China
Africa
Explore chapters and articles related to this topic
Bile duct stones
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Reports of late complications have been somewhat variable but occur in approximately 5% of cases [35]. Recurrent stones within the bile duct are usually of the brown pigment variety, although occasionally cholesterol stones may be present. It is likely that the brown pigment stones are secondary to bacterial contamination of the CBD secondary to duodenal biliary reflux. Stone formation within the duct may also be secondary to papillary stenosis. This may occur in 1–2% of patients due to extensive fibrosis of the sphincterotomy cut.
Bariatric and metabolic surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
One anastomosis gastric bypass, also known as mini-gastric bypass, was first described by Rutledge. The objective was to develop a technique that is technically less demanding, with only one anastomosis (antecolic loop gastrojejunostomy without a Roux-en-Y configuration) and a longer gastric pouch than for standard gastric bypass. Similar weight-loss outcomes have been reported, but there is concern regarding symptomatic biliary reflux causing gastritis or oesophagitis, marginal ulcers and the management of anastomotic leaks due to a potentially high volume of biliary and pancreatic secretions. With the Roux-en-Y historically the standard in surgery of the stomach for ulcer disease and cancer, there is further concern due to possibly increased risk of Barrett’s oesophagus and gastric or oesophageal cancer associated with biliary reflux. These outcomes will need long-term investigation.
Efficacy of endoscopic ultrasound after removal of common bile duct stone
Published in Scandinavian Journal of Gastroenterology, 2019
Yeon-Ji Kim, Woo Chul Chung, Ik Hyun Jo, Jaeyoung Kim, Seonhoo Kim
CBD diameter is known to be a risk factor for CBD stone recurrence. A large CBD diameter might cause difficulty in stone removal using a basket or balloon and could possibly lead to bile stasis, which might induce stone formation [14,24,25]. Previous studies have suggested that the larger the CBD diameter, the more likely it would result in recurrent CBD stone symptoms, with endobiliary bile stasis or duodenal–biliary reflux being proposed as the mechanism [14,26,27]. Furthermore, we assumed that small remnant biliary stone or sludge would be left in the CBD with a large diameter owing to the low sensitivity of ERCP with fluoroscopy [28]. The success rate of EPLBD for stone removal was reported to be high, reaching up to 95%, and the combination of EPLBD and EST was considered effective in removing large CBD stones [29,30]. However several previous studies also noted the complications of EPLBD such as perforation, pancreatitis and bleeding [30,31]. Recent guideline demonstrated that EST with EPLBD can be used when a difficult procedure is expected, such as large bile stones are seen on ERCP or cross sectional imaging. And another recommended indication is recurrent CBD stone case with previous EST [32]. Our result indicated that EPLBD was significantly associated with symptomatic CBD stone recurrence. It is necessary for clinician to decide whether they will perform EST and EPLBD in anticipation of the difficulty during the ERCP in patients with CBD stone before the procedure.
Perforation of the excluded segment without pneumoperitoneum following Roux-en-Y gastric bypass surgery: case report and literature review
Published in Acta Chirurgica Belgica, 2021
Maxime Peetermans, Jana Vellemans, Guido Jutten, Pieter D’hooge, Peter Delvaux, Frederik Huysentruyt, Anneleen Van Hootegem, Jos Callens, Olivier Peetermans
Bjorkman et al. [9] suggested another mechanism of mucosal damage. Due to deprivation of the buffering effect of ingested food in the excluded stomach, the acid may be unneutralised. This may be aggravated by a longer exposure of acid to the mucosa due to a delay in the release of pancreatic bicarbonate. At the same time, biliary reflux may also damage the mucosa and enhance the adverse effect of the unbuffered acid. Sundbom et al. [39] found scintigraphic evidence of biliary reflux in 36% of the RYGB patients.