Values of Contrast-Enhanced Ultrasound in Classification and Diagnosis of Common Bile Duct and Superficial Organ Lesions under Compression Algorithm

This work aimed to investigate values of contrast-enhanced ultrasound (CEUS) under DEFLATE in the classification and diagnosis of the common bile duct and superficial lymphoid lesions. 88 patients with lower common bile duct lesions and 126 patients with superficial lymphoid lesions were selected as the subjects investigated and examined by CEUS under DEFLATE to compare characteristics and diagnostic efficiency of CEUS in different types of lesions. The time-intensity curve (TIC) was for quantitative analysis on CEUS results. The results showed that there were statistically significant differences in the comparison of time to peak (TTP), area under the curve (AUC), and gradient (Grad) of common bile duct walls in patients from the malignant group ( P < 0.05), while the comparison of three indicators of patients in the benign group was not statistically remarkable ( P > 0.05). In addition, there were statistically great differences in TTP, AUC, and Grad among patients in the benign and malignant groups ( P < 0.05). The sensitivity, specificity, accuracy, and positive/negative predictive value of CEUS + ultrasound (US) in the diagnosis of benign and malignant lymph nodes were 92.83%, 87.14%, 89.54%, 91.23%, and 86.43%, respectively. The values of maximal intensity (Imax) in the reactive hyperplasia group (group A), lymphoma group (group B), and metastatic lymph nodes group (group C) were compared, showing statistical differences ( P < 0.05). The TTP and AUC of group B were higher than those of groups A and C, respectively ( P < 0.05), and the base-to-peak ascending slope (KUP) and the absolute value of the semidescending slope (KDOWN) in group C increased hugely compared to group A ( P < 0.05). It indicated that CEUS examination under DEFLATE could be applied in the qualitative diagnosis of lower common bile duct lesions and superficial lymphoid lesions, which was worthy of clinical application.

RIGHT HEPATIC DUCT STENOSIS DUE TO MULTIPLE METALLIC CLIPS AFTER CHOLECYSTECTOMY. IS THERE A WAY OUT? RE-LAPAROSCOPY AND ERCP STENTING

Bile duct lesions with leakage and stenosis can occur after open or laparoscopic cholecystectomy. Multiple factors are involved either related to the patient or external due to technical equipment or surgeon. Bismuth classification is generally accepted. The aim is to restore the bile duct and to prevent short-term and long-term complications such as biliary fistula, intra-abdominal abscess, biliary stricture, recurrent cholangitis, and secondary biliary cirrhosis. Endoscopic therapy with biliary sphincterotomy alone or with the additional placement of a biliary/nasobiliary stent drainage is recommended. Stenting should be avoided if complete strictures exist or a circumferential resection of the duct. Endotherapy can be considered a sensible option and should be the main-stay treatment in these patients but one must keep in mind it is costly and is usually practiced by experienced teams in tertiary centers. The purpose of our paper is to exemplify this complication which is inherently rare, to highlight the diagnostic and treatment tools with minimal long-term sequelae.

Tissue acquisition for diagnosis of proximal biliary lesions using endoscopic ultrasound-guided fine-needle aspiration.

Objectives: To report the diagnostic yield and safety of endoscopic ultrasound-guided fine-needle aspiration (EUS FNA) for the evaluation of proximal bile duct lesions. Materials and methods: A retrospective analysis of data of the patients, who had undergone EUS for proximal bile duct lesions was done. FNA was performed from either the bile duct mass, enlarged node, or liver lesions. Outcome measures were the diagnostic yield of EUS FNA and adverse events. Results: From April 2011 to August 2018, 147 patients with suspected proximal bile duct malignancy underwent EUS. Mass lesion was seen in 133 (90.47%) patients. FNA was performed in 125 (85.03%) patients. The final diagnosis in patients undergoing EUS FNA was malignancy in 118, benign disease in six, and one patient was lost to follow up. EUS FNA confirmed the diagnosis in 103/118 patients with malignancy (sensitivity 87.28%); was false negative in 15/118 cases with malignancy, and was truly negative in all the six patients with benign disease (specificity 100%). Positive predictive value, negative predictive value, and the accuracy of EUS FNA were 100%, 28.57%, 87.90% respectively. No serious adverse event was reported, five patients had self-limiting pain. Conclusion: EUS FNA is a sensitive tool for the evaluation of proximal bile duct lesions. Low negative predictive value warrants further evaluation in patients with non-malignant findings on cytology.

POSSIBILITIES OF EARLY DIAGNOSIS AND PROPHYLAXIS OF INTRAOPERATIVE BILE DUCT LESIONS IN MIRIZZY SYNDROME

Summary. Goal. To analyze the possibilities of early diagnosis and prevention of intraoperative injuries of the bile duct in the Mirizzy syndrome. Materials and research methods. The study is based on an analysis of 968 case histories of patients with acute calculous cholecystitis. The ratio of patients with Mirizzy syndrome to patients with calculous cholecystitis was 38 (3.9 %). There were 716 women (74 %), and 252 men (26 %). The age of patients ranged from 25 to 92 years. All patients with Mirizzy syndrome were divided into 4 groups (according to the classification of A. Csendes). The number of patients with type 1 SM was 27 (72 %); 2 types — 6 (18 %); 3 types — 2 (6 %); 4 types — 1 (3 %). Result. The treatment outcome of 35 patients with Mirizzy syndrome was evaluated. In type 1, LCE was performed in 27 (72 %) patients. In type 2, open surgery was performed. In 4 (12 %) patients of this group, a laparotomy was performed for cholecystectomy with plastic surgery of the common bile duct on Keru drainage. In 2 (6 %), subtotal cholecystectomy was performed with subsequent installation of drainage into the lumen of the remaining part of the bladder with fistula. In the presence of types 3 and 4 of Mirizzy’s syndrome, an “open” surgical intervention was performed, followed by hepaticojejunoanastomosis on the Loop-off loop in 3 (9 %) patients. The most informative non-invasive method of preoperative diagnosis of Mirrisi syndrome is MRI in cholangiography, which allows you to diagnose all types of this syndrome with a high degree of probability.

EFFECTIVENESS OF ENDOSCOPIC TREATMENT OF BILIARY FISTULAS

Despite the great experience in biliary surgery, the total frequency of iatrogenic bile duct lesions, accompanied by the formation of biliary fistulas, reaches 2%. The aim of the study is to analyze the results of endoscopic treatment of patients with biliary fistulas after cholecystectomy. Materials and methods of research. The results of endoscopic treatment of 19 patients with biliary fistulas that occurred after cholecystectomy were studied. Women were 11 (57.9%), men – 8 (42.1%). Research results. The reason of the formation of bile fistula was biliary hypertension in case of choledocholithiasis in 14 (73.6%) patients. Endoscopic papillosphincterectomy was performed to restore the free passage of bile into the duodenum. Lithoextraction with balloon was carried out in 11 (57.9%) patients, and in 3 (15.8%) patients was used litoextraction with basket. Endobiliary drainage was performed in 5 (26.3%) patients. Conducting decompression of bile ducts in all cases of type A fistulas resulted in the cessation of bile fistula the day after surgery. Conclusions. ERCP is a highly effective method for treating biliary fistulas, which identifies the location of leakage of bile, and restoring of bile flowing to the duodenum helps to heal the fistula.