Long-term Follow-up of Patients Undergoing Endoscopic Intervention for Abdominal Pain with Minimal Biliary Ductal Dilation, Stone Disease, or Malignancy

2021 ◽  
pp. 000313482095282
Author(s):  
Garrett F. Mortensen ◽  
Neal Bhutiani ◽  
Amber N. Brown ◽  
Vladimir Davidyuk ◽  
Hannah Palin ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Balloon Dilation ◽  
Median Number ◽  
Stone Disease ◽  
Biliary Colic ◽  
Endoscopic Management ◽  
Biliary Stones ◽  
University Of Louisville

Background Safety and efficacy of endoscopic methods in management of biliary colic after cholecystectomy in patients with minimal biliary ductal dilation and no evidence of biliary stones or malignancy have not been clearly demonstrated. This study aimed to assess the efficacy of endoscopic management of such patients. Methods The University of Louisville database was queried for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for colicky abdominal pain between 1996 and 2016 who had a common bile duct (CBD) diameter of ≤12 mm. All patients had undergone prior cholecystectomy and were free of malignancy. Demographic, serologic, procedural, and outcome variables were assessed. Results A total of 35 patients underwent a total of 99 ERCPs. Median CBD diameter was 10 (range 4-12) mm. A total of 31 patients (89%) underwent sphincterotomy, 28 (80%) underwent stent placement, and 5 (14%) underwent balloon dilation. The median number of ERCPs performed was 2 (range 1-10). Three of the 35 patients (9%) developed post-ERCP pancreatitis at some point during their treatment. At last follow-up since initial ERCP (median 16 months, range 2.4-184 months), 12 (34%) patients endorsed abdominal pain and 11 (31%) reported experiencing nausea. Conclusion For select patients with abdominal pain in the setting of minimal CBD dilation and no evidence of stone disease or malignancy, ERCP can safely and effectively be used to manage symptoms. While patients may require multiple interventions, they can derive long-term relief from these procedures.

scholarly journals The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years

2021 ◽  
Vol 10 (7) ◽  
pp. 1336
Author(s):  
Toshifumi Takahashi ◽  
Shinya Somiya ◽  
Katsuhiro Ito ◽  
Toru Kanno ◽  
Yoshihito Higashi ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Median Number ◽  
Small Sample ◽  
Age At Diagnosis ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Cystine Stones

Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.

scholarly journals Long Term Real-World Outcomes of Trifluridine/Tipiracil in Metastatic Colorectal Cancer—A Single UK Centre Experience

2021 ◽  
Vol 28 (3) ◽  
pp. 2260-2269
Author(s):  
Daniel Tong ◽  
Lei Wang ◽  
Jeewaka Mendis ◽  
Sharadah Essapen
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Real World ◽  
Systemic Treatment ◽  
Progression Free Survival ◽  
Median Number ◽  
Current Data ◽  
Real World Data

In the UK, Trifluridine-tipiracil (Lonsurf) is used to treat metastatic colorectal cancer in the third-line setting, after prior exposure to fluoropyrimidine-based regimes. Current data on the real-world use of Lonsurf lack long-term follow-up data. A retrospective evaluation of patients receiving Lonsurf at our Cancer Centre in 2016–2017 was performed, all with a minimum of two-year follow-up. Fifty-six patients were included in the review. The median number of cycles of Lonsurf administered was 3. Median follow-up was 6.0 months, with all patients deceased at the time of analysis. Median progression-free survival (PFS) was 3.2 months, and overall survival (OS) was 5.8 months. The median interval from Lonsurf discontinuation to death was two months, but seven patients received further systemic treatment and median OS gained was 12 months. Lonsurf offered a slightly better PFS but inferior OS to that of the RECOURSE trial, with PFS similar to real-world data previously presented. Interestingly, 12.5% had a PFS > 9 months, and this cohort had primarily left-sided and RAS wild-type disease. A subset received further systemic treatment on Lonsurf discontinuation with good additional OS benefit. Lonsurf may alter the course of disease for a subset of patients, and further treatment on progression can be considered in carefully selected patients.

scholarly journals Factors affecting the course of body and kidney growth in infants with urolithiasis: A critical long-term evaluation

2016 ◽  
Vol 88 (4) ◽  
pp. 249 ◽  
Author(s):  
Kemal Sarica ◽  
Fatma Narter ◽  
Kubilay Sabuncu ◽  
Ahmet Akca ◽  
Utku Can ◽  
...  
Keyword(s):  
Breast Feeding ◽  
Clinical Course ◽  
Stone Disease ◽  
The Body ◽  
Renal Growth ◽  
Related Factors ◽  
Growth Status ◽  
Long Term Follow Up

Objective: To investigate the possible effects of dietary, patient and stone related factors on the clinical course of the stone disease as well as the body and renal growth status of the infants. Patients and Methods: A total of 50 children with an history of stone disease during infancy period were studied. Patient (anatomical abnormalities, urinary tract infection - UTI, associated morbidities), stone (obstruction, UTI and required interventions) and lastly dietary (duration of sole breast feeding, formula feeding) related factors which may affect the clinical course of the disease were all evaluated for their effects on the body and renal growth during long-term follow-up. Results: Mean age of the children was 2.40 ± 2.65 years. Our findings demonstrated that infants receiving longer period of breast feeding without formula addition seemed to have a higher rate of normal growth percentile values when compared with the other children. Again, higher frequency of UTI and stone attacks affected the growth status of the infants in a remarkable manner than the other cases. Our findings also demonstrated that thorough a close follow-up and appropriately taken measures; the possible growth retardation as well as renal growth problems could be avoided in children beginning to suffer from stone disease during infancy period. Conclusions: Duration of breast feeding, frequency of UTI, number of stone attacks and stone removal procedures are crucial factors for the clinical course of stone disease in infants that may affect the body as well as kidney growth during long-term follow-up.

scholarly journals Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 120
Author(s):  
Edoardo Troncone ◽  
Michelangela Mossa ◽  
Pasquale De Vico ◽  
Giovanni Monteleone ◽  
Giovanna Del Vecchio Blanco
Keyword(s):  
Balloon Dilation ◽  
Common Bile Duct Stones ◽  
Endoscopic Management ◽  
Stone Extraction ◽  
Biliary Stones ◽  
Electrohydraulic Lithotripsy ◽  
Biliary Sphincterotomy ◽  
Single Operator ◽  
Large Balloon ◽  
Large Balloon Dilation

Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.

A Long-Term Follow-Up Study on Endoscopic Management of Children and Adolescents With Chronic Pancreatitis

2010 ◽  
Vol 105 (8) ◽  
pp. 1884-1892 ◽  
Author(s):  
Zhao-Shen Li ◽  
Wei Wang ◽  
Zhuan Liao ◽  
Duo-Wu Zou ◽  
Zhen-Dong Jin ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Children And Adolescents ◽  
Endoscopic Management ◽  
Follow Up Study ◽  
Long Term Follow Up

scholarly journals Transjejunal Laparoscopic Assisted ERCP in a Patient with Roux-en-Y Hepaticojejunostomy

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 483
Author(s):  
Baca-Arzaga ◽  
Navarro-Chavez ◽  
Galindo ◽  
Santibanez-Juarez ◽  
Cardosa-Gonzalez ◽  
...  
Keyword(s):  
Stone Disease ◽  
Endoscopic Management ◽  
Bilioenteric Anastomosis ◽  
Complex Anatomy ◽  
Laparoscopy Surgery ◽  
Management Of Complications ◽  
Intrahepatic Lithiasis ◽  
History Of ◽  
Laparoscopic Assisted

Background and Objectives: Nowadays, with the increasing laparoscopic expertise and accessibility to modern surgical tools, laparoscopic assisted ERCP (LAERCP) has become an effective approach for the management of bile stone disease in patients with modified gastrointestinal anatomy. In contrast to patients with gastric bypass in whom a transgastric LAERCP approach is usually performed, the resultant anatomy of Roux-en-Y hepaticojejunostomy precludes a gastric approach as the newly formed bilioenteric anastomosis is not reachable through the stomach. Therefore, a transjejunal approach has been described as an alternative LAERCP technique. To the best of our knowledge this is the tenth case of transjejunal LAERCP reported worldwide. Materials and Methods: We present the case of a 50-year-old female with history of biliary injury during a cholecystectomy corrected with Roux-en-Y hepaticojejunostomy who presented to our center with manifestations of acute abdomen. After laboratory and image analysis, diagnosis of intrahepatic lithiasis was confirmed. The decision to perform a transjejunal LAERCP was made due to the complex anatomy in this patient. No complications were found during surgery and in the follow up period. Conclusions: Transjejunal LAERCP is an effective approach for endoscopic management of biliary complications in patients with Roux-en-Y hepaticojejunostomy and other modified gastrointestinal anatomy. Previous recommendations by more experienced teams have been reported, nonetheless, there are too few cases reported to make definitive recommendations and conclusions. In limited settings, such as ours, some of these recommendations may not be applicable. We are certain that, with the increasing expertise and innovations in laparoscopy surgery for the management of complications that cannot be addressed by endoscopic or noninvasive measures, more cases will be reported.

scholarly journals Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale

2020 ◽  
Vol 35 (1) ◽  
pp. 104-112
Author(s):  
Vilja Koskensalo ◽  
Marianne Udd ◽  
Mia Rainio ◽  
Jorma Halttunen ◽  
Matias Sipilä ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
University Hospital ◽  
Long Term Results ◽  
Biliary Duct ◽  
Complication Rates ◽  
Biliary Sphincterotomy ◽  
Significant Difference ◽  
Upper Abdominal

Abstract Background Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP). If CBD cannulation is difficult, an endoscopist can open the septum between the pancreatic and biliary duct with a sphincterotome to gain access. Long-term results of this procedure are unclear. We wanted to evaluate the short- and long-term complications of TPBS on patients with native papilla and benign indication for ERCP. Patients and Methods ERCPs performed in Helsinki University Hospital between 2007 and 2013 were reviewed. The study group comprised 143 consecutive patients with TPBS and 140 controls (CG). Data were collected from patient records and a phone survey was performed as a follow-up ≥ 4 years after the index ERCP. Results Post-ERCP pancreatitis (PEP) developed in seven patients (4.9%) in TPBS and one patient (0.7%) in CG (p = 0.067). The rates of other acute complications were similar between the groups. ERCP ended with no access to CBD in four cases (2.8%) in TPBS. The median length of follow-up was 6 years in TPBS and 7 years in CG. During this period, three patients (2.1%) in TPBS and six patients (4.3%) in CG suffered from acute pancreatitis (AP) (p = 0.238). One (0.7%) patient in CG and none in TPBS developed chronic pancreatitis (CP). Abdominal pain was suffered by ten patients (6.9%) in TPBS and twelve patients (8.6%) in CG daily, whereas by six patients (4.2%) in TPBS and twelve patients (8.6%) in CG weekly. Conclusion TPBS is a useful procedure, with acceptable complication rates. No significant difference occurred between the groups when evaluating the short-term or long-term complications with a follow-up period of four to 10 years. Additionally, no significant differences occurred in upper abdominal pain, episodes of AP, or development of CP.

scholarly journals Durability and Long-Term Clinical Outcomes of Fecal Microbiota Transplant (FMT) Treatment in Patients with Recurrent C. difficile Infection

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S384-S385 ◽  
Author(s):  
Yafet Mamo ◽  
Michael Woodworth ◽  
Kaitlin Sitchenko ◽  
Tanvi Dhere ◽  
Colleen Kraft
Keyword(s):  
Clinical Outcomes ◽  
Medical Condition ◽  
Antibiotic Use ◽  
Median Number ◽  
Fecal Microbiota ◽  
Medical Conditions ◽  
Effective Treatment Option ◽  
Fecal Microbiota Transplant

Abstract Background Fecal microbiota transplant (FMT) has been shown to be safe and effective for treatment of recurrent C. difficile infection (RCDI). The aim of this study is to determine factors impacting the durability of FMT and assess patient long-term clinical outcomes and satisfaction with the procedure. Methods Eligible patients who had received FMT for RCDI at Emory Hospital between July 1, 2012 and December 31, 2016 were contacted via telephone for a follow up survey. Of 232 patients who received FMT, 27 were deceased and 15 were unable to be reached with listed phone number. Of the remaining 190 eligible patients, 137 patients completed the survey. Results The median time-period between FMT and follow up was 22 months. Median number of failed antibiotic courses for RCDI before FMT was 4. Overall, 82% (113/137) of patients experienced resolution of RCDI post-FMT (non-RCDI group) while 18% (24/137) of patients had recurrence of CDI post-FMT (RCDI group). In the RCDI and non-RCDI groups, antibiotic use post-FMT for non- C. difficile-related infections was 75% and 38% (P = 0.0004), respectively. PPI use post-FMT was 38% and 31% (P = 0.28), and probiotic use post-FMT was 63% and 41% (P = 0.026) in the RCDI and non-RCDI groups, respectively. There were 18 hospitalizations in the RCDI group and 9 were related to C. difficile complications; of the 36 hospitalizations in the non-RCDI group, only 1 was related to chronic complication of a previous C. difficile infection. Overall, 11% of patients reported improvement or resolution of medical conditions not related to CDI post-FMT while 33% reported diagnosis of a new medical condition or development of new symptoms; none of the new medical conditions or symptoms were attributable to the procedure. In all, 95% of patients indicated willingness to undergo FMT in the future if they experience another bout of C. difficile infection. Conclusion The findings show that FMT is a highly effective treatment option for RCDI with a cure rate, defined as resolution of RCDI post-FMT or recurrence attributable to antibiotic use post-FMT, of 96% (131/137) in the study group. Furthermore, clinical outcomes and patient satisfaction post-FMT indicate the safety of the procedure. Disclosures All authors: No reported disclosures.

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