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Development of a biliary multi-hole self-expandable metallic stent for bile tract diseases: A case report 预览
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作者 Makoto Kobayashi 《世界临床病例杂志》 2019年第11期1323-1329,共7页
BACKGROUND Uncovered stents used for malignant obstructions in the biliary tree, especially in the hilar area, are prone to obstruction by tumor ingrowths. In comparison, however, covered stents may block bile duct br... BACKGROUND Uncovered stents used for malignant obstructions in the biliary tree, especially in the hilar area, are prone to obstruction by tumor ingrowths. In comparison, however, covered stents may block bile duct branches and are at risk of migration. We have developed a multi-hole self-expandable metallic stent (MHSEMS), with a hole in each cell, to prevent the obstruction of bile duct branches. In addition, the holes may prevent migration due to small ingrowths by reducing the tension of the membrane. CASE SUMMARY MHSEMS were placed in five patients with a malignant obstruction and one with post-endoscopic sphincterotomy bleeding. Each MHSEMS was successfully deployed in all cases. Patients showed no complications. Two cases were reviewed. Case 1: A 74-year-old male presented with jaundice and was diagnosed with a sigmoid colon cancer and giant liver metastases in the right liver lobe. A MHSEMS was placed in the left bile duct. The jaundice improved and peroral cholangioscopy was performed. Case 2: A 90-year-old female was admitted to hospital for jaundice and diagnosed with cholangiocarcinoma. A MHSEMS was placed in the left bile duct but after 8 months the stent became obstructed by tumor ingrowth. We treated the patient by ablation therapy. A silicone cover separated the internal bile duct from the surrounding tissue, protecting the latter from thermal injury during treatment by endobiliary ablation of the reobstruction. CONCLUSION A MHSEMS is a new choice of stent for biliary tract diseases. 展开更多
关键词 Multi-hole self-expandable metallic stent Malignant BILIARY STRICTURE Benign BILIARY STRICTURE HILAR BILIARY OBSTRUCTION Distal BILIARY OBSTRUCTION Endobiliary radiofrequency ablation Case report
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Endoscopic management of biliary strictures post-liver transplantation 预览
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作者 Ahmed Akhter Patrick Pfau +2 位作者 Mark Benson Anurag Soni Deepak Gopal 《世界荟萃分析杂志》 2019年第4期120-128,共9页
Biliary complications play a significant role in morbidity of liver transplant recipients. Biliary strictures occur between 10%-25% of patients with a higher incidence in living donor recipients compared to deceased d... Biliary complications play a significant role in morbidity of liver transplant recipients. Biliary strictures occur between 10%-25% of patients with a higher incidence in living donor recipients compared to deceased donors. Strictures can be classified as either anastomotic or non-anastomotic and may be related to ischemic events. Endoscopic management of biliary strictures in the posttransplant setting has become the preferred initial approach due to adequate rates of resolution of anastomotic and non-anastomotic strictures (NAS). However, several factors may increase complexity of the endoscopic approach including surgical anatomy, location, number, and severity of bile duct strictures. Many endoscopic tools are available, however, the approach to management of anastomotic and NAS has not been standardized. Multi-disciplinary techniques may be necessary to achieve optimal outcomes in select patients. We will review the risk factors associated with the development of bile duct strictures in the posttransplant setting along with the efficacy and complications of current endoscopic approaches available for the management of bile duct strictures. 展开更多
关键词 Liver transplantation Endoscopic management ANASTOMOSIS BILIARY STRICTURES BILIARY BALLOON DILATION BILIARY STENTS
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Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience? 预览
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作者 Andrea Anderloni Edoardo Troncone +4 位作者 Alessandro Fugazza Annalisa Cappello Giovanna Del Vecchio Blanco Giovanni Monteleone Alessandro Repici 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第29期3857-3869,共13页
In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic inter... In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUSguided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and ECLAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients. 展开更多
关键词 Interventional ENDOSCOPIC ULTRASONOGRAPHY ENDOSCOPIC ultrasonography-guided BILIARY drainage ENDOSCOPIC ultrasonography-guided choledocho-duodenostomy BILIARY METAL STENT Lumen-apposing METAL STENT
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New antireflux plastic stent for patients with distal malignant biliary obstruction 预览
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作者 Xiang-Lei Yuan Bin Wei +8 位作者 Lian-Song Ye Chun-Cheng Wu Qing-Hua Tan Ming-Hong Yao Yu-Hang Zhang Xian-Hui Zeng Yan Li Yu-Yan Zhang Bing Hu 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第19期2373-2382,共10页
BACKGROUND Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction (MBO). However, the main problem with stent placement is the relati... BACKGROUND Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction (MBO). However, the main problem with stent placement is the relatively short duration of stent patency. Although self-expanding metal stents (SEMSs) have a longer patency period than plastic stents (PSs), the higher costs limit the wide use of SEMSs. A PS with an antireflux valve is an attractive idea to prolong stent patency, but no ideal design for an antireflux PS (ARPS) has been proposed. We developed a new ARPS with a “duckbilled” valve attached to the duodenal end of the stent. AIM To compare the patency of ARPSs with that of traditional PSs (TPSs) in patients with unresectable distal MBO. METHODS We conducted a single-center, prospective, randomized, controlled, double-blind study. This study was conducted at the West China Hospital of Sichuan University. Consecutive patients with extrahepatic MBO were enrolled prospectively. Eligible patients were randomly assigned to receive either an ARPS or a TPS. Patients were followed by clinic visits or telephone interviews every 1-2 mo until stent exchange, death, or the final study follow-up in October 2018. The primary outcome was the duration of stent patency. Secondary outcomes included the rate of technical success, the rate of clinical success,adverse events, and patient survival. RESULTS Between February 2016 and December 2017, 38 patients were randomly assigned to two groups, with 19 patients in each group, to receive ARPSs or TPSs. Stent insertion was technically successful in all patients. There were no significant differences between the two groups in the rates of clinical success or the rates of early or late adverse events (P = 0.660, 1.000, and 1.000, respectively). The median duration of stent patency in the ARPS group was 285 d [interquartile range (IQR), 170], which was significantly longer than that in the TPS group (median, 130 d;IQR, 90, P = 0.005). No significant difference in patient surviva 展开更多
关键词 ANTIREFLUX valve Plastic BILIARY STENT DISTAL malignant BILIARY obstruction STENT PATENCY Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY
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原发性胆汁性肝硬化患者血小板4项参数的变化及临床意义研究 预览
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作者 张海燕 杨必伟 +2 位作者 付雪 周雯婧 叶震璇 《现代医药卫生》 2019年第3期357-359,362共4页
目的探讨原发性胆汁性肝硬化(PBC)患者血小板4项参数[血小板计数(Plt)、血小板压积(PCT)、平均血小板容积(MPV)、血小板分布宽度(PDW)]的变化及其临床意义。方法收集2014年1月至2017年4月在该院住院的84例确诊为PBC患者(PBC组)的临床资... 目的探讨原发性胆汁性肝硬化(PBC)患者血小板4项参数[血小板计数(Plt)、血小板压积(PCT)、平均血小板容积(MPV)、血小板分布宽度(PDW)]的变化及其临床意义。方法收集2014年1月至2017年4月在该院住院的84例确诊为PBC患者(PBC组)的临床资料,收集同期该院67例健康体检者(对照组)临床资料。比较2组间血小板4项参数和生化指标的差异,评估血小板参数与生化指标、清蛋白-胆红素评分模型(ALBI)评分的相关性。结果与对照组比较,PBC组患者Plt、PCT、清蛋白(ALB)水平显著降低,而谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、谷氨酰转移酶(GGT)、球蛋白(GLB)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、总胆汁酸(TBA)水平显著升高,差异均有统计学意义(P<0.01),2组间MPV及PDW水平比较,差异均无统计学意义(P >0.05)。Spearman相关性分析显示,Plt与ALT、AST、ALP、GGT、ALB呈正相关[相关系数(r)=0.309、0.294、0.343、0.420、0.368,P<0.05或0.01];PCT与ALT、AST、ALP、GGT、ALB呈正相关(r=0.306、0.301、0.326、0.441、0.387,P<0.05或0.01);Plt、PCT均与ALBI评分呈负相关(r=-0.298、-0.312,P<0.01)。结论Plt、PCT在PBC患者中显著降低,且与生化指标、ALBI评分有良好的相关性,可为PBC患者病情严重程度和预后的初步评估提供重要参考。 展开更多
关键词 肝硬化 胆汁性 血小板参数 生化指标 原发性胆汁性肝硬化 血小板计数 血小板压积 ALBI评分
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Current therapies and novel approaches for biliary diseases 预览
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作者 Indu G Rajapaksha Peter W Angus Chandana B Herath 《世界胃肠病理生理学杂志:英文版(电子版)》 2019年第1期1-10,共10页
Chronic liver diseases that inevitably lead to hepatic fibrosis, cirrhosis and/or hepatocellular carcinoma have become a major cause of illness and death worldwide. Among them, cholangiopathies or cholestatic liver di... Chronic liver diseases that inevitably lead to hepatic fibrosis, cirrhosis and/or hepatocellular carcinoma have become a major cause of illness and death worldwide. Among them, cholangiopathies or cholestatic liver diseases comprise a large group of conditions in which injury is primarily focused on the biliary system. These include congenital diseases (such as biliary atresia and cystic fibrosis), acquired diseases (such as primary sclerosing cholangitis and primary biliary cirrhosis), and those that arise from secondary damage to the biliary tree from obstruction, cholangitis or ischaemia. These conditions are associated with a specific pattern of chronic liver injury centered on damaged bile ducts that drive the development of peribiliary fibrosis and, ultimately, biliary cirrhosis and liver failure. For most, there is no established medical therapy and, hence, these diseases remain one of the most important indications for liver transplantation. As a result, there is a major need to develop new therapies that can prevent the development of chronic biliary injury and fibrosis. This mini-review briefly discusses the pathophysiology of liver fibrosis and its progression to cirrhosis. We make a special emphasis on biliary fibrosis and current therapeutic options, such as angiotensin converting enzyme-2 (known as ACE2) over-expression in the diseased liver as a novel potential therapy to treat this condition. 展开更多
关键词 Chronic liver disease BILIARY FIBROSIS CURRENT THERAPIES for BILIARY FIBROSIS ANGIOTENSIN CONVERTING enzyme-2 Gene therapy
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Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis:A review of the literature 预览
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作者 Benedetto Mangiavillano Mouen A Khashab +9 位作者 Ilaria Tarantino Silvia Carrara Rossella Semeraro Francesco Auriemma Mario Bianchetti Leonardo Henry Eusebi Chen Yen-I Luca De Luca Mario Traina Alessandro Repici 《世界胃肠外科杂志:英文版(电子版)》 2019年第2期53-61,共9页
Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary,peri-ampullary,and pancreatic head neoplasia.Surgical bypass is no longer the gold-standa... Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary,peri-ampullary,and pancreatic head neoplasia.Surgical bypass is no longer the gold-standard therapy for these patients,as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique,with a high technical success in expert hands.In recent years,endoscopic ultrasonography(EUS)has evolved from a diagnostic to a therapeutic procedure,and is now increasingly used to guide biliary drainage,especially in cases of failed endoscopic retrograde cholangiopancreatography(ERCP).The advent of lumen-apposing metal stents(LAMS)has expanded EUS therapeutic options,and changed the management of synchronous bilioduodenal stenosis.The most recent literature regarding endoscopic treatments for synchronous biliary and duodenal malignant stenosis has been reviewed to determine the best endoscopic approach,also considering the advent of an interventional EUS approach using LAMS. 展开更多
关键词 MALIGNANT BILIARY strictures MALIGNANT DUODENAL STENOSIS Bilio-duodenal STENOSIS BILIARY self-expandable METAL stent DUODENAL self-expandable METAL stent Lumen-apposing METAL stents Gastro-jejunostomy
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Clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization combined with radiotherapy in hilar cholangiocarcinoma 预览
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作者 Wen-Heng Zheng Tao Yu +7 位作者 Ya-Hong Luo Ying Wang Ye-Fu Liu Xiang-Dong Hua Jie Lin Zuo-Hong Ma Fu-Lu Ai Tian-Lu Wang 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第6期489-498,共10页
BACKGROUND Radical surgical resection is regarded as the best treatment for hepatic hilar cholangiocarcinoma. However, 60%-70% of patients have lost the chance of surgery at the time of diagnosis. Simple biliary stent... BACKGROUND Radical surgical resection is regarded as the best treatment for hepatic hilar cholangiocarcinoma. However, 60%-70% of patients have lost the chance of surgery at the time of diagnosis. Simple biliary stent or drainage tube placement may fail in a short time due to tumor invasion or overgrowth, bile accumulation, or biofilm formation. Effective palliative treatments to extend the effective drainage time are of great significance for improving the quality of life of patients and changing the prognosis of patients. AIM To investigate the clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization (TACE) combined with radiotherapy in hilar cholangiocarcinoma.METHODS A retrospective analysis was conducted on patients clinically diagnosed with hilar cholangiocarcinoma from June 2014 to January 2017 at the Liaoning Provincial Cancer Hospital. Patients were evaluated by specialists, and those who were not suitable for surgery or unwilling to undergo surgery and met the inclusion criteria were included in the study. There were a total of 72 patients (34 males and 38 females) with an average age of 59.9 years (range, 40-72 years). According to percutaneous transhepatic biliary angiography and the patients’ wishes, stent implantation or biliary drainage tube implantation was used to relieve biliary obstruction. The patients were divided into either a control group or a combined treatment group according to their follow-up treatment. The control group consisted of a total of 35 patients who received simple biliary drainage tube placement and biliary stent implantation (7 patients with bilateral stents and 6 with a unilateral stent) and 22 patients receiving biliary drainage tube placement alone. The combined treatment group received TACE and extracorporeal radiotherapy after biliary drainage or biliary stent implantation and consisted of a total of 37 patients, including 21 patients receiving combined treatment after biliary stent placement (14 patients with bilateral stents an 展开更多
关键词 HILAR cholangiocarcinoma BILIARY stent Percutaneous BILIARY drainage GEMCITABINE CISPLATIN RADIOTHERAPY Transcatheter arterial CHEMOEMBOLIZATION
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Appropriate number of biliary biopsies and endoscopic retrograde cholangiopancreatography sessions for diagnosing biliary tract cancer 预览
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作者 Tadayuki Takagi Mitsuru Sugimoto +11 位作者 Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira 《世界胃肠内镜杂志:英文版(电子版)》 2019年第3期231-238,共8页
BACKGROUND Biliary ductal cancer(BDC) is a lethal disease;however, diagnosing BDC is challenging. Biliary biopsies are performed to pathologically diagnose BDC, but the appropriate parameters for biliary biopsy [numbe... BACKGROUND Biliary ductal cancer(BDC) is a lethal disease;however, diagnosing BDC is challenging. Biliary biopsies are performed to pathologically diagnose BDC, but the appropriate parameters for biliary biopsy [number of biliary biopsies, number of endoscopic retrograde cholangiopancreatography(ERCP) sessions, etc.] are unknown.AIM To clarify what constitutes an adequate method for biliary biopsy.METHODS In total, 95 patients who underwent endoscopic biliary biopsy without choledochoscopy and who were pathologically diagnosed with BDC were enrolled in this study. The patients were divided into two groups. Seventy-six patients who were diagnosed by biliary biopsy were defined as the positive group(P group), and nineteen patients who were not diagnosed by biliary biopsy were defined as the negative group(N group). The patient characteristics and ERCP-related procedures were compared between the P and N groups.RESULTS The numbers of ERCP sessions and biliary biopsies were significantly different between the two groups (ERCP sessions(one/two), P group 72/4 vs N group15/4, P value = 0.048;number of biliary biopsies, P group 2(1-6) vs N group 2(1-7), P value = 0.039)In a multivariate analysis, fewer than 2 ERCP sessions was an independent factor influencing the positivity of the biliary biopsies.CONCLUSION This study clarified that ERCP and biliary ductal biopsy should only be performed once. If biliary cancer is not pathologically diagnosed after the first ERCP session, other methods(Endoscopic ultrasonography-guided fine needle aspiration or choledochoscopy-guided biliary ductal biopsy) should be employed. 展开更多
关键词 BILIARY DUCTAL cancer BILIARY biopsy ENDOSCOPIC retrograde cholangiopancreatography ENDOSCOPIC ultrasonography-guided fine needle aspiration CHOLEDOCHOSCOPY
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Comprehensive review on EUS-guided biliary drainage 预览
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作者 Raffaele Salerno Sophia Elizabeth Campbell Davies +1 位作者 Nicolo Mezzina Sandro Ardizzone 《世界胃肠内镜杂志:英文版(电子版)》 2019年第5期354-364,共11页
Feasibility of endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary... Feasibility of endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary drainage has always been considered the only alternative for this indication. However, endoscopic ultrasonography-guided biliary drainage represents a valid option to replace percutaneous transhepatic biliary drainage when ERCP fails. According to the access site to the biliary tree, two kinds of approaches may be described: the intrahepatic and the extrahepatic. Endoscopic ultrasonography-guided rendezvous transpapillary drainage is performed where the second portion of the duodenum is easily reached but conventional ERCP fails. The recent introduction of self-expandable metal stents and lumen-apposing metal stents has improved this field. However, the role of the latter is still controversial. Echoendoscopic transmural biliary drainage can be challenging with potential severe adverse events. Therefore, trained endoscopists, in both ERCP and endoscopic ultrasonography are needed with surgical and radiological backup. 展开更多
关键词 ENDOSCOPIC ultrasonography-guided BILIARY drainage EUS Percutaneous transhepatic BILIARY drainage ENDOSCOPIC ultrasonography-guided hepatogastric anastomosis ENDOSCOPIC ultrasonography-guided ANTEGRADE stent placement ENDOSCOPIC ultrasonography-guided CHOLEDOCHODUODENOSTOMY ENDOSCOPIC ultrasonography-guided transgallbladder ENDOSCOPIC ultrasonography-guided rendezvous
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Should a fully covered self-expandable biliary metal stent be anchored with a double-pigtail plastic stent? A retrospective study 预览
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作者 Saad Emhmed Ali Wesam M Frandah +2 位作者 Leon Su Cory Fielding Houssam Mardini 《世界胃肠内镜杂志:英文版(电子版)》 2019年第5期365-372,共8页
BACKGROUND The migration rate of fully covered self-expandable metal stents (FCSEMSs) has been reported to be between 14% to 37%. Anchoring of FCSEMSs using a doublepigtail plastic stent (DPS) may decrease migration. ... BACKGROUND The migration rate of fully covered self-expandable metal stents (FCSEMSs) has been reported to be between 14% to 37%. Anchoring of FCSEMSs using a doublepigtail plastic stent (DPS) may decrease migration. AIM To compare stent migration rates between patients who received FCSEMS alone and those who received both an FCSEMS and anchoring DPS. METHODS We conducted a retrospective analysis of endoscopy reporting system and medical records of 1366 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with FCSEMS placement at the University of Kentucky health care. Between July 2015 and April 2017, 203 patients with FCSEMS insertion for the treatment of malignant biliary stricture, benign biliary stricture, post-sphincterotomy bleeding, bile leak, and cholangitis drainage were identified. The review and analysis were conducted through our endoscopy reporting system (ProVation? MD) and medical records. Categorical data were analyzed using Chi-Square and Fischer exact test and continuous data using nonparametric tests. A regression analysis was performed to identify factors independently associated with increased risk of stent migration. We determined an FCSEMS migration endoscopically if the stent was no longer visible in the major papilla. RESULTS 1366 patients had undergone ERCP by three advanced endoscopists over 21-mo period;among these, 203 patients had FCSEMSs placed. 65 patients had FCSEMSs with DPS, and 138 had FCSEMSs alone. 65 patients had FCSEMSs with DPS, and 138 had FCSEMSs alone. 95 patients had a malignant stricture, 82 patients had a benign stricture, 12 patients had bile leak, 12 patients had cholangitis, and nine patients had post-sphincterotomy bleeding. The migration rate in patients with anchored FCSEMSs with DPS was 6%, and those without anchoring DPS was 10%(P = 0.35). Overall, migration was reported in 18 patients with FCSEMSs placement out of 203 patients with an overall migration rate of 9.7%. There was no significant association between anchoring the FCSEMSs w 展开更多
关键词 Metal STENTS Double-pigtail plastic stent Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY BILIARY drainage BILIARY obstruction
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腹腔镜联合ERCP对胆总管结石合并肝硬化患者术后早期肝功能的影响研究 预览
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作者 曹波 李想 陈克霏 《中华普外科手术学杂志(电子版)》 2019年第5期472-475,共4页
目的 探讨腹腔镜联合ERCP对胆总管结石合并肝硬化患者术后早期肝功能的影响研究。方法 回顾性分析2015年1月至2018年6月经腹腔镜+ERCP治疗(联合组)及经开腹手术治疗(开腹组)的胆总管结石合并肝硬化患者各42例临床资料。数据分析用SPSS 1... 目的 探讨腹腔镜联合ERCP对胆总管结石合并肝硬化患者术后早期肝功能的影响研究。方法 回顾性分析2015年1月至2018年6月经腹腔镜+ERCP治疗(联合组)及经开腹手术治疗(开腹组)的胆总管结石合并肝硬化患者各42例临床资料。数据分析用SPSS 19.0软件处理,手术相关指标、术前及术后3 d炎症反应、术前及术后2周肝功能指标以(±s)表示,采用独立样本t检验;结石清除率、术后并发症采用χ 2检验或Fisher精确检验;P <0.05为差异有统计学意义。结果 两组手术时间比较,差异无统计学意义( P >0.05),腔镜+ERCP组术中出血量、术后住院时间及术后并发症总发生率明显低于开腹组( P <0.05)。术后3 d时,两组炎症反应(PCT、 CRP、 IL-6)均较术前升高( P <0.05),且开腹组高于联合组( P <0.05);两组肝功能指标(Child-Pugh评分、MELD评分、MELD-Na评分)均较术前降低( P <0.05),且联合组低于开腹组( P <0.05)。结论 腹腔镜+ ERCP对胆总管结石合并肝硬化患者治疗效果较好,能降低手术创伤,减轻炎症反应,降低术后并发症,缓解患者术后肝功能损伤有积极意义。 展开更多
关键词 胆总管结石 肝硬化 胆汁性 胰胆管造影术 内窥镜逆行 腹腔镜 剖腹术
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Aeromonas veronii biovar veronii and sepsis-infrequent complication of biliary drainage placement: A case report 预览
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作者 Manlio Monti Arianna Torri +4 位作者 Elena Amadori Alice Rossi Giulia Bartolini Chiara Casadei Giovanni Luca Frassineti 《世界临床病例杂志》 2019年第6期759-764,共6页
BACKGROUND Aeromonas species are uncommon pathogens in biliary sepsis and cause substantial mortality in patients with impaired hepatobiliary function. Asia has the highest incidence of infection from Aeromonas, where... BACKGROUND Aeromonas species are uncommon pathogens in biliary sepsis and cause substantial mortality in patients with impaired hepatobiliary function. Asia has the highest incidence of infection from Aeromonas, whereas cases in the west are rare. CASE SUMMARY We report the case of a 64-year-old woman with advanced pancreatic cancer and jaundice who manifested fever, abdominal pain, severe thrombocytopenia, anemia and kidney failure following the insertion of a percutaneous transhepatic biliary drainage. Blood culture results revealed the presence of Aeromonas veronii biovar veronii (A. veronii biovar veronii). After antibiotic therapy and transfusions, the life-threatening clinical conditions of the patient improved and she was discharged. CONCLUSION This was a rare case of infection, probably the first to be reported in West countries, caused by A. veronii biovar veronii following biliary drainage. A finding of Aeromonas must alert clinician to the possibility of severe sepsis. 展开更多
关键词 AEROMONAS veronii BIOVAR veronii AEROMONAS Pancreatic cancer CHOLANGITIS Sepsis BILIARY TRACT infection Case report
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原发性胆汁性胆管炎合并干燥综合征及免疫性血小板减少症1例报告 预览
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作者 陈庆灵 蒉乙文 +5 位作者 仲瑞 杨倩倩 张晓雪 温晓玉 禹成男 金清龙 《临床肝胆病杂志》 CAS 北大核心 2019年第7期1599-1600,共2页
原发性胆汁性胆管炎(PBC)是一种慢性进行性自身免疫性肝病,是以肝内小胆管破坏为主要特征的慢性胆汁淤积性疾病[1]。PBC可合并多种自身免疫性疾病,包括干燥综合征(sjogren′s syndrome, SS)、类风湿性关节炎、免疫性血小板减少症(immune... 原发性胆汁性胆管炎(PBC)是一种慢性进行性自身免疫性肝病,是以肝内小胆管破坏为主要特征的慢性胆汁淤积性疾病[1]。PBC可合并多种自身免疫性疾病,包括干燥综合征(sjogren′s syndrome, SS)、类风湿性关节炎、免疫性血小板减少症(immune thrombocytopenia, ITP)、溶血性贫血和系统性硬化症等,其中以SS最常见,而合并ITP者少见。PBC同时合并SS及ITP者更为少见,国内外均罕见报道。现报道PBC合并SS及ITP 1例,以期提高临床医生对该病的认识。 展开更多
关键词 肝硬化 胆汁性 干燥综合征 血小板减少
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Donor ductal anomaly is not a contraindication to right liver lobe donation 预览
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作者 Kenneth SH Chok James YY Fung +5 位作者 Wing Chiu Dai Sui Ling Sin Ka Wing Ma Albert CY Chan Tan To Cheung Chung Mau Lo 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第4期343-347,共5页
Background:Data of living-donor liver transplantation(LDLT)suggested that donor ductal anomaly may contribute to postoperative biliary complications in recipients and in donors.This retrospective study aimed to determ... Background:Data of living-donor liver transplantation(LDLT)suggested that donor ductal anomaly may contribute to postoperative biliary complications in recipients and in donors.This retrospective study aimed to determine if the occurrence of postoperative biliary stricture in donors or recipients in rightlobe LDLT(RLDLT)is related to donor biliary anatomy type.Methods:We analyzed our RLDLT recipients’clinical data and those of their graft donors.The recipients were divided into 2 groups:with and without postoperative biliary stricture.The 2 groups were compared.The primary endpoints were donor biliary anatomy type and postoperative biliary complication incidence;the secondary endpoints were 1-,3-and 5-year graft and patient survival rates.Results:Totally 127 patients were included in the study;25(19.7%)of them developed biliary anastomotic stricture.In these 25 patients,16 had type A biliary anatomy,3 had type B,2 had type C,3 had type D,and 1 had type E.In the 127 donors,96(75.6%)had type A biliary anatomy,13(10.2%)had type B,6(4.7%)had type C,10(7.9%)had type D,and 2(1.6%)had type E.Biliary stricture was seen in 2 donors,who had type A biliary anatomy.None of the recipients or donors developed bile leakage.No association between the occurrence of postoperative biliary stricture and donor biliary anatomy type was found(P=0.527).Conclusions:The incidence of biliary stricture in donors or recipients after RLDLT was not related to donor biliary anatomy type.As postoperative complications were similar in whatever type of donor bile duct anatomy,donor ductal anomaly should not be considered a contraindication to donation of right liver lobe. 展开更多
关键词 Living donor liver transplantation Right liver donation Biliary complications Cholangiograms Ductal anomaly
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Radiation therapy for extrahepatic bile duct cancer: Current evidences and future perspectives 预览
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作者 Taeryool Koo Hae Jin Park Kyubo Kim 《世界临床病例杂志》 2019年第11期1242-1252,共11页
Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant ... Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant pattern of initial treatment failure is locoregional recurrence. Accordingly, adjuvant radiotherapy has been administered after surgical resection based on these rationales. At this time, there is minimal evidence supporting adjuvant radiotherapy, because there have been no phase III trials evaluating its benefit. Relatively small retrospective studies have tried to compare outcomes associated with EBDC treated with or without radiotherapy. We aimed to review studies investigating adjuvant radiotherapy for resected EBDC. Because less than onethird of EBDC cases are amenable to curative resection at diagnosis, other locoregional treatment modalities need to be considered, including radiotherapy. The next aim of this review was to summarize reports of definitive radiotherapy for unresectable EBDC. Patients with advanced EBDC often experience biliary obstruction, which can lead to jaundice and progress to death. Biliary stent insertion is an important palliative procedure, but stents are prone to occlusion after subsequent ingrowth of the EBDC. Radiotherapy can be effective for maintaining the patency of inserted stents. We also reviewed the benefit of palliative radiotherapy combined with the biliary stent insertion. Lastly, we discuss the existing gaps in the evidence supporting radiotherapy in the management of EBDC. 展开更多
关键词 EXTRAHEPATIC BILE duct cancer Patterns of failure ADJUVANT RADIOTHERAPY Definitive RADIOTHERAPY PALLIATIVE RADIOTHERAPY BILIARY stent
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Bilateral vs unilateral placement of metal stents for inoperable highgrade hilar biliary strictures:A systemic review and meta-analysis 预览
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作者 Munish Ashat Sumant Arora +3 位作者 Jagpal S Klair Christopher A Childs Arvind R Murali Frederick C Johlin 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第34期5210-5219,共10页
BACKGROUND Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction.No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral s... BACKGROUND Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction.No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting.AIM To assess the efficacy and safety of bilateral vs unilateral biliary drainage in inoperable malignant hilar obstruction.METHODS PubMed,Embase,Scopus,and Cochrane databases,as well as secondary sources(bibliographic review of selected articles and major GI proceedings),were searched through January 2019.The primary outcome was the re-intervention rate.Secondary outcomes were a technical success,early and late complications,and stent malfunction rate.Pooled odds ratio(OR)and 95%confidence interval(CI)were calculated for each outcome.RESULTS A total of 9 studies were included(2 prospective Randomized Controlled Study,5 retrospective studies,and 2 abstracts),involving 782 patients with malignant hilar obstruction.Bilateral stenting had significantly lower re-intervention rate compared with unilateral drainage(OR=0.59,95%CI:0.40-0.87,P=0.009).There was no difference in the technical success rate(OR=0.7,CI:0.42-1.17,P=0.17),early complication rate(OR=1.56,CI:0.31-7.75,P=0.59),late complication rate(OR=0.91,CI:0.58-1.41,P=0.56)and stent malfunction(OR=0.69,CI:0.42-1.12,P=0.14)between bilateral and unilateral stenting for malignant hilar biliary strictures.CONCLUSION Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures,with no significant difference in technical success,and early or late complication rates. 展开更多
关键词 Metal stent HILAR BILIARY STRICTURE Re-intervention RATE Technical success RATE
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SpyGlass percutaneous transhepatic cholangioscopy-guided diagnosis of adenocarcinoma of the ampullary region in a patient with bariatric biliopancreatic diversion 预览
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作者 Davide Colombi Giovanni Aragona +3 位作者 Flavio Cesare Bodini Adriano Zangrandi Nicola Morelli Emanuele Michieletti 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第3期291-293,共3页
To the Editor: The definition of biliary stricture in patients with post-surgical biliary or enteric anatomy is challenging, due to limitations in accessing biliary system with a peroral approach. In these cases, perc... To the Editor: The definition of biliary stricture in patients with post-surgical biliary or enteric anatomy is challenging, due to limitations in accessing biliary system with a peroral approach. In these cases, percutaneous route is an option to obtain diagnosis and to steer patients’ therapy [1]. 展开更多
关键词 EDITOR BILIARY ANATOMY
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急性胆源性胰腺炎手术时机的探讨 预览
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作者 文雪刚 《中国继续医学教育》 2019年第1期78-79,共2页
目的探讨急性胆源性胰腺炎手术时机。方法选择2015年12月—2017年12月接受治疗的100例急性胆源性胰腺炎患者为对象,随机分为两组,每组各50例,对照组使用延期手术治疗,观察组则进行尽早手术治疗,对比两组患者临床治疗效果。结果观察组患... 目的探讨急性胆源性胰腺炎手术时机。方法选择2015年12月—2017年12月接受治疗的100例急性胆源性胰腺炎患者为对象,随机分为两组,每组各50例,对照组使用延期手术治疗,观察组则进行尽早手术治疗,对比两组患者临床治疗效果。结果观察组患者淀粉酶(174.13±20.02)IU/L、总胆红素(20.95±8.21)μmol/L、住院时间(4.14±0.22)d,均低于对照组(226.32±61.56)IU/L、(35.02±10.35)μmol/L、(9.23±1.56)d,P<0.05。结论急性胆源性胰腺炎采用尽早手术治疗方式,可快速对患者淀粉酶、总胆红素进行改善,显著提升治疗效果,及时对病情进行控制,促进患者恢复,缩短住院时间,是一种较为理想的治疗方法。 展开更多
关键词 急性 胆源性 胰腺炎 手术时机 效果 预后
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Difficult biliary cannulation: Historical perspective, practical updates, and guide for the endoscopist 预览
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作者 Rani Berry James Y Han James H Tabibian 《世界胃肠内镜杂志:英文版(电子版)》 2019年第1期5-20,共16页
Despite improvements in endoscopic technologies and accessories, development of advanced endoscopy fellowship programs, and advances in ancillary imaging techniques, biliary cannulation in endoscopic retrograde cholan... Despite improvements in endoscopic technologies and accessories, development of advanced endoscopy fellowship programs, and advances in ancillary imaging techniques, biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) can still be unsuccessful in up to 20% of patients, even in referral centers. Once cannulation has been deemed to be difficult, the risk of post-ERCP pancreatitis and technical failure inherently increases. A number of factors, including endoscopist experience and patient anatomy, have been associated with difficult biliary cannulation, but predicting a case of difficult cannulation a priori is often not possible. Numerous techniques such as pancreatic guidewire and stenting, early pre-cut, and rendezvous may be employed when standard approaches fail. Data regarding the rate of success and adverse events of these techniques have been variable, though most studies suggest that pancreatic duct stenting generally reduces the rate of post-ERCP pancreatitis in instances of difficult biliary cannulation. Here we provide a review on difficult biliary cannulation and discuss how the choice of which techniques to employ and how to best employ them should be individualized and take into account the skill of the endoscopist, the disorder being treated, the anatomy of the patient, and the available biomedical literature. 展开更多
关键词 Selective BILIARY CANNULATION Post-endoscopic RETROGRADE CHOLANGIOPANCREATOGRAPHY pancreatitis Periampullary diverticulum PRECUT technique ENDOSCOPIC ultrasound Rendezvous ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
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