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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
Gallstones are fairly common and are found in up to 20% of women under age 40 in autopsy series [3]. Gallstones have been reported in 7% of nulliparous women and 20% of multi-parous women [4]. Biliary sludge, which is a precursor to gallstones, is seen in up to 30% of pregnant women [2]. Gallbladder disease is the second most-common indication for non-obstetrical surgery in pregnancy [5]. Increasing physical activity to moderate or vigorous levels did not decrease the incidence of sludge or gallstones in one trial [6].
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Ultrasonography, without fetal radiation, is the initial test of choice to detect gallstones with a high accuracy during pregnancy. However, if common bile duct stones or biliary sludge are suspected based on ultrasound examination or biochemical abnormalities, a more invasive test may be required such as endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP), which can provide an adequate view of the bilio-pancreatic duct anatomy. EUS and MCRP do not involve radiation and are often the tests of choice for detecting CBD stones. Computer tomography (CT) scan is not recommended during pregnancy as it carries a small radiation risk to the fetus. Endoscopic retrograde cholangiopancreatography (ERCP) is no longer widely used as a diagnostic study due to its post-procedure pancreatitis risk, radiation exposure, and the availability of newer and safer techniques such as EUS and MRCP (119). Performing diagnostic EUS or MRCP helps to identify patients who require therapeutic ERCP.
Home Parenteral Nutrition*
Published in Fima Lifshitz, Childhood Nutrition, 2020
Adib A. Moukarzel, Marvin E. Ament
The chance of developing gallbladder sludge as a result of PN is almost 100% after patients have been receiving PN for 6 full weeks. Any patient who is on PN for more than thirty days and develops abdominal pain should be evaluated for cholecystitis. It is possible that stimulating the gallbladder by more frequent feeding would reduce the incidence of biliary sludge and stones. There has been a dramatic reduction in the incidence of PN-induced liver disease. The complication occurs less frequently because of a change in most protocols in initiating earlier enteral nutrition. The decrease of PN-associated liver disease in infants is due to the use of a balanced amino acid solution specifically designed for infants. There are multiple factors which explain the occurrence of liver disease. Monitoring patients for evidence of early cholestasis can be done by measuring the GGT, 5′-nucleotidase, serum bile acids, and direct bilirubin. Baseline and repeat ultrasound examinations of gallbladder for sludge may be appropriate for long-term PN.
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
The presence of remnant biliary stone or sludge after ERCP could be the main cause of symptomatic CBD stone recurrence rather than de novo choledocholithiasis or stone from the gallbladder, because recurrence mostly occurs within the first 3 years and ERCP with fluoroscopy fails to completely remove biliary stone or sludge [12–14]. Moreover, a previous study showed that small biliary stone or sludge was impossible to be identified using ERCP with fluoroscopy [15]. The clinical significance of biliary sludge is similar to that of CBD stones, and biliary sludge seems to be an early stage of choledocholithiasis [16]. In this study, it was so small that ERCP procedure could not confirm to remove it, and we expected that remnant biliary sludge was naturally emitted through endoscopic sphincterotomy. It is noteworthy to mention that remnant biliary stone or sludge on EUS was detected in a considerable percentage of patients (36.9%) despite sufficient CBD stone removal by experienced endoscopists. Judging from this, another treatment modality is required. EUS is the most anticipated, reasonable test and is known to be reliable with high sensitivity and specificity (>94%) [8].
The safety of lanreotide for neuroendocrine tumor
Published in Expert Opinion on Drug Safety, 2019
Amandeep Godara, Nauman S. Siddiqui, Margaret M. Byrne, Muhammad Wasif Saif
It appears prudent to evaluate patients for risk factors and symptoms related to gallstones prior to starting patients on lanreotide. Most clinical studies of lanreotide have included serial evaluations of gallbladder via ultrasonography, starting at study enrollment. Only a small proportion of patients (1–2%) who develop gallstones or biliary sludge will become symptomatic and require surgical intervention. Patients who are obese, sedentary or on oral contraceptive pills might be at higher risk of developing gallstones [18,22,24,27,33]. Baseline ultrasound of the gallbladder should be considered in high-risk patients. Though prophylactic cholecystectomy is not indicated, it is recommended in patients undergoing abdominal surgeries for alternative reasons (e.g. bowel resection or cytoreductive hepatic surgery) [6,7,52]. Evaluation for cholecystitis or acute pancreatitis should be considered as a part of initial workup in NET patients presenting with sudden onset severe abdominal pain.
Predictors for choledocholithiasis in patients undergoing endoscopic ultrasound
Published in Scandinavian Journal of Gastroenterology, 2018
Rutger Quispel, Nora D. L. Hallensleben, Lydi M. W. J. van Driel, Marco J. Bruno
Second, the results of EUS in this publication are described as either positive or negative for stones. The authors do not clearly define ‘bile duct lithiasis’. It is therefore unclear if and how biliary sludge and microlithiasis were classified in this study. Microlithiasis and sludge are detected using EUS in patients with suspected bile duct lithiasis in 20–25% of cases [5,8]. Although the clinical relevance is still not completely clear, the presence of sludge and/or microlithiasis can cause both biliary symptoms and complications of bile duct lithiasis such as pancreatitis. In our opinion, sludge and microlithiasis should therefore be regarded as bile duct lithiasis. One of the reasons for the known interobserver variance in EUS for bile duct lithiasis is the fact that clear definitions regarding bile duct stones, sludge and microlithiasis are lacking. This clearly is an opportunity for future research.