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Cystic Fibrosis and Pancreatic Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Elissa M. Downs, Jillian K. Mai, Sarah Jane Schwarzenberg
Surgical interventions may be required during an acute episode to address biliary disease. This may include an endoscopic retrograde cholangiopancreatography (ERCP), if obstructive jaundice or cholangitis, and/or a cholecystectomy for non-obstructing gallstones.
Peri-operative medicine
Published in Henry J. Woodford, Essential Geriatrics, 2022
Biliary disease, such as cholecystitis, is the commonest surgical emergency among older people, who have an increased incidence of gallstones.58 This may also present atypically and has a higher risk of complications, such as perforation of the gallbladder. Older people may develop pancreatitis without abdominal pain and they have a higher risk of necrotising pancreatitis.58 A raised serum amylase can be caused by other pathologies, including mesenteric ischaemia.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Pyogenic abscesses are most commonly due to ascending cholangitis from benign or obstructive biliary disease or from haematogenous seeding (e.g. from diverticulitis). On ultrasound they are usually poorly defined and may be septated with irregular walls.
Feasibility of machine learning-based modeling and prediction using multiple centers data to assess intrahepatic cholangiocarcinoma outcomes
Published in Annals of Medicine, 2023
Shuang-Nan Zhou, Da-Wei Jv, Xiang-Fei Meng, Jing-Jing Zhang, Chun Liu, Ze-Yi Wu, Na Hong, Yin-Ying Lu, Ning Zhang
Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer, accounting for 10–15% of all primary liver cancers [1], with rising incidence and mortality rate globally [2]. Radical surgery is the curative treatment for early-stage iCCA patients. However, many patients are found to be in the advanced stage and lose the opportunity to undergo the radical surgery. In addition, after iCCA patients undergoing radical surgery, the five-year survival still remains poor, less than one-third [3]. Achieving optimal outcomes depends on a skilled, multidisciplinary team that is experienced with the management of advanced biliary disease [4]. The alone or combination of the following methods, chemotherapy, locoregional therapies (such as percutaneous ablation, transarterial chemoembolization and external radiation) and systemic therapy, represent valid options to improve survival in iCCA patients, especially for patients who are poor candidates for resection [5]. Gemcitabine and cisplatin combination regimen is recommended as the standard first-line systemic therapy for iCCA patients [6]. The role of targeted therapy and immunotherapy is still inconclusive, and patient subgroups that can benefit from monotherapy or combination therapy with standard-of-care chemotherapy remains to be identified [4].
Same day endoscopic retrograde cholangio-pancreatography immediately after endoscopic ultrasound for choledocholithiasis is feasible, safe and cost-effective
Published in Scandinavian Journal of Gastroenterology, 2021
Wisam Sbeit, Anas Kadah, Amir Shahin, Tawfik Khoury
Exclusion criteria included malignant pancreato-biliary disease, history of gastrectomy or choledocho-jejunostomy and previous ERCP with papillotomy. In our center, the policy for choledocholithiasis assessment is to perform EUS before decision about ERCP, except in patients with high risk according to the American society of gastrointestinal endoscopy (ASGE) guidelines [5], or patients with documented choledocholithiasis by another modality, who undergo ERCP without EUS. All files of eligible patients were reviewed for demographic data (age, gender), medical history, and procedures' details including anesthetic drugs and doses, length of procedures (defined from the administration of the sedation until removing the endoscope from the patient’s mouth), length of hospitalization and in hospital complications. The data of these patients who underwent same day EUS and ERCP procedures or separate days’ procedures were be collected and compared for safety, cost and benefit. Cost analysis was based on the cost of the length of hospitalization. The cost of one day of hospitalization in the internal medicine or surgical department is approximately 1036.6$. Regarding the endoscopic procedures, EUS cost is approximately 460$and ERCP cost is about 1070$, given that all patients in our study had both EUS and ERCP examinations, thus the cost effectiveness analysis was based on the length of hospitalization.
Sump syndrome of the remnant common bile duct following a living donor liver transplant
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Gordon Robbins, Justin Brilliant, Yuting Huang, Jonah Rubin, Eric Goldberg, Zurabi Lominadze
Sump syndrome was initially described as digested food, debris, stones, bile, and/or bacteria accumulating in a poorly drained distal common bile duct (CBD) in patients undergoing choledochoduodenostomy[1]. The presenting symptoms of sump syndrome include indigestion, abdominal pain, nausea, vomiting, postprandial discomfort, and jaundice[1]. With the decline of choledochoduodenostomies in favor of endoscopic retrograde cholangiopancreatography (ERCP), sump syndrome is less prevalent and is now described mainly as a complication following Roux-en-Y hepaticojejunostomy for benign biliary disease[2]. Biliary complications following a living donor liver transplant are common, but sump syndrome has yet to be described in the literature. We present a case of sump syndrome in a patient with living donor liver transplantation for primary sclerosing cholangitis (PSC).