scholarly journals Transjejunal laparoscopic-assisted ERCP in Roux-en-Y patient: the new right path

2019 ◽  
Vol 101 (2) ◽  
pp. e45-e47 ◽  
Author(s):  
MT Mita ◽  
G Dalmonte ◽  
A Gnocchi ◽  
F Marchesi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastrointestinal Tract ◽  
General Population ◽  
Subtotal Gastrectomy ◽  
Gastric Surgery ◽  
New Right ◽  
Endoscopic Retrograde ◽  
Biliary Lithiasis ◽  
Surgically Altered Anatomy ◽  
Laparoscopic Assisted

The incidence of biliary lithiasis after gastric surgery seems to be higher than in the general population. Endoscopic retrograde cholangiopancreatography (ERCP) allows several biliary and pancreatic pathologies to be dealt with; however, in patients with an altered anatomy of the upper and mid gastrointestinal tract, this endoscopic manoeuvre can be extremely challenging. We report a case of a 79-year-old woman with previous subtotal gastrectomy and Roux-en-Y reconstruction, admitted with a diagnosis of cholecystitis and choledocolithiasis. She was successfully treated with transjejunal laparoscopic-assisted ERCP and laparoscopic cholecystectomy, which appears to be a safe and useful procedure for choledocolithiasis treatment in patients with surgically altered anatomy.

scholarly journals ‘Short’ Double-Balloon Enteroscope for Endoscopic Retrograde Cholangiopancreatography in Patients with a Surgically Altered Upper Gastrointestinal Tract

2011 ◽  
Vol 25 (11) ◽  
pp. 615-619 ◽  
Author(s):  
S Cho ◽  
P Kamalaporn ◽  
G Kandel ◽  
P Kortan ◽  
N Marcon ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Upper Gastrointestinal Tract ◽  
Papilla Of Vater ◽  
Endoscopic Retrograde ◽  
Bilioenteric Anastomosis ◽  
Double Balloon ◽  
Surgically Altered Anatomy ◽  
Working Length ◽  
Upper Gastrointestinal

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) remains a challenge for endoscopists in patients with surgically altered anatomy of the upper gastrointestinal tract. Double-balloon enteroscopes (DBEs) have revolutionized the ability to access the small bowel. The indication for its therapeutic use is expanding to include ERCP for patients who have undergone small bowel reconstruction. Most of the published experiences in DBE-assisted ERCP have used conventional double-balloon enteroscopes that are 200 cm in length, which do not permit use of the standard ERCP accessories. The authors report their experience with DBE-assisted ERCP using a ‘short’ DBE in patients with surgically altered anatomy.METHODS: A retrospective review of patients with previous small bowel reconstruction who underwent ERCP with a ‘short’ DBE at the Centre for Therapeutic Endoscopy and Endoscopic Oncology (Toronto, Ontario) between February 2007 and November 2008 was performed.RESULTS: A total of 20 patients (10 men) with a mean age of 57.9 years (range 26 to 85 years) underwent 29 sessions of ERCP with a DBE. Six patients underwent Billroth II gastroenterostomy, seven patients Roux-en-Y hepaticojejunostomy, five patients Roux-en-Y gastrojejunostomy, one patient Roux-en-Y esophagojejunostomy and one patient a Whipple’s operation with choledochojejunostomy. Some patients (n=12 [60%]) underwent previous attempts at ERCP in which the papilla of Vater or bilioenteric anastomosis could not be reached with either a duodenoscope or pediatric colonoscope. All procedures were performed with a commercially available DBE (working length 152 cm, distal end diameter 9.4 mm, channel diameter 2.8 mm). The procedures were performed under conscious sedation with intravenous midazolam, fentanyl and diazepam, except in one patient in whom general anesthesia was administered. Either the papilla of Vater or bilioenteric anastomosis was reached in 25 of 29 cases (86.2%) in a mean duration of 20.8 min (range 5 min to 82 min). Bile duct cannulation was successful in 24 of 25 cases in which the papilla or bilioenteric anastomosis was reached. Therapeutic interventions were successful in 15 patients (24 procedures) including sphincterotomy (n=7), stone extraction (n=9), biliary dilation (n=8), stent placement (n=9) and stent removal (n=8). The mean total duration of the procedures was 70.7 min (range 30 min to 117 min). There were no procedure-related complications.CONCLUSION: DBEs enable successful diagnostic and therapeutic ERCP in patients with a surgically altered anatomy of the upper gastrointestinal tract. It is a safe, feasible and less invasive therapeutic option in this group of patients. Standard ‘long’ DBEs have limitations of long working length and the need for modified ERCP accessories. ‘Short’ DBEs are equally as effective in reaching the target limb as standard ‘long’ DBEs, and overcomes some limitations of long DBEs to result in high success rates for endoscopic therapy.

scholarly journals Endoscopic ultrasound-guided hepaticogastrostomy and antegrade clearance of biliary lithiasis in patients with surgically-altered anatomy

2018 ◽  
Vol 06 (02) ◽  
pp. E127-E130 ◽  
Author(s):  
Amy Hosmer ◽  
Mohamed Abdelfatah ◽  
Ryan Law ◽  
Todd Baron
Keyword(s):  
Balloon Dilation ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Biliary Lithiasis ◽  
Endoscopic Techniques ◽  
Mechanical Lithotripsy ◽  
Electrohydraulic Lithotripsy ◽  
Surgically Altered Anatomy ◽  
Alternative Approaches

Abstract Background and study aims Endoscopic retrograde cholangiography (ERC) in patients with complex surgically-altered anatomy (SAA) is technically demanding and has limitations. Developments in EUS-guided procedures allow alternative approaches for patients with altered gastrointestinal anatomy and biliary lithiasis. Patients and methods Single-center, retrospective review of prospectively entered patients with SAA who underwent EUS-guided hepaticogastrostomy (HGS) followed by an interval antegrade endoscopic clearance of biliary lithiasis. Results 9 patients with Roux-en-Y anatomy underwent HGS to allow clearance of biliary lithiasis after a mean of 2.5 procedures. Technical success was achieved in 100 % of patients utilizing subsequent antegrade endoscopic techniques after HGS including: balloon sweep (9), transpapillary balloon dilation (8), cholangioscopy with electrohydraulic lithotripsy (4), and mechanical lithotripsy (1). HGS stents were removed in all patients. 1 adverse event (cholangitis) occurred after cholangioscopy and prolonged intraductal electrohydraulic lithotripsy. Conclusion EUS-guided antegrade therapy for the management of biliary lithiasis in patients with altered gastrointestinal anatomy appears efficacious with a low risk of adverse events. These preliminary results suggest this approach should be considered at centers with available expertise.

scholarly journals Results of combiation of laparoscopic cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (ERCP) simultaneously

2019 ◽  
Vol 9 (2) ◽  
Author(s):  
Đức Hùng Mai ◽  
Văn Nghĩa Nguyễn
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
General Anesthesia ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Operating Time ◽  
Endoscopic Retrograde ◽  
Cross Sectional ◽  
Biliary Lithiasis ◽  
Operative Complications ◽  
The Mean

Tóm tắt Đặt vấn đề: Đánh giá kết quả phẫu thuật nội soi cắt túi mật kết hợp nội soi mật tụy ngược dòng điều trị sỏi đường mật đồng thời trong cùng một thì gây mê. Phương pháp nghiên cứu: Nghiên cứu hồi cứu, mô tả cắt ngang với 88 bệnh nhân có sỏi túi mật và sỏi đường mật được phẫu thuật nội soi (PTNS) cắt túi mật kết hợp nội soi mật tụy ngược dòng (NSMTND) điều trị sỏi đường mật đồng thời từ 1/2015 đến 11/2017 tại Bệnh viện Nhân dân 115. Kết quả: Tuổi trung bình là 59,8 ± 15,0; tỉ lệ nữ 59,1%; tỉ lệ có bệnh mạn tính kèm theo 40,9%. Thời gian PTNS cắt túi mật và NSMTND lấy sỏi 123,1 ± 33,4 phút. Tỉ lệ thành công 93,2%, sạch sỏi 87,8%. Tai biến phẫu thuật 0%, biến chứng sớm 12,4%, tử vong 0%. Thời gian nằm viện sau phẫu thuật trung bình 4,2 ± 2,8 (2 – 20 ngày). Kết quả ra viện tốt 78,4%, khá 14,8%, trung bình 6,8%. Kết luận: Kết quả phẫu thuật nội soi cắt túi mật và nội soi mật tụy ngược dòng điều trị sỏi đường mật đồng thời là khả thi và an toàn. Abstract Introduction: To evaluate the results of the gallbadder and bile duct gallstone patients were treated with laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography ERCP in removing the stones when the patients were undergoing the same general anesthesia. Material and Methods: Cross-sectional retrospective study was conducted on 88 patients treated with laparoscopic cholecystectomy and ERCP to remove the stones under the same general anesthesia from January 2015 to November 2017 at the 115 Peoples Hospital. Results: The mean age of patients was 59.8 ± 15 years; the female was 59.1%; there were 40.9% of the patients with comorbidities. The mean operating time of laparoscopic and ERCP was 123.1 ± 33.4 minutes. The rate of successful surgeries was 93.2%, clearing stones was 87.8%. The rate of accident during the operation was 0%, early post-operative complications was 12.4%, death was 0%. The hospital stay after operating was 4.2 ± 2.8 (2 – 20 days). Outcomes classified when discharge were good 78.4%, rather good 14.8% and morderate 6.8%. Conclusion: The results of the gallbadder and bile duct gallstone patients treated with laparoscopic cholecystectomy and ERCP to remove the obstructive stones in the same general anesthesia were safe and feasible. Keywords: Gallstone, biliary lithiasis, laparoscopic cholecystectomy, endoscopic retrocholangiopancreatography.

scholarly journals Heterotopic gastric mucosa in the gallbladder—a rare find

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Roberto Cunha ◽  
Rafaela Parreira ◽  
Rui Quintanilha ◽  
Vítor Carneiro ◽  
Armando Medeiros ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastrointestinal Tract ◽  
Gastric Mucosa ◽  
Histological Change ◽  
Heterotopic Gastric Mucosa ◽  
Gallbladder Polyp ◽  
Usual Location ◽  
Common Situation

Abstract It is universally known and accepted that the development of a certain type of tissue outside its usual location, like in the gastrointestinal tract, can occur. This is a relatively common situation in the upper region of the gastrointestinal tract. However, the development of gastric mucosa in the gallbladder is a rare find. The following is the case of a 22-year-old male with an 18 mm gallbladder polyp, who electively underwent a laparoscopic cholecystectomy, having been diagnosed at a histopathological level with heterotopic gastric mucosa in the gallbladder. This brief article also aims to provide a reflection on the possible evolution of neoplasms from this histological change, based on the doubts raised in literature.

scholarly journals Are complications of endoscopic sphincterotomy age related?

Gut ◽  
1997 ◽  
Vol 41 (4) ◽  
pp. 545-548 ◽  
Author(s):  
G T Deans ◽  
P Sedman ◽  
D F Martin ◽  
C M S Royston ◽  
C K Leow ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Endoscopic Sphincterotomy ◽  
Short Term ◽  
Endoscopic Retrograde ◽  
Younger Patients ◽  
Age Related ◽  
Increased Risk ◽  
Ascending Cholangitis ◽  
Retroperitoneal Perforation ◽  
The Common

Background—Endoscopic retrograde cholangiopancreatography sphincterotomy is increasingly performed in younger patients undergoing laparoscopic cholecystectomy. However, the safety of endo- scopic sphincterotomy in this age group, relative to that in older patients, is unknown.Aim—To determine whether the development of short term complications following endoscopic sphincterotomy is age related.Patients and methods—A prospective multicentre audit of 958 patients (mean age 73, range 14–97, years) undergoing a total of 1000 endoscopic sphincterotomies.Results—Two deaths occurred, both from postsphincterotomy acute pancreatitis. Postprocedural complications developed in 24 patients: pancreatitis in 10, ascending cholangitis in seven, bleeding in four, and retroperitoneal perforation in three. There were six complications (five cases of pancreatitis and one bleed; 2.2%) and no deaths in the 281 (29.3%) patients aged under 65 years. In comparison, 18 (2.6%) of the 677 patients aged over 65 years developed a complication (cholangitis in seven, pancreatitis in five, bleeding in three, and perforation in three). Patients under 35, 45, 55, and 65 years were not at significantly increased risk of complication than those over these ages (relative risk for those under compared with those over 65 years 0.83, 95% confidence intervals 0.41–1.67, p=0.74).Conclusion—Short term complications following endoscopic sphincterotomy are not related to age. Younger patients undergoing laparoscopic cholecystectomy need not be denied endoscopic sphincterotomy for fear that the risks are greater than if they undergo surgical exploration of the common bile duct.

TO ASSESS THE IDEAL TIME OF LAPAROSCOPIC CHOLECYSTECTOMY AFTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CASES OF CHOLELITHIASIS WITH CHOLEDOCHOLITHIASIS

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Dhirendra Godara ◽  
Vineet Choudhary ◽  
Nitish Soni
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Medical Sciences ◽  
Early Recovery ◽  
Endoscopic Retrograde ◽  
The Mean ◽  
Group 2 ◽  
Late Group ◽  
Group 1 ◽  
The Ideal

Background: Aims of this study was assess the ideal time of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cases of cholelithiasis with Choledocholthiasis Methods: The present study was carried out on 150 patients admitted in Department of General surgery National Institute of Medical Sciences and Research, Jaipur, diagnosed with cholelithiasis along with choledocholithiasis  from 1stJanuary 2019 to 30thJune, 2020. Results: In group 1 out of 75 patients 7 patients developed complications in post operative period compared to 35 patients out of 75 patients developed complications in group 2. The The mean hospital stay (in day) in group 1 patients was 2.26, median 2 and the mean of group 2 was 5.26, median 5. Conclusion: To conclude in our study there has been found significant advantage of early laparoscopic cholecystecomy following ERCP over the late group to minimize complications and promote early recovery of the patients. Keywords: ERCP, Cholecystectomy, Endoscopic retrograde cholangiopancreatography

scholarly journals Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojia Chen ◽  
Fan Wang ◽  
Jing Liu ◽  
Wenhui Tao ◽  
Zhang Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Univariate Analysis ◽  
Balloon Dilation ◽  
Endoscopic Papillary Balloon Dilation ◽  
Endoscopic Retrograde ◽  
Therapeutic Success ◽  
Surgically Altered Anatomy

Abstract Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI 2.693–466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

scholarly journals Subtotal Gastrectomy for Atypical Carcinoid of Stomach– A Rare Tumour

2016 ◽  
Vol 12 (2) ◽  
pp. 145-148
Author(s):  
SM Shahadat Hossain ◽  
Md Mahbubur Rahman ◽  
Md Rayhan Mahmud ◽  
Farhana Israt Jahan
Keyword(s):  
Gastrointestinal Tract ◽  
Carcinoid Tumour ◽  
Subtotal Gastrectomy ◽  
Armed Forces ◽  
Gastric Carcinoid ◽  
Rare Tumour ◽  
Carcinoid Tumours ◽  
Medical College ◽  
Gastric Carcinoids ◽  
Gastrointestinal Carcinoid

The term carcinoid was first employed by Oberndorfer in 1907 to describe a group of tumours of the gastrointestinal tract that had a relatively indolent course and that were considered to be intermediate between adenoma and carcinoma in malignant potential. Gastrointestinal carcinoid tumours are a type of cancer that form in the lining of the gastrointestinal tract originating from entero-chromaffin like (ECL) cells. Gastric carcinoid tumours are rare tumors that develop within the gastric mucosa. They can present as an isolated lesion or there can be multiple lesions. The tumours can invade locally into deeper structures of the gastrointestinal tract (GIT) wall. Solitary gastric carcinoids have a greater chance for the development of malignancy and metastases as compared to multiple gastric carcinoids due to hypergastrinemia. A 60 years old man presented with abdominal pain, vomiting and weight loss and was found to have carcinoid tumour of stomach without classic carcinoid syndrome (CS). Despite advances in the understanding of patho-physiology of carcinoid tumour its complications remain enigmatic. Early, accurate diagnosis and aggressive treatment is recommended. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 145-148

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