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Alimentary Tract Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Ryan Lamm, Arturo J. Rios-Diaz, Priyadarshini Koduri, Francesco Palazzo
Choledocholithiasis is a sequela of cholelithiasis, for which the etiology, risk factors, and pathophysiology is described earlier. Specifically, choledocholithiasis results from gallstones migrating from the gallbladder through the cystic duct to the common bile duct where they become impacted and obstruct the flow of bile from the liver to the small intestine.
Hepatic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Ghassan M. Hammoud, Jamal A. Ibdah
The incidence of gallstones during pregnancy is estimated to be 3% to 12%; however, symptomatic gallstones occur in only 1.2% of these pregnancies (58). Hormonal changes during pregnancy, altered gallbladder motility, and increased cholesterol secretion are major predisposing factors for the development of gallstones and biliary sludge. The commonest clinical presentations are biliary pain and gallstone pancreatitis and the least common is acute cholecystitis. The management of symptomatic uncomplicated biliary tract disease is usually conservative. In patients with symptomatic choledocholithiasis, endoscopic management using endoscopic retrograde cholangiopancreatography (ERCP) is an alternative option. Since fluoroscopy poses a radiation risk to the fetus, abdominal shield to the pregnant patient should be provided. Laparoscopic cholecystectomy can be performed safely during pregnancy with no maternal mortality, although spontaneous abortions and preterm labor have been reported.
Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Cholangitis not related to choledocholithiasis — Several diseases other than bile duct stones may cause cholangitis and present with fever with or without pain or jaundice. Extrahepatic biliary obstruction may be due to carcinoma207 or helminthiasis, and may present with unexplained fever. Bacterial cholangitis is a common complication of hepatic portoen-terostomy.208 Acute cholangitis may complicate Caroli’s disease and present as FUO.188
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
The prevalence of choledocholithiasis in western countries is about 1.5%–4% of adult population. Retained choledocholithiasis can lead to serious complications with a potential of causing death, including biliary pancreatitis, obstructive jaundice, ascending cholangitis and sepsis. Therefore, patients with proven choledocholithiasis should undergo stone extraction by either endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative bile duct exploration during cholecystectomy [1]. ERCP is an invasive procedure with a potential of significant post-procedural complications including 1.3%–6.7% risk of pancreatitis, 0.6%–5% risk of infection, 0.3%–2% risk of hemorrhage and 0.1%–1.1% perforation risk, in addition to the high cost of the procedure itself [2–4]. In order to avoid unnecessary invasive interventions, all recent guidelines advocate stratifying patients into low, moderate and high risk of choledocholithiasis according to certain predictors. Patients presented with high risk should undergo ERCP for stone extraction, while in patients with moderate risk it is advocated to perform prior noninvasive examination by magnetic resonance cholangiopancreatography (MRCP), or minimally invasive examination by endoscopic ultrasound (EUS) to look for choledocholithiasis before decision about ERCP [5].
Choledocholithiasis in elderly patients with gallbladder in situ - is ERCP sufficient?
Published in Scandinavian Journal of Gastroenterology, 2018
Mafalda Sousa, Rolando Pinho, Luísa Proença, Jaime Rodrigues, João Silva, Catarina Gomes, João Carvalho
Choledocholithiasis is a common cause of hospitalization and may lead to cholangitis and gallstone pancreatitis. Once the diagnosis is confirmed, the common bile duct (CBD) stones should be removed usually by endoscopic retrograde cholangiopancreatography (ERCP) [1]. With increased life expectancy, the proportion of elderly patients with choledocholithiasis will increase and with this, the need for ERCP. Current recommendations suggest laparoscopic cholecystectomy in all patients with complications related to common bile duct stones with few relative or absolute contraindications [2]. The approach in patients with non-symptomatic/uncomplicated choledocholithiasis without associated cholelithiasis is more controversial, but generally cholecystectomy is also advocated to prevent biliary events [3,4]. However, adherence to these recommendations is low, especially in older patients [5].
Long term outcome of EUS-based strategy for suspected choledocholithiasis but negative CT finding
Published in Scandinavian Journal of Gastroenterology, 2018
Jae Keun Park, Jong Kyun Lee, Ju Il Yang, Keol Lee, Joo Kyung Park, Kwang Hyuck Lee, Kyu Taek Lee
Presently, the ASGE guideline suboptimally predicted choledocholithiasis in patients with negative CT finding, especially the high probability group. Previous studies found analogous results, with the accuracy of 50.0%–62% for the ASGE high-risk group [3,11]. In our study, among 49 patients with high probability criteria, except definite acute cholangitis, only 21 (42.9%) had choledocholithiasis or obstructive papillitis upon confirmatory testing by ERCP. A reasonable explanation for the discordance between the previous and current results is the difference of the study population. Unlike previous studies, we recruited patients with suspected choledocholithiasis but no visible choledocholithiasis on CT.