ERCP in the management of biliary complications after cholecystectomy

Open cholecystectomy has been associated historically with 0.2% to 0.5% risk of postoperative biliary injury. Laparoscopic cholecystectomy, which has become the first-line surgical treatment of calculous gallbladder disease, has been associated with a 2.5-fold to fourfold increase in the incidence of postoperative bile duct injury. The biliary endoscopist can expect to see a varied spectrum of complications after cholecystectomy by either technique, including postoperative biliary strictures, bile leaks, and retained calculi in the biliary tree. Proper diagnosis and treatment are paramount in ensuring a satisfactory outcome after bile duct injury. Endoscopic retrograde cholangiopancreatography (ERCP) has become the primary modality for treatment and effectively manages most bile duct injuries.     

The use of ERCP in the study of patients with hepatic echinococcosis before and after surgical intervention

Background: Biliary tree involvement is the most common complication of hydatid liver disease, which is difficult to detect and manage. Methods: During the last 7 years, we examined by ERCP 26 cases with echinococcal liver involvement. Indications in the preoperative group included cholangitis in 6 cases, right-sided hypochondralgia involving 4, preoperative assessment in 4, and icterus in 1 case. In the postoperative group, the indications for ERCP were cholangitis in 5 cases, external biliary fistulas in 5, and biliary colic in 1 case. Results: ERCP findings in the preoperative group included external bile duct compression in 11 cases (73.3%), biliary fistula affecting 3 (20%), and echinococcal remnants within the common bile duct in 1 case (6.6%). With regard to the postoperative group, biliary fistula formation was detected in 6 cases (54.5%), echinococcal remnants within the common bile duct in 4 (36.3%), and external bile duct compression involving 1 case (9%). Endoscopic sphincterotomy was successfully performed in 13 patients in both groups. No serious complications were encountered. Conclusion: ERCP is a safe and helpful preoperative or postoperative tool that aids in the diagnosis and often the treatment of echinococcal liver disease with involvement of the bile ducts. (Gastrointest Endosc 1996;43:575-9)     

肝移植术后胆栓形成过程中内镜的诊治价值

目的 探讨内镜逆行胰胆管造影（ERCP）在肝移植术后胆栓形成过程中的诊断治疗价值.方法 71例肝移植术后出现肝功能异常、磁共振检查提示胆道内异物的患者,采用ERCP明确诊断并给予相应的治疗,对其临床资料进行回顾性分析.结果 71例患者共接受188次ERCP诊疗,多数患者伴有不同程度的吻合口和（或）胆管狭窄.术后＜3个月者均取出胆泥,3～6个月者取少量色素样结石,＞6个月者取出铸型胆栓,平均每位患者行2.6次内镜治疗,肝移植术后平均（22.7±15.6）个月形成铸型胆栓.术后发生胰腺炎2例,胆管炎3例,发生率2.6%（5/188）,均经保守治疗控制.随访56例,经内镜处理后患者肝功能均有明显改善,42例达到内镜治愈标准,10例因胆管广泛硬化性改变而行二次肝移植,4例死于移植术以外原因.结论 ERCP处理肝移植术后胆栓形成过程中的胆泥、小结石和胆栓安全可行,近期疗效较好,并可反复进行.     

肝移植术后胆栓形成过程中内镜的诊治价值

Objective To evaluate endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management of biliary cast syndrome after orthotropic liver transplantation. Methods A total of 71 consecutive patients with abnormal liver function and MRCP findings after liver transplantation underwent ERCP for diagnosis and management. Their data were retrospectively reviewed. Results A total of 188 sessions of ERCP were carried out on the 71 patients, most of whom were found to have stenosis of anastomotic stoma and/or bile duct. Bile sludge was found and removed in all patients diagnosed within 3 months after liver transplantation, while pigmentoid stones were found and removed in patients diagnosed within 3-6 months and biliary casts in patients diagnosed at more than 6 months. Each patient underwent 2.6 sessions averagely. Biliary casts were formed at an average time of 22. 7 ± 15.6 months after transplantation. PostERCP complications included 2 cases of pancreatitis and 3 cholangitis, with an occurrence rate of 2. 6%(5/188), which were all controlled with conservative treatment. The follow-up data was available in 56 patients showing improvement in liver function after ERCP, among who 42 met the endoscopic criteria of cure,1 0 received second liver transplantation because of progressive sclerosing cholangitis and 4 died from diseases other than liver transplantation. Conclusion Therapeutic ERCP for the biliary cast syndrome after liver transplantation is feasible, safe and effective, and can be performed repeatedly with good short-term effect.     

肝移植术后胆栓形成过程中内镜的诊治价值

Objective To evaluate endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management of biliary cast syndrome after orthotropic liver transplantation. Methods A total of 71 consecutive patients with abnormal liver function and MRCP findings after liver transplantation underwent ERCP for diagnosis and management. Their data were retrospectively reviewed. Results A total of 188 sessions of ERCP were carried out on the 71 patients, most of whom were found to have stenosis of anastomotic stoma and/or bile duct. Bile sludge was found and removed in all patients diagnosed within 3 months after liver transplantation, while pigmentoid stones were found and removed in patients diagnosed within 3-6 months and biliary casts in patients diagnosed at more than 6 months. Each patient underwent 2.6 sessions averagely. Biliary casts were formed at an average time of 22. 7 ± 15.6 months after transplantation. PostERCP complications included 2 cases of pancreatitis and 3 cholangitis, with an occurrence rate of 2. 6%(5/188), which were all controlled with conservative treatment. The follow-up data was available in 56 patients showing improvement in liver function after ERCP, among who 42 met the endoscopic criteria of cure,1 0 received second liver transplantation because of progressive sclerosing cholangitis and 4 died from diseases other than liver transplantation. Conclusion Therapeutic ERCP for the biliary cast syndrome after liver transplantation is feasible, safe and effective, and can be performed repeatedly with good short-term effect.     

Prevention and treatment of postoperative complications of hepatic echinococcosis

The paper presents the outcomes of surgical treatment in 117 patients with complicated liver echinococciasis in the past 9 years. Hepatic function and immunity, their pre- and postoperative changes in the combined use of essentiale and T-activin were studied. It has been found that the functional status of the liver, its detoxifying function in particular, largely impairs and immunosuppression develops in patients with complicated liver echinococciasis. The postoperative combined use of essentiale and T-activin led to the normalization of hepatic function and immunity. The combined treatment reduced the incidence of postoperative complications from 34.83 to 17.2%, such as acute hepatic failure, suppuration of a wound and a residual cavity, isolated abdominal abscesses, pleurisy, and pneumonia.     

Risk factors for complications after performance of ERCP

BACKGROUND: ERCP has become widely available for the diagnosis and treatment of benign and malignant pancreaticobiliary diseases. In this prospective study, the overall complication rate and risk factors for diagnostic and therapeutic ERCP were identified. METHODS: Data were collected prospectively on patient characteristics and endoscopic techniques from 1223 ERCPs performed at a single referral center and entered into a database. Univariate and multivariate analyses were used to identify risk factors for ERCP-associated complications. RESULTS: Of 1223 ERCPs performed, 554 (45.3%) were diagnostic and 667 (54.7%) therapeutic. The overall complication rate was 11.2%. Post-ERCP pancreatitis was the most common (7.2%) and in 93% of cases was self-limiting, requiring only conservative treatment. Bleeding occurred in 10 patients (0.8%) and was related to a therapeutic procedure in all cases. Nine patients had cholangitis develop, most cases being secondary to incomplete drainage. There was one perforation (0.08%). All other complications totaled 1.5%. Variables derived from cannulation technique associated with an increased risk for post-ERCP pancreatitis were precut access papillotomy (20%), multiple cannulation attempts (14.9%), sphincterotome use to achieve cannulation (13.1%), pancreatic duct manipulation (13%), multiple pancreatic injections (12.3%), guidewire use to achieve cannulation (10.2%), and the extent of pancreatic duct opacification (10%). Patient characteristics associated with an increased risk of pancreatitis were sphincter of Oddi dysfunction (21.7%) documented by manometry, previous ERCP-related pancreatitis (19%), and recurrent pancreatitis (16.2%). Pain during the procedure was an important indicator of an increased risk of post-ERCP pancreatitis (27%). Independent risk factors for post-ERCP pancreatitis were identified as a history of recurrent pancreatitis, previous ERCP-related pancreatitis, multiple cannulation attempts, pancreatic brush cytology, and pain during the procedure. CONCLUSIONS: The most frequent ERCP-related complication was pancreatitis, which was mild in the majority of patients. The frequency of post-ERCP pancreatitis was similar for both diagnostic and therapeutic procedures. Bleeding was rare and mostly associated with sphincterotomy. Other complications such as cholangitis and perforation were rare. Specific patient- and technique-related characteristics that can increase the risk of post-ERCP complications were identified.     

肝泡球蚴病的非根治性手术治疗观察

目的 探讨非根治性手术对肝泡球蚴病的治疗价值.方法 对2000-2005年收治的38例行非根治性手术治疗肝泡球蚴病的患者进行回顾性调查分析.结果 38例患者中,12例行肝切除术,23例行经皮穿刺液化坏死引流,3例行经皮肝穿刺胆管引流.所有患者同时结合服用阿苯达唑(15 mg·kg~(-1)·d~(-1)).未行根治性切除的原因包括:病灶同时浸入肝左右叶、肝门部、横膈及并发腔静脉受阻等.术后随访1～3年,1例行经皮肝穿刺胆管引流患者在随访过程中死于肝功能衰竭.8例行肝叶切除及17例行经皮穿刺液化坏死引流患者随访期间无明显临床症状,2例行经皮肝穿刺胆管引流患者术后症状无明显改善,其余10例患者术后存在轻微症状.8例患者术后因持续性胆瘘行二次手术.结论 非根治性切除术可改善肝泡球蚴病患者症状,提高生存质量.行非根治性切除结合药物治疗对于不能行根治性切除的肝泡球蚴病患者是一种较好的选择.     

Treatment of complications of hepatic hydatid disease by ERCP

BACKGROUND: The aim of this study was to evaluate the effectiveness of endoscopic sphincterotomy for preoperative and postoperative complications of hepatic hydatid disease. METHODS: Nineteen patients underwent endoscopic treatment for complications of hepatic hydatid disease. Indications for ERCP in 5 patients treated before surgery (Group A) were obstructive jaundice in 1 and acute cholangitis in 4. In 14 patients treated after surgery (Group B), the indication was acute cholangitis in 6, obstructive jaundice 2, and persistent external drainage in 6 patients. OBSERVATIONS: In group A, ERCP detected hydatid vesicles within the bile duct. All patients underwent endoscopic sphincterotomy and clearance of the duct with no complications. The 6 patients in Group B with persistent external drainage had biliary fistulas that resolved after endoscopic treatment within 10 to 20 days. Among the 8 patients with postoperative obstructive jaundice or acute cholangitis, 7 had cyst remnants obstructing the bile duct and 1 had findings of sclerosing cholangitis. All underwent endoscopic sphincterotomy and clearance of the bile duct without complications. After treatment, all patients, with the exception of the one with sclerosing cholangitis, remained asymptomatic. CONCLUSION: Endoscopic sphincterotomy is a safe and effective treatment for biliary complications of hepatic hydatid disease.     

根治性手术治疗不同Child-Pugh分级的肝泡型包虫病患者疗效研究

目的 观察采取根治性手术治疗不同Child-Pugh分级的肝泡型包虫病患者的疗效.方法 2014年7月～2019年7月我院诊治的肝泡型包虫病患者60例,入院时Child-Pugh A级36例,B级24例.所有患者均接受根治性手术治疗,术后随访3年.结果 在术后1 w,Child-Pugh A级患者血清总胆红素和碱性磷酸...     

肝包虫病影像学诊断专家共识

包虫病是呈全球性分布的人畜共患性疾病,已成为严重危害全世界公共卫生健康的问题。影像学技术在肝包虫病的早期诊断、术前评价及疗效监测方面发挥着至关重要的作用。目前包虫病影像诊断缺乏统一共识,不利于影像专业人员学习培训以及临床对于包虫病的规范诊断与治疗,为此由首都医科大学附属北京佑安医院和新疆医科大学第一附属医院联合多家医院的感染与炎症放射学专家,在充分学习国际指南、文献以及国内外最新研究成果的基础上,结合循证医学对建立指南及标准的方法学要求,针对肝包虫病影像学诊断依据、诊断原则、诊断标准和鉴别诊断形成共识,为临床医师在肝包虫病影像学临床应用中提供明确的诊断依据。     

Metabolic complications of bariatric surgery: diagnosis and management issues

Acute complications after bariatric surgery include rhabdomyolysis and immobilization hypercalcemia. The most common long-term metabolic complications following bariatric surgery are anemia and metabolic bone disease. Neuropathy, acute Wemicke's encephalopathy and vitamin A deficiency also occur. Prevention, diagnosis,and treatment of these disorders are necessary parts of lifelong care after bariatric surgery.     

Value of ERCP in the diagnosis and management of pre- and postoperative biliary complications in hydatid disease of the liver

Twenty-nine patients with symptomatic hydatid disease of the liver were evaluated preoperatively by endoscopic retrograde cholangiopancreatography (ERCP) in the years 1982-1987. In the same period, 6 patients who previously underwent surgery for the parasitic disease also underwent ERCP because of postoperative symptoms of biliary obstruction. Findings at ERCP excluded biliary tract involvement in 11 cases. Positive findings were shown in 24 patients, including compression of the bile ducts in 4, small cysto-biliary communications in 5, intrabiliary rupture in 9, residual hydatid material in the common bile duct, and sclerosing cholangitis in 3. Endoscopic removal of migrated hydatid debris was achieved in 8 patients, avoiding reoperation in 4.     

Current status of diagnosis and treatment of hepatic echinococcosis

Echinococcus granulosus(E.granulosus) and Echinococcus multilocularis(E.multilocularis) infections are the most common parasitic diseases that affect the liver.The disease course is typically slow and the patients tend to remain asymptomatic for many years.Often the diagnosis is incidental.Right upper quadrant abdominal pain,hepatitis,cholangitis,and anaphylaxis due to dissemination of the cyst are the main presenting symptoms.Ultrasonography is important in diagnosis.The World Health Organization classification,based on ultrasonographic findings,is used for staging of the disease and treatment selection.In addition to the imaging methods,immunological investigations are used to support the diagnosis.The available treatment options for E.granulosus infection include open surgery,percutaneous interventions,and pharmacotherapy.Aggressive surgery is the first-choice treatment for E.multilocularis infection,while pharmacotherapy is used as an adjunct to surgery.Due to a paucity of clinical studies,empirical evidence on the treatment of E.granulosus and E.multilocularis infections is largely lacking;there are no prominent and widely accepted clinical algorithms yet.In this article,we review the diagnosis and treatment of E.granulosus and E.multilocularis infections in the light of recent evidence.     

青海地区肝细粒棘球蚴病患者术后炎性因子变化及乌司他丁干预作用的临床研究

目的 观察青海地区肝细粒棘球蚴病患者术后炎性因子变化,评价乌司他丁对肝棘球蚴病患者术后炎性因子的干预作用。方法 选取60例肝细粒棘球蚴病患者,随机分为两组,干预组术后使用乌司他丁,对照组不使用。所有患者于术前、术后第1、3、5天及第7天抽取外周静脉血,应用酶联免疫吸附试验（ELISA）检测白细胞介素?6（IL?6）、IL?8、IL?9、IL?10含量,并分析乌司他丁干预的效果。结果 乌司他丁干预组术后不同时间点IL?6、IL?8、IL?9和IL?10水平变化趋势不同。乌司他丁干预组IL?6、IL?8、IL?9、IL?10水平与对照组在术前、术后第1、3天比较差异均无统计学意义（t = -1.15 ~ 1.82,P均> 0.05）;而在术后第5、7 天低于对照组,差异均有统计学意义（t = 3.22、23.51,P均< 0.05）。结论 乌司他丁在抑制肝细粒棘球蚴病患者机体炎症因子方面有很好效果,对术后肝损伤可以起到保护和治疗作用。