AIM:To determine the long-term hepatobiliary complications of alveolar echinococcosis(AE) and treatment options using interventional methods.METHODS:Included in the study were 35 patients with AE enrolled in the Echin...AIM:To determine the long-term hepatobiliary complications of alveolar echinococcosis(AE) and treatment options using interventional methods.METHODS:Included in the study were 35 patients with AE enrolled in the Echinococcus Multilocularis Data Bank of the University Hospital of Ulm.Patients underwent endoscopic intervention for treatment of hepatobiliary complications between 1979 and 2012.Patients' epidemiologic data, clinical symptoms, and indications for the intervention, the type of intervention and any additional procedures, hepatic laboratory parameters(pre- and post-intervention), medication and surgical treatment(pre- and post-intervention), as well as complications associated with the intervention and patients‘ subsequent clinical courses were analyzed.In order to compare patients with AE with and without history of intervention, data from an additional 322 patients with AE who had not experienced hepatobiliary complications and had not undergone endoscopic intervention were retrieved and analyzed.RESULTS:Included in the study were 22 male and 13 female patients whose average age at first diagnosis was 48.1 years and 52.7 years at the time of intervention.The average time elapsed between first diagnosis and onset of hepatobiliary complications was 3.7 years.The most common symptoms were jaundice, abdominal pains, and weight loss.Thenumber of interventions per patient ranged from one to ten.Endoscopic retrograde cholangiopancreatography(ERCP)was most frequently performed in combination with stent placement(82.9%),followed by percutaneous transhepatic cholangiodrainage(31.4%)and ERCP without stent placement(22.9%).In 14.3%of cases,magnetic resonance cholangiopancreatography was performed.A total of eight patients received a biliary stent.A comparison of biochemical hepatic function parameters at first diagnosis between patients who had or had not undergone intervention revealed that these were significantly elevated in six patients who had undergone intervention.Complications(cholangitis,pancreatitis)oc展开更多
AIM: To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions. METHODS: In 37 post-surgical patients, a stepwise approac...AIM: To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions. METHODS: In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded. RESULTS: Push-enteroscopy (overall, 16 procedures) reached enteral anastomoses only in six out of 37 post-surgical patients (16.2%). DBE achieved a high rate of luminal access to the biliary tract in 23 of the remaining 31 patients (74.1%) and to the pancreatic duct (three patients). Among all DBE-based ERCPs (86 procedures), 21/23 patients (91.3%) were successfully treated. Interventions included ostium incision or papillotomy in 6/23 (26%) and 7/23 patients (30.4%), respectively. Biliary endoprosthesis insertion and regular exchange was achieved in 17/23 (73.9%) and 7/23 patients (30.4%), respectively. Furthermore, bile duct stone extraction as well as ostium and papillary dilation were performed in 5/23 (21.7%) and 3/23 patients (13.0%), respectively. Complications during DBE-based procedures were bleeding (1.1%), perforation (2.3%) and pancreatitis (2.3%), and minor complications occurred in up to 19.1%. CONCLUSION: The appropriate use of DBE yields a high rate of luminal access to papilla or enteral anastomoses in more than two-thirds of post-surgical patients, allowing important successful endoscopic therapeutic interventions.展开更多
Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an option.In these cases,palliative care and mechanical widening of the blocked biliary s...Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an option.In these cases,palliative care and mechanical widening of the blocked biliary system are preferred.The insertion of a stent is often necessary to prevent the recurrence of blockages caused by cancer progression.Prior to stent placement,endo-biliary radiofrequency ablation(EB-RFA)appears to result in longer-lasting stent effectiveness without increasing the risk of severe complications.However,its impact on overall survival is not yet clear.Additionally,while endoscopic retrograde cholangiopancreatography is the most common method for performing EB-RFA,percutaneous transhepatic cholangiodrainage seems to be a safe and potentially more efficient alternative,particularly for long,angulated,or significantly narrowed bile ducts.展开更多
BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients w...BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of fu展开更多
文摘AIM:To determine the long-term hepatobiliary complications of alveolar echinococcosis(AE) and treatment options using interventional methods.METHODS:Included in the study were 35 patients with AE enrolled in the Echinococcus Multilocularis Data Bank of the University Hospital of Ulm.Patients underwent endoscopic intervention for treatment of hepatobiliary complications between 1979 and 2012.Patients' epidemiologic data, clinical symptoms, and indications for the intervention, the type of intervention and any additional procedures, hepatic laboratory parameters(pre- and post-intervention), medication and surgical treatment(pre- and post-intervention), as well as complications associated with the intervention and patients‘ subsequent clinical courses were analyzed.In order to compare patients with AE with and without history of intervention, data from an additional 322 patients with AE who had not experienced hepatobiliary complications and had not undergone endoscopic intervention were retrieved and analyzed.RESULTS:Included in the study were 22 male and 13 female patients whose average age at first diagnosis was 48.1 years and 52.7 years at the time of intervention.The average time elapsed between first diagnosis and onset of hepatobiliary complications was 3.7 years.The most common symptoms were jaundice, abdominal pains, and weight loss.Thenumber of interventions per patient ranged from one to ten.Endoscopic retrograde cholangiopancreatography(ERCP)was most frequently performed in combination with stent placement(82.9%),followed by percutaneous transhepatic cholangiodrainage(31.4%)and ERCP without stent placement(22.9%).In 14.3%of cases,magnetic resonance cholangiopancreatography was performed.A total of eight patients received a biliary stent.A comparison of biochemical hepatic function parameters at first diagnosis between patients who had or had not undergone intervention revealed that these were significantly elevated in six patients who had undergone intervention.Complications(cholangitis,pancreatitis)oc
文摘AIM: To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions. METHODS: In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded. RESULTS: Push-enteroscopy (overall, 16 procedures) reached enteral anastomoses only in six out of 37 post-surgical patients (16.2%). DBE achieved a high rate of luminal access to the biliary tract in 23 of the remaining 31 patients (74.1%) and to the pancreatic duct (three patients). Among all DBE-based ERCPs (86 procedures), 21/23 patients (91.3%) were successfully treated. Interventions included ostium incision or papillotomy in 6/23 (26%) and 7/23 patients (30.4%), respectively. Biliary endoprosthesis insertion and regular exchange was achieved in 17/23 (73.9%) and 7/23 patients (30.4%), respectively. Furthermore, bile duct stone extraction as well as ostium and papillary dilation were performed in 5/23 (21.7%) and 3/23 patients (13.0%), respectively. Complications during DBE-based procedures were bleeding (1.1%), perforation (2.3%) and pancreatitis (2.3%), and minor complications occurred in up to 19.1%. CONCLUSION: The appropriate use of DBE yields a high rate of luminal access to papilla or enteral anastomoses in more than two-thirds of post-surgical patients, allowing important successful endoscopic therapeutic interventions.
文摘Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an option.In these cases,palliative care and mechanical widening of the blocked biliary system are preferred.The insertion of a stent is often necessary to prevent the recurrence of blockages caused by cancer progression.Prior to stent placement,endo-biliary radiofrequency ablation(EB-RFA)appears to result in longer-lasting stent effectiveness without increasing the risk of severe complications.However,its impact on overall survival is not yet clear.Additionally,while endoscopic retrograde cholangiopancreatography is the most common method for performing EB-RFA,percutaneous transhepatic cholangiodrainage seems to be a safe and potentially more efficient alternative,particularly for long,angulated,or significantly narrowed bile ducts.
文摘BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of fu
