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PubMed1999

[Sphincter of Oddi motility disturbances--etiologic factor or the consequence of choledocholithiasis].

UNLABELLED: Choledocholithiasis is often found in patients after cholecystectomy done previously for cholelithiasis. AIM: To evaluate the effects of cholecystectomy and common bile stones' presence on sphincter of Oddi (SO) motility. MATERIAL: 13 patients with common bile duct stones (2 men and 11 women, age 54 to 85 yrs) were studied. They were divided in two groups: A--6 pts age 54 to 85 yrs (with biliary lithiasis) and group B of 7 pts age 55-71 after cholecystectomy. Cholecystectomized group was further divided into 2 groups according to administration (B1 group) or not (B2) a premedication. METHOD: Sphincter of Oddi manometry was done in all patients as the part of routine ERCP. A water-perfused, low-compliance, triple-lumen manometric system (Synectics Medical Sweden) was used to record the SO tonic and phasic activity. Common bile duct (CBD) pressure, basal SO pressure, SO phasic contractions frequency, duration and amplitude as well as direction of propagation peristaltic waves, motility index (MI) and AuC (area under curve) were measured. RESULTS: The CBD pressure, the basal SO pressure and the frequency of phasic SO waves tended to be lower in patients after cholecystectomy (p > 0.05). We observed profound changes in the motility pattern of SO phasic activity. There was significantly less anterograde and more retrograde waves in patients from group B than A (18.9% vs. 68.8%; p < 0.01 and 52.4% vs. 10.4% respectively; p = 0.01). In the group B1 comparing with group B2 we found significant decrease of frequency (1.8/min +/- 0.53 vs. 3.3/min +/- 0.77; p < 0.05) and increase of the mean amplitude of phasic SO activity (223.2 mmHg +/- 22.9 vs. 137.3 mmHg +/- 25.0; p < 0.01). The duration of pressure waves was prolonged (with long "plateau" or multipeaked) with rapid pressure increase, what resulted in high AuC index (1155.61 +/- 100.42 vs. 515.23 +/- 210.9; p < 0.01). However no difference in MI was observed. CONCLUSION: Our results confirm hypothesis that cholecystectomy influences the pattern of phasic SO motility. Moreover increased percent of retrograde propagation of SO phasic contractions probably contributes to subsequent common duct stones development rather than being the consequences of their presence.

Aged↗
PubMedDate not supplied

The role of serum liver enzymes in the diagnosis of choledocholithiasis.

BACKGROUND/AIMS: The introduction of laparoscopic cholecystectomy has increased the need for preoperative diagnosis of common bile duct stones. The purpose of this study is to verify the sensitivity of the liver function tests in the detection of duct stones. METHODOLOGY: We evaluated 438 patients (223 retrospectively and 215 prospectively) who underwent endoscopic papillotomy for bile duct stones in two different services. In every case, blood samples for liver function tests levels were collected prior to endoscopic retrograde cholangiopancreatography. RESULTS: The most sensitive test was gamma-glutamyl transpeptidase, that was abnormal in 92.2% of the cases. Alkaline phosphatase was elevated in 74.7% of the patients with choledocholithiasis. The least sensitive parameter was AST, altered in only 50.8% of times. The sensitivity of all liver tests for the diagnosis of choledochal stones taken together was 94.3%. CONCLUSIONS: Liver function tests are very sensitive in the detection of common bile duct stones, however these blood tests are in the normal range of about 5% of endoscopically treated patients.

Adolescent↗
PubMed2001

[Value of MRCP for detection of choledocholithiasis in symptomatic patients: one-year experience with a standardized high resolution breath-hold technique].

In our institution, MRCP is actually replacing diagnostic ERCP. This study is addressing its accuracy in the diagnosis of symptomatic choledocholithiasis. 137 MRCP were performed in patients with upper abdominal pain and biological anomalies (n = 48), pain with cholelithiasis at sonography (n = 69) or non-alcoholic acute pancreatitis (n = 20) on a 1.5 T system with high gradients using a standardized combination of breath-hold HASTE and RARE sequences. We included in our study 74 patients who underwent as second test ERCP (n = 36), peroperative cholangiography (n = 13), or extensive follow-up with laboratory tests and/or sonography (n = 25). All examinations were judged as diagnostic, discrepancies between direct cholangiography and MRCP being noted in 4 patients (5.4%). Lithiasis was misinterpreted on MRCP as bubbles in 2 patients after sphincterotomy or surgery. We had two false positive diagnoses on MRCP: in one patient peroperative cholangiography was negative and in the other one ERCP was negative. With a sensitivity and PPV of 92%, a specificity and NPV of 96% MRCP in our experience is shown as an accurate diagnostic tool for the detection of stone in the common bile duct replacing ERCP.

Adolescent↗
PubMed2001

[Mini-invasive methods of treatment of choledocholithiasis].

Last years in the clinic in diagnosis and treatment of choledocholithiasis choledochofibroscopy is applied widely while performing an open or laparoscopic intervention and while introduction of choledochoscope through external biliary fistula as well. Best results were achieved in those patients, in whom it was possible to evacuate all concrements through ductus cysticus. Introduction of biliary stent have permitted to perform clippage of ductus cysticus without making external drainage, securing rapid rehabilitation of patients.

Adolescent↗
PubMed2002

Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study.

BACKGROUND: Our objective is to compare the results of laparoscopic cholecystectomy (LC) and common bile duct (CBD) exploration to those of endoscopic stone extraction and LC in patients with CBD lithiasis based on a prospective randomized study. METHODS: From April 1997 until August 2000, 78 patients were assigned in two groups. Group A (n'36) patients underwent laparoscopic either direct or trancystic duct, CBD exploration and LC. Group B (n'42) patients were referred for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) for duct clearance and at a later stage LC was performed. Selection of patients of both groups was done, considering prognostic factors of a preliminary study. RESULTS: Laparoscopic duct clearance was achieved in 85.7% of patients while the respective percentage for the combined approach was 84.3%. CONCLUSIONS: Laparoscopic CBD exploration is not yet established as the gold standard procedure for choledocholithiasis and there is the need for further randomized trials and possibly future meta-analyses.

Adult↗
PubMedDate not supplied

[Giant liver abscess due to nearly asymptomatic choledocholithiasis].

Solitary pyogenic liver abscess is usually caused by a metastatic infection through the portal blood flow or through the hepatic arterial blood flow from extra-abdominal pyogenic foci. Besides, it may be the result of local inflammatory diseases, such as cholecystitis, hydatid cyst, haematomas particularly with retained foreign bodies, etc. Suppurative cholangitis usually causes multiple pyogenic liver abscesses. Solitary pyogenic abscess is rarely caused by cholangitis, but practically always by suppurative cholangitis. Giant pyogenic liver abscess due to asymptomatic or mild cholangitis is a rarity. We present on a 63 year old man who developed a giant solitary pyogenic liver abscess in whom no other possible cause could be found or anticipated except practically almost asymptomatic choledocholithiasis accompanied with mild elevation of bilirubin content, alkaline phosphatase and gamma-GT. The patient was successfully treated operatively. Over 1800 ml. of pus was aspirated from the abscess cavity. Operative cholangiography performed in spite of the absence of gall bladder stones undilated and noninflamed common bile duct stone showed a small nonobstructing distal common bile duct stone. The duct was not dilated, the bile was clear and there were no signs of cholangitis in the inside of the common bile duct. Cholecystectomy and abscess cavity drainage led to uneventful recovery. The patient has been symptom-free for more than 3.5 years.

Gallstones↗
PubMed1992

Laparoscopic cholecystectomy and choledochoscopy for the treatment of cholelithiasis and choledocholithiasis.

A 33-year-old woman with symptomatic cholelithiasis underwent laparoscopic cholecystectomy. Preoperative evaluation did not suggest the presence of choledocholithiasis, but intraoperative cholangiography showed a totally obstructing stone in the distal common bile duct. Laparoscopically directed, transperitoneal choledochoscopy was performed by passing a 9.4 F flexible ureteroscope through the cystic duct into the distal common bile duct. A single calculus was visualized and removed with a basket. The patient was discharged the next day, returned to full activity within 1 week, and has done well in the subsequent postoperative interval. The management of incidentally discovered common bile duct stones during performance of laparoscopic cholecystectomy is discussed.

Adult↗
PubMed1992

Peroral cholangioscopy with intracorporeal electrohydraulic lithotripsy for choledocholithiasis.

Five patients with choledocholithiasis refractory to standard extraction methods after endoscopic sphincterotomy underwent peroral cholangioscopy with the "mother-daughter" endoscopy system. electrohydraulic lithotripsy of nine stones was performed successfully and without complication, other than minor transient bleeding in one patient. The outer sheath of the "daughter scope" sustained a linear burn in one instance. This method of stone fragmentation is a useful adjunct to achieve ductal clearance in difficult cases.

Adult↗
PubMed2002

Elevated carbohydrate antigen 19-9 levels in a patient with choledocholithiasis.

Carbohydrate antigen 19-9 (CA19-9) has been used as a tumor marker in the diagnosis and differentiation of pancreatic cancers. However, significantly high levels of CA 19-9 in the absence of pancreatic malignancy have also been reported. We present a 50-year-old woman with a common bile duct stone and cholangitis, whose CA 19-9 level of 1.500 U/ml returned to normal after definitive treatment of choledocholithiasis.

Journal Article↗
PubMed1991

Long-term follow-up of patients with gallbladder in situ after endoscopic sphincterotomy for choledocholithiasis.

Endoscopic sphincterotomy (EST) was performed on 148 patients with common bile duct stones and intact gallbladder. The duct was cleared in 130 cases (88%). Immediate complications occurred in 23 patients (15.5%), six of whom died. In 118 of the 139 patients discharged from the hospital, the bile ducts were cleared and the gallbladder in situ. The median observation time in these 118 cases was 42 (1-97) months, during which 13 (11%) were cholecystectomized because of symptoms or acute complications due to remaining gallbladder stones, and 49 (42%) died 2-87 (median 24) months after EST. The probability (life-table) of remaining free from cholecystectomy-requiring symptoms or complications was 0.87 after 42 months. There was no association between nonfilling of the gallbladder at ERC and subsequent problems with gallbladder stones. EST for choledocholithiasis with retained gallbladder is justified for elderly and frail patients. Indefinite postponement of cholecystectomy may be warrantable, restricting surgery to patients with symptoms from gallbladder stones. This most frequently means within 2 years after EST.

Acute Disease↗
PubMedDate not supplied

[Treatment of choledocholithiasis at the General Hospital of Mexico, S.S].

We present two years of our surgical experience in the Gastroenterologic department of General Hospital of Mexico city; we studied prospectively 23 patients with choledocholithiasis diagnosed preoperatively and postoperatively, 18 females (78%) and 5 males (22%). Diagnosis were performed preoperatively by sonogram, intravenous cholangiography and/or endoscopic retrograde pancreatocholangiography in 19 cases, and postoperatively in four cases. In 22 cases we performed colecistectomy with choledocotomy, extraction of calculi and placement of a "T" biliary catheter. In only one case was necessary a choledoco-duodenal anastomosis. We observed morbility in 3 cases (13%), and a patient died postoperatively (4%). The postoperative follow up was satisfactory in 83% of these cases.

Adult↗
PubMed1990

[Prognostication of the reversibility of changes in the bile ducts and choice of tactics in surgical treatment of patients with choledocholithiasis].

The reversibility of the changes in the common bile duct after elimination of mechanical obstruction and its adequate drainage in patients with choledocholithiasis was studied. A programmed system of prognostication permitting to choose the optimal type of operative intervention with regard for the sizes of the common bile duct after correction has been developed.

Cholestasis↗
PubMed1990

[Duodenal diverticula and its relations with choledocholithiasis].

The incidence of duodenal diverticula was accomplished by four different methods (autopsy, post operative cholangiography, ERCP and upper gastrointestinal X rays); the relationship with common bile duct stones, also was analyzed. The study was developed in the José Joaquín Aguirre Clinic Hospital and Paula Jaraquemada Hospital. The lower incidence was 0.72% in autopsy group and the highest was 8% in patients diagnosed by ERCP. All the diverticula were unique and located in the second duodenal portion. A minimal difference in sex groups was encountered. We did'nt find a major incidence of choledocholithiasis in the population with duodenal diverticula.

Adult↗
PubMed1990

[Ultrasonographic diagnosis of choledocholithiasis].

In recent years various authors have shown more than a threefold increase in us diagnosis of choledocholithiasis. To verify this premise, we examined prospectively with ultrasound, from January, 1987, to December 1990, 107 cases, all confirmed by subsequent intraoperative cholangiography. The ultrasound diagnosis was positive in 55 cases (51,5%), negative in 52, and the percentage of positivity was higher in prepared patients (59%) than in the emergency ones. Of the 55 positive cases, 54 showed common bile duct dilatation (more than 6 mm.), and only 1 had a normal diameter. Also our results show a marked improvement of ultrasound sensitivity in this kind of diagnosis, in comparison with previous series, depending on the continuous improvement in technology. Anyway some limiting factors remain, such as sonologist experience, poor patient intestinal preparation, absence of common bile duct dilatation.

Cholangiography↗
PubMed1990

[Shock-wave lithotripsy in the treatment of 12 patients with choledocholithiasis using an apparatus manufactured in Czechoslovakia].

Lithotripsy by shock wave was performed in 12 patients with choledocholithiasis using the authors' own apparatus. The shock wave is created by an electric spark and the concentration is made by a rotational semi-elipsoid. The pressures attained in the second focus are 150 MPa. The focusing of the stones and the setting to the site of maximal pressures is made by means of two X-ray projections. Patients were indicated for the procedure when the method of endoscopic extraction had failed. Before the procedure a nasobiliary drain was inserted and after administration of analgesia on average 520 shocks were applicated. During the procedure no complications were observed. Fragmentation was achieved in 11 patients. Spontaneous release of fragments was recorded in five of the patients and in 6 during the check-up ERCP endoscopic extraction was made.

Adolescent↗
PubMed1990

Endoscopic sphincterotomy in acute cholangitis due to choledocholithiasis.

The efficacy of endoscopic sphincterotomy in the treatment of acute cholangitis caused by choledocholithiasis was evaluated in a consecutive series of 30 patients. Twenty-five patients (83%) were satisfactorily treated, leading to a normalization of serum alkaline phosphatase, bilirubin and temperature. The procedure was unsuccessful in 4 patients because of large stones. All 4 were submitted to surgery. None of the patients in whom sphincterotomy had been performed had short-term complications. Follow-up with a mean observation time of 22 months showed that 84% of the patients, remained completely symptom-free. Our results are in agreement with those reported in the literature. It is concluded that treatment with instrumental extraction through endoscopic sphincterotomy is simple and fast, and that it should be considered the treatment of choice in the majority of patients with acute cholangitis. For these patients, relief of the biliary obstruction and normalization of the increased intrabiliary pressure remain an essential prerequisite for a favourable outcome.

Acute Disease↗