CBD) stones extraction. Large stones (? 12 mm) or multiple stones extraction may be challenging after ES alone. Endoscopic sphincterotomy followed by large balloon dilation (ESLBD) has been described as an alternative to ES in these indications. Efficacy, safety, cost-effectiveness and technical aspects of the procedure have been here reviewed. PubMed and Google Scholar search resulted in forty-one articles dealing with CBD stone extraction with 12 mm or more dilation balloons after ES. ESLBD is at least as effective as ES, and reduces the need for additional mechanical lithotripsy. Adverse events rates are not statistically different after ESLBD compared to ES for pancreatitis, bleeding and perforation. However, particular attention should be paid in patients with CBD strictures, which is identified as a risk factor of perforation. ESLBD is slightly cost-effective compared to ES. A small sphincterotomy is usually performed, and may reduce bleeding rates compared to full sphincterotomy. Dilation is performed with 12-20 mm enteral balloons. Optimal inflation time is yet to be determined. The procedure can be performed safely even in patients with peri-ampullary diverticula and surgically altered anatomy. ESLBD is effective and safe in the removal of large CBD stones, however, small sphincterotomy might be preferred and CBD strictures should be considered as a relative contraindication.

Rouquette, Olivier; Bommelaer, Gilles; Abergel, Armando; Poincloux, Laurent

2014-01-01

89

Endoscopic papillary balloon dilatation in comparison with endoscopic sphincterotomy for the treatment of large common bile duct stone  

PubMed Central

Background: There are concerns on the efficacy and safety of endoscopic papillary balloon dilatation (EPBD) as an alternative to endoscopic sphincterotomy (EST) in the treatment of choledocholithiasis. We compared the efficacy and safety of EPBD and EST for removing large common bile duct (CBD) stones. Materials and Methods: One hundred sixty patients with CBD stones of 10-20 mm were randomized to undergo EPBD or EST. A 15-mm dilatation balloon was used for EPBD. Cotton's criteria were used to determine the incidence of post-EPBD or post-EST complications. CBD stone removal and complications were compared between the two methods. Results: CBD stones were completely removed in 97.5% of the EPBD and 96.2% of the EST group (P = 0.5). The incidence of postoperative pancreatitis (11.2% vs 8.7%) and bleeding (1.2% vs 1.2%) were similar between the EPBD and EST groups (P > 0.05). Perforation did not occur in any patient. Conclusions: EPBD with 15-mm dilator balloon appears to be equally safe and effective compared with EST for removal of large CBD stones. So because of low complication and high success rate we recommend EPBD as the preferred method for removal of large (10-20 mm) CBD stones.

Minakari, Mahammad; Samani, Rahil R.; Shavakhi, Ahmad; Jafari, Alireza; Alijanian, Neda; Hajalikhani, Mehri

2013-01-01

90

Small Endoscopic Sphincterotomy plus Large-Balloon Dilation for Removal of Large Common Bile Duct Stones during ERCP.  

PubMed

Objective: This study compared the therapeutic benefits and complication rates of small endoscopic sphincterotomy plus large-balloon dilation (ESLBD) with those of endoscopic sphincterotomy (EST) alone for large bile duct stones. Methods: We compared prospectively ESLBD group (n=63) with conventional EST group (n=69) for the treatment of large bile duct stones (?15mm). Mechanical lithotripsy was performed when the stone could not be removed using a normal basket. We compared the rates of stone removal, frequency of mechanical lithotripsy use, procedure-related complications, and recurrent stones. Results: A total of 132 patients were reviewed in the study. The mean age of the patients was 67.9 years. The two groups showed significant differences in complete stone removal during the first session (80.9 vs. 60.8%; P = 0.046), the use of mechanical lithotripsy (7.94 vs. 24.6%; P = 0.041), and less duration of admission (P =0.045). After ERCP, there were some instances of oozing in both groups, All patients recovered completely, 14 patients had recurrent common bile duct stones among the follow-up duration. Conclusion: The ESLBD technique seems to be a feasible and safe alternative technique for conventional EST and EBD and has no more Post-ERCP complications. PMID:24353657

Jun Bo, Qian; Li Hua, Xu; Tian Min, Chen; Liu Gen, Gu; Yan Mei, Yang; Hua Sheng, Lu

2013-07-01

91

18-year old patient with extrahepatic biliary duct carcinoid - case report.  

PubMed

Abstract Most patients with obstructive jaundice caused by an etiology other than choledocholithiasis are at risk of adenocarcinoma development. Other types of tumors are less common, although more benign. The presented study described management in case of liver hilar tumors with special regards to common hepatic duct carcinoids. PMID:24578453

Ryka?a, Cezary; Bartosiewicz, Jacek; Pawlak, Jacek; Nawrocka-Kunecka, Agnieszka; Omulecka, Aleksandra

2014-01-01

92

Biliary-enteric anastomoses: spectrum of findings on Gd-EOB-DTPA-enhanced MR cholangiography.  

PubMed

Biliary-enteric anastomosis is a common surgical procedure performed for the management of a variety of benign and malignant diseases. This procedure presents a high risk of developing complications such as anastomotic leak, hemorrhage, cholangitis, stones, stricture formation, that have been reported as ranging from 3 % to 43 %. Because the endoscopic approach of the biliary tract is generally precluded in this setting, there is clearly a role for a non-invasive imaging technique to follow up these patients and to detect the possible complications. T2-weighted MR cholangiography has been shown to be effective in the evaluation of patients with biliary-enteric anastomosis. Some of these patients may have mild duct dilatation in spite of a patent anastomosis, and stenosis should be considered only when duct dilatation is associated with narrowing of the anastomotic site. T2-weighted MRC depicts the site of biliary-enteric anastomosis, the cause of obstruction, and the status of the biliary ducts upstream. However, the disadvantages of conventional MRC are that it lacks functional information and so, differentiation between obstructive and non-obstructive dilatation of the bile ducts is often extremely difficult. T1-weighted contrast-enhanced MR cholangiography using Gd-EOB-DTPA is a recently emerging technique that is useful for delineating the anatomy of biliary-enteric anastomoses and detecting complications such as strictures, intraductal stones, and biliary leaks; besides, this technique can provide functional information that are extremely promising in the grading of biliary obstruction. We present the spectrum of findings of biliary-enteric anastomoses on Gd-EOB-DTPA-enhanced MR cholangiography focusing on the main clinical applications. PMID:23820693

Boraschi, Piero; Donati, Francescamaria

2013-12-01

93

A modified technique for percutaneous insertion of biliary T-tube.  

PubMed

Following percutaneous removal of retained biliary calculi through a t-tube tract, a tube should be reinserted over a guide wire. Reinsertion usually is easy; however, if buckling occurs, a coaxial system consisting of a t-tube over a teflon dilator will give added stiffness, and the t-tube will advance easily into the common bile duct. PMID:441354

Sniderman, K W; Baxi, R K; Rumburg, K N; Sos, T A

1979-05-01

94

High-dose IgG therapy mitigates bile duct-targeted inflammation and obstruction in a mouse model of biliary atresia.  

PubMed

Background:A proposed etiology of biliary atresia (BA) entails a virus-induced, progressive immune-mediated injury of the biliary system. Intravenous Ig (IVIg) has demonstrated clinical benefit in several inflammatory diseases. The aim of this study was to determine the therapeutic effects of high-dose IgG treatment in the rhesus rotavirus (RRV)-induced mouse model of BA.Methods:Newborn mice were infected with RRV, and jaundiced mice were given high-dose IgG or albumin control. Survival, histology, direct bilirubin, liver immune cell subsets, and cytokine production were analyzed.Results:There was no difference in overall survival between RRV-infected groups, however high-dose IgG resulted in decreased bilirubin, bile duct inflammation, and increased extrahepatic bile duct patency. High-dose IgG decreased vascular cell adhesion molecule-1, resulting in limited migration of immune cells to portal tracts. High-dose IgG significantly decreased CD4(+) T cell production of interleukin (IL)-2, interferon (IFN)-?, and tumor necrosis factor (TNF)-? and CD8(+) T cell production of IFN-?, as well as increased levels of regulatory T cells.Conclusion:High-dose IgG therapy in murine BA dramatically decreased Th1 cell-mediated inflammation and biliary obstruction. This study lends support for consideration of IVIg clinical trials in infants with BA, to diminish the progressive intrahepatic bile duct injury. PMID:24727948

Fenner, Erika K; Boguniewicz, Juri; Tucker, Rebecca M; Sokol, Ronald J; Mack, Cara L

2014-07-01

95

[Late infantile GM1 gangliosidosis with progressive dilatation of common bile duct and obstructive apnea--an autopsy case].  

PubMed

We report a 5-year-old autopsy case of late infantile type of GM1 gangliosidosis,which developed rare respiratory and intestinal complications. Obstructive apnea by adenoidal hypertrophy was improved by adenoidectomy, but the right bronchus was compressed by hilar lymph node swellings. The lymph nodes could not be treated surgically because of her poor general condition. There was hyperplasia showing foamy histiocyte including mucopolysaccharide which demonstrated a vacuolar formation containing irregular arranged fibrillar material on electron microscopy. Cerebral atrophy progressed gradually, and epileptic apnea developed, which was intractable to all antiepileptic drugs administered. Glycolipid accumulation, showing membranous cytoplasmic body on electron microscopy, seemed to lead to neurodegeneration. Abdominal distension due to hepatosplenomegaly, common bile duct dilatation compressed by lymph node swelling of the caput pancreatis part, and enteroparalysis was uncontrolled. These findings suggest that severe glycolipid deposition in lymphoreticular organs can induce various complications in patients with late infantile type of GM1 gangliosidosis. PMID:17228820

Kuki, Ichiro; Tomiwa, Kiyotaka; Okazaki, Shin; Ikeda, Hiroko; Kawawaki, Hisashi

2007-01-01

96

The Detection of Bile Duct Stones in Suspected Biliary Pancreatitis: Comparison of MRCP, ERCP, and Intraductal US  

Microsoft Academic Search

OBJECTIVES:Early ERCP and endoscopic sphincterotomy for stone extraction can benefit the prognosis in patients with severe biliary pancreatitis, but are associated with complications. The ability to identify choledocholithiasis by noninvasive means in biliary pancreatitis is limited. The aim of this study was evaluation of the ability of MRCP to detect choledocholithiasis in patients with acute biliary pancreatitis. In addition, we

Jong Ho Moon; Young Deok Cho; Sang Woo Cha; Young Koog Cheon; Hyun Cheol Ahn; Young Seok Kim; Yun Soo Kim; Joon Seong Lee; Moon Sung Lee; Hae Kyung Lee; Chan Sup Shim; Boo Sung Kim

2005-01-01

97

Endoscopic papillary large balloon dilation vs endoscopic sphincterotomy for retrieval of common bile duct stones: A meta-analysis  

PubMed Central

AIM: To compare the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) in retrieval of common bile duct stones (? 10 mm). METHODS: PubMed, Web of Knowledge, EBSCO, the Cochrane Library, and EMBASE were searched for eligible studies. Randomized controlled trials (RCTs) that compared EPLBD with EST were identified. Data extraction and quality assessment were performed by two independent reviewers using the same criteria. Any disagreement was discussed with a third reviewer until a final consensus was reached. Pooled outcomes of complete bile duct stone clearance, stone clearance in one session, requirement for mechanical lithotripsy, and overall complication rate were determined using relative risk and 95%CI. The separate post-endoscopic retrograde cholangiopancreatography complications were pooled and determined with the Peto odds ratio and 95%CI because of the small number of events. Heterogeneity was evaluated with the chi-squared test with P ? 0.1 and I2 with a cutoff of ? 50%. A fixed effects model was used primarily. A random effects model was applied when significant heterogeneity was detected. Sensitivity analysis was applied to explore the potential bias. RESULTS: Five randomized controlled trials with 621 participants were included. EPLBD compared with EST had similar outcomes with regard to complete stone removal rate (93.7% vs 92.5%, P = 0.54) and complete duct clearance in one session (82.2% vs 77.7%, P = 0.17). Mechanical lithotripsy was performed less in EPLBD in the retrieval of whole stones (15.5% vs 25.2%, P = 0.003), as well as in the stratified subgroup of stones larger than 15 mm (24.2% vs 40%, P = 0.001). There was no statistically significant difference in the incidence of overall adverse events (7.9% vs 10.7%, P = 0.25), post-ERCP pancreatitis (4.0% vs 5.0%, P = 0.54), hemorrhage (1.7% vs 2.8%, P = 0.32), perforation (0.3% vs 0.9%, P = 0.35) or acute cholangitis (1.3% vs 1.3%, P = 0.92). CONCLUSION: EPLBD could be advocated as an alternative to EST in the retrieval of large common bile duct stones.

Jin, Piao-Piao; Cheng, Jian-Feng; Liu, Dan; Mei, Mei; Xu, Zhao-Qi; Sun, Lei-Min

2014-01-01

98

Combined transhepatic and endoscopic procedures in the biliary system.  

PubMed

Endoscopic biliary procedures are 89-97% successful in skilled hands. The commonest causes of failure are inability to cannulate the papilla of Vater due to difficult anatomy or tortuosity of the distal common bile duct and failure to cross a rigid biliary stricture. In nearly all of these cases, successful endoscopic procedures can be completed after percutaneous antegrade placement of a small catheter or guidewire to the duodenum. In 44 such combined procedures on 42 patients, the success rate was 43 (98%). There were two severe and eight mild complications. Combined procedures overcome the difficulties caused by tortuous biliary ducts and rigid strictures while obviating the need for more extensive percutaneous procedures and transhepatic tract dilatation. PMID:8346135

Verstandig, A G; Goldin, E; Sasson, T; Weinberger, G; Wengrower, D; Fich, A; Lax, E

1993-05-01

99

Combined transhepatic and endoscopic procedures in the biliary system.  

PubMed Central

Endoscopic biliary procedures are 89-97% successful in skilled hands. The commonest causes of failure are inability to cannulate the papilla of Vater due to difficult anatomy or tortuosity of the distal common bile duct and failure to cross a rigid biliary stricture. In nearly all of these cases, successful endoscopic procedures can be completed after percutaneous antegrade placement of a small catheter or guidewire to the duodenum. In 44 such combined procedures on 42 patients, the success rate was 43 (98%). There were two severe and eight mild complications. Combined procedures overcome the difficulties caused by tortuous biliary ducts and rigid strictures while obviating the need for more extensive percutaneous procedures and transhepatic tract dilatation. Images Figure 1 Figure 2 Figure 3

Verstandig, A. G.; Goldin, E.; Sasson, T.; Weinberger, G.; Wengrower, D.; Fich, A.; Lax, E.

1993-01-01

100

Less invasive causal treatment of ejaculatory duct obstruction by balloon dilation: a case report, literature review and suggestion of a CT- or MRI-guided intervention.  

PubMed

Uni- or bilateral ejaculatory duct obstruction (EDO) is a rare but correctable cause of infertility, chronic pelvic pain and postejaculatory pain. EDO is a congenital or acquired condition, it is the underlying cause of infertility in approximately 5% of infertile men. If acquired, the etiology often remains unresolved, but prostatitis or urethritis with post-inflammatory adhesion of the duct walls seems to be a common underlying pathomechanism.Although a certain constellation of physicochemical semen parameters may lead to correct diagnosis, EDO often resembles a diagnosis by exclusion. Imaging of acquired EDO remains a challenge and the established surgical therapy, transurethral resection of the ejaculatory ducts (TURED), leads to a low rate of natural conception and a high rate of complications such as reflux of urine and epididymitis. We present a case of a male with suspected EDO who underwent a combined approach to both, semi-invasive diagnosis and therapy by transrectal puncture of the seminal vesicles and antegrade balloon-dilation of the ejaculatory ducts. Possibilities and pitfalls of this procedure are described and the literature is reviewed.Furthermore, we suggest a CT- or MRI-guided, percutaneous intervention for treatment of ejaculatory duct obstruction by balloon dilation and demonstrate initial steps of this procedure with a body donor. We call this new procedure PTED (percutaneous transgluteal ejaculatory ductoplasty). PMID:22557939

Kayser, Ole; Osmonov, Daniar; Harde, Jonas; Girolami, Guido; Wedel, Thilo; Schäfer, Philipp

2012-01-01

101

Fight-or-flight: murine unilateral ureteral obstruction causes extensive proximal tubular degeneration, collecting duct dilatation, and minimal fibrosis  

PubMed Central

Unilateral ureteral obstruction (UUO) is the most widely used animal model of progressive renal disease. Although renal interstitial fibrosis is commonly used as an end point, recent studies reveal that obstructive injury to the glomerulotubular junction leads to the formation of atubular glomeruli. To quantitate the effects of UUO on the remainder of the nephron, renal tubular and interstitial responses were characterized in mice 7 and 14 days after UUO or sham operation under anesthesia. Fractional proximal tubular mass, cell proliferation, and cell death were measured by morphometry. Superoxide formation was identified by nitro blue tetrazolium, and oxidant injury was localized by 4-hydroxynonenol and 8-hydroxydeoxyguanosine. Fractional areas of renal vasculature, interstitial collagen, ?-smooth muscle actin, and fibronectin were also measured. After 14 days of UUO, the obstructed kidney loses 19% of parenchymal mass, with a 65% reduction in proximal tubular mass. Superoxide formation is localized to proximal tubules, which undergo oxidant injury, apoptosis, necrosis, and autophagy, with widespread mitochondrial loss, resulting in tubular collapse. In contrast, mitosis and apoptosis increase in dilated collecting ducts, which remain patent through epithelial cell remodeling. Relative vascular volume fraction does not change, and interstitial matrix components do not exceed 15% of total volume fraction of the obstructed kidney. These unique proximal and distal nephron cellular responses reflect differential “fight-or-flight” responses to obstructive injury and provide earlier indexes of renal injury than do interstitial compartment responses. Therapies to prevent or retard progression of renal disease should include targeting proximal tubule injury as well as interstitial fibrosis.

Forbes, Michael S.; Thornhill, Barbara A.; Minor, Jordan J.; Gordon, Katherine A.; Galarreta, Carolina I.

2012-01-01

102

Endoscopic papillary balloon dilatation may preserve sphincter of Oddi function after common bile duct stone management: evaluation from the viewpoint of endoscopic manometry  

Microsoft Academic Search

Background—Endoscopic papillary balloon dilatation (EPBD) has been reported as a safe and effective alternative to endoscopic sphincterotomy in the management of common bile duct (CBD) stones; its effect on papillary function has yet to be elucidated.Aim—To investigate sphincter of Oddi (SO) motility before and after EPBD to determine its effect on SO function.Patients and methods—The papillary function of 10 patients

H Sato; T Kodama; J Takaaki; Y Tatsumi; T Maeda; S Fujita; Y Fukui; H Ogasawara; S Mitsufuji

1997-01-01

103

[Multifactorial analysis of results of the open and endo-biliary surgical treatment of patients with obstructive jaundice due to the distal obstruction of the bile ducts].  

PubMed

The were analyzed the results of treatment of patients with the obstructive jaundice (OJ) due to obstruction of the biliary ducts distal part using surgical and endobiliary decompression using the variation statistics methods (distribution of patients on groups depending on the values of the investigated parameters, calculation of the mean values, evaluation of the authenticity of the indexes distinction), the multifactoral correlative-regressive analysis, the complex evaluation of indexes and probit-analysis. The dependence of results of treatment from value of clinical parameters was established, their prognostic significance was determined. The content of the bilirubin more than 300 mmol/l in distal level of affection of biliferous ducts cause high probability of the postoperative complications occurrence (coefficient of determination 34.8%), determining necessity of performance of draining endobiliary intervention on the first stage of surgical treatment. The dependence of lethality from age of patients and duration of the OJ was noted. PMID:12024709

Diachenko, V V

2002-03-01

104

Atypical presentation of an advanced obstructive biliary cancer without jaundice  

PubMed Central

Patient: Female, 60 Final Diagnosis: Cholangiocarcinoma Symptoms: Abdominal pain • abdominal discomfort Medication: — Clinical Procedure: — Specialty: Oncology Objective: Unusual natural history/clinical course Background: Cholangiocarcinoma remains to be a challenging case to diagnose and manage as it usually presents in advanced stage and survival rate remains dismal despite the medical breakthroughs. It is usually classified as intrahepatic, perihilar or distal tumor which can lead to bile duct obstruction causing sluggish flow of bile through the biliary tract and promoting increased absorption of bilirubin, bile acids and bile salts into systemic circulation accounting for the occurrence of jaundice, dark-colored urine and generalized pruritus. It usually becomes symptomatic when the tumor has significantly obstructed the biliary drainage causing painless jaundice and deranged liver function with cholestatic pattern. Jaundice occurs in 90% of the cases when the tumor has obstructed the biliary drainage system. A markedly dilated gallbladder as initial presenting feature in the absence of other typical obstructive clinical manifestations of an advanced stage of the cholangiocarcinoma is rare. Case Report: This case report presents an atypical case of an elderly woman who presented with advanced metastatic ductal cholangiocarcinoma with markedly dilated gallbladder and liver mass without other clinical manifestations and laboratory evidence of cholestatic jaundice. Conclusions: The mere presence of Courvoisier’s sign, even in the absence of other signs of biliary obstruction, could be suggestive of advanced neoplastic process along the biliary tract. Laboratory evidence of cholestasis might lag behind the clinical severity of the biliary obstruction in cholangiocarcinoma.

Salvador, Vincent Bryan; Samrao, Pushkinder; Leytin, Anatoly; Basith, Mohammed

2013-01-01

105

Differential Diagnosis of Focal Non-Cystic Pancreatic Lesions With and Without Proximal Dilation of Pancreatic Duct Noted on CT Scan  

PubMed Central

OBJECTIVES: Pancreatic duct (PD) dilation proximal to a solid focal pancreatic lesion on computed tomography (CT) scan is considered highly suggestive of pancreatic adenocarcinoma. There is, however, no published data on the differential diagnosis of focal non-cystic pancreatic lesions with and without PD dilation. We assessed the diagnostic utility of this radiologic finding. METHODS: This is a retrospective analysis of a prospectively maintained database of university-based clinical practice. A total of 445 non-jaundiced patients who underwent endoscopic ultrasound (EUS) (2002–2010) for evaluation of solid pancreatic lesions noted on CT scan were included. Final diagnosis was based on surgical pathology or definitive cytology with supporting clinical follow-up of ?12 months. Main outcome measurements included (1) differential diagnoses and (2) performance characteristics of EUS-fine needle aspiration (FNA) for diagnosing neoplasm in patients with non-cystic pancreatic lesions with and without PD dilation. RESULTS: A neoplasm was finally diagnosed in 152 of 187 patients with and 87 of 258 patients without PD dilation on CT scan. Chronic pancreatitis (diffuse and focal) was the predominant non-malignant diagnosis in patients with PD dilation. In patients without PD dilation, malignant lesions included neuroendocrine tumor, adenocarcinoma, metastasis, PEComa (perivascular epitheloid cell tumor), and lymphoma; and the non-neoplastic diagnosis included chronic pancreatitis, intrapancreatic lymph nodes, and infected pancreatic fluid collection. EUS-FNA had 97.6% accuracy for diagnosing a neoplasm in these patients. CONCLUSIONS: Dilation PD proximal to a focal solid pancreatic lesion increases the likelihood of malignancy but the performance characteristics of this radiologic finding are probably inadequate to guide clinical management. Neoplasms without dilated PD often require immunostaining for a definitive diagnosis.

Tummala, MD, Pavan; Rao, MD, Savitha; Agarwal, MD, Banke

2013-01-01

106

Protective effect of melatonin against oxidative stress induced by ligature of extra-hepatic biliary duct in rats: comparison with the effect of S-adenosyl-L-methionine.  

PubMed

In the present research, we studied the effect of the administration of melatonin or S-adenosyl-L-methionine (S-AMe) on oxidative stress and hepatic cholestasis produced by double ligature of the extra-hepatic biliary duct (LBD) in adult male Wistar rats. Hepatic oxidative stress was evaluated by the changes in the amount of lipid peroxides and by the reduced glutathione content (GSH) in lysates of erythrocytes and homogenates of hepatic tissue. The severity of the cholestasis and hepatic injury were determined by the changes in the plasma enzyme activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP), g-glutamyl-transpeptidase (GGT), and levels of albumin, total bilirubin (TB) and direct bilirubin (DB). Either melatonin or S-AMe were administered daily 3 days before LBD, and for 10 days after biliary obstruction. LDB caused highly significant increases in plasma enzyme activities and in bilirubin and lipid peroxides levels in erythrocytes and hepatic tissue. At the same time, this procedure produced a notable decrease in the GSH pools in these biological media. Both melatonin and S-AMe administration were effective as antioxidants and hepatoprotective substances, although the protective effects of melatonin were superior; it prevented the GSH decrease and reduced significantly the increases in enzyme activities and lipid peroxidation products produced by biliary ligature. S-AMe did not modify the increased GGT activity nor did it decrease greatly the TB levels (43% melatonin vs. 14% S-AMe). However, S-AMe was effective in preventing the loss of GSH in erythrocytes and hepatic tissue, as was melatonin. The obtained data permit the following conclusions. First, the LDB models cause marked hepatic oxidative stress. Second, the participation of free radicals of oxygen in the pathogenecity and severity of cholestasis produced by the acute obstruction of the extra-hepatic biliary duct is likely. Third, the results confirm the function of S-AMe as an antioxidant and hepatoprotector. Finally, melatonin is far more potent and provides superior protection as compared to S-AMe. Considering the decrease in oxidative stress and the intensity of cholestasis, these findings have interesting clinical implications for melatonin as a possible therapeutic agent in biliary cholestasis and parenchymatous liver injury. PMID:10739300

López, P M; Fiñana, I T; De Agueda, M C; Sánchez, E C; Muñoz, M C; Alvarez, J P; De La Torre Lozano, E J

2000-04-01

107

[Biliary atresia].  

PubMed

Biliary atresia is a rare, neonatal, progressive cholestatic liver disease caused by fibroinflammatory obstruction of the biliary tree. Typical symptoms include prolonged neonatal jaundice, pale stools, and conjugated hyperbilirubinemia. Treatment starts with portoenterostomy, where fibrotic remnants of the extra hepatic bile ducts are replaced with small intestine. Best operative results are achieved among the youngest patients treated in specialized centres. Despite clearance of jaundice after a successful operation, fibrotic change of the liver continues in most. Liver transplantation serves as a salvage procedure if the portoenterostomy fails, or complications of liver cirrhosis develop after an initially successful portoenterostomy. In Finland, biliary atresia treatment was centralized in 2005. Of the patients treated thereafter, 90% are alive and over 80% with their native livers. PMID:23961607

Lampela, Hanna; Pakarinen, Mikko

2013-01-01

108

Clinico-pathological studies on a transitional type between extrahepatic biliary atresia and paucity of the interlobular bile ducts  

Microsoft Academic Search

Among the neonatal and infantile cases of obstructive jaundice seen at Niigata and Yamagata University Hospitals between 1976 and 1990, extrahepatic bile ducts were visualized in 19 cases by either preoperative endoscopic retrograde cholangiopancreaticography (ERCP) or intraoperative cholangiography. Neonatal hepatitis was diagnosed in 3 of these cases by clear images of the bile duct system extending from the common bile

Iwao Yamagiwa; Kazuya Obata; Yasuharu Hatanaka; Hiroyuki Saito; Masahiko Washio; Makoto Iwafuchi

1993-01-01

109

Multicystic Biliary Hamartoma of the Liver  

PubMed Central

Multicystic biliary hamartoma (MCBH) is a very rare hamartomatous cystic nodule of the liver, which has recently been described as a new entity of a hepatic nodular lesion. We report a unique case of MCBH with a review of the literatures. A hepatic multicystic mass of segment 3 was detected in a 52-year-old male by abdominal computed tomography, and resection of this lesion was performed. Macroscopic examination revealed a 2.7×2.0 cm nodular mass with a multicystic honeycomb cut surface. Histologically, this lesion consisted of multiple dilated cystic ducts lined by biliary type epithelial cells, periductal glands and connective tissue, which included small amounts of hepatic parenchyma and blood vessels. Recognition of this unusual lesion is essential to avoid confusion with other cystic tumors of the liver, and to learn more about its natural history and response to treatment.

Song, Ji Soo; Noh, Sang Jae; Cho, Baik Hwan

2013-01-01

110

Endoscopic management of difficult common bile duct stones.  

PubMed

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

2013-01-14

111

Endoscopic management of difficult common bile duct stones  

PubMed Central

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities.

Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

2013-01-01

112

Rare event of biliary papillomatosis arising in a choledochal cyst.  

PubMed

A 31-year-old man presented with features of recurrent cholangitis for 7?months. Examination revealed icterus and a palpable 10×8?cm lump in the right hypochondrium extending into the epigastrium. Total and direct bilirubin was raised (8.4, 6.7?mg/dL). Alkaline phosphatase (468?U/L) was raised but other liver enzymes were normal. Ultrasound of the abdomen showed dilated intrahepatic biliary radicals (IHBRs) and common hepatic duct (CHD) with a significant intrahepatic portion. Contrast-enhanced CT scan of the abdomen showed similar findings. MR cholangiopancreatography demonstrated diffusely dilated IHBRs and choledochal cyst involving the CHD. The common bile duct was mildly dilated without any filling defect. Tumour markers (carcinoembryonic antigen and cancer antigen 19-9) were normal. The patient underwent complete excision of the extrahepatic biliary system including choledochal cyst and Roux-en-Y hepaticojejunostomy. Opening up the bile duct showed very thick gelatinous material and multiple pedunculated papillary type structures arising from the wall of the choledochal cyst. PMID:24990847

Nishant, Kumar; Singh, Varun Kumar; Sharma, Barun Kumar

2014-01-01

113

Future needs for ERCP: incidence of conditions leading to bile duct obstruction and requirements for diagnostic and therapeutic biliary procedures  

Microsoft Academic Search

Although the development of endoscopic methods of treatment for biliary obstruction has proceeded rapidly in recent years, endoscopic retrograde cholangiopancreatographic (ERCP) services are patchily distributed. A recent survey by the British Society of Gastroenterology has shown that almost half the district general hospitals questioned did not have a sphincterotomy service available locally. To assess the level of provision required, two

M W Gear; N A Dent; D G Colin-Jones; J H Lennard-Jones; J R Colley

1990-01-01

114

Endoscopic papillary balloon dilation: revival of the old technique.  

PubMed

Radiologists first described the removal of bile duct stones using balloon dilation in the early 1980s. Recently, there has been renewed interest in endoscopic balloon dilation with a small balloon to avoid the complications of endoscopic sphincterotomy (EST) in young patients undergoing laparoscopic cholecystectomy. However, there is a disparity in using endoscopic balloon papillary dilation (EPBD) between the East and the West, depending on the origin of the studies. In the early 2000s, EST followed by endoscopic balloon dilation with a large balloon was introduced to treat large or difficult biliary stones. Endoscopic balloon dilation with a large balloon has generally been recognized as an effective and safe method, unlike EPBD. However, fatal complications have occurred in patients with endoscopic papillary large balloon dilation (EPLBD). The safety of endoscopic balloon dilation is still a debatable issue. Moreover, guidelines of indications and techniques have not been established in performing endoscopic balloon dilation with a small balloon or a large balloon. In this article, we discuss the issue of conventional and large balloon endoscopic dilation. We also suggest the indications and optimal techniques of EPBD and EPLBD. PMID:24363517

Jeong, Seung Uk; Moon, Sung-Hoon; Kim, Myung-Hwan

2013-12-01

115

Endoscopic papillary balloon dilation: Revival of the old technique  

PubMed Central

Radiologists first described the removal of bile duct stones using balloon dilation in the early 1980s. Recently, there has been renewed interest in endoscopic balloon dilation with a small balloon to avoid the complications of endoscopic sphincterotomy (EST) in young patients undergoing laparoscopic cholecystectomy. However, there is a disparity in using endoscopic balloon papillary dilation (EPBD) between the East and the West, depending on the origin of the studies. In the early 2000s, EST followed by endoscopic balloon dilation with a large balloon was introduced to treat large or difficult biliary stones. Endoscopic balloon dilation with a large balloon has generally been recognized as an effective and safe method, unlike EPBD. However, fatal complications have occurred in patients with endoscopic papillary large balloon dilation (EPLBD). The safety of endoscopic balloon dilation is still a debatable issue. Moreover, guidelines of indications and techniques have not been established in performing endoscopic balloon dilation with a small balloon or a large balloon. In this article, we discuss the issue of conventional and large balloon endoscopic dilation. We also suggest the indications and optimal techniques of EPBD and EPLBD.

Jeong, Seung Uk; Moon, Sung-Hoon; Kim, Myung-Hwan

2013-01-01

116

Eosinophilic cholangiopathy: the diagnostic dilemma of a recurrent biliary stricture. Should surgery be offered for all?  

PubMed

A 63-year-old man presented with the initial diagnosis of autoimmune pancreatitis with obstructive jaundice. CT of the abdomen revealed an oedematous pancreas and dilated common bile duct (CBD), without gallstones. After failure of initial retrograde cholangiopancreatography, a percutaneous biliary catheter was inserted with good drainage. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) revealed a 2 cm distal CBD stricture. A biliary stent was inserted past the stricture. Biopsy of the stricture, brush cytology of the bile duct and fine needle aspiration of pancreatic head under endoscopic ultrasound guidance were negative for malignancy. Autoimmune screen was negative as well. However, the patient represented with cholangitis requiring repeat ERCP and insertion of a second biliary stent. He finally underwent cholecystectomy with excision of the distal CBD and Roux-En-Y hepaticojejunostomy. Histology revealed diffuse eosinophilic cholecystitis and cholangitis. A retrospective review of the blood results showed persistent eosinophilia in full blood count measurements from presentation and persisting throughout the treatment period. PMID:24390967

Seow-En, Isaac; Chiow, Adrian Kah Heng; Tan, Siong San; Poh, Wee Teng

2014-01-01

117

Biliary atresia  

PubMed Central

Biliary atresia (BA) is a cholangiodestructive disease affecting biliary tract, which ultimately leads to cirrhosis, liver failure and death if not treated. The incidence is higher in Asian countries than in Europe. Up to 10% of cases have other congenital anomalies, such as polysplenia, asplenia, situs inversus, absence of inferior vena cava and pre-duodenal portal vein, for which we have coined the term Biliary Atresia Splenic Malformation (BASM) syndrome. For these infants the aetiology lies within the first trimester of gestation. For others affected with BA, aetiology is more obscure and perinatal destruction of fully-formed ducts perhaps by the action of hepatotropic viruses has been suggested. Whatever the cause, the lumen of the extrahepatic duct is obliterated at a variable level and this forms the basis for the commonest classification (Types I, II, III). All patients with BA present with varying degree of conjugated jaundice, pale non-pigmented stools and dark urine. Key diagnostic tests include ultrasonography, biochemical liver function tests, viral serology, and (in our centre) a percutaneous liver biopsy. In some centres, duodenal intubation and measurement of intralumenal bile is the norm. Currently BA is being managed in two stages. The first stage involves the Kasai operation, which essentially excises all extrahepatic biliary remnants leaving a transected portal plate, followed by biliary reconstruction using a Roux loop onto that plate as a portoenterostomy. If bile flow is not restored by Kasai procedure or life-threatening complications of cirrhosis ensue then consideration should be given to liver transplantation as a second stage. The outcome following the Kasai operation can be assessed in two ways: clearance of jaundice to normal values and the proportion who survive with their native liver. Clearance of jaundice (<2 mg/dL or <34 µmol/L) after Kasai has been reported to be around 60%, whereas five years survival with native liver ranges from 40% to 65%.

Sinha, C. K.; Davenport, Mark

2008-01-01

118

Iatrogenic bile duct injuries in kashmir valley.  

PubMed

Cholecystectomy is one of the commonest operations performed throughout the world and bile duct injury is the worst complication of this procedure. In a prospective and retrospective study 25 patients were seen in a tertiary care hospital over a period of 10 years. 72% of patients were referred from other hospitals. 48% of patients presented within one month of injury. Pain was the commonest presentation (92%) followed by jaundice (80%). Liver functions were deranged in 70% of patients, USG revealed biliary dilatation in 69.6% of patients. ERCP was done in 16 patients and revealed cut off of the common hepatic duct in 43.8% of patients. Intraoperative findings revealed adhesions in 96% of patients. 48% of patients had bile duct stricture. Roux-en-Y hepaticojejunostomy was the commonest procedure performed. All patients showed improvement in liver function after surgery. Wound infection was the commonest complication seen in 32% patients. 3 patients died in our series. PMID:21938192

Chowdri, Nisar A; Dar, Farooq A; Naikoo, Zahoor A; Wani, Nazir A; Parray, Fazl Q; Wani, Khurshid A

2010-08-01

119

Resection of hepatic duct bifurcation and transhepatic stenting for sclerosing cholangitis.  

PubMed Central

Thirty-one patients with sclerosing cholangitis underwent reconstruction of their hepatic duct bifurcation and long-term stenting between 1980 and 1987. Indications for surgery were persistent jaundice in 29 and recurrent cholangitis in two. The mean serum bilirubin level before surgery was 10.4 mg/dl. Liver biopsy revealed that 26 patients had varying degrees of hepatic fibrosis, and five patients had progressed to secondary biliary cirrhosis. In 29 patients the major obstructive duct disease was at or near the hepatic duct bifurcation, and in two patients it was in the distal common duct. The operative procedure consisted of: (1) excision of the hepatic duct bifurcation and extrahepatic biliary tree, (2) dilatation of the intrahepatic ducts, (3) insertion of Silastic transhepatic biliary stents, and (4) bilateral hepaticojejunostomies. Two of the five patients (40%) with cirrhosis died after surgery. In contrast, only one of 26 patients (3.9%) with hepatic fibrosis died after operation. The 1-, 3-, and 5-year actuarial survival rates for patients with cirrhosis were 20%, 20%, and 20%, respectively. The only long-term survivor underwent a liver transplant. The 1-, 3-, and 5-year actuarial survival rates for patients with hepatic fibrosis were 92%, 87%, and 71%, respectively. In addition, the mean serum bilirubin levels of patients with hepatic fibrosis at 1, 2, 3, 4, and 5 years were 3.4 mg/dl, 2.9 mg/dl, 4.0 mg/dl, 5.4 mg/dl, and 4.3 mg/dl, respectively. Two of the long-term survivors subsequently underwent a liver transplant. Patients with sclerosing cholangitis, persistent jaundice, and biliary cirrhosis should be referred for consideration of liver transplantation. However, in the absence of biliary cirrhosis, if the major obstructive disease is at the hepatic duct bifurcation, primary biliary reconstruction and long-term stenting should be considered. Images Fig. 1. Fig. 2. Fig. 3. Fig. 6.

Cameron, J L; Pitt, H A; Zinner, M J; Herlong, H F; Kaufman, S L; Boitnott, J K; Coleman, J

1988-01-01

120

Anatomy and embryology of the biliary tract.  

PubMed

Working knowledge of extrahepatic biliary anatomy is of paramount importance to the general surgeon. The embryologic development of the extrahepatic biliary tract is discussed in this article as is the highly variable anatomy of the biliary tract and its associated vasculature. The salient conditions related to the embryology and anatomy of the extrahepatic biliary tract, including biliary atresia, choledochal cysts, gallbladder agenesis, sphincter of Oddi dysfunction, and ducts of Luschka, are addressed. PMID:24679417

Keplinger, Kara M; Bloomston, Mark

2014-04-01

121

Complications of the treatment of endoscopic biliary strictures developing after liver transplantation  

Microsoft Academic Search

Background  Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Endoscopic management\\u000a by the conventional methods of biliary dilatation and\\/or stent placement has been successful, but sometimes severe complications\\u000a occur, necessitating prolonged therapy. The aim of this study is to clarify the complications of the endoscopic approach for\\u000a endoscopic dilatation and\\/or stent placement.\\u000a \\u000a \\u000a \\u000a \\u000a Method  Of 46 patients

Noritoshi KobayashiKensuke; Kensuke Kubota; Takeshi Shimamura; Seitaro Watanabe; Shingo Kato; Kaori Suzuki; Takashi Uchiyama; Shin Maeda; Kazuhisa Takeda; Atsushi Nakajima; Itaru Endo

2011-01-01

122

Intraductal papillary neoplasms of the bile duct.  

PubMed

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare variant of bile duct tumors characterized by papillary growth within the bile duct lumen and is regarded as a biliary counterpart of intraductal papillary mucinous neoplasm of the pancreas. IPNBs display a spectrum of premalignant lesion towards invasive cholangiocarcinoma. The most common radiologic findings for IPNB are bile duct dilatation and intraductal masses. The major treatment of IPNB is surgical resection. Ultrasonography, computed tomography, magnetic resonance image, and cholangiography are usually performed to assess tumor location and extension. Cholangioscopy can confirm the histology and assess the extent of the tumor including superficial spreading along the biliary epithelium. However, pathologic diagnosis by preoperative biopsy cannot always reflect the maximum degree of atypia, because IPNBs are often composed of varying degrees of cytoarchitectural atypia. IPNBs are microscopically classified into four epithelial subtypes, such as pancreatobiliary, intestinal, gastric, and oncocytic types. Most cases of IPNB are IPN with high-grade intraepithelial neoplasia or with an associated invasive carcinoma. The histologic types of invasive lesions are either tubular adenocarcinoma or mucinous carcinoma. Although several authors have investigated molecular genetic changes during the development and progression of IPNB, these are still poorly characterized and controversial. PMID:24949206

Ohtsuka, Masayuki; Shimizu, Hiroaki; Kato, Atsushi; Yoshitomi, Hideyuki; Furukawa, Katsunori; Tsuyuguchi, Toshio; Sakai, Yuji; Yokosuka, Osamu; Miyazaki, Masaru

2014-01-01

123

Intraductal Papillary Neoplasms of the Bile Duct  

PubMed Central

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare variant of bile duct tumors characterized by papillary growth within the bile duct lumen and is regarded as a biliary counterpart of intraductal papillary mucinous neoplasm of the pancreas. IPNBs display a spectrum of premalignant lesion towards invasive cholangiocarcinoma. The most common radiologic findings for IPNB are bile duct dilatation and intraductal masses. The major treatment of IPNB is surgical resection. Ultrasonography, computed tomography, magnetic resonance image, and cholangiography are usually performed to assess tumor location and extension. Cholangioscopy can confirm the histology and assess the extent of the tumor including superficial spreading along the biliary epithelium. However, pathologic diagnosis by preoperative biopsy cannot always reflect the maximum degree of atypia, because IPNBs are often composed of varying degrees of cytoarchitectural atypia. IPNBs are microscopically classified into four epithelial subtypes, such as pancreatobiliary, intestinal, gastric, and oncocytic types. Most cases of IPNB are IPN with high-grade intraepithelial neoplasia or with an associated invasive carcinoma. The histologic types of invasive lesions are either tubular adenocarcinoma or mucinous carcinoma. Although several authors have investigated molecular genetic changes during the development and progression of IPNB, these are still poorly characterized and controversial.

Ohtsuka, Masayuki; Shimizu, Hiroaki; Kato, Atsushi; Yoshitomi, Hideyuki; Furukawa, Katsunori; Tsuyuguchi, Toshio; Sakai, Yuji; Yokosuka, Osamu

2014-01-01

124

[Application of endoscopic ultrasound in diagnostics of biliary lithiasis].  

PubMed

Endoscopic ultrasound (EUS) and Magnetic Endoscopic Cholangiopancreatography (MRCP) are important supplementary methods used for endoscopic extraction of common bile duct stones. The technical characteristics of both methods are excellent. If EUS is used for diagnostic purposes in diagnostic of biliary tree disorders there are almost no adverse consequences compared with other indication for this method. Nevertheless, the results are related to experience of physician. Advance of EUS compared to MRCP is its sensitivity and specificity even in cases where stones are small and dilation of biliary tract is minor. The role of EUS and ERCP in reveal of biliary tree stones and disorders is clearly defined. Comparasion of these two methods should be prospective and used in cases where definitive diagnosis is unclear. If EUS reveal stones in biliary tree then ERCP should be done in same session. Beside its role in excluding biliary pancreatitis, EUS can be used for examination of patient with acute and recurrent pancreatitis and is excellent for revealing ductal and parenchymal abnormalities of pancreas. PMID:18172993

Mesihovi?, Rusmir; Gribajcevi?, Mehmed; Masi?, Izet

2006-01-01

125

Topical nitrate drip infusion using cystic duct tube for retained bile duct stone: A six patients case series  

PubMed Central

A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice. An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (EST), followed by stone extraction, are usually an effective treatment for this condition. However, these procedures are associated with severe complications including pancreatitis, bleeding, and duodenal perforation. Nitrates such as glyceryl trinitrate (GTN) and isosorbide dinitrate (ISDN) are known to relax the sphincter of Oddi. In 6 cases in which a retained stone was detected following cholecystectomy, topical nitrate drip infusion via cystic duct tube (C-tube) was carried out. Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN, which was the regular dose of intravenous injection. Three other cases failed, and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed. One patient developed an adverse event of nausea. Severe complications were not observed. We consider the topical nitrate drip infusion via C-tube to be old but safe, easy, and inexpensive procedure for retained bile duct stone following cholecystectomy, inasmuch as removal rate was about 50% in our cases.

Shoji, Masatoshi; Sakuma, Hiroshi; Yoshimitsu, Yutaka; Maeda, Tsutomu; Nakai, Masuo; Ueda, Hiroshi

2013-01-01

126

Topical nitrate drip infusion using cystic duct tube for retained bile duct stone: A six patients case series.  

PubMed

A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice. An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (EST), followed by stone extraction, are usually an effective treatment for this condition. However, these procedures are associated with severe complications including pancreatitis, bleeding, and duodenal perforation. Nitrates such as glyceryl trinitrate (GTN) and isosorbide dinitrate (ISDN) are known to relax the sphincter of Oddi. In 6 cases in which a retained stone was detected following cholecystectomy, topical nitrate drip infusion via cystic duct tube (C-tube) was carried out. Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN, which was the regular dose of intravenous injection. Three other cases failed, and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed. One patient developed an adverse event of nausea. Severe complications were not observed. We consider the topical nitrate drip infusion via C-tube to be old but safe, easy, and inexpensive procedure for retained bile duct stone following cholecystectomy, inasmuch as removal rate was about 50% in our cases. PMID:23805368

Shoji, Masatoshi; Sakuma, Hiroshi; Yoshimitsu, Yutaka; Maeda, Tsutomu; Nakai, Masuo; Ueda, Hiroshi

2013-06-27

127

An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings  

PubMed Central

Background Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare. Case report We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn’t have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images. Conclusions Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.

Onder, Hakan; Ekici, Faysal; Adin, Emin; Kuday, Suzan; Gumus, Hatice; Bilici, Aslan

2013-01-01

128

Deep Sequencing of Cancer-Related Genes Revealed GNAS Mutations to Be Associated with Intraductal Papillary Mucinous Neoplasms and Its Main Pancreatic Duct Dilation  

PubMed Central

Background To clarify the genetic mutations associated with intraductal papillary mucinous neoplasms (IPMN) and IPMN-related pancreatic tumours, we conducted cancer-related gene profiling analyses using pure pancreatic juice and resected pancreatic tissues. Methods Pure pancreatic juice was collected from 152 patients [nine with a normal pancreas, 22 with chronic pancreatitis (CP), 39 with pancreatic ductal adenocarcinoma (PDAC), and 82 with IPMN], and resected tissues from the pancreas were collected from 48 patients (six IPMNs and 42 PDACs). The extracted DNA was amplified by multiplexed polymerase chain reaction (PCR) targeting 46 cancer-related genes containing 739 mutational hotspots. The mutations were analysed using a semiconductor-based DNA sequencer. Results Among the 46 cancer-related genes, KRAS and GNAS mutations were most frequently detected in both PDAC and IPMN cases. In pure pancreatic juice, GNAS mutations were detected in 7.7% of PDAC cases and 41.5% of IPMN cases (p<0.001 vs. others). All PDAC cases with GNAS mutations (n?=?3) were accompanied by IPMN. Multivariate analysis revealed that GNAS mutations in IPMN cases were associated with dilated main pancreatic ducts (MPD, p?=?0.016), while no statistically independent associations with clinical variables were observed for KRAS mutations. In the resected pancreatic tissues, GNAS mutations were detected in 50% of PDAC cases concomitant with IPMN, 33.3% of PDAC cases derived from IPMN, and 66.7% of IPMN cases, while no GNAS mutations were detected in cases of PDAC without IPMN. Conclusions The GNAS mutation was specifically found in the cases with IPMN and it was speculated that some PDACs might be influenced by the concomitant but separately-located IPMN in their pathogenic mechanism. Furthermore, the GNAS mutation was significantly associated with MPD dilatation in IPMN cases, suggesting its role in mucus hypersecretion.

Takano, Shinichi; Fukasawa, Mitsuharu; Maekawa, Shinya; Kadokura, Makoto; Miura, Mika; Shindo, Hiroko; Takahashi, Ei; Sato, Tadashi; Enomoto, Nobuyuki

2014-01-01

129

Endoscopic Papillary Large Balloon Dilation Reduces the Need for Mechanical Lithotripsy in Patients with Large Bile Duct Stones: A Systematic Review and Meta-Analysis  

PubMed Central

Background. Removal of large stones can be challenging and frequently requires the use of mechanical lithotripsy (ML). Endoscopic papillary large balloon dilation (EPLBD) following endoscopic sphincterotomy (ES) is a technique that appears to be safe and effective. However, data comparing ES + EPLBD with ES alone have not conclusively shown superiority of either technique. Objective. To assess comparative efficacies and rate of adverse events of these methods. Method. Studies were identified by searching nine medical databases for reports published between 1994 and 2013, using a reproducible search strategy. Only studies comparing ES and ES + EPLBD with regard to large bile duct stone extraction were included. Pooling was conducted by both fixed-effects and random-effects models. Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated. Results. Seven studies (involving 902 patients) met the inclusion criteria; 3 of 7 studies were prospective trials. Of the 902 patients, 463 were in the ES + EPLBD group, whereas 439 underwent ES alone. There were no differences noted between the groups with regard to overall stone clearance (98% versus 95%, RR ?= ?1.01 [0.97, 1.05]; P? = 0.60) and stone clearance at the 1st session (87% versus 79%, RR = 1.11 [0.98, 1.25]; P? = 0.11). ES + EPLBD was associated with a reduced need for ML compared to ES alone (15% versus 32%; RR? =? 0.49 [0.32, 0.74]; P? = ?0.0008) and was also associated with a reduction in the overall rate of adverse events (11% versus 18%; RR = 0.58 [0.41, 0.81]; P? = 0.001). Conclusions. ES + EPLBD has similar efficacy to ES alone while significantly reducing the need for ML. Further, ES + EPLBD appears to be safe, with a lower rate of adverse events than traditional ES. ES + EPLBD should be considered as a first-line technique in the management of large bile duct stones.

Madhoun, Mohammad F.; Wani, Sachin; Hong, Sam; Tierney, William M.; Maple, John T.

2014-01-01

130

Unexpected dilatation of the common bile duct after methyl tertiary butyl ether (MTBE) in rabbits. Possible implications to findings in man.  

PubMed Central

Methyl tertiary butyl ether (MTBE) rapidly dissolves cholesterol gall stones in vitro and in vivo. To further characterise tolerability and safety of this aliphatic ether, either MTBE (1 ml/kg body wt daily for two days) or an equal amount of saline was infused into the common bile duct (CBD) of eight cholecystectomised rabbits. Transient vomiting, dyspnoea and somnolence developed during MTBE instillation. Post-treatment values of serum transaminases and alkaline phosphatase were significantly higher in MTBE than in saline treated animals. Cholangiography one week after the last intraductal infusion showed a five-fold increase of CBD size in MTBE v control rabbits. At autopsy histological signs of chemical cholangitis and mild duodenitis were noted in MTBE treated animals. Prompted by these findings, we performed a cholangiography in two patients who had received intraductal MTBE (about 0.2 ml/kg body wt daily for one or two days) one year before: an abnormal dilatation of the CBD was present, which might represent a specific, hitherto undescribed permanent sequela of MTBE administration. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4

Tritapepe, R; Pozzi, C; Caspani, P; Di Padova, C

1989-01-01

131

Cystic Duct Dilatations and Proliferative Epithelial Lesions in Mouse Mammary Glands upon Keratin 5 Promoter-Driven Overexpression of Cyclooxygenase-2  

PubMed Central

Expression and pharmacological studies support a contribution of cyclooxygenase (COX)-2 to mammary gland tumorigenesis. In a recent transgenic study, mouse mammary tumor virus promoter-driven COX-2 expression in mouse mammary glands was shown to result in alveolar hyperplasia, dysplasia, and carcinomas after multiple rounds of pregnancy and lactation. In the study presented here, the effects of constitutive COX-2 overexpression in keratin 5-positive myoepithelial and luminal cells, driven by the keratin 5 promoter in a hormone-independent manner, was investigated. In nulliparous female mice, aberrant COX-2 overexpression correlated with increased prostaglandin (PG) E2 levels and caused cystic duct dilatations, adenosis, and fibrosis whereas carcinomas developed rarely. This phenotype depended on COX-2-mediated PGE2 synthesis and correlated with increased expression of proliferation-associated Ki67 in epithelial cells. No changes in the expression of apoptosis-related Bcl-2, caspase 3, or p53 were observed. Hyperproliferation of the mammary gland epithelial cells was associated with increased aromatase mRNA levels in this tissue. The spontaneous pathologies bear analogies to the human breast with fibrocystic changes. Intriguingly, strong COX-2 expression was observed in fibrocystic changes, as compared to low expression in normal breast epithelium. These results show for the first time that aberrant COX-2 expression contributes to the development of fibrocystic changes (FC), indicating that COX-2 and COX-2-mediated PG synthesis represent potential targets for the therapy of this most frequent benign disorder of the human breast.

Muller-Decker, Karin; Berger, Irina; Ackermann, Karin; Ehemann, Volker; Zoubova, Svetlana; Aulmann, Sebastian; Pyerin, Walter; Furstenberger, Gerhard

2005-01-01

132

[Percutaneous treatment of benign biliary stenosis: bilioplasty and stenting].  

PubMed

We reviewed our personal experience in 46 patients with biliary strictures, who underwent percutaneous balloon dilatation between 1983 and 1988. The strictures were iatrogenic in 24% of the cases, anastomotic in 52%, inflammatory in 17%, and associated with sclerosing cholangitis in 7%. The treatment consisted in dilating the bile ducts with balloon catheters of different kinds and sizes ("bilioplasty") and placing an internal drainage catheter for a varying period of time ("stenting"). In 22 patients the catheter was removed after an average time of 7.7 months. The rate of stricture recurrence was 13.5% (average follow-up: 20 months). In the remaining 24 patients the stents are still in situ, waiting for removing. Major complication rate was 6.4% (2 pleural effusions and 1 hepatic artery bleeding). We also report our initial experience with metallic self-expanding stents which appear as a promising tool in the management of recurring strictures. PMID:2608938

Rossi, P; Salvatori, F M; Maccioni, F; Santoro, P; Gandini, R; Maradei, A; Martinucci, A

1989-11-01

133

An intraductal papillary neoplasm of the bile duct mimicking a hemorrhagic hepatic cyst: a case report  

PubMed Central

An intraductal papillary neoplasm of the bile duct is a biliary, epithelium-lined, cystic lesion that exhibits papillary proliferation and rarely causes large hemorrhagic cystic lesions. Here, we report a case of an intraductal papillary neoplasm of the bile duct mimicking a hemorrhagic hepatic cyst in a middle-aged man with large hemorrhagic hepatic cysts who experienced abdominal pain and repeated episodes of intracystic bleeding. Following portal vein embolization, extended right hepatic lobectomy was performed, and intraoperative cholangiography revealed communication between the intracystic space and the hepatic duct. Although histological studies revealed that the large hemorrhagic lesion was not lined with epithelium, the surrounding multilocular lesions contained biliary-derived epithelial cells that presented as papillary growths without ovarian-like stroma. A diagnosis of oncocytic-type intraductal papillary neoplasm of the bile duct was made, and we hypothesized that intracystic bleeding with denudation of the lining epithelial cells might occur as the cystically dilated bile duct increased in size. Differential diagnosis between a hemorrhagic cyst and a cyst-forming intraductal papillary neoplasm of the bile duct with bleeding is difficult. However, an intraductal papillary neoplasm of the bile duct could manifest as multilocular hemorrhagic lesions; therefore, complete resection should be performed for a better prognosis.

2013-01-01

134

CT of the Extrahepatic Bile Ducts: Wall Thickness and Contrast Enhancement in Normal and Abnormal Ducts  

Microsoft Academic Search

duct wall on CT, and to develop a differential diagnosis for thickening of the duct wall. Routine CT examinations of 100 patients without biliary disease were evaluated pro- spectively. The common hepatic duct and common bile duct could be visualized in 66% and 82% of cases, respectively; the walls of these ducts could be separately discerned in 59% and 52%.

Scott J. Schulte; Richard L. Baron; Sharlene A. Teefey; Charles A. Rohrmann; Patrick C. Freeny; William P. Shuman; Michael A. Foster

135

Primary yolk sac tumor of the common bile duct.  

PubMed

Yolk sac tumor (YST) is a germ cell neoplasm usually arising from the gonads. Extragonadal YST has been reported in the mediastinum, retroperitoneum, liver, and pelvis. Primary YST of the common bile duct (CBD) has not been previously reported. We describe an 11-month-old girl with a YST arising from the CBD who presented with obstructive jaundice. Imaging studies revealed an intraluminal CBD mass with intrahepatic biliary dilatation and extraluminal infiltration of the head of the pancreas. A complete resection was carried out, and postoperative chemotherapy with cisplatin, etoposide and bleomycin was administered. PMID:21683236

Munghate, Gayatri S; Agarwala, Sandeep; Bhatnagar, Veereshwar

2011-06-01

136

Endoscopic management of bile duct stones: residual bile duct stones after surgery, cholangitis, and "difficult stones".  

PubMed

Endoscopic treatment has become, according to the latest recommendations, the standard treatment for common bile duct stones (CBDS), although in certain situations, surgical clearance of the common duct at the time of laparoscopic cholecystectomy is still considered a possible alternative. The purpose of this article is not to compare endoscopic with surgical treatment of CBDS, but to describe the various techniques of endoscopic treatment, detailing their preferential indications and the various treatment options that must sometimes be considered when faced with "difficult calculi" of the CBD. The different techniques of lithotripsy and the role of biliary drainage with plastic or metallic stents will be detailed as well as papillary balloon dilatation and particularly the technique of sphincterotomy with macrodilatation of the sphincter of Oddi (SMSO), a recently described approach that has changed the strategy for endoscopic management of CBDS. Finally, the overall strategy for endoscopic management of CBDS, with description of different techniques, will be exposed. PMID:23817008

Karsenti, D

2013-06-01

137

Endoscopic treatment of biliary complications after liver transplantation  

PubMed Central

AIM: To evaluate the efficacy of endoscopic treatment in patients who undergo OLTx or LRLTx and develop biliary complications. METHODS: This is a prospective, observational study of patients who developed biliary complications, after OLTx and LRLTx, with duct-to-duct anastomosis performed between June 2003 and June 2007. Endoscopic Retrograde Cholangiopancreatography (ERCP) was considered unsuccessful when there was evidence of continuous bile leakage despite endoscopic stent placement, or persistence of stenosis after 1 year, despite multiple dilatation and stent placement. When the ERCP failed, a percutaneous trans-hepatic approach (PTC) or surgery was adopted. RESULTS: From June 2003 to June 2007, 261 adult patients were transplanted in our institute, 68 from living donors and 193 from cadaveric donors. In the OLTx group the rate of complications was 37.3%, while in the LRLTx group was 64.7%. The rate of ERCP failure was 19.4% in the OLTx group and 38.6% in LRLTx group. In OLTx group, 1 patient was re-transplanted and 8 patients died. In the LRLTx group, 2 patients underwent OLTx and 8 patients died. The follow-up was 23.3 ± 13.13 mo and 21.02 ± 14.10 mo, respectively. CONCLUSION: Although ERCP is quite an effective mode of managing post-transplant bile duct complications, a significant number of patients need other types of approach. Further prospective studies are necessary in order to establish whether other endoscopic protocols or new devices, could improve the current results.

Tarantino, Ilaria; Barresi, Luca; Petridis, Ioannis; Volpes, Riccardo; Traina, Mario; Gridelli, Bruno

2008-01-01

138

Difficult bile duct stones  

Microsoft Academic Search

Opinion statement  Bile duct stones are routinely removed at time of endoscopic retrograde cholangiopancreatography (ERCP) after biliary sphincterotomy\\u000a with standard balloon or basket extraction techniques. However, in approximately 10% to 15% of patients, bile duct stones\\u000a may be difficult to remove due to challenging access to the bile duct (periampullary diverticulum, Billroth II anatomy, Roux-en-Y\\u000a gastrojejunostomy), large (> 15 mm in

Lee McHenry; Glen Lehman

2006-01-01

139

Management of iatrogenic bile duct injuries: role of the interventional radiologist.  

PubMed

Bile duct injuries are infrequent but potentially devastating complications of biliary tract surgery and have become more common since the introduction of laparoscopic cholecystectomy. The successful management of these injuries depends on the injury type, the timing of its recognition, the presence of complicating factors, the condition of the patient, and the availability of an experienced hepatobiliary surgeon. Bile duct injuries may lead to bile leakage, intraabdominal abscesses, cholangitis, and secondary biliary cirrhosis due to chronic strictures. Imaging is vital for the initial diagnosis of bile duct injury, assessment of its extent, and guidance of its treatment. Imaging options include cholescintigraphy, ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and fluoroscopy with a contrast medium injected via a surgically or percutaneously placed biliary drainage catheter. Depending on the type of injury, management may include endoscopic, percutaneous, and open surgical interventions. Percutaneous intervention is performed for biloma and abscess drainage, transhepatic biliary drainage, U-tube placement, dilation of bile duct strictures and stent placement to maintain ductal patency, and management of complications from previous percutaneous interventions. Endoscopic and percutaneous interventional procedures may be performed for definitive treatment or as adjuncts to definitive surgical repair. In patients who are eligible for surgery, surgical biliary tract reconstruction is the best treatment option for most major bile duct injuries. When reconstruction is performed by an experienced hepatobiliary surgeon, an excellent long-term outcome can be achieved, particularly if percutaneous interventions are performed as needed preoperatively to optimize the patient's condition and postoperatively to manage complications. PMID:23322833

Thompson, Colin M; Saad, Nael E; Quazi, Robin R; Darcy, Michael D; Picus, Daniel D; Menias, Christine O

2013-01-01

140

The use of silastic transhepatic stents in benign and malignant biliary strictures.  

PubMed Central

Between 1969 and 1978, 45 patients with biliary strictures have been managed surgically utilizing silastic transhepatic stents. In 25 patients the strictures were benign. After resection or dilatation of the benign stricture, an hepaticojejunostomy was performed to a Roux-en-Y loop. The anastomosis was stented with a large bore silastic tube with multiple side holes passed through the biliary tree, out the anterior surface of the liver, and then out through the abdominal wall. There was one hospital death. Most stents were left in place for one year. Of the 15 patients with long-term follow-up, all have had excellent results. In 20 patients the strictures were malignant and involved the common hepatic duct in 10 patients or its bifuraction in 10 patients. In 14 patients the tumor was thought to be primary in the biliary tree, and in six patients the tumor was felt to represent a metastasis or direct extension from another site. In three patients the tumors were resected, and in the remaining they were dilated or bypassed. After positioning a silastic transhepatic stent, a hepaticojejunostomy was carried out. There were two hospital deaths. Serum bilirubin on admission average 17.1 mg%, and after decompression 1.8 mg%. Five patients have survived over one year, and two over two years. Postoperative radiotherapy and a primary biliary tumor favored longer survival. Images Fig. 1. Fig. 2. Fig. 4.

Cameron, J L; Gayler, B W; Zuidema, G D

1978-01-01

141

A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction  

PubMed Central

Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent occlusion within six months or until death, whichever occurred first and (2) technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events. Results. Technical success was achieved in 98% (57/58), with demonstrated acute removability in two patients. Adequate clinical palliation until completion of followup was achievedin 98% (54/55) of evaluable patients, with 1 reintervention due to stent obstruction after 142 days. Mean total bilirubin decreased from 8.9?mg/dL to 1.2?mg/dL at 1 month. Device-related adverse events were limited and included 2 cases of cholecystitis. One stent migrated following radiation therapy. Conclusions. The WallFlex Biliary fully covered stent yielded technically successful placement with uncomplicated acute removal where required, appropriate reduction in bilirubin levels, and low rates of stent migration and occlusion. This SEMS allows successful palliation of malignant extrahepatic biliary obstruction.

Petersen, Bret T.; Kahaleh, Michel; Kozarek, Richard A.; Loren, David; Gupta, Kapil; Kowalski, Thomas; Freeman, Martin; Chen, Yang K.; Branch, Malcolm S.; Edmundowicz, Steven; Gluck, Michael; Binmoeller, Kenneth; Baron, Todd H.; Shah, Raj J.; Kinney, Timothy; Ross, William; Jowell, Paul; Carr-Locke, David

2013-01-01

142

[Atypical biliary stenting in patient with obstructive biliary jaundice].  

PubMed

Obstructive biliary jaundice is a common complication in patients with malignancies which infiltrate biliary ducts. If untreated efficiently the jaundice is fatal a short period of time. We present a case of 60-year-old male patient who had undergone Whipple procedure in the past and presented with local recurrence treated successfully by percutaneous stenting of obstructed biliary duct. When passing through the obstruction we observed a contrast-bile leakage at the level of occluded segment and instability of implanted stent which was a complication that extorted atypical approach. We applied a covered stent in association with oversized nitinol stent which allowed to form a funnel-like construction efficiently decompressing biliary tree. Thanks to this management we also avoided further complications. PMID:23276050

Garcarek, Jerzy; Kurcz, Jacek; Guzi?ski, Maciej; Janczak, Dariusz

2012-01-01

143

Assessment of bile flow by radioscintigraphy in patients with biliary-type pain after cholecystectomy.  

PubMed

Scintigraphy of the biliary system using 99mTc di-isopropyl iminodiacetic acid (DIDA) was performed in 65 subjects who had previously undergone cholecystectomy. Of the 65 subjects, 20 were free of pain and 45 had biliary-type pain both with (group I) and without (group II) features of sphincter of Oddi dysfunction. This dysfunction comprised dilatation of the bile duct, a transient rise in serum levels of liver enzymes after episodes of pain, or both abnormalities. After computer acquisition of images at intervals of 60 seconds for at least 90 minutes, time/activity curves were generated for five regions of interest: liver, common hepatic duct, common bile duct, duodenum, and background. The time at which counts in the common bile duct reached 50% of maximum (CBD T50) and the time of first entry of isotope into the duodenum (TD) were used to compare asymptomatic subjects with those with biliary-type pain. Patients in group I, but not those in group II, showed significant prolongation of CBD T50 (p less than 0.002) and TD (p less than 0.02) when compared to values in asymptomatic subjects. Six patients had a second scan at six to 12 months after endoscopic sphincterotomy and all showed a reduction in values for CBD T50 and TD. In patients with pain, a significant correlation was shown between bile duct diameter and CBD T50 (p less than 0.01) and between bile duct diameter and TD (p less than 0.02) but results from scintigraphy were independent of responses to morphine-neostigmine and motility in the sphincter of Oddi as assessed by endoscopic manometry.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3471197

Roberts-Thomson, I C; Toouli, J; Blanchett, W; Lichtenstein, M; Andrews, J T

1986-12-01

144

Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization.  

PubMed

Bile duct strictures in adults are secondary to a wide spectrum of benign and malignant pathologic conditions. Benign causes of bile duct strictures include iatrogenic causes, acute or chronic pancreatitis, choledocholithiasis, primary sclerosing cholangitis, IgG4-related sclerosing cholangitis, liver transplantation, recurrent pyogenic cholangitis, Mirizzi syndrome, acquired immunodeficiency syndrome cholangiopathy, and sphincter of Oddi dysfunction. Malignant causes include cholangiocarcinoma, pancreatic adenocarcinoma, and periampullary carcinomas. Rare causes include biliary inflammatory pseudotumor, gallbladder carcinoma, hepatocellular carcinoma, metastases to bile ducts, and extrinsic bile duct compression secondary to periportal or peripancreatic lymphadenopathy. Contrast material-enhanced magnetic resonance (MR) imaging with MR cholangiopancreatography is extremely helpful in the noninvasive evaluation of patients with obstructive jaundice, an obstructive pattern of liver function, or incidentally detected biliary duct dilatation. Some of these conditions may show characteristic findings at MR imaging-MR cholangiopancreatography that help in making a definitive diagnosis. Although endoscopic retrograde cholangiopancreatography with tissue biopsy or surgery is needed for the definitive diagnosis of many of these strictures, certain MR imaging characteristics of the narrowed segment (eg, thickened wall, long-segment involvement, asymmetry, indistinct outer margin, luminal irregularity, hyperenhancement relative to the liver parenchyma) may favor a malignant cause. Awareness of the various causes of bile duct strictures in adults and familiarity with their appearances at MR imaging-MR cholangiopancreatography are important for accurate diagnosis and optimal patient management. PMID:24819781

Katabathina, Venkata S; Dasyam, Anil K; Dasyam, Navya; Hosseinzadeh, Keyanoosh

2014-01-01

145

Hepato-biliary-enteric stent drainage as palliative treatment for proximal malignant obstructive jaundice.  

PubMed

The proximal malignant obstructive jaundice remains one of the most challenging problems for hepato-biliary surgeons. Particularly when the findings preclude surgical resection at exploration, the next decision seems hard to make. A novel palliative treatment called "hepato-biliary-enteric stent drainage" was designed for these proximal malignant obstructive jaundice patients. Hepato-biliary-enteric stent drainage was performed with silicone tube whose diameter was determined according to the degree of dilated biliary ducts, and the proximal end of the tube was placed to intrahepatic ducts as far as possible, the distal end was placed across the duodenal papilla. Between February 2011 and August 2012, 23 patients with the proximal malignant obstructive jaundice of unresectable tumors at exploration received hepato-biliary-enteric stent drainage. Patient's liver function results, symptoms, complications, and survival time were documented. The bilirubin levels of all 23 patients had a considerable and persistent decrease after operation and remained low or normal before death except for four cases of recurrent jaundice (two resulted from migration of tube and other two resulted from hepatocellular carcinoma extensively involving liver parenchyma). After effective drainage, clinical symptoms of cholangitis such as fever or pain were markedly relieved. No procedure-related bleeding, bile leakage, pancreatitis were observed. The median survival time was 212 days, half-year and 1-year survival rate were 56.5 and 21.7%, respectively. Hepato-biliary-enteric stent drainage with less expense, less complications, and easy operation may be an ideal option for patients with unresectable malignancy in the hilar region at exploration. PMID:24464214

Pan, Hao; Liang, Zhang; Yin, Tian-sheng; Xie, Yan; Li, De-wei

2014-03-01

146

Biliary intraepithelial neoplasia: an international interobserver agreement study and proposal for diagnostic criteria  

Microsoft Academic Search

Cholangiocarcinoma of the intrahepatic and extrahepatic bile ducts develops through a multistep histopathologic sequence. Premalignant or non-invasive neoplastic lesions of bile ducts have been historically called biliary dysplasia or atypical biliary epithelium. To this date, no standard terminology or classification system has been offered for these lesions. In 2005, a conceptual framework and diagnostic criteria for biliary intraepithelial neoplasia (BilIN)

Yoh Zen; N Volkan Adsay; Krystof Bardadin; Romano Colombari; Linda Ferrell; Hironori Haga; Seung-Mo Hong; Prodromos Hytiroglou; Günter Klöppel; Gregory Y Lauwers; Dirk J van Leeuwen; Kenji Notohara; Kiyoko Oshima; Alberto Quaglia; Motoko Sasaki; Fausto Sessa; Arief Suriawinata; Wilson Tsui; Yutaka Atomi; Yasuni Nakanuma

2007-01-01

147

[Endoscopic balloon dilatation of benign choledochal stenosis].  

PubMed

A 68-year-old woman was admitted because of septicaemia after cardiac valve replacement. Cause of the septicaemia was a proximal filiform common bile duct stenosis with recurrent gallstones and secondary cholangitis. A single pneumatic balloon dilatation widened the common bile duct. At the same time, specific antibiotic treatment cured the septicaemia. Nine months later no further dilatation has been necessary. PMID:2924692

Rustemeier, R; Harloff, M; Astheimer, W; Riemann, J F

1989-03-10

148

Scintiscanning in the evaluation of biliary enteric anastomoses  

SciTech Connect

The evaluation of symptomatic patients who have undergone biliary enteric anastomoses, particularly when the diversion was into the jejunum, is difficult. Conventional techniques for evaluation, such as oral cholecystography (OCG), intravenous cholangiography (IVC), ultrasonography (US), computer-assisted tomography scanning (CT scanning), or endoscopy are not adequate to provide definitive information on the patency of the anastomoses. Hepatobiliary scintiscanning using /sup 99m/Tc-HIDA and BIDA (iminodiacetic acid derivatives) was performed on 12 patients. The patients were from 11 to 72 years of age and included ten men and two women. The scan results were correlated with US, CT scan, percutaneous transhepatic cholangiography (PTC), operative findings, and final diagnosis. Scanning was highly accurate in this group and could be performed successfully even in jaundiced patients (total serum bilirubin level up to 20.0 mg/dl). In patients in whom dilated bile ducts were demonstrated (by US, CT scan, or scintiscan), only the scintiscan revealed the true patency of the anastomoses. The advantages of the technique are that it is simple and noninvasive. Delayed transit of bile (scanning agent) to bowel is a very reliable indication of partial or complete obstruction. Scintiscanning is the only technique that demonstrated the functional state of biliary secretion and excretion into bowel in patients with previous biliary enteric anastomoses.

Tidmore, H.; Ram, M.D.

1985-03-01

149

Successful surgical management of an extrahepatic biliary cystadenocarcinoma  

PubMed Central

Extrahepatic bile duct cancer is an uncommon disease, and few cases are curable by surgery. We report a case of extrahepatic biliary cystadenocarcinoma (BCAC) associated with atrophy of the left hepatic lobe. A 54-year old male was admitted with painless obstructive jaundice and a hepatic palpable mass noticed one month before presentation. Liver functions tests were consistent with cholestatic damage and serum carbohydrate antigen 19.9 (CA 19-9) was increased before treatment. Magnetic resonance imaging (MRI) disclosed dilatation of the left hepatic bile duct with irregular wall thickening close to the hepatic confluence, and atrophy of left hepatic lobe. The patient was submitted to en bloc extended left hepatectomy with resection of caudate lobe, hilar lymphadenectomy, and suprapancreatic biliary tree resection. All surgical margins were grossly negative, and postoperative course was uneventful, except for a minor bile leak. The patient was discharged on the 15th postoperative day; he is alive without tumor recurrence one year after primary therapy. Although technically challenging, extended en bloc resection is feasible in adults with extrahepatic BCAC and can improve survival with acceptable and manageable morbidity.

Pais-Costa, Sergio Renato; Martins, Sandro J.; Araujo, Sergio L. M.; Lima, Olimpia A. T.; Paes, Marcio A.; Guimaraes, Marcio L.

2011-01-01

150

[Biliary obstruction due to adenocarcinoma of the ampulla of Vater ten years after orthotopic liver transplantation].  

PubMed

The main causes of death in patients with liver transplants are derived from the graft itself. Given the increased survival in this group of patients, the rate of de novo neoplasms in other locations is increasing. We present the case of a 60-year-old man who underwent orthotopic liver transplantation 10 years earlier for terminal cirrhosis caused by hepatitis B. Imaging studies showed dilation of the intra- and extra-hepatic bile ducts with no evidence of lithiasis, anastomotic stenosis, or other biliary complications that are common in patients with liver transplants. The definitive diagnosis was reached by endoscopic retrograde cholangiopancreatography. Adenocarcinoma of the ampulla of Vater should be considered among the causes of biliary obstruction in patients with orthotopic liver transplants. PMID:19836032

Molina Granados, J F; Escribano Fernández, J; Vida Pérez, L; Barrena Baena, P

2009-01-01

151

Pneumoperitoneum Caused by Transhepatic Air Leak After Metallic Biliary Stent Placement  

SciTech Connect

A self-expanding metallic biliary stent was placed for palliation of a common bile duct obstruction in a 68-year-old male with unresectable pancreatic head cancer 3 days after initial percutaneous right transhepatic catheter decompression. The stent crossed the ampulla of Vater. Three days later, the stent was balloon-dilated and the percutaneous access was removed. At removal, a small contrast leak from the transhepatic tract was seen. Three days later, pneumoperitoneum was found with symptoms of peritoneal irritation and fever. A widely open sphincter of Oddi caused by the metallic stent, accompanied by delayed sealing of the transhepatic tract, may have caused the air and bile leakage into the peritoneal space. This case shows that pneumoperitoneum may occur without ductal tear or bowel injury, with a biliary stent crossing the ampulla of Vater.

Lee, Jei Hee; Lee, Deok Hee; Yu, Jeong-Sik [Department of Diagnostic Radiology, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270 (Korea, Republic of); Lee, Se Joon [Department of Internal Medicine, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270 (Korea, Republic of); Kwon, Woo-Cheol; Kim, Ki Whang [Department of Diagnostic Radiology, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270 (Korea, Republic of)

2000-11-15

152

Biliary stricture  

MedlinePLUS

Bile duct stricture ... is often caused by surgical injury to the bile ducts. For example, it may occur after surgery to ... causes of this condition include: Cancer of the bile duct Damage and scarring due to a gallstone in ...

153

Unexpected anomaly of the common bile duct and pancreatic duct  

PubMed Central

Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete non-union of distal common bile duct and pancreatic duct gives rise to double papillae of Vater. The separation of the drainage of the main pancreatic duct and bile duct can be appreciated by careful assessment at the time of endoscopic retrograde cholangiopancreatograpy. The cranial orifice is a bile duct opening, whereas the caudal orifice is a pancreatic duct opening. The separate orifice finding can be confirmed by cholangiogram and pancreatogram with no communication between the two orifices. Endoscopists should be aware of this rare variant because late recognition can result in unnecessary manipulation and contrast injections of the main pancreatic duct and biliary cannulation failure.

Chavalitdhamrong, Disaya; Draganov, Peter V

2014-01-01

154

Unexpected anomaly of the common bile duct and pancreatic duct.  

PubMed

Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete non-union of distal common bile duct and pancreatic duct gives rise to double papillae of Vater. The separation of the drainage of the main pancreatic duct and bile duct can be appreciated by careful assessment at the time of endoscopic retrograde cholangiopancreatograpy. The cranial orifice is a bile duct opening, whereas the caudal orifice is a pancreatic duct opening. The separate orifice finding can be confirmed by cholangiogram and pancreatogram with no communication between the two orifices. Endoscopists should be aware of this rare variant because late recognition can result in unnecessary manipulation and contrast injections of the main pancreatic duct and biliary cannulation failure. PMID:24579069

Chavalitdhamrong, Disaya; Draganov, Peter V

2014-02-16

155

Postcholecystectomy syndrome: evaluation using biliary scintigraphy and endoscopic retrograde cholangiopancreatography  

SciTech Connect

The authors prospectively studied 30 patients with postcholecystectomy syndrome to determine the efficacy of biliary scintigraphy in the detection of stenosis of the sphincter of Oddi. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP). Biliary scintigraphy disclosed stenosis of the sphincter by agreement with the ERCP or surgical findings in nine (90%) of ten patients and in eight (100%) of eight patients with biliary obstruction from other causes. Retention of activity at 2 hours in visually prominent ducts was the best predictor of abnormal biliary drainage. Biliary scintigraphy is a useful, noninvasive screening test for the detection of postcholecystectomy biliary obstruction.

Zeman, R.K.; Burrell, M.I.; Dobbins, J.; Jaffe, M.K.; Choyke, P.L.

1985-09-01

156

Extrahepatic Biliary Papillomatosis in a Child  

PubMed Central

In children, benign neoplasms of extrahepatic biliary ducts are extremely rare. We report a case of 3 year old girl who presented with abdominal pain and jaundice for 6 months. The final diagnosis on histopathology was papillomatosis in lower common bile duct.

Singh, A; Sharma, N; Jana, M

2013-01-01

157

Obstructive putty-like cast of the biliary tree.  

PubMed

A 62-year-old woman was presented at the emergency department with cholangiosepsis. She had a history of liver metastases for which she had a left hemihepatectomy and loco regional recurrence at the liver hilum for which she received chemoradiation therapy MR-imaging of the liver showed multiple intrahepatic fluid collections/abscesses, together with significantly dilated intrahepatic bile ducts. For her significant hepatic function impairment she received antibiotic treatment and percutaneous drainage. The differential diagnosis was local tumor recurrence or post radiation fibrosis causing outflow obstruction centrally in the liver hilum. During the admission the serum bilirubin values kept rising. During surgery surgeons decided to perform a hepatotomy and connect a loop of the jejunum directly on the liver parenchyma, in order to allow better drainage. Intra operatively, after the hepatotomy, we encountered green-brownisch putty-like material. By traction a 'cast' of a large part of the biliary tree was removed. PMID:24696838

Clermonts, Stefan Hem; van Dam, Ronald M

2014-02-01

158

Obstructive putty-like cast of the biliary tree  

PubMed Central

A 62-year-old woman was presented at the emergency department with cholangiosepsis. She had a history of liver metastases for which she had a left hemihepatectomy and loco regional recurrence at the liver hilum for which she received chemoradiation therapy MR-imaging of the liver showed multiple intrahepatic fluid collections/abscesses, together with significantly dilated intrahepatic bile ducts. For her significant hepatic function impairment she received antibiotic treatment and percutaneous drainage. The differential diagnosis was local tumor recurrence or post radiation fibrosis causing outflow obstruction centrally in the liver hilum. During the admission the serum bilirubin values kept rising. During surgery surgeons decided to perform a hepatotomy and connect a loop of the jejunum directly on the liver parenchyma, in order to allow better drainage. Intra operatively, after the hepatotomy, we encountered green-brownisch putty-like material. By traction a ‘cast’ of a large part of the biliary tree was removed.

van Dam, Ronald M.

2014-01-01

159

Medical treatment of primary biliary cirrhosis and primary sclerosing cholangitis.  

PubMed

Treatment of primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) with ursodeoxycholic acid (UDCA) has been in common use since 1985. In PBC, treatment with UDCA improves laboratory data, liver histology, enables a longer transplantation-free interval and prolongs disease survival. Because UDCA is unable to cure the disease newer drugs or combination therapies are still needed. Studies with UDCA and immunosuppressants such as prednisone, budesonide and azathioprine have shown that in selected patients combination therapy may be superior to UDCA monotherapy. PSC is treated successfully with UDCA and endoscopic dilatation of the bile duct strictures. Treatment of extrahepatic manifestations of cholestatic liver disease such as pruritus, fatigue, osteoporosis and steatorrhea can be problematic and time-consuming. PMID:11786661

Holtmeier, J; Leuschner, U

2001-01-01

160

Endoscopic ultrasound-guided double stenting for biliary and duodenal obstruction  

PubMed Central

Endoscopic biliary stenting for malignant biliary obstruction is currently the gold standard for biliary drainage. Biliary cancer treatment is crucial. Cases of gastric outlet obstruction that includes the duodenum because of cancer invasion and biliary obstruction are seldom observed. The required treatment for such cases is simple biliary stenting and a different treatment for duodenal obstruction. Hence, double stenting for bile duct and duodenal obstruction has drawn attention. In the present review, we state different treatment strategies for malignant duodenal obstruction and then describe double stenting in biliary obstruction that also includes non-biliary cancer malignant lesions and duodenal obstruction.

Itoi, Takao; Itokawa, Fumihide; Sofuni, Atsushi; Kurihara, Toshio; Ishii, Kentaro; Tsuji, Shujiro; Ikeuchi, Nobuhito; Umeda, Junko; Tanaka, Rena; Tonozuka, Ryosuke; Moriyasu, Fuminori

2012-01-01

161

Filling Defect on ERCP: Biliary Cystadenoma, a Rare Tumor  

PubMed Central

Biliary cystadenomas are rare tumors of the bile ducts most commonly presenting as large right liver lobe lesions. These are usually slow-growing and mostly benign. They commonly present with abdominal pain. On physical exam an abdominal mass can be identified occasionally. Walls of biliary cystadenomas appear thicker than simple cysts, with soft tissue nodules and enhancing septations on CT or MRI. Radiographic images can vary with the amount of protein content in the fluid on CT or MRI. Due to the risk of malignant transformation, complete surgical resection is advised. Hereby, we describe a 37-year-old lady who presented to the outpatient clinic with bloating and abdominal discomfort with intermittent elevated liver enzymes and hyperbilirubinemia. Ultrasound of the liver and bile ducts followed by CT scan and magnetic resonance cholangiopancreatography confirmed the presence of biliary cystadenoma of the intra- and extrahepatic ducts. It was seen as a filling defect of the intra- and extrahepatic ducts (common hepatic duct) on endoscopic retrograde cholangiopancreatography. Involvement of the intra- and extrahepatic bile ducts simultaneously is a rare presentation of this tumor. She later on underwent exploratory laparotomy with extrahepatic bile duct resection, left hepatic lobe resection and reconstruction with hepaticojejunostomy. Pathology confirmed the presence of biliary cystadenoma with ovarian-like stroma. She had recovered uneventfully from the surgery when seen 2 weeks later in the clinic. Biliary cystadenoma is a rare, mostly benign neoplasm of the biliary tract that should be considered in the differential diagnosis of cystic lesions of the biliary tract.

Rayapudi, Krishna; Schmitt, Timothy; Olyaee, Mojtaba

2013-01-01

162

Colloid Carcinoma of the Extrahepatic Biliary Tract with Metastatic Lymphadenopathy Mimicking Cystic Neoplasm: A Case Report  

PubMed Central

The patient is a previously healthy 52-year-old woman who presented with dyspepsia for two months. Multiple imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) showed diffuse bile duct dilatation with an obstructive lesion of the distal extrahepatic biliary duct (EHD) as well as two masses in the peripancreatic area. The peripancreatic masses appeared cystic with posterior acoustic enhancement on ultrasound, low density on CT imaging, and high signal intensity on T2-weighted MRI. The lesion in the distal EHD exhibited similar characteristics on CT and MRI. A Whipple procedure was performed and histological specimens showed malignant cells with large mucin pools that was consistent with a diagnosis of colloid carcinoma of the EHD with metastatic lymphadenopathies. Colloid carcinoma, also called mucinous carcinoma, is classified as a histologic variant of adenocarcinoma. Because the colloid carcinoma of the biliary tree is exceedingly rare, the imaging characteristics and the clinical features of colloid carcinoma remain relatively unknown. We report a case of colloid carcinoma of the common bile duct and its accompanied metastatic lymphadenopathies with characteristic imaging findings reflecting abundant intratumoral mucin pools.

Han, Na Yeon; Park, Beom Jin; Sung, Deuk Jae; Kim, Min Ju; Cho, Sung Bum; Kim, Dong Sik; Lee, Jeong Hyeon

2013-01-01

163

Molecular Mechanisms of Bile Duct Development  

PubMed Central

The mammalian biliary system, consisting of the intrahepatic and extrahepatic bile ducts, is responsible for transporting bile from the liver to the intestine. Bile duct dysfunction, as is seen in some congenital biliary diseases such as Alagille syndrome and biliary atresia, can lead to the accumulation of bile in the liver, preventing the excretion of detoxification products and ultimately leading to liver damage. Bile duct formation requires coordinated cell-cell interactions, resulting in the regulation of cell differentiation and morphogenesis. Multiple signaling molecules and transcription factors have been identified as important regulators of bile duct development. This review summarizes recent progress in the field. Insights gained from studies of the molecular mechanisms of bile duct development have the potential to reveal novel mechanisms of differentiation and morphogenesis in addition to potential targets for therapy of bile duct disorders.

Zong, Yiwei; Stanger, Ben Z.

2010-01-01

164

Management of Hyperbilirubinemia in Biliary Atresia by Hepatic Progenitor Cell Transplantation Through Hepatic Artery: A Case Report  

Microsoft Academic Search

Cholangiodestruction of bile ducts leads to biliary atresia, a rare disease characterized by intrahepatic and extrahepatic biliary inflammation. If the intrahepatic biliary tree is unaffected, surgical reconstruction by the Kasai procedure of hepatoportoenterostomy of the extra hepatic biliary tract is possible. Untreated, this condition leads to cirrhosis and death within the first year of the life. If the atresia is

A. A. Khan; N. Parveen; V. S. Mahaboob; A. Rajendraprasad; H. R. Ravindraprakash; J. Venkateswarlu; P. Rao; G. Pande; M. Lakshmi Narusu; M. N. Khaja; R. Pramila; A. Habeeb; C. M. Habibullah

2008-01-01

165

Primary biliary cirrhosis: therapeutic advances.  

PubMed

Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease characterized by destruction of the interlobular bile ducts, which, if untreated, leads to fibrosis, biliary cirrhosis, and liver failure. Because liver transplantation remains the only curative option for PBC, the goals of treatment are to slow the rate of progression, to alleviate related symptoms, and to prevent complications. Ursodeoxycholic acid is the only US Food and Drug Administration-approved medical treatment of PBC. Several agents are undergoing evaluation as monotherapy or as an adjuvant to ursodeoxycholic acid. This review summarizes current therapeutic advances in the care of patients with PBC. PMID:23540499

Czul, Frank; Peyton, Adam; Levy, Cynthia

2013-05-01

166

Bile duct cyst in adults: Interventional treatment, resection, or transplantation?  

PubMed Central

Cystic dilatations of the bile ducts may be found along the extrahepatic biliary tree, within the liver, or in both of these locations simultaneously. Presentation in adults is often associated with complications. The therapeutic possibilities have changed considerably over the last few decades. If possible, complete resection of the cyst(s) can cure the symptoms and avoid the risk of malignancy. According to the type of bile duct cyst, surgical procedures include the Roux-en-Y hepaticojejunostomy and variable types of hepatic resection. However, the diffuse forms of Todani type V cysts (Caroli disease and Caroli syndrome) in particular remain a therapeutic problem, and liver transplantation has become an important option. The mainstay of interventional treatment for Todani type III bile duct cysts is via endoscopic retrograde cholangiopancreatography. The diagnostic term “bile duct cyst” comprises quite different pathological and clinical entities. Interventional therapy, hepatic resection, and liver transplantation all have their place in the treatment of this heterogeneous disease group. They should not be seen as competitive treatment modalities, but as complementary options. Each patient should receive individualized treatment after all of the clinical findings have been considered by an interdisciplinary team.

Cerwenka, Herwig

2013-01-01

167

Bile duct cyst in adults: interventional treatment, resection, or transplantation?  

PubMed

Cystic dilatations of the bile ducts may be found along the extrahepatic biliary tree, within the liver, or in both of these locations simultaneously. Presentation in adults is often associated with complications. The therapeutic possibilities have changed considerably over the last few decades. If possible, complete resection of the cyst(s) can cure the symptoms and avoid the risk of malignancy. According to the type of bile duct cyst, surgical procedures include the Roux-en-Y hepaticojejunostomy and variable types of hepatic resection. However, the diffuse forms of Todani type V cysts (Caroli disease and Caroli syndrome) in particular remain a therapeutic problem, and liver transplantation has become an important option. The mainstay of interventional treatment for Todani type III bile duct cysts is via endoscopic retrograde cholangiopancreatography. The diagnostic term "bile duct cyst" comprises quite different pathological and clinical entities. Interventional therapy, hepatic resection, and liver transplantation all have their place in the treatment of this heterogeneous disease group. They should not be seen as competitive treatment modalities, but as complementary options. Each patient should receive individualized treatment after all of the clinical findings have been considered by an interdisciplinary team. PMID:23983423

Cerwenka, Herwig

2013-08-28

168

Biliary fascioliasis - an uncommon cause of recurrent biliary colics: Report of a case and brief review  

PubMed Central

Biliary parasitosis is one of the important causes of biliary obstruction in endemic areas, however due to migration and travel the disease is known to occur in non endemic zones as well. The spectrum of biliary fascioliasis ranges from recurrent biliary colics to acute cholangitis. The long term complications are gall stones, sclerosing cholangitis and biliary cirrhosis. We describe fascioliasis as a cause of recurrent biliary colics in a young male necessitating multiple hospitalizations over a period of four years. Investigative profile had been non-contributory every time he was hospitalized for his abdominal pain prior to the current presentation. He never had cholangitis due to the worm in the common bile duct. It was only at endoscopic retrograde cholangiopancreatography (ERCP) biliary fascioliasis was discovered to be the cause of his recurrent biliary colics. After removal of the live Fasciola hepatica from the common bile duct he became symptom free and is attending our clinic for last 11 months now. Clinical spectrum of biliary fascioliasis is discussed in this report.

Al Qurashi, Hesham; Masoodi, Ibrahim; Al Sofiyani, Mohammad; Al Musharaf, Hisham; Shaqhan, Mohammed; All, Gamal Nasr Ahmed Abdel

2012-01-01

169

Melatonin regulation of biliary functions.  

PubMed

The intrahepatic biliary epithelium is a three-dimensional tubular system lined by cholangiocytes, epithelial cells that in addition to modify ductal bile are also the targets of vanishing bile duct syndromes (i.e., cholangiopathies) such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) that are characterized by the damage/proliferation of cholangiocytes. Cholangiocyte proliferation is critical for the maintenance of the biliary mass and secretory function during the pathogenesis of cholangiopathies. Proliferating cholangiocytes serve as a neuroendocrine compartment during the progression of cholangiopathies, and as such secrete and respond to hormones, neurotransmitters and neuropeptides contributing to the autocrine and paracrine pathways that regulate biliary homeostasis. The focus of this review is to summarize the recent findings related to the role of melatonin in the modulation of biliary functions and liver damage in response to a number of insults. We first provide a general background on the general function of cholangiocytes including their anatomic characteristics, their innervation and vascularization as well the role of these cells on secretory and proliferation events. After a background on the synthesis and regulation of melatonin and its role on the maintenance of circadian rhythm, we will describe the specific effects of melatonin on biliary functions and liver damage. After a summary of the topics discussed, we provide a paragraph on the future perspectives related to melatonin and liver functions. PMID:24696836

Glaser, Shannon; Han, Yuyan; Francis, Heather; Alpini, Gianfranco

2014-02-01

170

Immunohistochemical Study of DPC4 and p53 Proteins in Gallbladder and Bile Duct Cancers  

Microsoft Academic Search

Gallbladder and bile duct carcinomas belong to the family of biliary tract tumors, but they demonstrate different clinical behavior. We evaluated a series of biliary tract carcinomas to determine whether they also had genotypic differences by analysis of the tumor suppressor genes DPC4 and p53. Twenty-one gallbladder cancers, 20 intrahepatic bile duct carcinomas, and 10 extrahepatic bile duct carcinomas were

Shih-Chang Chuang; King-Teh Lee; Kun-Bow Tsai; Pai-Ching Sheen; Eishi Nagai; Kazuhiro Mizumoto; Masao Tanaka

2004-01-01

171

The immunopathology of human biliary cell epithelium  

Microsoft Academic Search

Bile ducts lined with biliary epithelial cells, or cholangiocytes, are the main components of the biliary system in liver.\\u000a Cholangiocytes participate in the production and transport of bile substances, as well as participate in immune responses.\\u000a Cholangiocytes protect against pathogens by expressing toll-like receptors and anti-microbial peptides; act as antigen-presenting\\u000a cells by expressing human leukocyte antigen molecules and costimulatory molecules;

Ya-Hui Chuang; Ruth Y. Lan; M. Eric Gershwin

2009-01-01

172

Biliary tract neoplasms: diagnosis and staging  

PubMed Central

Abstract Most biliary tract neoplasms are malignant and have been traditionally divided into cancers of the gallbladder, the extrahepatic bile ducts, and ampulla of Vater. Although infrequent, bile duct carcinomas and cancer of the gallbladder are not rare. In the United States, an estimated 6000–7000 new cases of carcinoma of the gallbladder and 3000–4000 new cases of carcinoma of the bile ducts are diagnosed annually. Familiarity with the imaging characteristics of gallbladder and bile duct neoplasms is important to expedite the diagnosis and appropriate treatment of patients who often present with non-specific symptoms of right upper quadrant pain, jaundice, and weight loss.

Shelhamer, Ryan P.

2007-01-01

173

Endoscopic management of benign biliary strictures.  

PubMed

The majority of recent studies of benign biliary strictures (BBSs) have reported on treatment of stenotic injuries following cholecystectomy, orthotopic liver transplantation, living donor liver transplantation, chronic pancreatitis, and different inflammatory conditions such as common bile-duct-related strictures. Information about previous surgical procedures is very important for making a BBS diagnosis. Diagnostic tools for indeterminate strictures have increased to include (1) highly specialized cytological techniques such as fluorescence in situ hybridization, (2) cholangioscopy, and (3) endoscopic ultrasound with fine needle aspiration (FNA) and intraductal ultrasound. Magnetic resonance cholangiopancreatography before endoscopic retrograde cholangiopancreatography (ERCP) usually provides an adequate map to plan the endoscopic therapy. After traversing the stricture with a guidewire and, occasionally, performing balloon dilatation, plastic stents continue to be the basic endotherapy, trying to insert the maximum possible number, with an exchange every 3 months during a 12-month period. Progressive stenting requires a median number of five ERCPs; therefore, it is technically demanding and burdensome but has an average of 80% long-term durable stricture dilation. For not-hilar BBS, fully covered self-expanding metal stents (FCSEMSs) are emerging as a promising therapy needing fewer of the endoscopist's technical skills and reducing ERCP procedures and, probably, costs. To equal a 10-mm diameter provided by a single FCSEMS, about three plastic stents placed side-by-side are needed. Manufacturers are working to improve FCSEMS designs to reduce migration rate and to allow an easy extraction after several months in place. Many studies have tried to show reproducible protocols for the duration of FCSEMS therapy and the results in different types of BBSs. PMID:23857116

García-Cano, Jesús

2013-08-01

174

Biliary parasites.  

PubMed

Parasitic diseases of the biliary tract occur frequently in tropical and subtropical areas and cause high morbidity and mortality. In general, neither the clinical presentation nor the general laboratory findings are sufficiently unique to raise the possibility of a parasitic biliary infestation in the mind of the surgeon. Once considered, however, the presence of a parasitic biliary infestation is easily confirmed. Most commonly this is accomplished by the identification of the parasite in stools or duodenal contents. Ultrasonography, CT and MRI are not only important in the diagnosis of parasitic biliary diseases but also in the follow-up and surveillance. ERCP is an excellent diagnostic tool for demonstrating the presence of parasites in the biliary tree. Furthermore, ERCP is also used in the therapy of biliary parasitic infestations and carries less morbidity and mortality than the surgical approach. Surgery is only indicated in complicated cases. Mechanisms that may be effective against parasites include: antibodies; cytotoxic T cells; T-cell-induced activated macrophages; natural killer cells, and a variety of cells that mediate antibody-dependent cell-mediated cytotoxicity and modulators of the immune system such as cytokines. Future research has to focus on the importance of these mechanisms for the immune evasion by parasites. PMID:9845601

Osman, M; Lausten, S B; El-Sefi, T; Boghdadi, I; Rashed, M Y; Jensen, S L

1998-01-01

175

Section 9. Technical details of microsurgical biliary reconstruction in living donor liver transplantation.  

PubMed

Small size and multiple ducts, particularly in right lobe liver grafts, are major factors that contribute to biliary complications in living donor liver transplantation. To improve the outcome of biliary reconstruction, further investigation and refinement of reconstruction techniques and management strategies are necessary. From March 2006 to June 2012, routine MBR was performed in 584 grafts in 581 consecutive LDLT (including 3 dual graft transplants). All biliary reconstructions were performed using microsurgical technique by a single microsurgeon. The classification of biliary reconstruction was based according to the number of ducts in the graft, the manner in which these ducts were reconstructed (with or without ductoplasty), and the conduit used (recipient duct or jejunum) to reconstruct the biliary tree. In duct-to-duct reconstruction, posterior wall first technique by using interrupted suture and continuous running and interrupted tie technique (combined method) for the anterior wall were performed. Recipient reduction ductoplasty was done, if necessary. In duct-to-jejunum reconstruction, enterotomy was performed first under microscope; then, the serosal and mucosal layers were sutured together using 8-0 prolene to facilitate the anastomosis. Posterior wall first by using interrupted suture technique and combined method for the anterior wall were also performed. Overall, there were 397 right and 184 left lobe grafts. Single duct opening was noted in 440 (75.34%), two duct openings in 135(23.12%), and three duct openings in 9 (1.54%) grafts. Duct-to-duct anastomosis was performed in 473 (81%) and duct-to-jejunum Roux limb in 111 (19%) biliary reconstructions. Size discrepancy in the graft and recipient ducts was noted in 394 (83.3%) reconstructions. The overall biliary complication was 7.9%. These included 19 (3.3%) bile leaks and 27 (4.6%) biliary strictures. The routine use of MBR capably surmounts the difficulties brought about by the anatomic variations and the size discrepancies between the graft and recipient hepatic ducts with excellent outcome. PMID:24849831

Lin, Tsan-Shiun; Chen, Chao-Long; Concejero, Allan M; Yap, Anthony Q; Lin, Yu-Hung; Liu, Chun-Yi; Chiang, Yuan-Cheng; Wang, Chih-Chi; Wang, Shih-Ho; Lin, Chih-Che; Yong, Chee-Chien; Cheng, Yu-Fan

2014-04-27

176

Matrix proteins of basement membrane of intrahepatic bile ducts are degraded in congenital hepatic fibrosis and Caroli's disease.  

PubMed

Congenital hepatic fibrosis (CHF) and Caroli's disease are though to result from ductal plate malformation, and the basal laminar components play important roles in biliary differentiation during development. To clarify the involvement of basal laminar components in the ductal plate malformation, this study examined the immunohistochemical expression of laminin and type IV collagen in the livers of CHF and Caroli's disease. Using the polycystic kidney (PCK) rat, an animal model of Caroli's disease with CHF, in vivo and in vitro experiments were also performed. Immunostaining showed that basement membrane expression of laminin and type IV collagen around intrahepatic bile ducts was degraded in CHF, Caroli's disease, and the PCK rats. The degradation of laminin and type IV collagen around bile ducts was also observed in foci of cholangiocarcinoma in situ of Caroli's disease. In vitro, PCK cholangiocytes were found to overexpress plasminogen and a serine proteinase, the tissue-type plasminogen activator (tPA). When PCK cholangiocytes were cultured in Matrigel, the amounts of laminin and collagen in the gel were significantly reduced, and addition of alpha2-antiplasmin in the culture medium inhibited the degradation of laminin and collagen in Matrigel. These results suggest that biliary overexpression of plasminogen and tPA leads to the generation of excessive amounts of plasmin, and subsequent plasmin-dependent lysis of the extracellular matrix molecules may contribute to the biliary dysgenesis in CHF and Caroli's disease, including progressive cystic dilatation of the intrahepatic bile ducts in Caroli's disease. In addition, it is suggested that once cholangiocarcinoma in situ develops in the biliary epithelium of CHF and Caroli's disease, it tends to transform into invasive carcinoma, due to instability of the basement membrane of the bile ducts. PMID:19025978

Yasoshima, Mitsue; Sato, Yasunori; Furubo, Shinichi; Kizawa, Kazuo; Sanzen, Takahiro; Ozaki, Satoru; Harada, Kenichi; Nakanuma, Yasuni

2009-02-01

177

Bacteria and Primary Biliary Cirrhosis  

Microsoft Academic Search

Infectious agents have been postulated to play a pathogenic role in the loss of immunological tolerance and the induction\\u000a of primary biliary cirrhosis, an immune-mediated cholestatic liver disease characterized by progressive destruction of the\\u000a small intrahepatic bile ducts and subsequent cirrhosis and liver failure. This review discusses emerging issues implicating\\u000a infectious agents such as Escherichia coli, mycobacteria, chlamydia, helicobacter species,

Dimitrios P. Bogdanos; Diego Vergani

2009-01-01

178

Morphological and functional heterogeneity of the mouse intrahepatic biliary epithelium  

Microsoft Academic Search

Rat and human biliary epithelium is morphologically and functionally heterogeneous. As no information exists on the heterogeneity of the murine intrahepatic biliary epithelium, and with increased usage of transgenic mouse models to study liver disease pathogenesis, we sought to evaluate the morphological, secretory, and proliferative phenotypes of small and large bile ducts and purified cholangiocytes in normal and cholestatic mouse

Shannon S Glaser; Eugenio Gaudio; Arundhati Rao; Lisa M Pierce; Paolo Onori; Antonio Franchitto; Heather L Francis; David E Dostal; Julie K Venter; Sharon DeMorrow; Romina Mancinelli; Guido Carpino; Domenico Alvaro; Shelley E Kopriva; Jennifer M Savage; Gianfranco D Alpini

2009-01-01

179

Physiologic considerations in radionuclide imaging of the extrahepatic biliary tract  

SciTech Connect

Scintigraphy of the biliary system using /sup 99m/Tc-labeled radiopharmaceuticals enables the clinician to assess kinetics of bile flow through the gallbladder, common bile duct, and sphincter of Oddi. We review some aspects of biliary tract physiology and imaging which may be of interest to the physicians ordering and performing these studies. 56 references.

Chaudhuri, T.K.; Fink, S.

1988-01-01

180

Cytodiagnosis in the management of extrahepatic biliary stricture  

Microsoft Academic Search

A total of 117 patients presenting with extrahepatic biliary strictures between 1981 and 1989 had 206 cytological examinations of the bile duct or bile (153 non-operative, 53 intraoperative) to establish the presence of malignancy. A final diagnosis of cholangiocarcinoma was made in 88 patients, with 29 patients having benign biliary strictures. The cytological techniques used were fine needle aspiration (n

L A Desa; A B Akosa; S Lazzara; P Domizio; T Krausz; I S Benjamin

1991-01-01

181

Retrograde injections of formaldehyde into the biliary tree induce alterations of biliary epithelial function in rats.  

PubMed

Formaldehyde may induce severe lesions of intrahepatic and extrahepatic bile ducts. The purpose of this study was to examine in vivo the functional consequences of an alteration of the biliary epithelium induced by a retrograde intrabiliary injection of formaldehyde in rats. After basal bile collection, a 10% formaldehyde solution was injected into the biliary tree of anesthetized rats, and the cannula was occluded for 30 minutes. Choleresis was then reestablished, and bile flow, bile acid, and bicarbonate secretion were measured both spontaneously and during ursodeoxycholate infusions. Formaldehyde injections induced a significant increase in bile flow and a marked inhibition of ursodeoxycholate-induced increase in biliary bicarbonate concentration and secretion. Biliary glucose secretion, which is normally very low, was increased about 20-fold in animals injected with formaldehyde. Histological and ultrastructural examination of the liver showed alterations of biliary epithelial cells, whereas hepatocytes, bile canaliculi, and canalicular tight junctions remained normal. Hepatocytic excretory function, as assessed by biliary secretion of bile acids, was not affected. It was concluded that short-term formaldehyde intrabiliary injections cause an inhibition of ursodeoxycholate-induced hypersecretion of bicarbonate, an increase in biliary glucose secretion, and selective structural alterations of biliary epithelial cells. These results suggest that formaldehyde retrograde biliary injection may be a useful model to study alterations of biliary epithelial function in vivo. PMID:8903401

Dumont, M; D'Hont, C; Moreau, A; Mbape, H; Feldmann, G; Erlinger, S

1996-11-01

182

The effect of indwelling endoprosthesis on stone size or fragmentation after long-term treatment with biliary stenting for large stones  

Microsoft Academic Search

Background: Endoscopic biliary stenting is often used for large or difficult common bile duct (CBD) stones, but the effect of indwelling endoprosthesis on size or fragmentation of stones after long-term treatment with biliary stenting has not been formally established. We compared the stone size or fragmentation of common bile duct stones after a long period of biliary stenting. Methods: Endoscopic

P. Katsinelos; I. Galanis; I. Pilpilidis; G. Paroutoglou; P. Tsolkas; B. Papaziogas; S. Dimiropoulos; E. Kamperis; D. Katsiba; M. Kalomenopoulou; A. Papagiannis

2003-01-01

183

Oldest biliary endoprosthesis in situ  

PubMed Central

The advantages of endoscopic retrograde cholangiopancreatography over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing “irretrievable stones” include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting. The case presented was a referred 82-year-old Caucasian woman with a 7-year-old plastic biliary endoprosthesis in situ. To the best of our knowledge the examined endoprosthesis is the oldest endoprosthesis in situ reported in the literature. Endoscopic biliary endoprosthesis placement remains a simple and safe procedure for patients with stones that are difficult to manage by conventional endoscopic methods and for patients who are unfit for surgery or who are high surgical risks. To date no consensus has been reached regarding how long a biliary prosthesis should remain in situ. Long-term biliary stenting may have a role in selected elderly patients if stones extraction has failed because the procedure may prevent stones impaction and cholangitis.

Consolo, Pierluigi; Scalisi, Giuseppe; Crino, Stefano F; Tortora, Andrea; Giacobbe, Giuseppa; Cintolo, Marcello; Familiari, Luigi; Pallio, Socrate

2013-01-01

184

Endoscopic Management of Biliary Complications After Adult Living Donor Liver Transplantation  

Microsoft Academic Search

OBJECTIVES:Biliary complications and their treatment in adult cadaveric liver transplantation (CLT) are well described. However, biliary complications and their management in living donor liver transplantation (LDLT) are not well characterized. We assessed the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and management of biliary complications following LDLT.METHODS:We performed a retrospective cohort analysis of all LDLT recipients with duct-to-duct

Janak N. Shah; Nuzhat A. Ahmad; Kirti Shetty; Michael L. Kochman; William B. Long; Colleen M. Brensinger; Patrick R. Pfau; Kim Olthoff; James Markmann; Abraham Shaked; K. Rajender Reddy; Gregory G. Ginsberg

2004-01-01

185

Primary Choledochorrhaphy after Common Bile Duct Exploration  

Microsoft Academic Search

Aim: To prove further the safety of primary closure of the common bile duct. Method: Twenty patients among 99 common bile duct explorations underwent primary closure. Pre- and postoperative liver function test, ultrasound and intraoperative cholangiography data, operation time, postoperative complications and the length of postoperative stay were recorded. Results: Nineteen patients did not suffer any biliary complication. One had

Zhiyuan Tu; Jiadong Li; Hailin Xin; Qin Zhu; Tongnian Cai

1999-01-01

186

Neoplasms of Extrahepatic Bile Ducts  

Microsoft Academic Search

\\u000a In order to appreciate the molecular pathology of carcinomas occurring in the extrahepatic bile ducts (EBD), it is important\\u000a to understand the epidemiology and risk factors for these cancers. A chapter on cholangiocarcinoma with focus on intrahepatic\\u000a biliary neoplasms is included independently in this textbook (Chap. 59).

Nora Katabi; Juan Carlos Roa; N. Volkan Adsay

187

An unusual post-traumatic case of extrahepatic bile duct compression.  

PubMed

Jaundice and cholestatic disease by external bile duct compression may be caused by several conditions, including pancreatic masses, portal cavernoma, Ormond's disease, metastases from gallbladder cancer, neurinomas, and hydronephrotic kidney. We report a case of bile duct compression in a 56-year-old man with a known small (28 mm) right renal cyst and crossed, fused renal ectopia. The patient had a history of recent abdominal trauma due to a motorcycle accident and recurrent septic-type fever and jaundice. He also reported a weight loss of 5 kg in the last two months. Abdominal ultrasonography showed intra- and extra-hepatic bile duct dilatation, and computed tomography scan showed hydronephrosis, dilatation of intra- and extra-hepatic biliary tract, and a right renal complex cyst of more than 9 cm. One can hypothesize a relationship between the abdominal trauma and the increase in size of the renal cyst, which, moreover, had changed its original shape. The patient underwent cefuroxime and metronidazole therapy, with complete recovery from the cholangitis within one week. The treatment of choice would have been surgical excision or, alternatively, an image-guided percutaneous aspiration of the cyst, in order to avoid further episodes of cholangitis. Unfortunately, the patient refused either surgical or more conservative treatment and was lost to follow-up. PMID:17285201

Zardi, Enrico Maria; Malafarina, Vincenzo; Ambrosino, Giovanni; Uwechie, Valentina; Rollo, Massimo; Picardi, Antonio; Afeltra, Antonella; Lumachi, Franco

2006-12-01

188

Current treatment of benign biliary strictures  

PubMed Central

Endoscopy is a widely used approach for the treatment of benign biliary strictures. Most common benign biliary strictures amandable to endoscopic treatment are post-cholecystectomy, dominant biliary strictures due to primary sclerosing cholangitis, biliary anastomotic strictures occurring after liver transplantation, and common bile duct strictures due to chronic pancreatitis. Surgery is a valid option in cases of complete transection or ligation of the common bile duct, in selected patients with benign strictures related to chronic pancreatitis, and in noncompliant patients. In any case, even in these patients, endoscopy should always be attempted, because it is safe and repeatable. Endoscopic treatment consists of passing the stricture and placement of at least one large bore plastic stent, followed by further sessions of stenting with multiple plastic stents. Temporary placement of multiple plastic stents is the recommended approach in patients with benign biliary strictures. Self-expandable metal stents have a larger diameter compared to plastic stents, and can be covered and uncovered. Placement of uncovered metal stents in patients with benign biliary strictures is strongly discouraged. However, covered self-expandable metal stents can be safely placed in selected patients.

Costamagna, Guido; Boskoski, Ivo

2013-01-01

189

Resolution of biliary stricture after living donor liver transplantation in a child by percutaneous trans-hepatic cholangiography and drainage: a case report  

PubMed Central

Introduction Intra-hepatic cholestasis arising from biliary strictures is a frequent complication in pediatric patients after liver transplantation. Minimally invasive procedures such as percutaneous drainage placement and balloon dilation are the preferred diagnostic and therapeutic modalities. Case presentation We report the case of a 12-month-old Caucasian boy with biliary atresia who was initially treated with hepatoportoenterostomy. In the following months, he developed biliary cirrhosis, accompanied by cystic bile retention, recurrent bile duct infections and malabsorption. Six months after the initial surgical intervention, he underwent living donor liver transplantation. Within two months, the hepatico-jejunostomy became occluded leading to progressive intra-hepatic cholestasis. Under sonographic guidance, external drainage of bile was accomplished by percutaneous trans-hepatic cholangiography and drainage. In total, our patient underwent 12 interventions under general anesthesia until balloon dilatation of the hepatico-jejunostomy was successfully performed. Finally, our patient’s general condition improved and he gained weight. Conclusions Minimally invasive techniques are preferred to surgical revisions and justify even multiple attempts. Interventions under general anesthesia, though not without risks, are still reasonable. Co-operation with parents and multidisciplinary approach to complication management by the involved surgeon, radiologist, pediatrician and anesthesiologist are important.

2013-01-01

190

Episodic biliary obstruction due to an intrahepatic biliary cystadenoma: a case report  

PubMed Central

Introduction Biliary cystadenoma is a rare, benign neoplasm of the bile ducts with malignant potential. Symptoms, predominantly right hypochondrial pain and the feeling of a lump or fullness are usually due to the mass effect. Jaundice is rare. This is the fifth reported patient with an intrahepatic biliary cystadenoma giving rise to episodic biliary obstruction, which is usually caused by choledocholithiasis or periampullary carcinoma. Considering the mean age of previous similar patients (53.5, standard deviation 14.6 years), the early age of presentation is very unusual in our patient. Case presentation A 25-year-old Asian woman presented with right hypochondrial pain and episodic biliary obstruction. Contrast enhanced computed tomography revealed a cystic mass in segment 4B and protruding into and along the left hepatic duct. Laparotomy confirmed the contrast enhanced computed tomography findings and histology revealed an intrahepatic mucinous biliary cystadenoma. Conclusion Biliary cystadenoma should be considered as a differential diagnosis in patients with cystic liver lesions who present with episodic biliary obstruction. Due to the reported malignant potential, radical surgery such as wide local excision of the lesion or hepatic resection is needed to minimize the risk of local recurrence.

2009-01-01

191

Iatrogenic biliary injuries: identification, classification, and management.  

PubMed

Because it offers several advantages over open cholecystectomy, laparoscopic cholecystectomy has largely replaced open cholecystectomy for the management of symptomatic gallstone disease. The only potential disadvantage is a higher incidence of major bile duct injury. Although prevention of these biliary injuries is ideal, when they do occur, early identification and appropriate treatment are critical to improving the outcomes of patients suffering a major bile duct injury. This report delineates the key factors in classification (and its relationship to mechanism and management), identification (intraoperative and postoperative), and management principles of these bile duct injuries. PMID:24679422

Stewart, Lygia

2014-04-01

192

Operative management of biliary peritonitis complicating blunt hepatic trauma using partial hepatectomy and trans-hepatic biliary stenting  

PubMed Central

INTRODUCTION Biliary peritonitis complicating blunt hepatic trauma is a rare but potentially lethal condition. PRESENTATION OF CASE A 17-year old male patient who sustained a complex grade IV blunt hepatic trauma presented with severe haemorrhagic shock after an initial laparotomy in another hospital. An urgent exploratory laparotomy revealed a shattered posterior section of the right liver and suture haemostasis of the lacerated liver surface was performed. Postoperatively, the patient developed generalized biliary peritonitis and another laparotomy with peritoneal lavage and drainage was performed on postoperative day 12. However, ongoing manifestations of peritonitis and sepsis necessitated a third laparotomy 6 days later. This revealed ongoing biliary peritonitis due to major intra-hepatic bile duct injury. A partial hepatectomy with intra-operative trans-hepatic biliary stenting was undertaken. Postoperative recovery was uneventful and the biliary fistula healed completely by the end of the second postoperative week. DISCUSSION Major intra-hepatic bile duct injury following blunt hepatic trauma is an extremely rare cause of biliary peritonitis. CONCLUSION The combination of partial hepatectomy with intra-operative trans-hepatic biliary stenting proved to be a safe and effective method for treatment of biliary peritonitis due to major intra-hepatic bile duct injury following blunt hepatic trauma when non-operative management fails.

Osman, Ayman M. AbdelHady

2014-01-01

193

Biliary duplication cyst with heterotopic gastric mucosa resulting in obstruction of the biliary system: a case report.  

PubMed

Biliary tract duplication cysts with heterotopic gastric mucosa are rare congenital anomalies, with our case representing only the fourth reported case in the literature. An 8-year-old girl with several months of abdominal pain was found to have a complex cystic mass communicating with the biliary system via the common hepatic duct. Intraoperatively, inflammation caused by the cystic mass was found to have resulted in a Mirizzi-like syndrome, with a nearly complete obstruction at the confluence of the left and right hepatic ducts. Histopathologic examination of the biliary mass revealed it to be a duplication cyst lined by heterotopic gastric mucosa with secondary ulceration and fibrosis. Biliary duplication cysts are a rare but important process that should be considered in a child with a mass in the portal triad and biliary obstruction. PMID:22703824

Kim, Jina; Jarboe, Marcus D; Arnold, Meghan A; DiPietro, Michael A; Bloom, David A; Teitelbaum, Daniel H

2012-06-01

194

Causes and consequences of ischemic-type biliary lesions after liver transplantation.  

PubMed

Biliary complications are a major source of morbidity, graft loss, and even mortality after liver transplantation. The most troublesome are the so-called ischemic-type biliary lesions (ITBL), with an incidence varying between 5% and 15%. ITBL is a radiological diagnosis, characterized by intrahepatic strictures and dilatations on a cholangiogram, in the absence of hepatic artery thrombosis. Several risk factors for ITBL have been identified, strongly suggesting a multifactorial origin. The main categories of risk factors for ITBL include ischemia-related injury; immunologically induced injury; and cytotoxic injury, induced by bile salts. However, in many cases no specific risk factor can be identified. Ischemia-related injury comprises prolonged ischemic times and disturbance in blood flow through the peribiliary vascular plexus. Immunological injury is assumed to be a risk factor based on the relationship of ITBL with ABO incompatibility, polymorphism in genes coding for chemokines, and pre-existing immunologically mediated diseases such as primary sclerosing cholangitis and autoimmune hepatitis. The clinical presentation of patients with ITBL is often not specific; symptoms may include fever, abdominal complaints, and increased cholestasis on liver function tests. Diagnosis is made by imaging studies of the bile ducts. Treatment starts with relieving the symptoms of cholestasis and dilatation by endoscopic retrograde cholangiopancreaticography (ERCP) or percutaneous transhepatic cholangiodrainage (PTCD), followed by stenting if possible. Eventually up to 50% of the patients with ITBL will require a retransplantation or may die. In selected patients, a retransplantation can be avoided or delayed by resection of the extra-hepatic bile ducts and construction of a hepaticojejunostomy. More research on the pathogenesis of ITBL is needed before more specific preventive or therapeutic strategies can be developed. PMID:17139425

Buis, Carlijn I; Hoekstra, Harm; Verdonk, Robert C; Porte, Robert J

2006-01-01

195

Metastatic malignant biliary obstruction.  

PubMed

Jaundice due to metastatic tumor involving the extra-hepatic bile ducts is uncommon, and thus, the management of this problem is not standardized. Retrospective analysis of all patients admitted to University Hospitals of Cleveland with malignant biliary obstruction was thus undertaken to identify the incidence, origin, management, and outcome of these metastatic tumors. During a 5-year period, 56 patients with jaundice secondary to biliary, pancreatic, ampullary, or metastatic tumors were identified. Of these, 12 (21%) represented a distant malignant process metastatic to the porta hepatis. Sites of origin were diverse: lymphoma, 2; breast, 3; colon, 2; and 1 each with Hodgkin's, lung, ovary endometrium, and melanoma. Patients ranged in age from 31 to 90 years (mean: 60). Surgical intervention was undertaken in only two patients (cholecystojejunostomy, 1; transhepatic U-tube stenting, 1). The remainder were managed as follows: no procedure, 3 (25%); percutaneous stenting, 5 (42%); and radiation only, 2 (17%). Mortality was as follows: 5 of 12 (42%) died within 30 days and 8 of 12 (67%) within 60 days. The only survivors beyond 60 days were the patients with Hodgkin's (1 of 1), lymphoma (1 of 2), breast (1 of 3) and melanoma (1 of 1). Ten of the patients had obvious extensive metastatic disease, which would explain the poor outcome. Analysis of this data indicates that overall survival is dismal and palliative, nonoperative methods to manage the jaundice should be considered. PMID:3605855

Stellato, T A; Zollinger, R M; Shuck, J M

1987-07-01

196

Biliary response to glucagon in humans.  

PubMed Central

Glucagon has been demonstrated to have profound effect on biliary secretion in several species. Glucagon's biliary effects were studied in humans following biliary tract surgery. Nine patients underwent common bile duct exploration and insertion of a balloon-occludable t tube. An aliquot of the collected sample was kept and the enterohepatic circulation was maintained by reinfusion of the collected bile via the distal t-tube port. Glucagon increased bile flow and decreased cholesterol and phospholipid output during stable bile acid output. Furthermore high-performance liquid chromatographic analysis of bile acid profiles revealed no significant changes in bile salt species or conjugation after glucagon infusion. Glucagon is probably important in the physiologic regulation of biliary secretion in humans.

Branum, G D; Bowers, B A; Watters, C R; Haebig, J; Cucchiaro, G; Farouk, M; Meyers, W C

1991-01-01

197

Anomalous pancreatico-biliary junction—Report of a new experimental model and review of the literature  

Microsoft Academic Search

A model of anomalous pancreatico-biliary junction was developed and used to investigate a possible role in the development of choledochal cyst and tumors of the biliary tract. An anastomosis was constructed between an isolated pancreas-duodenal segment and the gallbladder in 20 minipigs, but the results did not show any subsequent dilatation of the biliary tract, although intestinal metaplasia was observed

Tahar Benhidjeb; Samir Said; Birgit Rudolph; Eva Siegmund

1996-01-01

198

Electron microscopic study of the liver with biliary atresia and neonatal hepatitis.  

PubMed

Eleven cases of biliary atresia (BA) and eight of neonatal hepatitis (NH) were studied, using transmission electron microscopy, to document their different ultrastructural characteristics and to elucidate the possible pathogenesis of biliary atresia. Among 30 consecutive liver biopsies obtained from 19 infants with BA or NH, 21 specimens composed (13 BA, 8 NH) were examined ultrastructurally. The electron microscopic features of NH (patients' age range, 35 to 60 days) were (1) giant hepatocytic transformation with scattered areas of dilated endoplasmic reticulum, indicative of intracytoplasmic degeneration, (2) frequent cytoplasmic biliary necrosis, and (3) relatively intact microvilli in most bile canaliculi, which contained some hepatocytic cytoplasmic fragments. These features strongly suggest that the main pathological process in NH is hepatocellular injury rather than bile duct damage. In contrast, all cases with BA (age range, 27 to 130 days) demonstrated (1) marked hepatocellular cholestasis associated with many lysosomes and myelin figures, (2) marked loss of bile canalicular microvilli, (3) degenerated bile ductular cells containing bile pigments, and (4) periductal inflammatory fibrosis. These features suggest that the main pathological process in BA involves the biliary system. A few viral inclusions were observed in two cases with BA, which suggests that viral infection is a potential cause. In two BA cases (aged 40 and 43 days at the time of first biopsy), the ultrastructural findings essentially were the same as those of NH, and follow-up biopsy specimens (at 48 and 94 days) showed findings consistent with BA. Such results support Landing's hypothesis that BA and NH are different manifestations of a single pathological process. PMID:8708905

Park, W H; Kim, S P; Park, K K; Choi, S O; Lee, H J; Kwon, K Y

1996-03-01

199

Biliary Atresia: Cellular Dynamics and Immune Dysregulation  

PubMed Central

The cause of biliary atresia (BA) is unknown and in the past few decades the majority of investigations related to pathogenesis have centered on virus infections and immunity. The acquired or perinatal form of BA entails a progressive, inflammatory injury of bile ducts, leading to fibrosis and obliteration of both the extrahepatic and intrahepatic bile ducts. Theories of pathogenesis include viral infection, chronic inflammatory or autoimmune-mediated bile duct injury and abnormalities in bile duct development. This review will focus solely on human studies pertaining to a potential viral trigger of bile duct injury at diagnosis and provide insight into the interplay of the innate and adaptive immune responses in the pathogenesis of disease.

Feldman, Amy; Mack, Cara L.

2012-01-01

200

Biliary concrements: the endoscopic approach.  

PubMed

Since 1970, endoscopic retrograde cholangiopancreaticography (ERCP) has received much attention as a diagnostic method in pancreaticobiliary disease. The information given by ERCP is of great value in the management of patients with symptoms after biliary tract surgery and especially in patients with suspected obstructive jaundice. In patients with symptoms highly suggestive of cholelithiasis, ERCP examination should be considered for definitive diagnosis despite a negative oral cholecystogram and ultrasound finding. Endoscopic papillotomy is a major advance in the treatment of many elderly and high-risk patients with common bile duct stones. It should replace surgery in most of these patients with retained or recurrent stones and appears justified in many patients who have not yet undergone cholecystectomy, either in the hope of avoiding biliary surgery altogether or to defuse an acute clinical situation. The rule of endoscopic treatment in the young and fit has yet to be established. PMID:2658363

Rosseland, A R; Osnes, M

1989-01-01

201

[Congenital cystic disease of the biliary system in adults].  

PubMed

Congenital cystic disease of the biliary system is a complex syndrome of ectasies of the intra-, extra- or both situation of biliary tree. This disease has an unsure etiopathogeny. It is uncommon through the third age, with a greater incidence in child, teen-ager and young adult. The goal of our study is to evaluate the symptoms, diagnosis, treatment and histological aspects of the congenital biliary cysts. We performed a retrospective study from March 1988 to July 2003 about 11 patients with this disease treated in our surgical clinic. Clinical features, methods of diagnosis and surgical treatment were assessed. All patients were females with mean age 51 years (extreme 26-77 years). The symptoms were: right upper quadrant pain--11 cases (100%), jaundice--6 cases (54.5%), fever--3 cases (27%), palpable abdominal mass--2 cases (18%), weight loss--1 case (9%). The imaging diagnosis was helpful (ultrasonography, CT, ERCP, percutaneous cholangiography and preoperative cholangiography). In concordance with Todani classification the patients were included in the following types: Ia--3 cases (27%), I b--1 case (9%), I c--3 cases (27%), IV a--2 cases (18%), IV b--1 case (9%), V--1 case (9%). All patients were operated on: after cholecystectomy and transcystic cholangiography (11 cases--100%) we performed the total excision of the cyst--9 cases (82%) with choledochal jejunostomy (Roux-en-Y)--6 cases (54.5%), choledochal jejunostomy (omega)--1 case (9%) and choledochal duodenostomy--2 cases (18%). In one case of neoplasic cyst with portal invasion we performed a cyst-jejunostomy (omega) and in one case of Caroli disease with total obstruction of the distal choledoc, the solution of choice was choledocal-duodenostomy. The microscopic pathology of the cyst wall showed: chronic intramural inflammation--9 cases (82%) and the absence of the nervous intramural terminations--1 case (9%). The additional lesions was: hepatic cirrhosis--1 case (9%) and hepatic fibrosis--3 cases (27%). We found three cases with neoplasia: malign cyst with advanced local invasion--1 case (9%), pancreatic carcinoma--1 case (9%) and gallbladder carcinoma (microscopic finding)--1 case (9%). The postoperative morbidity includes biliary fistula--2 cases (18%) and wound infection--2 cases (18%). Long-term follow-up revealed cholangitis in one case--9%. The cystic dilatations of the common bile duct is an exclusive indication for surgery as soon as it was discovered. PMID:14756026

Târcoveanu, E; Niculescu, D; Georgescu, St; Cotea, Elena; Vintil?, D; Dimofte, G; Neac?u, C N; Lupa?cu, C; Crumpei, Felicia; Cîrdei, C

2003-01-01

202

Profiling Circulating and Urinary Bile Acids in Patients with Biliary Obstruction before and after Biliary Stenting  

Microsoft Academic Search

Bile acids are considered as extremely toxic at the high concentrations reached during bile duct obstruction, but each acid displays variable cytotoxic properties. This study investigates how biliary obstruction and restoration of bile flow interferes with urinary and circulating levels of 17 common bile acids. Bile acids (conjugated and unconjugated) were quantified by liquid chromatography coupled with tandem mass spectrometry

Jocelyn Trottier; Andrzej Bia?ek; Patrick Caron; Robert J. Straka; Piotr Milkiewicz; Olivier Barbier

2011-01-01

203

Fully Covered Self-Expandable Metal Stents for Treatment of Both Benign and Malignant Biliary Disorders  

PubMed Central

Transpapillary stents are increasingly being used for biliary strictures, whether benign or malignant. However, there are different stent types and available data is controversial. Recently, completely covered self-expandable metal stents (CSEMSs) have been proposed as an alternative therapeutic option in different biliary indications, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, bile duct leaks, periampullary perforation following endoscopic sphincterotomy (ES), and postsphincterotomy bleeding. Despite the higher costs of these devices, fully covered self-expanding metal stents seem to be a suitable therapeutic option to relief biliary obstruction due to bile duct stenosis, regardless of the underlying cause.

Abdel Samie, Ahmed; Theilmann, Lorenz

2012-01-01

204

Magnetic resonance evaluations of biliary malignancy and condition at high-risk for biliary malignancy: Current status  

PubMed Central

Tumors of the biliary tree are relatively rare; but their incidence is rising worldwide. There are several known risk factors for bile duct cancers, and these are seem to be associated with chronic inflammation of the biliary epithelium. Herein, 2 risk factors have been discussed, primary sclerosing cholangitis and reflux of pancreatic juice into the bile duct, as seen in such as an abnormal union of the pancreatic-biliary junction because magnetic resonance imaging (MRI) is used widely and effectively in the diagnosis of these diseases. When biliary disease is suspected, MRI can often help differentiate between benignity and malignancy, stage tumors, select surgical candidates and guide surgical planning. MRI has many advantages over other modalities. Therefore, MRI is a reliable noninvasive imaging tool for diagnosis and pre-surgical evaluation of bile duct tumors. Nowadays remarkable technical advances in magnetic resonance technology have expanded the clinical applications of MRI in case of biliary diseases. In this article, it is also discussed how recent developments in MRI contributes to the diagnosis of the bile duct cancer and the evaluation of patients with risk factors affecting bile duct cancer.

Sugita, Reiji

2013-01-01

205

Indocyanine-green-loaded microballoons for biliary imaging in cholecystectomy  

NASA Astrophysics Data System (ADS)

We encapsulate indocyanine green (ICG) in poly[(D,L-lactide-co-glycolide)-co-PEG] diblock (PLGA-PEG) microballoons for real-time fluorescence and hyperspectral imaging of biliary anatomy. ICG-loaded microballoons show superior fluorescence characteristics and slower degradation in comparison with pure ICG. The use of ICG-loaded microballoons in biliary imaging is demonstrated in both biliary-simulating phantoms and an ex vivo tissue model. The biliary-simulating phantoms are prepared by embedding ICG-loaded microballoons in agar gel and imaged by a fluorescence imaging module in a Da Vinci surgical robot. The ex vivo model consists of liver, gallbladder, common bile duct, and part of the duodenum freshly dissected from a domestic swine. After ICG-loaded microballoons are injected into the gallbladder, the biliary structure is imaged by both hyperspectral and fluorescence imaging modalities. Advanced spectral analysis and image processing algorithms are developed to classify the tissue types and identify the biliary anatomy. While fluorescence imaging provides dynamic information of movement and flow in the surgical region of interest, data from hyperspectral imaging allow for rapid identification of the bile duct and safe exclusion of any contaminant fluorescence from tissue not part of the biliary anatomy. Our experiments demonstrate the technical feasibility of using ICG-loaded microballoons for biliary imaging in cholecystectomy.

Mitra, Kinshuk; Melvin, James; Chang, Shufang; Park, Kyoungjin; Yilmaz, Alper; Melvin, Scott; Xu, Ronald X.

2012-11-01

206

Indocyanine-green-loaded microballoons for biliary imaging in cholecystectomy.  

PubMed

We encapsulate indocyanine green (ICG) in poly[(D,L-lactide-co-glycolide)-co-PEG] diblock (PLGA-PEG) microballoons for real-time fluorescence and hyperspectral imaging of biliary anatomy. ICG-loaded microballoons show superior fluorescence characteristics and slower degradation in comparison with pure ICG. The use of ICG-loaded microballoons in biliary imaging is demonstrated in both biliary-simulating phantoms and an ex vivo tissue model. The biliary-simulating phantoms are prepared by embedding ICG-loaded microballoons in agar gel and imaged by a fluorescence imaging module in a Da Vinci surgical robot. The ex vivo model consists of liver, gallbladder, common bile duct, and part of the duodenum freshly dissected from a domestic swine. After ICG-loaded microballoons are injected into the gallbladder, the biliary structure is imaged by both hyperspectral and fluorescence imaging modalities. Advanced spectral analysis and image processing algorithms are developed to classify the tissue types and identify the biliary anatomy. While fluorescence imaging provides dynamic information of movement and flow in the surgical region of interest, data from hyperspectral imaging allow for rapid identification of the bile duct and safe exclusion of any contaminant fluorescence from tissue not part of the biliary anatomy. Our experiments demonstrate the technical feasibility of using ICG-loaded microballoons for biliary imaging in cholecystectomy. PMID:23214186

Mitra, Kinshuk; Melvin, James; Chang, Shufang; Park, Kyoungjin; Yilmaz, Alper; Melvin, Scott; Xu, Ronald X

2012-11-01

207

Biliary cysts: Etiology, diagnosis and management  

PubMed Central

Biliary cysts (BC) are rare dilatations of different parts of a biliary tract. They account for approximately 1% of all benign biliary diseases. BC occur the most frequently in Asian and female populations. They are an important problem for pediatricians, gastroenterologists, radiologists and surgeons. Clinical presentation and management depend on the BC type. Cholangiocarcinoma is the most serious and dangerous BC complication. The other complications associated with BC involve cholelithiasis and hepatolithiasis, cholangitis, acute and chronic pancreatitis, portal hypertension, liver fibrosis and secondary liver cirrhosis and spontaneous cyst perforation. Different BC classifications have been described in the literature. Todani classification dividing BC into five types is the most useful in clinical practice. The early diagnosis and proper treatment are very important, because BC are associated with a risk of carcinogenesis. A malignancy risk increases with the age. Radiological investigations (ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography) play an important role in BC diagnostics. Currently, prenatal diagnosis using ultrasonography is possible. It allows to differentiate biliary disorders in fetals and to perform the early surgical treatment that improves results. In most patients, total cyst excision with Roux-Y hepaticojejunostomy is the treatment of choice. Surgical treatment of BC is associated with high success rate and low morbidity and mortality. The early treatment is associated with a lower number of complications. Patients following BC surgery require permanent and careful postoperative observation using laboratory and imaging investigations because of possibility of biliary anastomosis stricture and biliary cancer in tissue remnant.

Jablonska, Beata

2012-01-01

208

Transformations - Dilation  

NSDL National Science Digital Library

In this interactive simulation, students are able to visualize and manipulate objects to understand dilation transformations. Students are able to adjust the center of dilation, rotate and move figures, change the scale factor to see what effect it has on the figures, add their own figures, and more. Across the top of the page, visitors will find links to activities to guide students as they explore the site, and more advanced activities involving computation are available in the Parent/Teacher section. The Instructions sections has detailed information for students and teachers alike on how to use the manipulative.

2003-01-01

209

Specific transduction and labeling of pancreatic ducts by targeted recombinant viral infusion into mouse pancreatic ducts.  

PubMed

Specific labeling of pancreatic ducts has proven to be quite difficult. Such labeling has been highly sought after because of the power it would confer to studies of pancreatic ductal carcinogenesis, as well as studies of the source of new insulin-producing ?-cells. Cre-loxp recombination could, in theory, lineage-tag pancreatic ducts, but results have been conflicting, mainly due to low labeling efficiencies. Here, we achieved a high pancreatic duct labeling efficiency using a recombinant adeno-associated virus (rAAV) with a duct-specific sox9 promoter infused into the mouse common biliary/pancreatic duct. We saw rapid, diffuse duct-specific labeling, with 50 and 89% labeling in the pancreatic tail and head region, respectively. This highly specific labeling of ducts should greatly enhance our ability to study the role of pancreatic ducts in numerous aspects of pancreatic growth, development and function. PMID:24100509

Guo, Ping; Xiao, Xiangwei; El-Gohary, Yousef; Criscimanna, Angela; Prasadan, Krishna; Rymer, Christopher; Shiota, Chiyo; Wiersch, John; Gaffar, Iliana; Esni, Farzad; Gittes, George K

2013-11-01

210

[Choledochal cyst in adults and cancer of the biliary tract].  

PubMed

We presented 3 cases of cystic dilatation of common bile duct classified as type IC, IVB an IVA. All 3 were women, admitted for right upper quadrant pain and jaundice. Two cases proved malignant degeneration in cystic dilatation in first cas and in gallbladder in third. Only the 3rd case had a positive preoperative diagnosis achieved through echography, TPHC, ERPC. Surgical treatment consisted of cysto-jejunal derivation in the cas of the common duct malignant cyst inoperative and cholecystectomy associated with the excision of the dilatation followed by the hepato-jejunal anastomosis in the other 2 cases. Adenocarcinoma of the gallbladder was a pathological surprise. A better knowledge of the risk of cancer on cystic dilations of the common bile duct should lead to an earlier diagnosis of this disease and a preventive treatment by radical excision of the dilatation. PMID:9296755

Târcoveanu, E; Strat, V; Chifan, M; Cotea, E; B?lan, G; Daniil, C; Crumpei, F; Florea, N

1997-01-01

211

One-channel double stent implantation for hilar biliary obstructions  

PubMed Central

The aim of this study was to evaluate the effect of percutaneous one-channel double stent implantation on hilar biliary obstruction involving both hepatic ducts and its clinical value. A total of 8 patients with hilar biliary obstruction involving the left and right hepatic ducts were enrolled. A percutaneous unilateral approach was adopted. Two stents were implanted, one between the left and right hepatic ducts and the other between the hepatic ducts and the common bile duct for biliary drainage. Interventional therapies such as arterial chemoembolization were performed for antitumor treatment. All surgical procedures were successfully accomplished. At 2 weeks after stenting, total bilirubin decreased to 61.2±13.4 ?mol/l (the preoperative value was 267.1±154.7 ?mol/l). No severe complications or mortalities occurred. Single-channel double stent implantation should be the preferred method of treatment for patients with hilar biliary obstruction involving both hepatic ducts. Drainage and antitumor treatment should also be used when necessary.

CAO, GUANGSHAO; CAO, HUICUN; LIU, JIAN; WANG, YUDAN; WANG, ZHENYU

2013-01-01

212

Successful Treatment with a Covered Stent and 6-Year Follow-Up of Biliary Complication After Liver Transplantation  

SciTech Connect

The role of covered stent in the management of biliary complications is not yet defined in liver transplant recipients. This Case Report presents a patient with anastomotic stricture and leakage with biloma treated with a covered stent 32 months following liver transplantation. Signs of in-stent restenosis developed 52 months following covered stent placement, which was resolved by balloon dilation. There were no complications during the interventions. The latest follow-up, at 69 months following primary and 19 months following secondary percutaneous intervention, shows a patent covered stent without any clinical or morphological sign of further restenosis. The clinical success with long-term follow-up data suggests that covered stent implantation can be a rational, minimally invasive option for simultaneous treatment of bile duct stenosis and bile leak following liver transplantation in selected cases.

Doros, Attila, E-mail: dorattila@yahoo.com; Nemeth, Andrea; Deak, Akos Pal; Hartmann, Erika; Gerlei, Zsuzsa; Fazakas, Janos; Kobori, Laszlo [Semmelweis University, Department of Transplantation and Surgery (Hungary)

2010-04-15

213

Profiling Circulating and Urinary Bile Acids in Patients with Biliary Obstruction before and after Biliary Stenting  

PubMed Central

Bile acids are considered as extremely toxic at the high concentrations reached during bile duct obstruction, but each acid displays variable cytotoxic properties. This study investigates how biliary obstruction and restoration of bile flow interferes with urinary and circulating levels of 17 common bile acids. Bile acids (conjugated and unconjugated) were quantified by liquid chromatography coupled with tandem mass spectrometry in serum and urine samples from 17 patients (8 men and 9 women) with biliary obstruction, before and after biliary stenting. Results were compared with serum concentrations measured in 40 age- and sex-paired control donors (20 men and 20 women). The total circulating bile acid concentration increases from 2.7 µM in control donors to 156.9 µM in untreated patients with biliary stenosis. Serum taurocholic and glycocholic acids exhibit 304- and 241-fold accumulations in patients with biliary obstruction compared to controls. The enrichment in chenodeoxycholic acid species reached a maximum of only 39-fold, while all secondary and 6?-hydroxylated species –except taurolithocholic acids – were either unchanged or significantly reduced. Stenting was efficient in restoring an almost normal circulating profile and in reducing urinary bile acids. Conclusion These results demonstrate that biliary obstruction affects differentially the circulating and/or urinary levels of the various bile acids. The observation that the most drastically affected acids correspond to the less toxic species supports the activation of self-protecting mechanisms aimed at limiting the inherent toxicity of bile acids in face of biliary obstruction.

Caron, Patrick; Straka, Robert J.; Milkiewicz, Piotr; Barbier, Olivier

2011-01-01

214

Biliary Atresia  

PubMed Central

Extrahepatic biliary atresia (EHBA), an inflammatory sclerosing cholangiopathy, is the leading indication for liver transplantation in children. The cause is still unknown, although possible infectious, genetic, and immunologic etiologies have received much recent focus. These theories are often dependent on each other for secondary or coexisting mechanisms. Concern for EHBA is raised by a cholestatic infant, but the differential diagnosis is large and the path to diagnosis remains varied. Current treatment is surgical with an overall survival rate of approximately 90%. The goals of this article are to review the important clinical aspects of EHBA and to highlight some of the more recent scientific and clinical developments contributing to our understanding of this condition.

Bassett, Mikelle D.; Murray, Karen F.

2011-01-01

215

Endoscopic biliary drainage.  

PubMed

Endoscopic biliary drainage (EBD) has become an established method of relieving posthepatic jaundice. This study comprises 399 patients in whom 472 EBD procedures were performed during a 5 year period; 272 patients had malignant obstruction, 36 had a benign stricture, 79 had common duct stones and 12 patients had other benign conditions requiring drainage. A 7F double pigtail endoprosthesis was used in the majority of patients and was inserted with an Olympus JF-1T duodenoscope. Ninety-two per cent of the prostheses were correctly positioned, and 88 per cent of these functioned well with relief of symptoms. The 30-day mortality was 22 per cent and one-third of these deaths were due to the procedure, septicaemia being the dominant hazard. This was more marked if the obstruction was not relieved satisfactorily. Antibiotic cover was not used routinely and had not been prescribed in any of the fatal cases. This omission probably made a significant contribution to the septicaemia. Acute pancreatitis and haemorrhage were rare complications and both were probably related to the coincidental sphincterotomy. Prostheses intended for permanent relief of malignant obstruction remained patent for 2-3 months (median) with a wide range of 1-618 days. Survival among these patients is so short, that one or two EBD procedures will keep the majority of patients free from symptoms related to biliary obstruction, and only two patients needed more than three procedures. Fifty-one patients with pancreatic head carcinoma had EBD as a bypass before an intended operation. Only 16 patients actually had a resection. The median survival among the 51 patients was 106 days (compared with 59 days among 100 patients with a permanent prosthetic bypass). Only one patient with a very small periampullary carcinoma has survived for more than 3 years. Forty-seven patients are dead. Among the 51 patients in whom radical resection was intended two-thirds were actually treated by permanent surgical or prosthetic bypass. PMID:2827833

Kiil, J; Kruse, A; Rokkjaer, M

1987-12-01

216

Biliary bypass surgery - Analysis of indications & outcome of different procedures  

PubMed Central

Objectives: This study reports the indications and outcome of various biliary bypass surgical procedures from a single centre over a period of 10 years. Methods: This is a prospective observational study conducted over a period of 10 years (January 2001-december 2010). A total of 1500 patients were included, who underwent pancreatico-biliary surgery due to common bile duct (CBD) stones, congenital anomalies of biliary tree, unoperable pancreatico-biliary malignancies, CBD strictures and cases who developed iatrogenic biliary injuries during cholecystectomy (both open & laproscopic) during this period of time. The patients who required biliary bypass surgery were further analysed for indications and outcome. Results: Out of 1500 patients 83(5.53%) required biliary bypass surgical procedures. The CBD stones were observed as the most common indication (25.3%), followed by CBD injuries after open(10.84%) or laproscopic-cholecystectomy (14.46%), carcinoma head of pancreas (12.05%) and CBD obstruction(14.46%) either due to CBD strictures or unknown distal obstruction. Roux-en-Y-hepatico-jejunostomy (26.51%) was the most frequently performed procedure, followed by choledochoduodenostomy and Roux-en-Y choledocho-jejunostomy (i.e. 25.3% and 12.05% respectively). Roux-en-Y biliary bypass procedure was observed to be associated with better outcome in terms of rate of complications as well duration of hospital stay. Conclusion: Biliary bypass surgical procedures are the better options to restore the continuity of biliary system in patients with iatrogenic biliary tree injuries and un-operable pancreatico-biliary malignancy. Roux-en-Y biliary bypass procedure is safe and problem solving method in these cases.

Hussain Talpur, K.Altaf; Mahmood Malik, Arshad; Iqbal Memon, Amir; Naeem Qureshi, Jawed; Khan Sangrasi, Ahmed; Laghari, Abdul Aziz

2013-01-01

217

Understanding Esophageal Dilation  

MedlinePLUS

Understanding Esophageal Dilation What is Esophageal Dilation? Esophageal dilation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your esophagus [swallowing tube]. Doctors ...

218

[A complication in biliary surgery: the biloma].  

PubMed

Authors stress that complications in laparotomic and laparoscopic extrahepatic biliary surgery aren't exceptional. Lesions could be due to section or to stenosis of biliary duct. We can distinguish: intraoperative lesions, which consist in a intraperitoneal bile groan that needs an immediate treatment; lesions that could be found in postoperative period and in any case many days after surgery. Among this complications there is biloma, i.e. a localized uncapsulated extraductal bile collection. Authors refer about their experience and describe clinical findings of this complication. They conclude affirming how biloma treatment doesn't require always resurgery or CT scan drain. Main biliary tract endoscopic decompression could be often useful. PMID:21232197

Barbuscia, M; Ilaqua, A; Lemma, G; Righettoni, A; Nucera, D; Sanò, M; Pergolizzi, F P

2010-01-01

219

[Diagnostic algorithm of biliary tract diseases in children].  

PubMed

Biliary tract (BT) diseases occupy one of the first places among the gastrointestinal diseases in children. The term "biliary tract" includes the gallbladder and intra-and extrahepatic bile ducts. The structure of biliary tract diseases had a significant increase in metabolic and inflammatory diseases, functional disorders. According to this, purpose of this study was to propose algorithms for children examination with biliary tract diseases in outpatient and hospital phases. In this article, based on their own experience was described the features and significance of laboratory and instrumental methods in the diagnosis of biliary tract disease in children. It was shown that the diagnostic significance of intrascope research methods in the identification of bile-excreting system diseases in children. PMID:20408261

Bogomaz, L V; Shcherbakov, P L; Tsar'kova, O N; Alekseeva, Iu E; Ermolenko, N A; Kochetova, E A; Shakorian, K A

2010-01-01

220

A simplified percutaneous hepatogastric drainage technique for malignant biliary obstruction.  

PubMed

We describe a technique to bypass a malignant biliary obstruction by creating a direct connection between the left biliary tree and the stomach. First, adherence between the left liver parenchyma and the stomach is achieved by a Cope anchor system. Then, the left biliary tree and stomach are connected by Colapinto needle puncture of the stomach from a left biliary duct with the needle inserted through a 9 Fr transhepatic sheath. Over a stiff guidewire, a Ring drainage catheter is placed. Later, the Ring catheter is replaced by a metallic stent. Four patients with malignant biliary obstruction underwent this procedure. The mean survival time was 77 days with maximum follow-up of 171 days. Neither obstruction nor dislocation of the metallic stents occurred. PMID:8846477

Tipaldi, L

1995-01-01

221

The effect of endoscopic sphincterotomy on acute and chronic complications of biliary endoprostheses  

Microsoft Academic Search

Background: Endoscopically placed biliary stents have become routine therapy for bile duct obstruction and bile leaks. Controversy exists regarding the use of biliary sphincterotomy to facilitate placement of 10F plastic stents. Methods: We retrospectively studied the effect of sphincterotomy on acute and chronic complications of 10F stent therapy. Data for acute complications, 30-day mortality and stent migration were obtained for

Craig Margulies; Eduardo Sampaio Siqueira; William Bruce Silverman; Xue Sen Lin; John Anthony Martin; Mordechai Rabinovitz; Adam Slivka

1999-01-01

222

Congenital duplex gallbladder and biliary mucocele associated with partial hepatic cholestasis and cholelithiasis in a cat  

PubMed Central

A 6-year-old neutered male domestic shorthair cat was presented for acute onset of vomiting. Exploratory laparotomy identified a duplex gallbladder and left cholecystectomy was performed. Histopathology confirmed biliary mucocele and hepatic cholestasis. While rare, biliary mucoceles should be considered as a differential diagnosis for feline extrahepatic bile duct obstruction.

Woods, Katharine S.; Brisson, Brigitte A.; Defarges, Alice M.N.; Oblak, Michelle L.

2012-01-01

223

Histological features of precancerous and early cancerous lesions of biliary tract carcinoma.  

PubMed

Biliary tract carcinoma develops within the intrahepatic or extrahepatic biliary tree and gallbladder. Primary sclerosing cholangitis, hepatolithiasis, congenital choledochal cyst, liver fluke infection, pancreatobiliary maljunction, toxic exposures and hepatitis virus infection are risk factors for the development of human biliary carcinoma. The precise molecular abnormalities of biliary carcinogenesis are still unknown, but chronic inflammatory conditions induce the production of reactive oxygen or nitrogen species leading to DNA damage. Recent studies indicate that cholangiocarcinoma of the large bile duct may arise in premalignant lesions such as biliary intraepithelial neoplasm (BilIN) and intraductal papillary neoplasm of the bile duct (IPNB). BilIN and IPNB are generally confined to the large and septal-sized bile duct. BilINs are occasionally observed in non-biliary liver cirrhosis as well as chronic biliary disease. In contrast, the precursor lesion of intrahepatic cholangiocarcinoma of the small bile duct type remains unclear. We herein demonstrated the histological characteristics of different tumor development pathways from premalignant lesion to carcinoma in different sites of the biliary tree. PMID:24446428

Aishima, Shinichi; Kubo, Yuichiro; Tanaka, Yuki; Oda, Yoshinao

2014-07-01

224

The effect of pancreatic and biliary depletion on the in vivo pharmacokinetics of digoxin in pigs  

Microsoft Academic Search

Several transporter systems in the liver and intestine are known to change their expression and function during cholestatic disease states. The objective of the present in vivo study was to investigate the effect of biliary depletion, as a method to mimic cholestasis, on the bioavailability and disposition of digoxin in biliary and pancreatic duct cannulated pigs. The study was divided

Christer Tannergren; Lena Evilevitch; Stefan Pierzynowski; Jose Valverde Piedra; Björn Weström; Kennedy Erlwanger; Marcin Tatara; Hans Lennernäs

2006-01-01

225

Biliary Origin Septicemia.  

National Technical Information Service (NTIS)

In Chengdu area most cases of septicemia of biliary origin are due to suppurative cholangitis, primary cholangiolithiasis and biliary ascariases. Two autopsies in this series showed thrombi mixed with free billirubin particles in numerous hepatic veins an...

L. Xiao J. Jiang X. Meng R. Chen

1981-01-01

226

[Pedicled small intestine segment for circular replacement of the extrahepatic bile duct in preserved papillary passage. An animal experiment study].  

PubMed

The effect of a small bowel segment as a extra-hepatic bile duct replacement was examined in 12 pigs followed-up for a period of 420 days. No complications, either during the operation or postoperatively, were observed in any of the animals. The laboratory parameters were within normal range over the entire observation period of 420 days. After 2, 6, and 12 months there was no anastomotic stenosis in the PTC. The intrahepatic biliary tract was not dilated. There was obvious peristalsis of the small bowel transplant towards the papilla of Vater. The autopsy showed that the grafts had healed without any sign of irritation. Histologically the structure of the graft remained undisturbed. There was a clear distinction between the mucosa of the bile duct and that of the small bowel, with no sign of a chronic infection. In the graft as well as in the vascular pedicle the nerve fibres were intact. Liver biopsy showed no pathological changes. In the light of these experiments, a small bowel segment presents a very promising alternative replacement of the extrahepatic biliary tract. PMID:1775001

Böttger, T; Weber, W; Sorger, K; Pickel, B; Mann, B; Junginger, T

1991-01-01

227

Recurrent cholangitis by biliary stasis due to non-obstructive afferent loop syndrome after pylorus-preserving pancreatoduodenectomy: report of a case.  

PubMed

Abstract We report a 71-year-old man who had undergone pylorus-preserving pancreatoduodenectomy (PPPD) using PPPD-IV reconstruction for cholangiocarcinoma. For 6 years thereafter, he had suffered recurrent cholangitis, and also a right liver abscess (S5/8), which required percutaneous drainage at 9 years after PPPD. At 16 years after PPPD, he had been admitted to the other hospital because of acute purulent cholangitis. Although medical treatment resolved the cholangitis, the patient was referred to our hospital because of dilatation of the intrahepatic biliary duct (B2). Peroral double-balloon enteroscopy revealed that the diameter of the hepaticojejunostomy anastomosis was 12 mm, and cholangiography detected intrahepatic stones. Lithotripsy was performed using a basket catheter. At 1 year after lithotripsy procedure, the patient is doing well. Hepatobiliary scintigraphy at 60 minutes after intravenous injection demonstrated that deposit of the tracer still remained in the upper afferent loop jejunum. Therefore, we considered that the recurrent cholangitis, liver abscess, and intrahepatic lithiasis have been caused by biliary stasis due to nonobstructive afferent loop syndrome. Biliary retention due to nonobstructive afferent loop syndrome may cause recurrent cholangitis or liver abscess after hepaticojejunostomy, and double-balloon enteroscopy and hepatobiliary scintigraphy are useful for the diagnosis of nonobstructive afferent loop syndrome. PMID:25058778

Sanada, Yukihiro; Yamada, Naoya; Taguchi, Masanobu; Morishima, Kazue; Kasahara, Naoya; Kaneda, Yuji; Miki, Atsushi; Ishiguro, Yasunao; Kurogochi, Akira; Endo, Kazuhiro; Koizumi, Masaru; Sasanuma, Hideki; Fujiwara, Takehito; Sakuma, Yasunaru; Shimizu, Atsushi; Hyodo, Masanobu; Sata, Naohiro; Yasuda, Yoshikazu

2014-01-01

228

Internal radiation for bile duct cancer  

Microsoft Academic Search

The clinical course of 27 patients with bile duct cancer who received intraductal exposure to192iridium was reviewed. All patients exhibited evidence of biliary obstruction prior to diagnosis of cancer and all underwent intubation for relief of obstruction either by surgical or radiologic methods. The patients then received either internal irradiation alone or the combination of internal plus external irradiation. The

William C. Meyers; R. Scott Jones

1988-01-01

229

[A new method for cannulation of the common bile duct in an experiment].  

PubMed

The proposed method of common biliary duct cannulation is simple, easily performed and permits studying bile hydrodynamics biligenesis for a necessary time. Tightness of the system is completely preserved after removal a choledochostomical tube. Walls of the invaginated stump of the cystic duct are swiftly abated as a result of hydrostatic pressure and cover its gap. The presence of purse string kapron suture in a stump orifice creates an obstacle to deinvagination. Good reparation properties of serous and subserous membranes, covering the biliary duct, promote rapid closing of stoma. Effectiveness of the proposed method of common biliary duct cannulation by means of the invaginated stump of the cystic duct is confirmed by the smooth postoperative course and absence of a biliary fistula after the tube removal. PMID:1286699

Va?da, R I; Slaby?, O B; Va?da, A R; Shul'ha?, O H

1992-01-01

230

Biliary Cast Syndrome in an Opium Inhaler  

PubMed Central

Biliary cast syndrome (BCS) is an uncommon complication which is mostly described in orthotopic liver transplantation. However, BCS has also been reported rarely in non-liver transplant patients. We describe a male long-term opium inhaler with BCS who underwent successful endoscopic cast removal by balloon enteroscopy-guided endoscopic retrograde cholangiopancreatography. A 52-year-old man, who was a known case of opium addiction, presented with the chief complaint of epigastric pain for 1 week prior to admission. Routine laboratory evaluation revealed cholestatic liver enzyme elevation. A cholestatic pattern was seen in radiographic modalities. Endoscopic retrograde cholangiopancreatography showed a linear filling defect in the intra- and extrahepatic duct. A long biliary cast was successfully removed using an extractor balloon. After removal of the biliary cast the patient is receiving ursodeoxycholic acid and does not report any problem 4 months after treatment. It seems that biliary dyskinesia due to long-term opium use can be a predisposing factor for biliary cast formation.

Dabiri, Reza; Aghdae, Hamid Asadzadeh; Rajabalinia, Hasan; Mohammad Alizadeh, Amir Houshang

2013-01-01

231

Lensing duct  

DOEpatents

A lensing duct to condense (intensify) light using a combination of front surface lensing and reflective waveguiding is described. The duct tapers down from a wide input side to a narrow output side, with the input side being lens-shaped and coated with an antireflective coating for more efficient transmission into the duct. The four side surfaces are uncoated, preventing light from escaping by total internal reflection as it travels along the duct (reflective waveguiding). The duct has various applications for intensifying light, such as in the coupling of diode array pump light to solid state lasing materials, and can be fabricated from inexpensive glass and plastic. 3 figures.

Beach, R.J.; Benett, W.J.

1994-04-26

232

Lensing duct  

DOEpatents

A lensing duct to condense (intensify) light using a combination of front surface lensing and reflective waveguiding. The duct tapers down from a wide input side to a narrow output side, with the input side being lens-shaped and coated with an antireflective coating for more efficient transmission into the duct. The four side surfaces are uncoated, preventing light from escaping by total internal reflection as it travels along the duct (reflective waveguiding). The duct has various applications for intensifying light, such as in the coupling of diode array pump light to solid state lasing materials, and can be fabricated from inexpensive glass and plastic.

Beach, Raymond J. (Livermore, CA), Benett

1994-01-01

233

Late biliary complications in human alveolar echinococcosis are associated with high mortality  

PubMed Central

AIM: To evaluate the incidence of late biliary complications in non-resectable alveolar echinococcosis (AE) under long-term chemotherapy with benzimidazoles. METHODS: Retrospective analysis of AE patients with biliary complications occurring more than three years after the diagnosis of AE. We compared characteristics of patients with and without biliary complications, analyzed potential risk factor for biliary complications and performed survival analyses. RESULTS: Ninety four of 148 patients with AE in Zurich had non-resectable AE requiring long-term benzimidazole chemotherapy, of which 26 (28%) patients developed late biliary complications. These patients had a median age of 55.5 (35.5-65) years at diagnosis of AE and developed biliary complications after 15 (8.25-19) years of chemotherapy. The most common biliary complications during long-term chemotherapy were late-onset cholangitis (n = 14), sclerosing cholangitis-like lesions (n = 8), hepatolithiasis (n = 5), affection of the common bile duct (n = 7) and secondary biliary cirrhosis (n = 7). Thirteen of the 26 patients had undergone surgery (including 12 resections) before chemotherapy. Previous surgery was a risk factor for late biliary complications in linear regression analysis (P = 0.012). CONCLUSION: Late biliary complications can be observed in nearly one third of patients with non-resectable AE, with previous surgery being a potential risk factor. After the occurrence of late biliary complications, the median survival is only 3 years, suggesting that late biliary complications indicate a poor prognostic outcome.

Frei, Pascal; Misselwitz, Benjamin; Prakash, Meher K; Schoepfer, Alain M; Prinz Vavricka, Bettina M; Mullhaupt, Beat; Fried, Michael; Lehmann, Kuno; Ammann, Rudolf W; Vavricka, Stephan R

2014-01-01

234

Development of the Bile Ducts: Essentials for the Clinical Hepatologist  

PubMed Central

Several cholangiopathies result from a perturbation of developmental processes. Most of these cholangiopathies are characterised by the persistence of biliary structures with foetal configuration. Developmental processes are also relevant in acquired liver diseases, as liver repair mechanisms exploit a range of autocrine and paracrine signals transiently expressed in embryonic life. We briefly review the ontogenesis of the intra and extrahepatic biliary tree, highlighting the morphogens, growth factors and transcription factors that regulate biliary development, and the relationships between developing bile ducts and other branching biliary structures. Then we discuss the ontogenetic mechanisms involved in liver repair, and how these mechanisms are recapitulated in ductular reaction, a common reparative response to many forms of biliary and hepatocellular damage. Finally, we discuss the pathogenic aspects of the most important primary cholangiopathies related to altered biliary development i.e. polycystic and fibropolycystic liver diseases, Alagille syndrome.

Strazzabosco, Mario; Fabris, Luca

2012-01-01

235

Biopsy - biliary tract  

MedlinePLUS

... removal of tissue or substances from the duodenum , bile ducts, pancreas, or pancreatic duct for examination under a ... results may be due to: Cancer of the bile ducts ( cholangiocarcinoma ) Cysts in the liver Liver cancer Pancreatic ...

236

Endotoxin and CD14 in the progression of biliary atresia  

Microsoft Academic Search

BACKGROUND: Biliary atresia (BA) is a typical cholestatic neonatal disease, characterized by obliteration of intra- and\\/or extra-hepatic bile ducts. However, the mechanisms contributing to the pathogenesis of BA remain uncertain. Because of decreased bile flow, infectious complications and damaging endotoxemia occur frequently in patients with BA. The aim of this study was to investigate endotoxin levels in patients with BA

Ming-Huei Chou; Jiin-Haur Chuang; Hock-Liew Eng; Ching-Mei Chen; Chiou-Huey Wang; Chao-Long Chen; Tsun-Mei Lin

2010-01-01

237

Treatment of Malignant Biliary Obstruction with Polyurethane Covered Walistents  

Microsoft Academic Search

OBJECTIVE. This study was undertaken to determine the safety, efficacy, and perfor- mance of polyurethane-covered Wallstents in the treatment of malignant biliary obstruction. SUBJECTS AND METHODS. This pilot study included 30 patients with malignant bil- iary obstruction. Palliative decompression of the obstructed bile duct was attempted with a polyurethane-covered Wallstent that is a prototype. Patients with hilar obstructions were cx-

Klaus A. Hausegger; Christoph L Zollikofer; Martin Uggowitzer; Christian Kugler; Johannes Lammer

238

Hepatobiliary scintigraphy for detecting biliary strictures after living donor liver transplantation  

PubMed Central

AIM: To investigate the diagnostic accuracy of hepatobiliary scintigraphy (HBS) in detecting biliary strictures in living donor liver transplantation (LDLT) patients. METHODS: We retrospectively reviewed 104 adult LDLT recipients of the right hepatic lobe with duct-to-duct anastomosis, who underwent HBS and cholangiography. The HBS results were categorized as normal, parenchymal dysfunction, biliary obstruction, or bile leakage without re-interpretation. The presence of biliary strictures was determined by percutaneous cholangiography or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: In 89 patients with biliary strictures, HBS showed biliary obstruction in 50 and no obstruction in 39, for a sensitivity of 56.2%. Of 15 patients with no biliary strictures, HBS showed no obstruction in 11, for a specificity of 73.3%. The positive predictive value (PPV) was 92.6% (50/54) and the negative predictive value (NPV) was 22% (11/50). We also analyzed the diagnostic accuracy of the change in bile duct size. The sensitivity, NPV, specificity, and PPV were 65.2%, 27.9%, 80% and 95%, respectively. CONCLUSION: The absence of biliary obstruction on HBS is not reliable. Thus, when post-LDLT biliary strictures are suspected, early ERCP may be considered.

Kim, Yu Jin; Lee, Kyu Taek; Jo, Young Cheol; Lee, Kwang Hyuck; Lee, Jong Kyun; Joh, Jae-Won; Kwon, Choon Hyuck David

2011-01-01

239

Methods of repair of noncircumferential bile duct defects.  

PubMed

Although noncircumferential bile duct defects are uncommon, they are important because they require careful repair to avoid subsequent biliary stricture. I have encountered three of these defects in more than 1000 biliary operations. The method of repair chosen for a particular case depends on the pathologic defect, the potency of the ampulla, and the tissues available for use. If the ampulla must be bypassed, a Roux-en-Y jejunal reconstruction is applicable for most biliary defects. An anastomosis between the bile duct and duodenum may be suitable to repair low biliary defects. Occasionally, the gallbladder can be used as a conduit between the bile duct defect and the duodenum or jejunum. If the ampulla need not be bypassed, a Heineke-Mikulicz repair is suitable only for very short defects. A patch technique is a better choice for larger defects. Patches can be made of autogenous vein, gallbladder, knitted Teflon, or a serosal onlay patch of duodenum or jejunum. A vein patch is especially appealing because it will easily cover any extrahepatic defect. A different method was chosen in each of three cases. Side-to-side Roux-en-Y hepaticojejunostomy was used to repair a large cholecystocholedochal fistula with associated pancreatitis. Heineke-Mikulicz repair was employed for a short hepatic duct stricture. Saphenous vein patch was used to repair a long bile duct defect during a left hepatectomy for hepatocellular carcinoma. This patient presumably represents the second successful reported vein patch repair and the only one with subsequent studies showing the fate of the vein patch. The vein patch apparently acts as a temporary scaffold allowing the outgrowth of biliary epithelium from the remaining bile duct wall. Careful initial repair of these noncircumferential bile duct defects is essential to avoid a subsequent biliary stricture with its disastrous consequences. PMID:6297108

Rutledge, R H

1983-02-01

240

Origins of biliary copper.  

PubMed

We tested the hypothesis that the copper present in bile--the major route of elimination of the metal from the body--is derived exclusively from hepatocytes by administering radiocopper (64Cu or 67Cu)-labeled ionic Cu, desialylated (AsCPN) or intact human ceruloplasmin (CPN), intravenously, to rats with cannulated bile ducts. The rates of appearance and the total amounts of radiolabeled isotope recovered in bile were measured. The three vehicles chosen for the delivery of radiocopper interact differently with hepatocytes: ionic Cu is taken up by a passive process (Schmitt, R. C. et al., Am. J. Physiol. 1983; 244:G183-G191); AsCPN is promptly cleared from the circulation by specific receptor-mediated endocytosis, and CPN largely remains in the circulation for the duration of the experiment. Similar amounts of radiocopper were recovered following injections of ionic Cu (3.1%) or CPN (2%), but substantially larger amounts (8.1%) were excreted after administration of AsCPN. Using an antibody to CPN which reacts also with AsCPN, we found about 70% of the bile radioactivity to be immunoprecipitable following injections of either glycoprotein, indicating that a fraction of these copper proteins had entered the bile essentially unmodified. Our observations indicate that in addition to the lysosomal compartment which catabolizes a portion of the AsCPN in hepatocytes, there appears to be a direct route for AsCPN from hepatocellular sinusoids to the bile canaliculi. Since CPN does not interact significantly with hepatocytes, its presence in bile suggests transcytosis via the biliary epithelium. PMID:6479854

Kressner, M S; Stockert, R J; Morell, A G; Sternlieb, I

1984-01-01

241

Primary biliary cirrhosis in adults.  

PubMed

Primary biliary cirrhosis (PBC) is a chronic, autoimmune, cholestatic liver disease. It is characterized by slow destruction of small intrahepatic bile ducts, impaired biliary secretion and stasis of toxic endogenous bile acids within the liver with progression to liver fibrosis and cirrhosis. It has an increasing prevalence worldwide. It occurs more commonly in women than men at a ratio of 10:1. In most cases, diagnosis relies on a positive antimitochondrial antibody in the context of chronic cholestasis, without the need for a liver biopsy. Ursodeoxycholic acid improves survival even in patients with advanced liver disease. Certain findings such as fatigue, anti-nuclear antibodies, anti-centromere antibodies and the GP210 antinuclear antibody predict a poor outcome. Up to 40% of patients do not respond satisfactorily to ursodeoxycholic acid therapy and should be considered for adjunctive therapies. Several adjunctive and newer therapies are being tested and some appear promising. We provide a review of PBC with a focus on advances in therapies that may impact the management of PBC in the near future. PMID:24580040

Momah, Njideka; Lindor, Keith D

2014-05-01

242

Management of Simultaneous Biliary and Duodenal Obstruction: The Endoscopic Perspective  

PubMed Central

Obstructive jaundice often develops in patients with unresectable malignancy in and around the head of the pancreas. Duodenal obstruction can also occur in these patients, and usually develops late in the disease course. Palliation of both malignant biliary and duodenal obstruction is traditionally performed with surgical diversion of the bile duct and stomach, respectively. With the advent of nonsurgical palliation of biliary obstruction using endoscopic transpapillary expandable metal stent placement, a similar approach can be used to palliate duodenal obstruction by placement of expandable metal gastroduodenal stents. Endoscopic palliation can be achieved in patients who require relief of both biliary obstruction and duodenal obstruction, although this can be technically difficult to achieve depending on the level of duodenal obstruction in relation to the major papilla. This article reviews the endoscopic approaches for combined palliative relief of malignant biliary and duodenal obstruction.

2010-01-01

243

Extended bile duct resection — a new oncological approach to the treatment of central bile duct carcinomas?  

Microsoft Academic Search

Since the results of surgical resection and transplantation in the treatment of central bile duct carcinomas have been poor and neither radiotherapy nor chemotherapy has shown promising results, a new attempt to achieve curative resection has been made to combine liver transplantation with the Kausch-Whipple operation. With this operation the complete biliary system can be resected without touching the region

P. Neuhaus; G. Blumhardt

1994-01-01

244

Extrahepatic biliary cancer: New staging classification  

PubMed Central

Tumor staging defines the point in the natural history of the malignancy when the diagnosis is made. The most common staging system for cancer is the tumor, node, metastases classification. Staging of cancers provides useful parameters in the determination of the extent of disease and prognosis. Cholangiocarcinoma are rare and refers to cancers that arise from the biliary epithelium. These tumors can occur anywhere along the biliary tree. These tumors have been previously divided into extrahepatic and intrahepatic lesions. Until recently the extrahepatic bile duct tumors have been considered as a single entity per American Joint Commission on Cancer (AJCC) staging classification. The most recent changes to the AJCC classification of bile duct cancers divide the tumors into two major categories: proximal and distal tumors. This practical classification is based on anatomy and surgical management. High quality cross-sectional computed tomography (CT) and/or magnetic resonance (MR) imaging of the abdomen are essential information to accurately stage this tumors. Imaging plays an important role in diagnosis, localization, staging and optimal management of cholangiocarcinoma. For example, it helps to localize the tumor to either perihilar or distal bile duct, both of which have different management. Further, it helps to accurately stage the disease and identify the presence of significant nodal and distant metastasis, which may preclude surgery. Also, it helps to identify the extent of local invasion, which has a major impact on the management. For example, extensive involvement of hepatic duct reaching up to second-order biliary radicals or major vascular encasement of portal vein or hepatic arteries precludes curative surgery and patient may be managed by palliative therapy. Further, imaging helps to identify any anatomical variations in the hepatic arterial or venous circulation and biliary ductal system, which is vital information for surgical planning. This review presents relevant clinical presentation and imaging acquisition and presentation for the accurate staging classification of bile duct tumors based on the new AJCC criteria. This will be performed with the assistance of anatomical diagrams and representative CT and MR images. The image interpretation must include all relevant imaging information for optimum staging. Detailed recommendations on the items required on the radiology report will be presented.

Ganeshan, Dhakshinamoorthy; Moron, Fanny E; Szklaruk, Janio

2012-01-01

245

Postoperative pancreatitis as a complication of biliary surgery.  

PubMed

Forty patients who underwent biliary surgery were investigated for postoperative pancreatic disturbance as measured by the amylase creatinine clearance ration (ACCR). Its relevance to preoperative pancreatitis, exploration of the common bile duct, and operative cholangiography were examined. The results suggested that a recent clinically proven episode of pancreatitis did not predispose to a postoperative recurrence following biliary surgery. Similarly, cholecystectomy alone did not produce a postoperative pancreatic disturbance. However, exploration of the common bile duct did frequently cause a postoperative elevated ACCR, and hence we recommend that duct exploration should be performed as carefully and as atraumatically as possible. The small number of patients who did not have operative cholangiograms prevented statistical evaluation of the effect of this procedure on the pancreas. However, information from elsewhere suggests that the plasma amylase level is not likely to be raised by cholangiography. PMID:291412

Ingram, D M; House, A K; Garcia-Webb, P

1979-08-01

246

[The late results after rehabilitative and reconstructive operations on the bile ducts].  

PubMed

Of 7000 patients operated on biliary ducts in 622 the recovering and reconstructive interventions were conducted. Late follow-up result was studied in 313 (51%) patients. Good result was noted in 179 (57.7%) patients, fair--in 99 (32.2%), poor--in 35 (10.1%) in terms from 3 months till 17 years. In patients operated on for the "forgotten" biliary ducts concrements, frequently combined with stenosis of common biliary duct terminal portion, most frequently good and fair result was noted. Late follow-up result of reconstructive operations using external transhepatic carcass drainage was significantly better than after application of other methods of correction for high stricture and injury of biliary ducts. PMID:7602940

Vecherko, V N; Minin, V V; Konoplia, P P; Khatsko, V V; Shatalov, A D

1994-01-01

247

Prevention of Biliary Lesions That May Occur During Radiofrequency Ablation of the Liver  

PubMed Central

Objective: To prevent bile duct injury by using a cold 5% glucose isotonic solution cooling in the bile ducts when radiofrequency (RF) is performed in a porcine model. Summary Background Data: Complications that may arise during liver RF ablation include biliary stenosis and abscesses. Methods: The RITA 1500 generator was used for the experiments. Two lesions were performed in the left liver. The pigs were killed 1 or 3 weeks after the procedure. An ex vivo cholangiogram was obtained by direct injection into the main bile duct. Samples of RF lesions, of liver parenchyma near and at a distance from the RF lesions, underwent pathologic studies. Two groups of 20 pigs each were treated: one without perfusion of the bile ducts and the other with perfusion of cold 5% glucose isotonic solution into the bile ducts. The Pringle maneuver was used in 50% of the RF procedures. Radiologic lesions were classified as biliary stenosis, complete interruption of the bile duct, or extravasation of the radiologic contrast liquid. Results: Histologic lesions of the bile ducts were observed near the ablated RF lesion site and at a distance from the RF lesions when a Pringle maneuver was performed. Radiologic and histologic lesions of the bile ducts were significantly reduced (P < 0.0001) when the bile ducts were cooled. Conclusions: Cooling of the bile ducts with a cold 5% glucose isotonic solution significantly protects the intrahepatic bile ducts from damages caused by the heat generated by RF when performed close to the bile ducts.

Marchal, Frederic; Elias, Dominique; Rauch, Philippe; Zarnegar, Rasa; Leroux, Agnes; Stines, Joseph; Verhaeghe, Jean-Luc; Guillemin, Francois; Carteaux, Jean Pierre; Villemot, Jean Pierre

2006-01-01

248

Percutaneous Transhepatic Cutting Balloon Papillotomy for Removal of Common Bile Duct Stones  

Microsoft Academic Search

We report the case of a 66-year-old female who presented with jaundice secondary to recurrent adenocarcinoma of the gallbladder and several common bile duct stones. Percutaneous papillary dilatation was planned to remove the common bile duct stones. Papilla was dilated through the percutaneous approach with an 8-mm peripheral cutting balloon instead of a standard balloon. All the stones were pushed

Levent Oguzkurt; Ugur Ozkan; Burcak Gumus

2009-01-01

249

Profiling circulating and urinary bile acids in patients with biliary obstruction before and after biliary stenting.  

PubMed

Bile acids are considered as extremely toxic at the high concentrations reached during bile duct obstruction, but each acid displays variable cytotoxic properties. This study investigates how biliary obstruction and restoration of bile flow interferes with urinary and circulating levels of 17 common bile acids. Bile acids (conjugated and unconjugated) were quantified by liquid chromatography coupled with tandem mass spectrometry in serum and urine samples from 17 patients (8 men and 9 women) with biliary obstruction, before and after biliary stenting. Results were compared with serum concentrations measured in 40 age- and sex-paired control donors (20 men and 20 women). The total circulating bile acid concentration increases from 2.7 µM in control donors to 156.9 µM in untreated patients with biliary stenosis. Serum taurocholic and glycocholic acids exhibit 304- and 241-fold accumulations in patients with biliary obstruction compared to controls. The enrichment in chenodeoxycholic acid species reached a maximum of only 39-fold, while all secondary and 6?-hydroxylated species--except taurolithocholic acids--were either unchanged or significantly reduced. Stenting was efficient in restoring an almost normal circulating profile and in reducing urinary bile acids. Conclusion: These results demonstrate that biliary obstruction affects differentially the circulating and/or urinary levels of the various bile acids. The observation that the most drastically affected acids correspond to the less toxic species supports the activation of self-protecting mechanisms aimed at limiting the inherent toxicity of bile acids in face of biliary obstruction. PMID:21760958

Trottier, Jocelyn; Bia?ek, Andrzej; Caron, Patrick; Straka, Robert J; Milkiewicz, Piotr; Barbier, Olivier

2011-01-01

250

Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study  

Microsoft Academic Search

Background  The ongoing debate between routine and selective users of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy\\u000a (LC) has not yet come to an end. Routine users argue that IOC decreases the rate of biliary complications such as bile duct\\u000a injury, biliary leak and missed common bile duct (CBD) stones, a claim that selective users do not fully support. On the other

Mostafa A. HamadAhmad; Ahmad A. Nada; Mohamad Y. Abdel-Atty; Ahmad S. Kawashti

251

100 consecutive common duct explorations without mortality.  

PubMed

It has been suggested that the incidence of morbidity and mortality after common duct exploration no longer justifies its use in patients with a gallbladder in situ. Therefore endoscopic sphincterotomy has been advocated for removal of common duct stones before cholecystectomy in selected patients. The purpose of this study was to determine our current rate of retained common duct stones and the morbidity and mortality rates associated with common duct exploration. Charts of 100 consecutive patients who underwent cholecystectomy and common duct exploration from January 1982 through December 1986 were reviewed. Indications for duct exploration included jaundice, dilated common bile duct, gallstone pancreatitis, multiple small stones, and abnormal intraoperative cholangiogram. Common duct exploration was done by manual technique or choledochoscopy, as determined by the surgeon's preference. Only two patients required duodenotomy for extraction of difficult stones. There were no deaths in this series of consecutive common duct exploration. The total morbidity rate was 15.7%, which included a 5.3% incidence of retained common duct stones. There was a 7.4% major complication rate, including deep vein thrombosis, bleeding gastric ulcer, and pneumonia. The remaining complications were minor and did not prolong hospitalization. There was one wound infection and no postoperative pancreatitis. None of the complications were directly attributable to choledochotomy or duct exploration. All retained common duct stones were removed by endoscopic retrograde cholangiopancreatography or by angiographic basket and did not require reoperation. It is concluded that operative common duct exploration not requiring duodenotomy is safe and does not appreciably increase the incidence of complications after cholecystectomy. Endoscopic sphincterotomy continues to be the preferable alternative to operative common duct exploration for patients with retained common duct stones. PMID:2310236

Pappas, T N; Slimane, T B; Brooks, D C

1990-03-01

252

Current Status of Photodynamic Therapy for Bile Duct Cancer  

PubMed Central

The most common form in bile duct cancers is a highly desmoplastic cancer with a growth pattern characterized by periductal extension and infiltration. The prognosis of bile duct cancers, especially hilar cholangiocarcinoma, is limited by tumor spread along the biliary tree leading to refractory obstructive cholestasis, cholangitis, and liver failure. Although biliary endoprosthesis improves occlusion rates and reduces the number of therapeutic interventions, median survival time is not ameliorated. Photodynamic therapy (PDT) is a local photochemical tumor treatment that consists of a photosensitizing agent in combination with laser irradiation of a distinct wavelength. Tumor ablation with PDT combined with biliary stenting reduces cholestasis and significantly improves median survival time in selected patients with bile duct cancers.

Lee, Tae Yoon; Shim, Chan Sup

2013-01-01

253

Systemic therapy for biliary tract cancers.  

PubMed

Biliary tract cancers (BTCs) are invasive carcinomas that arise from the epithelial lining of the gallbladder and bile ducts. These include intrahepatic, perihilar, and distal biliary tree cancers as well as carcinoma arising from the gallbladder. Complete surgical resection offers the only chance for cure; however, only 10% of patients present with early-stage disease and are considered surgical candidates. Among those patients who do undergo "curative" resection, recurrence rates are high; thus, for the majority of BTC patients, systemic chemotherapy is the mainstay of their treatment plan. Patients with unresectable or metastatic BTC have a poor prognosis, with a median overall survival time of <1 year. Despite a paucity of randomized phase III data, a consensus on first-line systemic therapy is emerging. In this review, we discuss the clinical experience with systemic treatment of BTC, focusing on the rationale for a first-line regimen as well as future directions in the field. PMID:18448556

Hezel, Aram F; Zhu, Andrew X

2008-04-01

254

Simultaneous non-traumatic perforation of the right hepatic duct and gallbladder: an atypical occurrence.  

PubMed

Simultaneous non-traumatic perforation of the extrahepatic bile duct and the gallbladder is an uncommon occurrence that has been infrequently reported. We describe a patient with a spontaneous perforation of both the extrahepatic bile duct and the gallbladder. A contrast-enhanced computed tomography (CECT) scan of the abdomen and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a perforation of the gallbladder and a free leak from the right hepatic duct, respectively. Endoscopic biliary drainage following a sphincterotomy and biliary stent placement led to a dramatic improvement in the patient's general condition. He was subsequently scheduled to undergo an elective cholecystectomy. Repeat ERCP performed at 4 weeks after the initial stenting showed a normal cholangiogram and a distally migrated stent, which was there after removed. However, early stent removal led to re-perforation of hepatic duct and gallbladder. A repeat endoscopic biliary drainage did not help, and the patient developed biliary peritonitis. Surgical exploration revealed a perforation at the fundus of the gallbladder, 400 ml of biliopurulent collection and a frozen Calot's triangle. A subtotal cholecystectomy, gall stone removal, and a thorough peritoneal lavage were undertaken. The patient improved postoperatively. The second biliary stent was removed after 4 months. This case report highlights the role of endoscopic biliary drainage in the management of an extrahepatic bile duct perforation and warns against the early removal of a biliary stent. PMID:23610553

Garg, Pankaj Kumar; Jain, Bhupendra Kumar; Pandey, Satya Deo; Rathi, Vinita; Puri, Amarendra Singh

2012-07-01

255

Simultaneous Non-Traumatic Perforation of the Right Hepatic Duct and Gallbladder: An Atypical Occurrence  

PubMed Central

Simultaneous non-traumatic perforation of the extrahepatic bile duct and the gallbladder is an uncommon occurrence that has been infrequently reported. We describe a patient with a spontaneous perforation of both the extrahepatic bile duct and the gallbladder. A contrast-enhanced computed tomography (CECT) scan of the abdomen and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a perforation of the gallbladder and a free leak from the right hepatic duct, respectively. Endoscopic biliary drainage following a sphincterotomy and biliary stent placement led to a dramatic improvement in the patient’s general condition. He was subsequently scheduled to undergo an elective cholecystectomy. Repeat ERCP performed at 4 weeks after the initial stenting showed a normal cholangiogram and a distally migrated stent, which was there after removed. However, early stent removal led to re-perforation of hepatic duct and gallbladder. A repeat endoscopic biliary drainage did not help, and the patient developed biliary peritonitis. Surgical exploration revealed a perforation at the fundus of the gallbladder, 400 ml of biliopurulent collection and a frozen Calot’s triangle. A subtotal cholecystectomy, gall stone removal, and a thorough peritoneal lavage were undertaken. The patient improved postoperatively. The second biliary stent was removed after 4 months. This case report highlights the role of endoscopic biliary drainage in the management of an extrahepatic bile duct perforation and warns against the early removal of a biliary stent.

Garg, Pankaj Kumar; Jain, Bhupendra Kumar; Pandey, Satya Deo; Rathi, Vinita; Puri, Amarendra Singh

2012-01-01

256

Biliary repair and carcinogenesis are mediated by IL-33-dependent cholangiocyte proliferation  

PubMed Central

Injury to the biliary epithelium triggers inflammation and fibrosis, which can result in severe liver diseases and may progress to malignancy. Development of a type 1 immune response has been linked to biliary injury pathogenesis; however, a subset of patients with biliary atresia, the most common childhood cholangiopathy, exhibit increased levels of Th2-promoting cytokines. The relationship among different inflammatory drivers, epithelial repair, and carcinogenesis remains unclear. Here, we determined that the Th2-activating cytokine IL-33 is elevated in biliary atresia patient serum and in the livers and bile ducts of mice with experimental biliary atresia. Administration of IL-33 to WT mice markedly increased cholangiocyte proliferation and promoted sustained cell growth, resulting in dramatic and rapid enlargement of extrahepatic bile ducts. The IL-33–dependent proliferative response was mediated by an increase in the number of type 2 innate lymphoid cells (ILC2s), which released high levels of IL-13 that in turn promoted cholangiocyte hyperplasia. Induction of the IL-33/ILC2/IL-13 circuit in a murine biliary injury model promoted epithelial repair; however, induction of this circuit in mice with constitutive activation of AKT and YAP in bile ducts induced cholangiocarcinoma with liver metastases. These findings reveal that IL-33 mediates epithelial proliferation and suggest that activation of IL-33/ILC2/IL-13 may improve biliary repair and disruption of the circuit may block progression of carcinogenesis.

Li, Jun; Razumilava, Nataliya; Gores, Gregory J.; Walters, Stephanie; Mizuochi, Tatsuki; Mourya, Reena; Bessho, Kazuhiko; Wang, Yui-Hsi; Glaser, Shannon S.; Shivakumar, Pranavkumar; Bezerra, Jorge A.

2014-01-01

257

Proposal of a new disease concept "biliary diseases with pancreatic counterparts". Anatomical and pathological bases.  

PubMed

The biliary tract and pancreas are located closely anatomically, and both develop from the endoderm foregut almost at the same time. Interestingly, the lining epithelia of the bile duct and main pancreatic duct show similar morphologies and phenotypes, and both are accompanied by periductal glands. Furthermore, the exocrine pancreatic acini are remnantly found in the peribiliary glands. Based on these findings, it seems plausible that the biliary tract has features of pancreatic elements in addition to the duct system, which is specialized for the drainage of bile secreted by hepatic parenchyma, particularly, hepatocytes. Interestingly, some pancreatic and biliary diseases show similar pathological features and even biological behaviors. For example, extrahepatic cholangiocarcinoma and ductal adenocarcinoma of the pancreas share many clinicopathological features. Both of them are hypothesized to arise from similar preneoplastic and early neoplastic intraepithelial lesions. Intraductal papillary tumors, with frequent mucin hyperproduction, develop in the pancreas (intraductal papillary mucinous neoplasm) and also in the biliary tract (intraductal papillary neoplasm of the bile duct). IgG4-related disease affects the biliary tract (IgG4-related sclerosing cholangitis) and the pancreas (autoimmune pancreatitis) in the same patients, with both showing similar morphologies. Herein, we propose that these non-neoplastic and neoplastic biliary diseases showing similarities to corresponding pancreatic diseases could be included in a new disease concept "biliary diseases with pancreatic counterparts". Based on this new concept, information obtained in biliary tract diseases could be applied to the analysis of pancreatic disease and vice versa, and also novel therapeutical strategies and molecular and genetic studies on pancreatic and biliary diseases may be developed with a unified approach. PMID:24108502

Nakanuma, Yasuni; Harada, Kenichi; Sasaki, Motoko; Sato, Yasunori

2014-01-01

258

Amylase creatinine clearance ratio after biliary surgery.  

PubMed

The amylase creatinine clearance ratio (ACCR) is considered to be a more sensitive index of acute pancreatitis than the serum amylase level. Serial ACCR estimations were undertaken in 25 patients undergoing an elective cholecystectomy. Using accepted criteria, 28% of these patients developed, in the postoperative period, biochemical evidence of pancreatic gland damage, although the serum amylase level remained normal. This raised ACCR was particularly noted in patients who had undergone an exploration of the common bile duct. The ACCR would appear to be a more sensitive index of pancreatic gland disruption secondary to biliary surgery than the serum amylase level. PMID:402305

Donaldson, L A; McIntosh, W; Joffe, S N

1977-01-01

259

Duct closure  

DOEpatents

A closure for an inclined duct having an open upper end and defining downwardly extending passageway. The closure includes a cap for sealing engagement with the open upper end of the duct. Associated with the cap are an array of vertically aligned plug members, each of which has a cross-sectional area substantially conforming to the cross-sectional area of the passageway at least adjacent the upper end of the passageway. The plug members are interconnected in a manner to provide for free movement only in the plane in which the duct is inclined. The uppermost plug member is attached to the cap means and the cap means is in turn connected to a hoist means which is located directly over the open end of the duct.

Vowell, Kennison L. (Canoga Park, CA)

1987-01-01

260

Intraoperative cholangiography and bile duct injury.  

PubMed

We are not in agreement with the opinion that the credit for excellent results after laparoscopic cholecystectomy is to be attributed to the routine performing of intraoperative cholangiography. We performed 2538 laparoscopic cholecystectomies without routine intraoperative cholangiography and we obtained very low rate and severity of common bile duct injuries: there was a total of four common bile duct injuries (0.16%), in no case was the injury a major transaction, and injuries were detected intraoperatively and easily repaired with a T-tube. Cholangiography could prevent bile duct transaction, but that it is not necessary for intraoperative cholangiography to be routinely performed for this purpose. It is sufficient for intraoperative cholangiography to be performed whenever the surgeon is in doubt as to the biliary anatomy or common bile duct clearance, and that when dissection of the cholecystic peduncle proves difficult he does not hesitate to convert to open access. PMID:16333543

Sarli, L; Costi, R; Roncoroni, L

2006-01-01

261

Choledocholithiasis associated with malignant biliary obstruction--significance and management.  

PubMed

Distal bile duct stones and proximal extra-hepatic malignant biliary obstructions may coexist. These stones, probably predating the development of the malignant obstruction but of unknown aetiological significance, were found in seven of 60 patients with proximal tumours (11.6%) at percutaneous biliary drainage. In two of these cases, stones blocked outflow from a supra-ampullary stent. All seven patients also had evidence of gall-bladder stones. Five of the seven patients had cholangiocarcinoma, giving an incidence of duct stones in such patients (n = 27) of 18.5%. In one case, the stones were removed endoscopically, in four, the stones were removed percutaneously and, in the remaining two cases, they were left in situ beside a stent. None of 120 cases with malignant obstruction had stones proximal to the obstruction. Distal common duct stones are associated with proximal malignant biliary duct obstruction, especially with cholangiocarcinoma and coexisting gall-bladder stones. They may interfere with stent function and cause diagnostic confusion at cholangiography. PMID:9464436

Nichols, D M; Macleod, A J

1998-01-01

262

[A case of mediastinal thoracic duct cyst].  

PubMed

This is a rare case of thoracic duct cyst in 34-year-old woman. She complained of a left supraclavicular mass and admitted our hospital. A clinical examinations were all within normal limit. The chest X-ray and the magnetic resonance imaging examinations revealed a round tumor 65 x 40 mm in diameter with clear margin located at the left upper mediastinum. The slightly dilated thoracic duct was connected to the tumor. The left supraclavicular vein was compressed by the tumor. The cystectomy was performed under diagnosis of thoracic duct cyst by Trap door method on September, 17, 1999. Macroscopically, thin-capsulated elastic soft tumor contained chyle, and it was connected to the thoracic duct and the left jugular vein. The histological diagnosis was thoracic duct cyst. The postoperative course was uneventful, and the patient was discharged 9 days after operation. The patient remains disease-free at 8 months after the operation. PMID:11712381

Suzuki, Y; Ogawa, N; Mukai, K; Ishiwa, N

2001-11-01

263

Percutaneous transhepatic biliary stenting in patients with intradiverticular papillae and biliary strictures caused by ampullary carcinoma: A case report  

PubMed Central

Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy is a well-established procedure for the treatment of bile duct strictures. However, the procedure is difficult to perform in patients with intradiverticular papillae or tumor infiltration of the major papilla. Percutaneous transhepatic biliary stenting (PTBS) is commonly used in the management of malignant biliary stricture. The current study reports two cases of PTBS performed to treat malignant obstructive jaundice caused by ampullary carcinoma complicated with intradiverticular papillae. PTBS is potentially a safe technique for this relatively rare condition.

NIU, HONG-TAO; HUANG, QIANG; ZHAI, REN-YOU

2014-01-01

264

Causes and consequences of ischemic-type biliary lesions after liver transplantation  

Microsoft Academic Search

Biliary complications are a major source of morbidity, graft loss, and even mortality after liver transplantation. The most\\u000a troublesome are the so-called ischemic-type biliary lesions (ITBL), with an incidence varying between 5% and 15%. ITBL is\\u000a a radiological diagnosis, characterized by intrahepatic strictures and dilatations on a cholangiogram, in the absence of hepatic\\u000a artery thrombosis. Several risk factors for ITBL

Carlijn I. Buis; Harm H Hoekstra; Robert C. Verdonk; Robert J. Porte

2006-01-01

265

[Obstruction of the common bile duct by a cystic duct cyst in the recipient after liver transplantation].  

PubMed

Four cases of tension mucocele of the cystic duct of the graft after orthotopic liver transplantation have been described in the English literature. We report the case of a mucocele of the recipient's cystic duct occurring in a patient who underwent liver transplantation for sclerosing cholangitis secondary to histiocytosis X. At variance with the 4 previously reported cases, this complication could be related to progression of the initial disease in the recipient's cystic duct. To avoid such a biliary complication in patients undergoing a liver transplantation for sclerosing cholangitis, resection of the extra-hepatic duct must be as large as possible and choledochojejunostomy seems to be the best procedure for biliary reconstruction. PMID:2221790

Aghzadi, R; Boillot, O; Bernard, O; Houssin, D; Chapuis, Y

1990-01-01

266

[Causes and prevention of bile duct injuries during surgery].  

PubMed

From 1977 till 1993 in the clinic 108 patients were treated for the injury of extrahepatic biliary ducts occurred during cholecystectomy or gastric resection, performed mainly in the other medical departments. Injury of the ducts was diagnosed while operation performance in 68 patients. In 58 (54,6%) observations the reason of injury was the lack of surgeon's qualification and in 22 (20,3%)--nonadequate conditions of operation performance. PMID:7658661

Vecherko, V N; Khatsko, V V; Konoplia, P P; Shatalov, A D; Tro?nikova, N V

1994-01-01

267

Biliary obstruction - series (image)  

MedlinePLUS

... indicate a high level of bilirubin, a waste product of the liver, or diagnosis may come from an endoscopic examination. Untreated biliary obstruction may cause life-threatening infection or chronic liver disease.

268

Antioxidant enzyme status in biliary obstructed rats: effects of N-acetylcystee  

Microsoft Academic Search

Background\\/Aims: N-acetylcysteine (NAC) is a modulator of thiol levels that protects against hepato- toxic agents. The aim of this study was to investigate whether NAC might improve hepatic antioxidant de- fenses in chronically biliary obstructed rats. Methods: Secondary biliary cirrhosis was induced by 28 days of bile-duct obstruction. Groups of control and cirrhotic animals received NAC (50 ~01 - kg-'

Ana Pastor; Pilar S. Collado; M. Almar; Javier Gonzalez-Gallego

269

Nitric Oxide-mediated Liver Injury in the Presence of Experimental Bile Duct Obstruction  

Microsoft Academic Search

We investigated the possible mechanism of common bile duct (CBD) obstruction-related liver cell necrosis in a guinea pig model during a 24-hour period of biliary occlusion. A total of 30 male albino guinea pigs were randomly and equally assigned to two groups. Group 1 underwent sham laparotomy (SL), and group 2 underwent common bile duct ligation (CBDL). All the animals

Atilla Engin; B. ?ükrü Bozkurt; Nilgün Altan; Leyla Memi?; Neslihan Bukan

2003-01-01

270

Orthoplasty for Bile Duct Stricture at the Liver Hilum, A Preliminary Report of 5 Cases.  

National Technical Information Service (NTIS)

The current operative treatment for stricture of the bile ducts at the liver hilum has been anastomosis of the proximal bile duct with a defunctioned limb of the jejunum. Such an operation bypasses a functioning papilla and leaves the proximal biliary sys...

R. Ran

1981-01-01

271

Double cystic duct in a child with VACTERL association: a case report.  

PubMed

Double cystic duct is an extremely rare anomaly of the biliary tract not described in the pediatric literature. We report the first pediatric case born with VACTERL association found to have double cystic ducts during gallbladder surgery for symptomatic cholelithiasis. Description of the anatomic variability, cholangiography images, and pathologic findings along with review of the literature is included. PMID:19954104

Lugo-Vicente, Humberto; Correa, Maria; Brunet, Hector

2009-01-01

272

Chronic Bile Duct Injury Associated with Fibrotic Matrix Microenvironment Provokes Cholangiocarcinoma in p53Deficient Mice  

Microsoft Academic Search

Intrahepatic cholangiocarcinoma (CCA) is a lethal malignancy of the biliary epithelium associated with p53 mutations, bile duct injury, inflammation, and fibrosis. Here, to validate these processes in CCA, we developed a liver cirrhosis model driven by chronic intermittent toxin exposure, which provokes bile duct injury\\/necrosis and proliferation, fibroblast recruitment, and progressive extracellular matrix (ECM) changes. Fibrotic changes in the matrix

Paraskevi A. Farazi; Michael Zeisberg; Jonathan Glickman; Yan Zhang; Raghu Kalluri; Ronald A. DePinho

273

Manometric study of the sphincter of Oddi in patients with and without common bile duct stones  

Microsoft Academic Search

Motor activity of the sphincter of Oddi has been evaluated in 34 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a polyethylene triple lumen catheter. At ERCP 16 patients had undamaged biliary ducts; six had undergone cholecystectomy and six had gall bladder stones; 18 patients had common bile

E De Masi; E Corazziari; F I Habib; B Fontana; V Gatti; G F Fegiz; A Torsoli

1984-01-01

274

Dilation and Curettage  

MedlinePLUS

What is dilation and curettage (D&C)? D&C is a surgical procedure in which the cervix is opened (dilated) and ... can occur. These complications are rare. • What is dilation and curettage (D&C)? • Why is a D& ...

275

Primary biliary cirrhosis.  

PubMed

Primary biliary cirrhosis often presents insidiously but progresses relentlessly in its later stages. Asymptomatic patients, however, may have a relatively benign course. Clinical, laboratory and histologic characteristics support an autoimmune pathogenesis. The complications of primary biliary cirrhosis are secondary to severe cholestasis, portal hypertension and progressive hepatocellular dysfunction. Currently, treatment is only supportive; no drug regimen has been shown to alter the disease course. PMID:3518374

Dabaghi, R E; Lester, R

1986-05-01

276

Biliary atresia: Will blocking inflammation tame the disease?  

PubMed Central

Biliary atresia is the most common cholangiopathy of childhood. With complete obstruction of segments or the entire length of extrahepatic bile ducts, the timely pursuit of hepatoportoenterostomy is the best strategy to restore bile drainage. However, even with prompt surgical intervention, ongoing injury of intrahepatic bile ducts and progressive cholangiopathy lead to end-stage cirrhosis. The pace of disease progression is not uniform; it may relate to clinical forms of disease and/or staging of liver pathology at diagnosis. Although the etiology of disease is not yet defined, several biological processes have been linked to pathogenic mechanisms of bile duct injury. Among them, there is increasing evidence that the immune system targets the duct epithelium and disrupts bile flow. In this review, we discuss how careful clinical phenotyping, staging of disease, and pre-clinical research give insight into response to ongoing trials and rational design of new therapies to block progression of disease.

Bessho, Kazuhiko; Bezerra, Jorge A.

2014-01-01

277

Biliary complications following liver transplantation  

PubMed Central

Biliary tract complications are the most common complications after liver transplantation. These complications are encountered more commonly as a result of increased number of liver transplantations and the prolonged survival of transplant patients. Biliary complications remain a major source of morbidity in liver transplant patients, with an incidence of 5%-32%. Post liver transplantation biliary complications include strictures (anastomotic and non-anastomotic), leaks, stones, sphincter of Oddi dysfunction, and recurrence of primary biliary disease such as primary sclerosing cholangitis and primary biliary cirrhosis. The risk of occurrence of a specific biliary complication is related to the type of biliary reconstruction performed at the time of liver transplantation. In this article we seek to review the major biliary complications and their relation to the type of biliary reconstruction performed at the time of liver tranplantation.

Kochhar, Gursimran; Parungao, Jose Mari; Hanouneh, Ibrahim A; Parsi, Mansour A

2013-01-01

278

Biliary complications following liver transplantation.  

PubMed

Biliary tract complications are the most common complications after liver transplantation. These complications are encountered more commonly as a result of increased number of liver transplantations and the prolonged survival of transplant patients. Biliary complications remain a major source of morbidity in liver transplant patients, with an incidence of 5%-32%. Post liver transplantation biliary complications include strictures (anastomotic and non-anastomotic), leaks, stones, sphincter of Oddi dysfunction, and recurrence of primary biliary disease such as primary sclerosing cholangitis and primary biliary cirrhosis. The risk of occurrence of a specific biliary complication is related to the type of biliary reconstruction performed at the time of liver transplantation. In this article we seek to review the major biliary complications and their relation to the type of biliary reconstruction performed at the time of liver tranplantation. PMID:23704818

Kochhar, Gursimran; Parungao, Jose Mari; Hanouneh, Ibrahim A; Parsi, Mansour A

2013-05-21

279

Biliary Cystadenomas: A Case for Complete Resection  

PubMed Central

Introduction and Objective. Biliary cystadenoma is a rare benign neoplasm of the liver with less than 200 cases being reported allover the world. We report a series of 13 cases highlighting the radiological findings and problems related to its management. Materials and Methods. Records of thirteen patients who underwent surgery for biliary cystadenomas, between March 2006 and October 2011, were reviewed retrospectively. Results. Majority of the patients were females (11 out of 13), with a median age of 46 (23–65) years. The most frequent symptom was abdominal pain (92%). Seven patients had presented with history of previous surgery for liver lesions. Five patients had presented with recurrence after partial resection for a suspected hydatid cyst and two after surgery for presumed simple liver cyst. Ten of the 13 patients had complete resection of the cyst with enucleation in 3 patients, 2 of whom in addition required T-tube drainage of the bile duct. There has been no recurrence during the follow-up period ranging from 3 months to 5 years. Conclusion. Biliary cystadenoma must be differentiated from other benign cysts. Hepatic resection or cyst enucleation is the recommended treatment option.

Ahanatha Pillai, Sastha; Velayutham, Vimalraj; Perumal, Senthilkumar; Ulagendra Perumal, Srinivasan; Lakshmanan, Anand; Ramaswami, Sukumar; Ramasamy, Ravi; Sathyanesan, Jeswanth; Palaniappan, Ravichandran; Rajagopal, Surendran

2012-01-01

280

Bile Duct Cancer  

MedlinePLUS

... Net Guide Bile Duct Cancer Overview Statistics Medical Illustrations Risk Factors Symptoms and Signs Diagnosis Stages Treatment ... down the bile duct from the liver. See illustrations of the bile duct . Types of bile duct ...

281

Apotopes and innate immune system: novel players in the primary biliary cirrhosis scenario.  

PubMed

Our understanding of primary biliary cirrhosis has been rapidly growing over the past decade and the disease is now regarded as a model for other female-predominant, organ-specific autoimmune conditions. Primary biliary cirrhosis ensues from a multi-lineage loss of tolerance to the E2 component of the pyruvate dehydrogenase complex. One of the major unanswered questions in the pathogenesis of primary biliary cirrhosis is the specificity of small intrahepatic bile ducts attack while PDC-E2 is present in mitochondria of all nucleated cells. Recent findings suggest that the uniqueness of the primary target tissue, biliary epithelium, may be of considerable importance for understanding primary biliary cirrhosis and that the biliary epithelial cell is more than an innocent victim. Rather, it attracts an immune attack by virtue of the unique apoptotic mechanisms and by the way it handles PDC-E2. Moreover, recent evidence suggests that apoptotic bodies of biliary epithelial cell are able to activate the innate immune system in the presence of anti-mitochondrial antibodies. This review article is intended to provide a critical overview of the role of apoptosis in biliary epithelial cells, the activation of the innate immune system, and its biological and clinical significance in primary biliary cirrhosis. PMID:23415798

Lleo, Ana; Invernizzi, Pietro

2013-08-01

282

Risk factors of acute cholecystitis after endoscopic common bile duct stone removal  

PubMed Central

AIM: To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct (CBD) stone removal. METHODS: A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder (GB) in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis: age, gender, serum bilirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications. RESULTS: During a mean 18-mo follow-up, 28 (28%) patients developed biliary symptoms; 17 (17%) acute cholecystitis and 13 (13%) CBD stone recurrence. Of patients with acute cholecystitis, 15 (88.2%) received laparoscopic cholecystectomy and 2 (11.8%) open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 10.2 mo (1-37 mo) and that to recurrent CBD stone was 18.4 mo. Of the 17 patients who received cholecystectomy, 2 (11.8%) developed recurrent CBD stones after cholecystectomy. By multivariate analysis, a serum total bilirubin level of <1.3 mg/dL and a CBD diameter of <11 mm at the time of stone removal were found to predict the development of acute cholecystitis. CONCLUSION: After CBD stone removal, there is no need for routine prophylactic cholecystectomy. However, patients without a dilated bile duct (<11 mm) and jaundice (<1.3 mg/dL) at the time of CBD stone removal have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy.

Lee, Jun Kyu; Ryu, Ji Kon; Park, Joo Kyung; Yoon, Won Jae; Lee, Sang Hyub; Lee, Kwang Hyuck; Kim, Yong-Tae; Yoon, Yong Bum

2006-01-01

283

From the Cover: IKK1 and IKK2 cooperate to maintain bile duct integrity in the liver  

Microsoft Academic Search

Inflammatory destruction of intrahepatic bile ducts is a common cause of vanishing bile duct syndrome and cholestasis, often progressing to biliary cirrhosis and liver failure. However, the molecular mechanisms underlying the pathogenesis of inflammatory biliary disease are poorly understood. Here, we show that the two IkappaB kinases, IKK1\\/IKKalpha and IKK2\\/IKKbeta, display distinct collaborative and specific functions that are essential to

Tom Luedde; Jan Heinrichsdorff; Rossana de Lorenzi; Rita de Vos; Tania Roskams; Manolis Pasparakis

2008-01-01

284

Duct Fires  

Microsoft Academic Search

This report analyzes fuel rich fires spreading within ventilated fuel-lined ducts. The conditions for the occurrence of these intense high hazard fires are discussed.Overall energy balance arguments can be used to predict the fire spread velocity provided one knows: (1) the energy Hvap required to vaporize unit mass of fuel at ambient temperatures and (2) the net heat loss rate

JOHN DE RIS

1970-01-01

285

Cutting-Edge Issues in Primary Biliary Cirrhosis  

Microsoft Academic Search

Several crucial issues remain open in our understanding of primary biliary cirrhosis (PBC), an autoimmune liver disease targeting\\u000a the small- and medium-sized intrahepatic bile ducts. These issues include the high tissue specificity of the autoimmune injury\\u000a despite the nontraditional autoantigens found in all mitochondria recognized by PBC-associated autoantibodies, the causes\\u000a of the commonly observed pruritus, and the disease etiology per

Marco Folci; Francesca Meda; M. Eric Gershwin; Carlo Selmi

286

Repair of a mal-repaired biliary injury: A case report  

PubMed Central

Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair (right to left hepatic duct anastomosis over the T-tube), with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepatico-jejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical mal-repair. We propose an algorithm for the treatment of early and late biliary injuries.

Aldumour, Awad; Aseni, Paolo; Alkofahi, Mohmmad; Lamperti, Luca; Aldumour, Elias; Girotti, Paolo; Carlis, Luciano Gregorio De

2009-01-01

287

Notice of the Cystohepatic Ducts in Cholecystectomy: A Report with Review of the literatures  

Microsoft Academic Search

A 74-year-old man presented with epigastralgia and was diagnosed as having cholelithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) initially visualized the cystic duct with the Heister valve from the common bile duct, and then two intra-hepatic biliary ducts of segment 5 (B5) were visualized from the neck of the gallbladder. There was a contrast medium filling defect in B5, which was considered

Ichiro Hirai; Akiko Takeshita; Toshiyuki Moriya; Akihiko Suzuki; Jinfeng Ma; Koichi Suto; Akira Fuse; Wataru Kimura

2006-01-01

288

Endoscopic retrograde cholangiopancreatography for stone burden in the bile and pancreatic ducts.  

PubMed

Stones in biliary and pancreatic ducts are entities that plague hundreds of thousands of patients worldwide every year. Symptoms can be mild (pain) to life threatening (cholangitis, severe acute pancreatitis). In the last few decades, management of these stones has transitioned from exclusively surgical to now predominantly endoscopic techniques. This article reviews the evolution of endoscopic techniques used in the management of stones in the common bile duct and pancreatic duct. PMID:22748241

Rosenkranz, Laura; Patel, Sandeep N

2012-07-01

289

Mucocele of the cystic duct remnant after orthotopic liver transplant: a problem revisited.  

PubMed

Mucocele of the cystic duct remnant is an uncommon hepatobiliary complication of a liver transplant. Current practice usually involves either excising the cystic duct, or incorporating the distal end of the transected cystic duct into the suture line of the biliary anastomosis to ensure drainage. We report a patient who developed cystic duct remnant mucocele after the latter approach was adopted. We believe that this is likely related to delayed anastomotic stricturing, which prevented draining from the remnant cystic duct. We also discuss the incidence, pathology, investigations, and treatment of this condition. PMID:21649573

Chatterjee, Suvadip; Das, Debasish; Hudson, Mark; Bassendine, Margaret Fiona; Scott, John; Oppong, Kofi Ernest; Sen, Gourab; French, Jeremy J

2011-06-01

290

Endoscopic sphincterotomy plus large-balloon dilation vs endoscopic sphincterotomy for choledocholithiasis: A meta-analysis  

PubMed Central

AIM: To perform a meta-analysis of large-balloon dilation (LBD) plus endoscopic sphincterotomy (EST) vs EST alone for removal of bile duct stones. METHODS: Databases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index, and important meeting abstracts were searched and evaluated by two reviewers independently. The main outcome measures included: complete stone removal, stone removal in the first session, use of mechanical lithotripsy, procedure time, and procedure-related complications. A fixed-effects model weighted by the Mantel-Haenszel method was used for pooling the odds ratio (OR) when heterogeneity was not significant among the studies. When a Q test or I2 statistic indicated substantial heterogeneity, a random-effects model weighted by the DerSimonian-Laird method was used. RESULTS: Six randomized controlled trials involving 835 patients were analyzed. There was no significant heterogeneity for most results; we analyzed these using a fixed-effects model. Meta-analysis showed EST plus LBD caused fewer overall complications than EST alone (OR = 0.53, 95%CI: 0.33-0.85, P = 0.008); subcategory analysis indicated a significantly lower risk of perforation in the EST plus LBD group (Peto OR = 0.14, 95%CI: 0.20-0.98, P = 0.05). Use of mechanical lithotripsy in the EST plus LBD group decreased significantly (OR = 0.26, 95%CI: 0.08-0.82, P = 0.02), especially in patients with a stone size larger than 15 mm (OR = 0.15, 95%CI: 0.03-0.68, P = 0.01). There were no significant differences between the two groups regarding complete stone removal, stone removal in the first session, post-endoscopic retrograde cholangiopancreatography pancreatitis, bleeding, infection of biliary tract, and procedure time. CONCLUSION: EST plus LBD is an effective approach for the removal of large bile duct stones, causing fewer complications than EST alone.

Yang, Xiao-Ming; Hu, Bing

2013-01-01

291

[Primary biliary cirrhosis and pregnancy].  

PubMed

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease, asymptomatic during a protracted time, characterized by changes in the small-sized bile ducts near portal spaces. The etiology of PBC is undefined, but immunologic and environmental disturbances may contribute to the disease. Infertility is often associated with PBC and cirrhosis, but pregnancy may well occur in women with PBC and without cirrhosis or in some others with compensated cirrhosis. A pluridisciplinary approach including gastroenterologists and obstetricians is recommended. The patient must be closely monitored throughout her pregnancy with maternal and routine antenatal care. Medical treatment requires ursodeoxycholic acid (UDCA). In non-cirrhotic UDCA-treated women with PBC, pregnancy often follows a normal course with vaginal delivery. In cirrhotic patients, UDCA must be continued during pregnancy, esophageal and gastric varices must be evaluated before pregnancy, and endoscopic ligature is recommended for treating large varices. Additionally, beta-blocker therapy may be associated, especially when variceal rupture occurred previously. Elective cesarean section is recommended in patients with large esophageal or gastric varices because of the potentially increased risk of variceal bleeding during maternal expulsive efforts in case of vaginal delivery. PMID:23628147

Ducarme, G; Bernuau, J; Luton, D

2014-05-01

292

Percutaneous Transhepatic Cutting Balloon Papillotomy for Removal of Common Bile Duct Stones  

SciTech Connect

We report the case of a 66-year-old female who presented with jaundice secondary to recurrent adenocarcinoma of the gallbladder and several common bile duct stones. Percutaneous papillary dilatation was planned to remove the common bile duct stones. Papilla was dilated through the percutaneous approach with an 8-mm peripheral cutting balloon instead of a standard balloon. All the stones were pushed successfully into the duodenum with a saline flush. No complications were encountered. Use of a peripheral cutting balloon for dilatation of the papilla seems to be safe and effective because it has the advantage of controlled incision and dilatation of the target at low pressures.

Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Ozkan, Ugur; Gumus, Burcak [Baskent University Faculty of Medicine, Department of Radiology (Turkey)

2009-09-15

293

Catheter dislodgement of percutaneous transhepatic biliary drainage: identification of role of puncture sites and catheter sheath  

Microsoft Academic Search

Background: To identify the appropriate puncture points in the bile duct to avoid catheter dislodgement.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Percutaneous transhepatic biliary drainage catheters (n = 300) were placed in 242 patients. The frequency of dislodgement (complete dislodgement or bending of the catheter) was prospectively\\u000a investigated. The puncture site of the bile duct was classified on the ultrasonographic findings as follows: Main-B3, main

K. Tamada; T. Tomiyama; S. Wada; A. Ohashi; Y. Satoh; T. Higashizawa; T. Miyata; K. Ido; K. Sugano

2000-01-01

294

Claudin-18 in biliary neoplasms. Its significance in the classification of intrahepatic cholangiocarcinoma  

Microsoft Academic Search

Claudin-18 (CLDN18), a tight junction protein specific to stomach and lung, is aberrantly expressed in preinvasive and invasive\\u000a neoplasms of the pancreas. To investigate the significance of CLDN18 expression in biliary neoplasms, immunohistochemical\\u000a analysis was performed. CLDN18 expression was frequently observed in the epithelial cells of extrahepatic bile duct carcinomas\\u000a (90%, n?=?99), intrahepatic intraductal papillary neoplasms of the bile duct

Aya Shinozaki; Junji Shibahara; Naohiro Noda; Mariko Tanaka; Taku Aoki; Norihiro Kokudo; Masashi Fukayama

295

Retrograde dilation of postsaccal lacrimal stenosis.  

PubMed

The causes of nasolacrimal duct stenosis in adults can vary greatly. In general, the symptoms can also vary, but most cases share a tendency toward recurring inflammations in the prestenotic area. The treatment of these disorders is limited to either conservative therapy to control inflammation or surgically invasive measures. By using balloon catheters, usually applied in percutaneous transluminal coronary angioplasty (PTCA), dilation of the relative postsaccal stenosis can be performed under radiographic control. An exact diagnosis using various testing methods, including digital dacryocystography for detailed localization and documentation of any pathologic changes, is decisive to success. Only in cases of incomplete postsaccal stenosis is retrograde balloon dilation of the distal nasolacrimal duct indicated. A guide wire, designed for the PTCA balloon catheter set, is introduced via the canaliculus to the nasal cavity antegradely and caught with a thin hook and pulled from the naris, under visual control with an image converter. The balloon catheter is retrogradely threaded over the guide wire. The baloon is then placed at the site of the pathologic stenosis under radiographic control and dilated with high pressure. To ensure the permeability of the system, monocanalicular silicone intubation has to be performed immediately afterwards. This procedure has been performed successfully on 6 patients with a follow-up of 6 to 27 months. These initial results give rise to the hope that this minimally invasive, interdisciplinary technique represents a new alternative in the treatment of incomplete postsaccal lacrimal stenosis. PMID:8311386

Steinkogler, F J; Huber, E; Kuchar, A; Karnel, F

1994-02-01

296

Hepatic transplant complicated by hepatic artery thrombosis and bile duct necrosis: case report and potential application of contrast-enhanced MR cholangiography following intravenous mangafodipir trisodium in the emergency room setting  

Microsoft Academic Search

.   Biliary tract strictures and leaks are the second most common complications following orthotopic liver transplantation. Nonanastomotic\\u000a bile duct complications are most often caused by hepatic artery thrombosis and can result in fulminant hepatic necrosis, bile\\u000a duct strictures, and bile duct leaks that increase the risk of cholangitis, sepsis, and abscess. The emergency physician and\\u000a radiologist should strongly suspect biliary

Kenneth M. Vitellas; Sangeeta Guttikonda

2002-01-01

297

Repair of bile duct defect with degradable stent and autologous tissue in a porcine model  

PubMed Central

AIM: To introduce and evaluate a new method to repair bile duct defect with a degradable stent and autologous tissues. METHODS: Eight Ba-Ma mini-pigs were used in this study. Experimental models with common bile duct (CBD) defect (0.5-1.0 cm segment of CBD resected) were established and then CBD was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-(1,3-propanediol)-co-(1,2-propanediol)]. In addition, a vascularized greater omentum was placed around the stent and both ends of CBD. Cholangiography via gall bladder was performed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture. Complete blood count was examined pre- and post-operatively to estimate the inflammatory reaction. Liver enzymes and serum bilirubin were examined pre- and post-operatively to evaluate the liver function. Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis. The other three pigs were raised for one year for long-term observation. RESULTS: All the animals underwent surgery successfully. There was no intraoperative mortality and no bile leakage during the observation period. The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation, the difference was not statistically significant (P = 0.652). The plasma level of alanine aminotransferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation (P = 0.810). Nevertheless, the plasma level of ?-glutamyl transferase was increased after operation in both groups (P = 0.004), especially 2 wk after operation. The level of serum total bilirubin after operation was not significantly elevated compared with that before operation (P = 0.227), so did the serum direct bilirubin (P = 0.759). By cholangiography via gall bladder, we found that the stent maintained its integrity of shape and was still in situ at month 1, and it disappeared completely at month 3. No severe CBD dilation and stricture were observed at both months 1 and 3. No pig died during the 3-mo postoperative observation period. No sign of necrosis, bile duct stricture, bile leakage or abdominal abscess was found at reoperation at month 3 postoperatively. Pigs had neither fragments of stent nor stones formed in the CBD. Collagen deposit was observed in the anastomosis by hematoxylin and eosin (HE) and Masson’s trichrome stains. No severe cholestasis was observed in liver parenchyma by HE staining. Intestinal obstruction was found in a pig 4 mo after operation, and no bile leakage, bile duct stricture or biliary obstruction were observed in laparotomy. No sign of bile duct stricture or bile leakage was observed in the other two pigs. CONCLUSION: The novel method for repairing bile duct defect yielded a good short-term effect without postoperative bile duct stricture. However, the long-term effect should be further studied.

Liang, Yue-Long; Yu, Yi-Chen; Liu, Kun; Wang, Wei-Jia; Ying, Jiang-Bo; Wang, Yi-Fan; Cai, Xiu-Jun

2012-01-01

298

Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.  

PubMed

This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy about endoscopic biliary stenting. The present Clinical Guideline describes short-term and long-term results of biliary stenting depending on indications and stent models; it makes recommendations on when, how, and with which stent to perform biliary drainage in most common clinical settings, including in patients with a potentially resectable malignant biliary obstruction and in those who require palliative drainage of common bile duct or hilar strictures. Treatment of benign conditions (strictures related to chronic pancreatitis, liver transplantation, or cholecystectomy, and leaks and failed biliary stone extraction) and management of complications (including stent revision) are also discussed. A two-page executive summary of evidence statements and recommendations is provided. A separate Technology Review describes the models of biliary stents available and the stenting techniques, including advanced techniques such as insertion of multiple plastic stents, drainage of hilar strictures, retrieval of migrated stents and combined stenting in malignant biliary and duodenal obstructions.The target readership for the Clinical Guideline mostly includes digestive endoscopists, gastroenterologists, oncologists, radiologists, internists, and surgeons while the Technology Review should be most useful to endoscopists who perform biliary drainage. PMID:22297801

Dumonceau, J-M; Tringali, A; Blero, D; Devière, J; Laugiers, R; Heresbach, D; Costamagna, G

2012-03-01

299

Porokeratotic eccrine ostial and dermal duct nevus.  

PubMed

We report 2 cases of congenital porokeratotic eccrine nevus in a 5-year-old girl and a 7-year-old boy. The clinical manifestations were those of nevus comedonicus palmaris. The histologic picture consisted of comedo-like dilatations and cornoid lamellae involving the eccrine ostia and ducts. One of the cases showed anomalies in the dermal eccrine ducts. We believe that these lesions are eccrine hamartomas unrelated to porokeratosis. We review similar cases from the literature and discuss the differential diagnosis. PMID:3280630

Moreno, A; Pujol, R M; Salvatella, N; Alomar, A; de Moragas, J M

1988-02-01

300

Primary Biliary Cirrhosis  

MedlinePLUS

... of liver cancer every 6 to 12 months. Health care providers use blood tests, ultrasound, or both to check for signs of ... make the diagnosis of primary biliary cirrhosis. A health care provider uses the test selectively when he or she is concerned that ...

301

The value of cholangiography through Jackson-Pratt drains in the management of postoperative biliary injuries.  

PubMed

Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution. Mean age was 51.7 ± 18.1 years (range, 19 to 86 years) with 30 (75%) females. Seventeen (42.5%) injuries were detected intraoperatively and in 13 (32.5%) cases, JP drains were placed for biliary drainage. Lesions were classified according to Bismuth grade: I (10 patients [25%]), II (10 patients [25%]), III (six patients [15%]), IV (10 patients [25%]), and V (four patients [10%]). TCC was performed in seven patients with JP drains (53.8%). It fully defined the injury site in three cases of limited magnetic resonance cholangiopancreatography (MRCP) such as common hepatic duct and common bile duct leaks and in four cases (57.1%) that endoscopic retrograde cholangiopancreatography (ERCP) was limited as a result of clipping of the distal common bile duct. TCC showed promising results in cases of limited MRCP and ERCP such as fistulous orifices or leakage. It may represent an alternative adjunct in the diagnostic armamentarium of complex biliary injuries. PMID:24401517

Macedo, Francisco Igor B; Casillas, Victor J; Davis, James S; Levi, Joe U; Sleeman, Danny

2014-01-01

302

Lithospheric Dilation on Europa  

Microsoft Academic Search

Lithospheric dilation on Europa has occurred at ridges, bands, and various hybrid lineaments on a global scale over a large part of the geological age of the surface. Dilational ridges (Class 2 in the R. Greenberg et al. (1998, Icarus135, 64–78) taxonomy) are elevated, are usually a few kilometers across, and may have a lineated or hummocky interior and a

B. Randall Tufts; Richard Greenberg; Gregory Hoppa; Paul Geissler

2000-01-01

303

Linear echoendoscope-guided ERCP for the diagnosis of occult common bile duct stones  

PubMed Central

Background Less than 67% of patients with intermediate risk for common bile duct (CBD) stones require therapeutic intervention. It is important to have an accurate, safe, and reliable method for the definitive diagnosis of CBD stones before initiating therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Few publications detail the diagnostic efficacy of linear echoendoscopy (EUS) for CBD stones. Methods 30 patients with biliary colic, pancreatitis, unexplained derangement of liver function tests, and/or dilated CBD without an identifiable cause were enrolled in the study. When a CBD stone was disclosed by linear EUS, ERCP with stone extraction was performed. Patients who failed ERCP were referred for surgical intervention. If no stone was found by EUS, ERCP would not be performed and patients were followed-up for possible biliary symptoms for up to three months. Results The major reason for enrollment was acute pancreatitis. The mean predicted risk for CBD stones was 47% (28–61). Of the 12 patients who were positive for CBD stones by EUS, nine had successful ERCP, one failed ERCP (later treated successfully by surgical intervention) and two were false-positive cases. No procedure-related adverse events were noted. For those 18 patients without evidence of CBD stones by EUS, no false-negative case was noted during the three-month follow-up period. Linear EUS had sensitivity, specificity, positive and negative predicted values for the detection of CBD stones of 1, 0.9, 0.8 and 1, respectively. Conclusion Linear EUS is safe and efficacious for the diagnosis of occult CBD stones in patients with intermediate risk for the disease.

2013-01-01

304

A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy  

PubMed Central

Background Cholecystectomy has been the treatment of choice for symptomatic gallstones, but remains the greatest source of post-operative biliary injuries. Laparoscopic approach has been recently preferred because of short hospitalisation and low morbidity but has an higher incidence of biliary leakages and bile duct injuries than open one due to a technical error or misinterpretation of the anatomy. Even open cholecystectomy presents a small number of complications especially if it was performed in urgency. Hemobilia is one of the most common cause of upper gastrointestinal bleeding from the biliary ducts into the gastrointestinal tract due to trauma, advent of invasive procedures such as percutaneous liver biopsy, transhepatic cholangiography, and biliary drainage. Methods We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage. Conclusion The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.

2009-01-01

305

Successful surgical treatment of extrahepatic biliary papillomatosis diagnosed with endoscopic retrograde cholangiopancreatography: a case report  

PubMed Central

Introduction Biliary papillomatosis is a condition characterized by multiple papillary tumors of variable distribution and extent within the biliary tract. Papillary carcinoma can develop in these lesions. It is a rare biliary pathological entity and its clinical features and outcome are not well known. Case presentation We experienced a case of biliary papillomatosis in a 51-year-old North African man who presented with obstructive jaundice. Laboratory tests showed elevated bilirubin, alkaline phosphatase and gamma-glutamyl transpeptidase levels. Imaging (ultrasound and magnetic resonance imaging) was suggestive of Klatskin tumor associated to common bile duct stones. After endoscopic retrograde cholangiopancreatography, a balloon sweep retrieved friable tissue from his bile ducts. Histology demonstrated papillary adenomatous proliferation showing high-grade dysplasia and he was referred for surgical management. Conclusions Although biliary papillomatosis is rare, it is a premalignant condition that should be well known and considered in all diagnoses of obstructive jaundice. We report a new case of biliary papillomatosis and highlight the contribution of endoscopic retrograde cholangiopancreatography in the diagnosis of this condition.

2014-01-01

306

Surgical management of non-parasitic hepatic cyst with biliary communication: a case report  

PubMed Central

Non-parasitic hepatic cysts with biliary communication are rare. The clinical symptoms involved are not specific to this condition, thereby making diagnosis difficult and treatment controversial. Here, we report a case of 70-year-old woman complaining of abdominal satiety, combined with non-specific pain in the right upper quadrant. The abdominal contrast-enhanced MRI-scan revealed a large and thick-walled septus cystic lesion in the liver. During operation, the biliary fistula was confirmed in the cyst cavity. A silica gel tube was inserted via the cystic duct for cholangiography, which demonstrated communication between the cyst and biliary tract. We performed wide-scale cyst wall resection; the biliary fistula was completely repaired by the closure of communicated bile ducts. The postoperative course was uneventful, and the patient was discharged with no sign of cholangitis or any other symptoms. The novel surgical management via wide resection of the cyst wall and closure of biliary communication proved to be an adequate and effective procedure for treating nonparasitic hepatic cysts with biliary communication.

Cui, Wei; Zhou, Hong-Yuan; Zhang, Yan-Hui; Zhang, Ti; Li, Qiang

2013-01-01

307

Role of antimicrobial-impregnated polymer and teflon in the prevention of biliary stent blockage  

Microsoft Academic Search

Biliary stent blockage and microbial colonization is a common complication associated with polyurethane stents used for the relief of bile-duct obstruction caused by benign or malignant disease. In an attempt to overcome this problem the application of a ‘Teflon” (polytetrafluoroethylene) stent and an antimicrobial benzalkonium chloride (BZC) impregnated polymer were investigated. The effects of these materials on microbial colonization were

E. N. Rees; S. E. Tebbs; T. S. J. Elliott

1998-01-01

308

In Vivo Study of Polyurethane-Coated Gianturco-Rosch Biliary Z-Stents  

Microsoft Academic Search

Purpose: Prototypes of Gianturco-Rosch Z-stents coated with polycarbonate urethane (PCU) were placed in the biliary tree of pigs, in order to test their biomechanical behavior, stability, and biocompatibility. Methods: The stents were surgically implanted in the common bile duct of three pairs of pigs, which were killed after 1, 3, and 6 months respectively. Explanted livers from pigs of the

Aldo Severini; Sara Mantero; Maria Cristina Tanzi; Alberto Cigada; Flaminio Addis; Guido Cozzi; Monica Salvetti; Salvatore Andreola; Antonella Motta; Enrico Regalia; Andrea Pulvirenti; Enrico De Pedri; Roberto Doci

1999-01-01

309

Serum and tissue tumor growth factor ?1 in children with biliary atresia  

Microsoft Academic Search

BackgroundBiliary atresia (BA) is an infantile disorder characterized by the obstruction of a portion or the entirety of the extrahepatic bile ducts, leading to hepatic fibrosis and loss of liver function. The gold standard for diagnosing and grading fibrosis is liver biopsy, but there are many groups searching for noninvasive biomarkers that could replace and\\/or complement this procedure.

Fernanda dos Santos de Oliveira; Carlos Oscar Kieling; Jorge Luiz dos Santos; Patrícia Ponce de Leon Lima; Sandra Vieira; Luise Meurer; Themis Reverbel da Silveira; Ursula Matte

2010-01-01

310

Opisthorchiasis-associated biliary stones: Light and scanning electron microscopic study  

Microsoft Academic Search

AIM: Biliary stones are frequently encountered in areas endemic for opisthorchiasis in Thailand. The present study was to describe the prevalence and pathogenesis of these stones. METHODS: Gallstones and\\/or common bile duct stones and bile specimens from 113 consecutive cholecystectomies were included. Bile samples, including sludge and\\/or microcalculi, were examined for Opisthorchis viverrini eggs, calcium and bilirubin. The stones were

Banchob Sripa; Pipatphong Kanla; Poonsiri Sinawat; Melissa R. Haswell-Elkins

2004-01-01

311

Recent advances in the morphological and functional heterogeneity of the biliary epithelium  

PubMed Central

This review focuses on the recent advances related to the heterogeneity of different-sized bile ducts with regard to the morphological and phenotypical characteristics, and the differential secretory, apoptotic and proliferative responses of small and large cholangiocytes to gastrointestinal hormones/peptides, neuropeptides and toxins. We describe several in vivo and in vitro models used for evaluating biliary heterogeneity. Subsequently, we discuss the heterogeneous proliferative and apoptotic responses of small and large cholangiocytes to liver injury and the mechanisms regulating the differentiation of small into large (more differentiated) cholangiocytes. Following a discussion on the heterogeneity of stem/progenitor cells in the biliary epithelium, we outline the heterogeneity of bile ducts in human cholangiopathies. After a summary section, we discuss the future perspectives that will further advance the field of the functional heterogeneity of the biliary epithelium.

Han, Yuyan; Glaser, Shannon; Meng, Fanyin; Francis, Heather; Marzioni, Marco; McDaniel, Kelly; Alvaro, Domenico; Venter, Julie; Carpino, Guido; Onori, Paolo; Gaudio, Eugenio; Alpini, Gianfranco; Franchitto, Antonio

2014-01-01

312

Percutaneous Transhepatic Cutting Balloon Papillotomy for Removal of Common Bile Duct Stones  

Microsoft Academic Search

We report the case of a 66-year-old female who presented with jaundice secondary to recurrent adenocarcinoma of the gallbladder\\u000a and several common bile duct stones. Percutaneous papillary dilatation was planned to remove the common bile duct stones.\\u000a Papilla was dilated through the percutaneous approach with an 8-mm peripheral cutting balloon instead of a standard balloon.\\u000a All the stones were pushed

Levent Oguzkurt; Ugur Ozkan; Burcak Gumus

2009-01-01

313

Abnormal /sup 99//sup m/Tc-PIPIDA scans mistaken for common duct obstruction  

SciTech Connect

/sup 99//sup m/Tc-PIPIDA scans were obtained in three patients with acute abdominal pain. The appearance of the scans suggested partial common duct obstruction. Two patients underwent surgery. One had acute appendicitis and the second had infarction of the distal ileum. In both cases, the gallbladder and biliary tract were normal. The third patient had been treated with morphine, which is known to increase biliary tract pressure and may cause contraction of the sphincter of Oddi. An ultrasound study of the gallbladder was normal and all symptoms resolved within 24 hours. Subsequently, three additional patients without biliary disease have been seen who had similar hepatobiliary scans. All three had received meperidine prior to the study. It is concluded that acute abdominal disease or the administration of morphine sulfate or meperidine can result in a scan pattern suggesting partial distal common duct obstruction in the absence of gallbladder or biliary tract disease.

Taylor, A. Jr. (Univ. of California Medical Center, San Diego); Kipper, M.S.; Witztum, K.; Greenspan, G.; Kan, M.

1982-07-01

314

Abnormal /sup 99m/Tc-PIPIDA scans mistaken for common duct obstruction  

SciTech Connect

/sup 99m/Tc-PIPIDA scans were obtained in three patients with acute abdominal pain. The appearance of the scans suggested partial common duct obstruction. Two patients underwent surgery. One had acute appendicitis and the second had infarction of the distal ileum. In both cases, the gallbladder and biliary tract were normal. The third patient had been treated with morphine, which is known to increase biliary tract pressure and may cause contraction of the sphincter of Oddi. An ultrasound study of the gallbladder was normal and all symptoms resolved within 24 hours. Subsequently, three additional patients without biliary disease have been seen who had similar hepatobiliary scans. All three had received meperidine prior to the study. It is concluded that acute abdominal disease or the administration of morphine sulfate or meperidine can result in a scan pattern suggesting partial distal common duct obstruction in the absence of gallbladder or biliary tract disease.

Taylor, A. Jr.; Kipper, M.S.; Witztum, K.; Greenspan, G.; Kan, M.

1982-07-01

315

Liver and portal histopathological correlation with age and survival in extra hepatic biliary atresia  

Microsoft Academic Search

Aim  To grade histopathological parameters in biliary atresia (BA) and correlate it with advancing age and outcome.\\u000a \\u000a \\u000a \\u000a Method  Liver and porta hepatis biopsies of 18 BA cases were graded for cholestasis (C), hepatocellular degeneration (HD), bile duct\\u000a proliferation (BDP), bile duct fibrosis (BDF), bile duct inflammation (BDI), portal edema (PE), portal inflammation (PI) and\\u000a portal fibrosis (PF) with a total histopathological score

Shilpa Sharma; Prasenjit Das; S. DattaGupta; Lalit Kumar; Devendra K. Gupta

2011-01-01

316

Primary Malt Lymphoma of the Common Bile Duct  

PubMed Central

Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising in the common bile duct (CBD) is extremely rare. In our case of MALT lymphoma, CT and MRI showed long, segmental, irregular wall thickening of the CBD and minimal dilatation of the upstream bile duct. A preoperative diagnosis of cholangiocarcinoma was made, but histologic evaluation confirmed MALT lymphoma of the CBD. We herein present a rare case of MALT lymphoma of the CBD with CT and MRI findings.

Cho, Young Hoon; Kim, Jin Hee; Lee, Seung Soo; Kim, Hyoung Jung; Lee, Moon-Gyu

2013-01-01

317

Plasma Cells and the Chronic Nonsuppurative Destructive Cholangitis of Primary Biliary Cirrhosis  

PubMed Central

There has been increased interest in the role of B cells in the pathogenesis of primary biliary cirrhosis. Although the vast majority of patients with primary biliary cirrhosis have antimitochondrial antibodies, there is no correlation of antimitochondrial antibody titer and/or presence with disease severity. Further, in murine models of primary biliary cirrhosis, it has been suggested that depletion of B cells may exacerbate biliary pathology. To address this issue, we have focused on detailed phenotypic characterization of mononuclear cell infiltrates surrounding the intrahepatic bile ducts of patients with PBC, PSC, AIH, CH-C and GVHD, including CD3, CD4, CD8, CD20, CD38 and immunoglobulin classes, as well as double immunohistochemical staining for CD38 and IgM. Interestingly, CD20 B lymphocytes, which are a precursor of plasma cells, were found in scattered locations or occasionally forming follicle-like aggregations but were not noted at the proximal location of chronic nonsuppurative destructive cholangitis. In contrast, there was a unique and distinct coronal arrangement of CD38 cells around the intrahepatic ducts in primary biliary cirrhosis but not controls; the majority of such cells were considered plasma cells based on their expression of intracellular immunoglobulins, including IgM and IgG, but not IgA. Patients with primary biliary cirrhosis who manifest this unique coronal arrangement were those with significantly higher titers of antimitochondrial antibodies. These data collectively suggest a role of plasma cells in the specific destruction of intrahepatic bile ducts in primary biliary cirrhosis and highlight the increasing interest in plasma cells and autoimmunity.

Takahashi, Toru; Miura, Tomofumi; Nakamura, Junichiro; Yamada, Satoshi; Miura, Tsutomu; Yanagi, Masahiko; Matsuda, Yasunobu; Usuda, Hiroyuki; Emura, Iwao; Tsuneyama, Koichi; He, Xiao-Song; Gershwin, M. Eric

2011-01-01

318

Cytodiagnosis in the management of extrahepatic biliary stricture.  

PubMed Central

A total of 117 patients presenting with extrahepatic biliary strictures between 1981 and 1989 had 206 cytological examinations of the bile duct or bile (153 non-operative, 53 intraoperative) to establish the presence of malignancy. A final diagnosis of cholangiocarcinoma was made in 88 patients, with 29 patients having benign biliary strictures. The cytological techniques used were fine needle aspiration (n = 102) or brushing (n = 24) of the bile duct, or exfoliative cytology of bile (n = 80). Forty one patients with malignancy had two or more examinations with differing results between samples in 20 cases. The overall sensitivity was 72%. There was only one false positive result, giving a patient predictive value of positive cytology of 98%. Intraoperative cytology was more sensitive than non-operative examination (80% v 42%). Overall, the sensitivity of fine needle aspiration (67%) was greater than that of brush cytology (40%) or exfoliative cytology (30%). No complications were encountered. Cytodiagnosis of extrahepatic biliary strictures is a safe procedure which is not technically demanding, and as it has a high sensitivity and predictive value for positive cytology, cytological confirmation of malignancy should be sought in all clinically and radiologically suspicious cases.

Desa, L A; Akosa, A B; Lazzara, S; Domizio, P; Krausz, T; Benjamin, I S

1991-01-01

319

Surgical resection of cystic intraductal papillary adenocarcinoma of the bile duct: report of a case.  

PubMed

We describe a cystic intraductal papillary neoplasm of bile duct (IPNB) of adenocarcinoma treated with surgical resection. An 82-year-old man was admitted to our hospital because of distension of the right upper quadrant of the abdomen. On admission, a huge nontender mass was palpated in the right upper abdomen. Initial laboratory tests revealed the following serum values: aspartate aminotransferase, 123 IU/L; alanine aminotransferase, 113 IU/L; alkaline phosphatase, 376 IU/L; bilirubin, 1.6 mg/dL; alpha-fetoprotein, 7.4 ng/mL; CA19-9, 39.8 U/mL; carcinoembryonic antigen, 4.1 ng/mL; and Duke pancreatic monoclonal antigen type 2, 200 U/mL. Abdominal ultrasonography revealed an anechoic mass with an elevated papillary lesion in the right paramedian section. Computed tomography showed a low-density hepatic lesion, measuring 12 × 10 cm, with thick, irregular walls. A T2-weighted magnetic resonance scan showed mural nodules with signal intensity higher than that of the liver. The cystic lesion was suspected to be a cystic IPNB, but we could not determine whether it was a carcinoma. We performed extensive right paramedian sectionectomy and cholecystectomy. The resected multilocular tumor was filled with a yellow fluid, and the cut surface showed multiple, yellowish papillary nodules lining the cystic wall. On histologic examination, the neoplastic biliary epithelium showed papillary growth in the dilated lumen. Papillary and micropapillary lesions exhibited cellular atypia: nuclear enlargement and hyperchromasia, mutilayering, and mitosis. Ovarian-like stroma was not detected. The tumor was diagnosed as an IPNB (carcinoma in situ lesion). These lesions had expanded into several intrabiliary ducts. No recurrence has been detected 2 year after operation. PMID:23832409

Shimoda, Tomohiro; Yoshida, Hiroshi; Hirakata, Atsushi; Makino, Hiroshi; Yokoyama, Tadashi; Maruyama, Hiroshi; Ueda, Junji; Tanno, Masataka; Naito, Zenya; Uchida, Eiji

2013-01-01

320

Trend towards Primary Closure Following Laparoscopic Exploration of the Common Bile Duct  

PubMed Central

INTRODUCTION The aim of this study was the assessment of patient outcome, peri-operative complications, length of stay and duration of operation after laparoscopic primary closure of the common bile duct (CBD) compared with choledochotomy with T-tube drainage and trans-cystic exploration. PATIENTS AND METHODS Analysis of prospectively collected data on 71 explorations of the common bile duct between July 2001 and March 2006. RESULTS A total of 71 patients had exploration of the CBD. Within this group, 12 were referred after failed endoscopic retrograde cholangiopancreatography (ERCP). The methods of exploration included trans-cystic (9 cases), choledochotomy with Ttube (12), and choledochotomy with primary closure (50). CBD stones were found in 66 patients. In the remaining cases, we found a stricture in 1, debris in 2, and dilatation of the CBD without a stone in 2. There were 5 conversions to open technique and 3 patients required postoperative ERCP (1 with permanent stenting). Peri-operative complications included T-tube (3), primary closure group (9), and trans-cystic (0). There was no statistical significant difference (Chi-square test, P = 0.296) between the groups. There was a trend towards a shorter length of stay in the primary closure group as compared with the trans-cystic and T-tube groups of 4.16, 4.44, and 6.33 days, respectively. However, it did not reach statistical significance (one-way analysis of variance with Boneferroni correction, mean difference between groups 1.89, 0.28, 2,17, statistical significance at P < 0.05). The shortest operating time was in the primary closure group (95.92 min) which was statistically significant (P < 0.001). We did not use a biliary drain in the last 48 patients. CONCLUSIONS Primary laparoscopic closure of the CBD is safe and results in a reduction in operating time. Choledochoscopy ensures clearance of the CBD and eliminates the need for T-tube.

Jameel, M; Darmas, B; Baker, AL

2008-01-01

321

Spatulated end-to-end bile duct reconstruction in orthotopic liver transplantation.  

PubMed

Biliary complications continue to be a major source of morbidity following orthotopic liver transplantation. The aim of this study was to analyze the incidence and management of biliary complications related to the technique of bile duct reconstruction. The patients were stratified into two groups: group I (n = 39) had bile duct reconstruction performed by an end-to-end single interrupted suture choledochocholedochostomy (EE-CDCD) and group II (n = 38) had a spatulated end-to-end CDCD (spEE-CDCD) reconstruction; both groups had an intraductal stent. The groups were similar in age, gender, liver transplant indications and Pugh score. Ten biliary complications (26%), including five bile leaks (13%) and five biliary strictures (13%), were observed in the EE-CDCD group, while one biliary stricture (2.6%) occurred in the spEE-CDCD group (p < 0.05). Subsequent imaging studies and endoscopic retrograde cholangiopancreatography were performed less often in patients undergoing spEE-CDCD reconstruction (p < 0.05). The technique of a spatulated end-to-end bile duct reconstruction provides a significant improvement in lowering biliary complication rates in liver transplant patients. Despite the modest number of cases in this study this technique shows promise and has become the technique of choice in our institution. PMID:17302585

Buczkowski, Andrzej K; Schaeffer, David F; Kim, Peter T W; Ho, Stephen G F; Yoshida, Eric M; Steinbrecher, Urs P; Erb, Siegfried R; Chung, Stephen W; Scudamore, Charles H

2007-01-01

322

Coronary dilators and cardioplegia  

PubMed Central

The distribution in the myocardium of cardioplegic solution is demonstrated in dog hearts with the aid of indocyanine green. When papaverine or nitroglycerin are added to the solution, a much improved diffusion is observed. Papaverine appears to be a better coronary dilator. We deduce from this observation that myocardial protection during ischemic arrest for open-heart surgery is enhanced considerably when coronary dilation is assured. Images

Romagnoli, Alexander; Koska, Adolph J.

1981-01-01

323

The Effect of Biliary Decompression on Bacterial Translocation in Jaundiced Rats  

PubMed Central

Patients with obstructive jaundice are prone to septic complications after biliary tract operations. Restoring bile flow to the intestine may help to decrease the complication rate. The present study is aimed at evaluating the effect of biliary decompression on bacterial translocation in jaundiced rats. Sixty-six male Sprague-Dawley rats were randomly allocated to six groups subjected to common bile duct ligation (CBDL) and transection (groups 2–6) or sham operation (group 1). In groups and 2 the incidence of enteric bacterial translocation was determined 2 weeks after sham operation or CBDL. In groups 3–6, biliary decompression was achieved by performing a choledochoduodenostomy after 2 weeks of biliary decompression. Bacterial translocation was then studied 1,2,3 and 5 weeks following biliary decompression. The rate of bacterial translocation to mesenteric lymph nodes in obstructive jaundice was significantly higher as compared with controls, and decreased with time to nil three weeks following biliary decompression. The incidence of bacterial translocation was closely correlated (r = 0.844; p = 0.034) with serum alkaline phosphatase activity and seemed to fit with the morphological changes noted in the small intestine. The decrease in bacterial translocation, however, lags behind the recovery of liver function as measured by routine liver function tests and antipyrine clearance. Obstructive jaundice thus promotes bacterial translocation in the rat. Biliary decompression gradually decreases the rate of bacterial translocation.

Ding, Jin Wen; Soltesz, Vasile; Willen, Roger; Loft, Steffen; Poulsen, Henrik E.; Parsson, Hakan; Olsson, Kjell; Bengmark, Stig

1993-01-01

324

Intraductal papillary neoplasm of the bile duct.  

PubMed

Intraductal papillary neoplasm of the bile duct (IPNB) is a variant of bile duct carcinoma that is characterized by intraductal growth and better outcomes compared with common cholangiocarcinoma. IPNBs are mainly found in patients from Far Eastern areas, where hepatolithiasis and clonorchiasis are endemic. According to the immunohistochemical profiles of the mucin core proteins, IPNBs are classified into four types: pancreaticobiliary, intestinal, gastric, and oncocytic. Approximately 40%-80% of IPNBs contain a component of invasive carcinoma or tubular or mucinous adenocarcinoma, suggesting that IPNB is a disease with high potential for malignancy. It is difficult to make an accurate preoperative diagnosis because of IPNB's low incidence and the lack of specificity in its clinical manifestation. The most common abnormal preoperative imaging findings of IPNB are intraductal masses and the involvement of bile duct dilation. Simultaneous proximal and distal bile duct dilation can be detected in some cases, which has diagnostic significance. Cholangiography and cholangioscopy are needed to confirm the pathology and demonstrate the extent of the lesions. However, pathologic diagnosis by biopsy cannot reflect the actual stage in many cases because different foci may be of different stages and because mixed pathologic findings may exist in the same lesion. Surgical resection is the major treatment. Systematic cholangioscopy with staged biopsies and frozen sections is recommended during resection to ensure that no minor tumors are left and that curative resection is achieved. Staging, histologic subtype, curative resection and lymph node metastasis are factors affecting long-term survival. PMID:24379576

Wan, Xue-Shuai; Xu, Yi-Yao; Qian, Jun-Yan; Yang, Xiao-Bo; Wang, An-Qiang; He, Lian; Zhao, Hai-Tao; Sang, Xin-Ting

2013-12-14

325

Absorption of biliary cobalamin in baboons following total gastrectomy  

SciTech Connect

Absorption of radiolabeled cobalamin in baboons was assessed by whole body counting. Retention of biliary cobalamin and an aqueous solution of cyanocobalamin was measured in normal baboons and in baboons after total gastrectomy by using /sup 57/Co-labeled biliary cobalamin and /sup 58/C0-cyanocobalamin, with and without baboon gastric juice containing intrinsic factor. Radiolabeled biliary cobalamin was obtained by intravenous injection of /sup 57/Co-cyanocobalamin in baboons and collection of bile through a cannula placed in the common bile duct. Cobalamin absorption was not completely abolished by gastrectomy and biliary cobalamin was better retained than cyanocobalamin; intrinsic factor enhanced absorption of both forms. After gastrectomy there was steady depletion of liver and serum cobalamin levels, which ceased after a new equilibrium was reached between a progressively diminishing cobalamin loss and the impaired but significant residual level of absorption. These studies in the nonhuman primate provide further information concerning the enterohepatic circulation of cobalamin and suggest that the form of cobalamin in bile may be more readily absorbed than is cyanocobalamin or that bile itself may have an enhancing effect on cobalamin absorption. The data also suggest that physiologically significant amounts of cobalamin may be absorbed in the absence of a gastric source of intrinsic factor.

Green, R.; Jacobsen, D.W.; Van Tonder, S.V.; Kew, M.C.; Metz, J.

1982-11-01

326

Questionnaire Based Assessment of Risk Factors for Primary Biliary Cirrhosis  

PubMed Central

Background Primary Biliary Cirrhosis is a cholestatic liver disease characterized by immune-mediated destruction of bile ducts. Its pathogenesis is largely unknown, although complex interactions between environment and genetic predisposition are proposed. Aims Identify disease risk factors using a detailed patient questionnaire and compare study findings to 3 published reports. Methods Questionnaire data were prospectively collected from 522 cases and 616 controls of the Mayo Clinic Primary Biliary Cirrhosis Genetic Epidemiology Registry. Case and control responses were compared using logistic regression, adjusting for recruitment age, sex, and education level. Results Cases reported ever regularly smoking cigarettes more frequently than controls (P < 0.001). History of urinary tract infection (UTI) was similar between groups; however, cases reported multiple UTIs more commonly than controls (P < 0.001). Frequency of other autoimmune disease was higher in cases than controls (P < 0.001). As well, prevalence of primary biliary cirrhosis among first-degree relatives was higher in case families than control families (P < 0.001). Conclusions Our study confirms prior reported risk factors associated with disease risk. Given the potential importance of gene and environment interactions, further examination of environmental risk factors considering genetic background may provide new insight into primary biliary cirrhosis pathogenesis.

Lammert, Craig; Nguyen, Douglas L.; Juran, Brian D.; Schlicht, Erik; Larson, Joseph J.; Atkinson, Elizabeth J.; Lazaridis, Konstantinos N.

2013-01-01

327

The extrahepatic bile duct stricture mimicking a hilar cholangiocarcinoma: Case report and review of the literature  

Microsoft Academic Search

We report a case of a 68-year-old Chinese man who presented with Fatigue, anorexia more than half month, the body clear yellow dye for a week, liver function tests with alkaline phosphatase, alanine transferase increased, etc. Abdominal ultrasound showed extrahepatic duct dilatation. Enhanced computed tomography revealed signs of hepatic duct obstruction. Magnetic resonance imaging showed about the confluence of hepatic

Jie Mao; Mei Li; Ai Lin Song; Xiao Chen; You Cheng Zhang

2011-01-01

328

Biliary physiology in rats with bile ductular cell hyperplasia. Evidence for a secretory function of proliferated bile ductules.  

PubMed Central

To establish the role of the biliary epithelium in bile formation, we studied several aspects of biliary physiology in control rats and in rats with ductular cell hyperplasia induced by a 14-d extrahepatic biliary obstruction. Under steady-state conditions, spontaneous bile flow was far greater in obstructed rats (266.6 +/- 51.9 microliters/min per kg) than in controls (85.6 +/- 10.6 microliters/min per kg), while excretion of 3-hydroxy bile acids was the same in the two groups. Infusion of 10 clinical units (CU)/kg per h secretin produced a minimal choleretic effect in controls (+3.8 +/- 1.9 microliters/min per kg) but a massive increase in bile flow in the obstructed animals (+127.8 +/- 34.9 microliters/min per kg). Secretin choleresis was associated with an increase in bicarbonate biliary concentration and with a decline in [14C]mannitol bile-to-plasma ratio, although solute biliary clearance significantly increased. Conversely, administration of taurocholate (5 mumol/min per kg) produced the same biliary effects in control rats and in rats with proliferated biliary ductules. In the obstructed animals, the biliary tree volume measured during taurocholate choleresis (67.4 +/- 15.8 microliters/g liver) was significantly greater than that determined during the increase in bile flow induced by secretin (39.5 +/- 10.4 microliters/g liver). These studies indicate that, in the rat, the proliferated bile ductules/ducts spontaneously secrete bile and are the site of secretin choleresis. Furthermore, because the proliferated cells expressed phenotypic traits of bile ductular cells, our results suggest that whereas under normal conditions the biliary ductules/ducts in the rat seem to contribute little to bile formation, secretion of water and electrolytes is a property of biliary epithelial cells. Images

Alpini, G; Lenzi, R; Sarkozi, L; Tavoloni, N

1988-01-01

329

Use of articulated catheters in the treatment of biliary strictures  

SciTech Connect

We have used a single articulated catheter to obviate the need for multiple catheters in patients with complex biliary strictures or strictures associated with small or immature tracts. Two- and three-arm articulated drains (8-14 Fr) made from segments of biliary catheters were placed in 16 patients. Nine were placed transhepatically, 6 transperitoneally through existing T-tube tracts, and 1 through a cystic duct fistula. Six malignant and 10 benign strictures were stented with various catheter configurations through a single tract. Fifteen patients had two catheter components with one articulation and 1 patient had three catheter components with two articulations. The average duration of catheter drainage was 7.0 {+-} 4.2 months. Routine catheter exchanges were performed; two spontaneous occlusions occurred. In patients where internal stenting may be difficult or undesirable, articulated catheters allow satisfactory external and internal drainage of complex benign and malignant strictures through a single tract, avoiding the need for multiple transhepatic catheters.

Shlansky-Goldberg, Richard D.; Soulen, Michael C.; Haskal, Ziv J.; Cope, Constantin [Hospital of the University of Pennsylvania, Department of Radiology (United States)

1997-05-15

330

Mesenteric lymphography and ligation of the thoracic duct in a cat with chylothorax.  

PubMed

Mesenteric lymphography was used to identify and ligate the thoracic duct in a 1-year-old Himalayan cat with chylothorax. Lymphography revealed the thoracic duct to be intact; however, multiple dilated lymphatics, indicative of lymphangiectasia were evident in the cranial portion of the thorax. Hemostatic clips were used to ligate the thoracic duct. The effusion stopped, and 9 months after surgery, effusion has not recurred. PMID:4066459

Fossum, T W; Birchard, S J; Arnold, P A

1985-11-15

331

Stents in the biliary tree.  

PubMed Central

Biliary stenting has become established as a valuable method of palliation in malignant biliary strictures. The development of percutaneous and endoscopic techniques is described and illustrative cases are shown. The role of percutaneous vs endoscopic procedures is examined. Images Figure 1 Figure 2 Figure 3 Figure 4

Rowlands, P. C.

1995-01-01

332

Simultaneous gallbladder and bile duct cancers: revisiting the pathological possibilities  

PubMed Central

The pathogenesis of gallbladder cancer presenting synchronously with malignancy of the bile duct has not been clearly understood. The possible causes for the simultaneous presence of these tumors could be due to local spread, metastases, de novo multifocal origin, or as part of a field change in the extrahepatic biliary apparatus. In this article, we discuss the cases of four patients with simultaneous gallbladder and bile duct malignancies and analyze their individual pathologies to provide an explanation into the mechanisms that may play a role in such conditions.

Barreto, S. G.; Shrikhande, S. V.; Ramadwar, M. R.; Deodhar, K. K.; Mehta, S.; Patil, P.; Mohandas, K. M.

2008-01-01

333

Ejaculatory Duct Obstruction: TRUS-Guided Opacification of Seminal Tracts  

Microsoft Academic Search

Objective: To assess the usefulness of TRUS-guided aspiration and opacification of seminal tracts in the evaluation and management of patients with ejaculatory duct obstruction (EDO). Methods: In 21 men who had dilated seminal vesicles and\\/or midline cysts on TRUS, a mixture of contrast media and indigocarmine was injected and then pelvic radiographs were taken. Results: The diagnoses based on the

Seung Hyup Kim; Jae Seung Paick; In Hee Lee; Seon Kyu Lee; Kyung Mo Yeon

1998-01-01

334

Obstructive jaundice caused by a biliary mucinous cystadenoma in a woman: a case report  

PubMed Central

Introduction Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition is more common in young women and accounts for non-specific symptoms. Cyst adenomas commonly affect the intrahepatic system (90%) and are rarely found in the extrahepatic biliary system or affecting both the systems. Case presentation A 39-year-old Sinhalese woman presented with features of obstructive jaundice and was found to have a biliary neoplasm on imaging. In the absence of a definitive diagnosis despite extensive imaging she underwent preoperative endoscopic biliary drainage followed by a left hemihepatectomy with Roux-en-Y hepaticojejunostomy. A pathological examination of the specimen revealed an obstruction of the bile duct caused by a biliary mucinous cystadenoma affecting both the intrahepatic and extrahepatic systems. Conclusions Biliary mucinous cystadenoma rarely present with obstructive jaundice affecting both intrahepatic and extrahepatic ducts. Exhaustive investigation might not help in the diagnosis and may need to be treated based on clinical judgment. The definitive treatment modality is surgery due to its malignant potential. The operative procedure is technically demanding and is best performed at specialist centers to minimize complications.

2013-01-01

335

Biliary tract infections: a guide to drug treatment.  

PubMed

Initial therapy of acute cholecystitis and cholangitis is directed towards general support of the patient, including fluid and electrolyte replacement, correction of metabolic imbalances and antibacterial therapy. Factors affecting the efficacy of antibacterial therapy include the activity of the agent against the common biliary tract pathogens and pharmacokinetic properties such as tissue distribution and the ratio of concentration in both bile and serum to the minimum inhibitory concentration for the expected micro-organism. Antimicrobial therapy is usually empirical. Initial therapy should cover the Enterobacteriaceae, in particular Escherichia coli. Activity against enterococci is not required since their pathogenicity in biliary tract infections remains unclear. Coverage of anaerobes, in particular Bacteroides spp., is warranted in patients with previous bile duct-bowel anastomosis, in the elderly and in patients in serious clinical condition. In patients with acute cholecystitis or cholangitis of moderate clinical severity, monotherapy with a ureidopenicillin--mezlocillin or piperacillin--is at least as effective as the combination of ampicillin plus aminoglycoside. In severely ill patients with septicaemia, an antibacterial combination is preferable. Therapy with aminoglycosides, mostly for Pseudomonas aeruginosa-related infections, should not exceed a few days because the risk of nephrotoxicity seems to be increased during cholestasis. Relief of biliary obstruction is mandatory, even if there is clinical improvement with conservative therapy, because cholangitis is most likely to recur with continued obstruction. Emergency invasive therapy is reserved for patients who fail to show a clinical response to antibacterial therapy within the first 36 to 48 hours or for those who deteriorate after an initial clinical improvement. Immediate surgery is indicated for gangrenous cholecystitis and perforation with peritonitis. Long-term administration of antibacterials is required for recurrent cholangitis, as seen in bile duct-bowel anastomosis. Oral cotrimoxazole (trimethoprim/sulfamethoxazole) is the preferred agent. Wound infection rates after biliary tract surgery can be significantly reduced by preoperative administration of prophylactic antibacterials. Newer generation beta-lactams have not proven to be of greater benefit than older agents such as cefuroxime or cefazolin. Antibacterial prophylaxis before endoscopic retrograde cholangiopancreatography (ERCP) should be reserved for patients with obstructive jaundice, since the risk of infectious complications seems to be strongly associated with this clinical condition. Failure to achieve full biliary drainage is the most important factor in predicting septicaemia, and prophylaxis should be prolonged until the bile duct is unobstructed. Piperacillin, cefazolin, cefuroxime, cefotaxime and ciprofloxacin are effective for this indication. PMID:9951953

Westphal, J F; Brogard, J M

1999-01-01

336

Duct joining system  

DOEpatents

A duct joining system for providing an air-tight seal and mechanical connection for ducts and fittings is disclosed. The duct joining system includes a flexible gasket affixed to a male end of a duct or fitting. The flexible gasket is affixed at an angle relative to normal of the male end of the duct. The female end of the other duct includes a raised bead in which the flexible gasket is seated when the ducts are properly joined. The angled flexible gasket seated in the raised bead forms an air-tight seal as well as fastens or locks the male end to the female end. Alternatively, when a flexible duct is used, a band clamp with a raised bead is clamped over the female end of the flexible duct and over the male end of a fitting to provide an air tight seal and fastened connection.

Proctor, John P. (44 Glen Dr., Fairfax, CA 94930); deKieffer, Robert C. (Boulder, CO)

2001-01-01

337

Duct Joining System  

DOEpatents

A duct joining system for providing an air-tight seal and mechanical connection for ducts and fittings is disclosed. The duct joining system includes a flexible gasket affixed to a male end of a duct or fitting. The flexible gasket is affixed at an angle relative to normal of the male end of the duct. The female end of the other duct includes a raised bead in which the flexible gasket is seated when the ducts are properly joined. The angled flexible gasket seated in the raised bead forms an air-tight seal as well as fastens or locks the male end to the female end. Alternatively, when a flexible duct is used, a band clamp with a raised bead is clamped over the female end of the flexible duct and over the male end of a fitting to provide an air tight seal and fastened connection.

Proctor, John P. (Fairfax, CA)

2001-02-27

338

Importance of surgical technique in prevention of retained and recurrent bile duct stones  

Microsoft Academic Search

Approximately 10% of the 500,000 patients who undergo cholecystectomy for gallstones each year in the U.S.A. have associated choledocholithiasis. Of the patients who have a choledocholithotomy, 10–13% are found to have retained bile duct stones in the immediate postoperative period, and an unknown additional number are found to have biliary calculi subsequently. Residual bile duct calculi come from 3 sources,

Marshall J. Orloff

1978-01-01

339

ERCP for biliary strictures associated with chronic pancreatitis.  

PubMed

Chronic pancreatitis (CP)-related common bile duct (CBD) strictures are more difficult to treat endoscopically compared with benign biliary strictures because of their nature, particularly in patients with calcific CP. Before any attempt at treatment, malignancy must be excluded. Single plastic stents can be used for immediate symptom relief and as "bridge to surgery and/or bridge to decision," but are not suitable for definitive treatment of CP-related CBD strictures because of long-term poor results. Temporary simultaneous placement of multiple plastic stents has a high technical success rate and provides good long-term results. PMID:24079793

Familiari, Pietro; Boškoski, Ivo; Bove, Vincenzo; Costamagna, Guido

2013-10-01

340

Primary biliary cirrhosis: What do autoantibodies tell us?  

PubMed Central

Primary biliary cirrhosis (PBC) is a chronic, progressive, cholestatic, organ-specific autoimmune disease of unknown etiology. It predominantly affects middle-aged women, and is characterized by autoimmune-mediated destruction of small- and medium-size intrahepatic bile ducts, portal inflammation and progressive scarring, which without proper treatment can ultimately lead to fibrosis and hepatic failure. Serum autoantibodies are crucial tools for differential diagnosis of PBC. While it is currently accepted that antimitochondrial antibodies are the most important serological markers of PBC, during the last five decades more than sixty autoantibodies have been explored in these patients, some of which had previously been thought to be specific for other autoimmune diseases.

Hu, Chao-Jun; Zhang, Feng-Chun; Li, Yong-Zhe; Zhang, Xuan

2010-01-01

341

[A case of primary hepato-biliary malignant lymphoma effectively treated with R-CHOP chemotherapy].  

PubMed

A 65-year-old man was admitted to our hospital because of obstructive jaundice caused by a mass extending in the porta hepatis, neck of gall bladder and extrahepatic bile duct. The specimens obtained with ultrasound-guided needle biopsy showed malignant lymphoma (diffuse large B-cell lymphoma: DLBCL). CHOP with Rituximab therapy (R-CHOP therapy) was performed. The treatment resulted in remarkable reduction of the tumor size and improvement of the biliary stenosis. We should take into consideration malignant lymphoma when we see a patient with a tumor of the hepato-biliary system. PMID:20647724

Hiramoto, Keiichiro; Kuroki, Michio; Shoji, Hirokazu; Matsumura, Yoshifumi; Miura, Atsushi; Kikuchi, Yoshifumi; Hirakawa, Hidetoshi; Kimura, Jun; Matsuda, Mikio

2010-07-01

342

Hollow lensing duct  

DOEpatents

A hollow lensing duct to condense (intensify) light using a combination of focusing using a spherical or cylindrical lens followed by reflective waveguiding. The hollow duct tapers down from a wide input side to a narrow output side, with the input side consisting of a lens that may be coated with an antireflective coating for more efficient transmission into the duct. The inside surfaces of the hollow lens duct are appropriately coated to be reflective, preventing light from escaping by reflection as it travels along the duct (reflective waveguiding). The hollow duct has various applications for intensifying light, such as in the coupling of diode array pump light to solid state lasing materials.

Beach, Raymond J. (Livermore, CA) [Livermore, CA; Honea, Eric C. (Sunol, CA) [Sunol, CA; Bibeau, Camille (Dublin, CA) [Dublin, CA; Mitchell, Scott (Tracy, CA) [Tracy, CA; Lang, John (Pleasanton, CA) [Pleasanton, CA; Maderas, Dennis (Pleasanton, CA) [Pleasanton, CA; Speth, Joel (San Ramon, CA) [San Ramon, CA; Payne, Stephen A. (Castro Valley, CA) [Castro Valley, CA

2000-01-01

343

A quantitative assessment of the structural changes the rat's liver following obstruction of the common bile duct.  

PubMed Central

A study has been made of sequential changes in the rat's liver from 1 to 40 days after obstruction of the common bile duct. The qualitative changes have been described and illustrated. The volume proportions of hepatocytes, bile duct epithelium and biliary stroma have been quantified by histological analysis using a point counting technique. The proliferation of hepatocytes and bile duct cells have been measured by labelling with tritiated thymidine. The absolute quantity of hepatocytes in each liver has been estimated and expressed as a percentage of body weight. Over 40 days there is a relative fall in the volume proportion of hepatocytes and an increase in bile duct cells and biliary stroma. These changes in volume proportions are related directly to the period of jaundice. Biliary stroma increases in support of new bile duct tissue and there is no excessive fibrosis. Hepatocytes proliferate at a greater rate than normal after obstruction of the common bile duct and the degree of proliferation reaches a maximum of 24 times that of normal 4 days after obstruction. Similarly, the proliferation of bile duct epithelium is increased in obstructive jaundice but in this instance it reaches a maximum of 50 times that of normal 24 h after ligation of the common bile duct. The absolute quantity of hepatocytes in the liver probably falls during the period of jaundice. However, the fall is less than anticipated from the volume proportion of hepatocytes because of the overall increase in liver size. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4

Johnstone, J. M.; Lee, E. G.

1976-01-01

344

Notch signaling regulates tubular morphogenesis during repair from biliary damage in mice  

PubMed Central

Background & Aims Repair from biliary damages requires the biliary specification of hepatic progenitor cells and the remodeling of ductular reactive structures into branching biliary tubules. We hypothesized that the morphogenetic role of Notch signaling is maintained during the repair process and have addressed this hypothesis using pharmacologic and genetic models of defective Notch signaling. Methods Treatment with DDC (3,5-diethoxycarbonyl-1,4-dihydrocollidine) or ANIT (alpha-naphthyl-isothiocyanate) was used to induce biliary damage in wild type mice and in mice with a liver specific defect in the Notch-2 receptor (Notch-2-cKO) or in RPB-Jk. Hepatic progenitor cells, ductular reaction, and mature ductules were quantified using K19 and SOX-9. Results In DDC treated wild type mice, pharmacologic Notch inhibition with dibenzazepine decreased the number of both ductular reaction and hepatic progenitor cells. Notch-2-cKO mice treated with DDC or ANIT accumulated hepatic progenitor cells that failed to progress into mature ducts. In RBP-Jk-cKO mice, mature ducts and hepatic progenitor cells were both significantly reduced with respect to similarly treated wild type mice. The mouse progenitor cell line BMOL cultured on matrigel, formed a tubular network allowing the study of tubule formation in vitro; ?-secretase inhibitor treatment and siRNAs silencing of Notch-1, Notch-2 or Jagged-1 significantly reduced both the length and number of tubular branches. Conclusions These data demonstrate that Notch signaling plays an essential role in biliary repair. Lack of Notch-2 prevents biliary tubule formation, both in vivo and in vitro. Lack of RBP-Jk inhibits the generation of biliary-committed precursors and tubule formation.

Fiorotto, Romina; Raizner, Aileen; Morell, Carola M.; Torsello, Barbara; Scirpo, Roberto; Fabris, Luca; Spirli, Carlo; Strazzabosco, Mario

2013-01-01

345

An unusual case of biliary atresia.  

PubMed

Intrahepatic biliary cysts are rarely seen in the patients with biliary atresia. We describe a ten-month-old child with biliary atresia in whom the abdominal imaging studies (ultrasonography, computed tomographic scan and magnetic resonance cholangiopancreatography) revealed multiple intrahepatic biliary cysts ('bile lakes'). The child also had intrapulmonary shunting of blood due to pulmonary arteriovenous fistulae, which were demonstrated on contrast-enhanced echocardiography. Both these findings, 'bile lakes' and pulmonary arteriovenous fistulae occur rarely in biliary atresia. PMID:12645163

Tullu, M S; Hanchate, V G; Hira, P R; Kamat, J R; Vaswanti, R K; Chaubal, N G

2002-08-01

346

Biliary Adenofibroma of the Liver: Report of a Case and Review of the Literature  

PubMed Central

We herein report the clinicopathologic features of a rare case of biliary adenofibroma (BAF) of the liver in a 79-year-old man. Grossly, tumour presented as a well-circumscribed, 5.5-cm mass with a solid and microcystic appearance. Histological examination was typical of biliary adenofibroma, showing a proliferation of variable-sized tubulocystic structures embedded in a moderately cellular fibrous stroma. Immunohistochemistry, revealing immunoreactivity of the epithelial component to cytokeratins 7 and 19, was consistent with a bile duct origin. Notably, the stromal cells had a myofibroblastic profile, showing a diffuse and strong expression of vimentin and ?-smooth muscle actin. Differential diagnosis with Von Meyenburg complex, biliary adenoma, biliary cistadenoma, congenital biliary cystsy, and hepatic benign cystic mesothelioma is provided. The occasionally reported expression of p53 in biliary adenofibroma has suggested that this tumour could represent a premalignant lesion. The absence of both cytological atypia and p53 immunoreactivity in our case confirms that BAF is a benign tumour with an indolent clinical behaviour. However, a careful histological examination of BAF is mandatory because malignant transformation of the epithelial component has been documented in two cases.

Gurrera, Alessandra; Alaggio, Rita; Leone, Giorgia; Aprile, Giuseppe; Magro, Gaetano

2010-01-01

347

Biliary adenofibroma of the liver: report of a case and review of the literature.  

PubMed

We herein report the clinicopathologic features of a rare case of biliary adenofibroma (BAF) of the liver in a 79-year-old man. Grossly, tumour presented as a well-circumscribed, 5.5-cm mass with a solid and microcystic appearance. Histological examination was typical of biliary adenofibroma, showing a proliferation of variable-sized tubulocystic structures embedded in a moderately cellular fibrous stroma. Immunohistochemistry, revealing immunoreactivity of the epithelial component to cytokeratins 7 and 19, was consistent with a bile duct origin. Notably, the stromal cells had a myofibroblastic profile, showing a diffuse and strong expression of vimentin and ?-smooth muscle actin. Differential diagnosis with Von Meyenburg complex, biliary adenoma, biliary cistadenoma, congenital biliary cystsy, and hepatic benign cystic mesothelioma is provided. The occasionally reported expression of p53 in biliary adenofibroma has suggested that this tumour could represent a premalignant lesion. The absence of both cytological atypia and p53 immunoreactivity in our case confirms that BAF is a benign tumour with an indolent clinical behaviour. However, a careful histological examination of BAF is mandatory because malignant transformation of the epithelial component has been documented in two cases. PMID:21151526

Gurrera, Alessandra; Alaggio, Rita; Leone, Giorgia; Aprile, Giuseppe; Magro, Gaetano

2010-01-01

348

Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results  

SciTech Connect

Purpose. Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. Methods. Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. Results. Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. Conclusions. In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

Mizandari, Malkhaz [Tbilisi State Medical University, Department of Radiology (Georgia); Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk; Xi Feng [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Ao Guokun [The 309 Hospital of Chinese PLA, Department of Radiology (China); Kyriakides, Charis [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Dickinson, Robert [Imperial College London, Department of Bioengineering (United Kingdom); Nicholls, Joanna; Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom)

2013-06-15

349

[Cholangiocarcinoma with bile duct adenoma and hamartoma-like lesion in the bile duct].  

PubMed

A 76-year-old man presented with fever of unknown origin. Diagnostic imaging showed a liver tumor measuring 3cm in maximum dimension. The tumor was subsequently resected, and histopathology showed a moderately differentiated adenocarcinoma. This showed a number of bile ductules with variable amounts of stroma, well circumscribed but not encapsulated, so the lesion was diagnosed as a cholangiocarcinoma. Within the tumor there was also a cholangiolocarcinoma-like lesion. In addition, cystically dilated ductules resembling bile duct hamartoma and bile duct adenoma adjacent to the tumor were found, but with no area of transition among them. In the Glisson's capsule around the tumor, there was also a bile duct hamartoma. PMID:20203450

Takahashi, Sho; Takada, Kohichi; Kawano, Yutaka; Miyanishi, Koji; Ishiwatari, Hirotoshi; Hayashi, Tsuyoshi; Sagawa, Tamotsu; Sato, Tsutomu; Sato, Yasushi; Takimoto, Rishu; Kobune, Masayoshi; Kuroiwa, Ganji; Hirayama, Michiaki; Tobioka, Hirotoshi; Hirata, Kouichi; Omatsu, Mutsuko; Hasegawa, Tadashi; Kato, Junji

2010-03-01

350

Antibodies against p53 protein in serum of patients with benign or malignant pancreatic and biliary diseases.  

PubMed Central

Specific markers for pancreatic or biliary cancer have been developed in the past few years. Ca 19-9 has a good sensitivity but it is also increased in benign cholestasis. Mutations in the p53 gene are commonly reported in pancreatic cancer and can be detected by a serological analysis. The aim of this work was to find out the sensitivity and specificity of this new assay in diagnosing cancer of the pancreas or of the bile ducts. The presence of antibodies against p53 was determined by an enzyme linked immunosorbent assay (ELISA) in 29 patients with pancreatic cancer, 33 with biliary tract cancer, and 33 with benign biliary or pancreatic diseases as controls. p53 Antibodies were detected in eight of 29 patients with pancreatic cancer (28%), in five of 33 patients with biliary tract (15%), and in one patient (3%) with stones of the common bile duct. The sensitivity and the specificity for the diagnosis of malignant biliary or pancreatic diseases were 21% and 96% respectively. It is concluded that the presence of p53 antibodies in the serum of patients with pancreatic and biliary diseases is specific for malignancy and independent from the presence of cholestatic disease.

Laurent-Puig, P; Lubin, R; Semhoun-Ducloux, S; Pelletier, G; Fourre, C; Ducreux, M; Briantais, M J; Buffet, C; Soussi, T

1995-01-01

351

[Gadolinium as an alternative radiocontrast agent in patients with allergy to iodine-based contrast provide for useful diagnostic imagings and safely treatment of biliary tract diseases].  

PubMed

Diagnosis and treatment of biliary tract disease requires an intraductal radiocontrast agent. Although iodine-based contrast medium is commonly used, some patients show severe allergy to iodinated contrast agent. We have retrospectively reviewed the usefulness and safety of gadolinium as an alternative radiocontrast agent in 3 patients with allergy to iodine-based contrast medium in the diagnosis and treatment of biliary tract diseases. In case 1, percutaneous transhepatic biliary drainage and cholangiography were performed successfully and it was possible to visualize an intrahepatic bile duct stone. Percutaneous transhepatic cholangioscopic lithotomy was performed and the intrahepatic bile duct stone was removed. In case 2, endoscopic biliary lithotripsy was performed. In case 3, percutaneous transhepatic cholangiography and cholangioscopy provided a diagnosis of moderately differentiated carcinoma. He underwent pancreatoduodenectomy. Postoperative cholangiograms were also obtained successfully. Gadolinium contrast agent is an alternative to iodine-based cholangiography for the patients with allergy to iodine. PMID:23648538

Natsume, Makoto; Sano, Hitoshi; Fukusada, Shigeki; Kachi, Kenta; Inoue, Tadahisa; Anbe, Kaiki; Nishie, Hirotada; Nishi, Yuji; Yoshimura, Norihiro; Mizushima, Takashi; Okumura, Fumihiro; Miyabe, Katsuyuki; Naitoh, Itaru; Hayashi, Kazuki; Nakazawa, Takahiro

2013-05-01

352

Primary biliary cirrhosis and bile acids.  

PubMed

The dihydroxylated bile acid ursodeoxycholic acid (UDCA) has now been regarded for 20 years as the standard treatment for primary biliary cirrhosis (PBC), a chronic cholestatic immune-mediated condition marked by progressive destruction of small intrahepatic bile ducts, impaired biliary secretion, hepatocellular retention of toxic endogenous bile acids and, ultimately, the development of fibrosis leading to cirrhosis that commonly requires liver transplantation. At first sight, it seems intriguing that a bile acid could be considered for use as a therapeutic agent in a bile-acid secretion disorder. Yet, in addition to its inherently greater hydrophilic nature and competitive effect on endogenous bileacid recycling, UDCA has indeed been demonstrated to be a potent post-transcriptional secretagogue as well as a potential anti-inflammatory and anti-apoptotic agent. While the combined glucocorticoid receptor/pregnane X receptor (PXR) agonist budesonide, in combinaison with UDCA, has been shown to exert additional beneficial effects in PBC, significant progress in understanding the regulatory mechanisms involved in bile-acid homeostasis has led to the identification of nuclear [farnesoid X receptor (FXR), PXR, peroxisome proliferator-activated receptor alpha (PPAR?)] and membrane (the membrane G protein-coupled bile acid receptor TGR5) receptors as critical pharmacological targets for future therapeutic approaches. Encouraging data from recent experimental and phase-II studies tend to confirm that the FXR agonist obeticholic acid and the PPAR? agonists bezafibrate and fenofibrate may be used as add-on therapies in PBC patients with inadequate responses to UDCA or even as alternative first-line agents. These results could mark the beginning of a new therapeutic era for PBC. PMID:23141888

Corpechot, Christophe

2012-09-01

353

Salivary duct stones  

MedlinePLUS

... of minerals in the ducts that drain the salivary glands. Salivary duct stones are a type of salivary gland disorder. ... Saliva (spit) is produced by the salivary glands in the mouth. The ... that can block the salivary ducts. When saliva cannot exit ...

354

Percutaneous Management of Biliary Strictures After Pediatric Liver Transplantation  

SciTech Connect

We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the catheters removed. Mean number of balloon dilatations performed was 4.1 (range, 3-6). No major complications occurred. All 20 patients are symptom-free with respect to BS at a mean follow-up of 13 months (range, 2-46 months). In 15 of 20 patients (75%) one course of percutaneous stenting and bilioplasty was performed, with no evidence of recurrence of BS at a mean follow-up of 15 months (range, 2-46 months). In 4 of 20 patients (20%) two courses of percutaneous stenting and bilioplasty were performed; the mean time to recurrence was 9.8 months (range, 2.4-24 months). There was no evidence of recurrence of BS at a mean follow-up of 12 months (range, 2-16 months). In 1 of 20 patients (5%) three courses of percutaneous stenting and bilioplasty were performed; there was no evidence of recurrence of BS at a mean follow-up of 10 months. In conclusion, BS is a major problem following pediatric liver transplantation. Radiological percutaneous treatment is safe and effective, avoiding, in most cases, surgical revision of the anastomosis.

Miraglia, Roberto, E-mail: rmiraglia@ismett.edu; Maruzzelli, Luigi; Caruso, Settimo [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Radiology (Italy); Riva, Silvia [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Pediatric Hepatology (Italy); Spada, Marco [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Transplantation Surgery (Italy); Luca, Angelo [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Radiology (Italy); Gridelli, Bruno [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Transplantation Surgery (Italy)

2008-09-15

355

Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment  

Microsoft Academic Search

BACKGROUND: Anomalous biliary opening especially the presence of the ampulla of Vater in the duodenal bulb is a very rare phenomenon. We report clinical implications, laboratory and ERCP findings and also therapeutic approaches in 53 cases. METHODS: The data were collected from the records of 12.158 ERCP. The diagnosis was established as an anomalous opening of the common bile duct

Selcuk Disibeyaz; Erkan Parlak; Bahattin Cicek; Cem Cengiz; Sedef O Kuran; Dilek Oguz; Hakan Güzel; Burhan Sahin

2007-01-01

356

Hepatobiliary imaging of common bile duct obstruction by a hydronephrotic kidney  

SciTech Connect

A patient with intermittent right upper quadrant abdominal pain thought to represent acute cholecystitis had common bile duct obstruction due to an enlarged right renal pelvis. A Tc-99m-HIDA scan provided the first clue to the diagnosis. The case reinforces the value of cholescintigraphy in diagnosing pathology outside the biliary system.

Levinson, E.D.; Henken, E.M.; Spencer, R.P.

1982-02-01

357

Bile duct crystals do not contribute to sphincter of Oddi dysfunction  

Microsoft Academic Search

Background: Microlithiasis has been proposed as a cause of both occult gallbladder disease and of idiopathic pancreatitis. Theoretically, microlithiasis could also cause postcholecystectomy pain by causing temporary biliary obstruction and may be more common in patients with sphincter of Oddi dysfunction. The frequency of crystals in bile duct aspirates was assessed from patients with symptoms after cholecystectomy with and without

Leonard G. Quallich; Mark A. Stern; Melissa Rich; William D. Chey; Jeffrey L. Barnett; Grace H. Elta

2002-01-01

358

The ins and outs of membrane movement in biliary epithelia.  

PubMed Central

We have developed a novel technique for the isolation from normal rat liver of morphologically polar, intrahepatic bile duct epithelial cells which exhibit clathrin-coated pits. Using electron microscopic cytochemistry, we demonstrated receptor-mediated endocytosis of EGF by cultured IBDEC. Also, using freshly isolated polar couplets of IBDEC, we demonstrated that these cells participate in fluid-phase endocytosis. Finally, using a novel fluorescence unquenching assay and our isolated bile duct epithelial cell model, we showed that secretin stimulates exocytosis in IBDEC, a finding compatible with the possibility that secretin-induced changes in ductular bile flow may occur by an exocytic process. The availability of a reproducible and reliable technique to prepare liver cell fractions highly enriched in intrahepatic bile duct epithelial cells with morphologic polarity has made it possible to do direct experiments on the functions of intrahepatic bile duct epithelial cells, including the study of plasma membrane movement (i.e., endocytosis and exocytosis). With the availability of this technique, other studies previously impossible to carry out in IBDEC are now feasible. Such studies are too numerous to mention, but would include experiments on ligand binding, transport of macromolecules, assessment of metabolic activities and toxicity studies, to name just a few. Indeed, virtually any question that has been asked about hepatocytes and addressed using isolated hepatocytes can now be directed toward isolated intrahepatic bile duct epithelial cells. Finally, the methodology described here is theoretically applicable to human liver. Indeed, intrahepatic bile duct epithelial cells are considered to be involved in the pathogenesis of several kinds of drug and immunologically induced liver diseases, including allograft rejection, primary biliary cirrhosis, and primary sclerosing cholangitis. The availability of the technology described here should make feasible direct experimental approaches to questions in all of these areas. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 10 Fig. 11

LaRusso, N. F.; Ishii, M.; Vroman, B. T.

1991-01-01

359

The role of biliary drainage in patients with pancreatic adenocarcinoma.  

PubMed

Pancreatic cancer is one of the leading causes of cancer deaths worldwide and constitutes a major public health problem. One of the most common symptoms associated with pancreatic adenocarcinoma is jaundice, caused by the obstruction of common bile duct. Endobiliary stenting is used to relief these patients either preoperatively or merely for palliation and plastic or metal stents are usually endoscopically or percutaneously placed. Two interesting studies were presented at the 2014 ASCO Gastrointestinal Cancers Symposium. Strom et al. sought to investigate the effect of preoperative biliary drainage on recurrence and survival and they concluded that percutaneous biliary decompression was an independent predictor of worse overall survival and was associated with non-significant increase in hepatic recurrence (Abstract #314). Montero et al. presented the results of their study regarding the cost-effectiveness of metal stents in patients with inoperable pancreatic cancer and they concluded that placement of metal biliary stents is cost saving, improves overall survival and quality-adjusted survival compared with plastic stents (Abstract #260). Both studies concluded to useful results that along with the existing literature and formulated guidelines may help the provision of more effective, higher quality management of these patients. PMID:24618435

Toki, Maria I; Syrigos, Konstantinos N; Saif, Muhammad Wasif

2014-03-01

360

Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study  

PubMed Central

Background Numerous clinical trials to improve the success rate of biliary access in difficult biliary cannulation (DBC) during ERCP have been reported. However, standard guidelines or sequential protocol analysis according to different methods are limited in place. We planned to investigate a sequential protocol to facilitate selective biliary access for DBC during ERCP. Methods This prospective clinical study enrolled 711 patients with naïve papillae at a tertiary referral center. If wire-guided cannulation was deemed to have failed due to the DBC criteria, then according to the cannulation algorithm early precut fistulotomy (EPF; cannulation time?>?5 min, papillary contacts?>?5 times, or hook-nose-shaped papilla), double-guidewire cannulation (DGC; unintentional pancreatic duct cannulation???3 times), and precut after placement of a pancreatic stent (PPS; if DGC was difficult or failed) were performed sequentially. The main outcome measurements were the technical success, procedure outcomes, and complications. Results Initially, a total of 140 (19.7%) patients with DBC underwent EPF (n?=?71) and DGC (n?=?69). Then, in DGC group 36 patients switched to PPS due to difficulty criteria. The successful biliary cannulation rate was 97.1% (136/140; 94.4% [67/71] with EPF, 47.8% [33/69] with DGC, and 100% [36/36] with PPS; P?duct cannulations, and PPS in failed or difficult DGC may facilitate successful biliary cannulation.

2014-01-01

361

Fracture of Self-Expandable Metal Stent during Endoscopic Removal in Benign Biliary Stricture  

PubMed Central

The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.

Joo, Kyu Re; Chung, Woo Chul; Lee, Kang-Moon; Yang, Jin Mo

2013-01-01

362

In vivo study of polyurethane-coated gianturco-rosch biliary Z-stents  

Microsoft Academic Search

Purpose: Prototypes of Gianturco-Rosch Z-stents coated with polycarbonate urethane (PCU) were placed in the biliary tree of pigs,\\u000a in order to test their biomechanical behavior, stability, and biocompatibility.\\u000a \\u000a \\u000a Methods: The stents were surgically implanted in the common bile duct of three pairs of pigs, which were killed after 1, 3, and 6\\u000a months respectively. Explanted livers from pigs of the

Aldo Severini; Sara Mantero; Maria Cristina Tanzi; Alberto Cigada; Flaminio Addis; Guido Cozzi; Monica Salvetti; Salvatore Andreola; Antonella Motta; Enrico Regalia; Andrea Pulvirenti; Enrico De Pedri; Roberto Doci

1999-01-01

363

Polyurethane-covered metal stent for management of distal malignant biliary obstruction  

Microsoft Academic Search

Background: The efficacy of polyurethane-covered metal expandable stents for treatment of neoplastic distal biliary obstruction was analyzed. Methods: Twenty-one patients with unresectable malignant tumors involving the mid to distal bile duct who were seen with obstructive jaundice were consecutively enrolled. Eighteen patients underwent endoscopic implantation of a polyurethane-covered metal stent and 3 patients underwent transhepatic insertion because of duodenal obstruction.

Hiroyuki Isayama; Yutaka Komatsu; Takeshi Tsujino; Haruhiko Yoshida; Minoru Tada; Yasushi Shiratori; Takao Kawabe; Masao Omata

2002-01-01

364

Biliary excretion of 17-(allylamino)-17-demethoxygeldanamycin (NSC 330507) and metabolites by Fischer 344 rats  

Microsoft Academic Search

Purpose17-(Allylamino)-17-demethoxygeldanamycin (17AAG), an analogue of the benzoquinone ansamycin geldanamycin, has been extensively studied preclinically and is being evaluated clinically. Studies were performed to define the biliary excretion of 17AAG after i.v. delivery to rats, and to characterize the metabolites of 17AAG observed in rat bile.Materials and methodsIn vivo studies were performed in bile-duct-cannulated Fischer 344 rats given a 10 mg\\/kg i.v.

Steven M. Musser; Merrill J. Egorin; Eleanor G. Zuhowski; Deborah R. Hamburger; Robert A. Parise; Joseph M. Covey; Kevin D. White; Julie L. Eiseman

2003-01-01

365

Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation  

PubMed Central

AIM: To compare the outcomes between double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) in patients with difficult biliary cannulation. METHODS: This was a prospective, randomized study conducted in single tertiary referral hospital in Korea. Between January 2005 and September 2010. A total of 71 patients, who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved, were randomized into DGT (n = 34) and TPS (n = 37) groups. DGT or TPS was done for selective biliary cannulation. We measured the technical success rates of biliary cannulation, median cannulation time, and procedure related complications. RESULTS: The distribution of patients after randomization was balanced, and both groups were comparable in baseline characteristics, except the higher percentage of endoscopic nasobiliary drainage in the DGT group (55.9% vs 13.5%, P < 0.001). Successful cannulation rate and mean cannulation times in DGT and TPS groups were 91.2% vs 91.9% and 14.1 ± 13.2 min vs 15.4 ± 17.9 min, P = 0.732, respectively. There was no significant difference between the two groups. The overall incidence of post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis was 38.2% vs 10.8%, P < 0.011 in the DGT group and the TPS group; post-procedure pancreatitis was significantly higher in the DGT group. But the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups; DGT group vs TPS group: 14.7% vs 16.2%, P < 1.0. CONCLUSION: When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved, DGT and TPS facilitated biliary cannulation and showed similar success rates. However, post-procedure pancreatitis was significantly higher in the DGT group.

Yoo, Young Wook; Cha, Sang-Woo; Lee, Woong Cheul; Kim, Sae Hee; Kim, Anna; Cho, Young Deok

2013-01-01

366

Effective Treatment of Biliary Cystadenoma  

PubMed Central

Objective: Evaluate experience over 15 years with treatment of this lesion. Summary Background Data: Biliary cystadenoma, a benign hepatic tumor arising from Von Meyenberg complexes, usually present as septated intrahepatic cystic lesions. Methods: Data were collected concurrently and retrospectively on patients identified from hospital medical records reviewed for pertinent International Classification of Diseases, Ninth Revision, Clinical Modification and CPT codes, pathology logs, and from operative case logs. Pathology specimens were rereviewed to confirm the diagnosis of biliary cystadenoma or biliary cystadenocarcinoma by 2 GI pathologists. Results: From October 1989 to April 2004 at our institution, 19 (18F:1M) patients had pathologically confirmed biliary cystadenomas, including one with a biliary cystadenocarcinoma. The mean age was 48 ± 15 years at initial evaluation. Complaints included abdominal pain in 74%, abdominal distension in 26%, and nausea/vomiting in 11%. Only 1 patient presented with an incidental finding. Symptoms had been present for 3 ± 5 years, with 1 to 4 different surgeons and many other physicians involved in the diagnosis or treatment prior to definitive ablation. Eight patients had undergone 20 previous treatments, including multiple percutaneous aspirations in 4 and 11 operative procedures. CT or US was diagnostic in 95%, with internal septations present in the hepatic cysts. Definitive operative intervention consisted of hepatic resection in 12 patients, enucleation in 6 patients, and fenestration and complete fulguration in 1 patient. There were no perioperative deaths. No recurrences were observed after definitive therapy, with follow-up of 4 ± 4 years. Conclusions: Biliary cystadenoma must be recognized and treated differently than most hepatic cysts. There remains a need for education about the imaging findings for biliary cystadenoma to reduce the demonstrated delay in appropriate treatment. Traditional treatment of simple cysts such as aspiration, drainage, and marsupialization results in near universal recurrence and occasional malignant degeneration. This experience demonstrates effective options include total ablation by standard hepatic resection and cyst enucleation.

Thomas, K Tyson; Welch, Derek; Trueblood, Andrew; Sulur, Paulgun; Wise, Paul; Gorden, D Lee; Chari, Ravi S.; Wright, J Kelly; Washington, Kay; Pinson, C Wright

2005-01-01

367

Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research.  

PubMed

Acute pancreatitis (AP) is a formidable disease, which, in severe forms, causes significant mortality. Biliary AP, or gallstone obstruction-associated AP, accounts for 30-50% of all clinical cases of AP. In biliary AP, pancreatic acinar cell (PAC) death (the initiating event in the disease) is believed to occur as acinar cells make contact with bile salts when bile refluxes into the pancreatic duct. Recent advances have unveiled an important receptor responsible for the major function of bile acids on acinar cells, namely, the cell surface G-protein-coupled bile acid receptor-1 (Gpbar1), located in the apical pole of the PAC. High concentrations of bile acids induce cytosolic Ca(2+) overload and inhibit mitochondrial adenosine triphosphate (ATP) production, resulting in cell injury to both PACs and pancreatic ductal epithelial cells. Various bile salts are employed to induce experimental AP, most commonly sodium taurocholate. Recent characterization of taurolithocholic acid 3-sulphate on PACs has led researchers to focus on this bile salt because of its potency in causing acinar cell injury at relatively low, sub-detergent concentrations, which strongly implicates action via the receptor Gpbar1. Improved surgical techniques have enabled the infusion of bile salts into the pancreatic duct to induce experimental biliary AP in mice, which allows the use of these transgenic animals as powerful tools. This review summarizes recent findings using transgenic mice in experimental biliary AP. PMID:22221567

Wan, Mei H; Huang, Wei; Latawiec, Diane; Jiang, Kun; Booth, David M; Elliott, Victoria; Mukherjee, Rajarshi; Xia, Qing

2012-02-01

368

Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research  

PubMed Central

Acute pancreatitis (AP) is a formidable disease, which, in severe forms, causes significant mortality. Biliary AP, or gallstone obstruction-associated AP, accounts for 30–50% of all clinical cases of AP. In biliary AP, pancreatic acinar cell (PAC) death (the initiating event in the disease) is believed to occur as acinar cells make contact with bile salts when bile refluxes into the pancreatic duct. Recent advances have unveiled an important receptor responsible for the major function of bile acids on acinar cells, namely, the cell surface G-protein-coupled bile acid receptor-1 (Gpbar1), located in the apical pole of the PAC. High concentrations of bile acids induce cytosolic Ca2+ overload and inhibit mitochondrial adenosine triphosphate (ATP) production, resulting in cell injury to both PACs and pancreatic ductal epithelial cells. Various bile salts are employed to induce experimental AP, most commonly sodium taurocholate. Recent characterization of taurolithocholic acid 3-sulphate on PACs has led researchers to focus on this bile salt because of its potency in causing acinar cell injury at relatively low, sub-detergent concentrations, which strongly implicates action via the receptor Gpbar1. Improved surgical techniques have enabled the infusion of bile salts into the pancreatic duct to induce experimental biliary AP in mice, which allows the use of these transgenic animals as powerful tools. This review summarizes recent findings using transgenic mice in experimental biliary AP.

Wan, Mei H; Huang, Wei; Latawiec, Diane; Jiang, Kun; Booth, David M; Elliott, Victoria; Mukherjee, Rajarshi; Xia, Qing

2012-01-01

369

Percutaneous Embolization of Transhepatic Tracks for Biliary Intervention  

SciTech Connect

Significant pain can occur after removing transhepatic catheters from biliary access tracks, after percutaneous biliary drainage (PBD) or stenting. We undertook a randomized prospective study to ascertain whether track embolization decreases the amount of pain or analgesic requirement after PBD. Fifty consecutive patients (M:F, 22:28; age range:29-85 years; mean age: 66.3 years) undergoing PBD were randomized to receive track embolization or no track embolization after removal of biliary drainage catheters. A combination of Lipoidol and n-butyl cyanoacrylate were used to embolize transhepatic tracks using an 8F dilator. The patients who did not have track embolization performed had biliary drainage catheters removed over a guide wire. A visual analog scoring (VAS) system was used to grade pain associated with catheter removal, 24 h afterward. A required analgesic score (RAS) was devised to tabulate the analgesia required. No analgesia had a score of 0, oral or rectal nonopiate analgesics had a score of 1, oral opiates had a score of 2, and parenteral opiates had a score of 3. The average VAS and RAS for both groups were calculated and compared.Seven patients were excluded for various reasons, leaving 43 patients in the study group. Twenty-one patients comprised the embolization group and 22 patients comprised the nonembolization group. The mean biliary catheter dwell time was not significantly different (p > 0.05) between the embolization group and nonembolization (mean: 5.4 days vs 6.9 days, respectively). In the nonembolization group, the mean VAS was 3.4. Eight patients required parenteral opiates, three patients required oral opiates, and five patients required oral or rectal analgesics, yielding a mean RAS of 1.6. In the embolization group, the mean VAS was 0.9. No patient required parenteral opiates, six patients required oral opiates, and two patients had oral analgesia. The average RAS was 0.6. Both the VAS and the RAS were significantly lower in the embolization group compared with the nonembolization group (p < 0.0023 and p < 0.002, respectively). No complications were seen related to track embolization. Percutaneous track embolization after removal of biliary drainage catheters decreases patient's perception of pain and decreases the amount of required analgesia. In particular, the amount of opiate analgesia required is considerably less.

Lyon, Stuart M.; Terhaar, Olaf; Given, Mark F.; O'Dwyer, Helena M.; McGrath, Frank P.; Lee, Michael J. [Beaumont Hospital, Department of Academic Radiology (Ireland)], E-mail: mlee@rcsi.ie

2006-12-15

370

Common bile duct exploration: the place of laparoscopic choledochotomy.  

PubMed

Since laparoscopic cholecystectomy was introduced, the treatment of choledocholithiasis has been modified. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) has been performed selectively in elderly patients and in those with a strong suspicion of biliary duct stones (jaundice, demonstrated at ultrasound). Intraoperative discovery of common duct stones at cystic duct cholangiography signifies that they must be removed intraoperatively [or postoperatively by ERPC and endoscopic sphincterotomy (ES)]. As ES has a failure rate of 3-23%, laparoscopic common duct exploration emerges as the treatment of choice. Since November 1990, we have performed 59 laparoscopic common bile duct explorations. In our experience, the transcystic technique (18 patients) with choledochoscopy appears easier to perform than with fluoroscopy without choledochoscopy. Since, during our early experience, we encountered some difficulty with the transcystic technique, we elected to evaluate common duct exploration through a choledochotomy (41 patients). The main advantage of this technique is that it provides complete access to the ductal system without damage to the papilla. This procedure seems more difficult to perform than the transcystic technique and can be used when there are contraindications to the latter. PMID:7866610

Dion, Y M; Ratelle, R; Morin, J; Gravel, D

1994-12-01

371

Polymorphisms of estrogen receptors and risk of biliary tract cancers and gallstones: a population-based study in Shanghai, China  

PubMed Central

Biliary tract cancer encompasses tumors of the gallbladder, bile duct and ampulla of Vater. Gallbladder cancer is more common in women, whereas bile duct cancer is more common in men, suggesting that sex hormones may play a role in the etiology of these cancers. The intracellular action of estrogens is regulated by the estrogen receptor (ESR); thus, we examined the role of common genetic variants in ESR genes on the risk of biliary tract cancers and stones in a population-based case–control study in Shanghai, China (411 cancer cases, 895 stone cases and 786 controls). We genotyped six single-nucleotide polymorphisms (SNPs), four in ESR1 (rs2234693, rs3841686, rs2228480 and rs1801132) and two in ESR2 (rs1256049 and rs4986938). In all participants, the ESR1 rs1801132 (P325P) G allele was associated with excess risks of bile duct [odds ratio (OR)?=?1.7, 95% confidence interval (CI) 1.1–2.8] and ampulla of Vater cancers (OR?=?2.1, 95% CI 0.9–4.9) compared with the CC genotype. The association with bile duct cancer was apparent among men (OR?=?2.8, 95% CI 1.4–5.7) but not among women (P-heterogeneity?=?0.01). Also, the ESR2 rs4986938 (38 bp 3? of STP) GG genotype was associated with a higher risk of bile duct cancer (OR?=?3.3, 95% CI 1.3–8.7) compared with the AA genotype, although this estimate was based on a small number of subjects. None of the other SNPs examined was associated with biliary tract cancers or stones. False discovery rate-adjusted P-values were not significant (P?>?0.1). No association was found for ESR1 haplotype based on four SNPs. These preliminary results suggest that variants in ESR genes could play a role in the etiology of biliary tract cancers, especially bile duct cancer in men.

Andreotti, Gabriella; Rashid, Asif; Chen, Jinbo; Rosenberg, Philip S.; Yu, Kai; Olsen, Jennifer; Gao, Yu-Tang; Deng, Jie; Sakoda, Lori C.; Zhang, Mingdong; Shen, Ming-Chang; Wang, Bing-Sheng; Han, Tian-Quan; Zhang, Bai-He; Yeager, Meredith; Chanock, Stephen J.; Hsing, Ann W.

2010-01-01

372

Hepatic and Biliary Ascariasis  

PubMed Central

Ascariasis mainly contributes to the global helminthic burden by infesting a large number of children in the tropical countries. Hepato-biliary ascariasis (HBA) is becoming a common entity now than in the past owing to the frequent usage of ultrasonograms and endoscopic diagnostic procedures in the clinical practice. There are a variety of manifestations in HBA and diagnosis depends on a high index of suspicion in endemic areas coupled with subsequent confirmation by sonographic or endoscopic demonstration of the worm. Most of them present with acute abdomen and jaundice. Oriental or recurrent pyogenic cholangiopathy is possibly the result of HBA, commonly encountered in South-East Asian countries. Conservative treatment with anthelminthic agents is used in the majority. Failure to respond to medical therapy usually indicates the need for endoscopic or surgical interventions. Overall, mortality is low and prognosis is good, but many epidemiological and immunological aspects of Ascaris infection are unclear, meaning our understanding the disease and infection still remains incomplete. Therefore, it is difficult to definitely put down a fixed modality of treatment for HBA. This underscores the need for further studies as ascariasis has the potential to adversely affect the national socio-economy by compromising the health of children and adults alike with its sheer number.

Das, Anup K

2014-01-01

373

Medium-term effects of endoscopic papillary balloon dilation on gallbladder motility  

Microsoft Academic Search

Background: Endoscopic papillary balloon dilation (EPBD) for removal of bile duct stones tends to preserve papillary function. However, EPBD may exert beneficial or deleterious effects on gallbladder motility. This was a prospective, medium-term investigation (2 years) of the effects of EPBD on gallbladder motility. Methods: Twelve patients with intact gallbladders (6 with and 6 without gallbladder stones) who underwent EPBD

Masanori Sugiyama; Yutaka Atomi

2001-01-01

374

Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function?  

Microsoft Academic Search

BACKGROUNDEndoscopic papillary balloon dilation (EPBD) is assumed to preserve sphincter of Oddi function because it causes little trauma to the papilla. However, few studies have addressed this issue specifically. In this study, we investigated whether EPBD can preserve sphincter function, and evaluated whether or not such preservation has clinical significance.METHODSSeventy patients with common bile duct (CBD) stones were randomly assigned

I Yasuda; E Tomita; M Enya; T Kato; H Moriwaki

2001-01-01

375

The diagnosis of primary biliary cirrhosis.  

PubMed

Primary biliary cirrhosis (PBC) is a chronic liver disease characterized by the immune mediated destruction of small intrahepatic bile duct epithelial cells leading to cholestasis and cirrhosis. The autoimmune basis of PBC is supported by the highly specific anti-mitochondrial antibodies (AMAs) and autoreactive T cells, the former being the basis for diagnosis in the vast majority of cases. Although a rare disease, the incidence rates of PBC have been increasing, possibly due to increased testing and diagnosis as opposed to a true increase in disease incidence. Presently, most cases are asymptomatic and only suspected based upon routine liver tests. Those with symptoms typically complain of pruritus and fatigue. The diagnosis of PBC is based on the presence of at least 2 of 3 key criteria including a persistently elevated serum alkaline phosphatase, the presence of serum AMAs, and liver histology consistent with PBC. Anti-nuclear antibodies specific to PBC are useful in cases in which AMAs are not detected and may indicate a more aggressive course. Ursodeoxycholic acid is the only proven therapy for PBC and in most cases can delay or prevent disease progression. However, a subgroup of patients does not adequately respond to ursodeoxycholic acid and for whom new therapies are needed. PMID:24424173

Bowlus, Christopher L; Gershwin, M Eric

2014-01-01

376

Time Dilation Equation  

NSDL National Science Digital Library

This online article is from the Museum's Seminars on Science, a series of distance-learning courses designed to help educators meet the new national science standards. The article, which offers a simple demonstration of Einstein's Time Dilation Equation, is part of the Frontiers in Physical Science seminar. It uses the example of a light beam bouncing between two mirrors in a rocket to illustrate the theory, and includes a step-by-step look at the math involved in calculating the quantitative solution.

377

Lightweight Valve Closes Duct Quickly  

NASA Technical Reports Server (NTRS)

Expanding balloon serves as lightweight emergency valve to close wide duct. Uninflated balloon stored in housing of duct. Pad resting on burst diaphragm protects balloon from hot gases in duct. Once control system triggers valve, balloon inflates rapidly to block duct. Weighs much less than does conventional butterfly, hot-gas, or poppet valve capable of closing duct of equal diameter.

Fournier, Walter L.; Burgy, N. Frank

1991-01-01

378

Percutaneous cholangioscopy in obstructed biliary metal stents  

Microsoft Academic Search

Purpose. To reevaluate the reasons for the occlusion of self-expanding biliary metal stents, on the basis of cholangioscopic findings. Methods. Percutaneous transhepatic cholangioscopy (PTCS) was performed in 15 patients with obstructed biliary Wallstents. The reason for stent insertion was a malignant obstruction in 14 patients; 1 had a benign biliary stricture. Conventional noncovered stents had been inserted in 12 patients;

Klaus A. Hausegger; Hans J. Mischinger; Radenko Karaic; Guenther E. Klein; Cristian Kugler; Robert Kern; Martin Uggowitzer; Dieter Szolar

1997-01-01

379

Bile duct obstruction  

MedlinePLUS

... cholangiopancreatography) Percutaneous transhepatic cholangiogram (PTCA) Magnetic resonance cholangiopancreatography (MRCP) A blocked bile duct may also alter the results of the following tests: Amylase blood test Gallbladder ...

380

Use of fully covered self-expanding metal stents in benign biliary diseases  

PubMed Central

Biliary fully covered self-expanding metal stents (FCSEMS) are now being used to treat several benign biliary conditions. Advantages include small predeployment and large postexpansion diameters in addition to an easy insertion technique. Lack of imbedding of the metal into the bile duct wall enables removability. In benign biliary strictures that usually require multiple procedures, despite the substantially higher cost of FCSEMS compared with plastic stents, the use of FCSEMS is offset by the reduced number of endoscopic retrograde cholangiopancreatography interventions required to achieve stricture resolution. In the same way, FCSEMS have also been employed to treat complex bile leaks, perforation and bleeding after endoscopic biliary sphincterotomy and as an aid to maintain permanent drainage tracts obtained by means of Endoscopic Ultrasound-guided biliary drainage. Good success rates have been achieved in all these conditions with an acceptable number of complications. FCSEMS were successfully removed in all patients. Comparative studies of FCSEMS and plastic stents are needed to demonstrate efficacy and cost-effectiveness

Garcia-Cano, Jesus

2012-01-01

381

IMP3 immunocytochemical staining increases sensitivity in the routine cytologic evaluation of biliary brush specimens.  

PubMed

Biliary brush cytology is an important diagnostic tool in the evaluation of biliary strictures. Here, we evaluated 64 patients with biliary strictures who underwent endoscopic retrograde cholangiopancreatography with bile duct brushings. We assessed the utility of combining routine Papanicolaou-stained cytologic evaluation with immunocytochemical expression of insulin-like growth factor mRNA-binding protein-3 (IMP3). Definitive diagnoses were obtained via tissue resection/autopsy, biopsy, fine needle aspiration, or clinical progression of disease. Thirty-nine of the 64 patients were ultimately diagnosed with malignancy. The sensitivity of routine cytology for the detection of malignancy was 33.3%, immunocytochemical-IMP3 expression was 64.1%, and the combined sensitivity was 71.8%. The specificity of each method was 100%. The sensitivity of IMP3 immunocytochemical staining in the detection of malignancy in biliary brushings was superior to routine PAP-stained cytologic evaluation. Moreover, the combined use of biliary brushing cytology and IMP3 immunohistochemistry proved superior to the use of either method alone. PMID:22431320

Hart, Jesse; Parab, Meena; Mandich, Daniza; Cartun, Richard W; Ligato, Saverio

2012-04-01

382

Rhabdomyosarcoma of the biliary tree.  

PubMed

Rhabdomyosarcoma (RMS) of the biliary tree is a rare tumor in children that has a very poor prognosis. Preoperatively, it is often mistaken for a choledochal cyst. We report a case of RMS of the biliary tree in a 4-year-old girl who presented with abdominal pain and obstructive jaundice. The RMS was diagnosed at laparotomy; excision was not possible due to its size and localization. Chemotherapy achieved complete regression of the tumor observed at second-look surgery. Preoperative chemotherapy can now avoid mutilating surgical procedures and improve survival. PMID:9156861

Sanz, N; de Mingo, L; Flórez, F; Rollán, V

1997-02-01

383

Hepcidin Is an Antibacterial, Stress-Inducible Peptide of the Biliary System  

PubMed Central

Background/Aims Hepcidin (gene name HAMP), an IL-6-inducible acute phase peptide with antimicrobial properties, is the key negative regulator of iron metabolism. Liver is the primary source of HAMP synthesis, but it is also produced by other tissues such as kidney or heart and is found in body fluids such as urine or cerebrospinal fluid. While the role of hepcidin in biliary system is unknown, a recent study demonstrated that conditional gp130-knockout mice display diminished hepcidin levels and increased rate of biliary infections. Methods Expression and localization of HAMP in biliary system was analyzed by real time RT-PCR, in-situ hybridization, immunostaining and –blotting, while prohepcidin levels in human bile were determined by ELISA. Results Hepcidin was detected in mouse/human gallbladder and bile duct epithelia. Biliary HAMP is stress-inducible, in that it is increased in biliary cell lines upon IL-6 stimulation and in gallbladder mucosa of patients with acute cholecystitis. Hepcidin is also present in the bile and elevated prohepcidin levels were observed in bile of primary sclerosing cholangitis (PSC) patients with concurrent bacterial cholangitis compared to PSC subjects without bacterial infection (median values 22.3 vs. 8.9; p?=?0.03). In PSC-cholangitis subjects, bile prohepcidin levels positively correlated with C-reactive protein and bilirubin levels (r?=?0.48 and r?=?0.71, respectively). In vitro, hepcidin enhanced the antimicrobial capacity of human bile (p<0.05). Conclusion Hepcidin is a stress-inducible peptide of the biliary epithelia and a potential marker of biliary stress. In the bile, hepcidin may serve local functions such as protection from bacterial infections.

Strnad, Pavel; Schwarz, Peggy; Rasenack, Maria C. D.; Kucukoglu, Ozlem; Habib, Rayan I.; Heuberger, Dominik; Ehehalt, Robert; Muller, Michael W.; Stiehl, Adolf; Adler, Guido; Kulaksiz, Hasan

2011-01-01

384

Advanced Duct Sealing Testing  

SciTech Connect

Duct leakage has been identified as a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums or branches in the duct system. At each of these connections a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field examinations of duct systems have typically shown that these seals tend to fail over extended periods of time. The Lawrence Berkeley National Laboratory has been testing sealant durability for several years. Typical duct tape (i.e. fabric backed tapes with natural rubber adhesives) was found to fail more rapidly than all other duct sealants. This report summarizes the results of duct sealant durability testing of five UL 181B-FX listed duct tapes (three cloth tapes, a foil tape and an Oriented Polypropylene (OPP) tape). One of the cloth tapes was specifically developed in collaboration with a tape manufacturer to perform better in our durability testing. The first test involved the aging of common ''core-to-collar joints'' of flexible duct to sheet metal collars, and sheet metal ''collar-to-plenum joints'' pressurized with 200 F (93 C) air. The second test consisted of baking duct tape specimens in a constant 212 F (100 C) oven following the UL 181B-FX ''Temperature Test'' requirements. Additional tests were also performed on only two tapes using sheet metal collar-to-plenum joints. Since an unsealed flexible duct joint can have a variable leakage depending on the positioning of the flexible duct core, the durability of the flexible duct joints could not be based on the 10% of unsealed leakage criteria. Nevertheless, the leakage of the sealed specimens prior to testing could be considered as a basis for a failure criteria. Visual inspection was also documented throughout the tests. The flexible duct core-to-collar joints were inspected monthly, while the sheet metal collar-to-plenum joints were inspected weekly. The baking test specimens were visually inspected weekly, and the durability was judged by the observed deterioration in terms of brittleness, cracking, flaking and blistering (the terminology used in the UL 181B-FX test procedure).

Sherman, Max H.; Walker, Iain S.

2003-08-01

385

Duct Tape Durability Testing  

SciTech Connect

Duct leakage is a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums, or branches in the duct system. At each of these connections, a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field examinations of duct systems have shown that taped seals tend to fail over extended periods of time. The Lawrence Berkeley National Laboratory (LBNL) has been testing sealant durability for several years using accelerated test methods and found that typical duct tape (i.e., cloth-backed tapes with natural rubber adhesives) fails more rapidly than other duct sealants. This report summarizes the results of duct sealant durability testing over two years for four UL 181B-FX listed duct tapes (two cloth tapes, a foil tape and an Oriented Polypropylene (OPP) tape). One of the cloth tapes was specifically developed in collaboration with a tape manufacturer to perform better in our durability testing. The tests involved the aging of common ''core-to-collar joints'' of flexible duct to sheet metal collars. Periodic air leakage tests and visual inspection were used to document changes in sealant performance. After two years of testing, the flex-to-collar connections showed little change in air leakage, but substantial visual degradation from some products. A surprising experimental result was failure of most of the clamps used to mechanically fasten the connections. This indicates that the durability of clamps also need to be addressed ensure longevity of the duct connection. An accelerated test method developed during this study has been used as the basis for an ASTM standard (E2342-03).

Sherman, Max H.; Walker, Iain S.

2004-04-01

386

Cecum perforation due to biliary stent migration.  

PubMed

The endoscopic placement of biliary stents for benign and malignant biliary disease has been performed for over a decade. Several complications of stent placement have been described such as pancreatitis, hemorrhage, cholangitis, and perforation. Migration of biliary stents is a rare event, which can cause severe complications such as gastrointestinal tract perforation. We report the case of a 26-year-old woman with a cecum perforation due to biliary stent migration. We present the second case of cecal perforation related to the migration of a biliary stent. PMID:25028235

Barut, Ibrahim; Tarhan, Omer R

2014-07-01

387

Duct-Flow Analysis  

NASA Technical Reports Server (NTRS)

Quasi-two-dimensional velocity distribution through annular duct calculated. Computer program ANDUCT developed for calculating velocity distribution along arbitrary line between inner and outer walls of annular duct with axisymmetric swirling flow. Velocity gradient equation used with assumed variation of meridional streamline curvature. ANDUCT written in FORTRAN IV for use on IBM 370/3033 computer.

Katsanis, T.

1985-01-01

388

Duct Pressure Actuated Nozzle.  

National Technical Information Service (NTIS)

The patent application relates to a variable area nozzle which uses high pressure duct nozzle air directly to actuate a variable area nozzle and thereby control the nozzle throat area. A servo controlled air valve directs the duct air pressure into a pres...

J. H. Maurer

1976-01-01

389

Loft duct project report  

SciTech Connect

On October 16, 1992, during a routine examination of the loft of Building 332, the Building Coordinator observed cracks in the welds of the duct work that services the fume hoods for Rooms 1313, 1321, and 1329. Further examination revealed cracks in the weld of the duct work that services the gloveboxes in Rooms 1321 and 1329. Upon discovery of the cracked welds, facility management immediately took the following two actions: Because one crack in the fume hood exhaust extended 70% around the duct circumference, a 1-ton chain fall was used to secure the duct to the roof support structure to prevent the duct from falling if the duct completely fractured. The Facility Manager suspended plutonium handling operations in the gloveboxes and work in the fume hoods in the affected rooms until the situation could be thoroughly investigated. Building 332 is ventilated by drawing conditioned air from the building hallways into the laboratories, hoods, and gloveboxes. This air is filtered through two sets of high-efficiency particulate air (HEPA) filters before being exhausted from the facility. Figure 1 is a schematic of the typical air flow pattern for the facility. All affected duct work is located in the loft of the facility or pressure zone 4. This ducting is fabricated from 12-, 14- and 16-gauge, 304 stainless-steel sheet stock and joined by the Gas Tungsten Arc Welding (GTAW) process.

Reed, J.R.

1993-06-01

390

A novel endoscopic treatment of major bile duct leak?  

PubMed Central

INTRODUCTION Bile leak is a serious complication of hepatobiliary surgery. The incidence has remained the same over the last decade despite significant improvement in the results of liver surgery. PRESENTATION OF CASE A 21-year-old man was a passenger in a motor vehicle and sustained a blunt abdominal trauma in a high-speed collision leading to major liver laceration. He had right lobe hepatectomy complicated by major bile leak. He was not fit for further surgery and he, therefore, had ERCP and obliteration of the leaking bile duct using a combination of metallic coil and N-butyl cyanoacrylate. DISCUSSION Endoscopic therapy has become the modality of choice in the treatment of biliary tract injuries. Different modalities of management of persistent bile leak such as sphincterotomy, plastic biliary stents, and nasobiliary drainage have been described. Obliteration of bile duct leak using N-butyl cyanoacrylate and coil embolization has been described but most of these reports used the percutaneous transhepatic approach. CONCLUSION In this paper, we describe the second reported case in English literature of a novel endoscopic technique using a combination of metallic coil embolization and N-butyl cyanoacrylate in a patient with major bile leak who was not a candidate for surgery as well as a third report of the late complication of coil migration to the common bile duct.

Wahaibi, Aiman Al; AlNaamani, Khalid; Alkindi, Ahmed; Qarshoubi, Issa Al

2014-01-01

391

Heterotopic gastric mucosa in the hilar bile duct mimicking hilar cholangiocarcinoma: report of a case.  

PubMed

We herein report a case of heterotopic gastric mucosa in the hilar bile duct. An asymptomatic 58-year-old male was noted to have mild liver dysfunction in March 2009 during the follow-up for angina pectoris. Abdominal-enhanced CT revealed wall thickening from the upper common hepatic bile duct to the left hepatic bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) showed stenosis at the junction of the left hepatic bile duct. Although the patient's serum tumor markers were all within the normal ranges, the possibility of malignant disease of the biliary tree could not be ruled out. Left hepatectomy with the caudate lobe and resection of the extrahepatic bile duct were performed. Histopathologically, the resected specimen showed a polypoid lesion measuring 2 × 2 cm in size that projected into the lumen of the left hepatic bile duct. Microscopic examination revealed this polypoid lesion to be composed of mucous glands resembling gastric fundic glands, with parietal and chief cells. We also review eight other reports of heterotopic gastric mucosa in the biliary tree previously published in the English literature. PMID:22706785

Fukuda, Saburo; Mukai, Syoichiro; Shimizu, Seiichi; Kouchi, Masatoshi; Fujisaki, Seiji; Takahashi, Mamoru; Sakimoto, Hideto; Eto, Takaaki; Takahashi, Makoto; Nishida, Toshihiro

2013-01-01

392

Abnormalities of the Distal Common Bile Duct and Ampulla: Diagnostic Approach and Differential Diagnosis Using Multiplanar Reformations and 3D Imaging.  

PubMed

OBJECTIVE. The distal common bile duct (CBD) and ampulla are extremely difficult sites to evaluate on CT. This article seeks to provide the reader with a framework and algorithmic approach to the evaluation of abnormalities involving the distal CBD and ampulla, including an emphasis on the use of multiplanar reformations and 3D imaging, the morphologic features on CT that suggest the presence of malignancy, and a differential diagnosis for abnormalities in this location. CONCLUSION. In our experience, both the distal CBD and ampulla are common sites of missed diagnoses for radiologists. Avoiding mistakes in interpreting imaging findings in this location requires a systematic approach especially in the setting of unexplained biliary ductal dilatation. Rather than simply suggesting that MRCP or ERCP be performed for the ultimate diagnosis, radiologists can perform a careful CT evaluation using multiplanar reformations and 3D imaging to determine the correct diagnosis prospectively. A timely and correct diagnosis is imperative because lesions in the ampulla and CBD can be very aggressive despite their small size. PMID:24951192

Raman, Siva P; Fishman, Elliot K

2014-07-01

393

Low loss duct burner  

SciTech Connect

A jet propulsion engine with a fan bypass duct includes a duct burner with a plurality of flame stabilizers therein each mounted to inner case and outer case members through spherical bearings. Each of the stabilizers consists of two blade members having integral arms thereon actuated by fore and aft motion of an external actuating ring to assume an expanded position to increase duct turbulence for mixing air flow therethrough with a fuel supply and into a retracted position against each other to reduce pressure drop under nonafterburning operation. Each of the flame stabilizer blades has a platform that controls communication between a hot air source and a duct for improving fuel vaporization during afterburner operation thereby to increase afterburning limits; the platforms close communication between the hot air source and the duct during nonafterburning operation when flame stabilization is not required.

Mar, H. M.; Reider, S. B.

1985-07-09

394

Pulse Widths and Time Dilatation.  

National Technical Information Service (NTIS)

The temporal widths of a light pulse as measured in different inertial frames are shown to have a relation more complicated than that of a simple time dilation. The result is compared with the dilatation in the twin paradox Gedanken experiment. The light ...

R. G. Newburgh

1974-01-01

395

Intrahepatic biliary cysts in deer.  

PubMed

The gross and histological appearances of intrahepatic cysts in red and roe deer are described. It is suggested that the structures arise as anomalous developments of the biliary tree. Although not of clinical significance, these cysts may pose a problem at meat inspection. PMID:1918448

Munro, R

1991-07-01

396

Cardiomyopathy, familial dilated  

PubMed Central

Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by ventricular dilatation and impaired systolic function. Patients with DCM suffer from heart failure, arrhythmia, and are at risk of premature death. DCM has a prevalence of one case out of 2500 individuals with an incidence of 7/100,000/year (but may be under diagnosed). In many cases the disease is inherited and is termed familial DCM (FDC). FDC may account for 20–48% of DCM. FDC is principally caused by genetic mutations in FDC genes that encode for cytoskeletal and sarcomeric proteins in the cardiac myocyte. Family history analysis is an important tool for identifying families affected by FDC. Standard criteria for evaluating FDC families have been published and the use of such criteria is increasing. Clinical genetic testing has been developed for some FDC genes and will be increasingly utilized for evaluating FDC families. Through the use of family screening by pedigree analysis and/or genetic testing, it is possible to identify patients at earlier, or even presymptomatic stages of their disease. This presents an opportunity to invoke lifestyle changes and to provide pharmacological therapy earlier in the course of disease. Genetic counseling is used to identify additional asymptomatic family members who are at risk of developing symptoms, allowing for regular screening of these individuals. The management of FDC focuses on limiting the progression of heart failure and controlling arrhythmia, and is based on currently accepted treatment guidelines for DCM. It includes general measures (salt and fluid restriction, treatment of hypertension, limitation of alcohol intake, control of body weight, moderate exercise) and pharmacotherapy. Cardiac resynchronization, implantable cardioverter defibrillators and left ventricular assist devices have progressively expanding usage. Patients with severe heart failure, severe reduction of the functional capacity and depressed left ventricular ejection fraction have a low survival rate and may require heart transplant.

Taylor, Matthew RG; Carniel, Elisa; Mestroni, Luisa

2006-01-01

397

Complications of T-tube drainage of the common bile duct.  

PubMed

The complications associated with T-tube drainage of the common bile duct following biliary surgery were studied prospectively. A high rate of complications especially associated with T-tube removal was found. Biliary leakage and bacteraemia were the two main problems though in most cases caused minimal clinical upset. Alternatives to T-tube drainage are discussed. It is suggested that if T-tubes are to be used broad spectrum antibiotic cover should be employed at the time of removal. PMID:4073767

Gillatt, D A; May, R E; Kennedy, R; Longstaff, A J

1985-11-01

398

Robotic-assisted surgery approach in a biliary rhabdomyosarcoma misdiagnosed as choledochal cyst.  

PubMed

Rhabdomyosarcoma is a soft tissue malignant tumor affecting 1% of children from 0 to 14 years. Preoperative imaging may not always be diagnostic for hepatobiliary rhabdomyosarcoma and differential diagnosis with choledochal cyst (CC) could be difficult. We report a case of 2-years-old girl with a strange CC pattern of presentation. A grapelike lesion involving the choledochal and biliary ducts was easily and completely resected by robotic assisted surgery. Since no previous reports were available about oncologic safety of robotic approach, the porto-enterostomy was performed in open surgery. On histologic examination, the specimen revealed a botryoidembryonal rhabdomyosarcoma affecting both the common bile duct and the common hepatic duct. One year postoperatively the child is safe of tumor relapse. Robotic approach seems to be safe and advantageous to obtain a radical excision of the tumor at the porta hepatis, even in case of misdiagnosed malignant lesion mimicking a CC. PMID:24711907

Nakib, Ghassan; Calcaterra, Valeria; Goruppi, Ilaria; Romano, Piero; Raffaele, Alessandro; Schleef, Jurgen; Pelizzo, Gloria

2014-01-23

399

Biliary tract schwannoma: A rare cause of obstructive jaundice in a young patient  

PubMed Central

Schwannoma is a tumor derived from Schwann cells which usually arises in the upper extremities, trunk, head and neck, retroperitoneum, mediastinum, pelvis, and peritoneum. However, it can arise in the gastrointestinal tract, including biliary tract. We present a 24-year-old male patient with obstructive jaundice, whose investigation with computed tomography abdomen showed focal wall thickening in the common hepatic duct, difficult to differentiate with hilar adenocarcinoma. He was diagnosed intraoperatively schwannoma of common bile duct and treated with local resection. The patient recovered well without signs of recurrence of the lesion after 12 mo. We also reviewed the common bile duct schwannoma related in the literature and evaluated the difficulty in pre and intraoperative differential diagnosis with adenocarcinoma hilar. Resection is the treatment of choice for such cases and the tumor did not recur in any of the resected cases.

Fonseca, Gilton Marques; Montagnini, Andre Luis; Rocha, Manoel Souza; Patzina, Rosely Antunes; Bernardes, Mario Vinicius Angelete Alvarez; Cecconello, Ivan; Jukemura, Jose

2012-01-01

400

21 CFR 876.5470 - Ureteral dilator.  

Code of Federal Regulations, 2010 CFR

...dilator is a device that consists of a specially shaped catheter or bougie and is used to dilate the ureter at the place where a stone has become lodged or to dilate a ureteral stricture. (b) Classification. Class II (performance...

2009-04-01

401

Expression of Deleted in Malignant Brain Tumor1 (DMBT1) Molecule in Biliary Epithelium Is Augmented in Hepatolithiasis: Possible Participation in Lithogenesis  

Microsoft Academic Search

Deleted in malignant brain tumor-1 (DMBT1) is a mucin-like molecule participating in mucosal immune defense. Given that bovine gallbladder mucin, which accelerates cholesterol crystallization, is a DMBT1 homolog, DMBT1 expression was examined immunohistochemically in biliary epithelial cells in livers with hepatolithiasis (N = 25), primary sclerosing cholangitis (N = 7), large bile duct obstruction (N = 12), and control normal

Motoko Sasaki; Shiu-Feng Huang; Miin-Fu Chen; Yi-Yin Jan; Ta-Sen Yeh; Akira Ishikawa; Jan Mollenhauer; Annemarie Poustka; Koichi Tsuneyama; Yuji Nimura; Koji Oda; Yasuni Nakanuma

2003-01-01

402

Stopping duct quacks: Longevity of residential duct sealants  

Microsoft Academic Search

Duct leakage has been identified as a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums or branches in the duct system. At each of these connections a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field

Max H. Sherman; Iain S. Walker; Darryl J. Dickerhoff

2000-01-01

403

Echinococcosis mimicking autoimmune or malignant bile duct disease.  

PubMed

Indeterminate strictures of the bile ducts are common diagnostic dilemmas in gastroenterology, and differential diagnosis includes inflammatory and neoplastic diseases. Alveolar echinococcosis (AE) is rarely considered as a differential diagnosis, although it is endemic in the Northern hemisphere. In this case report on a 50-year-old male patient, the lack of cystic lesions or calcifications on CT, and suggestive ERCP findings made a hilar cholangiocellular carcinoma the most probable differential diagnosis, and only explorative laparotomy provided the definite diagnosis of AE. AE should therefore be included in the differential diagnosis of indeterminate biliary strictures even in the absence of typical stigmata in imaging studies. PMID:24022203

Goetz, M; Hainz, M; Schadmand-Fischer, S; Kittner, J M; Heinrich, S

2013-09-01

404

Pneumoretroperitoneum, bilateral pneumothorax and emphysema following endoscopic biliary sphincterotomy.  

PubMed

We report a case of pneumothorax, subcutaneous emphysema and pneumoretroperitoneum after an endoscopic sphincterotomy. A 40-yr-old woman presented with dyspnea immediately after she had undergone an endoscopic retrograde cholangiopancreatogram for a residual stone in common bile duct. On arrival to our hospital, she complained about severe dyspnea and on examination subcutaneous emphysema was discovered. A CT scan was conducted and showed a right-sided pneumothorax, a pneumoretroperitoneum in the peritoneal cavity. We recommended to the patient an immediate laparotomic exploration. We discovered a duodenal perforation in which we sutured it with accompanying pyloric exclusion, double truncular vagotomy and gastroenteroanastomosis. Endoscopic retrograde cholangiopancreatogram (ERCP) is a popular procedure for biliary and pancreatic diseases, but it can cause severe complications such as intestinal perforation. Besides perforations, air can spread through the abdominal cavity, retroperitoneum, mediastinum, and the soft tissues of the neck, eventually causing pneumothorax. Early recognition and appropriate management is crucial for optimal results. PMID:23008997

Makni, A; Chebbi, F; Ben Safta, Z

2012-01-01

405

Endoscopic management of bile duct stones.  

PubMed

The surgical risk of common duct exploration for the treatment of biliary calculi is considerably higher than that of cholecystectomy. Therefore, introduction of endoscopic sphincterotomy in 1974 was a major advance. It has become the therapy of choice in cholecystectomized patients or in those with an increased operative risk. Endoscopic sphincterotomy has a mortality rate of around 1% and a morbidity rate of 7%. These figures compare favourably with open surgery, especially in old patients. The procedure fails in about 10% of all patients referred for endoscopic removal of their calculi. However, several techniques have been described or are currently under evaluation to overcome these failures: intracorporeal or extracorporeal lithotripsy, long-term stenting of the bile duct, or direct application of solvents. Long-term follow-up studies show that between 2% and 20% of successfully managed patients may develop recurrent stones, mainly caused by bile stasis and infection. Patients with a functioning gall-bladder and no concomitant gall-bladder stones probably do not require cholecystectomy after successful endoscopic treatment of their choledochal stones. While endoscopic stone removal has replaced surgery in the elderly frail patients it has no major advantages in the young and fit patients, especially when the gall-bladder is still in situ. PMID:1611022

Sauerbruch, T

1992-01-01

406

Flow-mediated dilatation  

PubMed Central

Arterial endothelial dysfunction is one of the key early events in atherogenesis, preceding structural atherosclerotic changes. It is also important in the late stages of obstructive atherosclerosis, predisposing to constriction and/or thrombosis. Endothelial function can be measured in coronary arteries and in the periphery by measuring vasomotor function after intra-arterial infusion of pharmacologic substances which enhance the release of endothelial nitric oxide. The disadvantage of these methods is their invasive nature, which generally makes them unsuitable for studies involving asymptomatic subjects. For this reason, noninvasive tests of endothelial function have been developed. In the most widely used of these, an ultrasound-based method, arterial diameter is measured in response to an increase in shear stress, which causes endothelium-dependent dilatation. Endothelial function assessed by this method correlates with invasive testing of coronary endothelial function, as well as with the severity and extent of coronary atherosclerosis. This noninvasive endothelial function testing has provided valuable insights into early atherogenesis, as well as into the potential reversibility of endothelial dysfunction by various strategies, including pharmacological agents (lipid lowering, ACE inhibition), l-arginine, antioxidants and hormones.

Raitakari, Olli T; Celermajer, David S

2000-01-01

407

Sound propagation in curved ducts  

NASA Technical Reports Server (NTRS)

An analysis of the sound field in a circularly curved duct of rectangular cross-section is carried out for both rigid and locally-reacting absorbing walls. The field is excited by a piston source at one end of the duct section, and comparisons of the acoustic field and the net power flow along the duct axis are made with corresponding results for a straight duct section for various frequencies. It is found that in general the curved duct yields a significant increase in sound attenuation along the duct axis as compared to the straight duct.

Myers, M. K.; Mungur, P.

1975-01-01

408

Sphincter patency and hepatic BSP uptake after biliary sphincterotomy.  

PubMed Central

An attempt has been made to assess the patency and function of the choledochoduodenal junction after biliary sphincterotomy by estimating the first arrival time of injected bromsulphalein (BSP) in duodenal aspirate and the effect of morphine on this. Studies on 49 patients 1--12 years after this operation showed the arrival time to be normal in 47, but in 2 cases there was delay, which suggests that stenosis may develop in time in abot 4 per cent of cases. This had not been detected clinically, radiologically, or by liver function testing. Although it did not effect the BSP arrival time in T-tube bile, morphine was found to prolong the duodenal arrival time in control patients and also after sphincterotomy of the type used, indicating that the protective mechanism of the sphincter region may not have been destroyed by this operation. Abnormal BSP retention in plasma has been reported up to 5 years afte supraduodenal exploration of the bile ducts in 30 per cent of cases. Similarly, in the present study after bili