scholarly journals Endoscopic Retrograde Cholangiopancreatography Findings Differs From Ultrasound Results: A Study On Choledocholitihisis Patients In A Tertiary Care Hospital Of Bangladesh

2019 ◽  
Vol 30 (1) ◽  
pp. 5-8
Author(s):  
Tareq Mahmud Bhiuyan ◽  
Mousumi Sanyal ◽  
Sabrina Yesmin S
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Tertiary Care ◽  
Ampullary Carcinoma ◽  
Care Hospital ◽  
Endoscopic Retrograde ◽  
Cross Sectional ◽  
High Clinical Suspicion ◽  
Normal Ultrasound

Background: Endoscopic retrograde cholangio-pancreatography (ERCP) is a universally established modality in evaluation and treatment of pancreatico-biliary disorders. Choledocholothiasis is one of its common indications. In the context of Bangladesh, clinical studies on ERCP, specially, assessment of the role of pre-procedural Ultrasound as a screening tool, is relatively rare. In this work, we have analyzed the ERCP outcome of 95 patients and compared their pre-procedural ultrasound results afterwards. Methods: This cross-sectional observational study was conducted in the BIRDEM General Hospital during June 2013 to January2015 on 95 ERCP patients. Among 95 patients, maximum (27.7%) were diagnosed as Choledocholithiasis. The important diagnosis among the rest were, Chronic Calcific Pancreatitis (13.8%), Ca head of Pancreas (12.7%), Cholangiocarcinoma (11.7%), and peri- ampullary carcinoma (11.7%). Ultrasound could not detect common bile duct stone in 42% of choledocholithiasis patients. It detected dilated common bile duct in 30% patients and 15% patients had normal ultrasound report while they underwent ERCP due to high clinical suspicion and found to have duct stone afterwards. Conclusion: The role of ultrasound as a screening test for choledocholithiasis should be progressively assessed by comparing it with MRCP and ERCP results. This study will encourage further research to find correlation between the ERCP and Imaging (both ultrasound and MRCP) in choledocholithiasis patients Bangladesh J Medicine Jan 2019; 30(1) : 5-8

scholarly journals Experience with laparoscopic common bile duct exploration in failed endoscopic retrograde cholangiopancreatography cases at a tertiary care hospital

2020 ◽  
Vol 7 (10) ◽  
pp. 3344
Author(s):  
Pradeep Panwar ◽  
Hetish M. Reddy ◽  
Rajendra Bagree ◽  
Gaurav Jalendra
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
Bile Leak ◽  
Common Bile Duct Exploration ◽  
Care Hospital ◽  
Early Recovery ◽  
Endoscopic Retrograde ◽  
Tube Removal

Background: Minimally invasive techniques for stone removal in common bile duct (CBD) are endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) or laparoscopic CBD exploration with LC (laparoscopic common bile duct exploration (LCBDE) and LC). Failed, multiple attempted or complications of ERCP leads to other surgical approaches where LCBDE is a preferable option by experts due to its added benefits.Methods:  We did LCBDE and LC in 40 cases of failed ERCP. Standard investigation protocol was followed in all cases and CBD were explored laparoscopically and stones were retrieved. Post retrieval choledochoscopy was done and sphincter of oddi was dilated by the dilators.Results: With careful selection of cases, stone calculi were retrieved successfully in 38 cases by laparoscopically and 2 cases by open method after conversion. Postoperative choledochoscopy were found normal. Bile leak seen in 3 cases, which were managed conservatively. Standard regime of postoperative care was taken followed by T-tube removal after cholangiogram on day 10-14. All patients survived the operation.Conclusion: We advocate that LCBDE is the most viable alternative for open surgery in failed ERCP cases for retrieval of CBD stones. This results in early recovery, better cosmetic scar, least complications with early resumption of routine life. Needs cautious patient selection and expertise in laparoscopic surgery.

scholarly journals Management of common bile duct calculi in a tertiary care hospital in North East India

2020 ◽  
Vol 7 (11) ◽  
pp. 3765
Author(s):  
Ranendra Hajong ◽  
Kewithinwangbo Newme
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Gallstone Disease ◽  
Tertiary Care ◽  
Treatment Modalities ◽  
Care Hospital ◽  
Common Bile Duct Calculi ◽  
North East ◽  
Number Of Patients ◽  
Bile Duct Calculi

Background: Common bile duct calculi are frequently encountered in patients with cholelithiasis. Treatment ranges from endoscopic retrograde cholangiopancreatography (ERCP) to various surgical treatment modalities done either by laparoscopic or open techniques.Methods: This was a retrospective cross-sectional study carried out in General Surgery department of NEIGRIHMS Hospital from April 2014 to March 2020. Patients attending the hospital with choledocholithiasis during the time period have been included in the study.Results: A total of 82 patients were included in the study. The prevalence of common bile duct (CBD) calculi in patients attending NEIGRIHMS Hospital with symptomatic gallstone diseases was 5.16%. Treatments ranged from primary CBD closure or T-tube drainage after CBD exploration either by laparoscopic techniques, choledocho-duodenostomy and ERCP. Bile peritonitis in 9 patients and retained stone were observed in some patients who were managed accordingly. No mortality was seen in any patient.Conclusions: The number of patients with CBD calculi and symptomatic gallstone disease attending NEIGRIHMS Hospital is less and standard of care is provided to the patients with acceptable morbidity and mortality.

scholarly journals Role of Endoscopic Retrograde Cholangiography and Nasobiliary Drainage in the Management of Postoperative Biliary Leak

1997 ◽  
Vol 3 (4) ◽  
pp. 221-229 ◽  
Author(s):  
M. K. Goenka ◽  
R. Kochhar ◽  
D. Bhasin ◽  
B. Nagi ◽  
J. D. Wig ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiography ◽  
Biliary Leak ◽  
Endoscopic Retrograde ◽  
Large Defect ◽  
Endoscopic Nasobiliary Drainage ◽  
Associated Lesions ◽  
Nasobiliary Drainage

In order to assess the role of endoscopic retrograde cholangiography in evaluating the patients with post-operative biliary leak and of endoscopic nasobiliary drainage in its management, 36 patients with biliary leak seen over a period of 9 years were studied. Thirty-two had biliary leak following cholecystectomy, 3 following repair of liver trauma and 1 following choledochoduodenostomy. Patients presented at an interval of 4 days to 210 days (mean ± SEM, 32.4 ± 6.7 days) following laparotomy. Hyperbilirubinemia was noticed in only 13 patients (36.1%), while abdominal ultrasonogram showed ascites or biloma in 24 (66.7%). Endoscopic retrograde cholangiography showed the leak to involve the common bile duct in 55.6%, cystic duct in 33.3% and intrahepatic biliary radicles in 8.3%. Associated lesions included bile duct obstruction due to stricture or accidental ligature in 20%, bile duct stone in 20% and liver abscess in 2.8%.Endoscopic nasobiliary drainage using a 7 Fr pig-tail catheter was attempted in 14 patients and could be established in 12 of them. Bile duct leak sealed in all but one of these 12 patients after an interval of 3 days to 40 days (mean ± SEM, 12.2 ± 3.2 days). A single patient with large defect and a proximal bile duct stricture did not respond and required surgery. Common bile duct stones were removed by endoscopic sphincterotomy in 3 out of 4 patients. One patient with large stone required surgical choledocholithotomy. In conclusion, endoscopic retrograde cholangiography was safe and useful in confirming the presence of leak as well as its site, size and associated abnormalities. Endoscopic nasobiliary drainage proved an effective therapy in post-operative biliary leak and could avoid re-exploration in 71.4% patients.

Contemporary Experience with Cholecystectomy: Establishing ‘Benchmarks’ Two Decades after the Introduction of Laparoscopic Cholecystectomy

2013 ◽  
Vol 79 (12) ◽  
pp. 1253-1257 ◽  
Author(s):  
Pascal O. Udekwu ◽  
William G. Sullivan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Tertiary Care ◽  
Acalculous Cholecystitis ◽  
Common Bile Duct Stones ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Attributable Mortality ◽  
Care Hospital ◽  
Preoperative Magnetic Resonance

With quality and public reporting of increasing importance, benchmarks are anticipated to grow in relevance. We studied cholecystectomy in a practice in an urban tertiary care hospital. A total of 1083 cholecystectomies were performed in 2008 and 2009. Laparoscopic cholecystectomy was performed in 97.8 per cent of patients with a 2.2 per cent conversion rate. A planned open procedure was performed in only 2.2 per cent of patients. Approximately half of procedures were urgent and performed during an acute hospitalization. Most patients (74%) were female and most patients were overweight or obese (64.8%). Ages into the tenth decade of life were represented. Comorbidities included hypertension, 28.7 per cent; coronary disease, 15.6 per cent; diabetes mellitus, 13.4 per cent; gastroesophageal reflux disease, 10.7 per cent; and asthma, 5.5 per cent. Of female patients, 98 (12.2%) were postpartum and five (0.6%) were pregnant. Of 137 patients without gallstones, 59.1 per cent had biliary dyskinesia and 27 per cent had acalculous cholecystitis. Preoperative magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) were performed in most patients with suspected choledocholithiasis. Intraoperative cholangiograms were performed in 6.9 per cent of patients, 3.3 per cent for abnormal liver function studies. Postoperative ERCP was used in most patients with positive intraoperative cholangiograms. All-cause mortality was 0.8 per cent and attributable mortality was 0.2 per cent. Complications occurred in 7.5 per cent of patients, including retained common bile duct stones in 1.1 per cent, bile duct leak in 0.3 per cent, and common bile duct injury in 0.1 per cent.

RESULTS OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY COMBINED WITH SPHINCTEROTOMY IN TREATMENT OF COMMON BILE DUCT STONES

2015 ◽  
pp. 70-76
Author(s):  
Khanh Vinh ◽  
Van Huy Tran ◽  
Dinh Hy Trinh
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Common Bile Duct Stone ◽  
Bile Duct Stone ◽  
Common Bile Duct Stones ◽  
Influential Factors ◽  
Influential Factor ◽  
Endoscopic Retrograde ◽  
Cross Sectional

Background: Common bile duct stone is the popular disease which leads to more severe complication. Endoscopic retrograde cholangiopancreatography is a useful therapy in treatment of common bile duct stone. However, the success of this therapy must depend on several specific impacts including the number of stones, stone diameter, diverticulum and endoscopist. Thus, we have performed this research on two major purposes: 1) to evaluate the results and complication of ERCP in treatment of common bile duct stone; and 2) to determine the influential factors causing failure of this therapy. Patients/Research methods: A total of 64 patients are involved in the treatment at the gastrointestinal endoscopic center. Methods: A cross - sectional study. Result: CBD stone with size from 10 – 20mm makes up the highest proportion of 76.7%. A single stone makes up for the large proportion at 68.7%. The successful rate of CBD is 89.1%. The rate of complication is 10.9%. The influential factor for failure of ERCP: The patients undergoing operation have diverticulum and large stone. Conclusion: ERCP is an effective and safe therapy for treatment CDB stone. Key words: Common bile duct stone, endoscopic retrograde cholangiopancreatography.

scholarly journals Gene Xpert MTB / RIF – Diagnostic Role in Tuberculous Pleurisy

2016 ◽  
Vol 22 (1) ◽  
pp. 78
Author(s):  
Muhammad Khalid Ch ◽  
Muhammad Saqib Saeed ◽  
Rizwan Iqbal ◽  
Akhtar Ali
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Tuberculous Lymphadenitis ◽  
Care Hospital ◽  
Cross Sectional ◽  
Diagnostic Role ◽  
Tuberculous Pleurisy ◽  
Medical University

<p><strong>Abstract</strong></p><p><strong>Background:  </strong>Tuberculous pleurisy is a common extrapulmonary manifestation and is second to tuberculous lymphadenitis. Due to its paucibacillary in origin, its diagnosis is a challenge. Furthermore, it is also complicated by the emergence of MDR. Gene Xpert MTB/RIF is a new rapid promising innovation for the detection of mycobacterium tuberculosis and its resistance to Rifampicin, giving result within two hours.</p><p><strong>Objective:  </strong>To evaluate the diagnostic role of Gene Xpert MTB/RIF in suspected cases of tuberculous pleurisy.</p><p><strong>Study Design:  </strong>Cross sectional study.</p><p><strong>Study Setting:  </strong>Institute of Chest Medicine Mayo Hospital – a Tertiary Care Hospital affiliated with King Edward Medical University, Lahore.</p><p><strong>Methodology:  </strong>The study group, one hundred (M-60 and F-40) cases having exudative, predominantly lymphocytic pleural effusion with strong suspicion of tuberculous in origin were enrolled randomly for Gene Xpert MTB / RIF.</p><p><strong>Results:  </strong>Among one hundred study cases, Gene Xpert detected mycobacterium tuberculosis in 12(12%) cases [M-8 (13.3%) and F-4 (10%)]. Resistance to Rifampacin was detected in 6 (6%) cases [M-2 (3.3%) and F-4 (10%)].</p><p><strong>Conclusion:  </strong>Gene Xpert MTB/RIF is a useful new rapid promising technique to diagnose tuberculous pleurisy. Although at present it has limited availability and utility.</p><p><strong>Key Words:  </strong>Gene Xpert. MTB – Mycobacterium tuberculosis. RIF – Rifampacin. TB – Tuberculosis. MDR – Multidrug resistance.</p>

scholarly journals Diagnostic and Prognostic Significance of CA 19-9 as Tumour Marker in Pancreatic, Hepatobiliary and Other Gastrointestinal Cancers

2021 ◽  
Author(s):  
Mitsu Vinay Vaishnav ◽  
Sameep Shyamlal Garg ◽  
Mayur Jitubhai Kokani
Keyword(s):  
Pancreatic Carcinoma ◽  
Predictive Value ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Tumour Marker ◽  
Enzyme Linked Immunosorbent Assay ◽  
Care Hospital ◽  
Prognostic Information ◽  
Cross Sectional

Introduction: The CA 19-9 antigen isolated by Koprowski and colleagues in 1979 is a lacto-N-fucopentaose II-like substance and one of the tumour-associated antigens present in serum in the mucin fraction. Close attention has been paid to the role CA 19-9 in the diagnosis of digestive tract tumours. In this study, serum analysis of CA 19-9 levels in 91 patients with gastrointestinal, hepatobiliary and pancreatic carcinoma was done. These data was used to evaluate the clinicians with adequate information on use of CA 19-9 as tumour marker- both diagnostic and prognostic. Aim: To study the role of tumour marker, CA 19-9 as a diagnostic and prognostic tool, and also to monitor the response of gastrointestinal, hepatobiliary and pancreatic cancer to treatment. Materials and Methods: This cross-sectional study was done on 91 cases of gastrointestinal, hepatobiliary and pancreatic carcinomas conducted in tertiary care hospital associated with medical college in Jamnagar, Gujarat, India were studied from September 2012 to March 2015 for two years and five months. The sample size was of 91 patients. Statistical method used was sensitivity, specificity, positive predictive value and negative predictive value. The material used was serum of the patient both pre as well as postoperatively and CalBiotech CA 19-9 Elisa Kit was used to determine the Value. The collected data were entered into Microsoft Excel spread sheet. The statistical methods used for variables were Mean and median along with Sensitivity and Specificity. Software used was “Epi Info”, version 7.0. Results: Total 91 cases of gastrointestinal, hepatobiliary and pancreatic carcinomas were studied. Enzyme Linked Immunosorbent Assay (ELISA) was used preoperatively and post operatively to determine the CA 19-9 values in patients of gastrointestinal, hepatobiliary and pancreatic carcinomas. It was found that CA 19-9 is an important tumour marker with sensitivity of 76.31% and specificity of 73.33% for diagnosis of the gastrointestinal, hepatobiliary and pancreatic carcinoma. When aided with Fine Needle Aspiration Cytology (FNAC) and histopathological findings it helps in giving a sure shot diagnosis. It also provides useful prognostic information for the same. Conclusion: This study helps to understand the role of CA 19-9 as diagnostic and prognostic marker for pancreatic, hepatobiliary and gastrointestinal carcinomas.

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