scholarly journals Infectious Complications after Different Percutaneous External-Internal Biliary Drainage Techniques for Malignant Jaundice

2021 ◽  
Vol 4 (2) ◽  
pp. 51-59
Author(s):  
O. I. Okhotnikov ◽  
M. V. Yakovleva ◽  
S. N. Grigoriev ◽  
V. I. Pakhomov ◽  
N. N. Grigoriev ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Acute Cholangitis ◽  
Biliary Tree ◽  
Infectious Complications ◽  
Internal Drainage ◽  
Malignant Jaundice ◽  
Liver Abscesses ◽  
Biliary Reflux ◽  
Different Types ◽  
Transpapillary Drainage

Purpose: Analysis of infectious complications incidence in different types of percutaneous externalinternal biliary drainage in patients with obstructive jaundice of tumor genesis.Material and methods: The results of using antegrade external-internal drainage of the biliary tree in transpapillary and suprapapillary variants in 110 patients were analyzed. External-internal biliary drainage was performed in stages, after percutaneous transhepatic cholangiostomy or involuntarily primary with proximal obstruction of the biliary tree with bile duct segregation if it is impossible to form a fixing element of drainage proximal to the obstruction zone.Results: In the first group, transpapillary external-internal drainage was performed in 30 patients with peripapillary tumor obstruction. Of the 26 patients with proximal obstruction, suprapapillary external-internal drainage was performed in 8 patients, transpapillary — in 18 patients. Postmanipulation cholangitis in the first group occurred in 16 cases (28.6 %), liver abscesses developed 4 cases (7.1 %). In the second group, among 30 patients with transpapillary drainage on the background of peripapillary tumor obstruction, signs of acute cholangitis developed in 4 cases. Cholangitis was stopped by timely transfer of external-internal drainage to external. Among 24 patients with proximal obstruction of the biliary tree, suprapapillary external-internal drainage without complications was performed in 18 cases, transpapillary in 6 patients with the proximal block without disconnecting of the biliary tree. Acute cholangitis developed in 2 cases. Patients of the second group had no liver cholangigenic abscesses. There were no cases of hospital mortality in both groups.Conclusion: Factors in the development of postmanipulation cholangitis and liver abscesses during external-internal drainage of the biliary tree against the background of its tumor obstruction are the transpapillary position of endobiliary drainage with duodeno-biliary reflux in persistent biliary hypertension. In the case of suprapapillary location of the working end of external-internal drainage during antegrade drainage of the proximal tumor obstruction of the biliary tree with dissociation, the risk of postmanipulation cholangitis in non-drained liver segments is minimal. In the event of post-manipulation cholangitis in the case of transpapillary drainage of the biliary tree, a temporary transformation of external-internal drainage into external cholangiostomy is necessary.

scholarly journals SOME FEATURES OF CHOLESTASIS IN CANCER PATIENTS DURING THE REDUCTION OF LIVER FUNCTIONAL RESERVES

2018 ◽  
Vol 23 (1) ◽  
pp. 14-19
Author(s):  
Oleg I. Okhotnikov ◽  
M. V Yakovleva ◽  
S. N. Grigoriev ◽  
V. I. Pakhomov
Keyword(s):  
Acute Cholangitis ◽  
Biliary Tree ◽  
Papilla Of Vater ◽  
Internal Drainage ◽  
Invasive Treatment ◽  
Endoscopic Papillotomy ◽  
Distal Tumor ◽  
Functional Reserves ◽  
Transpapillary Drainage ◽  
Made In

Purpose. To determine the indications for the supra - and transpapillary externally-internal drainaging of the biliary tree in case of jaundice syndrome. Material and methods. The results of minimally invasive treatment of 246 patients with external-internal drainage of the biliary tree were analyzed. Among patients with proximal tumor block the external-internal drainage is made in 92 cases, in 42 (45,7%) out of them in suprapapillary embodiment and in 50 (54,3%) - via transpapillary approach. In 154 cases with distal tumor (obstruction peripapillary cancer) transpapillary drainage was performed. Results. The technical success of the external-internal drainaging was achieved in 242 patients (98,4%). It was failed to pass the duodenum in 4 patients with the cancer of common bile duct (3) and cancer of papilla of Vater (1). There was no complications related to the technique of external-internal drainage. In 18 patients (8,8%) out of 204 with transpapillary location of the drainage, we were forced to temporarily return to full outer bile outflow because of acute cholangitis. The syndrome of an acute blockade of the papilla of Vater arising after transpapillary external-internal drainaging required endoscopic papillosphincterotomy in 42 (84%) out of 50 patients with proximal tumor block bile outflow and in 7 (4.5%) out of 154 patients with peripapillary cancer. Conclusion. Suprapapillary and transpapillary embodiment of the drainage are equivalent in terms of the efficacy of cholestasis elimination. Syndrome of an acute blockade of papilla of Vater is the most often complication of the transpapillary external-internal drainage requiring the carrying out of endoscopic papillotomy «on drainage». This syndrome arises very frequently in a case of transpapillary external-internal drainage due to the proximal tumor obstruction of the biliary tree. The risk of acute cholangitis due to regurgitation after manipulation is absent in the suprapapillary location of the external-internal drainage, and with its transpapillary position is realized only with a concomitant violation of the outflow of bile.

scholarly journals Infection of the biliary tract during palliative drainage in patients with hilar malignant jaundice

2021 ◽  
Vol 17 (2) ◽  
pp. 79-86
Author(s):  
Ya.M. Susak ◽  
R.Ya. Palitsa ◽  
L.Yu. Markulan ◽  
M.V. Maksуmenko
Keyword(s):  
Biliary Drainage ◽  
Census Data ◽  
Percutaneous Transhepatic Biliary Drainage ◽  
Index Number ◽  
Internal Drainage ◽  
Malignant Jaundice ◽  
Cumulative Survival ◽  
The Difference ◽  
Transhepatic Biliary Drainage

Background. Hilar malignant biliary obstruction in about 80 % of patients is not subject to radical treatment. Percutaneous transhepatic biliary drainage (PTBD) eliminates jaundice syndrome but is associated with bile loss. External-internal drainage is intended to eliminate this disadvantage, however, the balance between its benefits and the risk of complications, in particular cholangitis, has not yet been determined. The aim was to compare the rate of cholangitis and survival after percutaneous transhepatic biliary drainage and external-internal suprapapillary drainage treatment in patients with hilar malignant jaundice. Materials and methods. Fifty patients with hilar malignant jaundice were prospectively examined. Patients who underwent percutaneous transhepatic biliary drainage were included in the PTBD group (n = 24); patients who underwent external-internal suprapapillary biliary drainage (EISBD) treatment were included in the EISBD group (n = 26). The endpoints of the study were the rate of cholangitis, cholangitis duration index (number of cholangitis-days per 100 patient-days in a group), and cumulative survival. Results. Cholangitis during the entire follow-up period occurred in 7 (14.0 %) patients: in 3 (11.5 %) patients in the EISBD group, in 4 (16.7 %) patients in the PTBD group; p = 0.602. Taking into account the census data (patients who died during this period), the difference in the cumulative frequency of cholangitis was more significant (25.6 % in the EISBD group, 49.1 % in the PTBD group); p = 0.142. The average time of the onset of cholangitis from the beginning of the operation was 68.8 ± 14.7 days in the PTBD group, 90.7 ± 42.0 days in the EISBD group; p = 0.601. In the EISBD group, the cholangitis duration index was less than in the PTBD group: 0.46 versus 1.4 cholangitis-days per 100 patient-days, respectively, p = 0.001. Patients of the EISBD group had a greater cumulative survival rate compared with the PTBD group: the median survival was 90 days (95% CI: 70.0–109.9 days) and 75 days (95% CI: 51.1–98.9 days), respectively; p = 0.033. Conclusions. For palliative management of hilar malignant jaundice, EISBD treatment should be the priority over PTBD treatment.

scholarly journals Antegrade cholangiostomy: analysis and prevention of complications

2018 ◽  
Vol 23 (3) ◽  
pp. 37-46 ◽  
Author(s):  
Yu. V. Kulezneva ◽  
O. V. Melekhina ◽  
L. I. Kurmanseitova ◽  
M. G. Efanov ◽  
V. V. Tsvirkun ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Percutaneous Transhepatic Biliary Drainage ◽  
Acute Cholangitis ◽  
Related Complication ◽  
Percutaneous Balloon ◽  
Distal Obstruction ◽  
Transpapillary Drainage ◽  
Transhepatic Biliary Drainage

Aim. To analyze complications of percutaneous transhepatic cholangiostomy depending on biliary obstruction level and drainage type.Material and methods. Percutaneous transhepatic biliary drainage was carried out in 974 patients with mechanical jaundice of different genesis. External drainage was predominantly performed for distal obstruction, external-internal suprapapillary – for proximal obstruction. Strictures of biliodigestive anastomosis were managed using percutaneous balloon dilatation and long-term external-internal drainage.Results. Overall morbility was 19.1%. Significant relationship between morbidity and obstruction level, drainage type and tubes quantity was detected. Drainage tube dislocation was the most common drainage-related complication both in proximal and distal obstruction. External-internal transpapillary drainage was followed by suppurative cholangitis and acute pancreatitis in 81.5% of cases. External-internal suprapapillary drainage was accompanied by acute cholangitis in 17.1% of patients and was determined by disconnection of subsegmental ducts that required additional drainage tubes placement. In most cases, complications were corrected by minimally invasive surgery and nonsurgical treatment. Overall mortality was 1.3% (0.3% in cases of distal obstruction and 1.8% in cases of proximal obstruction).Conclusion. Percutaneous transhepatic biliary drainage is a routine non-traumatic method of biliary decompression that may be successfully used irrespective to obstruction level and cause of jaundice. External-internal suprapapillary drainage is preferable for proximal biliary obstruction while external-internal transpapillary drainage should be avoided. 

Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis

1980 ◽  
Vol 134 (4) ◽  
pp. 653-659 ◽  
Author(s):  
G Mendez ◽  
E Russell ◽  
JU Levi ◽  
H Koolpe ◽  
M Cohen
Keyword(s):  
Biliary Tree ◽  
Internal Drainage ◽  
Brush Biopsy

Preoperative biliary drainage for distal biliary obstruction and post-operative infectious complications

2012 ◽  
Vol 83 (4) ◽  
pp. 280-286 ◽  
Author(s):  
Wee Ngu ◽  
Michael Jones ◽  
Chrisopher P. Neal ◽  
Ashley R. Dennison ◽  
Matthew S. Metcalfe ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Infectious Complications ◽  
Preoperative Biliary Drainage

Gallstones in Sickle Cell Disease: A Single Institution Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4939-4939
Author(s):  
Thomas Coats ◽  
Kate Gardner ◽  
Swee Lay Thein
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Surgical Complications ◽  
Conflicts Of Interest ◽  
Acute Cholangitis ◽  
Biliary Tree ◽  
Ultrasound Scan ◽  
Cell Disease ◽  
Time Period ◽  
Elective Cholecystectomy

Abstract Background: There is an increased incidence of gallstones in patients with sickle cell disease (SCD), due to haemolysis. Complications of gallstones include cholecystitis, pancreatitis and cholangiopathy and gallstones can trigger an acute sickle cell crisis. It is not known whether patients with asymptomatic gallstones would benefit from elective cholecystectomy to avoid such complications. Method: Electronic patient records of all 767 adult SCD patients attending clinic at King’s College Hospital, London between 1st Jan 2003 and 31st Dec 2013 were retrospectively reviewed to identify cases of gallstones. Medical records and steady state blood values were analysed in all those patients with an ultrasound of the biliary tree during this time period. Results: Amongst the cohort of 767 patients with SCD, 481 (62.7%) were HbSS, 244 (31.8%) HbSC, 35 (4.6%) HbSB+, 6 (0.8%) HbSB0 and 1 (0.1%) HbSHFPH genotype. 43% were male. Mean age at the end of the study period was 36.6 +/- 12.5 years. 344 patients had an ultrasound scan of the biliary tree during the time period of the study. 38 of the 344 patients scanned had had a cholecystectomy prior to 2003. Of the remaining 306 patients with an ultrasound scan, 134 had gallstones identified within the gallbladder. The 134 patients with gallstones comprised 119 (88.8%) HbSS, 12 (9.0%) HbSC, 2 (1.5%) HbSB+ and 1 (0.7%) HbSB0. 39.6% were male. Mean age at the end of the study period was 35.4 +/- 12.2 years. Of the 134 patients with gallstones identified during the study, 35 developed serious complications directly relating to cholelithiasis (5 pancreatitis, 4 acute cholangitis, 8 choledocholithiasis and 18 isolated cholecystitis) and 8 of these patients required sphincterotomies +/- stone removal with endoscopic retrograde cholangio-pancreatogram. 34 of the 134 patients with gallstones went on to have a cholecystectomy during the 11 year study period. Of these 34, 3 had recorded surgical complications following cholecystectomy (2 bile leaks, 1 hepatic injury). All 3 cases had gallstone-related complications prior to the cholecystectomy. Discussion: Our findings of cholelithiasis in 134 of the 306 of sickle cell disease patients scanned, is similar to incidence reported in the literature. Notably, we documented a high incidence of complications associated with cholelithiasis. Furthermore, there were higher than expected rates of surgical complications in cholecystectomy undertaken following the development of a complication relating to gallstones. These findings make routine screening for cholelithiasis followed by elective cholecystectomy for positive cases an attractive approach. Disclosures No relevant conflicts of interest to declare.

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