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Esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Colin G. DeLong, Afif N. Kulaylat, Eric M. Pauli, Robert E. Cilley
Endoscopic retrograde cholangiopancreatography (ERCP) has a clear role in the diagnosis and management of pancreaticobiliary pathology in the pediatric population, but data on the use of ERCP in pediatric populations are limited due to a much lower incidence of disease than in the adult population. Magnetic resonance cholangiopancreatography (MRCP) provides a non-invasive means to obtain diagnostic information, though it lacks therapeutic potential. In children, the need for anesthetic evaluation/monitoring for conscious sedation during MRI must be considered. As in adult populations, however, ERCP should rarely be used for pure diagnostic purposes and a pre-procedure MRCP to confirm a disease warranting endoscopic indication is generally preferred.
Intraoperative Cholangiogram Shows <1 cm Stone at the Lower End
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
The majority of patients presenting with symptomatic gallstone disease with confirmation of gallstones on ultrasound require no further investigation prior to proceeding to surgical intervention (laparoscopic cholecystectomy and intraoperative cholangiography). The exception to this is in the case of patients with obstructive jaundice where there is concern about a malignant cause for the jaundice, a suspicious thickening or mass in the gallbladder, or the possibility of Mirizzi syndrome. In such cases, a magnetic resonance cholangiopancreatography (MRCP) may be helpful in planning further management. The routine use of computed tomography (CT) cholangiogram or MRCP is not required to diagnose common bile duct stones as in the absence of cholangitis the appropriate management is to proceed to laparoscopic cholecystectomy and intraoperative cholangiographyand treat the subsequent stones at the time of laparoscopic cholecystectomy. Although, some surgeons would perform an ERCP and clear the CBD as the initial procedure, as noted previously, performing the endoscopic retrograde cholangiopancreatography first is associated with a higher morbidity compared to performing the laparoscopic cholecystectomy first [2,3].
Surgery
Published in Seema Khan, Get Through, 2020
Other initial investigations for jaundice include clotting screen, FBC, inflammatory markers and U&Es. Ultrasound scanning and MRCP (magnetic resonance cholangiopancreatography) should be considered before ERCP, which is an invasive procedure.
Inherited causes of exocrine pancreatic insufficiency in pediatric patients: clinical presentation and laboratory testing
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Tatiana N. Yuzyuk, Heather A. Nelson, Lisa M. Johnson
Imaging studies progress from least invasive to more invasive to evaluate patients with acute, recurrent pancreatitis [48]. Computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) are noninvasive cross-sectional imaging techniques used for initial evaluation. More invasive endoscopic procedures may be considered if the CT or MRCP has equivocal or mild findings. When HP is suspected, mutational analysis of the genes PRSS1, SPINK1, CFTR, and CTRC is warranted. A patient meets the criteria necessary for genetic testing of pancreatitis-related gene variants if they satisfy one or more of the following criteria: (1) acute or recurrent pancreatitis in a child with an unknown cause, (2) idiopathic chronic pancreatitis in a patient less than 25 years old, (3) family history of acute recurrent pancreatitis or idiopathic chronic pancreatitis, or (4) relatives with known HP-related gene mutations [49].
Gallbladder torsion in pregnancy: a case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2022
Chiemi Ogawa, Shunichiro Tsuji, Daisuke Katsura, Rika Zen, Makiko Kasahara, Takako Hoshiyama, Shinsuke Tokoro, Kaori Hayashi, Takashi Murakami
This report describes the first case of a radiological, preoperative diagnosis of gallbladder torsion in pregnancy. The diagnosis was made based on findings of a distended, acalculous gallbladder ‘floating’ from the hepatic bed and normal liver enzyme levels in our case. Moreover, the findings of Doppler-US (Boer et al. 2011) and magnetic resonance cholangiopancreatography (MRCP) (Bekki et al. 2017) are useful to diagnose and to avoid foetal radiation exposure. There are only two reports of gallbladder torsion in pregnancy (Kleiss et al. 2003, Lee et al. 2013); both cases were treated for acute cholecystitis and only diagnosed as gallbladder torsion intraoperatively. In both previous cases and the present one, the symptoms began at 17, 30, and 34 weeks of gestation, respectively, and included epigastric and right upper quadrant pain; liver enzymes were normal in all cases. Further, in all three cases, imaging showed a distended, acalculous gallbladder; however, gallbladder floatation was only confirmed preoperatively in this case. Preoperative diagnosis is associated with a good prognosis at 0% mortality (Reilly et al. 2012); however, diagnosis is challenging in clinical practice. Therefore, we should consider surgery when symptoms are exacerbated or antibiotics are ineffective as in other cases even if a precise preoperative diagnosis is impossible.
Progression of pancreatic morphology in chronic pancreatitis is not associated with changes in quality of life and pain
Published in Scandinavian Journal of Gastroenterology, 2020
Emily Steinkohl, Søren Schou Olesen, Asbjørn Mohr Drewes, Jens Brøndum Frøkjaer
However, available imaging-based measures of morphological disease stage do not always correlate with patient-reported outcome measures (PROMS) in patients with CP [11–14]. Several studies based on computed tomography, endoscopic retrograde cholangiopancreatography, conventional MRI, and magnetic resonance cholangiopancreatography (MRCP) reported only weak associations between QOL, pain, and its interference with daily activities and pancreatic morphological pathology [12,13]. Likewise, the associations between pancreatic morphology and patients' pain reports were poor. Furthermore, since most studies are cross-sectional, little is known about the associations between progression in pancreatic morphological pathology over time and changes in PROMs such as QOL, pain, and daily functions.