scholarly journals Endoscopic Diagnosis of Biliary Stricture Combined with Digital Cholangioscope: A Case Series

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 12
Author(s):  
Seiichiro Fukuhara ◽  
Eisuke Iwasaki ◽  
Atsuto Kayashima ◽  
Yujiro Machida ◽  
Hiroki Tamagawa ◽  
...  
Keyword(s):  
Bile Duct ◽  
Diagnostic Accuracy ◽  
Biliary Stricture ◽  
Case Series ◽  
Endoscopic Diagnosis ◽  
Biliary Stenosis ◽  
Endoscopic Retrograde ◽  
Non Invasive ◽  
Background Data ◽  
Invasive Method

The endoscopic diagnosis of biliary tract lesions is applied as a non-invasive method; however, its diagnostic accuracy is not yet high. Moreover, digital cholangioscopy is used for directly visualizing the inside of the bile duct, resulting in a more precise biopsy. We present the case series of the outcomes of diagnosis using digital cholangioscopy in patients who underwent cholangioscopy for the evaluation of biliary stenosis in our department between January 2014 and March 2021. The controls were those who underwent a biopsy for biliary stenosis with conventional endoscopic retrograde cholangiopancreatography (ERCP). Background data for each case were collected, and the clinical outcomes by biopsy were evaluated, focusing on the accuracy of the diagnosis. Cholangioscopy was performed in 15 cases, while a conventional biopsy by ERCP was performed in 172 cases. Nine of 15 cases (60.0%) were diagnosed with cholangiocarcinoma. The number of specimens obtained through conventional ERCP and cholangioscopy was 2.5 ± 1.3 and 3.3 ± 1.5, respectively (p = 0.043). The diagnostic accuracy of conventional ERCP and cholangioscopy were 65.7% (113 of 172 cases) and 100%, respectively, which was significantly higher in the group with cholangioscopy. Digital cholangioscopy is useful when the diagnosis of the biliary stricture using the conventional ERCP method is difficult.

CEUS detection of biliary ischaemia during the first 4 weeks after liver transplantation predicts non-anastomotic biliary stricture

2021 ◽  
pp. 1-12
Author(s):  
Bo-wen Zheng ◽  
Shu-hong Yi ◽  
Tao Wu ◽  
Mei Liao ◽  
Ying-cai Zhang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Predictive Value ◽  
Biliary Stricture ◽  
Characteristic Curve ◽  
Validation Group ◽  
Gamma Glutamyl Transpeptidase ◽  
Full Cohort ◽  
Non Invasive ◽  
Invasive Method ◽  
Nas Score

BACKGROUND: Biliary ischaemia is an important factor in the pathogenesis of non-anastomotic biliary stricture (NAS) after liver transplantation (LT). Contrast-enhanced ultrasound (CEUS) can be used to detect biliary ischaemia, but no study has examined the utility of CEUS in predicting NAS. OBJECTIVE: To evaluate whether repeated CEUS as a non-invasive method of biliary ischaemia can identify NAS. METHODS: Consecutive LT patients who underwent CEUS examinations at 1–4 weeks after LT from September 2012 to December 2015 at our institution were included. The CEUS images and clinical data were analysed. RESULTS: Among 116 eligible LT patients, 39 (33.6%) were diagnosed with NAS within 1 year after LT. The patients with NAS had a significantly higher CEUS score at weeks 2–4 (all P <  0.05) and a higher slope of CEUS score progression (0.480 vs –0.044, P <  0.001). The accuracy of CEUS in identifying NAS improved over time after LT, reaching its maximum at week 4, with a sensitivity of 66.7%, a specificity of 87.9%, a positive predictive value (PPV) of 75.9%, a negative predictive value (NPV) of 82.3%, and an accuracy of 80.2%in the full cohort when a CEUS score≥3 was used as the cut-off. Multivariate analysis identified gamma-glutamyl transpeptidase (GGT), alanine transaminase (ALT) and the CEUS score at week 4 as independent predictors of NAS. In the task of identifying NAS, an NAS score combining the above 3 variables at week 4 showed areas under the receiver operating characteristic curve of 0.88 (95%CI, 0.78–0.99) in the estimation group (n = 60) and 0.82 (95%CI, 0.69–0.96) in the validation group (n = 56). An NAS score cut-off of 0.396 identified 87.2%of NAS cases in the estimation group, with a PPV of 93.3%; and 75.0%of NAS cases in the validation group, with a PPV of 58.8%. CONCLUSIONS: CEUS examination during the first 4 weeks is useful in assessing the risk of NAS within 1 year after LT. In particular, an NAS score combining the CEUS score, GGT level, and ALT level at week 4 can be used to accurately predict the risk of NAS in LT patients.

Positive Intraoperative Cholangiography during Laparoscopic Cholecystectomy: Is Laparoscopic Common Bile Duct Exploration Necessary?

2005 ◽  
Vol 71 (9) ◽  
pp. 750-753
Author(s):  
Gabriel Akopian ◽  
James Blitz ◽  
Thomas Vander Laan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Case Series ◽  
Common Bile Duct Stones ◽  
Common Bile Duct Exploration ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Technical Problems ◽  
The Common

The treatment of choledocholithiasis discovered incidentally during laparoscopic cholecystectomy is not yet standardized. Options include laparoscopic common bile duct exploration (LCBDE), postoperative endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (ERCP-ES), and no intervention. We undertook a review of our case series to determine whether LCBDE is obligatory and which LCBDE method is unsuccessful. During the 6-year study period, 91 patients with choledocholithiasis were identified. Fifty-six patients (62%) underwent LCBDE. Thirteen (23%) of these 56 patients subsequently required ERCP. Balloon sweeping of the common bile duct failed in 10 of 21 patients (48% failure) compared to any other combination of techniques with a failure rate of 1/33 (3%; P < 0.001). Two patients did not undergo complete duct exploration because of technical problems. Thirty-five patients (38%) did not undergo LCBDE. Nine of these patients (26%) did not have ERCP-ES. None of the patients who underwent postoperative ERCP-ES required additional procedures or surgery. LCBDE can successfully treat common bile duct stones, with minimal to no morbidity, but is not mandatory for safely treating choledocholithiasis. Additionally, advanced techniques for clearing the common bile duct are more successful. Surgeons should be proficient at performing these techniques.

scholarly journals Number of Endoscopic Retrograde Cholangiopancreatography Procedures Required for Short Biliary Cannulation Time

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Koichiro Mandai ◽  
Koji Uno ◽  
Yasutoshi Fujii ◽  
Takuji Kawamura ◽  
Kenjiro Yasuda
Keyword(s):  
Pancreatic Cancer ◽  
Bile Duct ◽  
Confidence Interval ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Odds Ratio ◽  
Biliary Stricture ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Malignant Biliary Stricture ◽  
Cannulation Success Rate

Background. Several previous studies assessed the competence in endoscopic retrograde cholangiopancreatography (ERCP) using the bile duct cannulation success rate. However, the cannulation time is also important, because a long cannulation time was reported to be a risk factor for post-ERCP pancreatitis. Aim. To determine the number of ERCP procedures required for short cannulation time of the bile duct. Methods. We retrospectively analyzed 605 ERCP procedures performed for bile duct cannulation in patients with native papilla at our institution between March 2012 and December 2015. The successful procedures were divided into 2 groups: group L and group S (cannulation time>15 minutes and ≤15 minutes, resp.). An analysis of the relationship among the biliary cannulation time, ERCP experience, and other factors was then conducted. Results. Multivariate analysis showed that the ERCP experience of ≤300 procedures (odds ratio, 2.080; 95% confidence interval, 1.337–3.142; P=0.001) and malignant biliary stricture due to pancreatic cancer (odds ratio, 1.912; 95% confidence interval, 1.072–3.412; P=0.028) were found to be significantly associated with a cannulation time of >15 minutes. Conclusions. Our findings suggested that an ERCP experience of ≤300 procedures and malignant biliary stricture due to pancreatic cancer were associated with prolonged biliary cannulation time.

scholarly journals Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) In-Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for Pancreaticobiliary Disorders

2021 ◽  
pp. 119-124
Author(s):  
M. Vignesh Kumar
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Common Bile Duct ◽  
Diagnostic Accuracy ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Periampullary Carcinoma ◽  
Endoscopic Retrograde ◽  
Common Cause ◽  
The Common ◽  
Study Participants

This is a prospective study done to compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) in patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for pancreaticobiliary disorders.Majority of the study participants were males (63.3%), while the rest 36.78% of them were females and periampullary carcinoma (11.7%) and common bile duct calculus (11.7%) are the common cause of obstruction found on MRCP followed by malignant stricture (10%). The extent of obstruction was determined in most of the study participants (91.7%) by MRCP while the rest 8.3% were not determined by MRCP. The Common bile duct calculus (11.7%) is the common cause of obstruction on ERCP followed by malignant stricture (10%) and Periampullary carcinoma (10%) and 20% of the patients were found to be normal in ERCP. Among them, 71.4 % did not show MRCP and the association was found to be significant. (p- Value < 0.00).

scholarly journals New Metabolic and Genetic Biomarkers for Diagnosis of Ulcerative Colitis

2021 ◽  
Author(s):  
Elena Emilia Tudoroniu ◽  
Mihaela Andreea Costache ◽  
Maria-Andreea Stancu ◽  
Anca Lucia Pop
Keyword(s):  
Ulcerative Colitis ◽  
Case Series ◽  
Diagnostic Value ◽  
Eligibility Criteria ◽  
Non Invasive ◽  
Randomized Controlled ◽  
Genetic Biomarkers ◽  
Bowel Diseases ◽  
Invasive Method ◽  
Inflammatory Bowel

Ulcerative colitis (UC) is one of the two disorders known as inflammatory bowel diseases (IBD) along with Crohn&rsquo;s disease (CD), with complex pathogenesis, requiring costly invasive investigations. Objective: to examine the most recent biomarkers proposed for UC diagnosis; to establish the strategy used to make the differential diagnosis between UC and CD relying on these biomarkers, also adding the benefit of finding new non-invasive tools in managing this condition. The search was performed in a single database (Web of Science) using the specific keywords &bdquo;ulcerative colitis&rdquo;, &bdquo;biomarkers&rdquo; and &bdquo;diagnosis&rdquo; for the last five years. Study eligibility criteria: clinical trials on adults and pediatric patients with ulcerative colitis compared with Crohn&rsquo;s disease. Results: We selected 57 studies, randomized controlled trials (RCTs) and clinical case series (CCS), summarizing the latest most specific biomarkers in diagnosis of UC. Limitations: we considered RCTs and CCS from one database, limited to the search topics. Our findings indicate a important number of potential biomarkers with diagnostic value, which bring the advantage of a non-invasive method to approach this challenging disorder.

scholarly journals Comparison of EUS and ERCP-guided tissue sampling in suspected biliary stricture

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258887
Author(s):  
Hye Gyo Chung ◽  
Jong-In Chang ◽  
Kwang Hyuk Lee ◽  
Joo Kyung Park ◽  
Kyu Taek Lee ◽  
...  
Keyword(s):  
Bile Duct ◽  
Confidence Interval ◽  
Biliary Stricture ◽  
Diagnostic Yield ◽  
Medical Center ◽  
Tissue Sampling ◽  
Distal Bile Duct ◽  
Biliary Strictures ◽  
Endoscopic Retrograde ◽  
Diagnostic Modalities

Background Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are commonly used diagnostic modalities in biliary strictures. We compared the diagnostic yield of EUS and ERCP-based tissue sampling in intrinsic biliary strictures without extrinsic mass outside the bile duct. Methods A total of 85 patients who underwent ERCP and EUS for diagnosis of suspected biliary strictures confined to the bile duct were analyzed retrospectively at Samsung Medical Center, Seoul, Korea, between 2010 and 2018. Results Seventy-one patients were diagnosed with malignancy and 14 patients were diagnosed with benign strictures. EUS-based tissue sampling was more sensitive and accurate than ERCP-based tissue sampling (p = 0.038). The overall sensitivity and accuracy were 67.6% (95% confidence interval (CI) 56.1–77.3) and 72.9% (95% CI 62.7–81.2) for ERCP-based sampling, and 80.3% (95% CI 69.6–87.9) and 83.5% (95% CI 74.2–89.9) for EUS-based sampling, respectively. EUS-based sampling was superior to ERCP-based sampling in distal bile duct strictures (accuracy: 87.0% vs. 72.5%, p = 0.007), but not in perihilar strictures. In cases without intraductal mass, EUS-based tissue sampling was also superior to ERCP-based sampling (accuracy: 83.3% vs. 69.7%, p = 0.029), but not in cases with mass. Conclusion EUS-based tissue sampling was superior to ERCP-based method in intrinsic biliary stricture with no mass outside the bile duct, particularly in those without intraductal mass or those with strictures located in distal bile duct. Therefore, EUS-based sampling should be considered for making a pathological diagnosis of suspected distal bile duct strictures even in lesions without definite mass.

scholarly journals A modification of rendezvous technique for endoscopically treating transected common bile duct following cholecystectomy

2014 ◽  
Vol 05 (03) ◽  
pp. 129-131
Author(s):  
Vishal Sharma ◽  
K. V. Raghavendra Prasada ◽  
Surinder S. Rana ◽  
A. C. Arun ◽  
Anupam Lal ◽  
...  
Keyword(s):  
Bile Duct ◽  
Biliary Stricture ◽  
Endoscopic Therapy ◽  
Percutaneous Transhepatic Biliary Drainage ◽  
Standard Of Care ◽  
Initial Attempt ◽  
Endoscopic Retrograde ◽  
Rendezvous Technique ◽  
Benign Biliary Strictures ◽  
Transhepatic Biliary Drainage

AbstractEndoscopic therapy is the standard of care for management of most benign biliary strictures. However, endoscopic therapy can fail in very tight strictures. We report a case of a 52-year-old lady who had complete bile duct transection with stricture after laparoscopic cholecystectomy. In initial attempt, at endoscopic retrograde cholangiopancreatography (ERCP), guidewire could not be negotiated endoscopically across the narrowing as there was complete cut off of the bile duct and so a percutaneous transhepatic biliary drainage (PTBD) was done and subsequently internalized into the duodenum. We cannulated the internalized end of PTBD catheter with the standard ERCP cannula with guidewire and advanced it across the biliary stricture. PTBD catheter was withdrawn externally, and the guidewire was left in the left ductal system. We report this innovation as this may be helpful in managing patients with ERCP after an initial PTBD has been successfully internalized into the duodenum.

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