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General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
What do you tell your patients during the consent process for laparoscopic cholecystectomy?Overall, this is a safe procedure with a low incidence of complications.There is a one in 40 chance of conversion to open surgery.There is a one in 400 chance of bile duct injury.There is a small risk of bile leak, postoperative bleeding, wound infection and port-site hernia formation.There is a one in 25 chance of common bile duct stones at cholangiogram, which would potentially require further treatment (if you do a cholangiogram).As with other operations, there is a small risk of chest infection, deep-vein thrombosis and pulmonary embolism.
Intraoperative Cholangiogram Shows <1 cm Stone at the Lower End
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Common bile duct stones are classified as either primary or secondary stones. Primary common bile duct stones form due to stasis in a dilated biliary tree. The stasis may be idiopathic, or secondary to ampullary stenosis, a biliary stricture, or a duodenal diverticulum (compressing the lower end of the common bile duct). Primary common bile duct stones usually have a brown pigment (calcium bilirubinate), are soft stones and are easily fragmented with the consistency of mud. Secondary common bile duct stones have formed in the gallbladder and migrated down via the cystic duct. The majority are cholesterol stones formed by combination of super saturation of bile with cholesterol, biliary stasis, accelerated nucleation, and mucin hypersecretion of the gallbladder. Less often, secondary common bile duct stones may be black pigment stones arise from increased levels of either unconjugated bilirubin (as seen in patients with cirrhosis or alcohol-related hepatitis), or elevated conjugated bilirubin (as seen in patients with various forms of intravascular hemolysis).
Nephrology
Published in Shibley Rahman, Avinash Sharma, MRCP Part 2 Best of Five Practice Questions, 2018
Shibley Rahman, Avinash Sharma
A 40-year-old male underwent an elective ERCP for a common bile duct stone. Post ERCP, he developed acute septicaemia. Biochemistry pre- and post-ERCP is shown below. He is diaphoretic, flushed and tachycardic (125 beats per minute). The blood pressure is 85/55 mmHg and he is producing 10 mL of urine per hour.
Real-life patency of plastic biliary stents in the pandemic era: is stent removal after 6 months safe and effective?
Published in Scandinavian Journal of Gastroenterology, 2023
Marta Freitas, Tiago Lima Capela, Vítor Macedo Silva, Tiago Cúrdia Gonçalves, Pedro Boal Carvalho, Bruno Rosa, Carla Marinho, José Cotter
ERCP is a paramount procedure in the context of biliary pathology, and plastic biliary stents are frequently placed temporarily for the management of benign and malignant pancreaticobiliary disease [7–9]. European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend the replacement or removal of the plastic biliary stents in patients with incomplete common bile duct stone clearance within 3-6 months to reduce the rate of complications, mainly cholangitis [8]. A randomized controlled trial that included patients submitted to a 10-Fr plastic biliary stent placement, showed that stent exchange on demand at the onset of symptoms was associated with higher incidence of acute cholangitis, compared to systematic stent exchange every 3 months (35.9% vs 7.7%; p = 0.03) [10]. On the other hand, Chiba et al. revealed that stent replacement after 6 months was acceptable in patients with benign biliary disorder [11], and Sohn et al. revealed that there were no differences in the development of cholangitis, presence of biliary stones, and success rate of endoscopic removal of stones and biliary stents in patients with stent placement more than 24 months comparing to 12 to 24 months [12]. Therefore, the ideal timing for biliary stent exchange has not been defined [8,9]. The aim of our study was to analyse the outcomes of patients who had delayed plastic biliary stent removal following ERCP in the pandemic era.
Clinical outcomes and predictors of technical failure of endoscopic transpapillary gallbladder drainage in acute cholecystitis
Published in Scandinavian Journal of Gastroenterology, 2023
Junya Sato, Kazunari Nakahara, Yosuke Michikawa, Ryo Morita, Keigo Suetani, Akihiro Sekine, Yosuke Igarashi, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
On the other hand, endoscopic transpapillary gallbladder drainage (ETGBD) is considered an alternative therapy in patients with acute cholecystitis [7]. Several reports have revealed the efficacy and safety of ETGBD, including endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS) [8–11]. ETGBD has the following advantages over PTGBD: 1) feasibility in patients with ascites or coagulopathy, 2) internal drainage can be considered, and 3) treatment of common bile duct stones (CBDs) and acute cholangitis can be performed in the same session as endoscopic retrograde cholangiopancreatography (ERCP). However, the reported technical success rate of ETGBD was 64–100%, which is lower than that reported for PTGBD [12]. Additionally, ETGBD carries the risk of ERCP-related adverse events, such as pancreatitis. Moreover, ETGBD may result in cystic duct injury as a specific adverse event during the procedure when a device, such as a guidewire, cannula, or stent, is advanced through the cystic duct.
Risk factors for post-endoscopic retrograde cholangiopancreatography cholangitis in patients with hepatic alveolar echinococcosis—an observational study
Published in Annals of Medicine, 2022
Fei Du, Wenhao Yu, Zhixin Wang, Zhi Xie, Li Ren
All patients were placed in the left-sided prone position, general anaesthesia with propofol was administered intravenously, and intraoperative oxygen and cardiac monitoring to monitor the patients' vital signs. All patients were intubated with conventional guidewire guidance. When intubation was difficult, double guidewire intubation and pre-cut sphincterotomy were used to assist intubation. After insertion of the guidewire, a contrast catheter was inserted to inject ultravist for imaging to assess the status of the patient's common bile duct and intrahepatic bile duct. In patients with extrahepatic biliary strictures, guidewire-guided balloon dilation followed by biliary stent placement was performed. In the case of intrahepatic biliary strictures, one or more plastic stents are placed for drainage as appropriate, depending on the guidelines and the physician's experience. In case of combined common bile duct stones, a reticular basket or balloon catheter was used to remove the stones.