Biliary Sludge Research Articles

Gastrointestinal involvement in STEC-associated hemolytic uremic syndrome: 10 years in a pediatric center

BackgroundThe gastrointestinal (GI) tract represents one of the main targets of typical hemolytic uremic syndrome (HUS) in children. In this observational study, we tried to establish (1) the main features of GI complications during STEC-HUS and (2) the relationship between Escherichia coli serotypes and Shiga toxin (Stx) variants with hepatopancreatic involvement.MethodsA total of 79 STEC-HUS patients were admitted to our pediatric nephrology department between January 2012 and June 2021. Evidence of intestinal, hepatobiliary, and pancreatic involvements was reported for each patient, alongside demographic, clinical, and laboratory features. Frequency of gastrointestinal complications across groups of patients infected by specific E. coli serotypes and Stx gene variants was evaluated.ResultsSix patients developed a bowel complication: two developed rectal prolapse, and four developed bowel perforation which resulted in death for three of them and in bowel stenosis in one patient. Acute pancreatitis was diagnosed in 13 patients. An isolated increase in pancreatic enzymes and/or liver transaminases was observed in 41 and 15 patients, respectively. Biliary sludge was detected in three, cholelithiasis in one. Forty-seven patients developed direct hyperbilirubinemia. Neither E. coli serotypes nor Shiga toxin variants correlated with hepatic or pancreatic involvement.ConclusionsDuring STEC-HUS, GI complications are common, ranging from self-limited elevation of laboratory markers to bowel perforation, a severe complication with a relevant impact on morbidity and mortality. Hepatopancreatic involvement is frequent, but usually short-lasting and self-limiting.Graphical abstractA higher resolution version of the Graphical abstract is available asSupplementary information

Risk stratification model for incidentally detected gallbladder polyps: A multicentre study

PurposeWe aimed to develop a 4-level risk stratification model using a scoring system based on conventional ultrasound to improve the diagnosis of gallbladder polyp. MethodPatients with histopathologically confirmed gallbladder polyps were consecutively recruited from three medical centres. Conventional ultrasound findings and clinical characteristics were acquired prior to cholecystectomy. Risk factors for neoplastic and malignant polyps were used to build a risk stratification system via interobserver agreement and multivariate logistic regression analysis. The model was retrospectively trained using 264 pre-surgical samples and prospectively validated using 106 pre-surgical samples. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and malignant polyp rate. ResultsIn total, 370 patients (mean age, 51.68 ± 14.41 years, 156 men) were enrolled in this study. Size (≥12 mm), shape (oblate or round), single, vascularity, gallbladder stone or sludge were considered risk factors for neoplastic polyps. Size (≥14 mm), shape (oblate), single, disrupted gallbladder wall, and gallbladder stone or sludge were risk factors for malignant polyps (all p < 0.05). In the scoring system, the sensitivity, specificity, and AUC of score ≥ 9 in diagnosing neoplastic polyps were 0.766, 0.788, and 0.876 respectively; and the sensitivity, specificity, and AUC of score ≥ 15 in diagnosing malignant polyps were 0.844, 0.926, and 0.949 respectively. In our model, the malignancy rates at the four levels were 0 % (0/24), 1.28 % (2/156), 9.26 % (5/54), and 70.37 % (38/54), respectively. ConclusionsThe 4-level risk stratification model based on conventional ultrasound imaging showed excellent performance in classifying gallbladder polyps.

Стан гепатобіліарної системи в підлітків з цукровим діабетом 1-го типу

Diabetes mellitus type 1 (DMT1) is one of the diseases in which liver lesions such as glycogenic hepatopathy and hepatic steatosis are frequently observed which makes our study appropriate. Purpose - to study the state of the hepatobiliary system in adolescents with DMT1 based on the results of a biochemical blood test, ultrasound examination of the hepatobiliary system and dynamic monitoring. Materials and methods. The study included 173 adolescents (87 girls and 86 boys aged 10 to 18 years who have DMT1 and were in the endocrinology department of the SI «Institute for Children and Adolescents Health Care of the NAMS of Ukraine»). Patients were divided according to the level of glycaemic control targets (GCT): the Group 1 - optimal (glycosylated hemoglobin (HbA1c) &lt;7.0%), the Group 2 - suboptimal (HbA1c = 7.0-9.0%), the Group 3 - high-risk GCT (HbA1c &gt;9.0%). The Control group included 20 healthy adolescents. All patients underwent a biochemical blood test and ultrasound. Results. Most of the examined adolescents had pain, dyspeptic syndromes and an increased size of the liver on ultrasonography regardless of the level of GCT. Ultrasound signs of hepatic steatosis were most often determined in patients with the Group 3. Dynamic observation indicated the absence of positive dynamics in reducing the size of the liver and normalizing the echogenicity of its parenchyma in 50% of patients, even when optimal GCT is reached. The majority of adolescents with DMT1 had hypotension of the gallbladder, and thickening of the gallbladder walls and the presence of biliary sludge were more often observed in patients with Groups 2 and 3. In the Groups 2 and 3 increased activity of alanine aminotransferase was revealed, which against the background of compensation for DMT1, decreased in only half of the patients. Lipidogram parameters were atherogenic in all patients, regardless of the level of GCT. Conclusions. The study revealed a high incidence of hepatopathy in adolescents with DMT1, which requires careful follow-up. The diagnostic algorithm requires the inclusion of non-invasive tests of the hepatobiliary system. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

HPB P07 HIDA scan utilisation and its influence on the management of patients with Gallbladder Dysmotility Disorders – A Retrospective Multicentre Cohort Study

Abstract Background Hepatobiliary Iminodiacetic Acid (HIDA) - Cholecystokinin (CCK) and fatty meal scan is widely used in the investigation of patients with acalculour biliary-like pain as they present a significant diagnostic and management challenge to the healthcare system. This scan detects functional capacity of gallbladder in the form of gallbladder ejection fraction (GBEF). GBEF of &amp;lt;35% is consistent with biliary dyskinesia and &amp;gt;80% with hyperkinesia, a recently postulated pathology. Laparoscopic cholecystectomy (LC) remains the treatment of choice of for both the entities. We performed audit of utility of HIDA scan and interpretation of its results across three sites. Methods A retrospective cohort study of patents undergoing HIDA scan across three hospitals between January 2015 and December 2022. Patients with biliary pain according to ROME IV criteria of functional GI disorders were included. Electronic case notes were reviewed and demographics, laboratory results of bilirubin and ALP, radiological investigations, endoscopy result and HIDA scan result. Results A total of 225 patients underwent HIDA scan; median age was 42 years (IQR 34-53) and 194 (86.2%) were female. Median time form the onset of symptoms to HIDA scan was 19 months (IQR 6-24). 35 (15.5%) had GBEF &amp;lt;35%, 157 (69.7%) with GBEF 36-79%, and 33 (14.6 %) had GBEF ≥80. 36 patients had LC after HIDA scan: 19 (52.7%) for biliary dyskinesia, 12 (33.3%) for microlithiasis and/or biliary sludge on EUS and 5 (13.8%) had it for symptoms but normal GBEF. Histopathology of 4 patients had normal gallbladder, while 27 had chronic cholecystitis and/or cholesterosis. Conclusions HIDA scan is vital investigation for recurrent biliary-like pain without presence of gallstones and gallbladder dysmotility is not uncommon in this group of patients. HIDA scan should be more liberally utilised to rule out gallbladder dysmotility. Reporting method of HIDA scan should also be standardised to help interpret the results accurately.

Biliary sludge syndrome induced by cephalosporins in children: clinical and diagnostic markers, management

Biliary sludge can occur when taking medicines (oral contraceptives, cephalosporins, octreotide, furosemide, clofibrate, morphine, calcium preparations, etc.). In particular, 30–40 % of ceftriaxone, which is widely used in pediatric inpatient practice, is excreted with bile, 5–15 % of all side effects of the drug are due to biliary sludge. The mechanism of ceftriaxone-associated biliary sludge is due to the fact that ceftriaxone competes with bilirubin for albumin, which induces an increase in unconjugated bilirubin in the blood. The drug enters the bile in the form of a divalent anion, binds to calcium in ceftriaxone-calcium complexes with inclusions of cholesterol monohydrate crystals and bilirubinate granules. In patients taking cephalosporins, when complaints from the gastrointestinal tract appear, ultrasound screening is mandatory. Children with a family history of gallstone disease and risk factors should undergo ultrasound screening on the 10th day and 1 month after treatment with cephalosporins, even in the absence of complaints. The administration of ursodeoxycholic acid leads to a significant regression of clinical symptoms of biliary sludge and objective ultrasound signs in 2/3 of children after 2 months.

Flea-Borne Typhus Presenting with Acalculous Cholecystitis and Severe Anemia

Background. Flea-borne typhus (FBT), an uncommon illness in the United States, typically presents as a high continuous fever with commonly associated symptoms including headache, myalgias, and rashes on the trunk and extremities. Patients infected with FBT may also present with atypical symptoms. As such, the combination of its relatively low incidence in the United States coupled with its variability in associated symptoms poses a diagnostic challenge for clinicians; early empiric treatment with doxycycline is warranted prior to a definitive diagnosis to reduce the risk of damage to vital organs. Case Report. This case describes a 54-year-old male who presented to an emergency room in Houston, Texas, with one week of constant right upper quadrant abdominal pain and fevers up to 40°C. The patient was initially diagnosed with Grade III severe acute cholangitis after abdominal ultrasound revealed gallbladder sludge and wall thickening without ductal dilatation, but a subsequent endoscopic retrograde cholangiopancreatography was unremarkable. Following intermittent fevers and worsening anemia, the patient was started on oral doxycycline for atypical infection, and an infectious disease workup subsequently returned a positive titer for Rickettsia typhi. He experienced rapid symptomatic and clinical improvement, and the patient was discharged home with a final diagnosis of flea-borne typhus. Conclusion. Albeit uncommon, the presentation of this patient’s symptoms and final diagnosis of flea-borne typhus demonstrates the importance of (1) keeping atypical infections such as FBT in the differential diagnosis and (2) beginning empiric treatment to prevent damage to vital organs if suspicion of FBT is high.

Endoscopic Ultrasound to Identify the Actual Cause of Idiopathic Acute Pancreatitis: A Systematic Review.

Idiopathic acute pancreatitis (IAP) presents a diagnostic challenge and refers to cases where the cause of acute pancreatitis remains uncertain despite a comprehensive diagnostic evaluation. Endoscopic ultrasound (EUS) has emerged as a valuable tool in the diagnostic workup of IAP. This review explores the pivotal role of EUS in detecting the actual cause of IAP and assessing its accuracy, timing, safety, and future technological improvement. In this review, we investigate the role of EUS in identifying the actual cause of IAP by examining the available literature. We aim to assess possible existing evidence regarding EUS accuracy, timing, and safety and explore potential trends of future technological improvements in EUS for diagnostic purposes. Following PRISMA guidelines, 60 pertinent studies were selected and analysed. EUS emerges as a crucial diagnostic tool, particularly when conventional imaging fails. It can offer intricate visualization of the pancreas, biliary system, and adjacent structures. Microlithiasis, biliary sludge, chronic pancreatitis, and small pancreatic tumors seem to be much more accurately identified with EUS in the setting of IAP. The optimal timing for EUS is post-resolution of the acute phase of the disease. With a low rate of complications, EUS poses minimal safety concerns. EUS-guided interventions, including fine-needle aspiration, collection drainage, and biopsies, aid in the cytological analysis. With high diagnostic accuracy, safety, and therapeutic potential, EUS is able to improve patient outcomes when managing IAP. Further refinement of EUS techniques and cost-effectiveness assessment of EUS-guided approaches need to be explored in multicentre prospective studies. This review underscores EUS as a transformative tool in unraveling IAP's enigma and advancing diagnostic and therapeutic strategies.

Conservative treatment of cholelithiasis: the effectiveness of the use of ursodeoxycholic acid

Relevance. Conservative treatment of cholelithiasis is most effective in the early stages of the disease. The use of ursodeoxycholic acid preparations is most justified, taking into account the pathogenesis of the disease. Effective conservative treatment can prevent the development of postcholecystectomy syndrome, the most common complication of surgical treatment. This is a socially significant task.Goal. Conducting conservative treatment with ursodeoxycholic acid to a patient with GI with dynamic monitoring and evaluation of the effectiveness of the therapy. Identification of early signs of the development of cholelithiasis and prevention of factors of the development of concretions in the gallbladder.Materials and methods. A patient with newly diagnosed cholelithiasis was prescribed ursodeoxycholic acid preparation under the control of laboratory and instrumental research methods. Dynamic observation of the patient was carried out during 1 year of treatment, and the previous results of ultrasound examination were also analyzed, which made it possible to identify predisposing factors of stone formation. The appointment of the drug ursodeoxycholic acid made it possible to achieve the goal – to «dissolve» gallstones. Regular ultrasound examination, even in the absence of clinical manifestations, is one of the methods for detecting cholelithiasis at an early stage – biliary sludge in the gallbladder.

Biliary sludge, microlithiasis and gallstone-induced acute pancreatitis are associated with comparable clinical outcome: a single-centre analysis and narrative review of the literature

Biliary sludge, microlithiasis and gallstone-induced acute pancreatitis are associated with comparable clinical outcome: a single-centre analysis and narrative review of the literature

Prospective multicentre study of indications for surgery in patients with idiopathic acute pancreatitis following endoscopic ultrasonography (PICUS).

Cholecystectomy in patients with idiopathic acute pancreatitis (IAP) is controversial. A randomized trial found cholecystectomy to reduce the recurrence rate of IAP but did not include preoperative endoscopic ultrasonography (EUS). As EUS is effective in detecting gallstone disease, cholecystectomy may be indicated only in patients with gallstone disease. This study aimed to determine the diagnostic value of EUS in patients with IAP, and the rate of recurrent pancreatitis in patients in whom EUS could not determine the aetiology (EUS-negative IAP). This prospective multicentre cohort study included patients with a first episode of IAP who underwent outpatient EUS. The primary outcome was detection of aetiology by EUS. Secondary outcomes included adverse events after EUS, recurrence of pancreatitis, and quality of life during 1-year follow-up. After screening 957 consecutive patients with acute pancreatitis from 24 centres, 105 patients with IAP were included and underwent EUS. In 34 patients (32 per cent), EUS detected an aetiology: (micro)lithiasis and biliary sludge (23.8 per cent), chronic pancreatitis (6.7 per cent), and neoplasms (2.9 per cent); 2 of the latter patients underwent pancreatoduodenectomy. During 1-year follow-up, the pancreatitis recurrence rate was 17 per cent (12 of 71) among patients with EUS-negative IAP versus 6 per cent (2 of 34) among those with positive EUS. Recurrent pancreatitis was associated with poorer quality of life. EUS detected an aetiology in a one-third of patients with a first episode of IAP, requiring mostly cholecystectomy or pancreatoduodenectomy. The role of cholecystectomy in patients with EUS-negative IAP remains uncertain and warrants further study.

Machine learning-based decision tool for selecting patients with idiopathic acute pancreatitis for endosonography to exclude a biliary aetiology.

Biliary microlithiasis/sludge is detected in approximately 30% of patients with idiopathic acute pancreatitis (IAP). As recurrent biliary pancreatitis can be prevented, the underlying aetiology of IAP should be established. To develop a machine learning (ML) based decision tool for the use of endosonography (EUS) in pancreatitis patients to detect sludge and microlithiasis. We retrospectively used routinely recorded clinical and laboratory parameters of 218 consecutive patients with confirmed AP admitted to our tertiary care hospital between 2015 and 2020. Patients who did not receive EUS as part of the diagnostic work-up and whose pancreatitis episode could be adequately explained by other causes than biliary sludge and microlithiasis were excluded. We trained supervised ML classifiers using H2O.ai automatically selecting the best suitable predictor model to predict microlithiasis/sludge. The predictor model was further validated in two independent retrospective cohorts from two tertiary care centers (117 patients). Twenty-eight categorized patients' variables recorded at admission were identified to compute the predictor model with an accuracy of 0.84 [95% confidence interval (CI): 0.791-0.9185], positive predictive value of 0.84, and negative predictive value of 0.80 in the identification cohort (218 patients). In the validation cohort, the robustness of the prediction model was confirmed with an accuracy of 0.76 (95%CI: 0.673-0.8347), positive predictive value of 0.76, and negative predictive value of 0.78 (117 patients). We present a robust and validated ML-based predictor model consisting of routinely recorded parameters at admission that can predict biliary sludge and microlithiasis as the cause of AP.

Sonographic Detection of Fetal Cholelithiasis.

Fetal biliary lithiasis is a benign condition characterized by the presence of gallstones in the gallbladder of a developing fetus. It is typically detected incidentally during a routine obstetric echography. The incidence of this condition varies from 0.03% to 2.3%. In most cases, fetal cholelithiasis resolves spontaneously and has an excellent prognosis. However, there are certain risk factors that may contribute to its development. Maternal factors that increase the risk of fetal cholelithiasis include placental abruption, elevated estrogen levels, narcotic use, diabetes, enteral nutrition, and specific medications, such as ceftriaxone, furosemide, and prostaglandin E2. Fetal factors that can contribute to the condition include Rhesus or ABO blood group incompatibility, congenital anomalies affecting the cardiovascular, gastrointestinal, or urinary systems, twin pregnancies with the fetal demise of one twin, genetic anomalies such as trisomy 21, chromosomal aberrations, cystic fibrosis, growth restriction, oligohydramnios, hepatitis, or idiopathic causes. Usually, the gallstones spontaneously resolve before or after birth without requiring specific treatment. However, in rare instances, complications can arise, such as the formation of biliary sludge, inflammation of the gallbladder (cholecystitis), or obstruction of the bile ducts. If complications occur or if the gallstones persist after birth, further evaluation and management may be necessary. Treatment options can include medication, minimally invasive procedures, or, in severe cases, surgical removal of the gallbladder.

Cholelithiasis in children: diagnosis and treatment

Introduction. Cholelithiasis in children is a rare disease. Making a decision on cholecystectomy in children is an urgent problem due to the lack of consensus on the tactics of managing children with cholelithiasis. Aim: determine the indications for surgical treatment of cholelithiasis in children based on laboratory and instrumental examination methods.&#x0D; Materials and methods. The study analyzed twenty seven patients operated on for cholelithiasis from 2018 to 2023.&#x0D; Results. Me = 18.7 months elapsed from the moment of diagnosis of cholelithiasis to surgery. In the prospective part of the work, 27 patients were studied, of which 26 were operated on. In 7 (26%) — the disease proceeded without symptoms, in 20 (74%) — pain syndrome was observed, in 4 — dyspeptic disorders were observed in the form of nausea and vomiting associated with food intake, in 2 — biliary sludge. According to the study, there was no statistically significant change in the level of C-reactive protein (p = 0.4). Analyzing the ESR data before and after surgical treatment, there was no statistically significant difference in the dynamics of this indicator (p = 0.223). In the trend in laboratory parameters, a statistically significant change in the parameters of leukocytes (p = 0.023) and neutrophils (p = 0.014) was revealed in the general blood test before and after surgical treatment.&#x0D; Conclusion. In children diagnosed with uncomplicated cholelithiasis, changes in laboratory parameters before and after surgery are uninformative and unreliable. In children with uncomplicated cholelithiasis, medical treatment was ineffective, as a result of which surgical treatment was indicated. The ineffectiveness of drug treatment and the deterioration of the general condition of the child are indications for surgical treatment. As a minimally invasive surgical intervention, laparoscopic CE is recommended.

MORPHOLOGICAL CHANGES OF THE GALLBLADDER IN PATIENTS WITH CHRONIC CHOLECYSTITIS AND CHOLESTEROLOSIS DEPENDING ON COMORBID PATHOLOGY: CHD. CARDIOSCLEROSIS AND OBESITY

Objective – to study the morphological changes of the gallbladder in patients with chroniccholecystitis and cholesterolosis of the gallbladder depending on comorbid pathologycoronary heart disease (CHD) and obesity. Materials and methods. A retrospective analysis of 300 autopsy protocols of the patientswith obesity, who died from complications of CHD (group A) and 100 protocols ofpathohistological examination of the gallbladder after cholecystectomy for chroniccholecystitis in obese patients (group B) has been carries out. The average age in groupA was 67.3±5.24 years, in group B – 52.8±3.24 years. 157 preparations were studied bythe pathohistological method, for stereometric analysis were selected histopreparationsof 112 cases of autopsy and biopsy of the gallbladder after cholecystectomy. Analysis ofthe morphological state of the gallbladder in patients with I-II degree obesity and CHDwas performed according to the groups.Results. According to autopsy data of deceased patients with CHD. Cardiosclerosiswith obesity of the I-II degree, the morphological features of the lesion of the GB(gallbladder)was comorbidity with chronic cholecystitis: with stones – in 24.3 %, nonstones – in 50.7 % of cases, and xanthogranulomatous cholecystitis was observedin 1.7 % of patients. In 41.7 % of cases, the accompanying cholesterolosis of thegallbladder was determined. Study of the morphological changes of the gallbladderremoved during cholecystectomy in people with CHD. Cardiosclerosis and obesity ofthe I-II degree established the presence of chronic cholecyctitis in 100.0 % of cases:calculous cholecystitis prevailed in 73.0 %, non-calculous cholecystitis accountedfor 20.0 % of cases, and in 7.0 % of patients, xanthogranulomatous cholecystitis wasobserved. In 57.0 % of cases, an accompanying cholesterolosis of the gallbladderwas determined: calculous cholecystitis – 40.0 % and non-calculous cholecystitis – in17.0 % with a predominance of reticular (64.9 %) form of diffuse type (56.1 %), mixed(reticular- polypous) (24.6 %) and polypous forms (10.5 %). Among patients with CHD.Cardiosclerosis and obesity, chronic cholecyctitis is more often observed in women(3.2:1), chronic cholecyctitis with cholesterolosis of the gallbladder – also in women – inthe ratio of men: 2.8:1. Morphological signs of chronic cholecyctitis in patients withCHD and obesity are probable thickening of the gallbladder wall (in the range of 2.6-3.0times (p&lt;0.05)), in case of the concomitant cholesterolosis of the gallbladder – 3.5-3.8times (р&lt;0.05), biliary sludge (100.0 %).Сonclusions. Among patients with coronary heart disease and obesity, chroniccholecystitis and chronic cholecystitis combined with cholesterosis of the gallbladderoccur more often in women (3.2:1 and 2.8:1, respectively). Morphological changes ofgall bladders removed during cholecystectomy in persons with ischemic heart diseaseand obesity of the I-II degree indicate the presence of chronic cholecystitis in 100.0 %of cases.

The strategy of laparoscopic surgery for asymptomatic antenatally diagnosed choledochal cyst

BackgroundThe aim was to investigate the characteristics, surgical management, and outcomes of asymptomatic patients with antenatally diagnosed choledochal cysts (ADCCs) and to justify the strategy of laparoscopic surgery (LS) for them in our hospital.MethodsWe developed our LS strategy for asymptomatic ADCCs. Patients with asymptomatic ADCCs who underwent LS or open surgery (OS) during January 2010 and January 2020 were included. Patients with recorded symptomatic ADCCs were exclude. All data of group LS and group OS were statistically compared and analyzed.ResultsTwenty-five patients received LS and 18 patients received OS were included. There was no significant difference in baseline characteristics between the groups. A total of 65.1% of biliary sludge formation was detected preoperatively by ultrasonography (US) (72.0% in group LS, 55.6% in group OS, P = 0.26). Compared to the OS group, the LS group had a longer operative time (313.4 ± 27.2 vs. 154.0 ± 11.9 min, P = 0.02), shorter postoperative fasting period (3.1 ± 1.2 vs. 6.2 ± 2.3 days, P = 0.03), and shorter postoperative hospital stay (5.1 ± 1.9 vs. 9.2 ± 1.1 days, P = 0.03). The incidence of late complications, such as reflux cholangitis, adhesive intestinal obstruction, and biliary enteric anastomotic stricture with stone formation, was not significantly different between the two groups. The liver function and liver stiffness of all patients in the two groups were normal.ConclusionsBased on the strategy for asymptomatic ADCCs in our hospital, the perioperative safety and midterm follow-up results after LS were satisfactory and comparable to those after OS.

Physicochemical properties of blood and urine in patients with alcohol-induced chronic pancreatitis against the background of obesity

In this article, the authors present the results of their studies of the physicochemical properties of blood and urine in patients with chronic alcohol-induced pancreatitis (CAP) combined with obesity.&#x0D; 110 patients with CAP in the acute stage against the background of obesity were examined. The ages of the examined patients ranged from 23 to 60. There were 77 (70.0%) men and 33 (30.0%) women among the patients. We also examined 30 almost healthy people aged 20 to 60 (the control group).&#x0D; There are significant changes in the physicochemical properties of blood and urine in patients with CAP against the background of obesity. Indices of interfacial tensiometry and rheometry of these biological fluids correlate with other clinical, laboratory, and instrumental data in patients with CAP combined with obesity. This allows us to recommend the assessment of dynamic surface tension and rheometric indices of blood and urine for screening and an integral assessment of the functional state of the pancreas in comorbidity. In addition, it is reasonable to use the results of interfacial tensiometry and rheometry for screening the metabolic syndrome in patients with CAP against the background of obesity. In the metabolic syndrome, there is a significant increase in the surface tension 3 of the blood; in the absence of this syndrome, on the contrary, the surface tension 3 of the blood is significantly reduced.&#x0D; In patients with biliary sludge and cholelithiasis, the blood viscoelasticity index (E) was significantly lower (23.18±1.07 mN/m), while without concomitant diseases of the biliary tract, the blood E was equal to 27.84±1.08 mN/m (p&lt;0.05). Both with and without changes in the biliary system, blood E in patients with CAP against the background of obesity was significantly lower than in the control group.&#x0D; The prospects of research are to study the dynamics of tensiometry and rheometry of biological fluids in CAP combined with obesity under the influence of treatment in order to study the possibility of using these indices in the integrated assessment of the effectiveness of therapy.

Novel Technique of Endoscopic Ultrasonography for the Differential Diagnosis of Gallbladder Lesions and Intraductal Papillary Mucinous Neoplasms: A Single-Center Prospective Study

Detective flow imaging endoscopic ultrasonography (DFI-EUS) is an innovative imaging modality that was developed to detect fine vessels and low-velocity blood flow without contrast agents. We evaluate its utility for the differential diagnosis of gallbladder lesions and intraductal papillary mucinous neoplasms (IPMNs). We enrolled patients who underwent DFI-EUS, e-FLOW EUS, and contrast-enhanced EUS for gallbladder lesions or IPMNs. The detection of vessels using DFI-EUS and e-FLOW EUS was compared with that via contrast-enhanced EUS and pathological findings. The vessel pattern was also categorized as regular or irregular. Of the 33 lesions included, there were final diagnoses of 13 IPMNs and 20 gallbladder lesions. DFI-EUS was significantly superior to e-FLOW EUS for discriminating between mural nodules and mucous clots and between solid gallbladder lesions and sludge using the presence or absence of vessel detection in lesions (p = 0.005). An irregular vessel pattern with DFI-EUS was a significant predictor of malignant gallbladder lesions (p = 0.002). DFI-EUS is more sensitive than e-FLOW-EUS for vessel detection and the differential diagnosis of gallbladder lesions and IPMNs. Vessel evaluation using DFI-EUS may be a useful and simple method for differentiating between mural nodules and mucous clots in IPMN, between solid gallbladder lesions and sludge, and between malignant and benign gallbladder lesions.

Abstract #1407180: Drug Induced Acute Pancreatitis Secondary to Ezetimibe

Drug induced acute pancreatitis (DIAP) is a rare clinical entity with incidence of <2% in general population. Most cases are typically mild and have excellent prognosis but prompt diagnosis and cessation of offending drug is important to avoid adverse outcomes. A 58-year-old female former smoker with history of COPD and hyperlipidemia presented to the hospital with sudden onset abdominal pain radiating to the back associated with nausea and vomiting for 12 hours. On arrival vitals were normal and physical examination showed epigastric tenderness with negative murphy’s sign. Labs showed normal CBC and CMP with elevated serum lipase (2469 U/L – Normal 16 - 61 U/L) concerning for acute pancreatitis. CT abdomen and pelvis showed normal biliary tract. US of the abdomen showed no evidence of gall stone or biliary sludge. Serum lipid panel showed total cholesterol of 193, HDL of 66, LDL of 111 and triglyceride of 87. Serum Calcium was normal. Detailed history revealed no alcohol but that patient recently started ezetimibe 10 mgs daily 8 weeks prior to present due to history of statin intolerance. Her only other medication was inhaled Albuterol taken as needed. Immune panel include IgG-4 was negative. Patient was diagnosed with drug induced acute pancreatitis secondary to ezetimibe, and was managed conservatively cessation of ezetimibe, pain meds and bowel rest. Her overall condition improved in 48 hours and diet was progressed. She was discharged with outpatient follow up. Serum lipase dropped to 74 U/L prior to discharge. Drug induced pancreatitis account for ∼ 5% of all cases of pancreatitis. There is limited data on the exact mechanism by which drugs can induce pancreatitis as most evidence is bases on case reports or meta-analysis. On the basis of these case reports drugs are classified from class I-IV depending on the probability to cause pancreatitis. Some proposed mechanisms include immunologic reactions, direct toxic effect, accumulation of a toxic metabolite, ischemia, intravascular thrombosis, and an increased viscosity of pancreatic juice. Though most cases are mild the identification of the offending drug is crucial to prevent ongoing damage and recurrence. However, in most instances the diagnosis of drug induced pancreatitis and identification of offending drug can be challenging due to the presence of multiple agents. Current proposed criteria for identification include: 1) Pancreatitis develops during treatment with the drug, 2) Other likely causes of pancreatitis are not present 3) Pancreatitis resolves upon discontinuation of the drug and 4) Pancreatitis usually recurs upon re-administration of the drug. Our patient fulfilled 3 of the above criteria which suggest Ezetimibe induced Pancreatitis. Prior to this case there is one more case reported cases of Ezetimibe induced Pancreatitis but in both the cases there is no re-challenge of Ezetimibe which makes it a Class IV drug to cause pancreatitis.

Novel anti-reflux biliary metal stent with a distal tapered end for distal malignant biliary obstruction: a feasibility study.

Background and study aims We developed a self-expandable metallic stent (SEMS) with a distal tapered end to reproduce the physiological bile flow with a pressure gradient due to the difference in the diameter. We aimed to evaluate the safety and efficacy of the newly developed distal tapered covered metal stent (TMS) for distal malignant biliary obstruction (DMBO). Patients and methods This single-center, prospective, single-arm study was conducted in patients with DMBO. The primary endpoint was time to recurrent biliary obstruction (TRBO), and the secondary endpoints were the survival time and incidence of adverse events (AEs). Results Thirty-five patients (15 men, 20 women; median age, 81 years [range: 53-92]) were enrolled between December 2017 and December 2019. The primary diseases were pancreatic head cancer in 25 cases, bile duct cancer in eight cases, and ampullary cancer in two cases. TMS was successfully placed in all cases. Acute cholecystitis occurred as an early AE (within 30 days) in two cases (5.7 %). The median TRBO was 503 days, median survival time was 239 days. RBO was observed in 10 cases (28.6 %), and the causes were distal migration in six cases, proximal migration in two cases, biliary sludge in one case, and tumor overgrowth in one case. Conclusions Endoscopic placement of the newly developed TMS in patients with DMBO is technically feasible and safe, and the TRBO was remarkably long. The anti-reflux mechanism based on the difference in diameter may be effective, and a randomized controlled trial with a conventional SEMS is required.

Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis

ObjectiveIn up to 20% of patients, the aetiology of acute pancreatitis (AP) remains elusive and is thus called idiopathic. On more detailed review these cases can often be explained through...