scholarly journals Endoscopic Treatment of Post-Cholecystectomy Biliary Leaks

2020 ◽  
pp. 1-9
Author(s):  
Ricardo Rio-Tinto ◽  
Jorge Canena
Keyword(s):  
Endoscopic Treatment ◽  
Open Cholecystectomy ◽  
Plastic Stents ◽  
Optimal Time ◽  
Endoscopic Retrograde ◽  
Procedural Approach ◽  
Technological Developments ◽  
Optimal Time Point ◽  
Bile Leaks

Postcholecystectomy leaks may occur in 0.3–2.7% of patients. Bile leaks associated with laparoscopy are often more complex and difficult to treat than those occurring after open cholecystectomy. Furthermore, their incidence has remained unchanged despite improvements in laparoscopic training and technological developments. The management of biliary leaks has evolved from surgery into a minimally invasive endoscopic procedural approach, namely, endoscopic retrograde cholangiopancreatography (ERCP), which decreases or eliminates the pressure gradient between the bile duct and the duodenum, thus creating a preferential transpapillary bile flow and allowing the leak to seal. For simple leaks, the success rate of endotherapy is remarkably high. However, there are more severe and complex leaks that require multiple endoscopic interventions, and clear strategies for endoscopic treatment have not emerged. Therefore, there is still some debate regarding the optimal time point at which to intervene, which technique to use (sphincterotomy alone or in association with the placement of stents, whether metallic or plastic stents should be used, and, if plastic stents are used, whether they should be single or multiple), how long the stents should remain in place, and when to consider treatment failure. Here, we review the types and classification of postoperative biliary injuries, particularly leaks, as well as the evidence for endoscopic treatment of the latter.

Findings at endoscopic retrograde cholangiopancreatography after endoscopic treatment of postcholecystectomy bile leaks

2009 ◽  
Vol 24 (7) ◽  
pp. 1752-1756 ◽  
Author(s):  
Gregory A. Coté ◽  
Michael Ansstas ◽  
Somal Shah ◽  
Rajesh N. Keswani ◽  
Saad Alkade ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Treatment ◽  
Endoscopic Retrograde ◽  
Bile Leaks

scholarly journals Personalized screening intervals for kidney function in patients with chronic heart failure: a modeling study

2021 ◽  
Author(s):  
Anne-Sophie Schuurman ◽  
Anirudh Tomer ◽  
K. Martijn Akkerhuis ◽  
Ewout J. Hoorn ◽  
Jasper J. Brugts ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Information Gain ◽  
Joint Model ◽  
Left Ventricular ◽  
Individual Risk ◽  
Optimal Time ◽  
Maximum Information ◽  
Heart Failure Patients ◽  
Optimal Time Point

Abstract Background High mortality and rehospitalization rates demonstrate that improving risk assessment in heart failure patients remains challenging. Individual temporal evolution of kidney biomarkers is associated with poor clinical outcome in these patients and hence may carry the potential to move towards a personalized screening approach. Methods In 263 chronic heart failure patients included in the prospective Bio-SHiFT cohort study, glomerular and tubular biomarker measurements were serially obtained according to a pre-scheduled, fixed trimonthly scheme. The primary endpoint (PE) comprised cardiac death, cardiac transplantation, left ventricular assist device implantation or heart failure hospitalization. Personalized scheduling of glomerular and tubular biomarker measurements was compared to fixed scheduling in individual patients by means of a simulation study, based on clinical characteristics of the Bio-SHiFT study. For this purpose, repeated biomarker measurements and the PE were jointly modeled. For personalized scheduling, using this fitted joint model, we determined the optimal time point of the next measurement based on the patient’s individual risk profile as estimated by the joint model and the maximum information gain on the patient’s prognosis. We compared the schedule’s capability of enabling timely intervention before the occurrence of the PE and number of measurements needed. Results As compared to a pre-defined trimonthly scheduling approach, personalized scheduling of glomerular and tubular biomarker measurements showed similar performance with regard to prognostication, but required a median of 0.4–2.7 fewer measurements per year. Conclusion Personalized scheduling is expected to reduce the number of patient visits and healthcare costs. Thus, it may contribute to efficient monitoring of chronic heart failure patients and could provide novel opportunities for timely adaptation of treatment. Graphic abstract

scholarly journals ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

2014 ◽  
Vol 51 (3) ◽  
pp. 240-249 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Wanderley Marques BERNARDO ◽  
Luca BERNARDO ◽  
Wellington ANDRAUS ◽  
Lucas TORRES ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Endoscopic Treatment ◽  
Clinical Success ◽  
Controlled Trial ◽  
Balloon Dilation ◽  
Plastic Stents ◽  
Metal Stents ◽  
Complication Rates ◽  
Biliary Strictures

Context Biliary strictures after liver transplantation are recognized as its Achilles’ heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objectives The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation. Methods A systematic review of the literature was performed on the management of anastomotic biliary strictures post- orthotopic liver transplantation. The Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were electronically searched from January 1966 to April 2013. Results No well-designed randomized controlled trial was found. Most studies were retrospective or prospective comparisons in design. One study (86 patients) compared the endoscopic and the percutaneous accesses. The sustained clinical success rates were similar but the treatment duration was longer in the percutaneous group access. Two studies (56 patients) compared balloon dilation with balloon dilation and multiple plastic stents. There were no differences concerning sustained clinical success and complication rates. Conclusions Balloon dilation is as effective as balloon dilation plus multiple plastic stenting for the resolution of the anastomotic biliary strictures. Well-designed randomized trials are still needed to compare balloon dilation versus multiple plastic stenting versus metallic stenting.

Long-term outcomes after noncurative endoscopic resection of early gastric cancer: the optimal time for additional endoscopic treatment

2018 ◽  
Vol 87 (4) ◽  
pp. 1003-1013.e2 ◽  
Author(s):  
Mi Young Jeon ◽  
Jun Chul Park ◽  
Kyu Yeon Hahn ◽  
Sung Kwan Shin ◽  
Sang Kil Lee ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Resection ◽  
Endoscopic Treatment ◽  
Optimal Time ◽  
Long Term Outcomes

scholarly journals Refractory Bergmann type A bile leak: the need to strike a balance

2019 ◽  
Vol 07 (02) ◽  
pp. E264-E267 ◽  
Author(s):  
Massimiliano Mutignani ◽  
Edoardo Forti ◽  
Alberto Larghi ◽  
Stefanos Dokas ◽  
Francesco Pugliese ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Endoscopic Therapy ◽  
Bile Leak ◽  
Type A ◽  
Stent Insertion ◽  
Endoscopic Retrograde ◽  
Abdominal Drainage ◽  
Biliary Sphincterotomy ◽  
Favorable Pressure Gradient ◽  
Bile Leaks

Abstract Background and study aims Endoscopic therapy for postoperative Bergmann type A bile leaks is based on biliary sphincterotomy ± stent insertion. However, recurrent or refractory bile leaks can occur. Patients and methods This was retrospective study including all consecutive patients who were referred to our center with a Bergmann type A bile leak refractory to previous conventional endoscopic treatments. Results Seventeen patients with post-cholecystectomy-refractory Bergmann type A bile leak were included. All had received prior endoscopic biliary sphincterotomy with biliary stent or nasobiliary catheter placement and all had a percutaneous or surgical abdominal drainage. Repeat endoscopic retrograde cholangiopancreatography (ERCP) confirmed a Bergmann type A bile leak and in all patients we observed that the abdominal drainage was placed adjacent to the origin of the fistula. Our treatment consisted of pulling the drain away from the fistulous site, with extension of the previous sphincterotomy when needed. The treatment was successful in all cases. Mild complications occurred in three patients. Conclusions Our retrospective study shows that refractory Bergmann type A bile leak may be a consequence of an unfavorable position of the abdominal drainage tube, which can be corrected by pulling the drain away from the origin of the fistula. This establishes a favorable pressure gradient that leads the bile flowing from the bile duct into the duodenum.

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