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At least 865 records · Page 48Linked to original sources
PubMed1996

[15 years of endoscopic therapy in choledocholithiasis].

INTRODUCTION: The relevance of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of common bile duct stones has increased since the introduction of laparoscopic cholecystectomy in 1989-1990. METHODS: The number, indications, success and complication rate of ERCP were analyzed retrospectively in 1121 consecutive patients with bile duct stones treated at Berne University Hospital between 1980 and 1994. RESULTS: The number of patients undergoing endoscopic stone extraction increased slowly from 1980 to 1990, but has shown a 4-fold increase in the last 5 years parallel to the introduction of laparoscopic cholecystectomy. Failure to diagnose and remove bile duct stones decreased 5-fold from 23% (14 of 60 patients) in 1986 to 4.4% (10 of 225 patients) in 1994. Major complications occurred in 3.2% (30 of 617 patients) and consisted of acute pancreatitis (1.6%), hemorrhage of the papilla (1%), and cholangitis (0.6%). The severity but not the number of complications has decreased in the last 15 years. CONCLUSION: Gallbladder stones with common bile duct stones are usually treated by endoscopic stone extraction combined with laparoscopic cholecystectomy. Open operation with bile duct exploration is reserved for a small subgroup of patients with specific problems.

Adult↗
PubMed1977

Ultrasonic scanning in postcholecystectomy choledocholithiasis.

Ultrasonic scanning of the right upper quadrant was performed in four patients with jaundice and fever. Each patient had undergone a previous cholecystectomy with common bile duct exploration for biliary tract calculi. No patient at that time revealed retained stones on either intraoperative or postoperative cholangiograms. In none of the patients studied was the exact nature of the obstruction appreciated by the clinical and laboratory data available. All patients revealed biliary duct dilatation on ultrasound, and the majority demonstrated a bile duct calculous as well. Based on our experience, we do not recommend that ultrasonic scanning be substituted for oral or intravenous cholangiography when the latter can be performed. Nor should ultrasonic scanning be used to replace endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or even liver biopsy if these procedures are indicated and can be completed with a reasonable degree of safety. However, we have found that ultrasound can be very helpful in the occasional patient whose biliary tract obstruction defies exact diagnosis when routine dye studies and invasive diagnostic procedures are neither accurate nor feasible.

Aged↗
PubMedDate not supplied

[Precut sphincterotomy in impacted choledocholithiasis at the Vater's ampulla].

BACKGROUND: Endoscopic sphincterotomy is an established treatment for common bile duct stones. Stone impaction at the ampulla makes deep cannulation and standard sphincterotomy more difficult. The use of precut papillotomy may facilitate stone extraction, although risks may be greater. AIM: To evaluate precut papillotomy in impacted common bile duct stone at the ampulla of Vater. PATIENTS AND METHODS: Between October 1990 and September 1995, 27 of 345 patients with common bile duct stones underwent needle knife precut papillotomy after conventional sphincterotomy failed due to impacted ampullary stone. This facilitated deep cannulation and subsequent standard sphincterotomy in 12 patients. RESULTS: Eleven patients had spontaneous expulsion of the stone when precut papillotomy was extended. Oedema or bleeding precluded stone extraction in 3 patients, and these stones were removed at a second endoscopic retrograde cholangiopancreatography (ERCP) session. Mild bleeding occurred in one patient and hemotransfusion was necessary. There was no perforation or pancreatitis following the procedure. CONCLUSIONS: Precut papillotomy is effective in the treatment of impacted common bile duct stone at the ampulla of Vater. It's a technique that should be performed only by an experienced endoscopist and does not increase the complications risk.

Adult↗
PubMed1996

[Sequential therapy concept in choledocholithiasis].

Of 4023 Patients with gallstone disease, 124 were treated for common bile duct stones by endoscopy (ERC/EPT). Stone clearance was completed in 81% of the patients. Due to a morbidity of 5.9% and a mortality of 0.6%, the concept of preoperative ERC followed by laparoscopic cholecystectomy seems to reduce risk for the patients.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1997

[Mechanical lithotripsy during retrograde cholangiography in choledocholithiasis untreatable by conventional endoscopic sphincterotomy].

Endoscopic papillotomy followed by the removal of stones with the Dormia basket is the treatment of choice in residual choledocolithiasis after cholecystectomy and in choledocolithiasis in patients with a high surgical risk. Nonetheless, the size of the stones may, occasionally, impede removal by this procedure. Mechanical lithotripsy may resolve this clinical situation. The authors present the results of this technique in 40 consecutive patients in whom the elimination of the stones was not possible by conventional methods and thus mechanical lithotripsy was performed. This procedure was found to be effective in 32 out of 40 patients (80%). In 22 cases (55%) lithotripsy was effective in one session performed during the first ERCP, 8 (20%) required two procedures and in 2 (5%) three sessions were necessary. In 9 cases the stones were spontaneously eliminated with lavage using physiologic serum or diluted contrast, in 6 the stones were extracted by lithotripsy, in 16 they were eliminated by a conventional Dormia basket and in the remaining case the Fogarty balloon was used. Lithotripsy could not be carried out in 8 out of the 40 patients (20%) due to inability to pick the stone up in 7 cases and because of the impossibility of breaking the stone up with the lithotripsy basket in the remaining case. No complications directly related to lithotripsy were observed. In conclusion, mechanical lithotripsy in an effective and safe therapeutic alternative in large size choledocolithiasis and can be performed during endoscopy.

Adult↗
PubMedDate not supplied

[A minimally invasive approach in choledocholithiasis].

In the last years several less aggressive procedures diminished the role of open choledochotomy (CT) in the treatment of common bile duct (CBD) lithiasis. Between them are endoscopic sphincterotomy (EST) and laparoscopic choledochotomy. In a lap of 18 month were followed up, in a prospective way, all the cases of CBD lithiasis admitted in our department. Twenty-seven patients were treated by EST and 28 by CT. The endoscopy was as efficient as open CT in clearing the CBD (85% vs. 83%). Even if the endoscopic group was at a higher risk the morbidity was lower than in the classic approach and the mortality was the same (3.5%). The most common complication after EST was acute pancreatitis (7.5%). The mean hospital stay was lower after EST. Near by are discussed 3 cases of associated gallbladder and CBD lithiasis treated exclusively by laparoscopic approach.

Adult↗