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At least 55 records · Page 3Linked to original sources
PubMed2005

Adaptative bile duct proliferative response in experimental bile duct ischemia.

BACKGROUND/AIMS: A rat model of bile duct ischemia was established and used to examine the potential of bile duct proliferation to provide an adaptative response in cholestatic disorders. METHODS: Rats underwent partial or complete arterial deprivation of the liver. Serum biochemical tests, histological analyses and bile secretion measurements were performed at different time points up to 6 weeks after surgery. RESULTS: Rats developed biochemical signs of cholestasis exclusively after complete arterial deprivation. Within 4h, cholangiocytes in these rats showed morphological signs of cell damage. After 48h, they displayed VEGF expression and became proliferative. The proportion of Ki67-labeled cholangiocytes ( approximately 30%) was similar in interlobular bile ducts and periportal ductules. A ductular reaction made of well-formed bile ducts confined to portal tracts developed within 1 week. Bile flow which was initially decreased, was restored at 3 weeks, while the biochemical signs of cholestasis completely resolved at 6 weeks. At this time, the number of bile duct sections was maximal. Fibrosis intensity was also maximal, although moderate (<F2 METAVIR staging) as assessed by Sirius-red staining morphometry. CONCLUSIONS: In the present model of bile duct ischemia, ductular reaction derives from bile ducts of all anatomical compartments, and provides a poorly fibrogenic functional response to biliary dysfunction.

Animals↗
PubMed2001

Effect of the diameter of the common bile duct on the incidence of bile duct stones in patients with recurrent attacks of right epigastric pain after cholecystectomy.

OBJECTIVE: To study the relationship between the diameter of the common bile duct and the incidence of bile duct stones in non-jaundiced patients with recurrent attacks of right epigastric pain after cholecystectomy. DESIGN: Retrospective study. SETTING: University hospital, Finland. SUBJECTS: 57 consecutive, non-jaundiced patients admitted for elective endoscopic retrograde cholangiopancreatography (ERCP) because of attacks of right epigastric pain after cholecystectomy. INTERVENTIONS: Measurement of maximum diameter of the common bile duct and presence or absence of bile duct stones. MAIN OUTCOME MEASURES: Diameter of bile duct (10 mm or less was regarded as normal) and presence or absence of stones. RESULTS: 33 patients had normal-sized bile ducts and in 24 they were widened. Only 2/33 patients with normal-sized ducts (6%) had stones, compared with 11/24 (46%) with wide ducts (p = 0.0008). However, the degree of ductal dilatation did not seem to have any influence on the presence or absence of stones. CONCLUSION: Bile duct stones are unlikely after cholecystectomy in patients who are not jaundiced and have a normal-sized common bile duct. However, nearly half of the patients with a wide common bile duct had stones, but the degree of dilatation was not important.

Abdominal Pain↗
PubMed1997

A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones. Lessons and limits from an initial experience of 92 patients.

BACKGROUND: Open exploration and endoscopic sphincterotomy (ES) remain the preferred treatment of common bile duct stones (CBDS). The recent spread of laparoscopy has worsened the dilemna of choosing between surgical and endoscopic treatment of CBDS. The aim of this study was to critically evaluate the results of our preliminary experience with laparoscopic common bile duct exploration (CBDE) for CBDS. METHODS: Ninety-two consecutive patients were prospectively submitted to laparoscopic CBDE. Surgical strategy included an initial transcystic approach or laparoscopic choledochotomy. Failure of stone clearance was managed by conversion to open CBDE or by postoperative ES. Electrohydraulic lithotripsy and papillary balloon dilatation were selectively used. Stone clearance was assessed by choledochoscopy and control cholangiography. RESULTS: The overall laparoscopic stone clearance in this series was 84% (transcystic route 63% and choledochotomy 93%). Conversion to laparotomy was mandatory in 12% of the patients because of incomplete stone clearance and in 5% because of intraoperative complications. Postoperative ES was required in 4% of the patients, giving an overall surgical success rate of 96%. When indicated (small and limited number of stones located below the cysticocholedochal junction, with a dilated and patent cystic duct) the transcystic route had the lower success rate, the higher complication rate, and the shorter operative time and postoperative hospital stay. When indicated (accessible and dilated common bile duct over 7 mm), laparoscopic choledochotomy had the higher success rate, the lower complication rate, the longer operative time, and the longer postoperative hospital stay, which is related to associated external biliary drainage. The hospital mortality included two high-risk patients (2%) and the complications rate was 15%. CONCLUSIONS: Laparoscopic CBDE is safe in selected patients. A stratified intraoperative surgical strategy is mandatory in deciding between a transcystic route and choledochotomy with specific indications for each approach. When feasible, laparoscopic choledochotomy is more efficient and safe than the transcystic route, but it is associated with a longer postoperative hospital stay, which is due to external biliary drainage.

Adolescent↗
PubMed1993

Bile duct pressure, hormonal influence and recurrent bile duct stones.

An obstacle to the outflow from the bile duct not only increases bile duct pressure but also facilitates the formation of primary bile duct stones. The bile duct pressure, an indicator of the balance between bile inflow and outflow, was studied postoperatively under similar conditions in 123 patients, who had been operated on for bile duct stones. Secondary bile duct stones had been present in 86 patients (group CC) and primary stones in 26 (group C), while 11 without sphincter of Oddi function were used as a control group. The basal bile duct pressure was similar in groups CC and C, but significantly lower in the controls. Intraductal injection of saline solution caused a similar increase in bile duct pressure in groups CC and C, but not in the controls. Intravenous administration of secretin and somatostatin increased the bile duct pressure in groups CC and C, while a "normal" response to cholecystokinin, a decrease in bile duct pressure, was observed only in group CC. The "abnormal" response to cholecystokinin found in group C indicates a motor dysfunction of the sphincter of Oddi, which may have been responsible for, or at least contributed to, the formation of recurrent bile duct stones in this group.

Adult↗
PubMedDate not supplied

Successful reconstruction of segmental or subsegmental bile ducts after resection of hilar bile ducts: short- and long-term results.

BACKGROUND/AIMS: Biliodigestive anastomoses to small bile ducts after extensive liver resection or central bile duct remain difficult. The inherent problems associated with this particular procedure have not been widely discussed. In order to demonstrate that reconstruction of segmental or subsegmental bile ducts with mucosa-to-mucosa alignment using transanastomotic stents can reduce morbidity associated with the procedure, we have reviewed our experience with small biliodigestive anastomosis after liver resection. METHODOLOGY: Thirteen patients were operated on from 1995 to 1997. Twelve had malignant diagnoses. A comprehensive standardized technique included the use of short or trans-intestinal trans-anastomotic stents and single layer interrupted absorbable sutures with mucosa-to-mucosa alignment. In the patients, in-hospital morbidity and mortality with focus on bile leaks and long-term signs of cholangitis and stricture formation were investigated with a median observation period of 42 months. RESULTS: Eleven underwent extensive liver resections and two had complicated central resections including the bile duct confluence. The procedures included 40 transected bile ducts and 32 anastomoses to the jejunum. One patient died as a result of rupture of a splenic arterial aneurysm caused by a pancreatic pseudocyst. Other complications which occurred in seven patients were intra-abdominal fluid collection (n=5), wound infection (n=1), minor bile leakage from the liver cut surface (n=1), and pleural effusion (n=4). Postoperatively four patients, who had local recurrence with jaundice, showed cholangitis, whereas the remaining nine patients showed no signs of cholangitis. CONCLUSIONS: Our technique for reconstructing small bile ducts with mucosa-to-mucosa alignment is considered adequate from the viewpoint of short- and long-term results.

Adult↗
PubMed1986

Is the bile duct diameter a reliable parameter to diagnose extrahepatic cholestasis? Relationship between bile duct diameter and bile duct pressure.

The common bile duct (CBD) pressure was determined in 57 patients before endoscopic retrograde cholangiography (ERC) and related to the diameter of the CBD and the common hepatic duct (CHD). We found that despite a weak overall positive correlation in the individual patient, CBD or CHD diameters do not correlate with CBD pressure. In patients without extrahepatic cholestasis and normal CBD pressure, both CBD and CHD diameters were measured in a wide range between 5 and 32 mm. Extrahepatic cholestasis due to distal CBD obstruction is reflected by a high CBD pressure, but cannot be identified reliably by measuring the CBD diameter which is found within the range of patients not obstructed. In cholecystectomized patients, CBD and CHD are significantly (p less than 0.005) wider than in non-cholecystectomized patients (8.8 +/- 1.0 vs. 13.3 +/- 1.2 and 9.2 +/- 0.9 vs. 14.2 +/- 1.2 mm, respectively). The CBD pressure, however, is nearly identical in both groups. It is concluded that the assessment of CBD and CHD diameter is not a reliable parameter for the diagnosis of extrahepatic cholestasis which--in certain cases--could be proved by endoscopic retrograde manometry.

Cholangiography↗
PubMed1993

Laparoscopic approaches to the common bile duct stone: transcystic bile duct exploration, choledochotomy and stone fragmentation.

It has been illustrated that a convergence of new technologies, including advanced laparoscopic techniques, flexible video endoscopy, coaxial balloon dilators and biliary lithotripsy, has allowed the modern laparoscopic surgeon to address a pressing issue: how to deal with choledocholithiasis. A variety of techniques and methods have been described; each has their advocates, philosophical advantages and potential drawbacks. The definitive decision as to which technique is the best awaits the results of future prospective studies. Until then, the three techniques outlined will allow the majority of surgeons to extend the advantages of minimally invasive surgery to patients with choledocholithiasis. There is no doubt that this is desirable. These procedures, however, are not without their failure rate and complications, and they remain technically demanding. Increased education and training of surgeons is needed and further improvement of existing technology is demanded. This includes improved fibreoptic choledochoscopes with better optics, more flexibility and larger working channels; better stone baskets and better mechanical graspers, and safer and more effective stone lithotriptors. Other questions remain unanswered, such as the relative and absolute contraindications to performing laparoscopic common duct explorations. Can patients with multiple common duct stones or very small ducts be safely handled using these methods? Is there a size of common duct stone that is safe to leave behind, and are there safe antegrade methods of treating distal duct stenosis? The new interest in avoiding the placement of T-tubes for common duct drainage also needs close scrutiny. All these questions need well-constructed studies to answer them; but in the meantime, laparoscopic common duct exploration is undoubtedly here to stay, and this new approach to an old problem is inducing biliary surgeons to question many traditionally held dicta, which can in the long run only be in the patients' best interest.

Endoscopy, Digestive System↗
PubMed2006

An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction.

BACKGROUND: Endoscopic sphincterotomy and stone extraction are standard procedures for the removal of bile duct stones. Stone recurrence can, however, occur in up to 25% of cases. Risk factors have been poorly defined, but are believed to be related to bile stasis. This study investigated whether an angulated common bile duct (CBD) that may predispose to bile stasis influences symptomatic stone recurrence after successful endoscopic therapy. METHODS: This study included 232 consecutive patients (mean age, 64.1 years; 86 men) who had undergone therapeutic endoscopic retrograde cholangiopancreatography for bile duct stones. Data from the follow-up period (36 +/- 17 months) were obtained from medical records and patient questioning. Common bile duct angulation and diameter were measured from the cholangiogram after stone removal. RESULTS: Symptomatic bile duct stones recurred in 16% of the patients (36/232). Three independent risk factors were identified by multivariate analysis: an angulated CBD (angle, < or = 145 degrees; relative risk [RR], 5.2; 95% confidence interval [CI], 2.2-12.5; p = 0.0002), a dilated CBD (diameter, > or = 13 mm; RR, 2.6; 95% CI, 1.2-5.7; p = 0.017), and a previous open cholecystectomy (RR, 2.7; 95% CI, 1.3-5.9; p = 0.0117). Gender, age, urgency of procedure, or a periampullary diverticulum did not influence the recurrence rate. CONCLUSIONS: Angulation of the CBD (< or = 145 degrees) on endoscopic cholangiography, a dilated CBD, and a previous open cholecystectomy are independent risk factors for symptomatic recurrence of bile duct stones. The findings support the role of bile stasis in stone recurrence. Further studies using these data prospectively to identify high-risk patients are warranted.

Adolescent↗
PubMed1984

[Clinicopathological study on metaplasia in the bile duct mucosa with special reference to bile duct carcinoma].

Metaplasia of bile duct epithelium was studied clinicopathologically in 36 autopsy cases (Group-A), 18 surgical cases of obstructive jaundice without bile duct carcinoma (Group-B) and 56 surgical cases of bile duct carcinoma (Group-C). The results were as follows: In Group-A there were 24 cases with metaplastic pyrolic glands, and no metaplastic goblet cells. In group-B, there were 16 cases with metaplastic pyrolic glands, 2 cases with metaplastic goblet cells and 1 case with enterochromaffin cells. The mucosa of non-tumorous region of Group-C had metaplastic pyrolic glands in 46 cases, metaplastic goblet cells in 14 cases, enterochromaffin cells in 2 cases and intestinal absorbtive epithelia in 5 cases. In the tumorous region, however, tumor cells with goblet vesicles (malignant goblet cells) were seen in 31 cases, malignant intestinal absorptive villi were in 18 cases, malignant enterochromaffin cells were in 8 cases. Thirty one cases with malignant goblet cells were classified as intestinal type of the bile duct carcinoma (I-type). And 25 cases without malignant goblet cells were classified as non-intestinal type of the bile duct carcinoma (non-I-type). Conclusively, these clinicopathological findings suggest that I-type and non-I-type in the carcinoma of the bile duct are identifiable and I-type in the carcinoma of the bile duct are identifiable and I-type may arise from the lesion with intestinal metaplasia of the benign epithelia of the duct.

Adenocarcinoma, Papillary↗
PubMed2001

A non-icteric cholecystectomized patient with recurrent attacks of right epigastric pain and dilated common bile duct--do liver function tests predict bile duct stones?

Cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct are a clinical challenge. In a number of these patients dilatation of the common bile duct is explained as a normal postoperative state following cholecystectomy and the recurrent pain attacks are of origin other than bile disorder, but in some cases dilatation of the common bile duct and attacks are caused by bile duct stones. The aim of the present work was to study the value of common plasma liver function tests in predicting bile duct stones in the group of non-icteric cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct. The study population comprised 24 consecutive non-icteric cholecystectomized patients admitted for elective endoscopic retrograde cholangiopancreatography because of attacks of right epigastric pain and dilated common bile duct in ultrasonography. All the liver function tests seemed to assist in separating patients with bile duct stones (n=11) from those without (n=13). Alanine aminotransferase levels were significantly higher (p=0.05) in patients with bile duct stones than in those without, but also alkaline phosphatase (p=0.07), gamma-glutamyl transferase (p=0.09) and bilirubin (p=0.09) levels seemed to be higher in patients with bile duct stones than in those without, although the differences in these values did not reach statistical significance. In conclusion, common plasma liver function tests assist in separating patients with bile duct stones from those without in this small but clinically important group of non-icteric cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct. However, the actual value of these measurements is limited in clinical decision making since overlapping of values occured.

Adult↗