Acute biliary conditions.
01 Oct 2013-Best Practice & Research in Clinical Gastroenterology (Best Pract Res Clin Gastroenterol)-Vol. 27, Iss: 5, pp 745-756
TL;DR: Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) may have an essential role in the management of acute biliary complications.
Abstract: Acute biliary complications may result from several medical conditions such as gallstone pancreatitis, acute cholangitis, acute cholecystitis, bile leak, liver abscess and hepatic trauma. Gallstones are the most common cause of acute pancreatitis. About 25% of theses patients will develop clinically severe acute pancreatitis, usually due to necrotizing pancreatitis. Choledocholithiasis, malignant and benign biliary strictures, and stent dysfunction may cause partial or complete obstruction and infection in the biliary tract with acute cholangitis. Bile leaks are most commonly associated with hepatobiliary surgeries or invasive procedures such as open or laparoscopic cholecystectomy, hepatic resection, hepatic transplantation, liver biopsy, and percutaneous transhepatic cholangiography. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) may have an essential role in the management of these complications.
Citations
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TL;DR: Prospective multicenter studies defining optimal management of pediatric pancreatitis are needed to guide care and improve outcomes for this patient population.
Abstract: Acute pancreatitis is an emerging problem in pediatrics, with an incidence that is rising in the last 2 decades. Data regarding the optimal management and physician practice patterns are lacking. We present a literature review and updates on the management of pediatric pancreatitis. Prospective multicenter studies defining optimal management of pediatric pancreatitis are needed to guide care and improve outcomes for this patient population.
72 citations
Cites background from "Acute biliary conditions."
...Gallstone pancreatitis usually needs to be managed by cholecystectomy or an ERCP before cholecystectomy (65,66)....
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TL;DR: The aim is to review the latest literature about acute cholangitis and to discuss its pathogenesis, clinical presentation, diagnosis, prognosis, risk factors and treatment.
Abstract: Background
Acute cholangitis, also known as ascending cholangitis, is a life-threatening systemic condition that results from a biliary tree infection and obstruction. Severe acute cholangitis was reported to have a mortality rate between 11 and 27% in the 1990s. This article is a literature review about acute cholangitis. Its aim is to review the latest literature about acute cholangitis and to discuss its pathogenesis, clinical presentation, diagnosis, prognosis, risk factors and treatment.
Methods
Ovid Medline and PubMed database searches were performed for articles about acute cholangitis published in English from 1877 to 2016. The keyword search headings included ‘acute’, ‘ascending’ and ‘cholangitis’, and a combination of these were used. Only articles with full-text descriptions were chosen for this literature review.
Results
Common causes of biliary tree obstruction include choledocholithiasis, benign and malignant biliary strictures. According to the Tokyo Guidelines, clinical presentation, laboratory blood results and diagnostic imaging are important in the diagnosis of acute cholangitis. Treatments consist of intravenous fluids and antibiotics followed by biliary decompression and drainage. Available drainage options include endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, endoscopic ultrasound and open surgical drainage.
Conclusion
It is important to diagnose acute cholangitis as early as possible to initiate appropriate treatments to reduce mortality and morbidity.
49 citations
Cites background from "Acute biliary conditions."
...Plastic stents are also less likely to have tumour ingrowth or overgrowth, which can cause stent obstruction, but are more likely to be occluded with biofilm and sludge compared to metallic stents.(49) The two commonly used biliary stent sizes are 7-Fr and 10-Fr....
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...Plastic stents are easier to insert and to remove and are more cost effective than metallic stents.(49) Plastic stents are also less likely to have tumour ingrowth or overgrowth, which can cause stent obstruction, but are more likely to be occluded with biofilm and sludge compared to metallic stents....
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TL;DR: Patients with SSC-CIP have a distinct microbial profile in bile and an ERC with bile fluid collection for microbiological analysis should be considered in case of insufficient antimicrobial treatment.
32 citations
TL;DR: In this review, relevant literature search and expert opinions have been used to evaluate the outcome of stenting in biliary and pancreatic benign and malignant diseases.
Abstract: Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct and may also be used to treat biliary or pancreatic leaks, pancreatic fluid collections and to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. In this review, relevant literature search and expert opinions have been used to evaluate the outcome of stenting in biliary and pancreatic benign and malignant diseases.
26 citations
TL;DR: Endoscopic management is the first line treatment for multiple pancreatobiliary disorders and covered self-expanding metal stents (SEMS) are preferred over plastic stents for palliation of malignant biliary strictures due to superior patency and have a role in preoperative management of mal cancers.
Abstract: To review the recently published literature on biliary and pancreatic stents. Covered self-expanding metal stents (SEMS) are increasingly being used in the endoscopic management of benign biliary strictures. Given the costs associated with SEMS, plastic stents are still the most commonly used stents. In this setting, SEMS are preferred over plastic stents for palliation of malignant biliary strictures due to superior patency and have a role in preoperative management of malignant biliary strictures. While plastic stents are predominantly used for management of pancreatic strictures, newer endoscopic ultrasound (EUS)-guided lumen-apposing SEMS have been increasingly used in management of pancreatic fluid collections. EUS-guided SEMS also enable safe transmural drainage of gall bladder and bile ducts in benign and malignant conditions. Endoscopic management is the first line treatment for multiple pancreatobiliary disorders. EUS-guided interventions have widened the scope of endoscopic management and decreased the need for surgical intervention. Further studies are needed to determine the safety and cost effectiveness of SEMS in benign pancreatic disorders.
13 citations
References
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TL;DR: The rate of complications after endoscopic biliary sphincterotomy can vary widely in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique, rather than to the age or general medical condition of the patients.
Abstract: Background Endoscopic sphincterotomy is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated risk factors for complications of this procedure and their outcomes. Methods We studied complications that occurred within 30 days of endoscopic biliary sphincterotomy in consecutive patients treated at 17 institutions in the United States and Canada from 1992 through 1994. Results Of 2347 patients, 229 (9.8 percent) had a complication, including pancreatitis in 127 (5.4 percent) and hemorrhage in 48 (2.0 percent). There were 55 deaths from all causes within 30 days; death was directly or indirectly related to the procedure in 10 cases. Of five significant risk factors for complications identified in a multivariate analysis, two were characteristics of the patients (suspected dysfunction of the sphincter of Oddi as an indication for the procedure and the presence of cirrhosis) and three were related to the endoscopic technique (difficulty in cannulating the bile duct,...
2,263 citations
TL;DR: 121 patients with acute pancreatitis thought to be due to gallstones were randomised to treatment with urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy or with conventional treatment, stratified by predicted severity of the attack according to the modified Glasgow system.
818 citations
TL;DR: Emergency ERCP with or without endoscopic papillotomy is indicated in the treatment of patients with acute pancreatitis and resulted in a reduction in biliary sepsis as compared with conservative treatment.
Abstract: Background Most patients with acute biliary pancreatitis have stones in the biliary tract or ampulla of Vater. Because these stones may be passed spontaneously soon after a patient is admitted to the hospital, the importance of early operative removal is not known. We tested the hypothesis that endoscopic papillotomy within 24 hours of admission decreased the incidence of complications in patients with acute biliary pancreatitis. Methods We studied 195 patients with acute pancreatitis who were randomly assigned to one of two groups: 97 patients underwent within 24 hours after admission emergency endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic papillotomy for ampullary and common-bile-duct stones, and 98 patients received initial conservative treatment and selective ERCP with or without endoscopic papillotomy only if their condition deteriorated. Results One hundred twenty-seven patients ultimately proved to have biliary stones. Emergency ERCP with or without endoscopic papillo...
742 citations
TL;DR: The findings suggest that acute pancreatitis associated with gallstone disease is frequently caused by transient blockage of the ampulla of Vater by migrating gallstones.
Abstract: Stools were screened for gallstones in 36 patients with acute pancreatitis associated with gallstones. These patients had typical clinical evidence of pancreatitis with transiently elevated serum amylase and bilirubin concentrations. Another 36 patients with gallstones but without acute pancreatitis served as controls. Gallstones were found in the feces of 34 out of 36 patients with pancreatitis, but in only three out of the 36 control cases. In the former group, the finding was usually preceded by a relief of the symptoms and a rapid decrease of serum amylase and bilirubin concentrations. The calculi found in the stools and those found in the biliary tracts of the patients at operation were identical as determined by gross inspection and chemical analysis. These findings suggest that acute pancreatitis associated with gallstone disease is frequently caused by transient blockage of the ampulla of Vater by migrating gallstones. (N Engl J Med 290:484–487, 1974)
575 citations
"Acute biliary conditions." refers background in this paper
...Gallstones can induce mechanical ampullary obstruction and its associationwith acute pancreatitis is well established [5]....
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TL;DR: Consider conservative or endoscopic/percutaneous measures if: Localised perforation with no extravasation No significant fluid collections No significant retroperitoneal emphysema Stable patient.
571 citations