Biliary Tract In Patients Research Articles

Sarcopenia Negatively Influences Translocations of Gut Microbiome into the Pancreas and Biliary Tract in Patients with Pancreatic Adenocarcinoma

Wagner, Doris MD; Wienerroither, Valerie MD; Ribeiro Skreinig, Marilia A MD; Faschinger, Florian MD; Kornprat, Peter MD; Werkgartner, Georg MD; Mischinger, Hans J MD Author Information

Sarcopenia Negatively Influences Translocations of Gut Microbiome into the Pancreas and Biliary Tract in Patients with Pancreatic Adenocarcinoma

Sarcopenia Negatively Influences Translocations of Gut Microbiome into the Pancreas and Biliary Tract in Patients with Pancreatic Adenocarcinoma

SP6.1.7 Meta-analysis of procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography in patients with previous Roux-en-Y gastric bypass surgery

Abstract Aims To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery. Methods We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data. Results A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137 minutes (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5,I2=0%), papillary access success was 95.3% (95% CI 92.5-97.5,I2=0%), cannulation success was 95.3% (95% CI 92.5-97.5,I2=0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1,I2=0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2=0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6,I2=0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8,I2=17%), cholangitis in 1.7% (95% CI 0.5 to 3.6,I2=0%), and perforation in 3.7% (95% CI 1.8- 6.3,I2=0%). The length of hospital stay was 3 days (95% CI 2-4). Conclusions Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.

Hepatobiliary continuum: non-alcoholic fatty liver disease, cholelithiasis ... what else?

The relationship between metabolic non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GSD) is complex and seemingly interrelated. There is no doubt that there is an increased risk of cholelithiasis in patients with NAFLD, which is primarily associated with general pathogenetic mechanisms. These include central and peripheral insulin resistance, changes in the expression of transcription factors (hepatic X-receptor, farnesoid X-receptor (FXR) and membrane bile acid receptors (TGR5)). At the same time, the effect of gallstone disease on the course of NAFLD is assumed, although the pathogenetic factors of this association are still insufficient. There are accumulating data on an increased risk of other pathologies of the biliary tract in patients with NAFLD, in particular, of gallbladder polyps and tumors of the biliary tract. Recently there have been convincing data on the role of cholecystectomy in the progression of NAFLD, which may be due to disruption of endocrine balance and signaling function of bile acids, as well as the development of bacterial overgrowth in the small intestine. General therapeutic approaches to the treatment of interrelated hepatobiliary pathology may include new generation insulinsensitizers, FXR agonists, and ursodeoxycholic acid. The link between NAFLD and the pathology of the biliary tract is complex and multifaceted, and its further study opens up prospects for the development of new methods of treatment.

ANATOMICAL VARIATIONS OF EXTRA HEPATIC BILIARY SYSTEM IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY IN CMH & PEMH RAWALPINDI

Objective: To assess the frequency of anatomical variations of the extra-hepatic biliary tract in patients undergoing laparoscopic cholecystectomy in Combined Military Hospital & Pak Emirates Military Hospital Rawalpindi.
 Study Design: Comparative cross-sectional study.
 Place and Duration of Study: Department of General Surgery, Combined Military Hospital & Pak Emirates Military Hospital, Rawalpindi, from Mar to Aug 2017.
 Methodology: A total of 136 patients of either gender with cholelithiasis of more than one month were included. Participants were distributed into equal number of groups for both hospitals by lottery method. All the participants had under gone laparoscopic cholecystectomy by consultant general surgeon or senior registrar under direct supervision. Structures mainly assessed for variations were gall bladder, cystic duct, common hepatic duct, supraduodenal part of common bile duct, cystic artery, and hepatic artery which were characteristically encountered during laparoscopy.
 Results: Overall Extra hepatic biliary variations were 136 (23%), at Combined Military Hospital 68 (16%) and Pak Emirates Military Hospital 68 (29.4%). Gall bladder anomaly was seen in 3% patients, cystic duct anomaly 4.4%, supraduodenal part of common bile duct anomaly 0.7%, cystic artery anomaly 11% and hepatic artery anomaly was seen in 3.6% patients (p>0.05).
 Conclusion: Anatomic variations were found to be not uncommon in our set up. Thus, there is a need for doctors to continuously refresh knowledge of normal anatomy and the variants of biliary tract.

Substantiation of the method for resolving obstructive jaundice in operable patients with malignant hepatopancreatobiliary tumors

The OBJECTIVE was to determine the best option for decompression of the biliary tract in patients with malignant neoplasms of the hepatopancreatobiliary zone to resolve obstructive jaundice before performing radical surgery.METHODS AND MATERIALS. The study of the results of examination and surgical treatment of 325 patients with mechanical jaundice caused by malignant tumors of the hepatopancreatobiliary zone allowed us to identify 93 (28.6 %) patients who initially underwent drainage operations on the bile ducts, and then radical surgical interventions.RESULTS. Stage I of the oncological process according to the TnM system (8 reconsideration) was determined in 16 (17.2 %) patients, stage II – in 71 (76.3 %) and stage III – in 6 (6.5 %). According to the ECOG scale, I or II scores were determined in all patients before radical surgery. Tumors of the head of the pancreas, common bile duct and large papilla of the duodenum led to the I level of biliary tract blockage in 81.7 % of patients. Tumors of the common bile duct and head of the pancreas (involving the cystic duct), tumors of the gallbladder and Klatskin (Bismuth–Corlette I) caused the II level of biliary tract blockage in 12.9 % of the examined patients. Klatskin tumor (Bismuth–Corlette II, IIIa, IIIb,) caused bile duct blockage of III level (5.4 % of patients). Pancreatoduodenal resection was performed in 85 patients, endoscopic papillectomy – 3, bile duct resection – 2 and bile duct resection in combination with liver resection – 3. The choice of a rational option for decompression of the biliary tract, taking into account the level of their blockage and the severity of the general somatic condition of patients, provides the possibility of performing radical surgery.CONCLUSION. Before performing radical surgery, obstructive jaundice in operable patients with malignant tumors of the hepatopancreatobiliary zone at the blockage of I level can be effectively and safely resolved by cholecystostomy, at the blockage of II level – endoscopic stenting, while the blockage of III level – percutaneous-transhepatic cholangiodrainage.

Procedural Outcomes of Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Roux-en-Y Gastric Bypass Surgery: a Systematic Review and Meta-analysis.

To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery. We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data. A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137min (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5, I2= 0%), papillary access success was 95.3% (95% CI 92.5-97.5, I2= 0%), cannulation success was 95.3% (95% CI 92.5-97.5, I2= 0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1, I2= 0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2= 0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6, I2= 0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8, I2= 17%), cholangitis in 1.7% (95% CI 0.5-3.6, I2= 0%), and perforation in 3.7% (95% CI 1.8-6.3, I2= 0%). The length of hospital stay was 3days (95% CI 2-4). Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.

Abnormalities of the biliary tract in patients with autosomal recessive polycystic kidney disease (ARPKD)

Abnormalities of the biliary tract in patients with autosomal recessive polycystic kidney disease (ARPKD)

RESULTS OF ACUTE PURULENT CHOLANGITIS TREATMENT WITH GENETIC ENGINEERING ANALOGUE OF DORNAZE-ALPHA NATURAL ENZYME

The aim: To evaluate the effectiveness of the proposed method of surgical treatment of patients with acute purulent cholangitis. Materials and methods: The research is based on the analysis of the treatment results in 104 patients with acute purulent cholangitis. The volume of surgical interventions on the biliary tract in patients was as follows: endoscopic papillosphincterotomy (EPST) + naso-biliary drainage; EPST + laparoscopic cholecystectomy; cholecystectomy + choledocholithotomy + drainage of the common bile duct. Results: The APACHE-2 scale assessment for patients in the control group was 12,80 ± 1,73, with the SOFA scale - 4,32 ± 0,31 points. Accordingly, the assessment for patients in the main group with the APACHE-2 scale is 11.76 ± 0.81, with the SOFA scale - 4.33 ± 0.79 points. The results obtained in both the control and the main group indicate that the physiological reactions of the organism to the disease, treatment, development of organ dysfunction are reflected in the integrated severity assessment scales. Conclusion: The performed analysis of clinical and laboratory results of treatment in both groups established the high efficiency of the proposed treatment method in patients with acute purulent cholangitis, which promotes the more rapid medical and social rehabilitation in this category of patients.

Biliary decompression in patients with obstructive jaundice

Aim. Evaluation of the biliary tract decompression methods and their use results, in patients with obstructive jaundice of various etiologies on the basis of our own clinical material.Material and Methods. A retrospective analysis of the biliary tract drain results in 6935 patients with obstructive jaundice with benign and tumor etiology. In 87% cases there was B Class of obstructive jaundice. In 93% we observed mild (A Class) obstructive jaundice. For the biliary tract drainage we used laparoscopic or open surgical access. The retrograde drain we used in sixty-seven percent cases with obstructive jaundice B Class. In sixty-six percent cases of obstructive jaundice C Class, we used antegrade drain.Results. The biliary decompression was effective in 98%. Regarding the rate and timing of bilirubin reduction, all the applied methods showed a similar result, however, the greatest number of complications and fatalities we recorded in patients after antegrade percutaneous drain of the biliary tract and transabdominal access. In 36% the performed interventions became the final treatment option, and the sixty-one percent of patients underwent two-stage treatment. The overall mortality rate was 3%.Conclusion. The use of percutaneous drainage is justified for obstructive jaundice with tumor origin, and possible radical surgical treatment. Transabdominal access drainage for benign etiology of obstructive jaundice in compensated patients can be safely used. Transduodenal endoscopic drain is an alternative to other methods biliary tract drain in severe and medium obstructive jaundice of benign etiology. The same drain method can be used for drainage of biliary tract in patients with tumors of the hepatopancreatobiliary zone organs, as a palliative treatment.

Hepatocholescintigraphy in diagnosis of functional state of biliodigestive anastomoses

Aim. To identify diagnostic value of hepatocholescintigraphy for evaluation of functional state of biliodigestive anastomoses (BDA).Material and methods. 99mTc-IDA hepatocholescintigraphy was applied in 52 patients to evaluate function of biliodigestive anastomoses.Results. Scintigraphic signs of “bowel-anastomosis” and/or “BDA-intrahepatic bile ducts” reflux were revealed in 14 (27%) cases. Obstruction of biliodigestive anastomosis occurred in 3 (5.7%) patients. Normal bile flow through BDA was observed in 10 (19.2%) patients, impaired passage – in 21 (40.3%) cases. Tracer delay in intrahepatic bile ducts was noted in 21 (25.0%) cases, signs of adhesive process near deferent bowel – in 3 (3.8%) cases.Conclusion. Hepatocholescintigraphy is highly effective method to assess biliary tract in patients after Roux-en-Y biliodigestive anastomoses formation.

FRI-372-Next generation sequenzing outperforms standard microbiological cultivation for detection of bacteria in the biliary tract in patients with ischemic type biliary lesions and/or anastomotic stricture

FRI-372-Next generation sequenzing outperforms standard microbiological cultivation for detection of bacteria in the biliary tract in patients with ischemic type biliary lesions and/or anastomotic stricture

Influence of Preoperative Endoscopic Retrograde Cholangiopancreatography (ERCP) on Bacterial Colonization of Biliary Tract in Patients Surgically Treated for Obstructive Jaundice.

Introduction:Cancelling elective procedures on the day of surgery presents a constant problem in all higher-level medical facilities, and the research of causes, consequences and possible solutions is the duty of every facility in order to enhance the quality of healthcare services.Methods:This prospective study included all patients that were scheduled for surgery from March 2016 to November 2018 in the operating rooms at our Department of Surgery, including both performed and cancelled cases. Cases by different surgical departments (general surgery, gynecology, orthopedics, urology, plastic surgery, ophthalmology and otorhinolaryngology) were all included.Results:Out of 8201 planned elective procedures from March 2016 to November 2018 at the General Hospital “Abdulah Nakas”, 7825 cases were performed and 376 cases (4.58%) were cancelled on the day of surgery. The most common reasons for cancelling a surgical procedure on the day of surgery were: lack of time to perform surgery, (33.51%), surgery cancelled due to medical/anesthetic reasons, (31.38%), surgical procedure cancelled by the surgeon on the day of surgery, (11.97%).Conclusion:This study has shown that the percentage of elective cases cancelled on the day of surgery at our institution stands at an acceptable 4.58%. The most common reasons for case cancellation on the day of surgery were identified. The majority of reasons for cancellation were avoidable, which means that appropriate steps could contribute to lowering the percentage of cancelled elective cases and an improved quality of healthcare services.

The method of treatment forms hypotonic
 dyskinesia of biliary tract in patients with chronic acalculous cholecystitis.

Aim. To determine the rational volume of conservative therapy with form of hypotonic biliary dyskinesia and vegetative disorders in patients with chronic acalculous cholecystitis (CAC). Material and methods. The comparative retro- and prospective analysis of conservative treatment in 114 patients with CAC, who had been treated in the clinic the clinic of surgery. K.T. Ovnatanyana DonNMU of M. Gorky from 2008 to 2015. Among them were 67 females (59.1%) and 47 (40.9%) males at the age of 43,0 ± 6,7 years. The following methods were used to patients: biochemical blood analyses, ultrasound of hepatopancreatoduodenal area, fractional chromatic duodenal intubation with microscopic, biochemical and bacteriological studies of bile, the dynamic ultrasound examination of the gallbladder with test meal. All patients were divided into two homogeneous groups of 70 people. 1st group (main one) received treatment based on the type of dyskinesia of gallbladder and vegetative disorders (Patent of the Russian Federation № 2589900 from 02.06.2015), and 44 people. 2nd group (compare one) got only standard conservative therapy (table №5, holekinetiki, choleretic and others.). Results. The treatment program of CAC consisted of dietotherapy, drug therapy during the exacerbation; pain relief; using of choleretic drugs; antibiotic therapy; normalization of the functions of the autonomic nervous system; immunomodulatory therapy, and improving of the general reactivity of the organism. At the hypotonia gallbladder good effect was obtained of using of Gerbastress with Polyphytohol and Vitam (Patent of the Russian Federation № 2589900 from 02.06.2015). In the 1st group various complications were noted in 2.1%, in the 2nd group - in 5.4%. In a remote period (after 1-5 years) the best indicators of the quality of life were in the 1st group. Conclusions. Using developed an improved method of treatment causes a more expressed in comparison with the control group, a reduction of pain, dyspeptic and asthenic-vegetative syndromes, improve the functional state of the biliary tract and biochemical indices of bile, improving the quality of life on all scales by 1.3-1.7 times .

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

Background: The prevalence and increase of obesity in the world are that 2.3 billion adults were overweight and 700 million adults were obese in 2015. In the context of the morbid obesity pandemic, bariatric surgery was presented as a gold standard treatment. It is known that the prevalence of cholelithiasis is 3 to 4 times higher in morbidly obese patients when compared to the general population. Literature reports that the first attempts to approach the biliary tract in patients with gastric bypass in Roux-en-Y, were performed transorally and had resulted in low success rates. The aim of this study was to analyze the results of the use of the endoscopic transgastrostomy technique for the treatment of biliary tract diseases in patients submitted to Y-de-Roux bypass. Methods: Between August 2010 and December 2014, procedures of transgastrostomy endoscopic retrograde cholangiopancreatography (TG-ERCP) were performed in six patients, previously submitted to Roux-en-Y gastric bypass for treatment of morbid obesity. Results: All patients were successfully submitted to procedures for duodenal papilla catheterization, cholangiography, and endoscopic papillotomy. No complications related to the surgical or endoscopic procedure were observed in the cases described, despite the small sample studied and also the variation of age and body mass index (BMI). Conclusions: The technique described in the current study has been shown to be safe and effective. The possibility of performing it in single surgical time, as well as the use of conventional duodenoscopes and their accessories, make it a choice in patients undergoing Roux-en-Y gastric bypass. J Curr Surg. 2017;7(4):58-63 doi: https://doi.org/10.14740/jcs336e

The peculiarities of the indexes of endogenous intoxication depending on concomitant pathology of the biliary tract in patients with obesity and non-alcoholic fatty liver disease

Аim – to study the features of indicators of endogenous intoxication (EI) as a function of the presence of various pathology of the biliary tract (BT) in patients with comorbid course of the obesity (OB) in combination with non-alcoholic hepatic steatosis (NAHS) or nonalcoholic steatohepatitis (NASH).Materials and methods. The study involved 200 patients with OB in conjunction with non-alcoholic fatty liver disease (NAFLD) and BT pathology, who at the time of sonographic and morphological study of liver biopsy revealed signs of hepatic steatosis: 100 patients with OB and NAHS, 100 – with OB and NASH. Depending on BT pathology patients with OB and NAHS and OB and NASH were divided into three subgroups: OB and NAHS or OB and NASH with chronic non-calculous cholecystitis (CNC); OB and NAHS or OB and NASH with chronic calculous cholecystitis (CCC); OB and NAHS or OB and NASH in patients with postcholecystectomical syndrome (PCES). The control group consisted of 20 practically healthy persons (PHP). Indicators of EI were determined by the content of middle weight molecules (MWM), their fractional composition: MWM-λ-210, MWM-λ-254, MWM-λ-280, concentration of copper (Cu) in blood serum.Results. It was revealed that high levels of MWM, MWM-λ-210, MWM-λ-254, MWM-λ-280, and Cu were observed in patients with the OB and NAHS or NASH with concomitant CNC and often with CCC, and lowest with concomitant PCES in relation to PHP (p<0.05 to p<0.001) and when compared with CCC.Conclusion. OB in combination with NAFLD on the background pathology of BT is accompanied by clinical symptoms of EI, which manifest itself in reliable laboratory growth of MWM, their fractional composition, and Сu compared to PHP (p<0.05 to p<0.001) and depend on the existence of various pathologies on the part of BT.

Gender and Ethnic Variations of Biliary Dilatation in Individuals on Methadone Maintenance Treatment: A Retrospective Observational Study in Inner City Population

Introduction: Individuals with opioid dependency has been traditionally treated with Methadone in drug rehabilitation programs. Biliary dilatation can result from several pancreto-biliary diseases including choledoholithiasis and malignancies. However, non-pathological dilatation of biliary duct can result from chronic methadone use. We designed our study to evaluate gender and ethnic variations of biliary dilatation in individuals on Methadone Maintenance Treatment (MMT). Methods: We conducted cross sectional observational study of all patients admitted to out hospital who are currently enrolled in MMT program and receiving methadone. We excluded patients taking methadone for pain management and palliative purposes. We also excluded patients with choledocholithiasis, pancreato-biliary malignancies and had cholecystectomy in the past. We collected demographic, laboratory and ultrasound imaging details by accessing our electronic medical records. We divided the patients into two groups based on common bile duct dilatation of more than 6 mm. Data was analyzed using standard statistical methods and JMP 12 software. Results: There were a total of 176 patients who met inclusion criteria. There was no difference in ethnicity and age between the two groups (Table 1). We also did not notice any difference in mean methadone dosage between the two groups. However, we observed more females (50 % vs 36% p 0.04) in the group with biliary dilatation compared to group without biliary dilatation. We also observed that mean CBD diameter in females is more than their male counter parts (6.8 mm vs. 5.8 mm, p 0.03)Table 1Conclusion: Methadone has been known to be associated with non-pathological biliary dilatation. Our study concluded that female gender is more commonly associated with biliary dilatation in individuals on MMT. We also conclude that mean biliary diameter is higher in females compared to males. Even though common physiological pathway can lead to non-pathological dilatation of biliary tract in patients on MMT, females are more likely to have biliary dilatation. Further research at molecular level can track the physiological phenomenon leading to these changes.

NON-ALCOHOLIC STEATOHEPATITIS IN PATIENTS WITH OBESITY: INTERCONNECTION BETWEEN BODY MASS, CHANGES OF LIPID METABOLISM AND CONCOMITANT PATHOLOGY OF BILIARY TRACT

Aim – to study the main indices of lipid blood spectrum, which changes lead to DL formation, depending of body mass index (BMI) and concomitant pathology of biliary tract in patients with NASH and obesity. Materials and methods. There were examined 100 patients with NASH in combination with obesity and BT pathology, in which during sonographic or morphological study of bioptat of the liver were revealed the signs of hepatic steatosis. Among patients were 40 men and 60 women. The mean age of patients – (54,68±1,15) years old. The control group included 20 practically healthy persons (PHP). BMI was determined by Quetelet formula. Depending of the degree of BMI increase all patients with NASH and obesity were divided into three groups: 1 group – with BМI 25-29,9 kg/m2 – EBM; 2 group – with BMI 30-34,9 kg/m2 – obesity of I degree; 3 group – with BMI 35-39,9 kg/m2 – obesity of ІІ degree. All examined patients had concomitant pathology from BT side. Depending on BT pathology all patients were also divided into 3 groups: NASH with chronic non-calculous cholecystitis (CNC); NASH with chronic calculous cholecystitis (CCC); NASH in patients after laparoscopic cholecystectomy (LCE) with concomitant postcholecystectomical syndrome (PCES). For characteristic of lipid exchange were determined the general cholesterol (GCS), general lipids (GL), triglycerides (TG), lipoproteins of the low density (LDL), lipoproteins of the high density (HDL). DL phenotype was determined by D.S. Fredrickson classification with modern additions. Results. Analysis of lipid changes in patients with NASH demonstrated the reliable increase of GCS with parallel rise of TG, GL, LDL, fixed at increase of BMI relative to PHP (р&lt;0,05, р&lt;0,001) and to patients of other groups (р&lt;0,05). Maximal values of GCS, TG, GL and also LDL were determined in 2 and 3 groups of observation at obesity of I and II degrees. There was registered the reliable decrease of HDL content in most patients of 3 group relative to the ones of 2 group, (р&lt;0,01) and of 1 one. The level of GCS, TG, GL and LDL was almost equally increased in all groups of observation of NASH: with concomitant CNC, CCC and in patients with PCES relative to PSP, (р&lt;0,001). HDL indices were equally decreased at concomitant CNC and CCC relative to the patients with PCES background with HDL level within physiological norm (р&lt;0,001, рF=0,009). There are separated two main phenotypes of DL: IIa and IIb that were typical for patients with NASH and obesity with BT pathology. It was established, that IIb phenotype of dyslipidemia was most often observed in patients with BMI 30-34,9 kg/m2 and 35-39,9 kg/m2. Discussion. There were determined the features of changes of lipid blood spectrum of in this category of patients that are manifested by variability of disorders from hypercholesterolemia and hypertriglyceridemia on the background of increase of GCS, TG, GL, LDL and decrease of HDL. The progression of lipid disorders in patients with NASH in combination with obesity and BT pathology depends on increase of BMI parameters. The concomitant pathology from BT side partially influenced the indices of lipid blood spectrum. Thus, the low level of HDL in patients with NASH in combination with obesity and concomitant CNC and CCC can be explained by the intense inflammatory processes in BT, attended with disorder of indices of lipid profile with decrease of HDL and increase of GCS, TG, GL, LDL. Conclusion. Progression of intensity of lipid disorders in patients with NASH in combination with obesity and BT pathology depends on increase of BMI parameters. The concomitant BT pathology partially influences the parameters of lipid blood spectrum. HDL was equally decreased in all patients with NASH at CNC and CCC relative to patients with concomitant PCES and HDL level within physiological norm. At NASH in combination with obesity at increase of BMI the DL phenomena more often appear in patients. There are separated two main phenotypes of dyslipidemias: IIa and IIb.

Применение антеградного дренирования желчевыводящих путей у пациентов с нерезектабельными опухолями органов билиопанкреатодуоденальной зоны, осложненной механической желтухой

Применение антеградного дренирования желчевыводящих путей у пациентов с нерезектабельными опухолями органов билиопанкреатодуоденальной зоны, осложненной механической желтухой

Characteristic Findings of Primary Sclerosing Cholangitis on Endoscopic Retrograde Cholangiography: Which is the Most Common Finding?

BackgroundPrimary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease and one of the most common indications for liver transplantation in adults. There are conflicting data regarding characteristic findings of PSC disease on endoscopic retrograde cholangiography (ERCP). We undertook this study to clarify whether there is a specific pattern of involvement of the biliary tract in patients with PSC and to evaluate features of PSC disease on ERCP in order to be able to manage this disease better.MethodsThis retrospective study included 45 patients admitted to Taleghani Hospital in 2004–2010 and diagnosed to have PSC on the basis of typical cholangiographic findings in combination with clinical and laboratory data. Patients suspected to have secondary sclerosing cholangitis were excluded. Demographic and clinical data were recorded, along with cholangiographic findings and the frequency of large duct and small duct PSC.ResultsForty-five patients of mean age 34.8 (range 15–66) years were included. Twenty-nine patients (64.4%) had inflammatory bowel disease, and the frequency of large duct PSC and small duct PSC was 93.4% and 6.6%, respectively. The intrahepatic ducts alone were involved in 11 (24.4%) patients and the extrahepatic ducts were involved in 14 (31.1%), with 17 (37.7%) patients having both intrahepatic and extrahepatic PSC. Three (6.6%) patients did not have bile duct involvement on ERCP, and their disease was diagnosed by liver biopsy as small duct PSC. The most common type of cholangiographic feature of intrahepatic duct involvement was type 2, found in 15 (33.3%) patients, with type 3 being the most common type of extrahepatic duct involvement and detected in 16 (35.5%) patients.ConclusionOur study demonstrates that the most common PSC finding on ERCP is involvement of both the extrahepatic and intrahepatic bile ducts, with small duct PSC being less common than large duct PSC.