Mechanical jaundice caused by common bile duct obstruction due to hepato-biliary ascariasis

The paper presents a case of successful surgical treatment of a patient with common bile duct ascariasis, which caused obstructive jaundice. Modern methods of examining a patient with obstructive jaundice did not allow to make the right diagnosis of the common bile duct ascariasis before surgical intervention. The rarity of this pathology arouses interest in this material.

Titanium clip migration after cholecystectomy: original technique for laparoscopic transcystic extraction when endoscopic retrograde cholangiopancreatography fails

Surgical clip migration into the common bile duct (CBD) is a rare complication after laparoscopic cholecystectomy (LC). Few cases of surgical clip migration have been reported in the literature, and most of them have been successfully treated with endoscopic retrograde cholangiopancreatography (ERCP). We present a 71-year-old woman with 48 h of abdominal pain, jaundice and fever 6 years after laparoscopic cholecystectomy. She was diagnosed with common bile duct obstruction from surgical clip migration. After failure of ERCP, the patient was successfully treated with an innovative approach by laparoscopic transcystic extraction using endoscopic hose-type biopsy forceps. The presented technique was feasible and safe in expert hands, representing a valuable alternative to avoid the need of a choledochotomy in patients with unsuccessful ERCP.

Endoscopic Management of a Proximally Migrated Fully Covered SEMS Using the Stent-in-Stent Technique

Endoscopic biliary decompression via stent placement is an important approach for the palliative management of distal malignant biliary obstruction. However, migration of the inserted stent can occur, either distally or proximally; proximal migration is less common, but it also presents a greater challenge for endoscopic resolution. We present a case of a 67-year-old woman who had locally advanced pancreatic cancer and developed a common bile duct obstruction. Upon clinical presentation of chronic, painless, progressive jaundice, the obstruction was managed by placing of a 10 mm × 60 mm covered self-expandable metal stent (CSEMS), which successfully facilitated palliative biliary drainage. Six months later, however, the patient developed recurrent jaundice, which was determined to be due to proximal migration of the CSEMS. Repeat endoscopic retrograde cholangiography was performed, and initial attempts to retrieve the migrated stent failed. Finally, another 10 mm × 60 mm CSEMS was placed across the stricture site, inside the previous stent, which remained in place. The treatment resolved the obstruction and jaundice, and the patient experienced no adverse events.

Aspirin for metal stent in malignant distal common bile duct obstruction (AIMS): Study protocol for a multicenter randomized controlled trial

Background Endoscopic retrograde biliary drainage (ERBD) is the treatment of choice for patients with malignant distal common bile duct (CBD) obstruction. Self-expandable metal stents (SEMS), which are commonly used in unresectable cases, have many clinical advantages, including longer stent patency. Although the expected patency of SEMS is around eight months, it has recently been reported that the duration of SEMS patency in patients using aspirin is prolonged. Our study therefore aims to confirm the effect of aspirin on SEMS patency. Methods This is an investigator-initiated, prospective, multicenter, double-blind, randomized placebo-controlled trial that will be conducted from November 2017 in four tertiary centers in South Korea. We intend to include in our study 184 adult (≥ 20 years) patients with malignant distal CBD obstruction for whom ERBD with SEMS was successfully performed. The patients will be randomly allocated to two groups, which will comprise patients who have either taken 100 mg aspirin or a placebo for six months after index ERBD. The primary outcome will be the rate of stent dysfunction, and the secondary outcomes will be the duration of patency, the rate of reintervention, and the occurrence of adverse events. Discussion The aspirin for metal stents in malignant distal common bile duct obstruction (AIMS) study will determine the efficacy of aspirin in maintaining metal stent patency in patients with malignant distal CBD obstructive.