Treatment Of Biliary Tract Disease Research Articles

Known and unknown hymecromone. A review

Hymecromone (4-MU) is a recognized agent currently used in clinical practice. Since 1960, hymecromone has been used in many countries as a choleretic and cholespasmolytic, a drug approved for use in humans with biliary tract disorders. The review presents both traditional European and Russian studies of the selective antispasmodic and choleretic properties of hymecromone, due to which hymecromone is the drug of choice for the treatment of biliary tract diseases, as well as new fundamental and clinical studies of numerous pleiotropic effects of 4-MU associated with inhibition of hyaluronic acid and many other properties of this exciting molecule. These include antibacterial, antiviral, and nonspecific anti-inflammatory effects. Positive results have been demonstrated in carbohydrate and lipid metabolism disorders, autoimmune diseases, as well as liver, heart, and kidney diseases. Numerous in vitro and in vivo studies have been presented in pancreatic, prostate, skin, esophagus, breast, liver, ovary, bone cancers, metastatic lesions, leukemia, autoimmune and inflammatory diseases. Hymecromone is indicated not only as a choleretic and cholespasmolytic but also as a choleseptic in cholangitis and chronic cholecystitis, including opisthorchiasis, which does not disagree with its label. Odecromone® (hymecromone, tablets 200 mg) is available on the Russian market; it replaced the originator drug and is its fully equivalent generic.

Percutaneous transhepatic choledochoscopy in the management of hepatolithiasis: a narrative review.

From the 1980s and continuing into the 21st century, percutaneous transhepatic choledoscopy (PTCS) has been increasingly used in the clinical management of cholelithiasis. However, when compared to conventional minimally invasive techniques such as endoscopic retrograde cholangiopancreatography (ERCP), PTCS is characterized by greater invasiveness and a higher rate of complications. As a result, PTCS is frequently used as a supplementary treatment option. Nevertheless, it plays a unique and indispensable role in addressing hepatolithiasis. In this study, to facilitate safer clinical applications and gain a deeper understanding of PTCS-related complications, we conducted a comprehensive examination of these complications. Research studies related to PTCS were reviewed in PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) (year range, 1952-2024). There was no restriction on language. The occurrence and management of complications at various steps of PTCS were examined and compared with those of first-line minimally invasive treatments via a tabular method. Additionally, we evaluated the feasibility of using PTCS in the context of intrahepatic bile duct stones. Information on the types, incidence, and treatment of complications of PTCS was extracted in this review. A total of 5,923 results were retrieved, of which 41 were excluded. The reason for exclusion was that the article was a meeting comment. The findings indicate that PTCS plays an important role in the treatment of biliary tract diseases. Although PTCS is frequently used as an adjunctive therapeutic approach, its distinct utility in treating intrahepatic bile duct stones remains difficult to replace. Thus, a deeper understanding of PTCS-related complications, coupled with ongoing advancements in instrumentation, could significantly enhance the efficiency of minimally invasive gallstone management.

Диагностика и лечение заболеваний желчных путей у больных с COVID-19

The features of diagnosis and treatment of biliary tract diseases in patients with COVID-19 were studied. An increase in the number of non-calculous cholecystitis and gallbladder gangrene in severe cases of COVID-19 was revealed. The immunosuppressive effect of SARS-CoV-2, anti-inflammatory and antibacterial therapy, and multiple organ failure led to a decrease or complete absence of local symptoms and leukopenia in acute cholecystitis. In severe cases of COVID-19, the basis for diagnosing acute cholecystitis was dynamic ultrasound examination of the abdominal cavity, diagnostic laparoscopy and laparotomy in patients with the highest levels of leukocytosis, CRP and PCT. The greatest number of postoperative complications and deaths were observed in patients with severe COVID-19. In patients with malignant neoplasms of the biliary tract, the main symptom was “painless” jaundice. The diagnosis was confirmed by abdominal CT scan. All patients underwent minimally invasive ultrasound and endoscopic drainage operations. Keywords: Acute cholecystitis, new coronavirus infection, COVID-19.

Advances in functional coatings on biliary stents.

Biliary stenting is an important interventional method for the prevention and treatment of biliary tract diseases. However, complications, such as postoperative biliary infection and restenosis, frequently occur due to the extensive scope of the biliary system and the complex composition of bile. The combination of coating technology and biliary stents is expected to bring new approaches to the solution of these problems. The cutting-edge advance on functional coatings on biliary stents is reviewed from seven perspectives: anticorrosion, -bacterial, -tumor, stone-dissolving, X-ray visibility, antistent migration and functional composite coatings. The development trend is also discussed. Overall, the performance of the numerous functional coatings for various purposes is generally up to expectations, but the balance between the medications' effectiveness and their safety needs to be further adjusted. Many contemporary investigations have advanced to the level of animal experiments, offering crucial fundamental assurance for broader human studies. The combination of biliary stents and functional coatings is an innovative idea with great potential for future development.

IL-10 dependent modulatory effect of regulatory B10 cells on local scar formation following Roux-en-Y choledochojejunostomy in a novel rat model

Choledochojejunostomy has been common surgical treatment of biliary tract disease. Scar formation at anastomotic often results in postoperative complications associated with bleak post-operative recovery, in which local inflammation may be a potential target to modulate local scar formation. This study investigated the effect of regulatory B10 cells on local scar formation through interleukin-10 signal pathway following Roux-en-Y choledochojejunostomy (RCJS) in a novel rat model. Sprague-Dawley (SD) rats with RCJS were randomly divided into blank group, experimental group, IL-10 blocking group, control group, and received different interventions and duration. Injected through dorsal vein of penis, rats in different groups were treated respectively according to scheme. These interventions were performed during surgery, on 1st day, and 2nd day after surgery. Related indexes, including blood examination, specimen tissue of anastomotic detection, were recorded and compared in different interventional groups. Rats in experimental groups had more rapid recovery in liver function and inflammatory index, and higher in IL-10 level. Flow cytometry analysis showed that rats in experimental groups had highest content of B10 cells and lowest content of CD4+CD25− T cells in peripheral blood. Wider anastomotic by macroscopical observation, and slighter proliferation of collagen fiber and smooth muscle fiber, lower α-SMA and TGF-β1 levels by pathological staining were detected in experimental groups. Higher expression of the IL-10 gene and lower expression of TGF-β1 at anastomotic were detected in experimental groups. B10 cells may relieve local inflammation of anastomotic following RCJS in rats through IL-10-dependent modulatory effect, and improve local scar formation.

Clinical Advances in the Diagnosis and Treatment of Biliary Tract Diseases

Although the biliary tract is a small organ, it is diverse in location (intrahepatic bile ducts, extrahepatic bile ducts, gallbladder, and ampulla) and disease (including benign and malignant), thus a multidisciplinary approach involving endoscopists, surgeons, oncologists, radiologists, and infectious disease specialists is often required to treat biliary tract disease [...].

Utility of endoscopic retrograde cholangiopancreatography in management of pediatric pancreaticobiliary disease

BackgroundThe purpose of this study was to evaluate the utility of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients with pancreaticobiliary diseases.MethodsA retrospective review was performed on patients who underwent ERCP for the treatment of biliary tract disease and detailed examination of pancreatitis at our institution from January 1999 to December 2020.ResultsERCP was performed for congenital biliary dilatation (CBD) (n = 42), choledocholithiasis (n = 9), common bile duct stenosis (n = 1), and several types of pancreatitis (n = 13). The only severe complication of ERCP was common bile duct injury. Three (5.8%) of 52 biliary diseases failed to be treated by ERCP. All patients with pancreatic disease were correctly diagnosed and treated.ConclusionsEndoscopic biliary drainage with a temporary stent was adequate for symptomatic relief in CBD. Stenting of the pancreatic duct was useful for improving the angulation and drainage of the pancreatic duct. ERCP was useful for understanding the anatomy of the pancreatic duct and revealing potential treatments. Therefore, ERCP and transendoscopic therapy are sufficiently feasible in pediatric patients and should be actively introduced for the investigation and treatment of pancreaticobiliary diseases.

The Status and Development of Oral Choledochoscopy Diagnosis and Treatment of Biliary Tract Diseases

Choledochoscopy technology has realized the direct observation of bile duct lesions, and can be loaded with a variety of special accessories to perform the corresponding diagnosis and treatment operations, and has become an important means for the diagnosis of unexplained bile duct stricture and treatment of refractory bile duct stones. With the further enhancement of the imaging quality and operability, the clinical application of choledochoscopy has gradually expanded to the precise positioning of cholangiocarcinoma before surgical resection, the drainage of the gallbladder through the nipple, the removal of the displaced bile duct stent and other fields. This paper briefly reviewed the historical evolution of choledochoscopy and reviewed the latest clinical advances of oral choledochoscopy in the diagnosis and treatment of biliary tract diseases.

Endoscopic ultrasound for diagnosis and treatment of biliary tract diseases

Endoscopic ultrasound for diagnosis and treatment of biliary tract diseases

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

Peroral direct cholangioscopy using an ultra–slim gastroscopy assisted by a snare

Objective To evaluate the feasibility of diagnostic and therapeutic peroral direct cholangioscopy (PDCS) using an ultra–slim upper endoscopy assisted by a snare. Methods Between November 2014 and January 2015, 8 patients underwent PDCS with assistance of an ultra–slim endoscopy. After endoscopic papillary balloon dilation, the duodenoscopy was withdrew, an ultra–slim endoscopy was inserted directly into the biliary tract assisted by a snare, and biopsy or laser lithotripsy was performed. The snare was closed tightly in the bent portion of the scope, and the snare was pulled while scope shaft had to become the form of U loop by counterclockwise rotation, in order to advance the scope into common bile duct. Results PDCS succeeded in all eight cases, one common hepatic duct adenoma was diagnosed by biopsy, and confirmed by surgery; one benign biliary stricture was diagnosed by PDCS; laser lithotripsy was successfully performed in 4 patients with large CBD stones; bile duct clearance was verified by PDCS in two patients who was suspected of residual CBD stones. No perforation, bleeding or post–operative pancreatitis was found. Conclusion PDCS using an ultra–slim gastroscopy assisted by a snare is a safe, simple and practical procedure in the diagnosis and treatment of biliary tract diseases. Key words: Biliary tract diseases; Choledocholithiasis; Gastroscopes; Lithotripsy, laser; Peroral direct cholangioscopy

Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for the treatment of biliary tract disease after Roux-en-Y Gastric Bypass

Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for the treatment of biliary tract disease after Roux-en-Y Gastric Bypass

Peroral cholangioscopy for diagnosis and therapy of biliary tract disease using an ultra-slim gastroscope

High-resolution video cholangioscopy is expected to improve diagnostic validity for diseases of the biliary tract. We report our experience in using an ultra-slim gastroscope for diagnosis and treatment of biliary tract disease. Cholangioscopy was attempted in 25 cases (22 patients) and succeeded in 22 cases (success rate 88%; 19 patients). Cholangiocellular carcinoma (CCC) was diagnosed by cholangioscopy in five of 10 cases (histopathologically confirmed in four), or ruled out in five. Cholangioscopy was used to detect stones in mega-choledochus (n=3), to clarify the postoperative condition of the bile ducts (n=2), to diagnose bile duct varices (n=1), and to release a dislodged self-expanding metal stent (n=1), and others. Argon plasma coagulation was successfully completed in a patient with mucin-producing adenomatosis of the bile ducts. One case of non-fatal air embolism occurred before replacing air with CO2 insufflation. In summary, peroral cholangioscopy with an ultra-slim gastroscope is feasible and helpful in selected patients, improving diagnostic validity, and offering new therapeutic interventions. This technique should only be performed using CO2 insufflation.

Double-balloon enteroscopy application in biliary tract disease—its therapeutic and diagnostic functions

On occasion, it is impossible to perform ERCP with a traditional duodenoscope in patients who have had a Billroth II gastrectomy or hepatojejunostomy, and who now have biliary tract problems. Repeat surgery is not a suitable course of action in these patients. Therefore, finding alternative modalities to resolve these obstructions is of great importance. To report successful endoscopic examination and treatment of difficult biliary obstructions by using double-balloon enteroscopy. Five patients. Cases series. Double-balloon enteroscopy (DBE) for biliary tract examination and treatment. We report on 5 patients who underwent Billroth II gastrectomy or biliary tract Roux-en-Y surgery and who later had biliary tract obstruction from various causes. We were unable to perform ERCP with traditional duodenoscopy but successfully completed ERCP with DBE. DBE was originally designed to examine the small intestine. The successful biliary tract cannulation rate when using DBE is lower than with duodenoscope. We performed ERCP by using DBE a total of 5 times, with a successful biliary cannulation rate of 60%. We performed a special-method papillotomy in 2 patients. This method entailed inserting an electric sphincterotome through the percutaneous transhepatic cholangiography and drainage (PTCD) route after performing DBE intubation to the ampulla of Vater. We then successfully completed a papillotomy with an electric sphincterotome under DBE guidance. DBE appears to be a promising alternative in the examination and treatment of biliary tract disease in patients after GI operations such as Billroth II gastrectomy and choledochojejunostomy.

Utility of Peroral Cholangioscope (Spy Glass System) in Treatment of Stones in Chronic Pancreatitis

Chronic pancreatitis is a difficult clinical condition to treat. Stones in the main pancreatic duct could lead to increased ductal pressure and cause pain, inflammation and other complications. Endoscopic therapy is aimed at reduction of the pressure in the main pancreatic duct. Endoscopic armamentarium is limited. Extracorporeal shock wave lithotripsy though useful is available only at a very few centers in the United States. Mechanical lithotripsy is difficult and is associated with significant complications including the inability to crush the stones, broken and captured baskets. Electro hydraulic lithotripsy (EHL) would be beneficial but could not be used earlier because of the limitation of direct visualization of the stones in the main pancreatic duct. Recently a single operator duodenoscope assisted cholagiopancreatoscopy (Spy glass system, Boston Scientific, MA) was introduced. This was primarily developed for evaluation and treatment of biliary tract disease. Aim: To evaluate the feasibility and efficacy of electrohydraulic lithotripsy of main pancreatic duct stones in chronic pancreatitis using Spy glass system. Methods: Retrospective analysis of the data of pancreatoscopies done using Spy glass. Results: Between July 07 and November 07, 16 procedures were performed with Spy glass system. 8 patients had chronic pancreatitis. Of these 8, 2 underwent cholangioscopy for evaluation of the bile duct and 6 underwent pancreatoscopy. Main pancreatic duct calcifications were seen in 5 patients and EHL was performed. In 4 of the 5 patients stones could be fragmented by EHL and subsequently stones were removed by stone/basket. All the stones could not be removed and 2 of these patients had subsequent pancreatoscopies with removal of more stone material. In one case EHL was attempted but was unsuccessful because of difficult angulation and inability to achieve adequate contact between the probe and the stone. No procedure related complications were seen. Conclusions: 1. Spy glass system allows for direct visualization of the stones in the main pancreatic duct and EHL could be safely performed to decompress the main pancreatic duct. This adds to the current armamentarium of the endoscopic accessories for therapy of pancreatic stones. 2. Limitations include use in non dilated/strictured ducts because of the current size of the catheter (7Fr) and maneuverability within the duct. 3. Currently used EHL probes are designed for urological procedures and hence the length of the probe is a limitation, moreover the probe is not rigid and can kink easily. Specially designed probes are in development and might solve this problem.

Diagnosis and treatment of biliary tract diseases using a percutaneous transhepatic biliary drainage route

Diagnosis and treatment of biliary tract diseases using a percutaneous transhepatic biliary drainage route

Duodenoscopic treatment of biliary tract diseases in patients after gastrectomy and Billroth II gastrojejunostomy

Objective To introduce and discuss the treatment of patients with biliary tract diseases after gastrectomy and Billroth Ⅱ gastrojejunostomy under electronic side-view duodenoscopy. Methods Twenty-five patients with biliary tract diseases who had undergone gastrectomy and Billroth Ⅱ gastrojejunostomy before were diagnosed and treated by using electronic side-view duodenoscopic techniques including ERCP, ENBD, ERBD and EST. Results For the 20 patients without Braun＇s anastomosis （side-to-side jejunojejunostomy）, duodenoscope insertion was completed in 19 （95 % ） and failed in 1 due to the stenosis of jejune lumen （5 %）. For the patients with Braun＇s anastomosis, duodenoscope insertion was completed in 2 （40%） and failed in 3 because of the prolonged jejune loop （60%）. Of the 21 patients who had successful ERCP, 17 with common bile duct stones were treated by EST＋ENBD （n=9）, ENBD （n=6） and ERBD （n=2）, respectively, 3 with bile duct cancers by ERBD and 1 with postoperative distal common bile duct stenosis by ERBD. Two patients treated by ERBD had complication of transient acute pancreatitis and relieved soon after medical treatment. All the patients had no complications of perforation and hemorrhage caused by endoscopic management. Conclusions Electronic duodenoscopic treatment is a mini traumatic and safe therapeutic technique for patients with biliary tract diseases after gastrectomy and Billroth Ⅱ gastrojejunostomy. The success rate of the treatment is related to the ways of postgastrectomic reconstructive operation. Key words: Biliary tract diseases; Duodenoscopy; Postgastectomy and Billroth Ⅱ gastrojejunostomy; ERCP; EST; ENBD; ERBD

Fistule cholécysto-cutanée spontanée

Spontaneous cholecystocutaneous fistula is now a rare entity due to the advent of antibiotics, ultrasonography, and safe and early surgical treatment of biliary tract diseases. Such a case is reporting here, revealed by the systematic histological examination of the skin biopsy. A 65 year-old male presented with an inflammatory and ulcerated lesion located on his right flank, with a long-standing but asymptomatic course. Biological tests and biliary tract ultrasonography were not very contributive. Histopathological findings consisted in a granulomatous dermal reaction enclosing biliary fragments. Per-operative data were in favour of a compound biliocutaneous fistula complicating an inflammatory process of the gall-bladder. Spontaneous cholecystocutaneous fistula is unusual. Diagnosis might be difficult because of the lack of clinical specificity and a occasionally insidious evolution. Consequently, systemic histological examination is fundamental.

Spontaneous Cholecysto-cutaneous fistula

A thirty-year-old woman was transferred to the United Kingdom two weeks after bowel resection for superior mesenteric vein thrombosis. She was dehydrated, malnourished and complained of abdominal pain. Computerized Tomography revealed no intra abdominal collection and she was managed conservatively. She settled without intervention and was sent home after 30 days. Fourteen days later (fifty-nine days since her initial operation), she represented with abdominal pain and discharge from two small wound sinuses on the anterior abdominal wall. A sinogram was performed and contrast was seen to pass into the common bile duct, the cystic duct and into the duodenum. A cholecysto-cutaneous fistula was demonstrated. She underwent an ERCP and biliary stenting. The discharge settled and her abdominal pain resolved. Spontaneous cholecysto-cutaneous fistulae are rare due to the early diagnosis and treatment of biliary tract disease. This case is particularly unusual as the patient had no evidence of biliary tract disease and the cause of the fistula still remains unclear.

Gene transfer to the rat biliary tract with the HVJ-cationic liposome method

Background/Aims: The ability to transfer foreign genes into the biliary tract would be useful for the treatment of biliary tract diseases, including cancer, cystic fibrosis and other genetic diseases. To introduce a foreign gene precisely into the rat biliary epithelial cells, we developed a new technique, inserting a polyethylene catheter into the common bile duct through the papilla of Vater by use of a fusigenic cationic liposome with hemagglutinating virus of Japan (HVJ-cationic liposome). Methods: Transfection efficiency was estimated with the use of FITC-oligonucleotides (FITC-ODNs) and cDNA of β-galactosidase (pCAG-lacZ). Results: FITC-ODNs encapsulated in HVJ-cationic liposome were effectively transfected into cell nuclei of human cholangiocellular carcinoma in vitro after a 30-min incubation as compared with the simple application of naked FITC-ODNs. After in vivo injection of FITC-ODNs using the HVJ-cationic liposome method through the papilla of Vater, fluorescence accumulation was observed only in the epithelial cells of the biliary tract, but not in the parenchymal cells of the liver. β-galactosidase expression was observed in the biliary epithelial cells 3 days after the transfection of pCAG-lacZ and was also detected at 14 days, but not at 28 days, without obvious cytotoxicity. Conclusions: HVJ-cationic liposome-mediated gene transfer to the biliary tract via the papilla of Vater is a minimally-invasive and an effective gene-delivery method for site-specific targeting to the epithelial cells of the biliary tract, which could be applied to the treatment of human biliary tract diseases.