The role in the decision-making of the surgeon in choledochal cysts during pregnancy

The diagnosis and management of bile duct diseases during pregnancy are highly controversial because preserving both the fetus and pregnancy often required surgical intervention. In this manuscript we reported three cases of pregnant patients referred to our hospital with choledochal cyst. Medical management was implemented until fetal well-being was compromise with moderate cholangitis and oligohydramnios. A C-section prior induction with lung ripeness was performed, four weeks later cyst resection and biliodigestive derivation was performed prior preoperative parenteral total nutrition was implemented. All patients and products survived without complications.

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY IN THE DIAGNOSTICS OF COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE*

Aim: Evaluation of the effectiveness of percutaneous transhepatic cholangiography in the diagnostics of bile duct diseases complicated by obstructive jaundice. Material and methods: This article presents the experience of using percutaneous transhepatic cholangiography in 88 patients with benign and malignant common bile duct diseases complicated by obstructive jaundice. Results: Methods of direct contrasting of the biliary tract make it possible to visualize choledocholithiasis with 86.5% accuracy, with 84.1% common bile duct strictures, with 87.8% stricture of biliodigestive anastomosis and with 97.5% accuracy of cholangiocarcinomas. Conclusions: Direct antegrade bile duct enhancement should be used if ERCPG has low explanatory value. PTCG in case of “endoscopically complicated forms” of choledocholithiasis, CBD and BDA strictures and cholangiocarcinomas enhances all bile duct sections and helps assess the level and completeness of biliary blockade. Following PTCG, measures can be taken to achieve biliary decompression regardless of OJ genesis.

The diagnostic and prognostic value of UBE2T in intrahepatic cholangiocarcinoma

Background Ubiquitin-conjugating enzyme E2T (UBE2T) is overexpressed in several types of malignancies. However, little is known about its diagnostic significance in intrahepatic cholangiocarcinoma (ICC) and other bile duct diseases or its prognostic value in ICC. Methods The expression levels of UBE2T in the intrahepatic bile duct (IHBD, N = 13), biliary intraepithelial neoplasia (BilIN; BilIN-1/2, N = 23; BilIN-3, N = 11), and ICC (N = 401) were examined by immunohistochemistry. The differential diagnostic and prognostic values were also assessed. Results The number of UBE2T-positive cells was significantly higher in ICC tissues than in nonmalignant tissues, including the IHBD, BilIN-1/2, and BilIN-3 tissues. Kaplan–Meier analysis showed that overexpression of UBE2T was correlated with a shorter time to recurrence (TTR) and overall survival (OS). The 5-year TTR rates in the high UBE2T and low UBE2T groups were 100% and 86.2%, respectively. The corresponding OS rates were 1.9% and 22.2%, respectively. High expression of UBE2T was an independent risk factor for both TTR (hazard ratio: 1.345; 95% confidence interval: 1.047,1.728) and OS (hazard ratio: 1.420; 95% confidence interval: 1.098,1.837). Conclusions UBE2T can assist in differentiating benign bile duct diseases from ICC, and high expression of UBE2T suggests a poor prognosis for ICC.

OPTIMUM DURATION OF PERCUTANEOUS TRANSHEPATIC CHOLANGIODRAINAGE IN COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE

The aim: Is to determine the optimum duration of percutaneous transhepatic cholangiodrainage depending on the duration of obstructive jaundice and the baseline total bilirubin level in patients with benign and malignant common bile duct diseases complicated by obstructive jaundice. Materials and methods: The experience of applying percutaneous transhepatic cholangiodrainage was combined for 88 patients with common bile duct diseases complicated by obstructive jaundice. The patients were divided into three groups: the Group 1 included 15 patients (17.1%) with benign common bile duct diseases, the Group 2 included 11 patients (12.5%) with resectable cholangiocarcinomas, and the Group 3 included 62 patients (70.4%) with unresectable cholangiocarcinomas. To determine optimal terms of biliary decompression using percutaneous transhepatic cholangiodrainage, the Poisson process was applied, and, to be more precise, the quasi-Poisson distribution. Results: It was found that the reduction of total bilirubin was the fastest in Group 3 patients. It took these patients an average of 7-8 days to reduce total bilirubin to 50 μmole/l. In Group 1 patients, the process is somewhat slower. The duration of biliary decompression in this category of patients averages 10-12 days. For Group 2 patients, biliary decompression requires at least 12 days. Conclusions: Using the Poisson process, or, to be more precise, the quasi-Poisson distribution, we managed to determine the optimum duration of biliary decompression using percutaneous transhepatic cholangiodrainage depending on the obstructive jaundice duration and the baseline total serum bilirubin.

Liver Functional Evaluation Using Gadoxetic Acid Versus the Gold Standard Hepatobiliary Scintigraphy in Patients with Bile Duct Diseases

Objective. To compare liver function assessments using Gd-EOB-DTPA-enhanced MRI and the gold standard hepatobiliary scintigraphy (HBS) in patients with bile duct diseases.Material and methods. The investigation enrolled 18 patients (male/female = 11/7; age, 29–70 years, Klatskin tumor (n=16), bile duct epithelial dysplasia (n=1), intrahepatic cholangiolithiasis (n=1)) after biliary decompression, who underwent 21 paired MRIs and 99mTc-mebrofenin HBS at a study interval of no more than 3 days. In the same regions of interest with a size of 30–50 pixels located in liver segments II–III, IV, V–VIII, and VI–VII, a MRI signal was measured before MR contrast agent (MRCA) injection into the standard vascular phases and at 10, 20, 30 and 40 minutes, then the signal was expressed as a percentage of intensity compared to the precontrast series. After MR volumetry, the functional volumes of the left and right liver lobes were also defined as the area under the MRCA accumulation curve, which was multiplied by the lobe volume and expressed as a percentage of the similarly calculated function of the entire liver. Similar intensity parameters and functional volumes were estimated for a HBS study.Results. The lobe functional volumes measured by the two methods were highly correlated (R=0.8; p<0.001) and did not show a significant difference at all when comparing with the Mann–Whitney test (p>0.3). The excretion rate of 99mTc-mebrofenin was also highly correlated with MRI findings (R=0.5–0.9; p<0.05). Conclusion. Gd-EOB-DTPA-enhanced MRI revealed a high correlation with the gold standard; however, additional studies are needed to clarify the possibilities and limitations of replacing one method with another one.><0.05).Conclusion. Gd-EOB-DTPA-enhanced MRI revealed a high correlation with the gold standard; however, additional studies are needed to clarify the possibilities and limitations of replacing one method with another one.

Confocal laser endomicroscopy in the diagnosis of extrahepatic bile duct diseases

Aim. To evaluate information content of confocal laser endomicroscopy with targeted biopsy in verifying etiology of extrahepatic bile duct strictures.Material and methods. There were 28 patients with extrahepatic bile duct strictures who underwent retrograde intervention with confocal laser endomicroscopy and targeted biopsy. Data of confocal laser endomicroscopy and biopsy were compared with final postoperative and histological diagnosis. Follow-up within 1–4 years after endoscopic treatment was also considered.Results. Diagnostic sensitivity, specificity and overall accuracy of the method in differential diagnosis of common bile duct strictures were 91.7%, 93.7% and 92.8%, respectively. Complication (acute edematous pancreatitis) occurred in 1 (3.6%) case.Conclusion. Confocal laser endomicroscopy is new effective method for in vivo microscopic assessment of mucous membrane. Despite technical complexity, the method is not associated with advanced morbidity and, accordingly, has no additional contraindications in comparison with ERCP.

Cholangioscopy in diagnosis of diseases of extrahepatic bile ducts

An analysis of the diagnosis of extrahepatic bile duct diseases in 115 patients is presented. With the diagnostic purpose they performed ERCP, EPT, cholangioscopy. The method of direct visualization of the mucous membrane of the bile ducts allows you to identify endoscopic signs of strictures. Differential diagnosis of benign and malignant strictures of the bile ducts using cholangioscopy is difficult. Nevertheless, we were able to identify some typical signs for malignant strictures, including ulceration and mucosal infiltration, vascular pattern irregularity, stricture asymmetry.