Type Of Stricture Research Articles

S762 Evaluation of Clinical Variables, Radiological Visual Analog Scoring, and Radiomics Features on MR Enterography for Characterizing Severe Inflammation and Fibrosis in Stricturing Crohn’s Disease

S762 Evaluation of Clinical Variables, Radiological Visual Analog Scoring, and Radiomics Features on MR Enterography for Characterizing Severe Inflammation and Fibrosis in Stricturing Crohn’s Disease

Endoscopic versus percutaneous intervention for palliation in malignant hilar bile duct obstruction – A comparative cohort study

BackgroundBiliary drainage in patients managed palliatively for malignant hilar obstruction can be achieved by endoscopic transpapillary stenting using endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic stent or catheter placement using percutaneous transhepatic cholangiography (PTC). This study compares ERC and PTC drainage for malignant hilar bile duct obstruction. MethodsA retrospective study of drainage procedures at two academic hospitals was conducted from 2015 to 2020. Procedural success (divided into access-, bridging-, and technical success), therapeutic success, duration of therapeutic success and complications were analysed for different Bismuth-Corlette stricture types. ResultsA total of 293 patients were included, 153 (52.2%) in the ERC group and 140 (47.8%) in the PTC group. Access and bridging success in the ERC and PTC groups were 83.5% vs. 97.2% (p < 0.001) and 90.2% vs. 84.5% (p = 0.119), respectively. Technical and therapeutic success were equivalent between the two groups (98.3% vs. 99.3%, p = 0.854 and 81.7% vs. 73.3%, p = 0.242). Duration of therapeutic success was longer after ERC drainage compared to PTC drainage (p = 0.009) with a 3-month gain in duration of therapeutic success after ERC drainage (p = 0.006, 95% CI [26–160]). Cholangitis rates were equivalent (21.4% vs. 24.7%, p = 0.530), pancreatitis was more common in the ERC group (9.4% vs. 0%, p < 0.001) and procedure-related deaths more common in the PTC group (6.0% vs. 15.8%, p < 0.001). ConclusionAlthough ERC and PTC drainage of malignant hilar obstruction were similar regarding technical and therapeutic success, ERC drainage was more durable. Outcome differences for B–C stricture types should be explored in future studies.

STUDY OF BUCCAL MUCOSA GRAFT URETHROPLASTY IN URETHRAL STRICTURES: A SINGLE CENTRE EXPERIENCE

Background/purpose: This study was conducted to present our experience in urethral mucosal graft urethroplasty to repair urethral stricture, bulbar, penile and pan anterior urethral stricture. This is a prospective hospital-Methods: based study that had been designed to review management outcomes of buccal mucosal graft urethroplasty for anterior urethral stricture from August 2017 to July 2021. The total number of involved patients was 50. The success rateResults: was found to be 92% (n=46), while 4 (8%) had a recurrence of stricture. Pain and pain combined bleeding from internal suture lines were the only early complication encountered in 40 (80%) and 2 (4%) patients, respectively. late complications occurred as follows 14 (28%) patients had UTI, 7 (14%) had wound infections, 7(14%) had changes in ejaculation, and decrease in intensity of orgasm, and 3 (6%) had erectile dysfunction. One of the long-term complications was graft diverticulum in one case and was treated conservatively (in ventral on lay BMG). Conclusion: BMG urethroplasty is a versatile technique for all types of anterior urethral stricture with all types of aetiologies with good long term results even in a small scale private hospital.

Main Pathological Changes of Benign Ureteral Strictures.

ObjectiveTo identify the pathological classification of benign ureteral strictures according to the histological features and explore the relationship between various pathological types and inflammatory cells, fibroblasts, and collagen.Patients and MethodsThirty one specimens from patients diagnosed with ureteral strictures between 2013 and 2021 were included and classified according to the histopathological characteristics. The number of fibroblasts and inflammatory cells was counted, and the proportion of type I and type III collagen in ureteral stricture tissues was detected by picrosirius red staining.ResultsWe identified three types of benign ureteral strictures in 31 specimens: inflammatory cell infiltration (n = 10, 32%), fibroplasia (n = 14, 45%), and hyalinization (n = 7, 23%), with significant differences in obstruction history and hydronephrosis grades among the three types. The number of inflammatory cells (lymphocytes, neutrophils and eosinophils) was significantly lower in hyalinization ureteral strictures than in the other two types (p < 0.05). The number of foreign-body giant cells associated with foreign-body reactions increased significantly in suture-induced ureteral strictures (p < 0.05). Fibroplasia type had the largest number of fibroblasts, whereas the other two types had smaller numbers. The results of type I and III collagen analysis showed that type I and III collagen were the most abundant in hyalinization among all ureteral stricture types (p < 0.05). Compared to ureteral strictures, the content of type I and III collagen in atresia increased significantly (p < 0.05).ConclusionCommon pathological types of benign ureteral strictures include inflammatory cell infiltration, fibroplasia, and hyalinization. Changes in type I and III collagen, inflammatory cells, and fibroblasts in different pathological types may be related to the progression of ureteral strictures.

Classification of tracheobronchial tuberculosis in 252 children

Objective: To provide theoretical basis for early diagnosis and accurate bronchoscopic classification of tracheobronchial tuberculosis (TBTB) in children through analyzing the clinical characteristics, bronchoscopic classifications and treatment effect in children with TBTB. Methods: In this respective study, we collected clinical data of patients with TBTB who accepted bronchoscopies in Interventional Pulmonology Department of Beijing Children's Hospital Affiliated to Capital Medical University between January, 2006 and December, 2019. The basic data, including clinical manifestations, imaging features, bronchoscopic characteristics and effects of interventional therapy were analyzed. The results of the study were statistically described and analyzed using SPSS 22.0 statistical software for relevant data. Results: Total 252 children with TBTB were included in this study. The median age was 1.7 years (quartile: 0.8 years, 5.2 years). Analysis of the classification of TBTB showed that the percent of lymph node fistula type was 96.4% (243/252), ulcerative necrosis type 1.2%(3/252), granulation proliferation type 0.4% (1/252), and cicatricial stricture type 0.8% (2/252). In addition, 1.2% (3/252) of the cases showed the same bronchoscopic manifestations as lymph node fistula type, but it was not clear on imaging whether the caseous material in the lumen was caused by lymph node or lung erosion. Therefore, the "bronchial fistula type" was proposed. Conclusions: Lymph node fistula type of TBTB was the common in children. The classification of lymph node fistula mostly depended on imaging evidence, and this may lead to some uncertainty in classifying TBTB in cases with no imaging evidence of enlarged lymph nodes.

Percutaneous Transhepatic Treatment of Benign Bile Duct Strictures Using Retrievable Covered Stents: Long-Term Outcomes in 148 Patients.

ObjectiveTo investigate the long-term outcomes of percutaneous treatment of benign biliary strictures using temporary placement of a retrievable expanded polytetrafluoroethylene (PTFE) covered stent.Materials and MethodsWe retrospectively analyzed the outcomes of 148 patients (84 male and 64 female; age range, 11–92 years) who underwent percutaneous transhepatic placement and removal of a retrievable PTFE-covered stent for the treatment of benign biliary strictures between March 2007 and August 2019 through long-term follow-up. Ninety-two patients had treatment-naïve strictures and 56 had recurrent/refractory strictures.ResultsStent placement was technically successful in all 148 patients. The mean indwelling period of the stent was 2.4 months (median period, 2.3 months; range, 0.2–7.7 months). Stent migration, either early or late, occurred in 28 (18.9%) patients. Clinical success, defined as resolution of stricture after completing stent placement and removal, was achieved in 94.2% (131 of 139 patients). The overall complication rate was 15.5% (23 of 148 patients). During the mean follow-up of 60.2 months (median period, 52.7 months; range, 1.6–146.1 months), 37 patients had a recurrence of clinically significant strictures at 0.5–124.5 months after removal of biliary stent and catheter (median, 16.1 months). The primary patency rates at 1, 3, 5, 7, and 10 years after removal of biliary stent and catheter were 88.2%, 70.0%, 66.2%, 60.5%, and 54.5%, respectively. In the multivariable Cox proportional hazard regression analysis, sex, age, underlying disease, relation to surgery, stricture type, biliary stones, history of previous treatment, and stricture site were not significantly associated with the primary patency.ConclusionLong-term outcomes suggest that percutaneous treatment of benign biliary strictures using temporary placement of retrievable PTFE-covered stents may be a clinically effective method.

Clinical Study of Single Stage Dorsolateral Onlay Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

1.1. Objectives: To evaluate the results of dorsolateral onlay buccal mucosal graft (BMG) urethroplasty in various types of long segment anterior urethral stricture. 1.2. Materials and Methods: This is a prospective study, conducted in the Department of Urology, Medical College, Kolkata and Burdwan Medical College, Burdwan from April 2017 to March 2021. Forty patients with long segment (more than 1.5 cm) anterior urethral stricture who underwent substitution urethroplasty using dorsolateral onlay BMG urethroplasty were evaluated with detailed history, physical examination, ultrasonography of KUB with PVRU, uroflowmetry, retrograde urethrography and voiding cystourethrography, sono-urethrograms and cystoscopy. After treatment with dorsolateral onlay BMG urethroplasty, they were followed-up with uroflowmetry at 3 monthly interval for one year and RGU and/or urethroscopy if indicated. Success was defined as normal voiding pattern without any intervention post-operatively. 1.3. Results: With nineteen of the forty cases (47.5%), lichen sclerosus formed the single most common etiology. Panurethral strictures were more common. Out of total 40 cases, 33 (82.5%) had successful outcome and 7 (17.5%) were failure. 1.4. Conclusion: We conclude that it is a simple, technically feasible, easily adoptable and finally successful procedure

LAPAROSCOPIC TRANSPERITONEAL URETEROURETEROSTOMY COMBINED WITH RETROGRADE FLEXIBLE URETEROSCOPY ASSISTANCE FOR URETERAL STRICTURE- CASE SERIES OF SEVEN PATIENTS

Most strictures of the ureters are detected and usually occur in the part of the ureter when the calculus has been trapped for a long time, after ESWL or as a complication of transureteral lithotripsy after the introduction of the holmium laser. The treatment of these strictures variesand depends on many parameters, the most important being the type of stricture, severity, length and location. In many cases, endoscopic treatment with stenting is the first choice of treatment performed retro or antegrade. In case of failure or contraindication for endoscopic treatment, ureteral reconstruction can be performed by open, laparoscopic or robotic techniques. Laparoscopic ureteroureterostomy is a preferred minimally invasive technique for the treatment of benign ureteral strictures.

Outcomes of transecting urethroplasty in management of different types of bulbar urethral strictures: single center experience

Background: The study aimed to evaluate the outcomes of transecting bulbar urethroplasty techniques used for management of bulbar urethral stricture as regards the success rate and sexual dysfunction.Methods: Our study was a prospective study and it was carried out at urology department Tanta university, Egypt. The study was approved our ethical committee and an informed consent was obtained from all participants. Thirty patients underwent transecting urethroplasty either excision and primary anastomosis (EPA) or augmented anastomotic urethroplasty. Assessment of the sexual function by sexual health inventory for men (SHIM) questionnaire and postoperatively. Retrograde urethrogram (RGU) and micturating cystourethrogram (MCUG) were performed by an experienced urological surgeon.Results: The age of studied patients ranged from 15-72 years with a mean of 41±13.87. The length of stricture ranged from 2-3 cm with a mean of 2.57±0.38. The stricture was non obliterative in 13 patients (43.3%), obliterative in 4 patients (13.3%) and near obliterative in 13 patients (43.3%). Anastomotic urethroplasty was carried out in 20 out of 30 patients (66.7%) and augmented anastomotic urethroplasty was carried out in 10 out of 30 patients (33.3%). The success rate was 90%. As regard erectile dysfunction, 5 patients reported erectile dysfunction (16.7%).Conclusions: Anastomotic urethroplasty of short segment bulbar strictures continues to have excellent success rates and durability, but some patients who undergo anastomotic urethroplasty experience de novo sexual dysfunction.

Quality of life after repair (hepatico-jejunostomy) for post-cholecysyectomy bile duct injury

Health-related quality of life (QoL), physical component score (PCS) and mental component score (MCS), was assessed for bile duct injury sustained at cholecystectomy. QoL was studied using Short Form-36 in 119 patients at least 24 months after repair (hepatico-jejunostomy), 50 patients who underwent uneventful cholecystectomy at least 24 months ago were controls. Effect of age, sex, type (laparoscopic, open, laparoscopic converted-to-open) of cholecystectomy, pre-repair interventions, (endoscopic and surgical) number of pre-repair interventions, Bismuth type of biliary stricture, post-repair complications, need for intervention in the follow up, total number of operations required, total duration of hospitalization on QoL was studied. Age > 50 years (n = 25) (PCS, MCS 44, 51 vs. 66, 70 in < 30 vs. 61, 62 in 30-50; p < 0.001, 0.018), need for pre-repair intervention (n = 102) (MCS 61 vs. 75; p = 0.01), post-repair Clavien-Dindo III, IV complications (n = 8) (PCS, MCS 46, 50 vs. 64, 68; p = 0.03, 0.04), need for post-repair surgical intervention (n = 28) (PCS, MCS 49, 54 vs. 60, 63; p = 0.004, 0.01) and need for reHJ in follow up (n = 16) (PCS 44 vs. 59; p = 0.12) adversely affected QoL. Patients (n = 15) who did not require pre-repair intervention, did not have post-repair complication and did not require intervention in follow up had better QoL (PCS 63 vs. 51, MCS 82 vs. 56, p < 0.03) than those (n = 32) who required pre-repair intervention, had post-repair complication, and required intervention in follow up. QoL is compromised, even after repair of BDI at biliary center; older patients, those who required pre-repair (HJ) interventions, had post-repair (HJ) complications, required post-repair (HJ) surgical intervention and required reHJ in follow up had poorer QoL.

Types of urethral stricture and their recurrence rates post urological treatments

Urethral strictures can significantly impact the quality of life for patients because it can be associated with significant complications such as fistulas, bladder calculi, infections and sepsis. Additionally, it might even lead to renal failure. The worldwide prevalence of urethral strictures is high, with an estimated rate of 229-627 patients per 100,000 population. In this literature review, the aim was to discuss the types and etiology of urethral strictures and the recurrence rates following the different management modalities. Studies that were included in this review were published between January 2005 until May 2021. The results support the current evidence that the idiopathic and iatrogenic bulbar strictures are the most common types while penile strictures, the iatrogenic and inflammatory are the most common causes. Recurrence rates are reported after management with almost all of the current management modalities, indicating the need for better interventions to enhance the outcomes and alleviate the quality of care. The recurrence rate of strictures after treatment with internal urethrotomy and direct vision internal urethrotomy by three years is 65%. Other studies reported that the rate of recurrence was estimated to be around 14 after 6 months from internal urethrotomy and up to 27% after 12 months. The rate of complications and recurrence following treatment with anastomotic urethroplasty was estimated to be less than 5%. Detailed information and discussion were provided in the study manuscript.

Percutaneous transhepatic cholangiography in the era of magnetic resonance cholangiopancreatography: A prospective comparative analysis in preoperative evaluation of benign biliary stricture

Background and AimAccurate anatomical delineation is the key before definitive repair for benign biliary stricture (BBS). The role of percutaneous transhepatic cholangiography (PTC) as a road map is less studied in the era of magnetic resonance cholangiopancreatography (MRCP).MethodsA prospective observational study, performed between July 2012 and December 2013. All patients of post‐cholecystectomy BBS were evaluated with MRCP and PTC prior to definitive repair. Findings of MRCP and PTC were compared with intraoperative details.ResultsThirty patients with BBS were included in the study. MRCP was performed in all but PTC was amenable in 28 of 30 (93.3%) patients. PTC was comparable to MRCP in diagnosing stricture type (96.4% vs 89.3%), intrahepatic stones (75% vs 75%), and biliary anomalies (95.6% vs 100%). Additionally, PTC revealed internal biliary fistula in 4 (85.7% vs 61.4%; P value 0.04). PTC‐related minor complications were noted in 2 (7.1%) patients.ConclusionPTC is comparable to MRCP in diagnosing the stricture type, intrahepatic biliary stones, and biliary anomalies. Though comparable to MRCP, the authors could not reveal any additional information that could change the course of management in BBS.

Treatment of Urethral Stricture Disease in Women: Nonsystematic Review of Surgical Techniques and Intraoperative Considerations.

Female urethral strictures are rare, but underdiagnosed pathologies that can cause voiding dysfunction. These strictures are best managed with open reconstruction, as endoscopic treatments have high rates of failure. A flap urethroplasty can be performed with vaginal, labial or bladder tissue. Meanwhile, graft urethroplasties can utilize vaginal, labial, buccal or lingual tissue. It is important to consider the etiology and type of stricture, local vascularity, and prior attempts at repair when selecting the type of repair. Multiple different techniques have been described with theoretical advantages to each one. While some studies have reviewed a few of the reconstructive techniques to treat female urethral strictures, no single study has accounted for each individual technique. In this review, we discuss techniques captured by a number of systematic reviews and other articles. We will herein focus on reviewing and describing each unique technique of reconstruction in the setting of female urethral stricture.

Intractable Biliary Strictures After Living Donor Liver Transplantation: A Case Series

Biliary stricture (BS) is a severe complication after liver transplantation. It is difficult to treat, especially after living donor liver transplantation (LDLT). We successfully treated 4 patients for intractable BS after LDLT. All patients had developed cholangitis with stenosis of bile ducts anastomosis. CASE 1: . A 65-year-old woman underwent LDLT with right lobe graft and duct-to-duct biliary reconstruction. Internal plastic stents inserted by endoscopic retrograde cholangiography (ERC) were changed quarterly for the next 2 years. CASE 2: A 55-year-old man underwent LDLT with right lobe graft and duct-to-duct biliary reconstruction. Insertion of internal plastic stents by ERC was attempted; however, the posterior bile duct branch showed complete obstruction. After percutaneous transhepatic biliary drainage (PTCD), the stents were inserted using the rendezvous technique of ERC and were changed by ERC quarterly for the next 3 years. CASE 3: A 22-year-old man underwent LDLT with left lobe graft and hepaticojejunostomy. An external drainage tube was inserted by PTCD, and stents were changed quarterly for the next 2 years. CASE 4: A 60-year-old man underwent LDLT with right lobe graft and hepaticojejunostomy. An external drainage tube was inserted by PTCD, and changed to a metallic stent after 1 year. Three months later the stent was extracted using the rendezvous technique of double balloon enteroscopy. BS of complete obstruction type after LDLT is difficult to treat. Appropriate procedures should be chosen based on the types of strictures and biliary reconstruction methods.

The Classification of Biliary Strictures in Patients With Right-Lobe Liver Transplant Recipients and Its Relation to Traversing the Stricture With a Guidewire.

Traversing the stricture with a guidewire is a prerequisite for the endoscopic treatment of biliary strictures after living donor liver transplantation. We aimed to evaluate the effect of variations in the biliary anastomosis and strictures on the success of endoscopic treatment and suggest a cholangiographic classification. The 125 strictures among the 104 patients with right-lobe living donor liver transplantation were reviewed. The strictures were classified by the anastomosis pattern according to the number (1, 2, or >2), location (common bile, hepatic, or cystic duct), the angle between the proximal and distal sites of the anastomosis, and the contrast enhancement pattern. The relationship between the success rate of traversing the anastomosis and the classification was evaluated. Of the 125 biliary strictures, 86 (68.8%) could be passed via endoscopically. Thirty-three strictures were managed either percutaneously (n = 13) or by magnetic compression anastomosis (n = 20). Compared with the round, the triangular (odds ratio [OR], 6.5), the intermediate form (OR, 17.7), and the end-to-side anastomosis (OR, 5.1) were associated with an increased chance of traversing. The contrast enhancement pattern of the strictures and the bile ducts was also related to the successful rate of the endoscopic treatment (P < 0.001). The success rate was higher in the patients with the angle between the proximal and distal sites of the anastomosis approximated was small (0°-30° = 74%, 30°-60° = 69%, 60°-90° = 63%, >90° = 41%). The type of biliary anastomoses and stricture affect the success rate of endoscopic treatment. These data may play role in making decision about the type of anastomosis during the surgery.

Endoscopic retrograde cholangiopancreatography and carbohydrate antigen 19-9 in the differential diagnosis of biliary strictures.

bile-duct strictures include a wide spectrum of benign and malignant diseases. to determine the usefulness of endoscopic retrograde cholangio-pancreatography (ERCP) and circulating carbohydrate antigen 19-9 (CA 19-9) for the differential diagnosis of biliary strictures. an observational, prospective, cross-sectional study was performed in 75 patients with biliary stricture diagnosed by ERCP between October 2018 and January 2020. The variables included type of biliary stricture as diagnosed by ERCP, biliary cytology, and CA 19-9 levels. For the statistical analysis, descriptive statistics were used according to type of variable. The relationships between them was analyzed using Pearson's chi-square and Fisher's exact probability tests, assuming differences were significant when p < 0.05. The cut-off point for CA 19-9 was calculated using the ROC curve, and Cohen's kappa index was used to measure concordance between diagnostic methods. cytology was positive in 51 (68 %) patients with biliary stenosis. Mean age was 63 years. Acute cholangitis predominated in malignant strictures (93.7 %). There was agreement between cytology and the cut-off value calculated for CA 19-9 of 85.4 U/mL, with a kappa agreement index of 0.332 (p = 0.004), and between ERCP and cytology, with a kappa concordance index of 0.701 (p < 0.001). a serum CA 19-9 value higher than 85.4 U/mL is highly related to neoplastic biliary stenosis.

One-stage buccal two-flap urethroplasty using the Kulkarni technique for extended anterior urethral strictures

Introduction. The problem of extended urethral strictures treatment remains relevant due to the complexity of the supervision of such patients and the high frequency of disease recurrence after surgical treatment.Purpose of the study. Evaluation of the effectiveness of one-stage buccal urethroplasty according to the Kulkarni technique using two flaps for extended anterior urethral strictures.Materials and methods. The study included 18 men with an extended anterior urethral stricture, who underwent buccal urethroplasty by perineal access using the Kulkarni dorsolateral onlay technique using two flaps from January 2018 to March 2020, and a postoperative follow-up period of at least 6 months. The study was prospective. Control examination was carried out 3, 6, 12, 18 and 24 months after surgery. The criteria for the recurrence of urethral stricture were the presence of complaints of deterioration in the quality of urination in combination with a decrease in the maximum urinary flow rate of less than 12 ml/sec and the presence of residual urine in an amount of more than 100 ml, as well as the need to perform any surgical intervention to restore the normal passage of urine.Results. The age of the patients ranged from 32 to 72 years (median 58 years). The length of the stricture ranged from 6 to 11 cm (median, 8 cm). The stricture was localized in the penile segment in 11 (61.1%) cases and the penile and bulbar urethra in 7 (38.9%) cases simultaneously. An iatrogenic cause of urethral stricture occurred in 11 (61.1) patients, idiopathic in 5 (27.8%) patients and inflammatory in 2 (11.1%) patients. The stricture was primary in 12 (66.7%) cases and recurrent in 6 (33.3%). Spontaneous urination was preserved in 6 (33.3%) patients, cystostomy existed in 12 (66.7%) patients. The follow-up period after surgery ranged from 3 to 24 months (median - 12 months). Recurrence of urethral stricture was noted in 3 (16.7%) cases. The use of this technique for recurrent forms of the urethral stricture (recurrence after the previous urethroplasty) is the most significant risk factor for treatment failure. 1 (5.6%) case of erectile dysfunction and stress urinary incontinence has taken place of the late postoperative complications.Conclusions. The Kulkarni operation using two buccal flaps for extended strictures of the anterior urethra allows to achieve high rates of efficacy and safety of a treatment, however, the risk of failure increases significantly when used for the treatment of recurrent types of strictures.

S3344 A Tight Squeeze: A Case of Metastatic Poorly Differentiated Gastric Adenocarcinoma Presenting as Malignant Biliary Strictures After a Recent Laparoscopic Cholecystectomy

INTRODUCTION: Biliary strictures are subdivided into benign and malignant etiologies. Benign strictures often result from an array of causes including chronic or autoimmune pancreatitis, Mirizzi syndrome, and iatrogenic causes, including post-cholecystectomy strictures. Malignant strictures are often seen as a result of cholangiocarcinoma or pancreatic adenocarcinoma. Gastric adenocarcinoma is an exceedingly rare cause of biliary strictures, with resultant obstruction estimated in 1.3-2.3% of cases. Differentiating between these stricture types is of the utmost importance given vast differences in management. This case represents a diagnostic challenge in a patient presenting with biliary strictures after a recent laparoscopic cholecystectomy who was found to have metastatic gastric adenocarcinoma. CASE DESCRIPTION/METHODS: A 32-year-old female with a past medical history significant for a laparoscopic cholecystectomy four months prior to admission presented with subacute fatigue, jaundice, and dark urine. Initial laboratory values were notable for a direct pre-dominant hyperbilirubinemia. An MRCP showed stricturing at the confluence of the biliary ductal system, moderate ascites, and enlarged para-aortic/retroperitoneal nodes that were visualized four months prior. Initial provider concerns included post-cholecystectomy complications; however, the persistent lymphadenopathy remained a cause for concern. An ERCP demonstrated erythematous mucosa throughout the stomach and severe biliary strictures in the entire main bile duct, with a thickened gastric fold biopsy revealing poorly differentiated gastric adenocarcinoma (surgical pathology from her recent cholecystectomy demonstrated only acute and chronic calculous cholecystitis). Her hospital course was complicated by peritoneal carcinomatosis, peritonitis, recurrent gastric outlet obstructions, and enteral and biliary stent placement. Palliative chemotherapy was initiated in the inpatient setting prior to discharge. DISCUSSION: Given the temporal relationship of the patient’s symptoms to her recent cholecystectomy, initial concerns involved post-cholecystectomy complications such as benign biliary strictures. However, the importance of the patient’s persistent lymphadenopathy was noted and additional procedures were pursued, leading to the diagnosis of malignancy as the cause of the patient’s strictures. Determining the etiology of the patient’s biliary stricture was of paramount importance to ensure the expedient delivery of chemotherapy.

S0044 Cholangitis in Patients With Post Liver Transplant Biliary Stricture: A Retrospective Cohort

INTRODUCTION: Biliary stricture is one of the most common complications after liver transplantation. Stricture in the biliary tract can lead to other complications including cholangitis, which can be life threatening. The management of biliary strictures after liver transplant requires utilization of substantial healthcare resources. The aim of this study is to investigate the frequency of endoscopic interventions, risk factors and outcome in patients with known biliary stricture following liver transplantation who develop cholangitis. METHODS: In this retrospective cohort study, patients who had undergone liver transplantation and had a diagnosis of biliary stricture based on endoscopic retrograde cholangiopancreatography (ERCP), were included. Those with missing records and those who were followed for less than 6 months were excluded. The diagnosis of cholangitis was confirmed based on the assessment of treating gastroenterologist. Patients with at least one episode of cholangitis were compared to those without a history of cholangitis. RESULTS: Ninety-two patients with a history of liver transplantation and a confirmed diagnosis of biliary stricture were followed for an average of 55 months (range: 6 to >120). Overall, 28 patients (30.4%) had at least one episode of cholangitis, of whom 10 had more than one episode. Sixteen out of 28 (57.1%) had cholangitis within the first 6 months following liver transplantation. Patients with cholangitis had undergone more frequent endoscopic treatments for the management of their biliary stricture compared to those without cholangitis (5.3 ± 0.9 vs. 3.2 ± 0.3, P value: 0.007). Additionally, patients with cholangitis underwent a significantly higher number of total ERCPs (7.2 ± 0.9 vs. 4 ± 0.3, P value: 0.0001). There was no difference in cholangitis by patient age, gender, transplant type (deceased donor vs. living donor), or stricture type (anastomotic vs. non-anastomotic). CONCLUSION: The results of this study show that cholangitis is frequently seen in patients with post liver transplant biliary stricture. Compared to patients who do not develop cholangitis, those with cholangitis undergo a greater number of total ERCPs, as well and more procedures specifically performed for the management of their biliary strictures. Further studies with larger study populations are required to better characterize the risk factors and outcome of cholangitis in patients with post liver transplant biliary stricture.Table 1.: Comparing patients with post liver transplant biliary stricture who have cholangitis compared to those who do not.

Urethral Strictures and its Management at Tertiary Hospital of Nepal

Urethral stricture can occur from urethral meatus to bladder neck. Treatment of urethral stricture include dilatation, endoscopic incision and anastomotic urethroplasty. The aim of this study is to report our experience in the management of different types of urethral strictures. We retrospectively reviewed the chart of all the patients of urethral stricture who received treatment at Kathmandu model hospital between January 2015 and October 2019. Different types of urethral stricture along with various modalities of treatment given were recorded. Fifty patients were included in this study, all were males. Mean age was 49 (16-82) years. Bulbar urethra was the most common site in 54% of cases and bulbomembranous least common, only 10% of cases. Depending on sites and size of stricture, different types of surgery performed were meatoplasty, dviu and anastomotic urethroplasty. Urethral stricture is a troublesome disease and can occur anywhere from meatus to the bladder neck. Different surgical techniques are present and the treatment should be individualized, depending on location and length of the stricture.